AN INTERAGENCY MODEL FOR DESIGNING AND EVALUATING COMMUNITY, SOCIAL, AND. REHABIUTATION SERVICES Dissertation for the Degree of Ph. D. MICHIGAN STATE UNIVERSITY JOHN B. AYCOCK 1976 ——-— IIIIIIIIMIIIIIIIIZIIIIIIIIIIIIIIIIIIIIIII This is to certify that the thesis entitled An Interagency Model for Designing and Evaluating Community, Social, and Rehabilitation Services presented by John Buell Aycock has been accepted towards fulfillment of the requirements for Counseling, Personnel SerVices and Educational Psychology Ph ‘D’ degree in /4://2"/:"‘7P (743114). 1‘] 2/7, Maj%fessor Date May 7, 1976 0-7 639 fl“ rt?» In}; a“... A, o .1 .9": I. m i I ABSTRACT AN INTERAGENCY MODEL FOR DESIGNING AND EVALUATING COMMUNITY, SOCIAL, AND REHABILITATION SERVICES By John B. Aycock Statement of the Problem A great deal of research, energies, and public monies have been invested over the years in developing effective rehabilitation programs for the mentally and emotionally handicapped and disabled. Much more remains to be accomplished. In these economic times community programs are finding public dollars in increasingly short supply, and the value of these dollars is constantly decreasing. Accordingly, there is an increasing necessity of developing programs which are both fiscally economical and accountable in terms of measurable results and responsiveness to Specific client needs. Community agencies and groups must, out of necessity, now collaborate in program planning, service delivery, and evaluation. Models must be developed which lend themselves to these tasks if theprocessis to be orderly, measurable, and replicable. Methodolo- gies for collaboration must be reviewed and adopted. Instruments for measuring changes in attitude-behaviors must be utilized if prevention programs are to be justified. Rehabilitation programs must be defined and delivered with precisely defined behavioral Objectives with the goal of producing socially competent persons. ties tern vagu begi sent ever on ste; John B. Aycock If such demanding objectives are to be achieved, communi- ties as well as clients must be carefully defined and described in terms of Specific needs. Vaguely defined problems usually precede vaguely defined programs. Standard demographic surveys are a beginning, but must be followed byepidemiological surveys as pre- sented in this work. Beyond that, communities and persons may be even more precisely defined for even clearer understanding of the community and its population. A Social Competency model is a giant step in such definition. The sick—well dichotomy so prevalent in mental health pro- grams may be replaced by keying in on the precise functional disabilities of a client, and rehabilitation activities may then be directed to those specific disabilities. The social skills of a person may then be emphasized, utilized, and supported during the time of rehabilitation. Purpose of the Study The purpose of the studywasto develop a basis for a compre— hensive plan for community-based mental health prevention and rehabilitation programs. This program includes: 1. Conceptualizing and organizing basic facets and elements of the overall task: A program plan and service delivery based on that plan will be as valid and usable as the initial task organiza- tion is reflective of the actual problems and the possible response to the problem. It is perhaps a truism to state that a program can hardly be expected to effectively respond to a vaguely defined I I I probl to e1 incll effes very must sent tia' Sent tic map ent tic John B. Aycock problem. Similarly, a well-defined problem can only be responded to effectively with a well-defined program. This response must include a framework within which the program activities can be effectively organized. A theory base for delivery of services in very carefully identified and measurable rehabilitative activities must then be adopted. Initially, the basic task is to develop a reliable and usable'map'upon which problem definition, organization planning and theory, and finally, service delivery may proceed. The organization of this thesis is based on the'mapping sentence“technique. This allows for the organization of the essen- tial variables of the task in a logical framework. The mapping sentence allows for a multifaceted answer to the seemingly simplis- tic questions: “What is the problem?” and ”How do we begin concep- tualizing an adequate response?” 2. Organizing the needs of the consumer population: The mapping sentence approach identifies and organizes variables inher- ent in program planning. However, a method for careful identifica- tion of the client population must also be devised if the later—to- be developed response is to be relevant and specific to the client needs. This identification of client need is presented through a standard survey approach, identifying data describing the incidence and prevalence of specific disabilities such as alcohol and drug use, mentally disabled, homicide and suicide rates, and retardation. John B. Aycock Further, a plan for more precise and useful definition of client needs is also projected within a “Social Competency" model. The theoretical explanation of this approach is discussed in the section of Community Response. 3. Organization of community resources: The technology for organizing an environment within which both problem definition and community rehabilitation may most effectively take place is provided with the theory of Interagency Collaboration. A collaborative envi- ronment among community agencies is essential for precise definition of problems as they exist in the community. Interagency Collabora- tion is also essential for precise and comprehensive design and delivery of both preventive and rehabilitative services. Without such collaboration both gaps and overlaps in commu- nity services abound, planning remains haphazard and narrow, and rehabilitation is then more a matter of chance and luck as opposed to thoughtfulness and precision. 4. A comprehensive community response--prevention and rehabilitation: Within an established collaborative environment among the agencies of the community, the organization or concepts and technologies for prevention and rehabilitation programs can begin. The effectiveness of the ”gatekeeper" approach to community prevention can be scientifically measured by Attitude-Behavior instruments. A “Social Rehabilitation“ approach is used as a con— ceptual approach to the definition of rehabilitation problems and in the delivery of rehabilitation services. The theory of Social Competency, with its precise breakdown of effective and noneffective behavio gran ap Collabc sons i The St Effect rehab tiona sun Ing] y UIder John B. Aycock behaviors, is employed as a basis for a Social Rehabilitation pro- gram approach. Consequently, methodologies to be reviewed are Interagency Collaboration, Attitude—Behavior Theory, and Social Competency. Methodology The methodology of the study emphasizes the need for the development and delivery of both prevention and rehabilitation pro— grams in a community. Prevention programs are essential to preclude the disable- ment of "vulnerable" persons in the community. Without such preven- tion programs, direct service programs become inundated with clients and theprograms flounder. Prevention programs are directed to the ”breakdown" process in individuals. Specific “gatekeeper" groups are identified who are trained to respond to client crises before such crises develop into serious disabilities. Rehabilitation programs are also emphasized for those per- sons who, despite prevention programs, become socially disabled. The Social Competency approach is specifically helpful in delivering effective and accountable mental health rehabilitation services. This double-barreled approach to community mental health rehabilitation becomes truly comprehensive when applied in a func— tional milieu of interagency collaboration. Duplication and gaps in service can be more clearly identified, agency roles become increas- Ingly specific, and the community effort becomes more economical and orderly. use and substan able" p nevertt across client Police1 indical popula' suppor‘ increa increa 0t p0] fined Indice PIesuH alter adult While e“lilo need lien John B. Aycock Results The survey directed to the incidence of drug and alcohol use and abuse portrayed the significant extent to which chemical substances were prevalent in an urban-rural community. A "vulner- able" population was thereby identified among persons who were nevertheless socially functional. Substance abuse was indicated across the community agencies, not only in the mental health drug client population. For instance, records of Juvenile Probation, Police, Jail, and Social Service departments, among others, all indicated the presence of drug and alcohol use among their client populations. Such use had already led to jail sentences, welfare support, and unemployment or underemployment. Additional usage increases could only result in the necessity of significantly increasing the scope of rehabilitation programs. Specifically, the use of soft-drugs often in combinations, or poly-drug use, was portrayed. This substance use was not con- fined to the young, as indicated in the youth survey, but was also indicated in the household survey. The fact that adult use may be presumed to include drugs administered by prescription does not alter the fact that drug use, albeit legal, was prevalent in this adult population. The Virginia Commonwealth Attorney's data indicated that while many of the clients were employed at the time of arrest, this employment was often in unskilled labor areas. This suggests the need for additional vocational training as one phase of rehabilita- tion for this population. both "vu identifi the nee: ing skil lied am keepers' intervel as effe social tines o zens in treatrne often c further In the world, donn, . rehabi tinnin John B. Aycock Conclusions When viewing a community in terms of social functioning, both "vulnerable” and disabled populations can and must be carefully identified. In order to produce effective rehabilitation programs the needs of these populations, social skill needs, independent liv- ing skill needs, and vocational needs, must be specifically identi- fied and responded to in the prevention and rehabilitation programs. In terms of the “vulnerable” population, trained "gate- keepers" can effectively assist the vulnerable population. Crisis intervention-based value clarification and decision-making are posed as effective antidotes to disorganization and initial levels of social dysfunction. By contacting the vulnerable population in times of crisis, gatekeepers can assist and support "hurting” citi- zens in their specific needs without referring them into traditional treatment programs. Admission into treatment programs is of itself often disruptive of client functioning in the community, leads to further breakdown in confidence levels, and fosters socialization to the treatment community as opposed to socialization to the real world, the community—at-large. Where treatment is indicated because of severe social break- down, the treatment is actually a carefully defined and customized rehabilitation directed to restoring social competency and func- tioning. AN AN INTERAGENCY MODEL FOR DESIGNING AND EVALUATING COMMUNITY, SOCIAL, AND REHABILITATION SERVICES By [, ‘\\ John BI Aycock A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Personnel Services, and Educational Psychology I976 “The test we say again and again, of any civilization is the measure of consideration and care which we give to our weakest members.” --Pearl S. Buck CD a It _- l DEDICATION To Sharon, John, Tom, and Andy, my expert consultants in mental health rehabilitation; and Warren and Mary Frances, loyal cheerleaders. I iii LIST OF TABL IIST 0F FIGU PREFACE . Chapter TABLE OF CONTENTS Page LIST OF TABLES . . . . . . . . . . . . . . . . vii LIST OF FIGURES . . . . . . . . . . . . . . . xi PREFACE . . . . . . . . . . . . . . . . . . xiii Chapter I. INTRODUCTION . . . . . . . . . . . . . . l The Functional Person: Defining A Community I The Functioning Community. . . . . 2 Snapshots and Movies . . . . . . 3 Human Skills and Responsible Systems . . . 4 8 II. REVIEW OF THE LITERATURE . Comprehensive Community Rehabilitation in Interagency Collaboration . . . 9 Review of Open Systems Theory . . . 15 Coordination, Cooperation, and Collaboration . . 22 Interorganizational Relationships . . . . . . 29 Personality and Role Behavior Needs . . . . . 38 The Guttman- Jordan Facet Theory. . . . . . . 4l Six Levels of Attitudes . . . . . . 59 Social Rehabilitation and Evaluation . . . . . 62 Organizing the Program Variables . . . . . 62 Analyzing Behavior in an Attitude- Behavior Context . . . . . 63 Social Competency Perspective . . 64 Attitude Behavior Measurement in the Prevention and Rehabilitation Model . 65 Attitude- Behavior Theory Development and Social Rehabilitation . 68 Social Competency System as a Community 68 Rehabilitative Response . . . . . . . . 70 Definition of Social Competency . . . Disorganization and Desocialization . 72 Methodological Framework for Social Competency 74 Social structural control mechanisms . . . 75 Interactional control mechanisms . . . . . 76 Program and Treatment . . . . . . . . . g: Treatment Plan . Chapter III. METHI Prf to IV. RESL H1 Dnnnclc Chapter III. METHODOLOGY AND CONCEPTUAL APPROACHES Prevention Programs: Stemming the Tide The Concept of ”Prevention” Intervention. The Goal of Prevention Objectives of Prevention Programs: The Concept of ”Breakdown“ . . . "Breakdown” defined . Developing a Public Health Approach . Prevention Programs. Developing a Training Effort . A Community Response to the VulnerabIe Citizen Relating Prevention with Rehabilitation . Organization of Concepts and Efforts Defining the Vulnerable Population Conclusion . IV. RESULTS Prevalence of Drug Abuse The Professional Community Methodology. . . Results . The Business Community. Methodology. . . Results Households in Virginia Beach. Methodology . . . . Results . . Household Demographic Data . Survey of Youth of Virginia Beach Methodology. Results . Department of Social Services Methodology . . . Results Drug Outreach Center . Juvenile Probation Department City of Virginia Beach Adult Probation Department : City of Virginia Beach Jail Commonwealth Attorney's Office Department of Public Safety, Police Division 207 Chapter II. C0 AN BIBLIOGRAI APPENDICES A. St Di 8. SI C. SI Chapter V. CONCLUSIONS, IMPLICATIONS FOR FURTHER RESEARCH, AND RECOMMENDATIONS . . . Conclusions . Implications for Future Study Recommendations . BIBLIOGRAPHY APPENDICES A. SOCIAL COMPETENCY THEORY. SAMPLE TREATMENT DIAGRAMS . . . . . . . . . . B. SURVEY FORMS . C. SUGGESTIONS FOR OPERATIONALIZING THE MODEL . vi Page 214 2T4 219 222 23] 232 240 285 Table w A LIST OF TABLES Table Page l. Facets Used to Determine Joint Struction of an Attitude Universe . . . . . . 44 2. Joint Level, Profile Composition, and Labels for Six Types of Attitude Struction . . . . . 45 3. Comparison of Guttman and Jordan Facet Designations 4. Five-Facet Six-Level System of Attitude Verbalizations: Levels, Facet Profiles, Attitude-Behavior Dimension and Definitional Statements for Twelve Combinations . 5. A Simplex for Six Variables 57 6. Response Rates of Professionals to the Mailed Questionnaires . . . . . . . l2l 7. Knowledge of Persons Engaged in Abuse of Drugs (Professional Survey) . . . . . . . . 122 8. Knowledge of Persons Engaged in Sale of Drugs (Professional Survey) . . 123 9. Belief in Illegal Drug Trafficking (Professional Survey) . . . . . 124 10. Persons You See Who Have Drug Problems (Professional Survey) . . . . . . . 125 11. Adequacy of Drug Programs (Professional Survey) . . . 127 12. Awareness of Drug Abuse Prevention Programs (Pro- fessional Survey) . 128 13. Effectiveness of Drug Prevention Programs (Pro— fessional Survey) . 129 14. Need for More Drug Prevention Programs (Professional Survey) . . . . . . . . 129 15. Knowledge of Persons Abusing Drugs (Business Survey) . l3] Table 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. Reported Experience With Drug Use by Adults Demographic Characteristics by Percent of Users of Cigarets, Alcohol, and Legal Drugs . . Alcoholic Beverage Consumption Related to Demographic Characteristics . Demographic Characteristics of Adult Illicit Drug Users . . . Incidence of Poly-Drug Use . Use of Prescription, Nonprescription, Legal, and Illegal Drugs . Household Survey for Availability of Drugs Results from Household Survey on Question 9: Factors Most Affecting Decision Not to Abuse Drugs . Household Survey of Adequacy of Treatment Programs: Question 12 . . . . Household Survey: Age of Respondents Marital Status of Respondents . Number of Children Per Family of Respondent Education of Respondents Income of Respondents Respondents‘ Area of Residence Within Virginia Beach Results of Youth Survey: 14-18 Year Olds . Results of Youth Survey: Age 14 . Results of Youth Survey: Age 15 . Results of Youth Survey: Age 16 . Results of Youth Survey: Age 17 . Results of Youth Survey: Age 18 . Youth Survey: Poly-Drug Use, Age 14 viii Page 138 142 144 147 148 149 152 154 156 158 159 159 160 161 162 165 166 167 168 169 170 171 Em] Table 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. Youth Survey: Poly-Drug Use, Age 15 Youth Survey: Poly-Drug Use, Age 16 Youth Survey: Poly—Drug Use, Age 17 Youth Survey: Poly-Drug Use, Age 18 Results of Social Service Survey of Drug Use in Virginia Beach . . Age of Social Service Clients Using Drugs in Virginia Beach . . Marital Status of Social Services Clients Using Drugs in Virginia Beach . . . Number of Dependents of Drug— —Using Clients in Virginia Beach . . Education Levels of Drug- Using Clients in Virginia Beach Education Levels of Social Service Clients Compared to the Virginian- -Pilot/Ledger- -Star Survey of Virginia Beach Residents . . Virginia Beach Residence of Social Service Clients Using Drugs Length of Residence in Virginia Beach of Social Service Clients Using Drugs . . . . . Employment Status of Social Service Clients Who Used Drugs . . Occupation or Trade of Social Service Clients Who Used Drugs . . . . . . . . Department of Social Services Clients in Virginia Beach Using Drugs, By Age . . . . Department of Social Services Clients in Virginia Beach Who Are Poly— —Drug Users . Outreach Center Counseling Data for Virginia Beach . Outreach Hotline Data Summary for Virginia Beach Page 172 173 174 175 179 180 181 182 182 183 184 185 186 186 188 189 191 192 hNe 5t Outre Bea . One J Use . Drug tio . Juven anc . Demog as Table 56. 57. 58. 59. 60. 61. 62. 63. 64. Outreach Center Hotline Data Summary for Virginia Beach: Reason for Calling (Detail) One Juvenile Probation Caseload Illustrating Drug Use in Virginia Beach . . . . . Drug and Poly- -Drug Use by Individual Juvenile Proba- tion Clients in Virginia Beach. . . . Juvenile Probation Caseload by Demographic Statistics and Drug Use in Virginia Beach. . . . Demographic Description of 94 Cases of Drug Offenders as Handled by the Commonwealth Attorney's Office in Virginia Beach . . . Total Charges and Drugs Involved: 1974, Virginia Beach . . . . . . . Monthly Breakdown of Drug Charges and Persons Arrested in 1974, Virginia Beach . . Annual Drug Arrests, January through December, 1975, Virginia Beach . . Types of Drugs and Drug Charges, January- December, 1975, Virginia Beach . Page 193 197 197 198 204 210 211 212 213 figure I. A Mam Spe 2. Mappi and Sca Con go . ABS 8 Tra .3:- . Progr (J! . Mappi age as - Sonia PH 3. Flow LIST OF FIGURES Figure 1. A Mapping Sentence for the Facet Analysis of Joint and Lateral Struction of Attitudes Toward Specified Persons . . . . . Mapping Sentence for the Facet Analysis of Joint and Lateral Dimensions of Attitude— Behavior Scale Toward Internal- External Locus of Control . . . . ABS Scales as Instruments in Evaluating Crisis Training . . . Program Approaches and Evaluation Instruments Mapping Sentence for a System of Evaluation, Inter- agency Collaboration in Virginia Beach, Virgin1a . Social Competency Program Relationships Flow Chart: Socially Incompetent Behavior to Program . . . . . . . . . . . Flow Chart: Organization of Response A Mapping Sentence for ”Breakdown” Prevalence of Drug Abuse in Virginia Beach (Question 1): Marihuana . . . . . Prevalence of Drug Abuse in Virginia Beach (Question 1):Inha1ants . . . Prevalence of Drug Abuse in Virginia Beach (Question 1): Hallucinogens . . Prevalence of Drug Abuse in Virginia Beach (Question 1): Stimulants . . Prevalence of Drug Abuse in Virginia Beach (Question 1): Depressants . Prevalence of Drug Abuse in Virginia Beach (Question 1): Opiates . . xi Page 51 52 60 61 66 79 83 83 92 103 104 105 107 108 . Prev . Prev . Intr . Ager . Desv Figure Page 16. Prevalence of Drug Abuse in Virginia Beach (Question 1): Cocaine . . . . . . . . 109 17. Prevalence of Drug Abuse in Virginia Beach (Question 1): Methaqualone (Quaaludes, etc.) . . 110 18. Interdepartmental Human Services Task Force . . . 289 19. Agency Social Skills Evaluation Chart . . . . . 292 20. Description of Disabilities and Resources . . . . 294 xii 11 many year prolific ‘ Jordan-Go Spivak, a significa and Socia l by the Ca and tents Updike, I tonpeten term the data Conceptu tonal (x Profess( to "V or and 155 Dr. Jam PREFACE This study is one of a series of investigations spanning "any years. Of Special significance has been the monumental and prolific work of Dr. John E. Jordan in his development of the Jordan-Guttman Attitude-Behavior Scales. Dr. Zvi Feine and Dr. Mark Spivak, as Consultants to the City of Virginia Beach, have provided significant contributions in the areas of Interagency Collaboration and Social Competency. The workshops and seminars on Social Competency sponsored by the Commonwealth of Virginia, Division of Mental Health Clinics and Centers, and the Bureau of Drug Rehabilitation, Dr. Thomas F. Updike, Director, provided the environment for translating Social Competency and Interagency Collaboration theories into programmatic terms. The author, therefore, collaborated in many aspects although the data, results, integration of concepts, and comprehensive program conceptualization and implementation are those of the author. I sincerely appreciate the efforts and assistance of my doc— toral committee: Dr. John E. Jordan, Chairman, Dr. Thomas Gunnings, Professor James Howard and Dr. Alexander Cade. I am also grateful to my colleagues and classmates for their support, encouragement, and assistance, especially Dr. John Castro, Dr. Jay Lazier, and Dr. James Hightower. xiii I body, net of descr‘ terms of they cam (Or he) POIIce r assesser Nultipha by his ‘ the per If what I115 pm Pf his Iengin! cIPIc CHAPTER I INTRODUCTION The Functional Person: Defining a Community A human being may be defined in many ways. Height, weight, body, measurements, color of hair and eyes may all form the basis of description. A person may also be defined by life history, in terms of country or state of origin. Who his parents were, where they came from, how much money they made (or he made), and how they (or he) made their money, also aid in defining a human being. Negatively, his crime file may be reviewed in the local police records, or in F.B.I. files. Personality deviations may be assessed by the administration of some instrument such as a Minnesota Multiphasic Personality Inventory. Medically, he may be described by his ulcers, heart condition, poor circulation, or hemorrhoids. While all these descriptive elements may say something about the person, he is still described in parts, and most often in terms of what he cannot do, or at very best, by what he appears to be-- his profile. To describe the person as he is, in the manner and capacity of his human functioning, his human skills, is quite a more chal- lenging enterprise. It is also more realistic. This treatise looks at community symptomology with spe- cific reference to drug and alcohol abuse. The conclusive emphasis is on a 1n laborativ A describe: describe state of may also and type and phil new home deliver descripa nalnutr and 31C and tak PIOII 1 e Shiite: truly . I0 and CIIIZe "Atati 1" bel is on a more individualized approach to client evaluation and col- laborative community-based social rehabilitation. The Functioning Community As is true with individual clients, a community may be described in a number of perspectives. Census data may be used to describe the community in its citizens' numbers, their nation or state of origin, their ages, occupations, and incomes. The community may also be described in its financial assets, tax base, or number and type of industries, or in its political tendencies, affiliations. and philosophies. A community may also be defined by its number of new homes, its slums, its public institutions, its capacity to deliver its own public services, or by its payroll. More specific descriptive indicators may be added such as the incidence of disease, malnutrition, physical handicaps, mental regardation, drug abuse, and alcoholism. All the above indicators tell something about a community, and taken collectively they may go far in portraying a community profile-—an appearance of the community, its size, its shape, its symptoms. But these indicators hardly describe a community as it truly is--as its citizens function, and as its institutions relate to and respond to the specifically defined human need of its citizenry. This work describes a community in profile, and suggests a metatheory for more meaningful community and citizen descriptions, in behavior-specific terms, in their functional capacity, in their social 51 human res rehabil ii files be initial are stil point iv picture comuni' Vie bu Moment connuni within belend itself his so is thr t0 hin Dense IS Va social skills, and in their social relatedness to the community's human resources. This work also recommends an interagency rehabilitative community response to citizen needs. Snapshots and Movies Community profiles based on symptomology, like client pro- files based on symptomology, serve as informative data bases for initial rehabilitative planning, but symptomology-based profiles are still-life pictures: snapshots of a client at a particular point in time. Such profiles do not provide the complete detailed picture of communities or clients upon which specific and measurable community responses and rehabilitative programs can be programed. The community profile we want is not merely the snapshot type but rather a movie, in motion, constantly changing, developing, augmenting, acquiring, and specifically relating—-relating to the community, relating to its human processes, and relating to citizens within its environment. This goes beyond a demographic profile, beyond what seems to be, and even beyond what a community perceives itself to be. If time is the measure of that which changes, then man in his Social Skills is one unit measuring the quantity of change. It is this measuring unit--these Social SkillS--by which man is measured to himself, and to others. It has been said that mental health is the capacity of a person to pleasantly anticipate the next moment. If the definition is valid, then it insists that there be some founded hope on the part of i in that v is termev l gories: and Skil when we knowing --relat Birth, 1 human since F I0 cite nent av Social hin th Iht‘0ug tennin BINays head, the f; econo part of the person that he can function adequately as a human being in that next moment. In its broad sense, this functioning capacity is termed "Social Skills." Human social skills may be programed into three broad cate- gories: Skills in Independent Living, Skills in Vocational Living, and Skills in Social Living. We begin to know the functional person when we begin to see him within these parameters. Human Skills and Responsible Systems Time, change, functioning are three key terms and concepts in knowing, assessing, and rehabilitating a human being. A fourth note --re1ating--must also be kept in the foreground of the picture. Birth, death, marriage, divorce, employment, all the key notes in a human life, encompass relationships. Every human theorist since Freud-—Jung, Frankl, Sullivan, Horney, Adler, Perls, Rogers, to cite some of the more notable—-has emphasized the critical ele- ment and functioning of relationships in human life processes. As Social Skills give man the breath to function, relationships give him the necessary space in which to flex his social muscles. Through the relationships which he forms, and strengthens, or terminates: man to a great extent describes his own environment. It is almost trite to add that relationships are, however, always a two-way street——man reflecting upon himself (the "I-Me“ of Mead, the “I-Thou" of Buber and Tillich), man interacting within the family and the social community, man interacting with the economic and industrial community. soon fol narriagv the ind‘ revolut existen and Det lutions nan hir social indivi Pl its respor in his the in Of th also ing E the 1 CIti; viab 015 When the "I-Me” relationship breaks down, existential crises soon follow; when family and community relationships break down, marriage and community crises occur; when communications between the individual and the economic/industrial community break down, revolutions, peaceful or otherwise, are not far behind. Witness the existential crises on the campuses of the 'SOS, the riots of Watts and Detroit of the '60s, and the volcanic American and Russian revo- lutions of the less recent past. Rehabilitative systems must then of necessity look keenly at man himself, but especially man in his Social Skills, and man in his social relationships. The skilled marriage counselor looks at the individual, but also at the marital relationship itself, as described by its capacities, its needs, its communication, and above all, its responsiveness. The rehabilitation counselor also addresses the individual in his capacities, deficits, skills--but also in a perspective of the world into which the client returns--the ongoing relationship of the citizen with his community. Like marriage, this relationship also is one of resources and needs, asking and receiving, confront— ing and supporting. The citizen brings his skills and his needs—- the community has its demands and resources~-and its needs for the citizen's Skills. If this relationship between citizen and community is to be viable, or even sane, it must be the two-way street. The many facets of such a relationship must be somehow organized to be understood-- and the re able, orga 11 I must be a very fiber 11 the progra his handiv tation pr customize and getti tionships viewed as Viduals, 119. char 1 tvmunit. on truth Growth t munity a in his 5 resDonsi PM in 1 files. 1 IgenCIe and the rehabilitation program must be built in such an understand- able, organized framework if it is to make sense at all. There must be clear communication on both Sides. There must be a meeting of needs, a quid pro quo, on both sides, or the very fiber of human life, of social life, breaks down at its base. The task of relating to man as he is, is a challenge to the program planner and the counselor. For man functions,even with his handicaps and disabilities, as a unique social being. Rehabili- tation programs and activities must be framed in an environment of customized variables identifying the ebbing and flowing, giving and getting, of personal, social and vocational activities and rela- tionships. In this context, community agencies, or groups, are viewed as moral persons, as partners in relationships with indi- viduals, communicating back and forth, giving and receiving, adapt- ing, changing, growing. For here it is posited that only within such a socialized community can true rehabilitation take place--a rehabilitation based on truth, openness, flexibility, and especially responsiveness. Growth then is a mutual process, from the individual, from the com- munity and its rehabilitative units or agencies. The client grows in his social capacities and skills, the agencies grow in their responsiveness to individual need, in their sensitivity to clients, and in the strength that comes from thoughtful flexibility. Rehabilitation is about persons first, and then about agen- cies. Rehabilitation must be individualized to personal need, and agencies must be organized within the many variables necessary to deliver tivel y. Th ized rehab and highly A for organ iected. ' issues mi 1 to deliver their resources and services both sensitively and effec- tively. This work addresses this two-fold objective of individual- ized rehabilitation, delivered in an environment of community-based and highly collaborative agencies. A community profile will be offered, but beyond that, a plan fer organized and individualized rehabilitation will also be pro- jected. To attain this total objective, the following concepts and issues will be addressed. 1. The concept of prevention, including a definition and conceptual analysis of the phenomenon "social breakdown." Concepts relevant to Social Rehabilitation, with specific regard to the theory of Social Compe— tency. The development of a community response to Social Breakdown based on Interagency Collaboration. The initial diagnosis of a community using drugs and alcohol as symptoms of desocialized behavior. Projection to a method of assessing a community in terms of social functioning and dysfunctioning. gram u study. effect opment enhanc turn 1 and r1 only 1 else 1 10 ct inter must it iv indi It 1 air CHAPTER II REVIEW OF THE LITERATURE The interagency collaboration approach to the issues of pro- gram utilization by clients, as outlined above, is pursued in this study. Such an approach could result in enhanced utilization and effectiveness of mental health rehabilitation programs. The devel- opment of a conceptual framework, which when effectively used would enhance interagency collaboration and thus program utilization, may turn out to be more successful than other methods such as "outreach" and reliance upon court referrals, which have in the past been the only methods of referral for rehabilitation programs. Also, a pre- cise methodology for client rehabilitation, Social Competency, is the other crucial component of any mental health rehabilitation program, and is also included as an integral part of this study. The conceptual framework should encompass a systems approach to collaboration because of the complex, continually changing, and interrelated nature of interorganizational relationships. Techniques most useful for enhancing the quantity and quality of contact aimed at improving collaboration should be explored. The ”needs" of the individual community agency staff members must also be analyzed. It is posited that agency needs are in part reflected by the needs of individual staff members of that agency. Relevant concepts from these be study '5 chapter. systems interpev zationa‘ interagv comuni by too author from p client to isc cooper visor: 11pm. deman these bodies of social science knowledge will be utilized in the study's conceptual framework and will be explained later in this chapter. Services to clients are not delivered in a vacuum. A systems and interorganizational perSpective combined with the use of interpersonal techniques and the fulfillment of personal and organi- zational role needs of community agency staff members comprise the interagency collaboration conceptual framework of this study. Comprehensive Community Rehabilitation in Interagency Collaboration The development of responsive, measurable, and economic community-based rehabilitation programs is continually frustrated by two major factors: 1. The lack of communication, cooperation, and func- tional interaction among community agencies and groups reSponsible for rehabilitation program planning and implementation. 2. The lack of a sensible model and terminology on which to plan, deliver, and measure rehabilita- tion activities. This effect is hardly surprising. Legislative acts proposing, authorizing, mandating, and funding community programs often result from political needs and political compromises as well as justified client needs and scientific program planning. Also, agencies tend to isolate turfs and define “kingdoms,“ confounding interagency cooperation and interaction. Ego needs of administrators, super- visors, and line workers also serve as reinforcers of territorial approaches. Present international, national, and local economic factors demand more economical cooperative and measurable programs. Politic in the l and com both co tion, 51 rented on whic Collabo comuni Social comuni respons ing ant scales client: been d These health many 5 are or inner tion, 10 Politicians and government administrators, presently ”under the gun" in the Watergate aftermath, are demanding accountability measures and concrete results in community programs. Three methodologies provide great promise as foundations for both cooperative and understandable programs: Interagency Collabora- tion, Social Competency, and Jordan-Guttman Facet Theory as instru- mented in Attitude-Behavior scales. These three systems may be melded into one functional model on which community rehabilitation programs can be based. Interagency Collaboration provides the rationale and guidelines for interagency communication, planning, funding, implementation,and evaluation. Social Competency is a methodology which can be used for identifying community rehabilitation problems, designing specific rehabilitative responses, in identifying gaps and overlaps in services, and measur- ing and tracking rehabilitation results. The Jordan-Guttman ABS scales provide a unique methodology for quantifying changes in clients', or trainees' attitude-behaviors. In recent years mental health rehabilitation programs have been developed to meet the treatment needs of the mentally ill. These programs extend across agencies and services, including mental health, public health, social services, vocational rehabilitation,and many similar service groups in the private sector. These programs are usually comprised of a combination of major segments: outpatient, inpatient, consultation and education, alternatives to hospitaliza- tion, emergency services, and drug rehabilitation. These segments represent oped to d addiction 8 the feeder Treatment nonexiste usually 1 to preve ill clie of input commit. trative 1 and inte inputs t tion of poured i Neverthv health 1 utilize. and the vith st for thv ll represent the best, albeit imperfect, answers our society has devel- oped to date to respond to the problems of mental illness and addiction. Such responses are still fragmented, often uncoordinated at the federal, state,and local levels. Funding sources remain varied. Treatment objectives often are unclear, effective prevention almost nonexistent. Programs are often underutilized, tracking systems usually ineffective if extant at all. The major goal of a mental health rehabilitation program is to prevent the onset of the disability, or to rehabilitate mentally ill clients. To accomplish this, the program must secure a number of inputs and organize a number of variables, such as funding, staff, community support, clients, methodologies and theories,and adminis- trative endorsements. These inputs and variables are interrelated and intergenerating. These are, in systems theory terms, necessary inputs to achieve an output--namely, the prevention or rehabilita- tion of mental disability. Millions of federal, state,and local dollars have been poured into mental health programs and drug rehabilitation programs. Nevertheless, it is the opinion of Virginia's state-level mental health administrators that virtually all drug programs are under- utilized in terms of the people who could benefit from such programs, and there is little evidence to suspect that this is not also true with state mental health programs in general. Mental health centers and clinics remain ”9 to 5" operations for the most part. Programs tend to be isolated from the mainstream of conmu which is grannati had only programs data rec its prog difficul have had comes as if at al perspect the broa explain reierra? of l‘ESPI process the eff lhe pm its pre the tar gran, i other uunity 12 of community agencies, offer traditional, if not archaic, “therapy“ which is at best unmeasurable and at worst conceptually and pro- grammatically disorganized. The effects are predictable. One drug program in Virginia had only three percent (3%) of its clients “graduating" from its programs. One mental health center has had no meaningful systematic data recording or tracking system for the past five years in any of its program units. It is readily apparent that programs have had difficulty in successfully reaching and binding in clients and have had little means to explain or justify their activities. It comes as no surprise, then, that such program staffs relate poorly, if at all, to the other service agencies, and have little sense of perspective of how what is going on in their program relates to the broader community rehabilitative effort. Poor collaboration may explain low utilization of mental health programs in terms of low referrals, lack of proper client maintenance, and a consequent lack of respect for the program by the community at large. Two major avenues are available then for analyzing the process of referral and maintenance of clients. On the one hand, the effectiveness of the treatment program itself can be questioned. The pr0gram's understanding of the community rehabilitation problem, its precisely defined response, the use of outreach approaches to the target population, the method of binding-in clients to the pro- gram, and the rehabilitation itself may all be ineffective. 0n the other hand, collaborative efforts of the programs with other com- munity agencies may be poor or nonexistent. One component of comun collah may be centre gran a ents' (19491 disagr agenc: effec‘ refer from rule in th gran util of c tern cost 13 community collaborative failure is that the quality of interagency collaboration may be lacking as well as the quantity. 0r agencies may be interacting with poor agendas, weak methodologies, undefined central terminology, vaguely defined problems, and nonspecific pro- gram activities. The crucial effects of intrastaff relationships upon cli— ents' treatment was first clearly documented by Stanton and Schwartz (1949). They described the highly detrimental results of staff disagreement for hospitalized mental patients. Nevertheless, inter- agency staff relationships have not been carefully studied for their effects upon various aspects of client treatment such as appropriate referral and participation in treatment programs. The concept of SSR (Social Systems‘ Relatedness) comes from systems theory and in this study calls for fulfilling the role behavior needs of other staff members and significant others in the community by a staff of a mental health rehabilitation pro- gram. It is hypothesized that such collaboration increases program utilization by increasing the number of referrals and the number of clients maintained in the program, and is more feasible in terms of amassing community resources, and control of program costs. However, just referring clients into a program is not the final program goal. Clients are needed by a program, but there are also other program needs. For example, a program needs clients to whom it can adequately and responsibly respond in terms of treatment and reh thought capacit needs a to pros and the to cliu not re call y they a strate fulfil 0f con all ir study puts for 1 tens envir 51th seen (lug and the agency is actually able and in fact does respond effectively l4 and rehabilitation. Therefore, the referrals must necessarily be thoughtfully considered in terms of clients' needs and the agencies' capacity to respond. Such referrals can only be made if clients' needs are accurately assessed, program operations are clearly defined to program staffs within the agency and throughout the community, to client needs. Further, agencies who duplicate efforts, as agencies who do not respond to proven (or mandated) needs,will be in jeopardy fis- cally and politically. Community programs, then, need clients, but they also need credibility. This credibility is enhanced by demon— strated program effectiveness, clear definition of agency roles, the fulfilling of political and fiscal needs by responsible definition of community needs, elimination of gaps and overlaps in services-- all in an interorganizational collaborative community effort. The interorganizational environment is the focus of this study because we are interested in the transfer of inputs and out- puts across organizational boundaries. Thus, a promising perspective for improving interorganizational relationships is that of'bpen sys— tems theoryfl' It calls for a view of the organization and the environment in which it operates. Within the context of a systems theory approach, the acqui- sition of referrals (input resource) can, for the most part, be seen as one part of an exchange relationship. According to Blau (1968) ”the concept of exchange refers to voluntary social actions that are when thr rehabil selves procity and the are net of the in the System consis This c to an admini lllma 0f thi and d[ asSllllu tunic 15 that are contingent on rewarding reactions from others and that cease when these respected reactions from others are not forthcoming." Referrals, then, are exclusively seen as input resources to rehabilitation programs, and will not usually be generated by them- selves in the normal course of business. Some exchange or reci- procity must take place between those individuals referring clients and the staff of a mental health program. The extent to which the "needs" of other service agencies are met by the mental health administrators is a major determinant of the other community agencies initiating or continuing to engage in the referral of clients to the mental health program. The conceptual framework of this study incorporates a social system approach which is termed Social System Relatedness (SSR), consisting of areas of SSR, techniques, and role behavior needs. This conceptual framework will be explicated below and can be used to analyze the interorganizational-oriented activities of agency administrators and staff members. SSR might also be used as an approach to altering agencies' collaborative behavior. The following section deals with the open systems approach of this study. Included in this section is a review of the concepts and development of systems theory which is one major perspective assumed by the study. Review of Open Systems Theory A frequent objection to organizational research is that "the typical models of organizational theorizing concentrate upon principl indepen< The resr and int system on the urganiz light, process this at An ana' the op analog, of an operat "Oi en ment. fatter undel 0f th Cizec urga, Olga] Spec and 16 principles of individual functioning as if these problems were independent of changes in the environment" (Katz and Kahn, l966). The result is an emphasis on the concepts of production, efficiency, and internal stability in analyzing organizations. This is a closed system approach to organizational analysis because it concentrates on the internal operations of an organization. Recently, however, organizational researchers have viewed the organization in a new light, applying some of the principles of biology and physics in the process. This was the beginning of open systems thinking. Initially, this approach considered somerrfthe biological aspects of organisms. An analogy was made between organisms and organizations. It involved the organism’s symbiotic relationship with its environment. The analogy posited a tie between organism and environment, consisting of an exchange between them, an exchange that was necessary for the operation of both. In applying this analogy the organization does not exist in isolation but operates with close ties to its environ- ment. For the organization, then, the environment is an essential factor underlying the system's models (Buckley, l967). The analogy of an organization as a mechanistic or organic model occurred at the beginning of systems thinking. As this school of thought has developed these approaches have been widely criti- cized. Thus, Buckley (T967) speaks of the mistake of equating the organization with an organism and not the entire species. The organization in this system should not be an organism, but the species, for if it were an organism, then the parts would cooperate and not compete in a struggle for survival (Buckley, l967). F extent 01 is thougl and as $1 the orgar burden or 1967). research today. that the general dSpects lrist: The are tom may nos- uhe don und the dellellde He Polr traffic leachr, AS the 17 Physical systems also differ from social systems in their extent of purposiveness; therefore, the analogy to physical systems is thought to be erroneous. Social systems are more goal directed and as such have embodied in them the concept of feedback between the organization and the environment. This places a much larger burden on the input, throughput, and output of the system (Buckley, T967). Work in this area has given the field of organizational research the concept of "systems,“ usage of which is fashionable today. However, as Blegen (l968) points out, this is not to state that there exists one "system school”; although it does signify a general approach to the study of organizations, even if different aspects of those organizations are stressed. The significance of this approach is stated by Emery and Trist: The environmental contexts in which organizations exist are themselves changing, at an increasing rate, and towards increasing complexity . . . . In a general way it may be said that to think in terms of systems seems the most appropriate conceptual response so far available when the phenomena under study at any level and in any domain display the character of being organized, and when understanding the nature of interdependencies constitutes the research task (Emery and Trist, 1965, p. 2l Warren (T967) expands this notion of complexity and inter- dependency in the development of the concept of “density of events.“ He points out that as the density of events increases, such as when traffic increases to the point of needing a light, the chance of reaching stability by mutual adaptation and competition is reduced. As the density of events increases, the focus is on the occurrence of in also actor resea stand tems is be hon: acth that aPPT is a of t many oh oh dl‘l T8 of interaction and its structure. Moreover, this higher density also results in new forms of interaction for different types of actors. As the environment becomes increasingly more complex and as researchers focus in on the network of relationships to aid in under- standing an organization's operation, the assumption of an Open sys— tems approach becomes more significant and almost unavoidable. This is because the area of interest is the relation between organiza- tions; therefore, an approach that focuses on the nature of inter- action among subunits will be more appropriate than a perspective that focuses on the subunits alone. Thus open systems theory is a promising perspective or approach for use in analyzing interorganizational relationships. It is a major vantage point of this project. It has been called a "way of thinking and a way of analysis that accommodates knowledge from many sciences" (Janchill, l969). A system is a set or arrangement of parts related to form a whole, such that a change in one part causes a change in the whole. Blegan (l968) cites the definition of concept as "a set of objects together with the relationships between the objects and their attri- butes." The relationships "tie the system together" and the environment "is the set of all objects, a change in whose attributes affects the system and also those objects whose attributes are changed by the behavior of the system“ (Blegan, l968). To deter- mine when an object is part of the environment, one draws a boundary around the phenomenon one is studying. Everything within the bounda l968) . and ii the to bound poten' as th syste excha It is tens Systu The ( ilhiil (Bus olos dete the all holes him not tau ing v , 19 boundary is the system, outside of it is the environment (Blegen, 1968). The perspective is to view both the system (the organization) and its environment—~in short, an open systems approach. Dill uses the term "task environment," which is a more workable concept than boundary maintenance, because it compresses those inputs which bear potentially on goal setting and attainment (Dill, 197T). The distinction between "open" and "closed“ systems, as well as their respective approaches, relates to the interaction between systems and their environment. A system is Open, generally, when an exchange occurs across the boundaries between system and environment. It is closed when no interchange occurs. Hence, with an open sys— tems perspective, one is interested in the exchange and relation of system to environment. This can be stated in terms of “entropy.“ The closed system increases in entropy, or in other words, runs down, while the open system is negentropic or tends to decrease in entropy (Buckley, 1967). By extending this distinction between open and closed systems, we see that within a closed system approach one determines or has knowledge of cause and effect relationships from the results of action within the system. Furthermore, the actions all arise from within the system. With an open systems approach, however, the cause and effect relation is more difficult to deter- mine because the consequences within the system might arise from actions outside the system, that is, actions in the environment. Causal actions could then extend throughout the system with vary- 1."9 degrees of effect (Thompson, l967). cones cont openr nair men of] lag Sys‘ lie the 51s des 20 Herein lies the dependence of the system on the environment for energy. As Katz and Kahn (1966) point out, the organization is "continually dependent upon inputs from the environment." Moreover, "the inflow of materials and unit energy is not constant. The flow of energy is broken up into the stages of input, transformation or throughput, and output. With this perspective referrals can be conceptualized as an input resource, which is necessary for the continued existence of the organization. This implies a degree of openness of the organization to its environment. In this process of energy transfer, only throughput involves a stage contained within the system itself; the others involve the system and some parts of its environment. Because of this energy transfer, there is the premise of constant flux for the organization, although it seeks stability. Rice (1963) says that a characteristic of an open system is that "it exerts forces to attain, and then to maintain, a steady state" (p. 184). In an effort to make the environ— ment more predictable, organizations might engage in the investment of relationships with other organizations. Systems theory at the same time tends to be very general and vague. In its focusing on the ”organization-set" of the total system, a little precision is lost in attempting to have a broader view. Moreover, the very generality of systems theory means that the concept can be manipulated according to individual bias. Given these shortcomings and our realization of their existence, open systems theory nevertheless is a useful tool in any attempt to describe and view an organization's operation in its environment. ‘ In fact entirel to into sions, theory to enhe the sys real it; highly concep testin review agency incorp this n study used i in eel Usefu' iitior the rt 1more is th 21 In fact, it is essential, for any other approach which is focused entirely on a particular subunit would not provide a viable approach to interagency relationships. From the systems perspective is derived a number of dimen- sions, described below, for viewing organizations. While systems theory is the vantage point, the dimensions indicate means of action to enhance agency effectiveness, and are the functional elements of the systems perspective. A conceptual framework attempting to explain a large area of reality based on interagency collaboration runs the risk of being highly abstract and difficult to translate into reality. Such a conceptual framework may well be a prelude to further research in testing various elements of hypotheses of the framework. Literature will be reviewed below. The focus of the initial review will be upon discovering useful concepts for effecting inter- agency collaboration. Such an applicable conceptual framework can incorporate only a small number of unified concepts at one time. In this way, empirical tests become possible. We are attempting in this study to glean from social science findings knowledge that can be used to improve comprehensive community planning and service delivery. An eclectic approach from various social science areas could be most useful. The conceptual framework for effecting interagency collabo- ration must at the same time use social science findings, deal with the realities of collaboration, and, if found to be effective, be communicable to practitioners. This collaboration among agencies is the necessary foundation for the rehabilitation process itself. Bell col' pm 901 and eff 1ap tia res ope is: oil till 22 Below is a review and discussion of work done in the area of collaboration. Coordination, Coogeration, and COllaboration Those who work at providing mental health rehabilitative and social services are probably more aware than other professionals of the problems in planning and service delivery. Potentially effective programs remain underutilized by clients, gaps and over- laps of services are apparent and result in either a lack of essen- tial services of competition between agencies. Moreover, community resources may be wasted when a comprehensive plan is not in Operation. As a result, community counselors have been concerned with issues regarding collaboration, COOperation, and coordination with other professionals and agencies to reduce the problems and improve the delivery of services. The interest in this subject is reflected in the number of articles emphasizing the importance of collaboration. Yet most of the professional articles dealing with this subject simply survey the issues involved and emphasize the need for collaboration (Visotsky, 1966). Despite the vital practical implications for clients in enhancing effective collaboration between professionals and agencies, there has been a relative lack of integration of recent social science findings and actual experience on the community level to enhance collaboration. Relatively little sophisticated conceptualizing of the vari- ous issues in collaboration as well as translating the social science knowlec of refs in the and Ca: litern artich agency streng site 0 do not Moreov labora and on Rein ( coordi °lsani depent on wh; A5 Pm and h healrl tiong other State IIIIIIIIIIIIIIIIIIIII33:_______________________———7 ‘_——"” 23 knowledge we possess into practical planning and interventive frames of reference has been accomplished. Behavioral sciences have only in the last decade begun to relate to interorganizational behavior. Articles by Parnicky, Anderson, Nakoa, Thomas (1961), Black and Case (1973), and Wolkon (1970) exemplify much of the social work literature on "coordination and cooperation.” These particular articles deal with the securing of referrals as the focus of inter- agency cooperation. The articles generally point out the need for strengthening referral procedures, the need for cooperation, and cite obstacles preventing such cooperation. These articles, though, do not present a conceptual framework for achieving such cooperation. Moreover, the distinction between coordination, cooperation, and col- laboration, is not usually clarified. Reid (1969) sees coordination of services as an ideal state and carefully lists many of the reasons why this goal is so elusive. Rein (1970), on the other hand, points to the dangers of too much coordination, and he adds that confusion and competition between organizations may be all for the best—-otherwise a client may be dependent upon one social worker or agency who will impose controls on what he considers deviant behavior on the part of the client. As Powell and Riley (1970) point out, the coordination, development, and integration of relevant services can place the community mental health agency "in a potentially competitive and threatening rela- tionship to other agencies and private practitioners" (p. 120). Onthe other hand, Kahn (1973) points out that "efforts need to be inte- grated, interrelated policies coordinated. This goal does not result collabl and the is to i cept o achiev tion a result tion a by Mo New Mott 24 result simply from value orientation but the belief that increased collaboration will lead to a system with reduced overlap of services and therefore, increased efficiency" (p. 7). Much confusion, then, is to be found in the social science literature regarding the con- cept of coordination. Thompson (1967) outlines three methods for achieving coordination. These include: 1. Standardization--which involves establishing rou- tines and rules to constrain the actions of an organization and thereby to make them consistent; 2. Planning--which creates a schedule for the inter- dependent units to govern their actions; and 3. Manual adjustment—-or “feedback" in March and Simon's terms, which involves the transmission of new information while in action. These three methods involve progressively more communica— tion and decision and include real costs for the organization as a result of the coordination. Kahn (1967) cites a number of methods for achieving coordina- tion of policy and programs through: 1. The structuring of executive and administrative authority; 2. The formal administrative mechanisms at the level below the executive; 3. Interagency, interdepartmental, or interorganiza- tional committees; and 4. Joint or unified service operations. The ambiguity of the term coordination is well pointed out by Mott. In essence, it is the value which we attach to the term coordination and the ways in which it is secured. According to Mott (1970): Coc niz are tai uhi ser "often interag imply ‘ concep tradit ence f tOgeth about carrie betuee bringy 01‘ bel 15 on 25 Coordination is an ambiguous term that describes all orga- nized behavior, for the efforts of individuals and groups are coordinated when their behavior is concerted in respect to some desired purpose or consequence. The term only takes on specific meaning in relation to the methods by which coordination is accomplished and the ends that they service (p. 55). White (1968) points to cooperation including processes "often called collaboration, teamwork, multidiscipline approach or interagency integration." By whatever technical name,theseprocesses imply individuals working together towards a shared Objective. The term “cooperation,“ according to Cohen (1969), may be conceptually analyzed among five types of cooperation: automatic, traditional, contractual, directed, and spontaneous. Collaboration seems more appropriate as the frame of refer- ence for this study than that of cooperation or coordination. Although COOperation emphasizes association or working together for a mutual objective between groups, it says nothing about the relative position of the groups that are cooperating. Coordination, on the other hand, isidentical with "being carried out from above" and hints at a less than equal relationship betweenifluepartners. The term coordination can be conceived as bringing "into common action" various programs whose aims, skills, or beliefs are strikingly different (Stukes, 1965). In comparison to cooperation and coordination, collaboration is usually associated with more equality and involvement among the partners in any particular undertaking. An exchange or reciprocal relationship will exist.- tend this find retu tend thou rela 26 In focusing on the collaborative efforts made by one agency toward another the sphere of interest is the interorganizational environment and the relationships within that sphere. The concern then becomes relationships between organizations as reflected in the relationships between the administrators and staffs of different organizations. These relations assume importance since organiza- tions cannot collaborate without both administrators and staffs of those agencies collaborating. One way to look at interagency collaboration is through exchange theory. Exchange theory provides a means to conceptualize the collaborative process as a flow of goods between organizations. Exchange, as defined by Levine and White (1961), refers to "any voluntary activity between two organizations which has consequences, actual or anticipated, for the realization of their respective goals or objectives“ (p. 583). Gouldner (1970) criticizes the concept of exchange for its tendency to become ”more and more one sided.” To counterbalance this tendency, Gouldner prefers the concept of reciprocity which he finds "implies that each party receives something from the other in return for what he has given him.” Gouldner maintains that people tend not only to receive, “but to reciprocate relationships“ (Gouldner, 1970). For Thompson (1967), the result of a reciprocal relationship is a form on interdependence between organizations. It is a situation in which the outputs of one organization become the inputs of another; thus each organization involved is penetrated by another organization. tionsh' barrier mental values obstac Rome 1 Comprg cOlunur 11' erg . shoe 1 flfiflh .7 IIIIIIIIIIIIIIIIIIIIIIl33333___________________________‘___—_________7777"7777' 27 Another approach for understanding interorganizational rela— tionships can be found in the literature dealing with obstacles or barriers in delivering human services. Furman lists seven obstacles in the development of community mental health centers. His approach questions various professional values and practices as well as community beliefs. Furman's seven obstacles are listed below: The obstacles that we consider to be paramount for the next decade or so are the following: (1) the persisting illusion of "cure” as the standard goal, coupled with emphasis on a higher status for long-term or “open-end" - psychotherapy, as well as depreciation of other methods; = (2) rigid concepts of professionalization, interdiscipli- nary conflicts and lack of clarity about the boundaries of the field itself; (3) overestimation of public tolerance of the mentally ill; (4) postponement of evolutionary approaches due to a magical aura attached to the term CMHC itself; (5) the dominance or primary of research, result— ing in overall selectivity of intake; (6) inappropriate training models in community mental health settings, lead- ing to the same self-defeating result; and (7) abuse or distortion of the mental health consultation and referral processes (Furman, 1967, p. 757). Rome (1966) extensively surveys barriers to the establishment of comprehensive community mental health centers. He cites a model for community action that is intended to circumvent organizational bar- riers. His behind-the—scenes attack on the decision-making power structure includes the following six steps: ) informing the executive committee of the Board of Health; ) conferring with leaders ofthepower structure; ) involving community professionals; ) stimulating citizen interest; ) securing support from leaders; and ) obtaining action from policymakers (Rome, 1966, p. 48). areas of the to re prior commu back, to 0t (9) d Previ ness. to co Ofga Pres PFOb IIIIIIIIIIIIIIIIIIIIIIIIII33_____________________——fir 28 It is noted in the text that a deficiency in any of the areas of community planning--professional involvement, utilization of the existing power structure—-will create a barrier to any attempt to reconcile overlapping and competing bureaucracies (Rome, 1966). Borus (1971) speaks of eight obstacles which may lead to a prior antagonism between the private medical practitioner and the community mental health centers. These include (a) lack of feed— back, (b) fear of receiving “dumped” clients, (C) lack of sensitivity to others, (d) differing modes of behavior and decision making, (8) different funding patterns, (f) fear of "snooping," (9) poor previous referral experience, and (h) fear of being put out of busi— ness. Borus goes on to list a series of strategies and techniques to counteract antagonism and effect collaboration. Lastly, Dubey (l968) lists a series of socio—cultural fac- tors which lead to resistance to technological change in traditional socities. The technological change may (a) not be approved by significant others, (b) be incompatible with their expected role behavior, (C) conflict with their value system, (d) not be related to their felt needs, and (e) bear a very wide impact upon their lives. The factors listed above are thought provoking in the com- plex area of human service delivery. The obstacles or barriers approach to understanding inter- organizational relationships has its limitations. The literature presented above provides some helpful perspectives for viewing the problem and suggests some helpful strategies and techniques. Ff concep in the servic collat envirc intere across tiona‘ 01 thl dSa' are e tiling those Oi‘ga] deli IIIIIIIIIIIIIIIIIIIIII3333:______________________———7 29 In the following chapter, we shall expand upon the study's conceptual framework alluded to in this chapter, and begin to tie in the relationship of Interagency Collaboration, as a system, to service delivery in a Social Competency model. Interorganizational Relationships As was indicated in the sections on open systems theory and collaboration, one concern of this study is the organization, the environment, and the relationship between the two. Since we are interested in interagency collaboration and the flow of services across organizational boundaries, the concern becomes interorganiza- tional relationships. Therefore, this section involves a discussion of the literature on interorganizational relationships and its use as a frame of reference for interagency collaboration. The interorganizational field has only recently been recog- nized as a distinct area of study in the social sciences (Epstein and Rothman, 1971). Both Etzioni (1969) and Warren (1967) point to the growing literature on interorganizational relationships and to the need for research in this area. The areas of health, welfare, and community organization are especially well suited for studying interorganizational rela- tions. Most of the articles in the interorganizational field are in those three areas. Vlasak and White (1970) explain the applicability of inter- organizational relationships to the study of the health service delivery system: the el such a "the r more a throug theory 11 ol 11 Zr —7_ 30 Any attempt at "rationalization" of the American health service delivery system must inevitably come up against the problems of recognizing interorganizational relationships and adapting, changing, or bringing them about. This neces- sity affects the most naive, exhortative, general coordina- tion schemes as much as the more modest and realistic ones. While such problems are not limited to the health field, it is the field where problems of interorganizational relation— ships seem to be currently most widely noted, discussed, and occasionally even tackled on a large scale. Coordination, cooperation, comprehensiveness, planning-~all of these and others are only slightly more specific, directional terms for the same generic phenomenon: They all speak of proc- esses that by definition take place between and among, as well as within, organizations. Endeavors intended or actu— ally undertaken under the banners of Regional Medical Plan— ning or Comprehensive Health Planning can be seen as pure examples of interorganizational processes (Vlasek and White, 1970, p. l) Etzioni (1969) indicates that agencies cannot usually control the elements necessary or helpful to carrying out their operations, such as securing funding and clients. Indeed, Etzioni states that "the need for a sufficient number of clients, for example, is often more efficiently met through exchange with other organizations than through independent casefinding procedures“ (p. 120). The interorganizational field is closely tied to systems theory. Warren states: The concept Of interorganizational field is based on the observation that the interaction between two organizations is affected, in part at least, by the nature of the organi- zational pattern or network within which they find them- selves (Warren, 1967, p. 398). Emery and Trist (1965) point to ”those processes in the environment itself which are among the determining conditions of the exchanges" between the organization and elements in its environment. The additional concept of the causal texture of the environment at selec over dlnam field the i We from 11am like. with than IIIIIIIIIIIIIIIIIIIIIIII3333:______________________———7 31 a social level of analysis is necessary, according to Emery and Trist. They add: With this addition, we may now state the following general proposition: that a comprehensive understanding or organi- zational behavior required some knowledge of each member of the following set, where L indicates some potentially law- ful connection, and the suffix 1 refers to the organization and the suffix 2 to the environment: L 11, L 12 L 21, L 22 L 11 here refers to processes within the organization-—the area of internal interdependencies; L 12 and L 21 to exchanges between the organization and its environment-- the area of transactional interdependencies, from either direction, and L 22 to processes through which parts of the environment become related to each other—-i.e., its causal texture-—the area of interdependencies that belong within the environment itself (Emery and Trist, 1965, p. 28). In a similar vein, Terreburry's (1971) thesis is "that the selective advantage of one intro— or interorganizational configuration over another cannot be assessed apart from understanding of the dynamics of the environment itself“ (p. 70). A systems approach is at the basis of the interorganizational field. Indeed, the quickly changing network, its complexities, and the interrelated nature of organizations indicates the necessity of a systems approach to the interorganizational field. Literature reviews of the interorganization field, ranging from listings of articles to comprehensive critiques can be found in Warren (1967), Terreberry (1971), Turk (1960), Evan (1971), and Aiken and Hage (1968). White and Vlasak (1970) have presented us with a highly sophisticated collection of papers on interorganiza- tional relationships in health. The papers represent the ”state of the art" of the interorganization field. We shall present below the thrust field. hypoth standi (1963) organi fied t These a Sim on th 31’ to input Gums of it turn They IIIIIIIIIIIIIIIIIIIIIIII3333:______________________———fi 32 thrust of the major articles which comprise the interorganizational field. Some have conceptual frameworks and others, series of hypotheses. In studying interorganizational relationships and under— standing the elements of collaboration, Levine, Paul, and White (1963) advise those who study health and welfare agencies to study ’ organizational factors which influence collaboration. They identi- fied three organizational factors as determinants of interaction. These include: 1. The function of the agency and therefore the ele— I i ments of inputs needed; 2. The access the organization has to elements out- side itself or its relative dependence on the local environment; and 3. The degree to which domain concensus exists. Gummer (1972) approaches interorganizational relations from a similar perspective as Levine, White, and Paul. His emphasis is on the use of systems theory in interorganizational relationships. By categorizing organizations in tenns of the concentration of inputs, and the acceptance of claim to function (domain concensus), Bummer establishes a typology of organizations similar in a number of its main points to the framework of Levine, White, and Paul. Hylton and Litwak, on the other hand, take a more "struc- tural" view of interorganizational relationships and coordination. They stress that: Interorganizational analysis suggests two important facets of analysis which differ somewhat from intraorganizational analysis: (1) the operation of social behavior under condi which than (Hylt t such as a whose “me mmalor ized coor 1 their ma toor tenc agen defi izes ence coor orga P- 4 Standard tiOnal r ence hit “10“ int frame 0. factor . With 0t °lganiz Scircit IIIIIIIIIIIIIIIIIIIIIIZ3I:____________________———fi 33 conditions of partial conflict and (2) the stress on factors which derive equally from all units of interaction rather than being differentially weighted by authority structure (Hylton and Litwak, 1962, p. 398). Hylton and Litwak (1962) identify the coordinating agency, such as a community chest or social service exchange, as a mechanism whose ”major purpose is to order behavior between two or more other formal organizations.” The authors view this mechanism as “special- ized coordination” (p. 399). From this point of departure, Hylton and Litwak present their major hypothesis: Coordinating agencies will develop and continue in exis- tence if formal organizations are partly interdependent; agencies are aware of this interdependence, and it can be defined in standardized units of action. What character- izes the three variables in this hypothesis (interdepend- ence, awareness, and standardization of the units to be coordinated) is the extent to which they are tied to the organizations to be coordinated (Hylton and Litwak, 1962, p. 400). The three concepts of interdependency, awareness, and standardization are used by the authors for analyzing interorganiza- tional relationships and coordinating mechanisms. Aiken and Hage (l968) relate an organization's interdepend- ence with other organizations, or the impact of the environment, upon internal organization behavior. In the interorganizational frame of reference, the scarcity of resources is identified as the factor that forces organizations to engage in cooperative activities with other organizations, thus creating greater integration of the organizations in a community structure. Assael (1969) also related functional interdependence to the scarcity of resources. The potential for conflict is high in situat when i there condit for st associ frau Shor aim 34 situations of functional interdependence. Conflict may be positive when it leads to a more stabilized system, but destructive when there is lack of recognition of mutual objectives. Assael lists conditions for constructive conflict. Turk (1973) utilizes an interorganizational level of analysis for studying the integrative significance of government and voluntary associations. He contends that: The establishment of formal relations among an important set of the community's organizations depends upon the community's capacity for such relationships and upon the need for them. Capacity is defined in terms of the community's overall organizational structure, measured here by two organizations' sources of integration: (1) the scale and diversification of municipal government, and (2) the extent to which voluntary associations are community-wide and uncontested (Turk, 1973, p. 37) Turk generates two major hypotheses that are confirmed by his data. They are: Hypothesis 1. Formal relations in any broad class of local organizations will occur more frequently (a) the more diver- sified the municipal government and the larger its scale or (b) the less contested and the more community-wide the voluntary associations. Hypothesis 2. The correlation between the need for formal relations in any broad class of local organizations and the occurrence of such formal relations will be greater (a) the more diversified the municipal government and the larger its scale or (b) the less contested and the more community- wide the voluntary associations (Turk, 1973, Pp. 42-43). The authors cited below relate also to the individual in the framework of interorganizational relationships. Yuchtman and Sea- shore (1962) utilize a conceptual framework based on a systems approach. The framework views the distinctiveness of an organization as an identifiable social structure and its interdependence with the enviro SUCCES genera Speci‘ ways: towar of wl envi‘ trib outp “Bot 35 environment. Organizational effectiveness is to be measured by success in securing scarce and valued resources. A ”bargaining position” is viewed as pointing to the more general capability of the organization as a resource-getting system. Specific goals are incorporated in this conceptualization in two ways: (a) as specifying means or strategies employed by members toward enhancing the bargaining position of the organization, and (b) as specifying personal goals of members of the organization. The better the bargaining position of the organization, the more capable it is of allowing the attainment of the personal goals of members (Yuchtman and Seashore, 1962). Thompson (1962) developed a typology of output roles, all of which are boundary Spanning roles linking organization and environment. The output roles are designed to arrange for the dis- tribution of the organization's ultimate product or services. The output roles are defined in part by reciprocal roles of non-members. ”Both member and non—member roles contain the expectation of closure or completion of interaction or bringing the relationships into a new phase." We feel that the concept of boundary spanning roles can also be used in viewing input transactions which are the focus of this study. Thompson has emphasized that within the organization's structure an individual worker's role may span the boundaries of the organization. Evan (1971) utilizes the dynamic concept of “role-set” for analyzing role relationships. “A role-set consists of the complex of roles and role relationships that the occupant of a given status has by V' of depart Instead i will now actions "The rel set are personne services 1ridivid lie feel in mi the mo: 01 act Giganj 36 has by virtue of occupying that status.” With role-set as a point of departure, Evan develops the concept of “organization-set." Instead of taking the individual as a unit of analysis, the unit will now be an organization or class of organizations. The inter- actions the organization has within its network are then traced. "The relations between the focal organization and its organization- set are conceived as mediated by: (a) the role-sets of its boundary personnel, (b) the flow of information, (c) the flow of products or services, and (d) the flow of personnel." Evan's dimensions of organization sets is as follows: '1, 1. Input vs. output organization sets; 2. Corporative vs. normative reference organization; Size of the organization-set; 3‘») Concentration of input organizational resources; 5. Overlap in membership; 6. Overlap in goals and values; and 7. Boundary personnel (Evan, 1971). In his notion of boundary personnel, Evan deals with the individual's role and behavior in an interorganizational context. We feel a stronger emphasis upon understanding an individual's role in an interorganizational relationship. The major interorganizational studies discussed above for the most part are either too vague to indicate any definite course of action or deal with effecting collaboration and overcoming organizational obstacles to successful collaboration. organi than r less, coope infan dimen empir proce labor ownl foun betw ton tio ffl cit 37 Reid (1970) believes the representative sample of inter- organizational theories he studied "offers us better descriptions than explanations of cooperation among organizations.“ Neverthe- less, they make "us aware of the range of factors that may affect cooperation in giving us systematic ways Of viewing them" (p. 99). Seemingly, the interorganizational field is still in its infancy, being highly abstract and comprising conceptual frameworks, dimensions, and hypotheses which have not, for the most part, been empirically tested. Moreover, little has yet been translated into processes or practice for use in effecting interorganizational col- laboration. The interorganizational perspective has influenced our own thinking and the development of some of this study's major foundation included in the conceptual framework. Much overlap exists between many of the studies presented above. Nevertheless, if we are to effect and enhance interagency collaboration in human services delivery, the individual will be the beneficiary of any form of effective interaction. This study is interested in interstaff (including administra- tors) collaboration and the effect of collaboration on the acquisi- tion of inputs, specifically the development of programs, elimination 0f gaps and overlaps, and efficient services. Reciprocal need ful- fillment is an integral element in the collaborative process. To cite Piedmont (1968), ”the failure to reciprocate leads to withdrawal of initiated communication" (P- 31)- Interorganizational programming demands a "quid pro quo.“ In this study, the "quid" might be fulfilling legislative mandates and ti goverr inclu organ "need reinf fillm into inter behal Persl coll have Each also beha 011 iii org act 19f 38 and the "quo" could relate to fulfilling the needs of the local governing bodies. The role behavior needs of agency representatives include personality makeup, the role of the staff member in the organization, and organization needs. The extent to which these "needs" are fulfilled will largely determine the completion and reinforcement of an exchange or reciprocal relationship. Need ful- fillment then will be viewed in terms of the effects of the inputs into the organization. Lastly, a focus on the individual in the interorganizational context will emphasize personality and role behavior need fulfillment for enhancing interagency collaboration. Personality and Role Behavior Needs In previous sections we have discussed open systems theory, collaboration, and interorganizational relationships, however, we have not yet dealt with the individuals involved in collaboration. Each of these individuals besides having a role in the organization also has certain role behavior needs. The importance of these role behavior needs will be discussed below. The development of the human resources school in the study of organizations is a dramatic change from the traditional "scien- tific management“ emphasis. With the new approach, the behavior of the organization's member is determined not only by his role in the organization but also by his personality. Role is defined as "definite acts or complexes of customary ways of doing things organized about a Particular problem or design to attain a given objective" (Inkeles, 1964, p. 66). Individuals may have comparable job descriptions and y nant becau it is he al nize is t relf focu skil sit fiv can act it 39 and yet may carry out their roles differently depending upon their own unique personalities. The role itself will be a major determi— nant of an individual‘s behavior in a work situation. However, because personality has some impact on the performance of a role, it is necessary to delineate the personality variables involved. An individual develops a self-concept through interaction; he also develops a concept of others. Both concepts work to orga- nize behavior. Behavior then represents an ongoing process which is the result of a transaction between the individual and others. It is posited that patterns of behavior are in response to and relfect a "need for that individual." The study of personality then focuses on the individual as a system of needs, feelings, aptitudes, skills, and defenses (Smelser and Smelser, 1970). Murray defines needs as: A construct (a convenient fiction or hypothetical concept) which stands for a force . . . a force which organizes perception intellection, conation and action in such a way as to transform apperception in a certain direction, an existing, unsatisfying situation (Hall and Lindzey, 1970, p. 175). Maslow (1970) constructed a need hierarchy for the work situation. He separated the needs struCture of individuals into five categories: (1) physiological, (2) safety, (3) belonging, (4) self—actualization, and (5) esteem. The five needs categories can be divided into deficit and growth needs, of which self— actualization is the only growth need. Bartow (1972) uses the concept of need to illustrate the idea that individuals participate in activities for a number of reasor satis an ac actor effe indi in 1 ing We the dir Stl 16! 40 reasons. In participation, there is an exchange that occurs and satisfies some individual's needs. As a result of the interaction, an actor will satisfy to an extent some of the needs of the other actors participating in the interaction. Many studies have been conducted on personality and needs as influencing job performance. Aram, Morgan and Esbeck (1971) studied collaboration, needs satisfaction, and goal attainment. They hypothesized that collaboration and consensus in interpersonal rela- tions would benefit both the individual and the organization. The results of the study indicated that individuals do benefit from Ill collaboration and consensus; however, it did not confirm the hypothe- sis that organizations benefit from collaboration and consensus. Yet, team collaboration was not an obstacle to the organization's effectiveness. The unit of analysis in Murray's conceptual efforts was the individual's needs (Hall and Lindzey, 1970). Since he was interested in human motivation, his framework incorporated twenty needs reflect- ing the complexity of human motives. Like Maslow, Murray employs the idea of prepotency. He suggests there is a hierarchy of needs which is constantly changing as needs are being satisfied according to their hierarchical ordering. The delineation of the "needs” of individuals should have a direct bearing on program design and program directions. In this study we are interested in the needs of community citizens, the response by the community programs to these citizens, and the mutual fulfillment of both organizational and individual needs by the n model munit needs tion tency Face deve prog tudr hasr Soc for US( 41 the response. Thus the concern of this study is the operational model that provides a map for interagency collaboration on the com- munity level, a methodology designed for precise responses to client needs, and a conceptual approach to melding interagency collabora- tion with these specific rehabilitative responses (social compe- tency). In summary, this section of this chapter has emphasized the usefulness and interrelatedness of an approach for enhancing inter- agency collaboration which would use perspectives of systems theory, collaboration, interorganizational relationships, and an individual's role behavior needs. In the following sections of this chapter we shall address Facet Theory and the theory of Social Competency in its recent development and in its implications in a community rehabilitative program. Facet theory provides the theory base for measuring atti- tudes, and attitude changes. Facet theory also serves as a theory base for the design of social rehabilitation programs based on a Social Competency theory model. A review of Facet Theory is there- fore critical for the purposes of this study. The Guttman-Jordan Facet Theory One of the perennial problems in mental health programming is the identification and utilization of theories and instruments useful in the evaluation of prevention programs. clinica' (in the ing of mental changes measuri Guttman dissert 1959, l tive; i le ir attrac‘ 115 lo ing to quanti derdar resper in an depenl d1Vey~ Parts IIIIIIIIIIIIIIIIIIIIIIIIII3:—___________________________—'—__i 42 The Guttman-Jordan Facet Theory provides a conceptual, clinical, and instrumental base for measuring attitudes as a facet (in the broad sense) of behavior. Behavior change, not mere impart- ing of information, is postulated as the most essential goal of mental health prevention. Evaluation activities must measure such changes. Because of its import and applicability for quantitatively measuring the effects of prevention programs, a review of the Guttman-Jordan Facet Theory is included as an integral part of this dissertation. The quest of Guttman-Jordan's attitude facet theory (Guttman, 1959, 1970, 1971; Jordan, 1971a, 1971b) is to quantify the qualita- tive; to be able to construct a scale, an index, an instrument which will indeed be able to "measure” attitude-behaviors. Two of the most attractive traits of the Guttman-Jordan proposition are the rigor of its logic and the precision of its “ordering principle” in attempt- ing to introduce the concept of semantic ”structure” as a means of quantifying qualitative data (Foa and Turner, 1970). Contrary to many other psychological researchers, Guttman— Jordan define an attitude as a “delimited totality of behavior with respect to something" (Guttman, 1950a, p. 51). Thus, they consider an attitude as a whole, a universe, a totality: composed of inter- dependent parts, which parts can be subdivided and rearranged in diverse a priori specified ways to represent the given whole. It is this concept of a content universe or whole, and its parts of components as applied to attitude-behavior, that "allows“ the r facet objec the p under pdet attii elem: ment: It c comb step rati call atti —7—7 43 the researcher to be able to quantify qualitative data. Basic to facet theory, then, is the concept of set theory. The individual objects in a set are called elements or members of that set. All the possible combinations of elements derived from the diverse sets under consideration are called the set product or the Cartesian product (Elizur, 1970). In facet analysis the set product is synonymous with the attitude-behavior universe which encompasses the combinations of all elements from the divers sets. In this sense, as a profile of ele— ments across sets, facet theory attitude research is multivariate. It considers the many variables, aspects, qualities, or facets which combine to comprise the attitude-behavior universe. Founded on the principles of set theory, there are two basic steps in facet design. The first step is the development of a rationale for the selection and specification of the basic sets called facets (e.g., aspects or qualitative variables of the attitude—behavior universe, as illustrated in Table 1). Each basic facet is composed of various elements. The second step is the selection of sets of elements, com- binations, or profiles which together form the Cartesian product of the facets of the total universe under consideration. 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N.H 3.3% 3.3?on Nx OHEocouo H muH can wocmHm> H mUHmuu Hmcompoa A oucc:HNcH on mOCMumHmou Hx HMHuom Hfl mcoHumauHm oNHq mmwwmflwiwmwflmmwm mwucwzvumcou 3V 3: :3 m“ zuHHHnHmconwmu mH mxmumHE m; mmwcHNMH NH mumcuo N: :Hou mannHHw 0H oumw c; m m a mchcmHm H cwozuon xozH c Honucou w umouwucH 3H anmcoHumHou coHum>HuoE <2 mm m m Anchu vcmv m wuuoN ocu Ao>HumcouV :oHuum w :oHuum H quHHnm L we N mchpmmmu N wucmuavcw NH NUHHHnmamo N; oucozHNCH w Aw>HuuwNwmv mMCHwaN w >HHmcoHumuomo No xuoa cum: HH mHHwa Hz umaoa Hm Hm>HuchouV wonHoa Hm >HHmuHquuomN£ Hm HoH>mLom Hmmsmm mc:umz NuHHmvoz ~0H>mcmm uoH>m£om m Heuu. o H J 3 2: Go E . 4 a Fe; m: N AHV suHJ muuwuquH u Has AuoH>mson unw No H u0uum \ocHEV N uho>ov am . . a mounmfloo c any umzu wHom u mH>rman> mucoHumoxo Na 7 c 053 uuw kucuHuw xm ucwuwwmu ou H H zuucsou as :H H mwuanuuum uOH>mcmm mnwcuo o NmHHwn a muozuo m Axv uuonnom NSOHMHOUCH m.h°uu< hOuU< Mamm/ I H> com “conuuom acououom 8 V so a: 3 operati Table 1 five fa levels sents a repress p. 6). measur' cognit action the fo attitu the fa vi s-a. facet tion 1 behav Drogw "Stro ing" 01 Ta 1 u 53 operationally defined as the ordered sets of the five facets of Table 1, from low (subscript "1") to high (subscript "2"), across all five facets simultaneously (Jordan, 1968, p. 76); leading to six levels of attitude—behavior strength. Low (subscript "1") repre- sents a cognitive-other-passive orientation and high (subscript "2") represents an affective-self-action orientation (Kim et al., 1974, p. 6). It is this quantitative rank ordering or joint struction, measuring the increasing strength of attitude-behavior from a "weak" cognitive-other—passive orientation to a ”strong“ affective—self- action orientation, that quantifies the qualitative data and lays the foundation for considering the multidimensional aspect of attitude-behavior. The resulting six levels derived from the combinations of the facet-elements can thus be ordered from weakest to strongest, vis-a-vis object interaction; depending on the number of "strong" facet elements appearing in each level. Using this type of struc- tion or ordering, Guttman-Jordan arrive at a multivariate attitude- behavior content universe which is "scaled" into six levels, each progressive level, from one to six, containing from zero to five "strong" facet-elements (Table 2). The following analysis defines the joint struction or "order- ing" rationale as applied by Guttman-Jordan to the facet—elements of Table l: Facet A--the referent "other" (a ) is weaker than the ref- erent "self”—I (a2) in being less personal. Fac beh Fac ‘ imp Fac tha tac att new i net 1 men Fat tin struct Pragre vis th contai Part1 c 21 the Procee est. are me PfiHC‘ 1Hten for t "0rde dttEm IIIIIIIIIIIIIIIIIIIIlII3I:-____________________——fi 54 Facet B--“belief" (by) is weaker than "experience”-overt behavior (b2) in being "passive“ rather than "active." Facet C——referring to the behavior of one's “self“-mine/my (c2), rather than of "others" (c1), is stronger in that it implies personal involvement. Facet D--in behavioral terms, “comparison” (d ) is weaker than ”interaction” (d2) since it does not imply social con- tact. A member of some identified group (i.e., the attitude object) is seen by the subject in comparison to members of some group-—his own or another-~without any necessary implication of interactions between §_and the members of the other group. Facet E--"hypothetical“ behavior (e1) is weaker than "opera- tional" (eg) in that it does not imply acting-out behavior (Kim et al., 1974, p. 6). As is obvious, there is a rank order underlying the joint struction facet-elements in this design. Guttman refers to it as a progression from a weak to a strong form of subject's behavior vis—a- vis the attitude object. The more subscript "2" elements a profile contains the greater the strength of the attitude-behavior at that particular level. In summary, there is a progression through (Table 2) the subscale levels, "stereotype” (level 1) being the weakest, proceeding through to "personal interaction" (level 6), the strong- est. Table 2 represents the special case in which all the facets are monotonic functions of the rank order specified in the ordering principle by the number of weak-strong elements of interpersonal interaction. Jordan has attempted to establish also an ordering principle for the attitude item content itself so that it, too, could be "ordered” with some explicit a priori semantic meaning, rather than attempting to a posteriori evolve the meaning by some procedure such as facto structio main pri 2) in an of atti‘ a cogni its ran 0biect. negativ Princip a Dosii EXPPESS with n 1111011! with t ieVels behavi 55 as factor analysis. Guttman calls this type of ordering "lateral struction“ and the rationale Jordan (1971b) proposes considers three main principles in the selection of the item content (Figures 1 and 2) in an attitude-behavior scale. 1. Relevance of the content-area for the subject: Low-high. Is “situation y? relevant and/or impor- tant to the subject? 2. Ego involvement of subject: Cognitive-affective. Is the "attitude object in situation y? dealt with cognitively or affectively by the subject? 3. Social distance between subject and attitude— object: Distant-close. Is subject's "self" touched in situation y_by the attitude object? In other words, an item (variable) belongs to the universe of attitude items if and only if its domain asks about behavior in a cognitive, affective, instrumental modality toward an object; and its range is ordered from very positive to very negative toward that Object. Therefore, attitude items toward a given object are not negatively correlated for usual populations. Consistent with the above discussion of the weak-strong principle in the evaluation of facets A—E and attitude levels 1-6, a positive or stronger attitude in the lateral struction would be expressed by a subject who “agreed with or chose" items that dealt with the attitude object in "highly important situations that involved the 'self' of the §_in close interpersonal action." By combining the content ordering, or lateral struction, with the joint struction ordering of the six attitude-behavior levels, Jordan has developed several ABS type measures of attitude— behaviors toward varied ”attitude objects" (Bray and Jordan, 1973; Dell, 0r Harrelsc 1974). attitude the resr ture of a speci‘ guity h. scale 0 321). one ano mnar norm” ( "Person sonal a COncerr lufini 01 sub nature IIIIIIIIIIIIIIIIIIIIIlIII3:________________________7 ”'777444477744” 7747 56 Dell, Orto, andJordan, 1974; Hamersma, Paige, and Jordan, 1973; Harrelson, Jordan, and Horn, 1972; Jordan, 1974; Jordan and Brodwin, 1974). Although each ABS can be differentiated by its content and/or attitude object, the underlying joint struction/ordering provides the researcher a social psychological basis for predicting the struc— ture of the empirical intercorrelation matrix of its six levels into a specific type of matrix: 5 simplex, as shown in Table 5. This prediction was stated by Guttman (1959) as the conti— guity hypothesis: "Subuniverses closer to each other in the semantic scale of their definitions will also be closer statistically” (p. 324). The contiguity hypothesis postulates that levels adjacent to one another will correlate to a stronger degree than will levels that are more distant from each other. In other words, "Societal norm" (level 2) will correlate more highly with a closer level, "Personal hypothetical action“ (level 4) than it will with ”Per- sonal action" (level 6), a more distant level. Nevertheless, Guttman (1959) does caution the researcher concerning the ordering principle: One cannot presume to predict the exact size of each cor- relation coefficient from knowledge only of the semantics of universe ABC, but we do propose to predict a pattern or structure for the relative sizes of the statistical coefficients from purely semantic considerations (p. 324). Facet analysis provides a means of selecting items from an infinite sample of items that are representative of the particular dimensionality Of the scale being constructed. That a rank order of subjects can be established for material that is qualitative in nature is especially significant. By means of a semantic facet numb 1119. qua‘ that eat Hmof th1 how. “Wml Moo 1eSults 19mm 57 TABLE 5.--A Simplex for Six Variables. 1 --_ 2 .55 —-- 3 .39 45 --- 4 27 .30 7O -_- 5 24 .28 62 86 -—- 6 21 24 .59 82 88 --- l 2 3 4 5 6 analysis, qualitative data can be interpreted by quantitative means. The qualitative variable is given quantitative significance "such that each attribute in the universe of attributes is a simple func— tion of that quantitative variable" (Guttman, 1950b, p. 88). Jordan's recent summary (Kim et al., 1974) of the results he has obtained from the application of the multidimensional facet theory approach in numerous attitude-behavior studies serves as a résumé of the Guttman-Jordan attitude facet procedure. The impor- tance of a facet-designed approach to attitude research, and the results obtained thereby can be considered under three aspects-- (a) methodological, (b) theoretical, and (c) applied: title is, 1 jobs be ing 5E StUd gene 58 l. The facet-theory approach has proved a powerful tool in (a) defining research problems, (b) finding relationships within and among variables, (c) dealing with problems of relevancy, equiva- lency, and comparability in cross-cultural research, and (d) assist- ing in the analysis and interpretation of empirical data. 2. Certain aspects of attitude—behavior are cross-culturally invariate (i.e., the simplex-determined largely by structure of the object—subject relationship. 3. Certain aspects of attitude-behavior are ppjgpp specific. 4. Certain aspects of attitude-behavior are situation spe- gifig (9.9., the same attitude object in different situations-~that 1 is, attitudes of Whites towards Blacks re: education vs. housing vs. 1 jobs vs. etc.). 5. Certain aspects of attitude—behavior are pplppp§_§p§- Ejjjg_(racial attitude—behaviors in New Zealand are quite similar in structure to those in the U.S. but more equalitarian in magnitude). 6. Certain aspects of attitude—behavior may be pgf§pp§li£y Specific, as has been demonstrated in the authoritarian personality studies. 7. Knowledge p§£_§g about the attitude objects does not generally lead to attitude positiveness. 8. Amount of contact E§£_§§ increases attitude intensity but not positiveness unless accompanied by (a) enjoyment 0f the con- tact and (b) perceived voluntariness of the contact. Mere exposure "is not" enough (Zajonc, 1968)! contact 1 dimensio tive lev related (Jordan . total it but is delimit "degreE to Wee tuc acr re' SCE 59 9. Attitude positiveness is related to a value-affective- contact base rather than a cognitive-knowledge one. 10. Attitude-behavior change must be approached multi- dimensionally: knowledge is more related to Stereotypic and Norma- tive levels and contact, values, and enjoying factors are more related to the Actual Feeling and Action (acting-out) levels(p. 15). Six Levels of Attitudes The concept of Attitudes is broken down into six levels (Jordan, 1972) as noted below: 1. Societal stereotype 2. Societal norm 3. Personal—moral evaluation 4. Personal hypothetical action 5. Personal feeling 6. Personal action Each of these levels represents a ”delimited” or defined totality of behavior. Attitude is no longer a "psychic condition," but is actual behavior defined among six correlated levels, or delimited totalities of behavior. Behaviors are measured by ”degrees of favorableness toward a specific object.” In commenting on the relationships of the six-level paradigm to predictiveness, Jordan (1972) notes: In the six-level paradigm in Tables 3-6, stereotypic atti— tudes are farthest removed from personal action and 1 t according to the contiguity hypothesas should be thed eas related to action type behavior. Thus, if an attitu e b scale is of the stereotypic nature (Level 1) it should e expo 6) . rese obje obje the inte pfOCESSt ABS sca'. actual t individx grams d' decisior be Ofa up 6O expected that it should not predict personal action (Level 6). This turned out to be the case in most of our research: across cultures, across groups, across attitude objects, and across situations: (i.e., the same attitude object in different situations or contexts) (Jordan 1971a, p.8). The first five levels of the Attitude-Behavior Scales reflect the internal behavior of a person, not dissimilar to the internal processes of the ”Disorganization" factor in Social Competency. The notion is posed, then, of the utility and efficiency of ABS scales in identifying a “Vulnerable” population previous to actual behavioral breakdown as defined by Antonovsky (1968, p. 9). ABS scales also lend themselves to identifying change within individuals, or groups, that have undergone training/education pro- grams direct to creating empathy, clarifying values, and increasing decision-making skills. To illustrate the evaluation design, a comparative sketch may be of assistance here: R X 0 R O ABS Scales Crisis Training 1. Stereotype Opinion and information 2. Normative Value clarification 3. Personal-moral ---------------- Value clarification 4- Hypothetical ------------------ Decision—making 5. Feeling (affective) ----------- Empathy ——Decision—making (overt behavior) 6. Behavior Figure 3.--ABS Scales as Instruments in Evaluating Crisis Training. 61 .mpcm53mecH cowgmaHm>m use mwzowocaa< Emcmocaxx .q mczmHm J mzmma :umocaa< Ewcmoca mwpmum acmemmmmm< mH—me HmHuom mm—mom Low>mzomtwnzuwpp< ucwszewmcH :oHpm3Hm>m pcmumqsoocH z—Hmwuom Hampmaeoo H—HmHuom mmwg pneumasoo HHHMHuom the co' demogr data r need t at the must b detail to wor be des in the theory which activi are d1 IHtere “be socia felat 1mDer behav IIIIIIIIIIIIIIIIIIIIIIIIIIllIIII"""""""————___"iIT 62 Social Rehabilitation and Evalpppipp Program planning, aswell as program evaluation, necessitates the collection of data describing program functioning. Specifically, demographic data, operating expenses, crisis training effectiveness data reflecting the impact of the prevention program on the community need to be collected, analyzed, stored and communicated. Evaluation needs demand that program goals be clearly defined at the onset. Specific evaluation instruments and statistical tools must be identified. Data collection procedures must be specifically detailed and organized. Specific staff personnel must be identified to work with the evaluation procedure. Data recording sheets must be designed to accurately match needed data categories as described in the evaluation design. Some program theories carry their own evaluation (e.g., theory of Social Competency). Other instruments are available which lend themselves to evaluation of the impact of prevention activities (e.g., attitude-behavior scales). Still other instruments are directed to the measurement of interagency relationships (e.g., Interagency Collaboration). Organizing the Program Variables Mapping sentences enhance evaluation as instruments for social rehabilitation concepts and variables and their respective relationships. Facet theory serves as a base or tool for two important elements of mental health behavior systems: attitude- behavior evaluation, and Social Competency (social skills) theory. sema ized the 1109 orga orga both Anal @ func gran w nati char con: fan tudx Wht The 63 Facet theory also allows for specific evaluations of semantic statements as these statements are broken down or "facet— ized” in specific semantic elements. This unique approach provides the conceptual and instrumental base for a detailed organization of program behaviors not possible in the more traditional program organizational approaches. Above all, the use of mapping sentences organizes the program variables into a ”research design" upon which both planning and evaluation may be based. Analyzing Behavior in an Attitude- Behavior Context Community—based social rehabilitation programs are usually funded with the supposition that one of the objectives of such pro- grams is behavioral change from asocial or anti-social behavior to "socialized" behavior. Such behavior is ordinarily viewed as con- native or muscular-skeletal behavior. The implications for similar changes in attitudes, values and feelings may often be only vaguely considered. It seems reasonable to assume that in at least some fashion a change in actual behavior implies client changes of atti- tudes, knowledge, thought processes, values, and feelings. The assigned task, then, is to specify the levels of behavior which lend themselves to evaluation and, if necessary, redirection. The basic supposition is two-fold: l. A client is behaving asocially or anti-socially and is in some significant way a threat to him- self and/or the community; or 2. A client is in proximate liability or danger of becoming a threat to himself and/or society. any of t pose W the mus Behe pro tom rel pre g hea SOC ter ex; the 1101 IIIIIIIIIIIIIIIIIIIIIIIIIIlIIII"""""""————"_777W' 64 The term "threat“ is used in a broad sense and may relate to any individual functioning outside the social systems and subsystems of the community and either interferes with community functioning or poses as a danger to his own functioning, or both. If in this broad context community social rehabilitation programs are to address specific symptoms or grouping of symptoms of the l‘threatening" or "vulnerable" community, a frame of reference must be adopted which lends itself to the task of behavior change. Behavior needs to be addressed in its manifestations in intersocietal processes and interpersonal relationships. The theory of Social Competency as reviewed in this section provided a base from which to develop a rehabilitation process with a view toward the client's relationships to his environment, with specific implications for prevention as well as treatment. Social Competency Perspective Social Competency is a behavioral and community approach to health services delivery. It asks questions concerning the present social skills of clients, and the effectiveness of client functioning in a particular social situation. The client's ineffective (incompe- tent or unskilled) behaviors are evaluated and actions taken to expand the repertoire of social skills and options in behaviors of that individual within the range of client expectations and community norms. In this sense, it is a personal-social-community approach with the goal of enabling the individual to function more effectively within a community or community subgroup. Socialization of the Res dev M Pre bei tux bel m c Ci: _,, 65 rehabilitatee must then be in terms of the community and the client himself, and not the agency or unit delivering the rehabilitation services. Dr. Mark Spivak, of the Israel Institute of Applied Social Research, Jerusalem, Israel, has used the concept of competency to. develop a program for the treatment and rehabilitation of mental illness (1974). Attitude—Behavior Measurement in the Prevention and Rehabilitation Model In evaluating behavior, the Guttman-Jordan (1971) attitude— behavior theory provides the evaluator with (a) a breakdown of atti— tude into six levels from the "stereotypic“ or opinion level down to behavior itself; previous attitude-behavior studies with which to compare future local efforts; (b) a methodology allowing for a pre- cise quantitative system of measure across and down the semantic statements of attitude. Guttman defines attitude as a ”delimited totality of behavior." Spivak addresses sanity-insanity in terms of Social Skills. Antonovsky describes ”breakdown" as a concept and a process involving ”choice“ or "decision-making" in a definite behavioral context. In examining the concepts, what immediately becomes evident is the conceptual link between the Jordan-Guttman attitude theory on the one hand and the Spivak Social Competency model on the other: HOV 66 v mmmcnmumHmm meoumxm HmHuomm .Hpcowwm Hum::E=oo apnocammme .m>HumLoaoou m :H mcw>HmemLeu . , maggocg < mamNHuHu acwmmn-xmu wEouwn ou mcomcwu wwHQQmHu acma_mc Lo» :owpmgoanHou xuzmmmgmpcw o»nmw=mmwOmummw:wm mammamzne.m mczmwu chHmcH> .cumwm nH:HDLH> cH :owumconmppou accommcwucH .coHpmaHm>m we Empm m wcwncomn< mewaa:_eeem mcwncsd H sesou once, um um: mmwwwuwmww wmwucomm uHHmwN Acomv wmwmwwwu zoo _m:owpmuo> ”mmuH>emm Newaon>mo com memgpo pmmmwwWflEew to Lou ou Hmwuom cowpmpH—Hnmxmm mchHmchaz umHnmmHu w mwcmppu w :mH: Hmcomcwm. \Hmwuom mcwxwwpcwvH . ucwEwgammwz mmxm mmo can mucwH Humm c; E E E Am>HpomamLmav :oHumEeowcH mo Hocucou nwummc mcwuczm mcowuc:_o> uwuwwc ch:0mtwa mmwucmmc mum>HLa AucwEmmLoucmv kuHpHHom venom: ma_uw_wuau ”taxmaxae Aspe_a=c _aczaocrv aucmumaEcu . _ mau_>cwm eo moecacam maoL30m mzcecsa Aaucaomwxav Dewecza asp ac. mmu_>cwm co avenue: eempm mCHJ eo Hpaacm m>Huacmaoouv mmmcvmua_mm -HHHNH=e mawwwzwm toe mama: mmeccama u_znsa AHH_>euo=eocav maa=a>apumccm Lee H com :H m aw :oHumLumHEFEum NHHU xcHummc we Hocpcouv Lozoa mwur>me cowuquummU coqu—SQOQ Pwurzou \AHHU A Amzwchv AEOCOHDJ. sl11l‘11111l cowuws—mxfl LwUH>OL¢ mbwwz Low>m£mm m—om Amy “av Amy Mwuwwcmwmcowwcw>mea\puma_o m:_NH_wp= co HmuceeLoeemav mcmoo H v mo uxcHH xcozumz mCHumew achwmu:_mz . m AcoHum>HuoEv m:_x_4 AmmHLowgpv mmHmoHoccuwH * 202“ mcwqo_m>wa mo Axuwumamuv mmumHzocx mmmm mo mmwc< mmmm eo mmxh :oHuu< HmHucwHom onpu< ADV ADV Amy Agmm ~m_uom cmcwsmm asocm mcwcwmch prxm Lwcpo EwFQOLa m__Fxm chopumuo> :Hme: ow_n:m gnawewm qzocm mcwcwmgh FFme cmzpo EanoLm mFFFxm FmFoom cufimm: Fmpcmz . . cowpmuzum cowpmwucscm cowpm_:uWuLm .nmsmm _m:owumuo> + u_:u< + zamcmcp :ummam + .cowpmwucscoca + Loom + mFFFxm mcF>Fg .ucH allzlum+llllflm.(ilm(um+(m(8 .Ememocm o» Low>mgwm pcmuwgsouca >__mwuom ”pcmcu gopdni.n wgamwd mcowpwucou vmwwfimwuommo 8m 27:; $.88 $.88 mpfiwxm chompmoo> nunuunniniu u: :Hm r4 acmccmawucH _mp:wE:mecH mcowuwucoo uw~_cmmcomwo to hh are ll SCB's of fu will goal withi 0i va high PUtpc that Spell inap; and1 the: tlcu' ment cone. atte 84 to him upon completion of treatment. In effect, two key strategies are involved in comprehensive client evaluation: l. The careful identification of client skills and disabilities; and 2. Careful referral to the specific unit and activity of rehabilitation; at the rehabilitative facility or elsewhere in the community. By applying the approach of outlining the necessary SCA's, SCB’s, and SCU's, it is possible to group them in terms of similarity of function. After grouping, the development of a treatment plan will be much simplified. That is, SCA's taken for one treatment goal can be applied to another goal, all of which can be accomplished within given units. In this way, the overlap and counterproductivity of various rehabilitation actions can be reduced. The application of SIB's, SCB's, SCA's, and SCU's entails a high degree of Specificity regarding the program's treatment and its purpose. To create and then use the social competency model requires that everything occurring in the rehabilitation process be clearly spelled out. The 518's and SCB's state what behaviors or skills are inappropriate and need to be obtained. The goals of rehabilitation and treatment are then very certain and exact. The means by which the SCB's are learned are the SCA's and the SCA's occur within par- ticular parts of the program or SCU's. This might be called Treat- ment By Objectives (TBO) similar to the management by objectives concept. With this approach the rehabilitator knows what he is attempting to accomplish and by what means. —7———_—" 85 However, this is not necessarily an easy model to apply although its clarity and effectiveness is great. It is a tremendous challenge to the program staff for they must have categorized all the SCA's and SCU's of the program in terms of the SCB's to be inculcated. Therefore, the social competency model, to work properly, requires a thorough understanding of the rehabilitation process and precise and extensive evaluation concerning the program. Yet, it adds flexibility to the program in that the needs of the clients must continually be matched with the program's clinical actions. As a result, the program must remain open to change in terms of the treatment it offers. The necessity of the continuing program rele- vance to client needs demands continual client and program evaluation. It also requires a great deal of interagency effectiveness on the part of city department heads and private facility administrators. Application of the socialcompetency model provides a framework by which a program can be evaluated on a basic treatment level. Its specificity enables a measure of effectiveness of specific program components. Treatment Plan M In applying a treatment model of this kind, the rehabilita- tor must realize that the assessment of the client for his competent and incompetent behaviors is a continuous process. The measuring of success in achieving any rehabilitation goal is in the short and the long term. After each assessment, the competent and incompetent —’——__'W 86 behaviors of the client will alter and therefore so will the SCA's and SCU's for that client. Of course, with a model of this nature the treatment plan will be different for each client and a schedule appropriate to his needs and priorities will need to be established. The specific program arrangements for establishment of a treatment plan will undoubtedly alter between programs; however, a general outline of this process has been created which might prove helpful. To develop a treatment plan for a client, a team should be established consisting of at least two members of the treatment staff, the client, and significant others. After assessment of the client's behavior, a determination of the client's 518‘s and the predominant disorganizing and desocializing conditions associated with the 518's is made. The 518's are then categorized according to the three treatment subgoals previously established. In conjunc— tion with the conditions associated with the 518's and the 518's themselves, list all SCB's. Next list the SCA's for each SCB, and the SCU's that the program can provide and those that other commu- nity agencies can provide. Contact the community agencies that can have the needed SCU's for that client which the program does not offer. The total rehabilitation schedule, SIB's, SCB's, SCA's and SCU's must be clearly defined. A total rehabilitation schedule, including place, time, and transportation needs can then be easily devised. The review of the literature has focused primarily on the theory of Interagency Collaboration, with briefer review of the related areas of Social Competency and Attitude-Behavior scaling. tion, the 9 often munit inter colla labor both Socia (l.e. Preve fUnci l“esp: the 1 lehd theo CHAPTER III METHODOLOGY AND CONCEPTUAL APPROACHES The introductory chapter of this study addressed the ques- tion, “Why is collaboration necessary?” The answer is contained in the general chapter theme: clients' socialization needs are most often too complicated to be effectively addressed by a single com- munity agency. The second chapter addressed the question of the "how" of interagency collaboration (i.e., a review of theories for effecting collaboration among agencies or community resources). This chapter addresses the question, "What is there to col- laborate about?” or the programmatic directions and content that both generate and comprise the community's responsive behavior to social dysfunction. The most specific concept reviewed will be that of Prevention (i.e., the most effective response to social rehabilitation is to prevent dysfunction in the first place, or at least to arrest dys— function in its earliest stages). The other major response is that of a specific rehabilitative response for those clients who, for whatever reason, slip through the prevention efforts and become socially dysfunctional. This rehabilitative response was presented and discussed in terms of the theory of Social Competency in the previous chapter. 87 are no physic The H clear within physio ally i need i indiV' vocat‘ Dreva Any nI Citeg are 3‘ or re munit and o Clll‘eC litter close means 88 Prevention Programs: Stemming the Tide Within any community, some citizens are functional and some are not. In the latter group are persons disabled by one or another physical, neurological, educational, economical, or social handicap. The lines separating the various lines of disability are at times clear and at times blurred. Often enough a disabled person may fall within a number of disability areas. For example, a significant physical disability may render a person also socially and vocation- ally handicapped. A social disability, in its broad sense, is any unfilled need within a person‘s immediate environment which renders the individual unable to provide for his personal, interpersonal, or vocational needs and precludes normal functioning as compared to prevalent and general norms of the immediate society or community. Any number of conmunity agencies are prepared to respond to various categories and degrees of citizen need. However, community services are seldom if ever categorized and utilized as preventive resources, or resistance resources. Another way of saying this is that com- munity agencies tend to view themselves and to be viewed as static and often isolated agencies that deliver rather narrowly defined direct treatment services with vaguely described goals and objectives. In this study services are viewed as interrelated in an Interagency concept as described in the previous chapter. These close relationships among agencies are not ends in themselves, but means for more accountable and efficient service delivery. The vaguel cisely M sugges in the In tel o‘wflz‘UrP-S‘U-fi nlc—r‘fi—mleD—Dlw ‘15 Wt —i——_” vaguely defined goals and objectives alluded to above must be pre- cisely defined if Interagency Collaboration is to be productive. The Concept of "Prevention" Discussing this concept of "prevention," Antonovsky (1968) suggests that the phenomenon we should be trying to prevent, both in the behavioral as well as the medical sciences, is ”breakdown." In terms of social breakdown, he comments: It should . . . be obvious that there is an intimate rela- tionship between the culture a person is socialized into, the social system in which he participates, and the resist- ance resources available to him. Public health and preventive medicine have overwhelmingly been devoted to controlling the threats posed by the outer environment, moving close to people only in matters such as immunization. Even health educators have focused on equipping persons with specific, static responses to threats. It seems . . . that a new health profession is needed. The practitioner whose responsibility it is, working in the com- munity, to augment the resistance resources of people prior to breakdown. Conceivably this could be the ”community psychiatrist,“ the public health nurse or the medical social worker; but by and large this is not the job being done today by those professions. The training of such a profes- sional would, of course, depend upon learning much more about breakdown and resistance resources than we know today. But what would such a person do? I can here only throw out a few general suggestions. He (or she) could identify the high-risk populations, primarily in terms of those with poor resistance resources, and not only for those confronted by much threat. He could not only provide information about existing facilities available to people to meet threat, but help uncover the resources which people have unknown to them. He could mobilize the resources of the many in a community who want to do for others but neither know who these others are nor how to go about doing such a good (pp. 12, 13). Antonovsky (l968) calls for a searching for inner resources as well as community resources in a comprehensive prevention effort involw more c notior that i m eithel the ti of pri Point socia Dtecl. ‘. 9O involving the total community. He also notes that much more is to be learned, which is really very similar to treatment programs, in which there is also much more to be learned. Antonovsky‘s thoughtful comments suggest the obvious: Much more can be done with community programs than relegating the whole notion of prevention to the usual level hardly above “lip-service" that is sometimes found in the traditional mental health program. Intervention: The Goal of Prevention _________________________________________ If the thesis is accepted that social dysfunction often either leads to or is a result of social skill deterioration, then the task of a prevention program is somewhat delimited. The goal of prevention then is to intervene in a person's lifestyle at a point in time, in a sensitive and effective manner, so that the social breakdown of an individual, or groups of individuals, may be precluded. It should be noted that "mental health prevention“ and "mental health education” are not synonymous terms or concepts. Drug education may be one phase or facet of drug prevention, but "drug education” may also have the effect of raising the incidence 0f drug abuse. Information is of itself no guarantee of prevention. Objectives of Prevention Programs: The Concept of “Breakdown“ An individual may become dysfunctional for a variety of reasons--escape from pain (physical or psychic), social pressure, daring, excitement, peer pressure, striking out at authority, fear, and so apathy of "de are be dimens is oft be des progra vulner suppor desigr to im COHllllLlr be dil the f: deSpi lllUCh l mu ment EVlde 9l and so on. Other variables such as rigidity, isolation, confusion, apathy, and indecision are also related to the onset and development of "desocialization” and ”disorganization" behavior patterns that are both the cause and result of social breakdown. Antonovsky (l968) notes that breakdown is not a one- dimensional concept, and the factor of “choice" or decision-making is often inherent in the breakdown process. Whatever else they may be designed to do (e.g., organize, coordinate, inform), prevention programs should be directed to the decision—making processes of vulnerable individuals in order to prevent social breakdown and support social functioning. Prevention programs should also be designed to enhance an individual's adaptability, effective ties to immediate resources, and ties between an individual and his community. Again, a truly comprehensive rehabilitation program will be directed toward the prevention of social breakdown occurring in the first place, and the social rehabilitation of individuals who, despite community preventive efforts, break down socially. “Breakdown“ defined.-—But perhaps more importantly, Antonovsky (l968) suggests that "breakdown” can be prevented, inas- much as it is any state or condition which is described by the map- Plng sentence contained in Figure 9. When breakdown is viewed as the failure to function in a critical social institution or set, the implication for the employ— ment of internal and external resistance resources becomes even more evident. A cond (C Lam Limits Impai r in H, sOpal A"tom A3? 5"! 92 (A) (B) Dysfunctioq Debilitation Not at all Painful to the A condition which Mildly directly individual, and is Moderately dysfunctional Severely (C) (D) (E) Impairmepp_ Intensity Condition Limits him/ Not at all described l. Neither acute nor Impairs her Minimally by chronic Moderately 2. Mild chronic Severely 3. Acute but not life threatening 4. Serious & chronic but not degenerative 5. Serious, chronic, degenerative, acute and life threatening (Fl Social/Medical Response Not at all Observation only with active therapy and is responded to societally/ medically Figure 9.--A Mapping Sentence for ”Breakdown.“ Breakdown, then, doesn't just accidentally occur. Changes in life tasks, values, resources, tension intensity, and other per- sonal and environmental factors all relate to social breakdown. Antonovsky (l968) states: At any given time, the individual is confronted with demands (one might well use terms like presses, problems, threats, Stressors) placed upon him by his inner and outer environ- ments. These demands upset equilibrium and create a state of t woul can for and grat can foot one repi It rat lea DOS mmor tively prevent the qui est, m servic identi levels lstral ance: deliv that in a tota‘ a re vent 93 of tension. Every individual has at his disposal what I would call resistance resources, by which I mean power which can be applied to resolve tension. Tension is inevitable for living human beings. It is, moreover, often deliberately and willfully brought into being; it is a state which can be gratifying and rewarding in two major ways. First, tension can be directly pleasurable; the sexual experience and the football match are only two of innumerable examples which could be given. Second, the experience of tension provides one with the values of any experience: adding to one's repertoire for future use. It is not, then, the imbalance which is pathogenic. It is, rather, the prolonged failure to restore equilibrium which leads to breakdown. When resistance resources are inadequate to meet the demand, to resolve the problem which has been posed, the organism breaks down (l968, pp. l-2). Some clients need to be referred into the health service sys- tem or a similar care-giving agency, but other clients may be effec- tively helped without formal entry into the system and thereby prevented from entry into the system. This rationale responds to the question, Why collaborate? The answer is to provide the earli- est, most efficient, most accountable and most economical human services response to disabled persons. This is accomplished by identifying gaps and overlaps in services, identifying the various levels of resistance resources in the community, sensitizing admin— istrators and staffs of their roles in developing community resist- ance resources, and developing precisely defined direct service delivery programs and referral processes. In effect, this means that community agencies are conceptualized, and actually function in a manner which intercepts, or intervenes with, clients before total social breakdown occurs. The role of the community agency as a resistance resource is an essential element in a community pre- ventive approach. Conversely, in a community where little or no preven lists grow w object and ac munity sensit desigr energ basic 9ff9( that Sl’Stl to n ousl func 94 prevention occurs, direct care services expand enormously, waiting lists of clients develop and lengthen, budgets balloon, counselors grow weary and frustrated, staff turnover rates increase, goals and objectives blur, case notes and tracking systems become neglected, and accountability disappears. With respect to treatment, if com- munity rehabilitation programs are to be effective, economical, and sensible, a strong prevention approach to social disability must be designed and implemented. When agency administrators begin to work together, their energies may be appropriately directed to three tasks: 1. Communication and planning based on interagency collaboration; 2. The development of resistance resources; and 3. The development of organized and effective rehabilitation programs. Developing a Public Health Approach Prevention program development is centered around a few basic concepts. These basic concepts include: l. Whenever possible, individuals in crisis can be more effectively assisted before their crisis develops to the point that they have to be referred into the mental health treatment system; 2. The many human resources of a community can be organized to react to individuals in emotional stress before that stress seri- ously interferes with community, vocational, and personal functioning; for inc‘ grox tif‘ con' and men COI'l tea 95 3. Prevention programs can be developed on theory bases for implementation and evaluation; 4. The activities associated with prevention programs include activities directed to cognitive learning and personal growth, including sensitivity to feelings of self and others, iden- tification of personal values and guidelines for resolution of value conflicts, ability to make decisions, adequate defense mechanisms, and sufficient personal flexibility; 5. The training of trainers is a critical factor in imple- menting a crisis intervention program with ”community gatekeepers” or persons in critical positions in the community who have regular contact with large community groups (e.g., policemen, social workers, teachers, parks and recreational personnel, clergy, probation, etc.); 6. The training of gatekeepers emphasizes their sensitiza- tion to their roles as “resistance resources“ (i.e., their capacity to intervene in a preventive response with clients and individuals who are becoming desocialized). Prevention Programs: Developiflfl a Training Effort Activities associated with crisis training program delivery include: l. Adaption, as necessary, of training curriculum emphasizing value clarification and deciSion- making; 2. Identification, employment and training of train- ing staff; 3. Organization of target population for training; and la and st YEt ti model: and in often tiona if it munit both w at test] 96 4. Development of logistical steps for training, including time, place, training aids; 5. Identification of specific behaviors associated with prevention training; 6. Collection and interpretation of data; 7. Evaluation of prevention/training effectiveness; 8. Communication of data reflecting program effective- ness or deficits to program administration and responsible community and funding groups, agencies, and bodies; and 9. Adjustment of program curriculum and delivery in light of collected evaluation data, for improved program effectiveness. Above all, evaluation data must be translated in concepts and language readily interpretable to the consumer, taxpayer, client, and staff. For unlike the treatment model, prevention programs have yet to fullyenter into the free enterprise money market. Prevention models, as well as prevention curricula, are also relatively rare and not easily understood by professional or politician. All too often, "prevention” curricula turn out to be little more than educa- tional or informational curricula. The program must be understood if it is to receive professional and political endorsement. A Community Response to the Vulnerable Citizen The organization of inner human resources and external com- munity resources obviously dictates two broad areas of responsibility, both essential in effective prevention programs: the responsibility of the individual for the development of his human resources-- resiliency, flexibility, sensitivity, insight, awareness, toughness, rest with resp rehal of cr tion, the e withil approe resour a sepe ————————f” 97 or sound defenses; and the responsiblity of a community to actively respond to a threatened individual and assist him/her in dealing with the threat in a manner that portrays that this community value- responsibility has been truly institutionalized. The above discussion identifies two main thrusts of a social rehabilitation program in a public health (preventive) model: 1. The adaption and implementation of a specific curriculum of crisis intervention aimed at developing empathy, value clarifica— tion, and decision-making processes. This approach is directed to the establishment of inner human resources; 2. The implementation of agency interaction processes within and between city departments and resource groups. This approach is directed to the coordination and development of community resources. This theory of Interagency Collaboration is included in a separate section of this study. Relating Prevention with Rehabilitation Regardless of how well this preventive approach is accom— plished, needs of some citizens for direct services in a rehabilita- tive sense will always be present, although these numbers should be significantly reduced. When the need for direct services is indi- cated, such services should be provided as quickly as needs indicate, within a comprehensive community effort with gaps and overlaps deleted, and with client needs clearly defined and integrated in a precise treatment plan. This treatment plan, and rehabilitation tir in: b UN 5 — T 98 process, is most precisely defined within the context of a Social Competency model, and was discussed in the preceding chapter. Organization of Concepts and Efforts Some form and substance, then, begins to appear. Collabora- ting agencies must: 1. Identify agency needs and concerns, and develop a framework for communication around these needs; 2. Identify the incidence and prevalence of community dis- abilities (client needs), and develop preventive programs to reduce the incidence of social breakdown; 3. Develop a precise and effective community rehabilitation system which eliminates gaps and overlaps in services, reSponds to the needs of individual clients, and can be translated into trackable and measurable results; and 4. Develop, administer, analyze, and utilize a method for identifying specific social disabilities of community citizens in order to effect a community rehabilitation approach. Defining the Vulnerable Population In a real sense, every person is subject to social breakdown and in that sense every person may be broadly classed as "vulnerable.“ The usual formula declaring "out of a city of so-many-thousand, such—and-such a percentage of persons may be considered drug abusers or mentally ill” is only a beginning step in a specific identifica- tion of the population. Data must be useful in making programmatic IIIIIIIIIIIIIIIIIIIIIllI3333TTTTTTTTTTTTTTTTTTTTTTTTTTTTTT'—'_—_—_———___T__———_—TTT77 99 decisions concerning specific responses to vulnerable or disabled persons at specific age levels. In determining vulnerability at adolescent, early and adult levels, such factors as ”needed social skills,” vocational needs, relationship needs, decision—making skill need, and value clarifica— tion needs all may be helpful guides to identifying "at risk“ or vulnerable populations. Specifically, the Virginia Beach Drug Abuse Survey gave some indications of use/abuse of drugs at specific age levels and with various substances of abuse. Definition of specific rehabilitation needs within such age groups may be made by more specific evaluation of the subjects prior to training or rehabilitation (i.e., the use of a social skills assessment instrument). Primary, secondary, and tertiary prevention in the public health literature relates to the question of ”what to“ do in respond- ing to community breakdown. Interagency Collaboration, Social Compe— tency, and Facet theories provide methodological bases as a response to "how to" implement primary, secondary, and tertiary prevention approaches in the community. For background reading in the public health prevention model, the reader is especially referred to the important contributions of Hanlon (T974), and also to Wilbur (l963) and Burton and Smith (l975). Conclusion Chapter III has presented the methodology necessary to study the two specific areas of disability surrounding the use of drugs ———————1" 100 and alcohol, but primarily from a conceptual framework rather than from an empirically data-based framework. However, Chapter IV does present detailed demographic data related to the disability areas of drugs and alcohol use from the Interagency Collaboration framework. in Vi ever as W' smal stai resp cern are how COM( havl bus any dii use WEl CHAPTER IV RESULTS Prevalence of Drug Abuse For this study of the incidence and prevalence of drug abuse in Virginia Beach, two methods of collecting data were used. When- ever there were large groups from which data were to be obtained, as with physicians, a questionnaire form was developed and mailed to a sample of that group. The second procedure, followed with smaller groups of only a few members, as with the Juvenile Probation staff, was to conduct a personal interview with each member. The mail-out questionnaires were similar in certain respects, particularly in regard to the first question, which con- cerned the prevalence of drug abuse. The directions stated, “Below are listed several categories of drugs. We would like you to check how widely you think these drugs are being used by people you have come in contact with.“ The directions explained that "people you have come in contact with include not only friends, relatives, business and professional associates, and acquaintances, but also anyone you know who is using drugs." Bar graphs were constructed to show differences among the different groups who were surveyed to portray the prevalence of the usage of each of the types of drugs. The groups which were surveyed were combined for purposes of this study into ”The Professional l0l Comu siona which viewe from respc “wide respc with esth "Mod acqu hash thou wide knew and Thes more thov widv VEys l02 Community" (attorneys, clergy, pharmacists, physicians, and profes- sional service organizations), ”The Business Community” (businesses which received mailout questionnaires, and those which were inter- viewed), and the ”Households in Virginia Beach" section (results from a random sample of l,OOO households in Virginia Beach). Figures lO-l7 are graphs representing the percentage of respondents who thought usage of that particular drug was either "widespread” or ”moderately widespread," two of the four possible responses to the question. ”Widespread” meant: ”Of the people with whom I have come in contact in thepast l2 months, I would estimate that about 20 or more use this drug on a regular basis.” "Moderately widespread” differed because the estimated number of acquaintances taking this drug regularly was only lO to 20 people. Figure lO illustrates the prevalence of marihuana and hashish usage. As many as 85.7% of the attorneys who responded thought marihuana and hashish were either widespread or moderately widespread. In other words, 64.3% were saying that they personally knew 20 or more people who used marihuana and/or hashish regularly, and another 2l.4% knew lO to 20 people who used these regularly. These percentages total to 85.7% of the attorneys who know l0 or more people who use these drugs regularly. Eighty percent of the pharmacists and 70% of the clergy also thought that marihuana usage was either wideSpread or moderately At least 50% of all the respondents in the other sur- widespread. veys, physicians, service organizations, and businessess, all except 103 ists Physicians Household Pharmac 5 0 0 8 O 2 3 58. |///////// .0 |%////////////// mgg/flflf am 1%??? g 30.0 47.8 7 lg; OOOOOOOOOOOOOOOOOOOOOO 99999999999999999999 W? Widespread Figure lO.--Prevalence of Drug Abuse in Virginia Beach (Question l): Moderately Widespread Marihuana. l04 Percentage Attorneys Business General Household Pharmacists Physicians a d 236d 8 1&5 1L1 CC 3.3 \\\ .. , m s [—1 a Mail Out Survey § Widespread b Business Interviews c Clergy Survey . d Service Organization Moderately Widespread Surveys Figure ll.--Prevalence of Drug Abuse in Virginia Beach (Question 1): Inhalants. l05 Percentage Attorneys Bpsinegs ngergl Household Pharmacists Physicians 100 < 95 - 90 . 85 . 80 . 75 . Mail Out Survey . Business Interviews I Moderately Widespread Clergy Survey 7 Service Organization Surveys 9 Widespread A anm Figure l2.--Prevalence of Drug Abuse in Virginia Beach (Question l): Hallucinogens. l06 Percentage Attorneys Busingss General Household Pharmacists Physicians a c d 87.5 37.5 5&3 ' 33.3 42.9 50.0 25.0 l8.l ”.9 6.2 a Mail Out Survey I Moderately Widespread b Business Interviews ‘ c Clergy Survey ‘ , d Service Organization Surveys § Widespread Figure l3.--Prevalence of Drug Abuse in Virginia Beach (Question l): Stimulants. 107 Percentage Attorneys Business General Household a b c d Pharmacists Physicians 54.2 a Mail Out Survey b Business Interviews c Clergy Survey (1 Service Organization Surveys Moderately Widespread 7 Widespread % .A Figure l4.--Prevalence of Drug Abuse in Virginia Beach (Question 1): Depressants. l08 Percentage Attorneys Business General Household Pharmacists Physicians a b c d mo 95 90 85 80 d a 1s7 153 C 125 10 1L5 a 5 4.5 29 _L— as 0 0 ll (”771.4 a Mail Out Survey - b Business Interviews I Moderately W1despread c Clergy Survey . . . V d Serv1ce Organization Surveys % Widespread 44 22.2 Figure l5.--Prevalence of Drug Abuse in Virginia Beach (Question l): Opiates. 109 Percentage Attorneys Business General Household Pharmacists Physicians 6 c d 2L7 l6.0 16'7 7.7 a C 12 18 'd ead a Mail Out Survey ' Moderately W1 espr b Business Interviews , C Clergy SUVVE)’ z Widespread d Service Organization Surveys A Figure l6.--Prevalence of Drug Abuse in Virginia Beach (Question 1): Cocaine. llO Percentage Attorneys Busingss General Household Pharmacists Physicians 100- a C 95. 90. 85. Mail Out Survey Business Interviews Clergy Survey Service Organization Surveys 7 Wides read a D Figure l7.--Prevalence of Drug Abuse in Virginia Beach (Question l): Methaqualone (Quaaludes, etc.). Moderately Widespread an 0'9) hm spv —:——————V lll households, stated that marihuana and hashish usage were either wide- spread or moderately widespread. Of the respondents in the household survey, only 30% believed these drugs wideSpread or moderately widespread. There was quite a difference of opinion among those professionals and business people who work or practice daily in Virginia Beach and those who live there but may work elsewhere. In the Tidewater area, Virginia Beach is acknowledged to be a ”bedroom” or commuter community where many people live but do not necessarily work. Tourism seems to be the major industry in Virginia Beach, and those not involved in providing services for tourists or residents might work elsewhere in Tidewater, particularly in Norfolk at the naval bases. The professional and business people surveyed in this study were the ones who work in Virginia Beach providing legal and medical services and operating department and food stores for the residents, as well as tourists. These professionals, whose work was more problem-oriented than the average resident, were more likely to encounter drug use. The results from theprofessional and business people seemed to generally agree on how widespread was the usage of each drug. The persons who responded to the household survey seemed to consistently underestimate the drug abuse problem in Virginia Beach. As stated earlier, part of this might have been due to the large numbers who live in Virginia Beach but worked elsewhere, outside the city. Also, residents seemed to remain fairly isolated within their own housing developments in Virginia Beach. In some ways they remained out of contact with the areas beyond their own neighborhoods. The den eve llZ There could have been quite a flourishing drug problem, as the evi- dence seemed to indicate, without the residents of Virginia Beach ever quite realizing it. Although certain residents realize the problem with drugs, some residents may not have known what was going on concerning the ”drug scene” because there had been, until the survey, a lack of data in this area. The flow of drugs is very difficult to trace even in large cities with narcotic squads and federal agents. It was especially difficult to detect in a fairly urbanized area like Virginia Beach where so few people even knew the indicators of a drug abuse problem and often seemed to say that what they did not know would not hurt them. No city agencies except the police department had been col- lecting data on this subject. The information in this report often came from personal recollections and impressions. Since there were no data readily available to city officials, it was not surprising that residents of Virginia Beach, who relied on these city officials to inform them of potential problems like drug abuse, were so unin- formed regarding the prevalence of drug abuse. A comparison of survey results from Virginia Beach business people and professionals with results from household questionnaires was necessary in order to detect this disparity of opinion concerning drug abuse. Figures l0-l7 on the usage of the various drugs better illustrated the dis- parity of opinion between household reSpondents and business and professional people. Less than 30% of the respondents seemed to think that use of inhalants (including glue and other vapors and volatile intoxicants) ll3 was widespread or even moderately widespread (Figure ll). The per- son using inhalants was usually a young boy, 8 to l4 years of age, who sniffed “airplane glue” or gasoline or paint to ”get high.” This is a particularly dangerous form of drug abuse because repeated use can cause severe brain damage. The professional service organizations, many of whom deal with young boys, like the Boy Scouts and YMCA, had the highest per- centage of respondents who personally knew 10 or more people who used this drug regularly in the last l2 months. Many of the attor- neys, businesses, and pharmacists also knew people who used inhalants regularly. The service organizations also had the highest percentage of respondents who knew people taking hallucinogens, like LSD, mescaline, STP and other drugs (Figure 12). These are drugs that, like inhal- ants, were favored primarily by young people. Attorneys, pharmacists, physicians, and business people who were interviewed were all in close agreement on how widespread hallucinogen usage was. i The business people who were interviewed represented busi— nesses which were located in areas where they were most likely to encounter drug abuse. They were specifically selected for this reason. In order to learn about the prevalence of drug abuse, it seemed best to question those businesses located in the Beach Borough or which would have young people primarily as customers, such as fast food diners, motels, and entertainment centers. These business people are usually in agreement with the professionals about the prevalence of these different drugs. They did not often agr que SHIll exp BBC bus Sdll Vll ——7————1 ' "W ll4 agree with the results from the random sample of businesses to whom questionnaires were mailed. Many of the businesses in this second sample were backyard mechanics and construction companies, but, as explained later, this type of sample of the business community was necessary in addition to the business interviews. At any rate, the businesses in the mail—out questionnaire sample and the household sample seemed most likely to underestimate the drug problem in Virginia Beach, as they did with the hallucinogens. The use of stimulants seemed to be widespread according to pharmacists (Figure l3). Almost 88% of these professionals knew people taking stimulants; 50% of them knew 20 or more people using stimulants. In the course of their work, pharmacists apparently filled many prescriptions for stimulants including amphetamines, and various "pep pills” and diet pills. Over 50% of the clergy and physicians believed that use of stimulants was widespread or moderately widespread. The attorneys, service organizations and businesses who were interviewed were in agreement as to how widespread usage of this type of drug was. Once again, the businesses in the mail-out survey and the households, particularly the households, greatly underestimated the use of this drug. The same trends were noted for depressants as well (Figure l4). About 90% of the pharmacists and physicians believed that depressants (meaning the range of sedative anti-anxiety agents ranging from barbiturates to ”minor tranquilizers") were widespread or moderately wideSpread. Over 50% of these two professions thought .a e e e d a C r! f. l l l in 0 h r VA n e r h n 0 0 .l e ml Cl 0 a In In fa. .l t 2 t d e a r p .Tv a h m w b d l S m t t a t w 0 ll5 that depressants were widespread, meaning that they knew more than 20 people who took these drugs regularly. The people who took these sedatives and tranquilizers probably ranged from school chil- dren, taking drugs illegally for "kicks," to housewives and business executives who used the drugs to help them cope with anxiety, stress, and tension, to the elderly who may be overusing sedatives for many reasons. Use of sedatives and tranquilizers was widespread and was probably pervasive throughout all levels of the community. Most of the other survey results were in agreement, from attorneys to clergy and service organizations. Only 20% of the household respondents, however, agreed that use of these drugs was either widespread or moderately widespread. Apparently, the use of depressants was not widely discussed by those who take them. In other words, people may be reluctant to discuss whether they were taking such mood-altering drugs as depressants and stimulants, because their use, particularly if prescribed by a doctor, is often associated with some very per- sonal problem, such as anxiety or work pressures. Therefore, one may not have known what drugs his neighbors and friends took, but the doctors and pharmacists for the community knew, and they believe these mood—altering drugs were used quite widely in Virginia Beach. Opiates, however, did not seem to be nearly so widely used according to most professionals and business people, with the excep- tion of the pharmacists (Figure l5). Almost half of the pharmacists who responded stated that opiates were either moderately widespread or widespread. From l0% to 22% of the clergy, physicians, service orga opia deri drug and — 7 ll6 organizations, and business people interviewed agreed that regular opiate use was at least moderately widespread. Opiates were defined as including heroin, codeine, morphine, paragoric, and other opiate derivatives. For a community that was not reputed to have a hard drug problem, significant numbers of Virginia Beach professionals and business people knew 10 or more people who use opiates pp_p regular basis. Although cocaine is a rare and very expensive street drug, from 16% to 22% of the business peOple interviewed, as well as the clergy and physicians, believed its use to have been at least mod- erately widespread (Figure 16). As might be expected, pharmacists had no knowledge of the use of this drug since it cannot be pur- chased in a pharmacy. About 8% of the attorneys had had some experience with users of the drug, a finding which concurs with data from the police department and Commonwealth Attorney's office concerning the number of arrests and convictions for use of this drug. Quaaludes, one type of methaqualone, are believed to be rather widespread, more so than cocaine or the opiates, like heroin (Figure l7). About 35% of the pharmacists and physicians believed this drug to be widespread or moderately widespread. Quaalude is one brand name for methaqualone, which was available in most local pharmacies on prescription. It must be prescribed by a Physician, so both groups of professionals were likely to know how widely it is used. Twenty—seven percent of those business people who were interviewed agreed that it was fairly widely used in Vir men soon has? Vir» ano izeu lies pg dru prc R91 ll7 Virginia Beach. As one professional close to the drug scene com— mented, "If Virginia Beach hasn't heard about Quaaludes, they will soon." Its use was quite widespread in metropolitan areas like Washington, D.C., and in the surrounding suburbs of Maryland and Virginia, according to the Washington Post's several feature arti- cles in the spring of 1973. The use of Quaaludes and "Sopors,” another name for methaqualone, is expected to spread to less urban- ized areas, particularly along the Atlantic Seaboard and on the West coast. The Professional Community Methodology In planning this study of the incidence and prevalence of drug abuse in Virginia Beach, surveying the professional community (including attorneys, clergy, pharmacists, physicians, as well as professional service organizations like Girl Scouts, Boy Scouts, Red Cross, etc.) seemed to be of primary importance. With a prob- lem like drug abuse, it was important to survey not just one segment of the community, such as law enforcement officials or physicians, but to survey a wide spectrum of people who might have some informa- tion on the drug abuse problem. By carefully adding together all the pieces of information from the professional community, one i should attain a valuable perspective of the drug scene. l In order to survey the "professional“ community, as distinct from the ”business" community or military bases, it was first neces- sary to list all those groups of people who in the course of their worl was pers and answ poss ioun also anot QUES as m tap ‘ diff takh ways Enco 0f e; rand: haVe ever, lnfoy thOSe basis ll8 work might come in contact with people using drugs. From that list was extracted those professions that had so many members to make personally interviewing each member an unwieldy, time-consuming, and costly task. From the standpoint of response rate and completeness of answers, the personal interview was preferable and was used whenever possible during the study. For the larger samples, however, it was found to be most economical to mail questionnaires. This method also ensured some uniformity from one measurement situation to another by standardizing instructions, wording, and the order of questions. For these professions with more than 15 or 20 members, such as medicine or law, special questionnaires were devised which would tap their knowledge of the drug abuse situation. Each profession differed somewhat in how it related to society and to those people taking drugs, so special questions were created to find out in what ways and how often in the course of their work these professionals encountered problems caused by drug abuse. Next careful pretests of each questionnaire were conducted. Theoretically, the ideal sample for most surveys is the random sample (i.e., a certain percentage of each profession could have been chosen by randomly drawing their names from a hat). How- ever, it was the opinion of one attorney that the most accurate infonnation on the drug problem could be attained by surveying only those attorneys who deal with drug offenses on a fairly regular basis. Not all attorneys worked with drug abuse cases, and their answe resul orju (surv pharm handp examp listv had 5 v naire l envel ‘ Prehe to a ‘ As a omitt less "Phys were thsi haVe lt se Quest AEn. ll9 answers or lack of them might have had a tendency to skew the results. So the logical course seemed to include using purposive or judgmental samples for some professions and universal samples (surveying all the organizations within a profession like all the pharmacies) for other professions (Selltiz et al., 1967). The objective of a purposive or judgmental sample was to handpick the subjects to be included by using good jugment. For example, a local attorney was asked to choose, from a comprehensive list of all attorneys in Virginia Beach, those attorneys which have had some experience with drug cases. Then "Attorneys' Question- naires" were mailed with cover letters and self-addressed, stamped envelopes to the 44 attorneys that he selected. Similarly, a com— prehensive list of all physicians and their specialities was given to a person who was familiar with the medical aspects of drug abuse. As a result, specialties like radiology and plastic surgery were omitted from the sample since radiologists and plastic surgeons were less likely to have had encounters with persons abusing drugs. "Physicians' Questionnaires” were then mailed to 60 physicians who were considered likely to have encountered drug abuse cases. These physicians, who would be consulted for other medical reasons, might haVe detected the patients' abuse of drugs. Since there were only about 25 pharmacies in Virginia Beach it seemed reasonable to survey each one. Therefore, a ”Pharmacists' Questionnaire” was mailed to the chief pharmacist of each pharmacy. A similar procedure was followed for the survey of clergy- men. There were about 36 churches and synagogues of numerous dent quel chu sma que sio peo The Boy Crc Int YOI IIIIIIIIIIIIIIIIIIIIIlII33:—TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT====="' l20 denominations in the Virginia Beach survey sample. "General Survey" questionnaires were mailed to the pastor, priest, or rabbi of each church or synagogue. The general survey form was created for the smaller samples. It was more general in format and did not ask questions that could be answered by only particular professions. The general survey form was also mailed to certain profes- sional service organizations, especially those connected with young people since they might have had some experience with drug abuse. The following organizations were included in the purposive sample: Boy Scouts, Girl Scouts, Young Men's Christian Association, Red Cross, Salvation Army, Association for Research and Enlightenment, Inc., Things Unlimited (the Friends School Thrift Shop), and the Young Women's Christian Association. The rate of response, measured by percentage of question- naires returned by mail for each individual sample, may not seem encouraging, as indicated in Table 6. Yet one of the foremost methodology textbooks in the field of sociology states, "When ques- tionnaires are mailed to a random sample of the population, the proportion of returns is usually low, varying from about 10% to 50%“ (Selltiz et al., 1967). In view of this statement, the mail- back return rates for the different surveys are within these boun— daries and are quite good with respect to the physicians and service organizations as the table indicates. Results The purpose of constructing separate questionnaires for each of the different professions was to allow for questions reg; fess fror rate Cl"05 were tior Pl‘Ol l21 TABLE 6.—-Response Rates of Professionals to the Mailed Question- naires. Number of Percentage 5g??? Mail—back Mail-back Responses Responses Attorneys 44 16 36.4 Clergymen 36 10 27.8 Pharmacists 24 11 45.8 Physicians 60 32 53.3 Professional service organizations 8 8 100'0 regarding drug abuse as specifically related to each of these pro— fessions. Some of the individual questions, therefore, differed from questionnaire to questionnaire and should be discussed sepa- rately, but some were quite similar and allowed for a degree of cross-comparison. Initially, results from very similar or identical questions were compared across the different professions. The following ques- tion is the first of this type. 00 you know of persons in Virginia Beach enga ed in the abuse of drugs (excluding alcohol and tobacco)? Table 7 seems to show that a rather high percentage of those professionals in a client-professional relationship know of persons engaged in the abuse of drugs, excluding pharmacists and service organizations. Pharmacists were more likely to see people in customer- professional relationships as they filled prescriptions and, as one 122 TABLE 7.--Knowledge of Persons Engaged in Abuse of Drugs (Profes- sional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. N=l6 N=lO N=l0 N=25 N—8 Yes 75.0% 70.0% 50.0% 68.0% 37.5% No l2.5 20.0 30.0 20.0 37.5 No answer l2.5 l0.0 20.0 12.0 25.0 pharmacist noted, are not often in a position to know the drug taking practices of others. The responses from the service organizations were also likely to differ significantly from those of other professionals. The groups in the service organization sample were highly diverse, rang- ing from the youth organizations like Boy Scouts and Girl Scouts, to the Red Cross, and Salvation Army. The clients they served dif- fered greatly in average age, education, economic background, and likelihood of exposure to various drugs, including alcohol. Some organizations which had a predominantly young membership (from 8 years to 17 years) and with a clean-cut, “good guy" image may have attracted relatively few drug users as members. The pro- fessionals involved with these organizations may also have had very little experience with drug abuse and may have had difficulty spot- ting drug users. On the other hand,an organization like the Salvation Army may have had considerable contact with middle-aged people, many of whom may have been alcoholics or frequent users of depressants and l23 stimulants. A social worker at the Salvation Army noted that she was seeing increasing numbers of hard drug users seeking treatment for their addictions at the different drug clinics. She viewed this trend optimistically as evidence that increasing proportions of the addict population were trying to become drug-free. In considering results from these organizations, it must also be pointed out that often the client-professional ratio may have been as high as 20 or 30 to 1. In such situations it would be most difficult to ascertain whether or how many people were abusing drugs or which drugs are involved. While the majority of the members of most professional groups knew of persons engaged in the abuse of drugs, very few mem- bers of any of the groups knew of persons engaged in the illegal sale of drugs, as indicated in Table 8. Attorneys seemed to be the exception, but these percentages may reflect those attorneys with clients who were accused of selling drugs. 00 you know of persons in Virginia Beach engaged in the illegal sale of drugs? TABLE 8.—-Knowledge of Persons Engaged in Sale of Drugs (Profes- sional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. N=8 N=l6 N=10 N=10 N=25 Yes 43.8% 10.0% 0.0% 16.0% 12.5% No 37.5 70.0 70.0 72.0 75.0 No answer 18.8 20.0 30.0 12.0 12.5 124 The responses to the question in Table 9 indicate that although the professionals did not know actual persons involved in the illegal sale of drugs, the vast majority of each group believed that there was illegal drug trafficking in Virginia Beach. In other words, they believed there was illegal buying and selling of drugs in the community. These were professionals in daily contact with different segments of the community and who could supply invaluable information on the drug scene. Without necessarily having direct knowledge, do you believe that there is illegal drug trafficking in Virginia Beach? TABLE 9.--Belief in Illegal Drug Trafficking (Professional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. N=l6 N=lO N=10 N=25 N—8 Yes 81.3% 100.0% 70.0% 88.0% 75.0% No 0.0 0.0 0.0 0.0 0.0 No answer 18.8 0.0 30.0 12.0 25.0 It is interesting to note that while at least 70% of the respondents in each profession stated that they believed that there was illegal drug trafficking, there were absolutely no negative responses to this question. There was no one who would say that there was no illegal drug trade in Virginia Beach. The conclusion to be drawn fromthesestatistics, therefore, is that from the view- point ofthetwofessional community, there was certainly a drug abuse problem in Virginia Beach. — T 125 The question in Table 10 is most important in ascertaining whether these professionals actually encountered cases of drug use in their daily work with their patients or clients. Of course, these figures vary by profession depending upon the professional's need to know this information in order to help his client or patient. The number of drug abuse cases practitioners within a profession are likely to observe depends upon their ability to spot a drug user. Many professionals have received no specific training in this area and may not know the indicators of drug abuse, such as dilated pupils, and so on. Therefore, there is the strong possibility of undercount in the results of such a question. If these professionals had been trained in detecting cases of drug abuse, these results would be much more accurate. How many persons do you see during an average month for non- drug reasons whom you suspect or have found to have drug problems? Under 18 years old 18 years of age and older___: TABLE lO.--Persons You See Who Have Drug Problems (Professional Survey). Average Range No Answer Under 18 Years of Agea Attorneys N=16 3.31 0 to 10 3 Clergy N=lO 2.75 O to 5 2 Physicians N=25 5.39 O to 15 11 Service org. N= 8 2.60 0 to 10 3 18 Years of Age and Oldera Attorneys N=l6 5.08 0 to 15 3 Clergy N=10 4.17 l to 11 4 Physicians N=25 6.96 O to 25 7 Service org. N= 8 1.60 0 to 5 3 aPharmacists were omitted since they did not really see People as either clients or patients. ,, ._ . 126 The percentage of professionals preferring not to answer this question was fairly high, up to 44% of one sample. This is a question that was difficult to answer for two reasons. First, it required some review of records, and second, it suggested a ques— tion that many professionals may not have previously considered, ”How many of my patients or clients were actually using drugs?" As the results indicate, some felt that none of their patients or clients were using drugs; others, especially attorneys and physi- cians, seemed to have many clients or patients who used drugs. As stated earlier, the actual findings certainly represent only a fraction of persons who actually used drugs. The discrepancy was in the lack of training and experience some professionals have in detecting symptoms or drug use. The solution to this dilemma lies in education of the public, particularly the professional com- 1 munity, as to the causes, effects, and indicators of drug abuse. If people knew what to look for, the drug abusers would not be so indistinguishable from the rest of the population. On one page of each questionnaire various programs were listed which advised or treated alcoholics and drug abusers in Virginia Beach. These programs were Alcoholics Anonymous, Alcohol Information Center, Broken Needles, Drug Information Center, Drug Outreach Center, and Martus, Inc. (no longer in operation). The question in Table 11 sought information on how well these programs responded to the drug abuse situation there. From these results, one can conclude that the majority in each of these professions thought that these programs as a whole are 127 Do you think these programs can adequately handle the drug problem in Virginia Beach? TABLE ll.--Adequacy of Drug Programs (Professional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. N=16 N=lO N=10 N=25 N=8 Very well 0.0% 30.0% 20.0% 8.0% 0.0% Fairly well 31.3 40.0 40.0 28.0 37.5 Not too well 43.8 20.0 10.0 32.0 25.0 Not at all 0.0 10.0 0.0 8.0 0.0 No answer 25.0 0.0 30.0 24.0 37.5 only handlingthechug problem "fairly well" to "not too wellJ' In not one profession did the majority of respondents think these pro- grams were handling the drug abuse situation "very well." There was some consensus of opinion among these professional groups that these drug programs could have responded more effectively to the drug prob- lem in Virginia Beach. The professionals were not asked to explain to what they attributed the inadequacy of these programs. The short- comings may have been due to lack of funding, inadequate staff training, understaffing, misdirection of program objectives, or any number of other factors. A whole new survey would have been neces- sary in order to ascertain the problems with the treatment programs. The facts established thus far by this survey were that there was a significant drug problem in Virginia Beach and, in the public eye, the prOgrams in operation could not adequately respond to the drug problem. ————¥v' 128 Are you aware of any drug abuse prevention programs in Vir- ginia Beach or in this area? TABLE 12.--Awareness of Drug Abuse Prevention Programs (Professional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. N=l6 N=10 N=10 N=25 N=8 Yes 50.0% 70.0% 50.0% 68.0% 50.0% No 25.0 30.0 20.0 16.0 0.0 No answer 25.0 0.0 30.0 16.0 50.0 At least half the respondents from each profession stated t that they had heard of some drug abuse prevention programs in Vir— ginia Beach. Many, however, had not heard of any prevention programs which pointed up the need for wider—spread publicity concerning drug abuse prevention programs. Another factor which must be considered in looking at this data is whether the respondents understood the concept of a drug abuse prevention program, as distinguished from a drug abuse treat- ment program. The answer to the question in Table 13 concerning the drug abuse prevention programs indicated that most professionals answer- ing this question thought these programs were effective. Another obvious finding seemed to be a lack of willingness on the part of any of the professionals to answer ”no, indicating the prevention programs were not effective. The majority of the professionals seemed to think that these programs were effective. 129 Do you think these (drug abuse prevention programs) are effective? TABLE 13.-—Effectiveness of Drug Prevention Programs (Professional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. N=l6 N=10 N=10 N=25 N=8 Yes 50.0% 60.0% 30.0% 60.0% 37.5% No 0.0 10.0 0.0 4.0 25.0 No answer 50.0 30.0 70.0 36.0 37.5 Opinion on the question in Table 14 seemed more or less divided as on the previous question concerning drug abuse prevention programs. Attorneys and pharmacists were somewhat in favor of more drug abuse prevention programs. Clergymen and physicians were over- whelmingly in favor of more drug abuse prevention programs. 00 you think more drug abuse prevention programs are needed? TABLE 14.--Need for More Drug Prevention Programs (Professional Survey). Attorneys Clergy Pharm. Physicians Serv. Org. = 6 N=lO N=10 N=25 N=8 Yes 43.8% 60.0% 30.0% 64.0% 25.0% No 12.5 10.0 10.0 12.0 25.0 No answer 43.8 30.0 60.0 24.0 50.0 —7———r’m 130 The Business Community Methodology Surveying the Virginia Beach business community was accom- plished in two steps, after the initial steps of constructing and pretesting the “Business Questionnaire" (see Appendix B). First, a random sample of the 5,746 businesses licensed with the Commissioner of Revenue was taken, yielding 3l2 businesses to whom "Business Ques- tionnaires" were mailed. Of these 3l2 businesses, 6l responded by returning their questionnaires. Second, to insure that a significant number of businesses who might have had some experience with drug abusers (i.e., snack bars, hamburger stands, motels, Beach Borough businesses, etc.) were sampled; Drug Focus Committee volunteers as well as staff members conducted personal interviews with selected businesses using the ”Business Questionnaire“ forms. Out of 95 attempts, 45 completed questionnaires resulted. The results of the two samples were often substantially dif— ferent and will be presented in separate tables and not combined. Results The results from Question 5 (Table l5) indicate that more of the businesses interviewed knew of persons involved in the abuse of drugs (48%) compared to 33% of the businesses in the mail-out sample. This finding substantiated our reasons for conducting two surveys of the business community. To be more specific, the list —7———i** l3l Do you know of persons in Virginia Beach enga ed in the abuse of drugs (excluding alcohol and tobacco)? TABLE l5.——Knowledge of Persons Abusing Drugs (Business Survey). Business Interview Gail—Out Business N=45 N= Yes 46.7% 3l.l% No 37.8 60.7 No answer l5.6 8.2 of businesses at the office of the Commissioner of Revenue was, on one hand, the most complete and up-to-date list; however, since it held the name of §v§:y_licensed business, it tended to be heavily weighted with very small businesses, such as the backyard auto mechanic and the one- or two-person construction company. Therefore, it is important to consider the results of the business interviews. While l6% of the businesses interviewed said they.knew of persons in Virginia Beach engaged in the illegal sale of drugs, 20% preferred not to answer. This was a question which people who really knew something about the drug scene often preferred not to answer. One employee in a local business refused to answer because he said it was against the law to know something on this subject and not report it, that is, to withhold this information from the police. These results compared interestingly to those from the mail— out business survey where only 9% stated that they knew persons illegally selling drugs. Ninety-one percent said that they did not know of persons engaged in the illegal sale of drugs. 132 High percentages of both business samples answered Question 7 affirmatively. Ninety-three percent of the mail-out businesses and 82% of the businesses interviewed believed there is illegal drug trafficking in Virginia Beach. In other words, in their opinion, without necessarily having direct knowledge, the majority of busi- nesses in both surveys felt that there was illegal buying and selling of drugs in Virginia Beach. This question differed significantly from Questions 5 and 6 which concerned only peOple they actually knew. The results from Question 8 indicated many businessmen in both samples have observed persons entering their businesses who appear to be involved in the abuse of drugs. Business managers in the interview sample gave more affirmative responses (36% compared to 5l%). The question concerning drug abuse by those frequenting Virginia Beach businesses was subject to underestimation by respond- ents. Often people in business indicated that they found it diffi- cult to identify the physical symptoms of drug abuse with the usual exception of alcohol. As many stated during interviews or on ques— tionnaires mailed in, they usually could not tell which drugs people were on or even whether they were taking drugs, except alcohol. Most of the businessmen interviewed stated that the drug causing them the most problems was alcohol, especially regarding their own employees. In addition to being often unaware of the the physical effects of drug abuse, many business people stated that they simply did not have the time during most business days to observe whether their l33 customers were on drugs. Therefore, there seemed to be two factors affecting the accuracy of the business people‘s observations: their lack of knowledge or experience, and their lack of time. Thus, there could have been considerably more people on drugs than indi- cated by these statistics from business people. Another possible source of undercount is the fact that 97% of the mailed—back questionnaires were answered by the business owners or by the manager-operators (69% of the business interviews were conducted with owners—managers). While it was necessary to address the questionnaires to someone in charge to insure a greater response rate, those in control of the businesses might not always be sufficiently attuned to the “drug scene” to accurately estimate actual numbers of people taking drugs. It might have been better to interview only workers, clerks, waiters, salespeople in the different businesses, but often these persons were transient and had not been with the business long enough to form opinions about the drug scene. The responses to Question l0, which asked if existing alco- hol and drug abuse programs could adequately handle the drug problem in Virginia Beach, were quite similar for both business samples. Question l0 concerned the following programs: Alcoholics Anonymous, Alcohol Information Center, Drug Information Center and Drug Out- reach Center. Only 5% of the business interviews and l0% of the mailed-in questionnaires stated that the programs were handling the drug problem "very well." While 33% of those in both samples felt that — r 134 the programs were doing "fairly well” at handling the drug problem, at least that many in each sample thought the programs were doing "not too well." Apparently, those responding to these questionnaires were not very enthusiastic about how well these programs were handling the drug abuse problem in Virginia Beach. According to the results from Question ll, substantial num- bers of business people were aware of drug abuse prevention programs in Virginia Beach or in this area. Only small percentages (27% of business interviews andl7% of the mailed—in questionnaires) thought that these programs were effective. Large numbers in each sample, however, seemed reluctant to judge their effectiveness and simply did not answer the question. Substantial numbers in each sample (46% and 47%) felt that more drug abuse programs were needed. Only a very few people, less than 7% of either sample, believed that no additional programs were needed. Once again, at least 47% of each sample refused to answer this question, perhaps believing themselves not informed enough to answer. It seemed evident that more information on the drug abuse problem was needed, from effects, to incidence, to treatment. Among people with opinions on the subject, the overwhelming majority felt that more drug abuse prevention programs were needed. Future objectives of the drug abuse programs should include education of the public concerning cause, effect, and treatment of drug abuse. Even though the public was much better informed at present than in —i—f” l35 past years, the average person still seemed to know relatively little about this area of public concern. Households in Virginia Beach Methodology In surveying the incidence and prevalence of drug abuse, a survey of Virginia Beach residents seemed essential. The study would not have been complete without an opinion survey of residents in order to compare their perceptions of the drug problem with those of the business and professional communities, as well as with law enforcement and court officials, and with public health and hospital spokespersons. After studying various questionnaires on drug abuse admin- istered in Virginia, New Jersey, California, and elsewhere in the country, a comprehensive questionnaire was formulated. The purpose of administering the questionnaire was two—fold: First, to inquire of the prevalence of drug use among acquaintances of the respondents, as did the questionnaires for the business and professional commu- nities. Second, unlike the questionnaires for business and profes- sional people, it was necessary to seek information about the respondent's personal drug use, as well as the demographic data con- cerning the respondent‘s age, sex, education, income, marital status, number of children, and occupation. There was and is some question as to the reliability and validity of the self-reporting of drug use. One problem with using a self-reporting form would be that people might over- or under- report the types and amounts of drugs that they were using. Thus IIIIIIIIIIIIIIIIIIIIIII33_'__'_'__'_'_'__'_'________________________________—_—'_—'———__‘77V l36 far, drug abuse researchers have devised no method of studying the occurrence of under—reporting in self-report questionnaires. They have studied the occurrence of over—reporting and have found in several studies that the percentage who exaggerate their use of drugs or who report using fictitious drugs is quite small. With the acknowledged exception of adequately studying under-reporting, Paul C. Whitehead and Reginald G. Smart (l974) make the following statement: ”The evidence supports what has been an assumption on the part of many researchers in this area: there is reason to have confidence in the validity and reliability of self—reports of drug abuse” (p. 3). First, an extensive pretest of the questionnaire was under— taken in the community with the help of members of the Drug Focus Committee. The questionnaire was then revised and pretested on a smaller sample once again. Then after another and final revision, the survey was reviewed once more and printed for distribution. Questionnaires with cover letters and self-addressed, stamped envelopes were then mailed to the l,000 households in the sample. The sample consisted of l,000 households randomly selected from the Virginia Beach City Directory. Although this directory may not have seemed to be the ideal universe or population of addresses from which to select the sample, it was the only source available for Virginia Beach. The city planning office for Virginia Beach did not have a comprehensive up-to-date list of addresses for Virginia Beach, nor did the local Chamber of Commerce. Therefore, |IIIIIIIIIIIIIIIIIIIIII333:__________________________-__________________________________4liW7 l37 the City Directory was found to be the most complete and up—to- date source of addresses for Virginia Beach. From the sample of l,000 questionnaires mailed to various homes and apartments, ll were returned by the post office for having insufficient addresses and 270 were filled out and returned by respondents. This resulted in a response rate of 27% for this sur- vey, which is within the limits of expectations as defined by Selltiz et al. (l967). Perhaps the response might have been higher if questions con- cerning personal drug use and personal information such as education, income, and occupation had been omitted. But these questions seemed important from the standpoint of obtaining a profile of the commu- nity. This profile could then be compared with other surveys (The Virginian—Pilot/Ledger Star City Profiles, August l973, and l970 census data) to see how closely the samples matched. This informa— tion will be discussed at a later point in this section. Information of these personal characteristics is also essen- tial in order to perform ”descriptive cross-tabulations" (Layarsfeld, Pasanolla, and Rosenberg, l972). By recording the data concerning each adult in the survey onto individual McBee cards, it was possi- ble to obtain descriptive, statistical profiles on the users of different drugs. These tabulations should indicate the role of demographic characteristics, such as age, sex, and income in drug use. Results Drug use is fairly widespread in Virginia Beach, according to Table l6. All types of drugs from tobacco and alcohol, to l38 TABLE 16. --Reported Experience With Drug Use by Adults (in per- 465. centages), Minimal Regular Drug N Total Use Use Tobacco, cigarets l94 4l.9 6.6 35.3 Alcohol 404 86.8 57.6 29.2 Over-the-counter drugs, __ __ all types 428 92.0 Prescription tranquil- izers, sedatives 47 10'] 6'2 3'9 Prescription stimulants 3 0.6 0.0 0.6 Prescription, other- opiates 37 8.0 6.9 l.l Marihuana 3l 6.7 5.8 0.9 Inhalants, glue, etc. 0 0.0 0.0 0.0 Hallucinogens 2 0.4 0.4 0.0 Stimulantsa 10 2.2 2.2 0.0 Depressantsa 29 6.2 6.0 0.2 Opiates, heroin, etc. 5 l l l l 0.0 Cocaine 2 0.4 0.4 0.0 Methaqualone 2 0.0 0.0 0.0 Other 0 0.0 0.0 0.0 aNonmedical use only. l39 legitimate nonprescription drugs such as Bufferin and Anacin ("over-the-counter” drugs) and prescription psychoactive drugs, to illicit drugs such as marihuana, LSD, and heroin were included in this first table. As was noted in the second report of the National Commission on Marihuana and Drug Abuse (1973), ”Although the use of illicit drugs tends to arouse the greatest public clamor and concern, it is, with the exception of marihuana use, a relatively uncommon occurrence when measured against other types of drug experience” (p. 63). Use of certain drugs, especially alcohol, and "over-the- counter" drugs, was quite widespread in Virginia Beach. While almost 90% of the residents drank alcoholic beverages at least occasionally, only 30% used them regularly (meaning at least once a week or daily). Among respondents admitting to smoking cigarets, 35% smoked at least half a package or more a day. Only about 7% reported minimal use, that is, smoking less than half a package a day. The implication here was that very few people smoked only a few ciga- rets daily. Smoking at all seemed to lead to smoking at least a half pack a day. "Over-the-counter" drugs are remedies for headache, insomnia, nervous tension, etc., that can be purchased in most drugstores. Specifically mentioned in the questionnaire were Tylenol, Bufferin, Aspirin, Anacin, Quiet World, Compoz, Sleepeze, No 002, Vivarin, and Be Bright. No tabulation of frequency of usage was made due to the nature of these drugs, except to note that at least 92% of the l40 population of Virginia Beach used one or more of these drugs at least occasionally. Prescription psychoactive drugs (tranquilizers, stimulants, etc.) seemed to be fairly widely used with l8.7% of the population reporting at least minimal use. The usage of illicit drugs, such as marihuana, hallucinogens, and opiates seemed to be used to a much lesser extent or at least their use was not reported with any regularity. Of course, the use of these drugs is against the law, and this consideration might have caused extensive under—reporting, as noted elsewhere in this study. There were two possible alterna- tives: users of these drugs may not have returned their question— naires just because questions concerning illicit drug use were present, or they may have mailed their questionnaires but denied taking these drugs. For these questions concerning personal drug use, the research case was broadened to include the husband or wife of the respondent. The questionnaire form included space for the respond- ents to answer the questions on personal drug use for other members of their families as well. Of course, this approach offered the possibility of some error in that drug use may be occasionally disguised or hidden even from other members of the family, and the respondent may not have known the types of drugs his spouse used nor the extent. For example, a housewife may not have wanted her husband to know that she took tranquilizers. The advantage of this method was evident in the near doubling of sample size. This enabled subtle trends to be more easily l4l recognized and analyzed, and methodologically this procedure had sound precedents (Riley, l963). For the remainder of the questions on the household survey, mostly concerning opinions and attitudes, the research case remained the actual respondent who completed the questionnaire. The sample size for these questions was 26l; nevertheless, for questions on personal drug use, the sample size was 465. The contents of Table I7 describe users of various ”legal" drugs using certain demographic characteristics such as age, sex, etc. About the same proportion of males and females in the sample were likely to be cigaret smokers. 0n the other hand, about 13% more males than females drank alcoholic beverages at least occa- sionally; however, more female than male respondents reported using prescription drugs. Extent of drug use differed by age to any great degree only with respect to alcohol. At least some minimal use of alcohol was highest among those who are 30 to 49 years of age (90%), and lowest among those who are 50 years of age and older (76.3%). Apparently, use of alcohol, at least on an occasional basis, was not quite as widespread among those over 50 years of age as it was among those who are under 50. Level of education did not seem to be a significant variable, except regarding those with less than a high school education. Among these people, only about 7% of the total sample, fewer seemed to smoke, drink, or take prescription or over—the-counter drugs than those with more education. 142 TABLE 17.--Dem09raphic Characteristics by Percent of Users of Ciga— rets, Alcohol, and Legal Drugs (N = 465). Over- Demographic Data N Cigarets Alcohol Counter Prgsfirip. gs Drugs .82: Male 227 41.9 93.4 92.5 11.9 Female 226 41.6 80.5 93.0 21.2 No answer 12 41.7 83.3 66.7 25.0 Age 18-29 136 39.0 86.0 94.9 19.1 30-49 252 43.7 90.0 92.5 14.7 50 + 59 40.7 76.3 94.9 18.6 No answer 18 38.9 83.3 55.6 22.2 Education < High school 31 38.7 71.0 90.3 13.0 High school grad. 147 49.0 87.8 94.6 14.3 Some coll. or tech. 259 37.1 87.3 92.7 17.8 No answer 28 50.0 96.4 75.0 25.0 Marital Status Never married 18 50.0 83.3 83.3 27.8 Married 415 40.5 86.7 94.0 15.4 Widowed, sep., div. 18 61.1 94.4 83.3 27.8 No answer 14 42.9 85.7 57.1 (28.6 Family Income < $10,000 86 43.0 81.4 94.2 24.4 $10,000-$15,000 139 41.7 82.0 95.7 16.5 $15,000—$20,000 122 45.9 93.4 92.5 13.9 $20,000 + 101 34.7 89.1 90.0 12.9 No answer 17 47.0 94.1 58.8 23.5 l 143 There seemed to be great differences in extent of drug use when cross-tabulated by marital status. A much larger percentage of those who were widowed, separated, or divorced smoked cigarets and/or drank alcoholic beverages. More unmarried respondents also smoked cigarets than married ones, but married respondents were more likely to take over-the-counter drugs, while more unmarried and more of those who were widowed, separated, or divorced took prescription drugs. Cigaret smoking seemed to be more widepsread among those whose annual income was less than $20,000 per year,but alcohol was more widely usedanmng those who had incomes of $15,000 or more per year. Use of all types of legal psychoactive drugs, whether over- the-counter or prescription, seemed to decline as the income rose. Perhaps these statistics indicate a trend toward substituting alcohol use for psychoactive drugs to lessen such symptoms as nervous ten- sion and insomnia among the higher income respondents. According to Table 18, which gives the demographic charac- teristics of the different types of alcohol users, more females than males never used alcohol or used it only minimally. More males used one or more types of alcohol (beer, wine, or other alcohol) regularly, meaning at least weekly or daily. Regular use of alcohol was more characteristic of those over 30yearsof age. Those respondents under 30 were more likely to use alcohol occasionally rather than regularly. Almost one-quarter of those over 50 never used alcohol at all while slightly over a quarter of this age group used alcohol regularly. 144 TABLE 18.——Alcoholic Beverage Consumption Related to Demographic Characteristics (in percentages), N 65. Never Minimal Regular Demographic Data N Use Use of Use of Total Alcohol Alcohol Alcohol §e><_ Male 227 10.1 54.6 35.2 99.9 Female 226 15.9 61.5 22.6 100.0 No answer 12 16.7 41.7 41.7 100.0 593 18-29 136 14.0 63.2 22.8 100.0 30-49 252 9.9 58.3 31.7 99.9 50 + 59 23.7 47.5 28.8 100.0 No answer 18 16.7 38.9 44.4 100.0 Education < High school 31 29.0 51.6 19.4 100.0 High school grad. 147 17.7 62.6 19.7 100.0 Some coll. or tech. 259 9.7 56.4 34.0 100.1 No answer 28 3.6 50.0 46.4 100.0 Marital Status Never married 18 16.7 38.9 44.4 100.0 Married 415 13.3 59.3 27.5 100.1 Widowed, sep., div. 18 5.6 55.6 38.9 100.1 No answer 14 14.3 35.7 50.0 100.0 Family Income < $10,000 86 18.6 62.8 18.6 100.0 $10,000-$15,000 139 18.0 56.8 25.2 100.0 $15,000-$20,000 122 6.6 60.7 32.8 100.1 $20,000 + 101 10.9 54.5 34.7 100.1 No answer 17 5.9 35.3 58.9 100.1 145 Education seemed to be a key variable in studying alcohol use patterns. Many more of those respondents with at least some college or technical training (34%) were using alcohol regularly while only 10% of these respondents reported never using alcohol. Those with less education seemed more likely to report never using any type of alcohol or using it only minimally. There were also important distinctions in alcohol use according to marital status with those who were unmarried and those who were widowed, separated or divorced being much more numerous among the regular users of alcohol. Almost 95% of those who were no longer married, or married but separated, used alcohol at least occasionally, indicating perhaps some use of alcohol as a possible escape. Regular use of alcohol seemed to rise along with the income, according to Table 18. About the same proportion (60%) of all income groups reported minimal use of some type or types of alcohol, with those who reported never using alcohol having incomes of less than $15,000 per year. The most significant findings occur if one considers how the proportions of each income group that used alcohol regularly rose as the amount of the annual income increased. Only 18.6% of those with incomes of less than $10,000 per year used alcohol regularly, but of those respondents earning $20,000 or more per year, 34.7% used alcohol regularly. So regular use of alcohol seems to be more prevalent among those with higher incomes. Perhaps drinking 146 was only for social purposes, but perhaps it was also used in some cases for release of tensions and relaxation in a competitive world. Table 19 gives some insight into the characteristics of those respondents who used different types of illicit drugs. For example, respondents who reported using only marihuana (no other illicit drugs) at least minimally seem to be predominantly young, under 30 years of age, to have had some college or technical train- ing, and to be spread across the economic spectrbm. Slightly more female than males used marihuana only. Almost two times as many females as male reSpondents reported illicit use of soft drugs (not including marihuana). The majority (numerically) of the soft drug users were 30 to 49 years of age and, in numbers, almost as many graduated from high school as went on to college or technical training. By far the majority were married and clustered in the $10,000 to $20,000 income range. The number of respondents admitting to use of hard drugs only, heroin or some other opiate derivative or cocaine, was so small as to make demographic analysis statistically hazardous. Those respondents who claimed to use more than one type of illicit drug, from marihuana to hard drugs, tended to be predomi- nantly male, mainly young, of all different educational and income backgrounds, and all were married. Table 20 attempts to investigate ”poly-drug” use, which means using more than one type of drug, whether it be alcohol, over-the-counter drugs, prescription drugs, or illicit drugs. The tabulations were performed, and the table was created to see if 147 TABLE 19.——Demographic Characteristics of Adult Illicit Drug Users (in percentages), N = 62. . Soft Hard . Demographic Data N g:§]' Drugs Drugs 22:23; Total y No Mari. Only Six Male 26 34.6 26.9 11.5 26.9 99.9 Female 36 36.1 52.7 2.8 8.3 99.9 No answer 0 0. 0.0 0.0 0.0 0.0 492 18-29 33 51.5 27.3 0.0 21.2 100.0 30-49 26 19.2 53.8 15.4 11.5 99.9 50 + 3 0.0 100.0 0.0 0 0 0.0 No answer 0 Education < High school 7 42.9 14.3 0.0 42.9 100.1 High school grad. 14 14.3 71.4 0.0 14.3 100.0 Some call. or tech. 37 43.2 37.8 8.1 10.8 99.9 No answer 4 25.0 25.0 25.0 25.0 100.0 Marital Status Never married 4 75.0 25.0 0.0 0.0 100.0 Married 54 33.3 40.7 7.4 18.5 99.9 Widowed, sep., div. 4 25.0 75.0 0.0 0.0 100.0 No answer 0 Family Income < $10,000 14 50.0 35.7 7.1 7.1 99.9 $10,000-$15,000 18 16.7 61.1 11.1 11.1 100.0 $15,000-$20,000 13 15.4 61.5 0.0 23.1 100.0 $20,000 + 13 69.2 15.4 7.7 7.7 100.0 No answer 4 25.0 0.0 0.0 75.0 100.0 148 TABLE 20.--Incidence of Poly-Drug Use (N = 62). . Soft Drugs Mari. Hard Drugs Comb. Drug Type Only (11601131 ) Only Only 1. No other drug/alcohol 0 O 0 O 2. Alcohol only 2 O 0 1 3. Over—counter drugs only 0 2 0 0 4. Prescription drugs only 0 0 0 0 5. Over-counter drugs and alcohol (no prescrip.) 16 17 3 9 6. Combination of some/all 22 26 4 10 there were individuals in the survey who might be users of one illi- cit drug only such as marihuana or if all users of illicit drugs used some legal drugs as well, perhaps in conjunction. The results in Table 20 show that no respondents who used an illicit drug used only that drug; they were all “poly-drug" users. Almost all these illicit drug users reported using alcohol as well as some type of over-the-counter drug (see line 5). Line 6 would be the total of the separate types of drugs used plus those respondents who used all three: over—the-counter drugs, prescription drugs, alcohol, as well as the illicit drug at the top of the column. As Table 20 indicates, "poly—drug" use seemed to be the pattern in Virginia Beach. The results from the question on personal drug use could be generalized to the population of Virginia Beach because of the sampling techniques that were used. A random sample of the population ._ ._.‘.:.., 7 149 TABLE 21.——Use of Prescription, Nonprescription, Legal, and Illegal Drugs. User type Percent Marihuana and/or hashish 6.7 Inhalants (like glue, paint, and gasoline) 0.0 Hallucinogens (LSD, mescaline, etc.) 0.4 Stimulants (amphetamines, diet pills, etc.) 2.8 Depressants (tranquilizers, sedatives, etc.) 16.3 Opiates (heroin, morphine, etc.) 9.1 Cocaine 0.4 Methaqualone (Quaaludes, “Sopors“) 0.0 of Virginia Beach was carefully drawn (see the discussion of sampling methods earlier in this section) enabling us to generalize from the findings of the survey to the population of this city at large. There was, however, the possibility of a significant amount of under- reporting of personal drug use in a survey of this nature, as noted later in the report. The household statistics indicated personal drug use in Virginia Beach was not as widespread as the results from the survey of professionals (like physicians, pharmacists, and attorneys) and of business people indicated. The results on personal drug use provided minimum figures and should be read “at least 6.7% ul of the population of Virginia Beach use marihuana. These 1The official population estimate for Virginia Beach from the Department of City Planning, as of October 1, 1974, was 225,000. Unofficial estimates are as high as 235,000 in 1976. IIIIIIIIIIIIIIIIIIIIlI333:______________________________________________________________________’==?" 150 statistics include use of prescription and nonprescription, legal and illicit drugs. Almost 7% of the respondents stated that they used marihuana. One-seventh of these used it daily or at least once a week. In comparing these results with those from Question 1 (Figures 10-17) concerning the prevalence of drug abuse, it seemed possible that people were under-reporting their use of marihuana. In other words, 30.2% of the respondents stated that they had come in contact with ten or more people in the last twelve months who used marihuana on a regular basis (compared with an average of 67.3% of the respond- ents in the sample of professionals and 55.9% in the sample of busi- ness people). It seemed unusual that 30% of the respondents would have acquaintances who used marihuana regularly, but only 7% of the respondents admitted using marihuana. Part of the under-reporting may have occurred because smok— ing marihuana, hashish, and THC was illegal. In spite of the anony- mous nature of the questionnaire, people may have been too afraid of arrest and legal entanglement to give a full and honest report of their drug use. Also, some drug use may have occurred without the knowledge of one‘s husband or wife, or parents in some cases. There was also the possibility to under-report frequency of use for all these drugs, to check “occasionally" instead of "once a week" or ”daily," especially when the drugs were not only illegal but could also have dangerous effects and side effects, as could hallucinogens and opiates. 151 The use of depressants and stimulants may also have been under—reported. All drugs, except tobacco and alcohol, were grouped together in this one question including those that could be obtained legally with a doctor's prescription but taken illicitly (for exam- ple, using another family member's prescription for tranquilizers), to those that could be purchased legally but taken illegally (for example, inhalants like gasoline and paint) and including those drugs which are both illegal to buy and to consume (such as hallu- cinogens and cocaine). Some under-reporting may have occurred because many people did not want to admit, perhaps even to them- selves, that they were taking mood-altering drugs, ones that could have become drugs of abuse. The frequency of taking these drugs may also have been under— estimated. It was probably easier to check "occasionally" than to remember exactly how often one took a certain drug. The large majority of respondents stated that they took these drugs only occa- sionally. The question analyzed in Table 22 concerned the availability of various drugs in Virginia Beach. Since the question excluded those drugs which were available by prescriptions for medical reasons, it therefore referred to those drugs which had to be obtained ille- gally. The majority of respondents answered that they would not know how difficult it is to obtain the drugs. Surprisingly high percentages of respondents, however, seemed to know how difficult it would be to obtain most of these drugs illegally and perhaps this was one of the important findings. That people actually knew how 152 m.mm . . m _ _ 4 o F.~ m.m cacao ._ . . n m N n N.¢ o.mn A.uum .muzfimmzav mcopmzcmgumz m.m . . A—mmnzv Amm>wpm>wcmc mummqo v m m :. m.o_. mdm .5st ucw .otommgmn .mczn lace .mcemnoo .cwocwcv mmpmwgo P.m A=mLme—waccacp Locma= «.mm m.FP 5.0 m.om op mmpmgswwncmn Eocm mewmcmc mucmmm zpmwxcmumpcm m>wp .888m 40 mmcmc «spy mpcmmmmcawo AmFFwa awn .mwcwEmpmngm m.m_ w.mm . m NF . . m o N on .gme .mmcwamumcaEmv mpcmpsewpm m.v m.o_ m.mp m.N o.mm Amazes Larwewm ncm new .w:w_m8mwe .ommv mcmmocwusppmz o.¢ . . Ampcmo_xop:w m mm m N m._ m.mm m_wpm—o> co mcoam> Lmzuo ncm mspmv mucmpmscH &M.N em.mm se.m No.0 ao.mm Amoebaebezm-uze o .cmwcmm; mcwuzfiocwv mcmsgwcmz sage ceabao op mH 8H bpsuwctwa 36: weak mzta zocx u.=n_=oz H gmzmc o p_38w$wwo up:u_mwwo p sop — < z ~F< um uoz umszwsom _>cu»m.o PmN.uz Ammzcu uwawgumwga AFquwcme nevus—oxmv mazes we prFwnmpmm>< Low xm>czm u_o;mm:o:--.mm m4m cw wmacc mewzoFFOm mgw mo Ace :wmuno on wmpcmzuaoz mm 111111IIIIIIIIIIIIIIIIIIlIIIIIIIII------------ — 1 153 easily illegal drugs can be obtained in Virginia Beach is of great significance. The next important finding seemed to be that such large numbers of the respondents thought that most of the drugs were "not at all difficult” to obtain in Virginia Beach. About one—third of the respondents thought marihuana, inhalants, stimulants, and depres- sants were not at all difficult to buy illegally. Fewer (about 10%) believed that hallucinogens were easily obtainable, while only about 5% felt that opiates and methaqualone could be obtained easily. No one thought that marihuana was very difficult to buy, and only one or two percent thought that inhalants, hallucinogens, stimulants, and depressants were very difficult to buy. The con- census of opinion seems to be that all these illegal drugs are available and are fairly easy to obtain in Virginia Beach. This finding coincided with results from a question that was asked on the business and professional surveys, "Check those drugs which you think residents of Virginia Beach buy in and/or outside Virginia Beach. Check both if appropriate.” The vast majority of the respondents checked both "in and outside of Vir- ginia Beach” for all the drugs. Slightly fewer checked that opiates could be bought inside Virginia Beach. In other words, not quite as large a majority of professional and business people were unsure that heroin could be obtained in Virginia Beach, but large numbers of others felt that all the other drugs could be bought in Virginia Beach. IIIIIIIIIIIIIIIIIIIIIII:________________________________________________________________E===’W 154 One question on the household survey was designed to learn why people decided not to abuse drugs. As Table 23 indicates, the great majority of respondents answered they ”never had any desire to abuse drugs” when asked the question: If you do not presently abuse drugs, which one of the fol- lowing has most influenced your decision not to abuse drugs? TABLE 23.—~Results from Household Survey on Question 9: Factorsa Most Affecting Decision Not to Abuse Drugs (N = 261 . Total Percent of . . . Responses All Responses Factor Affect1ng Dec1s1on 13 3.3 What your parents told you about drugs 3 0.8 What your brothers and sisters told you about drugs 11 2.8 What your friends told you about drugs The information you got in school or in 30 7.7 drug abuse education classes 78 20.1 The information you got from television, books, or newspapers 5 1.3 The information you got from your family doctor 6 1.5 The information you got from your minis- ter, priest, or rabbi 187 48.1 I just never had any desire to abuse drugs 48 12.3 Other 8 2.1 None of the above 389 100.0 Totals aTotal responses exceed number of respondents because fre- quently respondents checked more than one reason for not abusing drugs. 155 As stated earlier, most people did not abuse drugs primarily because they never had any desire to do so. The second most popular reason was the information on drugs that people got from television, books, or newspapers. Many people noted under "Other" reasons that their occupations, as nurses, policemen, pharmacists, kept them from abusing drugs because they knew the potential for harm. In this category, some respondents also noted that friends of acquaintances had bad trips on drugs or suffered other damaging side effects and this possibility had prevented them from ever experimenting with drugs. About 8% of the respondents stated that the information they got in school or in drug abuse education classes kept them from try- ing drugs. Since most of the respondents were in their twenties or older, many had not been exposed to drug education classes in school, so the percentages in this category were rather low. The answers to the question in Table 24 helped evaluate how well the respondents in the household survey thought that alco- hol and drug information treatment programs were handling the drug problem in Virginia Beach. The programs which the question con- cerns are Alcoholics Anonymous, Alcohol Information Center, Drug Information Center, and Drug Outreach Center. Only about 7% of the household survey respondents thought the drug and alcohol information and treatment programs responded to the drug problem in Virginia Beach "very well." The majority thought the programs responded only “fairly well“ or "not too well." The results are quite similar to those from the professional and business communities; most people felt that, for whatever reasons, —————’W 156 How well do you think these programs [Alcoholics Anonymous, Alcohol Information Center, Drug Information Center, and Drug Outreach Center] respond to the drug problem in Virginia Beach? TABLE 24.-—Household Survey of Adequacy of Treatment Programs: Question 12 Response Total Respondents Percent Very well 17 6.5 Fairly well 94 36.0 Not too well 70 26.8 Not at all 6 2.3 No answer _14 _2§:4 Total 261 100.0 the programs were simply not adequately responding to the drug problem. Household Demographic Data The sample of 261 households contained in this survey is very similar to the sample of 366 households in the Virginian-Pilot/ Ledger-Star City Profiles sample in terms of age, sex, marital status, and so forth. Both samples are relatively similar to the results from the 1970 U.S. Census of Population and Housing for Virginia Beach. Of course, the area has grown from a population of 172,106 in 1970 to the present 231,000 (i 500), a population increase of about - 7 157 1 I n a c 0 11,778 per year. The increase of one—third could have Sign1f1cantly altered the population composition since 1970. The demographic data on the 261 households was obtained from the questions at the end of the household questionnaire. The ques— tions concerned age, marital status, number of children living at home, last year of school completed, family income, area of residence in Virginia Beach, and occupation. Although the census offered no data on age, the figures from this sample of households are quite similar to those from the Virginian-Pilot/Ledger Star sample as indicated in Table 25. One of the purposes of these questions on age, sex, etc., was to check the sampling procedures to see if the sampling techniques produced a random sample that was similar to the Virginia Beach population at large. Since there was such a similarity, it became possible to generalize from the sample to the population at large. For the question concerning sex of the respondents, there was no comparable data from the Virginian-Pilot/Ledger—Star survey or from the 1970 census. It seemed important for the accuracy of the survey that the sex composition ofthe respondents be similar to In other words, the respondents should About the population in general. have numbered about 50% male and 50% female, which they did. 47.9% were male and 46.0% were female, with 6.1% of the respondents not answering the question. 1These figuresare from the Office of City Planning of Vir- ginia Beach and represent population projections as of October 1, 158 TABLE 25.--Household Survey: Age of Respondents. Virginian-Pilot/ Age Drug Abuse Survey Ledger-Star Survey N = 261 N = 366 Under 29 30.0% 31% 30 - 49 51.0 51 50 + 13.8 19 No answer __§g1_ _;;_ Total 100.0% 101% The respondents in this survey were primarily married and living with their marital partners (Table 26). The Virginian—Pilot/ Ledger-Star survey had no data on this subject, but one assumes that the statistics on marital status resemble the Virginia Beach population rather closely. Of course, the predominantly young age of most of the sample (77.1% were 22 to 49 years of age) means that the number of widowed will probably be low. Virginia Beach is also a predominantly young community, made up of married couples, usually with children. Table 27 from the drug abuse survey gives the percentages with one, two, three, four or more children and those with no chil- These statistics were not comparable to the Virginian-Pilot/ There is the possi— dren. Ledger-Star survey data nor to census data. bility, moreover, that slightly more families with no children or with only one child were represented in this sample. Perhaps these families had more time to respond to lengthy surveys of this type. 159 TABLE 26.-~Marital Status of Respondents (N = 261). Status Percent Never married 6.9 Married 80.1 Widowed, separated, divorced 8.0 No answer __§;Q Total 100.0 TABLE 27.-~Number of Children Per Family of Respondent (N = 261). Children Percent 0 31.8 1 23.0 2 18.8 3 10.0 4 + 10.3 No answer __§yl 100.0 Total 160 Educational attainment (Table 28) can be compared from this drug abuse survey and the Virginian-Pilot/Ledger—Star survey. There were some differences, but most of these could be accounted for by chance. There were also some differences in categories; for example, the Virginian-Pilot/Ledger-Star survey had no category for "technical training.” TABLE 28.--Education of Respondents. Virginian-Pilot[ Level of Education Drug Abuse Survey L§99§£1§£3£ Survey N = 261 N = 366 0 - 7 0.0% 5% 8th 0.4 3 Some high school 5.7 15 High school graduate 29.1 37 Some college 22.5 19 College graduate 14.6 16 Post-graduate 16.8 4 Technical 4.7 -— No answer 5.7 2 Total 99.5% 101% The data on income (Table 29) for Virginia Beach was com- parable for drug abuse survey data, Virginian-Pilot/Ledger-Star data, and 1970 census data. Incomes in Virginia Beach have undoubtedly increased in the five years since the 1970 census. It is also important to remember that the current average income for the nation 161 TABLE 29.--Income of Respondents. Drug Abuse Virginian-Pilot/ Survey Ledger-Star Survey Income 1970 Census N = 261 N = 366 Under $5,000 1.1% 8% 15% $5,000-$10,000 17.6 27 33 $10,000-$15,000 29.1 27 29 $15,000 and over 46.4 24 23 No answer __jigi_ _ij_ -- Total 100.0% 100% 100% is about $12,000, and the Virginia Beach average was also probably higher than the national average. In the directions for the drug abuse survey, it was stressed that respondents were to combine the incomes of husband and wife, perhaps raising the number in the $15,000 or more category, as evident in Table 29. The respondents in the drug abuse survey were primarily located (Table 30) in the major population centers of Virginia Beach: the Beach Borough, Lynnhaven, London Bridge, Hilltop, Bayside, and Kempsville. The distribution of the same was in accord with popu- lation figures on these areas. Survey of Youth of Virginia Beach Methodology One of the more important segments of the population of Virginia Beach is the youth population. This is the population where drug abuse often causes the most public concern. This is also the 162 TABLE 30.--Respondents‘ Area of Residence Within Virginia Beach. Zip Code Area Number Percent 23450 Mail Handling Annex 0 0.0 23451 Main Post Office, Beach Borough 41 15.7 23452 Lynnhaven Station 61 23.4 23453 London Bridge Station 0 0.0 23454 London Bridge Station, Hilltop 33 12.6 23455 Bayside, Naval Amphibious Base 41 15.7 23456 Princess Anne Station, Pungo 5 1.9 23457 Back Bay 0 0.0 23458 Main Post Office, Beach Borough O 0.0 23459 Fort Story 0 0.0 23460 Naval Air Station, Oceana O 0.0 23461 Dam Neck Naval Base 0 0.0 23462 Kempsville Area, Witchduck Annex 62 23.8 No answer 17 6.5 Other zip code " __l_ ___;4 Total 261 100.0% —7—~.’ 163 polulation where drug abuse often causes the most public concern. This is also a population which is vulnerable to the abuse of psychoactive drugs as well as alcohol. The most efficient way to survey this population was to con— tact the Virginia Beach School Board to gain permission, assistance, and support in administering questionnaires to a sample of the junior high and high school students. A proposal outlining the pro- jected survey was submitted to school officials who reviewed the proposal and informed the principals and assistant principals of the ten junior and senior high schools of the upcoming survey. The questionnaire to be used was created by Dr. John D. Swisher and Dr. John J. Horan of Pennsylvania State University. Dr. Swisher was contacted and gave permission to use the "Drug Education Evaluation Scale” as the survey instrument. The school principals all designated assistants to select the individual classes to which the questionnaires were to be administered. An effort was made to stratify the sample by age, to get a somewhat even breakdown. The ideal situation would have been a simple random sample with the total population of young people from 14 to 18 years of age in Virginia Beach as the universe. However, a more realistic research model had to be adopted considering limitations in staff size, circumstances, and budget. The school principals and their assistants chose the classes to be surveyed and asked the teachers' help in administering the anonymous questionnaire. The students were assured that the - v . 164 identities of themselves, their classes and their schools would remain anonymous. They were only asked to write their ages on their individual questionnaires. The questionnaires were then col— 1ected from all the participating classes in all ten junior high and senior high schools and shuffled together to prevent identification. Results Tables 31-41 give the results of the youth survey. Table 31 gives an overview of the drug use patterns of youths from 14 through 18 years of age. Some explanation of this Table 31 is essen- tial, since it is in the form of a work table. In other words, much information that might have taken three or four tables to present is presented on one large table. The percentage of the youth sample using each drug is pre- sented on the right-hand side of the double column under the appro- priate frequency heading. For drug program implementation purposes, projections were made from the percentages of the youth sample using drugs to the total population of young people inVirginia Beach who are 14 to 18 years of age. These projection figures appear on the left-hand side of the double column. Table 31 would read ”36.9% of the youths in the sample never used cigarets. A projection of this figure of the total youth 1 population of 21,182 of Virginia Beach would mean that 7,818 young 1 people never smoked cigarets.‘ The other figures can be read similarly. _ 1This figure was obtained from the Department of City Plan- n1ng, City of Virginia Beach. 1(55 JT/l/ OO.O . . . . . . . . NNOuzO OO O OO O OO O OO O OO O OO OO.OO_ OO._ mm.ONN OO.F mm.ONN OO._ OO.OFN mm.mO OO ONN ON A cacao ON. . . . . . . . . __muzO NO NO OO O OO O ON ON NO ON._ OO.NNN Om. OO.NON ON. NN.mO_ mm.N NN.NOO em NO Om New OF McwmuOO . . . . . . . . . NOE: OO O OO O OO O OO O OO O OO O ON. ON.NO OO.O OO.O Om. NO.ON_ NO.F ON.NFO ON NO ON NOO ON AOOOLOI . . . . . . . . . . OOmuzO ON on NO OO O OO O ON ON NO NO. Om.NON ON.N OO.OOO mO.N NO.ONO ON.m mO.NN_ O NO NO OO «we O_ .mmOLOaO ow. om.~¢ oo. . . . . . . . . . . . . . . AFomnzv O OO O OO OO NN_ O4 N NN OOm ON N NO OOm OO.N 4O NNO ON O ON ONO F NN mm NO mmO Op .Eeum ON. ON.NO . . . . . . . . . . . . . . . Ammcnzv OO O OO O ON ON NO .8 . 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gzm gaze» mo mu—smwznu.wm m4mwz NOOanO LOONO NNNNuzO wcwmuou NONNuzO :Nocm: NONNuzO wgmgzu NONNuzO .mmwNOmo NONNqu .ENNN NONanO .ONOONNOO NNNanO OONOOO: NONNqu Ocmscwgmz NNNNHOO NozouN< NONNuzO meNmmOu I ngo .NOONNONOOOO NONON NOO.OO ON OOO ”NOOLON ONOON NO 8NONON...NN OOOON 168 . . . . . Nmpuz 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 m.o ¢.mm m.o v.mm w o w mm m nm m wNn m s A Luna“ . . . n . . a . . o a ANMFHZV 0.0 0.0 0.0 0.0 0.0 0.0 o o o o o m m mN— m o v mm m N A sea a mm M ONm m wcwmuou . . . . . . . . . . . . ANN—"2V 0.0 0.0 0.0 0.0 o o 0.0 w o v mm o o o o o o o o o O o o N mm o —¢F v CwOLw: . . . . . . . . . . a . . a ANN—.HZV 0.0 0.0 0.0 O O O O O O O O O O O O O O O O O O O O O O O OON O ONN O ONONOO . . . . . . . . . . . . . . . . . ANN—nzv o o o o O o o o o o o o w 0 v mm m — o me n N 0 mm m m m wmp N —m m wNw m .mmeawD . . . . . . . . . . . . . . . . O ANmFuzv o o o o o o O o m o w mm m o v mm o m m mNF o m m mNF w m N mm— m ww — mam m .Emum . . . . . . . . . . . . . . . . . A—m—nzv o o o o o o O o o o o o m o Q mm m P m N@ F m w mN— m N 0 mm w Nm 5 nmw m .cwuzpwm: . . . . . . . . . . . . . . . . O ADM—nzv o o o o o o o o m — o Ne w m m wmp m M A wmp m N 0 mm m m N mm? o «w — Nmm m cwwcmw: . . . . . . . . . . . . . . . . O Amm—uzv O N O NO O N N OON O O O NON O NN O NOO O O O NN O NN O NOO N O O OON O NO O ONN N OOOOONLOZ w.o v.mm o.m N.mN_ m.o— p.v—w m.mN N.oo_J m.mp n.mmo 0.0 m.omN w.NF ¢.¢mm M.¢~ o.nmm MMMWWdW . . O . . . . . . . . . . . . . . n AFMPHZV 0 AN — vap a o — wmm m — w No m a F Nap m m n wm— F m v mw— m mp w Pam m mm P «mm P mqummru N .OOLN N .OOLN N .OOLO N .OOLN N .OOLN O .OOLO N .OOLN N .OOLO zoz Noz zoz Noz OOLO One One O NOO: O Oucoz O New» O O 3 ON Lw>o zoom :Ouwo wukaxmuco OOOzNNOOOo muNxNNOUOO Ouszxmuco wumOMwaMm WLMOMMNVMWO O a z .NOONNONOOOO NONON ONN.OO ON OOO wa>gzm sync» No Napammm11.vm u4mOz N.OON :38 3328.5 83:85 . K O . N SEN OOOO _ ONONOO BOO .Acozmpaaoa N33 @3va e wm< "3:3 53> No mupzmwmldm 39:. 171 TABLE 37.--Youth Survey: Po1y-Drug Use, Age 14 (N = 102). Drugs 0n1x: 5 Used to Use A1coho1: 1 1. Present1y smoke tobacco 4 regu1ar 2. Marihuana 2 regu1ar 2 minima1 3. Depressants 0 4. Hashish 0 5. Stimulants 1 1-2 times/mo. A1coho1 0n1x: 31 Present1y smoke tobacco 9 minima1 3 regu1ar Drugs and A1coho1: 22 Drinking present1y 14 minima1 8 mari. minima1 2 regu1ar 3 mari. 1-2 times/wk; hash 1-2 times/yr. 1 mari. & hash 1-2 times/wk. 8 regu1ar 2 mari. regu1ar 2 minima1 1 mari. &hash dai1y; ha11u. 1-2 times/wk.; & coc. 1-2 times/mo. 1 mari. dai1y; stim. 1-2 times/ wk. 1 mari. dai1y; hash, depr. & heroin 1-2 times/mo. 1 mari. dai1y; hash, ha11u. & stim. 1—2 times/mo. Nonusers; 26 never drank 4 use cigarets regu1ar1y 3 used cigarets before 1/73 2 used cigarets since 1/73 18 used to drink, but no 1onger drink 15 used no other drugs ever 3 used to use marihuana 1 used to use hashish 1 used to use g1ue TABLE 38.--Youth Survey: 172 Po1y-Drug Use, Age 15 (N = 124). Drugs 0n1y: 4 1 Marihuana . Depressants . Hashish A1coho1 0n1y: 42 Present1y smoke tobacco Drugs and A1coho1: . Present1y smoke tobacco 2. 32 Drinking present1y Nonusers: OONNN GUN Used to Use A1coho1: 3 regu1ar regu1ar minima1 minima1 regu1ar minima1 1 mari. dai1y, hash & stim. 1-2 times/wk; ha11u. 1-2 times/mo.; depr. 1-2 times/yr. 8 mari. minima1, 1-2 times/wk. 2 mari. dai1y 2 mari. 1-2 times/wk.; hash 1-2 times/yr. 1 mari. & hash 1-2 times/mo. 1 mari. 1-2 times/mo.; hash 1-2 times/yr. 1 depr. 1-2 times/yr. regu1ar 1 mari. regu1ar1y 7 mari. minima1 1 mari. 1-2 times/mo.; heroin & coc. dai1y 1 stim. & coc. 1-2 times/mo. 1 mari. 1—2 times/wk.; hash 1-2 times/mo. 1 depr. & stim. 1-2 times/yr.; so1vents 1-2 times/mo. never drank cig. before 1/73 cig. since 1/73 mari. minima1 used to use ha11u. & stim. 1 8 using cig. on1y--6 minima1, 2 regu1ar 1 1 used to drink, but no 1onger drink used used used used used h—Ide—amwh mari. mari. 1 1 to to to to to no other drugs ever cig. on1y, min., 4 regu1ar -2 times/wk. -2 times/yr. use mari. use hash & stim. & depr. use ha11u. use stim. smoke cig. 173 TABLE 39.-~Youth Survey: Po1y-Drug Use. Age 16 (N = 133). Drugs 0n1x: 5 1. Present1y smoke tobacco 2. Marihuana 3. Stimu1ant 4. Hashish 5. Po1y-drugs A1coho1 0n1y: 54 Present1y smoke tobacco Drugs and A1coh01: 33 Drinking present1y Nonusers: d—l—A—a—l—l—l—Aw 17 21 20 regu1ar Used to Use A1coho1: 5 1-2 times/yr. 1-2 times/mo. 1-2 times/wk. 1-2 times/day 1-2 times/yr. 1-2 times/mo. 1-2 times/wk. mari. 1-2 times/day; hash 1-2 times/wk.; ha11uq stim., heroin, cocaine 1-2 times/mo.; codeine 1-2 times/yr. hash 1-2 times/yr. hash 1-2 times/yr. hash 1-2 times/mo. ha11u. 1-2 times/yr. hash 1-2 times/mo. stim. 1-2 times/yr. minima1 regu1ar minima1 9 mari. 1-2 times/mo. 2 mari. 1-2 times/mo.; 1 mari. 1-2 times/wk. 1 mari. 1-2 times/wk.; 1 mari. 1-2 times/da.; 1 mari. 1-2 times/wk.; 1 mari. 1-2 times/wk.; 1 mari. 1-2 times/wk.; regu1ar 4 mari. regu1ar 5 mari. minima1 1 hash 1-2 times/wk.; stim., depr. 1-2 times/yr. 1 cocaine 1-2 times/mo. 1 mari. & hash minima1 2 mari. regu1ar; hash minima1 1 mari. dai1y; hash 1-2 times/mo.; ha11u. 1—2 times/yr.; stim. 1-2 times/wk.; depr. & coc. 1-2 times/mo. 1 mari. dai1y; stim. & depr. 1-2 times/yr.; COC . 1-2 times/mo. never drank 2 used to use ci arets 1 used to use stimu1ants used to drink, but no 1onger drink 3 smoke cigarets regu1ar1y 6 used to smoke cigarets 5 used to use marihuana 1 used to use marihuana, hash. & stimu1ants 174 TABLE 40.--Youth Survey: Po1y-Drug Use, Age 17 (N = 142). QEEHE_QQLX: 7 Used to use A1coho1: 5 1. Present1y smoke tobacco 3 regu1ar 2. Marihuana 1 dai1y 6 minima1 3. Depressants D 4. Hashish 3 minima1 5. Cocaine 1 1—2 times/mo. A1coho1 Dn1y: 43 Present1y smoke tobacco 4 minima1 11 regu1ar Drugs and A1coho1: 64 Drinking present1y 24 minima1 11 mari. regu1ar 13 minima1 1 hash 1-2 times/wk. 10 hash minima1 1 ha11u. regu1ar 2 minima1 10 stim. minima1 4 depr. minima1 2 cocaine minima1 40 regu1ar 27 mari. regu1ar 12 minima1 1 hash regu1ar 22 minima1 1 ha11u. regu1ar 9 minima1 1O stim. minima1 7 depr. minima1 6 cocaine minima1 Nonusers ; 16 never drank 20 no other drugs ever use cigarets regu1ar1y uses cigarets minima11y used to use ha11u., stim., depr. used to use cigarets 9 used to drink, but no 1onger drink used no other drugs ever use cigarets regu1ar1y used to use cigarets used to use marihuana used to use hash. and stim. used to use hash., stim., ha11u., depr., heroin & cocaine #N—JN d—‘WNMOW 175 TABLE 41.-~Youth Survey: Po1y-Drug Use, Age 18 (N = 86). Drugs 0n1v: 3 Used to Use A1coho1: 1 1. Present1y smoke tobacco 2. Marihuana regu1ar 2 1 1-2 times/yr. 1 1-2 times/day 1 1 1—2 times/mo. 1-2 times/yr. 3. Depressants 4. Hashish A1coho1 0n1y: 33 Present1y smoke tobacco 9 minima1 11 regu1ar Drugs and A1coho1: 29 Drinking present1y 7 minima1 2 mari. 1-2 times/yr. 2 mari. 1-2 times/mo. 1 mari. & hash 1-2 times/mo. 1 mari. 1—2 times/wk: hash 1-2 times/mo.; stim. 1-2 times/yr. 1 mari. 1-2 times/wk; hash 1-2 times/mo.; ha11u. & stim. 1-2 times/yr. 22 regu1ar 5 mari. regu1ar 3 mari. 1-2 times/mo. 1 hash 1-2 times/mo.; mari. 1-2 times/wk.; ha11., stim., depr. coc. 1-2 times/yr. 1 ha11. 1-2 times/mo.; hash 1-2 tines/yr.; mari. 1-2 times/wk.; stim. & depr. 1-2 times/yr. 1 stim. 1-2 times/yr.; mari. 1-2 times/wk. 1 depr. 1-2 times/wk. 1 mari. 1-2 times/day; hash, ha11u., stim., depr. 1-2 times/yr. 1 mari. 1-2 times/wk.; hash & coc. 1-2 times/mo. 1 mari. 1-2 times/wk.; hash 1-2 times/mo.; ha11u. 1-2 times/yr. 1 mari. 1-2 times/day; hash 1-2 times/mo.; ha11u. 1-2 times/yr. 1 mari. dai1y; hash 1—2 times/yr. 2 mari. 1—2 times/wk.; hash 1-2 times/yr. 1 mari. 1—2 times wk.;hash1-2 times/mo. 1 mari. & hash 1-2 times/mo. 1 mari. dai1y; hash & stim. 1-2 times/mo. never drank 1 used to use cigarets 1 used to use stimu1ants & depressants 7 used to drink, but no 1onger drink used no other drugs ever uses cigarets regu1ar1y used to use cigarets used to use marihuana used to use stimu1ants Nonusers: 12 dww—l—l 176 The next doub1e co1umn indicates that 14.7% of the youth popu1ation surveyed smoked cigarets before January 1, 1973, but do not smoke now. Projected figures to the popu1ation indicate that approximate1y 3,100 young peop1e from 14 to 18 used to smoke but no 1onger do. The percentage of young peop1e smoking (Tab1e 31) was a striking1y high 43.8%. Of course, some of these young peop1e smoke somewhat infrequent1y; however, a1most one-third of those surveyed smoked dai1y, with a quarter of the samp1e smoking "often each day.n Tab1es 32-36 indicate that smoking dai1y increased even1y a1ong with age from 14 to 17, but at age 18 there was a noticeab1e drop in the percentage who smoke dai1y. Perhaps this finding that smoking dai1y was so widespread shou1d not be surprising when viewed with the fact that 41.9% of the adu1ts samp1ed in the househo1d sur- vey a1so smoked. This compares with 38% of adu1ts and 17% of youths who reported smoking in the nationwide survey conducted and pub1ished by the Nationa1 Commission on Marihuana and Drug Abuse (1973, p. 46). A1coho1 consumption was a1so quite high, with 64.8% of the youths aged 14 to 18 reporting a1coho1 use at 1east once or twice a year. Most of them were occasiona1 users with about 3% using a1coh01 dai1y. As with smoking, use of a1coho1 rapid1y increased with age up to 18 when over a third of the samp1e admitted using a1coho1 at 1east ”once or twice per week." The second report of the Nationa1 Commission on Marihuana and Drug Abuse (1973) made the fo11owing statement concerning a1coho1 consumption and age, “With regard to —: v a 177 age, use begins its steep c1imb during the midd1e teens, reaches its high point (66%) in the 22-25 year age group and gradua11y 1eve1s off thereafter. . .” (p. 47). The use of marihuana among Virginia Beach youths from 14 to 18 years of age as reported in Tab1e 31 was quite preva1ent. 0f the 512 youths in the samp1e, 43.4% reported having ever used marihuana; 13.3% of the samp1e no 1onger used marihuana but 30.1% or near1y one-third of the samp1e reported using marihuana at 1east once or twice per year. Dai1y use was reported by 6.3% of the samp1e. Regu1ar use of marihuana was particu1ar1y preva1ent among those 17 and 18 years of age. Hashish was not as wide1y used as marihuana. It was most popu1ar with 17 year o1ds. Ha11ucinogens seemed to have been more wide1y used in the past than at present. About 4.4% of the samp1e reported current use, whi1e 6.3% report having used ha11ucinogens in the past but no 1onger. Ha11ucinogen use was highest among 17 and 18 year o1ds (about 8%), according to Tab1es 35 and 36, but no one in the samp1e reported using them dai1y. Stimu1ants a1so were once more wide1y used than at present. About 9% of the samp1e reported using stimu1ants in the past but no Tonger, whi1e 6% reported present use. However, current stimu- 1ant use sti11 was rather high among those who are 17 years of age. Seventeen year o1ds a1so seemed to be the ones most 1ike1y to be currentTy using depressants (7.9%) compared to 3.7% for the samp1e as a who1e and 5.9% for the 18 year o1ds. Once again, use of these soft drugs increased with age up to 18 years. - v . 178 Current heroin use was quite minima1 and seems to have been most1y used in the past by 17 and 18 year ons. The picture for cocaine was quite different, with 3.3% of the samp1e admitting to its current use; some even used it dai1y. The youth survey indicated that drug use, particu1ar1y of soft drugs (ha11ucinogens, stimu1ants, and depressants) was much higher in the past but significant numbers of young peop1e sti11 used these drugs fair1y regu1ar1y (about 5% to 10%). Hard drugs have never been too wide1y used in Virginia Beach but were used more in the past than current1y. Marihuana use was quite widespread, but the most wide1y used and abused drug is a1coho1. There was sti11 a soft drug prob1em in Virginia Beach which had been compounded by increased use of a1co- ho1, resu1ting in a po1y-drug prob1em of considerab1e proportions, as Tab1es 37-41 indicate. Increased po1ice attention to drug sa1es as we11 as pub1ic concern with the drug prob1em and the resu1ting drug education pro- grams in the ten junior and senior high schoo1s may have a11 effected a decrease in the numbers of young peop1e using drugs. However, much more needs to be done, particuTar1y with prevention prOgrams. Department of Socia1 Services Methodo1ogy The Department of Socia1 Services was considered to be a prime source of data about drug abuse, especia11y as it affected their c1ients. The department, however, had no “hard“ data 179 concerning drug abuse readi1y avai1ab1e. It was therefore neces- sary to create a “Drug Abuse Data Sheet" to be compieted by a samp1e of caseworkers. One—fourth the tota1 of 60 caseworkers were se1ected by their supervisors to comp1ete the "Data Sheet." They were instructed to go through their fi1es to co11ect information on their c1ients who used drugs. The information obtained provided the data for a profi1e of those Socia1 Service c1ients who used drugs, but the number of c1ients in this samp1e by no means equa1ed the tota1 of a11 Socia1 Service c1ients who used drugs. Resu1ts Data from the Virginia Beach Department of Socia1 Services indicate that a11 caseworkers in the samp1e had some c1ients who were using drugs. The number of c1ients who were using drugs ranged from 1 to 20, and the average was 7.5 per caseworker, tota1ing 105 c1ients in a11. To be more precise, Tab1e 42 indicates the number of c1ients using drugs that most caseworkers had. TABLE 42.--Resu1ts of Socia1 Service Survey of Drug Use in Virginia Beach. Number of C1ients Number of Caseworkers on Drugs Having C1ients on Drugs 1 - 4 5 5 - 9 5 10 - 14 1 15 - 20 3 180 About 30% of the c1ients using drugs were 21 years of age or younger. It is interesting to note, however, that among those c1ients using drugs, the majority (44%) of those whose ages were known were 30 years of age or over. Of course, many of those over 30 primari1y abused a1coho1. Tab1e 43 gives more precise information on ages of c1ients using drugs. TABLE 43.-~Age of Socia1 Service C1ients Using Drugs in Virginia Beach. C1ients in Age Range Age of C1ients Number Percent 10 - 14 3 2.9 15 - 17 17 16.2 18 — 21 11 10.5 22 - 29 10 9.5 30 - 49 32 30.5 50 + 14 13.3 Age unknown __l§_ __lZ;l_ Tota1 105 100.0 About two-thirds of Socia1 Services c1ients using drugs were either never married or widowed, separated, or divorced (Tab1e 44). About 23% were married, with husband or wife present, as Tab1e 44 shows. It seems that the majority of drug users among the c1ients of Socia1 Services were not current1y married. IIIIIIIIIIIIIIIIIIIIIIIIIllIlIII"""""""""""""""""""""""""""'"""""""""""i7. 181 TABLE 44.——Marita1 Status of Socia1 Services C1ients Using Drugs in Virginia Beach. Marita1 Status Number Percent Never married 31 29.5 Married, spouse present 24 22.9 Widowed, separated, or divorced 32 30.5 Marita1 status unknown _1§ .lZ;l Tota1 105 100.1 The fair1y high percentage of never married (30%) may ref1ect the 30% of the samp1e who were 21 years of age or younger. The fact that the numbers of those widowed, separated, or divorced outnumbered those who were married with husband or wife present might indicate greater marita1 instabi1ity for those using drugs. As indicated in Tab1e 45, the percentage of drug-using c1ients with no dependents (38%) perhaps ref1ects the high percentage of c1ients who have never married (30%). This area of data was one where caseworkers often 1acked information, as the fair1y high per- centage in the “number unknown" category indicates. A1though the education 1eve1 (Tab1e 46) was not known for a1most ha1f (47%) of the drug-abusing popu1ation, most of those where the educationa1 1eve1 was known were not high schoo1 graduates. Thirty-five percent of the c1ients had 1ess than 12 years of schoo1- ing, a finding which is probab1y due to the young age of a third of the clients who used drugs. IIIIIIIIIIIIIIIIIIIIII33:_____________________________________________________________7:::i 182 TABLE 45.—-Number of Dependents of Drug-Using Clients in Virginia Beach. Clients Number of Dependents Number Percentage 0 40 38.1 1 6 5.7 ( 2 9 8.6 3 6 5.7 4 + 8 7.6 Number unknown _36 _§4¢3 Total 105 100.0 TABLE 46.--Education Levels of Drug-Using Clients in Virginia Beach. C1ients Education Number Percentage Less than high school 1 1.0 Some high school 36 34.3 High school graduate 13 12.4 Technical school 0 0.0 Some college 6 5.7 ‘ College graduage O 0.0 Graduate or professional school 0 0.0 Education unknown _&2_ _fl§;Z Total 105 100.1 183 If a table were to be constructed for only those 56 clients whose educational level is known, the results would appear as in Table 47. Results from the City Profiles survey conducted by the Virginian-Pilot/Ledger-Star are given for Virginia Beach for pur— poses of comparison. TABLE 47.-~Education Levels of Social Service Clients Compared to the Virginian-Pilot/Ledger-Star Survey of Virginia Beach Residents (in percentages). Social Services Virginia Beach Education C1ients Residentsa Less than high school 1.8% 8.0% Some high school 64.3 15.0 High school graduate 23.2 37.0 Technical school 0.0 (omitted) Some college 10.7 19.0 College graduate 0.0 16.0 Graduate or professional school 0.0 4.0 Education unknown (omitted) 1.0 Refused (omitted) 1.0 Total 100.0 101.0 aAs surveyed by Virginian-Pilot/Ledger-Star. Those clients of Social Services who used drugs fell far below the educational levels attained by Virginia Beach residents, as reported by the Virginian-Pilot/Ledger-Star survey. 184 Table 48 indicates the areas where some of the Social Service clients who used drugs actually lived in Virginia Beach. This infonmation, however, was not available for the majority of clients using drugs. TABLE 48.--Virginia Beach Residence of Social Service Clients Using Drugs. Zip Code Area Number Percent 23450 Mail Handling Annex 0 0.0 23451 Main Post Office, Beach Borough 5 4.8 23452 Lynnhaven Station 9 8.6 23453 London Bridge Station 0 0.0 23454 London Bridge Station, Hilltop 2 1.9 23455 Bayside Area, Naval Amphibious Base 5 4.8 23456 Princess Anne Station, Pungo l 1.0 23457 Back Bay 0 0.0 23458 Main Post Office, Beach Borough 0 0.0 23459 Fort Story 0 0.0 23460 Naval Air Station Oceana 0 0.0 23461 Dam Neck Navy Base 0 0.0 23462 Kempsville Area, Witchduck Annex 1 1.0 Elsewhere in Tidewater 3 2.9 Unknown .13 _Z§;§ 105 100.2 Total The majority (55%) of Social Service clients who used drugs had lived in Virginia Beach at least five years (Table 49.) Another 20% had lived in Virginia Beach from one to five years. Very few (11%) of clients on drugs had lived in Virginia Beach one year or less. TABLE 49.-—Length of Residence in Virginia Beach of Social Service Clients Using Drugs. C1ients Length of Residence Number Percent 30 days 1 1.0 1—6 months 4 3.8 6-12 months 6 5.7 1-5 years 21 20.0 5 years + 58 55.2 Unknown _l§ _14;§ Total 105 100.0 Fifty-three percent of the Social Service clients who were on drugs were unemployed (Table 50). Only 14% were employed at the time, as Table 50 indicates. Among those Social Service clients who listed an occupation or trade (Table 51), whether or not they were employed during 1973, 30% were unskilled laborers. Unfortunately, the occupation or trade of 40% of the clients was unknown. Only 3% were skilled laborers. 186 TABLE 50.--Employment Status of Social Service Clients Who Used Drugs. Clients Employment Status Number Percent Employed 15 14.3 Unemployed 55 53,3 Other 2 1.9 Unknown _32 30.5 Total 105 100.0 TABLE 51.-—Occupation or Trade of Social Service Clients Who Used 1 Drugs. C1ients Occupation Type Number Percent Skilled 3 2.9 Unskilled 31 29.5 Business person 9 8.6 Public servant 0_ 0.0 Professional 0 0.0 Student 7 6.7 Housewife 11 10.5 Retired 2 1.9 Unknown _42 _49;Q Total 105 100.1 187 Twelve (or 11%) of the 105 Social Service clients who used drugs had prior arrests for drug abuse. Seventy-five percent of the arrests were for abuse of alcohol, 17% were for possession of drugs other than alcohol, and 8% were for possession of drug para- phernalia. The Department of Social Service clients who used drugs used primarily alcohol (36.2% of 105 clients) or were poly-drug users (22.9%) meaning that they used several drugs in combination. Of the 38 clients who used only alcohol, about 61% were 30 to 49 years of age with most of the others, 24%, being 50 years of age or older. Only about 16% of those using only alcohol were under 30 years of age. Many of the poly-drug users combined alcohol with other drugs, such as marihuana or depressants. About 16% of the 105 clients used marihuana only, and most of these (94%) were under 30 years of age; none were 50 years of age or older. Marihuana was often used by the poly-drug users along with other drugs. It is interesting to note that the majority or 62.5% of the poly-drug users were under 29 years of age (Table 52). The trend seems to be for the clients over 30 who were classified as using drugs to use only alcohol. Those under 30 were primarily poly-drug users who experiment with different drugs from marihuana to stimu- lants and depressants to even opiates. Relatively few, if any, of the clients used stimulants or depressants. As expected, those c1i— ents using inhalants were in the 10 to 17 years of age group. Very few people beyond these ages (Tables 52 and 53) were using inhalants. NF :ocx p.coa . m.N~ o.mN n.2, w.om o.mN 0.0 0.0 em mmszlhroa o oo_ O.O O.O o.o 0.0 0.0 o.o 0.0 o A.opw .mvzpmmzov wco_m:cm;pwz O O . O.O O.O O.O O.O O.O 0.0 O 8588 0.0 o o Amm>NpO>chu mpmwao . . . .o 0.0 o ewcuo a .UNLommLOO .m:w;O 0.0 0.0 0.0 o o o o o o o -LoE .mcwmuou .ONOLOOV NOOONOO A=NLONONN3c . -OOLp LOCOS: o» mmuogzpwncmn . 0.0 0.00 0.00 0.0N 0.0 o o m Eogw mpcwmo Numwxcmiwpcm w>wp O.OON o o umuww No mace; wcwv mucmmmwgawo . AOFNNQOOQ .mchEOumcaEmzumE 8 . o.o o.o o.o 0.0 0.0 0.02 o o — .mmcwsfimzaeg 3,535.55 010 O OS . 39% 22.2.: O .5 o.o 0.0 0.0 0.0 o.o 0.0 o o o .chNOONOE ,omOV OOOOOCNUONNO: o o Ampcmuwxopcw ONOpO—o> Lo .O O.O O.O O.O N.NN N.OO O.O N 282, .556 O 2:3 3:225 o oo_ o Amowpwspczmuoxh .o O.O O.N. ONN 0.00 0.0 0.0 NN .5352 3.638;: 2358: o oo— o . s . $.N mm 3:82. 3.02 NNNN dem .NmO NON N.N O No 0 . NNHON +om melon mmnmm Fm-w_ NN-m_ ON-o_ ON News: 2 mocmpmnzw Oo waxy mm< mmmmmeUz—mfl mm Nh m_m__t— ”So—rm Enmm moP:_a—rmy—c—. :o—r . a . a—I 189 N . NHOONOENHN _ NcwmocNOONNO: .Ocmscwgmz _ _ mcwmocwozppm: w chzcwgmz N F mpcmmmwgawu a Ocmzcwgmz F N mucmNOENpm w mcwzcwcmz m mpcmmmwgawu N _ .mpcmpsswpm .FocouN< m m NHOONOENHN a mammocNUONNm: m m mpcmmmwcawc .mucmpzswpm .mcwmocwo:_NO: mmumwao .mucmwmmgawu _ N .mpcmstNpm .mcmmOCNuzN 1PM; .mcwzcwgwe .Nocou—< _ F N mucwmmwgawc w mu:m_:ENpm mpcwmmwcamv .mpcm_:ewpm N F m .mcwmocwusNNO; .chzcwcmz F m O mpcwmmmgaww a Nocou_< _ N m Ocmzcwcws w Nocoo_< . u u i 1 gm :3 +om me om mm NN Fm mp NF mp ON ON on u z mucmumnzm mo maxp wm< .mcmm: magaanom wL< on: :ummm Owcwmgw> cm NpcmwNumwoN>meNNN80m mo pcmEpLOOmQ--.mm m4mrmmeme wo 2x0; monHo< 4mcmm EanoLm uwywowam APPENDIX B SURVEY FORMS 1 240 APPENDIX B SURVEY FORMS SURVEY OF PHYSICIANS IN VIRGINIA BEACH Please state your nane and the address of your office in the following spaces. Due to the small size of this sample, it will be necessary'to send out follow—up questionnaires to those physicians who do not respond to the first questionnaire. It is for this purpose only that we ask your news. Please write your name and the address of your office on this page. We will separate this page from the rest of the survey and discard it when all the surveys have been returned. Your answers will be held strictly confidential. Your name Office Address Area of specialization within the field of medicine 241 j“ 242 1. In this survey, we are trying to ascertain facts about drug abuse, ‘ not merely opinions. That is why the following questions are asked about people you have actually come in contact with, not about the population at large. These "people you have come in contact with" in- clude not only patients, friends, relatives and acquaintances but also people you have passed in the stores or streets, people you think may have been using drugs. Below are listed several categories of drugs. We would like you to check how widely you think these drugs are being used by people you have come in contact with. Degree of Use ' KEY u WIDESPREAD— g :3 E g Of the people whom I have a 3 a E‘ a a) h come in contact with in the o, m Q40 .0 m past 12 months, I would $ 3 8 > 8 313 8 estimate that about 20 DRUGS E Egéggé’g or more use this drug on a regular basis. 5 Marihuana (including Hash— ish, THC—synthetics) MODERATELY WIDESPREAD— Of the people whom I have cone in contact with in the past 12 months, I would estimate that about 10 to 20 use this drug regularly. Inhalants (glue & other vapors or volatile intoxicants) Hallucinogens (ISD, nesca— _}§§e, STP & similar drugs) NOT VERY WIDESPREAD— Of the people whom I have - . cone in contact with in the Stimulants (Amphetamines, past 12 months, I would "EthamphetarrdneS. pep estimate that about 5 to 10 P1113) use this drug regularly. Depressants (the range of ‘ HARDLY EVER USED BY ANYONE- sedative anti—anxiety Of the people whom I have agents ranging from come in contact with in the barbiturates to "ndnor _ 'past 12 nonths, I would _§§anquilizerSW) estimate that less than 5 . use this dru re arly- Opiates (heroin, codeine, 8 gul norphine, paragoric, & other opiate derivatives) Cocaine -‘ Quaaludes Other, specify: Nwflomm uhofivo Lmfilsalgm . mfimuoo 7.52.5.5 3&8 Mafia 6 6.20mi .oqwfihnu . .0538 .5805 e338 _ 4%. heads: 3 movmthwnhmn 59G wqmwnau gnome 503735 03333 no ammo." 05v 3538an finial non 503323533 .moguoéé magi—5pm 243 Tea than a new .258 Inna .nmd mummofiosam “ascetic?“ c.1339 .3 gong 35.0 a. 3H3 35% Hmefimfififi Ema. Inmmx wasaofiv 55.32 H0283. 8038. .8. amnesia. .9: um: 9: 55:3 .8. .85 zumom .m> nomwm .m> C. (e Z I I T. 1:0: .w>< 15m .o>< Ice: .m>< 156 .o>< ouamuzo .96 :H .95 O W ac ma J: mv @035 .350 a mumoh ma memo» ma you—5 «7 To R R M W .Eflofiwhnm m mm 50% 5 m lungOo 5 “ovum.“ mfifififinucoo a no “opmenaohaqm .3." m 09.80 gig on» .853 98 mg 98.8.38 one 80:: 5:9: u§?coc swap: 5 MESS :25 9.8 5:08 .2556 gauge 9.3 in com :0.» 3:393 has to: 39:33 33.8 .4 58 x85 .5QO age I35 mo muamuno .3 U5 5 as deem 35 .5 .wo 3:338 in?» 39» cows: mg 305 x026 .m no? gate x55 50% :02: moflom 133 owe 2.3 #028 .N w 244 5. Please place the approximate number of patients that you see during an average summer month and average non—summer month who use the following non-prescription drugs on a regular basis. List any additional drugs that people may be abusing. Check the age categories which you think primarily use each type 0 +) Number who use these drugs V80 veo 6. 245 and the average non-summer month Please estimate the number of patients you see during the average summer month Do you know of persons in Virginia Beach engaged in the abuse of drugs 7. (excluding alcohol and tobacco)? Yes No. Estimate of number . Predominate age group . 8. Do you know of persons in Virginia Beach engaged in the illegal sale -of drugs? Yes No. Estimate of number . Predominate age group . l 9. Without necessarily having direct knowledge, do you believe that there is illegal drug trafficking in Virginia Beach? Yes No. Estimate of number of such persons . 10. How many patients do you see during an average month for non-drug reasons whom you suspect or have found to have drug problems? Under 18 years old . 18 years old and over . 1]. Check those Check those From which of the following Check these programs . programs sources did you hear about programs with which which you each of these progrars? you feel you are have not Other, should be PROGRAM famfiliar heard of gflgdia Friends School Specify egpggded Alcoholics Anonymous Alcohol Infor— mation Center Broken Needles Drug Informa- tion Center Drug Outreach flats}; Martus 1 Inc. Other: Specify k; 246 12. Do you think these programs can adequately handle the drug problem in Virginia Beach? __ Very we11 __ Fairly well __ Not too Hell __ Not at all. If not, what kinds of additional program do you think should be established? Please explain 13. Are you aware of any drug abuse prevention programs in Virginia Beach or in this area? Yes No. Which ones? Do you think these are effective? Yes No. Do you think more drug abuse prevention programs are needed? Yes No. What kinds? ' 11». Here is a list of alternatives for drug abuse treatment. Read the fol- lowing descriptions of the different types of treatment before answering the questions. Zhygician or private clinic —Go to a doctor for care and proper guidance. local General Hospital— enter this type of a hospital for treatment. Local Pgéhiatric Hosgtal—enter this type of a hospital for treatment. State Psychiatric Hospital—enter this type of a hospital for treatment. Methadone many—enter a methadone program to stop use of heroin. Traditional church—go to minister of a conventional church for guidance. Live- in therapeutic commun ity—Join a group of other drug users living at a psychological counseling center. Non-conventional reli ions or anization—join an uhcoventional religious WWW strength. Hotline or referral center—talk to a community referral agency to find out what facilities can best help. F‘I'iendsétalk with people you trust to find out what they think is best. Professional psychotherapy—consult with a psycholOgist or psychiatrist. Out-patient counselling center—visit a community counselling recgeritgriy Icgal restraint—Jail or correctional institution. Eggs—no treatment alternative is recommended. Mmome other alternative not mentaioned here is preferable. , ‘Don't know—I really can't say with what I know now about the problem. Cl“— 247 14. (See the previous page for instructions.) (A.) Where would you refer someone who was addicted to-heroin or one of the other opium derivatives (codeine, morphine, paragoric, etc.)? Please check one or more of the following alternatives in Column A. (8.) Where would you refer someone who was misusing some other drug - (ha11ucinogens, stimulants, depressants, etc.)? Please check one or more of the following alternatives in Column B. 248 SURVEY OF ATTORNEYS IN VIRGINIA BEACH Please state your name and the address of your office in the fbllowing spaces. Due to the small size of this sample, it will' be necessary to send out followHup questionnaires to those attorneys who do not respond to the first questionnaire. It is for this purpose only that we ask your name. Please write your name and the} address of your office on this page. We will separate this page from the rest of the survey and discard it when all the surveys have been returned. Your answers will be held strictly confidential. Your name Office Address 249 1. In this survey, we are trying to ascertain Eagle about drug abuse, not merely opinions. That is why the following questions are asked about people you have actually come in contact with, not about the population at large. The "people you have come in contact with" include not only clients, friends, relatives and acquaintances but also people you have passed in the stores or streets, people you think may have been using drugs. Below are listed several categories of drugs. We would like you to check how widely you think these drugs are being used by people you have come in contact with. ' Degree of Use KEY WIDESPREAD— ,6 mg U E Of the people whom I have 8 '3‘, a, big: q) cone in contact with in the ‘5. *3 ‘* a, 3 (Dr past 12 months, I would 3, g, E, : "g, a .8 8 estimate that about 20 , . . o more us th'sdrugona DRUGS 9 g Q ‘2) g g 3 3 regular basis. 1 Marihuana (including Hash- (ADDERATELY WIDESPREAD— ishx THC—smthetlcsl Of the people whom I have come in contact with in the Inhalants (glue & other . past 12 months, I would Vapors or volatile - estimate that about 10 to 20 intoxicantsL use this drug regularly. Hallucinogens (ISD, mesca— .. ' or VERY WIDESPREAD- line, STP & similar drugs} Of the people whom I have St‘ ' come in contact with in the 1mulants (Amphetamines, past 12 months, I would milliamphetamnes. pep estimate that about 5 to 10 2 8) use this drug regularly. Depressants (the range of _ HARDLY EVER USED By ANYONE- :edative anti-anxiety 0f the people whom I have 13:21: 11:82ng from come in contact with in the tran Idlizzrs-s"; "Cl-nor past 12 months, I would ‘9 estimate that less than 5 Opiates (heroin, codeine, use this drug regularly. morphine, paragoric, & other 0 iate derivativgg) Cocaine Quaaludes Other, specify x 250 1|] JJIHMIQW (jog .IIIIIIIlllnuuuunlnlllnnunllxll wfidooo mgfivgfihflfi 0gb O . a .owhommhma mogmmwa“ . 9:868 .5935 mounds Acacia w rmficfimh noses: op messagesnew Eon.“ Manda macaw—m 533735 3333 mo smash .ean 3532an ‘ . mad“. Q1 . use . meagfiteeamfipa wépwénb wvfigfium hexane nausea a mam .mfiamo Imus .owd mnmwofiogwnmm 1 amufimt Tact; oflumag .Ho whom? hmnpo a 253 mundamfifl (Ill—III Ave.. J4 amp ewe Inmmm mandofiv egg H9892 . fl _ __ ooompom. a i .oE use .8 spam .8 nee momem .m> u nommm .m? C. E Z T. .L T. momma neon .2, 155 51:8: .2115m .92 teased tam .w E bum o p 1 a. M p n96 a mummH m1. memoir ma noun». we no “a E L W make 0mm... mo 33% and. on sowed?“ "teeaumoammm .3 m _ 9330.3 no.“ ©3928 one numwm choc. 2.096 .333 madam J _ .a> 5 509893 5 mm :6» pmnu 5mg... omens: 5 mafia. .8 hoards opmndnoumae one 8.3% .mg opmflmonmmm «5 on BBQ .4 13S no oeumnuo .3 use .H.” ~30. .8QO mdh “4.. mo 35.3mm.“ trifle mom node», mmehe 323 2.025. .N 138 ems e 0 "mad mo oaths. some mom: Eugene seat 30% 833 mean om 5 x35 N 251 5. During an average nonth, do you counsel young people, between the ages of 12 and 21, who cone to you for advice but who were not as yet in trouble9 (Counseling directly related to the drug problem) Yes ‘No Estimate of the number you have talked with during the last 12 months . 6. Do you know of persons in Virginia Beach engaged in the abuse of drugs? (excluding alcohol and tobacco) Yes No - . Estimate of number . Predominate age group . 7. Do you know of persons in Virginia Beach engaged in the illegal sale of drugs? . Yes No. Estinete of number Predondnate age group 8. Without necessarily having direct knowledge, do you believe that there is illegal drug trafficking in Virginia Beach? Yes No. Estimate of the nunber of such persons . 9. How many clients do you see during an average month for non-drug reasons whom you suspect or have found to have drug problems? Under 18 years old 18 years of age and older '. 10. Check th‘ose Check those From which of the following Check those prOgrams programs sources did you hear about prograns ~ with which which you each of these prOgrams? you feel you are ' have not Other, should be PROGRAMS . familiar heard of Media Friends School Specifly egpanded Alcoholics Anonym mus Alcohol Infor— nation Center Broken Needles tion Center DrUg,0utreach Center { 1 Drug Informa- \ \ ] Martus, Inc. Other - L ‘ 252 11. Do you think these programs can adequately handle the drug problem in Virginia Beach? Very well Fairly well Not too well Not at all. If not, what kinds of additional pregrams do you think should be established? Please explain 12. Are you aware of any drug abuse prevention progress in Virginia Beach or in this area? Yes No. Which ones? Do you think these are effective? Yes No. Do you think more drug abuse prevention programs are needed? Yes No. What kinds? H t 13. Here is a list of alternatives for drug abuse treatment. Read the fol- lowing descriptions of the different types of treatnent before answering the questions. . Physician or private clinic-—Go to a doctor for care and preper guidance. local General Hospital—— enter this type of a hospital for treatment. local Psychiatric Hospital-—enter this type of a hospital for treatnent. State Psychiatric Hospital-—enter this type of a hOSpital for treatment. Methadone progganh—enter a nethadone prOgram to stop use of heroin. Traditional church-—go to ndnister of a conventional church for guidance. IdNe-in therapeutic community——join a group of other drug users living at a psychological counseling center. Non-conventional religious organization-join an uhcoventional religious group in order to develop spiritual strength. Hotline or referral center—-talk to a community referral agency to find out what facilities can best help. Friends-—talk with people you trust to find out what they think is best. Professional psychotherapy—-consult with a psychologist or psychiatrist. Out-pgtient counselling center-—Nisit a community counsellingegflyagiy. legal restraint——jail or correctional institution. figggr-no treatment alternative is reconmended. Qfihggr-some other alternative not nentaioned here is preferable. Don‘t knowa-I really can't say with what I know now about the problem. a 253 SURVEY OF PHARMACISTS IN VIRGINIA BEACH Please state your nane and the address of your business in the following spaces. Due to the swell size of this sample, it will be necessary to send out followeup questionnaires t0.th088 pharmacists who do not respond to the first questionnaire. It is for this purpose only that we ask your news. Please write your nane and the address of your business on this page. We will separate this page from the rest of the survey and discard it when all the surveys have been returned. Your answers will be held strictly confidential. Your name Address Please describe the location of your pharmacy. Is it in a hospital, doctor's building, part of a business ("drug store"), other, please specify ii; a, 254 1. In this survey, we are trying to ascertain 3333 about drug abuse, not merely opinions. That is why the following questions are asked about people you have actually come in contact with, not about the population at large. These "people you have come in contact with" include not only customers, friends, relatives and acquaintances but also people you have passed in the stores or streets, people you think may have been using drugs. Below are listed several categories of drugs. We would like you to check how widely you think these drugs are being used by people you have coma in contact with. Degree of Use KEY h WIDESPREAD- g 34'}? '3 9 Of the people whom I have E #3 8 5’22 0 5‘ m come in contact with in the am, 3 3 > 3%“ 5 past 12 months, I would a e u 4: u «1: estimate that about 20 "1311.105 :3 g ‘53 2° E: 53 59> or more use this drug on a . regular basis. Marihuana (including Hash- ishLTHC—synthetics} mDERAT'ELY WIDESPREAD- Of the people whom I have Inhalants (glue 8: other come in contact with in the vapors or volatile past 12 months, I would intoxicants) estimate that about 10 - 20 use this drug regu1ar1y. Hallucinogens (LSD, mesca— ‘ . lineJ STP a similar drugs) . NOT VERY WIDESPREAD— Of the people whom I have Stimulants (amphetanfines, come in contact with in the methamphetandnes, pep past 12 months, I would pills) estimate that about 5 - 10 use this drug regularly. Depressants (the range of . sedative anti-anxiety HARDLY EVER USED BY ANYONE- agents ranging from 01‘ the people whom I have barbiturates to "minor come in contact with in the tranquilizers“) past 12 months, I would estimate that less than 5 Opiates (heroin, codeine, use this drug regularly. morphine, paragoric, & other opiate derivatives) Cocaine Quaaludes Other, specify 255 2. . Check the age cate— Check thoase drugs which gories which you you think residents of think primarily uses Vir inia Beach buy in each type of drug: and pr.outside of Vir— ginia Beach. Check both E if appropriate: DRUGS g a :3 §- 3 33m? in Buy outside _.___9 ,4 .4 a. Beach Va. Beach Tobacco Alcohol Marihuana (including Hash— ish, THC-synthetics)i Inhalants (glue & other vapors or volatile intoxicants Hallucinogens (LSD, nes- caline, STP & similar amiss Stinmlants (amphetamines, nethamphetamines, pep pills) Depressants (the range of sedative anti—anxiety agents ranging from barbiturates to "ndnor tranguilizersfi) Opiates (heroin, codeine, morphine , paragoric , 8: other opiate derivatives) Cocaine Quaaludes Other A. What is the approximate number of prescriptions filled during an average sunner nonth? .__ During an average non—summer nonth? 5. Do you believe that items such as snaking accessories which are sold in your pharmacy, are being used for any form of drug abuse? ___ Yes ___ No. Check which Ones of the following: ___ Pipes ___ Lighter fluid ___ Cigarette papers ___ Others, specify 256 6. Try to estimate the number of the following drugs sold by your pharmacy during an average summer and non-suumer-nnnth. List any additional drugs that people may be abusing. Check the age categories which you think primarily use each of drug: at! who use these drugs: O .p non—sum— Ve o VB 0 summer NON-PRESCRIPTION For Headaches: Ty enol 257 7. Of all the prescrip— Of all the prescrip— 8. tions filled during tions filled during < an average sunmer an average Non-sum; month, what percent- mgr month, what per- ‘ age would you centage would you estimate were for: estimate were for: In the last 12 months Average Summer Average Non-summer have certain types Month Month of dru s been stolen? DRUGS ~ (Please check) Tranguilizers Berbituratggfi Morphine Codeine Paragoric Meperidine Amphetamines 9. Do you think that the drugs were stolen for private use or for illegal sale? Private use Sale. 10. If you believe that you have noticed instances of abuse of drugs in the above categories, how many prescriptions would you say were involved? . 111 Do you know of persons in Virginia Beach engaged in the abuse of drugs (excluding alcohol and tobacco)? Yes No. Estinate of \ number Predominate age group . 12. Do you know of persons in Virginia Beach engaged in the illegal sale of drugs? Yes No. Estimate of number Predominate age group 0 13. Without necessariLy having direct knowledge, do you believe that there is illegal drug trafficking in Virginia Beach? Estimate of the number Yes No. Predoninate age group . tr 258 1A. Have you observed persons who frequent or who enter your business occasionally, who appeared to be involved in the abuse of drugs? Yes No. Please state the number during the average" sunmer nonth . Please state the number during the average non—summer month . 15. Number the following age categories (1 through 3, 1 being the most‘” likely, etc.) according to howljkely each is to take drugs they don't need. ‘ under 22, 22 to 29, 30 to A9, so andbver. 16. Check those Check those From which of the following Checkrthose programs programs sources did you hear about programs with which which you each of these programs? you feel you are have not Other, should be PROGRAM familiar heard of Media Friends School Specigx egpanded Alcoholics I Anomus Alcohol Infor- mation Center Broken Needles Drug Informa- tion Center Drug Outreach Center Martus, Inc. Qfiher, (Specify) 17. 18. 19. 259 Do you think these pregrams can adequately handle the drug problem in Virginia Beach? __ Very well __ Fairly well __ Not too we11 __ Not at all. If not, what kinds of additional program do you think should be established? Please explain Are you aware of any drug abuse prevention program in Virginia Beach or in this area? Yes No. Which ones? Do you think these are effective? Yes No. Do you think more drug abuse prevention programs are needed? Yes No. What kinds? Here is a list of alternatives for drug abuse treatment. Read the fol- lowing descriptions of the different types of treatment before answering the questions. . Physician or private clinic—Go to a doctor for care and proper guidance. Local General Hospital— enter this type of a hospital for treatment. Local ngchiatric Hospital—enter this type of a hospital for treatment. State Psychiatric Heepital—enter this type of a hospital for treatmnt. Methadone program—enter a methadone program to stop use of heroin. Traditional church—go to minister of a conventional church for guidance. Live -in therapeutic community—Join a group of other drug users living at a psychological counseling center. Non-conventional religious organization—Join an u'ncoventional religious group in order to develop spiritual strength. Hotline or referral center—talk to a community referral agency to find, out what facilities can best help. F'riends--talk with people you trust to find out what they think is best. Profession}; psychotherapy—consult with a psycholOgist or psychiatrist. Out-patient counselling center—visit a community counselling center *— ' regularly. legal restraint—jail or correctional institution. None—no treatment alternative is recommended. Other—some other alternative not mentaioned here is preferable. 'Don't know—I really can 't say with what I know now about the problem. a 260 _(A.) Where would you refer someone who was addicted to-heroin or one of the other opium derivatives (codeine, morphine, paragoric, etc.)? Please check one or more of the following alternatives in Column A. (3.) Where would you refer someone who was misusing some other drug (hallucinOgens, stimulants, depressants, etc.)? Please check one or more of the following alternatives in Column B. Cements 26] SURVEY OF BUSINESSES IN VIRGINIA BEACH I Please check one or more: . , ~ Type of business: motel, hotel restaurant, snack shop,-cafe, bar store or shop: grocery, supermarket, - drug store, hardware, clothing store, head shop, etc. entertainment center: theater, amusement park, discotheque, etc. building contractors, construction business, e C. other, specify Size of business: ___ Business valued at less than $10,000 Business valued at $10,000 to $25,000 Business valued at $25,000 to $100,000 Business valued at $100,000 to $500,000 Business valued at $500,000 to $1,000,000 Business valued at $1,000,000 and over 'Don‘t know Other, explain I I‘ll-HI! Location of business: Please write in the zip code of your business address to give its approximate location: Your position in the business: Owner Manager—operator Worker: waiter, clerk, etc. _— - _— ___- Other, explain 262 1. v In this survey, we are trying to ascertain £15333 about drug abuse, hot merely opinions. That is why the ‘following questions are asked about people you have actually come in contact with, not about the population at large. These "people you have come in contact with" include not only customers, friends, relatives and acquaintances but also people you have passed in the stores or streets, people you think may have been using drugs. Below are listed several categories of drugs. We would like you to check how wide1y you think these drugs are being used by people you have come in contact with. Degree of Use KEY $4 ‘3 3% R 9 WIDESPREAD— 2 3 a 3‘ a o 5’ Of the people whom I have 8' 2 m é’ mg 2 come in contact with in the DRUGS 3 .3 .8 +3 ,8 n '8 0 past 12 months, I wofld g g g g g a g", < estimate thathebogt 20 , We (mcludmg Has - °r more use .15 “‘5 °n ish, THC—synthetics) a regular “515' MDDERATELY WIDESPREAD— Inhalants (glgetgclother Of the people whom I have 125°“ ”t“; a e ' , come in contact with in the oncan 5 past 12 months, I would' , stimate that about 10 to 20 HalluCinogens (LSD, mesca— ‘ e . line, STP at similar drugs) use this drug mg‘flaflV' . . NOT VERY WIDESPREAD- Stimulants (Amxphetamunes, Of the people whom I have ”33:?hetame3' P8P come in contact with in the P past 12 months, I would timate that about 5 to 10 Depressants (the range of. es . . sedative anti-anxiety use this drug regularly. agents ranging from ' mum to am “new: flqmizers") come in contact with in the . . ast 12 mo ths I would Oplatlegnwemin, codeine, ' Estimate that less than 5 morp e paragoric & . other opiate derivatives) use this drug regularly. Cocaine Quaaludes Other, specify 263 unaapmuuaqu xxxqumeNMIqmmmmm nonfidmmmm mgflmooo mo>wum>fihou 09m. 0 hvcuo a .uwhowmhma .ocflsnhou $52.60 .5535 mopmflo ‘ emanated hands: op wopmndpwnhmn Eon.“ wfimcmh mpnmmm huofixdslwpnd m>HPMUmm Ho mmnnu mnpv mp:dmmmhaon mmHHQWI and .wmuHEmpoanmanu .nocasooocae Ho macam> honwo a odfimv mpcmflmndH “nonconcmwmumme .nna Inna: mcfludaoadv mandnwhmz Honooa< Ooomnoe nummm .m> nommm .m> C; re 7o TL T. T. momma oufimudobfi 5%.” H m we H mu .oxHH o 66 RAW 50» we owed on» go season "eponymoumdw ma 2909 m on» an :Hwaqu .pwmd xoono .nomom macaw J on» :H cannon» oaufiomam mmocamsn Ado» no do» vowsmo m>an has cusps omen: awake omonv enamon xoono a woman .4 IMH> mo enemaso no van on son noocm one“ hes no mucoUHmon xnwnw 50% none: emote omens xoono O m "mans Mo ooh» none none naawnsawo zones 30% song: mofihom Isaac omm on» xomno .N 264 5. Do you know of persons in Virginia Beach engaged in the abuse of drugs? (excluding alcohol and tobacco) Yes No. Estimate of number . Predominate age group . 6. Do you know of persons in Virginia Beach engaged in the illegal sale of drugs? Yes No. Estimate of number . Predominate ___ age group . 7. Without necessarily having direct knowledge, do you believe that there is illegal drug trafficking in Virginia Beach? Yes No. Estimate of number of such persons . 8. Have you observed persons who frequent or who enter your business occasionally, who appeared to be involved in the abuse of drugs? Yes No. Please state the number during an average summer _— month . Please state the number during an average non-summer month . those which of the fellowing those did you hear about of these th which are Alcoholics Alcohol Infor— Drug Informa- Drug Outreach 10. ll. 12. 265 Do you think these programs can adequately handle the drug problem in Virginia Beach? __ Very we11 __ Fairly well __ Not too V811 __ Not at all. If not, what kinds of additional programs do you think should be established? Please explain Are you aware of any drug abuse prevention prOgrams in Virginia Beach or in this area? Yes No. Which ones? Do you think these are effective? Yes No. Do you think more drug abuse prevention programs are needed? Yes No. What kinds? Here is a list of alternatives for drug abuse treatment. Read the fol- lowing descriptions of the different types of treatment before answering the questions. ' P_hysician or private clinic—Go to a doctor for care and proper guidance. local General Hoseital— enter this type of a hospital for treatmnt. local PsyChiatric Hospital—enter this type of a hospital for treatment. State Psychiatric Hospital—enter this type of a hospital for treatment. Methadone program-enter a methadone program to stop use of heroin. Traditional church—go to minister of a conventional church for guidance. Live -in therapeutic comm—Join a group of other drug users living at a psychological counseling center. Non-conventional religious organization—join an uhcoventional religious group in order to develop spiritual strength. Hotline or referral center—talk to a community referral agency to find out what facilities can best help. Friends—talk with people you trust to find out what they think is best. Professional psychotheram—consult with a psychologist or psychiatrist. Out-Etient counselling center—visit a commity counsellingecgeunltgziy. Iagal restraint—jail or correctional institution. Egg—no treatment alternative is recommended. 0ther—-some other alternative not mentaioned here is preferable. 'Don't know—I really can 't say with what I know now about the problem. 266 '12.” (See the previous page for instructions.) (A.) Where would you refer someone who was addicted to heroin or one of the other opium derivatives (codeine, morphine, paragoric, etc.)? Please check one or more of the following alternatives in Column A. (8.) Where would you refer someone who was misusing some other drug (hallucinogens, stimulants, depressants, etc.)? Please check one or more of the following alternatives in Column B. 267 VIRGINIA BEACH DRUG ABUSE SURVEY 1. In this survey, we are trying to ascertain facts about drug abuse, not merely opinions. That is why the following questions are asked about people you have actually come in contact with, not about the population at large. The ”people you have come in contact_with" . include not only clients, friends, relatives and acquaintances but also people you have passed in the stores or streets, people you think may have been using drugs. ' - Below are listed several categories of drugs. We would like you to check how widely you think these drugs are being used by people you have come in contact with. Degree of Use KEY IWIDESPREAD- . .d . gg .3 5,; ‘ or the people whom I have 8 73 o i? 22 o come in contact with in the S. 13 ‘d o 5' o past 12 months, I would 41"} Egg: :5} and), 8A estimate that about 20 . . . u this me e e e: e :2 e a: 3 intense “8 °“ Marihuana (including Hash- .NDDERATELY WIDESPREAD— 15h, THC—synthet1081 Of the people whom I have come in contact with in the Inhalants (glue & other ' past 12 months, I would vapors or volatlle - estimate that about 10 to 20 intoxicants) use this drug regu1ar1y. Hallucinogens (LSD, mesca- . . OT VERY WIDESPREAD— . line, STP at similar drugs) Of the people whom I have . come in contact with in the Stimulants (Amrphetamnnes, past 12 months, I would mthamhetamnesy pep estimate that about 5 to 10 Pills) use this drug regularly. Depressants (the range of . HARDLY EVER USED BI ANYONE- Bedative anti-annety 0f the people whom I have agents ranging from come in contact with in the barbiturates to "minor past 12 months, I would tranquilizers") estimate that less than 5 . use this re ar . Opiates (heroin, codeine, ' drug gul 1y morphine, paragoric, & other opiate derivativei) Cocaine Quaaludes Other, specify 268 auaooon .scspo mouadmmsm mcflmUou amopwum>ahoo banana bongo . 6 .ofihommhoa .ongnhns 05330 .5935 mundane A t ”Hg house: on novnnspwnamp Scum mawwcmn mucmmm hpogwpqo 938$ no omens ospv npsonnonaco madam moo .nosEoponsmnfime . nogopofiaso nosmdsfim hmwdho snaaean a new .ocaamo Imus .QWS nflomofiunddmm mmpcmowxopnfl oHHpmHo> no whoamp nonuo a ozdmv mpnmaondH Anoapossswnqome .sma acne: wcaosaonav ocosnanns Honooas ooomnoa .ce umEESm .oE nos .05 .Edm .oE nos nomom .m> nomom .m? rt so ,L .L cL momma loo: 55¢ 15m .m>< Icon .o>< 15m .o>< cognac >45 5 El m no we H mu 1.0 E R .6 Mn no>o e mnowN,mH mnoow ma noon: \4m3nc page go shape on» on nonmaon nEoHnonQ sopcsooco do» once noose ommno>n cm CH woman mo gonads opmeflxonddm one woman .4 .msho opmanaonaam on» on pxoz "oumflaQOHQmm an .nomom macaw Iua> mo moflmpso newest on son semen mass mo mucooflmop xnflnp so ness: omens omens gonzo soon xoeno .HH.>. .m zano p 09 "wand mo bah» some news haflaoewnd xcnnp so» nuns: mofinom taboo own one xoono .N 269 5. During an average month, do you counsel young people, between the ages of 12 and 21, who come to you for advice but who were not as yet in trouble? (Counseling directly related to the drug problem) 'Yes Nb Estimate of the number you have talked with during the last 12 months 6. Do you know of persons in Virginia Beach engaged in the abuse of drugs? (excluding alcohol and tobacco) Yes No . Estimate of number . Predominate age group 7. Do you know of persons in Virginia Beach engaged in the illegal sale of drugs? Yes No. Estimate of number Predominate age group 8. Without necessarily having direct knowledge, do you believe that there is illegal drug trafficking in Virginia Beach? Yes No. Estimate of the number of such persons . 9. How many persons do you see during an average month for non-drug reasons whom you suspect or have found to have drug problems? Under 18‘years old 18 years of age and older . 10. Check those Check those From which of the fbllowing Check those prOgrams prOgrams sources did you hear about programs with which which you each of these programs? you feel you are have not {Other, should be EBQGRAMS familiar heard of Media Friends School Speci expanded Alcoholics Anonymous Alcohol Infor- _§§tion Center Ezpken‘Needles Ihflgihnbrma- _tion Center Drug,0utreach _Qenter Mgrtus , Inc . filer, 11., 12. 13. 270 Do you think these programs can adequately handle the drug problem in Virginia Beach? Very Well Fairly well Not too well Not at all. If not, what kinds of additional programs do you think should be established? Please explain Are you aware of any drug abuse prevention prOgrams in Virginia Beach or in this area? Yes No. _‘I‘I— Which ones? Do you think these are effective? Yes No. Do you think more drug abuse prevention programs are needed? Yes No. What kinds? If you have any specific information concerning drug abuse in Virginia Beach which you think might be useful to this survey, would you please relate it in the following space. ___ if, 271 1A. (A) Where would you refer someone who was addicted to heroin or one of the other opium derivatives (codeine, morphine, paragoric, etc.)? Please check one or more of the following alternatives in Column A. ‘ (B) Where would you refer someone who was misusing some other drug hallucinogens, stimulants, depressants, etc.)? Please check one or more of the following alternatives in Column B. A ’ B Physician or private clinic Local General Hospital Local Psychiatric Hospital State Psychiatric Hospital Methadone program (enter a Eethadone prOgram to stop using heroin) Traditional church ' go to minister of conventional church for __‘guidance) Live-in therapeutic community (join a group of other drug users living at a psychological counseling center), Non—conventional religious organization (develop spiritual strength by joining an un— conventional religious grggp) Hotline or referral center (find out what facilities can best_hgio) Friends ..i§§}k With people you trust) Professional psychotherapy __i!i§it a psychologist or psychiatrist) Out-patient counselling center (ViSit a community counselling center regularly) legal restraint all or correctional institution) None no treatment alternative is recommended) Other (Some other alternative not mentioned here We) Don't Know (I really don't know much about the problem) Comments 272 SURVEY OE HOUSEHOIDS IN VIRGINIA BEACH DO NOT WRITE YOUR NAME OR ADDRESS ON THIS QUESTIONNAIRE! The City of Virginia Beach is conducting a comprehensive study of drug abuse in order to plan future drug abuse centers and drug education programs. Therefore, it is necessary to ask questions about personal drug use. These questions concern legal use of medically prescribed drugs as well as illegal drug use. Remember the survey is anonymous. No one can ever contact you concerning your answers. 1. In this survey, we are trying to ascertain facts about drug abuse, ra- ther than opinions. That is why the following questions are asked about people you have actually come in contact with, not about the population at large. These "people you have come in contact with" include not only friends, relatives, business and professional associates, and acquaintances but also anyone you know who is using drugs. Below are listed several categories of drugs. We would like you to check how wide1y you think these drugs are being used by people you have come in contact with. KEY 8 WIDESPREAD- ,6 o o n _0 Of the people whom I have come in “NE m m E 3 contact with in the past 12 months 22 ,3 22 i’: :2 I would estimate that about 20 or 3 s 3 3 «853“ u more use this drug on a regular DRUGS _H :3 p:o o 3 basis. 0 a m m o 3 zzzmsz . DDDERATELY WIDESPREAD— Migihugfig_§i::i:gigg)Hash Of the people whom I have come in -————L—————— contact with in the past 12 months Inhalants (glue & other ’ I would estimate that about 10-20 vapors or volatile use this drug regularly. intoxigants)47 NOT VERY WIDESPREAD— “iiiucégggzngiéiig; g::;:§‘ Of the people whom I have come in -——-r1 contact with in the past 12 months Stimulants (Amphetamines, I would estimate that about 5—10 methamphetamines, pep use this drug regu1ar1y. pills) ' HARDLY EVER USED BY ANYONE- Dggggfiggtgngyggnggge M or at pane mom I have come in y . agents ranging from contact with in the past 12 months barbiturates to "minor I would estimate that less than 5 , this drug regularly. tranquilizers') use Opiates (Heroin, codeine, ' NEVER USED— morphine, paragoric & Of the people whom I have come in other opiate derivatives) contact with in the past 12 months Cocaine I would estimate that no one was -———-~A—— . using this drug regularly. MathagualongQuaalude ,etc . ) Other, specify I " sari-kw 273 AhWfiuunmv “heave "a: mxm: ca «mmSHU nowvmfihomohm Icon wnflzoaaow 2: so be also 5:3 .30» @350 .8\on @995 .39” .Ho \ecm so» on .m :GNVEISHH (broads asesm) Hit-ENE“ 1'11}in HEHLO (191:0st aseetd) HEBREW X’IINVJ HELLO 274 3. Please list any drugs and/or medicine that your doctors have prescribed for you and your spouse within the past year and place a check by how frequently you take them. ~ l o ' o o . o 3 :3 8 x :3 5.3 § ~o ~ 3 - 2’ 3 < s U) -H m 3 m g: 0 +3 . DRUGS g :33. 3 S o :3 8 E 2 '3 Husband: ' Wife: Other member of family (Please specify)r Other member of family (Please specify): 1+. Please place a check in the correct column. Do you and/or your spouse and/or others in your family smoke cigarettes? Yes,less Yes, Yes, more than if an pkg. than 1 Don't Not Ap— No pkg./day a day pkg./day Know plicable Husband: Wife: Other family member (Please specify): ' Other family member (Please specify): 275 5. Do you and/or your spouse and/or others in your famdly'drink alcoholic é... beverages? cable HUSBAND: Beer Wine Other alcoholic - beverages (whis- key, etc.) WIFE: Beer Wine Other alcoholic beverages (whis- key, etc.) OTHER FAMILY MEMBER (Please specify): Beer Wine Other alcoholic beverages (whis- key, etc.) OTHER FAMILY MEMBER (Please Specify): Beer ‘ Wine Other alcoholic beverages (whis.._ Ray, etc.) Yes,o caSion- ally Yes, once a week es, ally .p - 3 . g 43 HQ 8E g No 6. Would you estimate how many persons in Virginia Beach might be engaged in the illegal sale of drugs. Estimate of number Predominate age group . 276 05800 .350 um . bamboo mopmwno A..whmnwawqmup 905E: on wwumhpfifihmn scum mquth wpcomm hpmdamprnm .gflpmomm Ho smug mpdmmmmraon mom . mogongamnuma menmdsflm a Pam msmm ofiufiHmm Amvfiofiaoofi edged; no when?» umnpo a mpnmdmafi A mafia: . ”momma 0N have 95348 23 mo bum on: ing .59» mo Aoosms .350 .98 .8 .35on Hook :8» on .N. wean e aouo (£313st aseatd) :HEEWIHN XIIN VJ HELLO (Anaeds aseatd) WERNER XIII/WEI HELLO 277 8. If you wanted to obtain any of the following drugs in Virginia Beach,. how difficuld would it be to do so? (Exclude drugs obtained by pre- scription for medical reasons.) I WOULDN'T KNOW HOW DIFFICULT IT VERY SOMEHHAT NOT AT ALL IS TO OBTAIN THEN DIFFICULT DIFFICULT DIFFICULT Marihuana (including Hash- ish, THC-synthetics) Inhalants (glue & other vapors or volatile in- toxicants) Hallucinogens (LSD, mes- caline, STP & similar drugs) Stimulants7(amphetamdnes, mothamphetamdnes, pep pills) Depressants (the range of sedative anti—anxiety agents ranging from barbiturates to "minor tranquilizers" Opiates (Heroin, codeine, morphine, paragoric, & other opiate derivatives) Cocaine Methaqualone(Quaaludqetc) Other, Specify 9. If you do not presently abuse drugs, which one of the following has most influenced your decision "not to abuse drugs." _Please check. What your parents told you about drugs What your brothers and sisters told you about drugs What your friends told you about drugs The information you got in school'or in drug abuse education classes The information you got from television, books, or newspapers The information you got from your family doctor The information you got from your minister, priest or rabbi I Just never had any desire to abuse drugs. _____ Other, Specify None of the above. ___ HHIH 278 10. Please check the age categories which you think primarily uses each type of the following drugs: . ,1 33‘ A: 0' cH 0- m a, 3 a I ' J: 3 Io x. g g .. “A 2.5 as .3“ 8:59 ° air: 3 we so, -rg mg 5053 erg s .5 -H 71 o +> .. :4 8 = o I: E 'U. +3 98 - a H a) on H o as a v m g m 2 es? ~ as 3 0'” :2'* a)"8 «'3 4543-5 m 2 '5 5‘0 €? .5 E, no 9 c: E: v as 5 on o a) 8 4: a, - V3 “In; an as a sea sea a ° m m o 4: o +2 .c 5 g :4 g 0 _° 8. gas 4’ a 5 * a e '3 ° 3 n O H g If) - (DA A U) “H (I) +3 (D o d) o o 54 o o 5 to cu m m +3 43 -rI a) £4 0‘ v- o n :5 - 3'51 :3- Eng agnngp'go .3 54 as o .c .3 +2 o s. m .c. o Dos-.00 goa «lg. gamma-ngogn , o .—-I g H 4: o 42 p. a) u: as .o +9 o. o o +2 w [-o q a: m c: o o 0 .Under 10 I I J 10 to ll, T I 15 to 17 I I Li I 18 to 2.1 I IJ J I 22 to 29 I iI L I I 30 to 1+9 1 LI I I 50 and over I I _I lI L] 11. Check those Check thos From which of the following Check those programs programs sources did you hear about programs which you which you each of these programs? you feel have heard have not a! Other, should be PROGRAM of heard of Bladi Friends Schoo Speci expanded ' Alcoholics Anonymous Alcohol Infor- mation Center Broken Needles Drug Informa- I I I I tion Center I Drug Outreach . '7! . I I I I I _l I I Center I T I I 7 I Martus, Inc. Other, Specify NT 12. 13 . 279 How well do you think these programs respond to the drug problem in - Virginia Beach? __ Very well, __ Fairly well, __ Not too well, __ Not at all. If not, what kinds of additional programs do you think should be established? Please explain Are you aware of any drug abuse prevention programs in Virginia Beach or in this area? Yes. No. Which ones? If you are presently a student in a._Virginia Beach high school, do you know whether your school has a drug abuse education program? __ Yes __ No. If yes, how effective is it? __ Very effective, __ Fairly effective, __ Not very effective, __ Not at all effective. If there is no drug abuse education program, do you think one is needed? __ Yes __ No. If yes, what kind, describe __ 280 15. (A) Where would you refer someone who was addicted to heroin or one of the other opium derivatives (codeine, morphine, paragoric, etc.)? Please check one or more of the following alternatives in Column A. (B) Where would you refer someone who was misusing some other drug hallucinogens, stimulants, depressants, etc.)? Please check one or more of the following alternatives in Column B. A B Physician or_private clinic Local General Hoopital Local Psychiatric Hospital State Psychiatric Hospital Methadone program (enter a methadone program to stop using heroin) Traditional church (go to minister of conventional church for goidance), Live-in therapeutic community (join a group of other drug users living at a psychological counseling center) Non—conventional religious organization (develop Spiritual strength by joining an un- conventional religious group) Hotline or referral center (find out what facilities can best help) Friends (talk with people you trust) Professional psychotherapy __(vislt a psyoholggist or psychiatrist) Out-patient counselling center (visit a community counselling center regularly) ' legal restraint ail or correctioooliinstitotion) None (no treatment alternative is recommended) Other (some other alternative not mentioned here __ois preferable) Don't Know (I really don't. know much about the problem) Comments 28] For this survey to be meaningful, it is necessary to ask certain ques- tions concerning population characteristics. In order to describe who is using which drugs, we must ask the following questions. They will help deter- mine where in Virginia Beach to locate drug abuse centers and drug education programs. Remember, the survey is anonymous. No one can ever contact you concerning your answers. Please fill in the following spaces as accurately as you can. All answers are completely confidential. 1. Age: __ 2. Sex: __ Male __ Female 3. Marital Status: '_____ Never married, ____ Widowed, separated, divorced Married h. Ages of children living at home ___, __, _, _. . 5. Last year of school completed: 1 2 3 h 5 6 . 7 8 9 10 ll 12 Elementany Junior High High School 1 2 3 a 1 2 3 h 5 + l 2 College Graduate or Professional School Technical or gocational School If you are presently in school, what grade or year are you in? 6. Family income: (Please check the category which roughly approximates your income or the combined income of you and your husband or wife if you are married. If you are living with your parents, check their approximate combined incomes) Below $5,000 a year $15,000 to $20,000 $5,000 to $10,000 a year $20,000 to $30,000 $10,000 to $15,000 a year. $30,000 and above a year 7. Residence: It is important for purposes of the survey to determine the approximate area in which you live. Please write your zip code in the following space. Remember this is an anonymous questionnaire. 8. Occupation: Type of business Position or profession . in it (or rate or trade or rank if military) Yours: Your husband's or wife's: If you live with your parents: Your father's occupation: Your mother's occupation: YOUTH DRUG USE poop We would like your help in a survey 5}mnrored by the Virginia Beach Mental Health—bbntal Retardation &:rviccs Board. lbny other people in this city are helping us in this survey by answering questionnaires such as you have Infore you. This is a survuy of drug use and abuse in Virginia Beach. About 1000 persons are participating in this part of the survey. The survey is designed so that no school or person can be identified in the results. The questionnaires from all the different classes and schools will be mixed up together as soon as they are collected. We assure you that there is no way that any person can be identified. The purpose of all this is to help plan future drug programs in the city. We are asking you to help us with this, but you don't have to. Filling out the questionnaire is completely voluntary. DIRECTIONS: Below you will find a list of products. Fone people have not had any contact with these products at all. Other people have had considerable contact with each product. Use the following code to describe the freoucncy of your contacts with these products. A. I have never used this product. 8. I have used this product BEFORE January 1, 1973,bUt d0 “Ct use it now- C. I have used this product SINCE January 1, 1973,but do not use it now. D. I use this product about once or twice a year. E. I use this product about once or twice a month. F. I use this product about once or twice a week. G. I use this product about once or twice a day. H. I use this product often each day. Circle only one choice for each oucstion. a) a.) Q) 0) .U .0 .° .3 e fig Ms E s 3 e d.) 0 US 43 +7: #3 +> O n 'O-‘H A +3 x to as interested) h «7 r4 >. 2 g -o c a) 'U . ’O ' (D G.) Q) 0) 0.) 33:5 225 a“ a“ a“ was zswmwo&oao&o3oo 1. Cigarettes A B c D E F 0 H 2. Alcohol (beer, wine, mixed drinks) A B c D E F G H 3. Marihuana (pot, grass) A B C D E F G 1.. Hashish (hash) A B c D E F G H 5. Hallucinogens (LSD, peyote, ' mescaline) A B C D E F G H 6. Stimulants without pres— I criptions (pep pills, uppers, speed) A B C D E F G H 7. Depressants without pres- criptions A B C D E F G H 8. Curare (coolies) A B D E F G H 9- Heroin or other opiates A B C‘- D E F G H 10. COCaine A B D E F G H 11. Any other similar products without prescriptions? If so, what: A B C D E F G H Please fill in your age here_____._l 283 Ill «omnom mane now mpmohhm sowed cm; pmoa ommo ado» ca mess 3c~ downed won: so Avoonnonnmflmz no mooo QflNv "10213.n12. mo 4g HmCOHmmm OH .HO Quad WHO omoflfloo Meow 9393,3043 Hoowom C. [Hm Hoonom Lwdc meow loosfiwma Avocflmppm oompm amormfimv otflsmmuo. ”zeasesana osmo,om +4 raccwmmwm0hq fl punt/pom 9.723% m Cowkgvuecwvflf H Unwrrlmfp D boo: no mead eceadm ooAOHQEo honownzv "MQo>hdm mflcp CH muonsomfio now Umpcdooom pop.MHv . .nrzinzdLIJ #0 .0m r. _r A r», ooflgtfl.l mum vm>crcsu nonhame Ao>oz " . w Amn Om coca me. tbs as on "8283mm so 5054 5.3 82% 3mm: was 22mg ,8 82mm 968: El mezmmoo so 0:3 92de .oz .2; oz: $7948 .02 dab mo .02 dag. .oz .289 J Am to N amuse >m>x3m mwbm< mama mmuH>xmm Am3m mm2m< 03mm wmuH>mmm Agwm _mwoom m swpmm: UWPnaa eu_aa= _mpemz mm>wuaucam -mgaw; huwcseaou :u—mw: _mpcmz eatseu cawumwteo mwow>cmm Pawuom wvwwmmm w £28: _Scaz lulawflul oz :owucmmamcoo menu Awe smeaeu z_tau_m ;p_awz uwrnza Acmwuczpo> Fpm .va muw>gwm meuom mvmzam wzuwwm A.muawa mcmu a wUWFoav Aumwmm uwpnsa spree: Foucwz noca w_wcm>:o memcmz zuwu cowuw m—oozum UWFQJQ wwuw>cwm _mwuom ;u_aax UTFD=Q ;p_maz _apcaz mucou xmmk mwuw>amm cuss: FaucwEuLmamo .mugom meH mm0w>cwm scan: FoucmEuLmamucwucHna.m_ wcsmwm muw>gmm meuom SHmeI Fmpcmz covpmuzum .pmwmmo a pgoaazm Eooammmpu .a.4.m.z wmmFFou prcJEEou £p_mm: _mucmz wow>awm meuom gprmwz uwrasa , . cowumnoga wfiwcw>zo ,, A pawn :ucmwmwmv :owpauzcm ., mcwm< :0 .5500 m_go>mz .. mw>wpmucmmmgawg zuwczssou azoaw Anzum ._wam;mm _mwuom 290 Community Resources Orgagized Into the Social Competengy Model If the community at large is viewed as an entity, a meta- agency, or even a large residence inhabited by the community residents—-then the individual service agency or group in the com- In other munity can be viewed as SCU's--Social Competing Units. words, the theory of Social Competency may be conceptually, and operationally, applied to the municipal human services delivery system. If each agency is viewed as an SCU, then each program seg- ment is viewed as an SCA--a Social Competency Activity--and the Specific rehabilitative actions are SCB's--Social Competency Behaviors, or Skill Training Behaviors. Any meaningful community assessment, or agency evaluation, should include a comparison of the Social Skill Training (specific rehabilitative activities) offered by the Agency and the identified needed SIB's (Socially Incompetent Behaviors--or needed skills) of the clients seeking assistance from that agency. Two instruments are needed for suchiicomparison/evaluation: (7) an Agency Program Skills Evaluation Chart, and (2) a Client Skills Assessment Scale. The Agency Program Skills Evaluation Chart is administered by: l. The agency administrator/director filling out columns 1’ 2’ 3, 4, and 5; 2. The agency unit heads (supervisors, coordinators) fill- ing out columns 6 and 7, and 29] 3. The agency line staff filling out column 7. The Skills Assessment Scale is also a response to Column 8 The scale is of the Agency Social Skills Evaluations Sheet. administered to clients of the specific agencies, the results are tabulated, significant SIB's (Socially Incompetent Behaviors) recorded in Column 8 of the Agency Social Skills Sheet, and the match or mis-match is then surveyed. Be innin a Communit Agency Assessment A working group or agency heads can begin their assessment of which agencies provide what skill training may begin with the use The uses of such scales are of a scale similar to Figure l9. many, including identifying specific social skill training available in the community, which agencies provide this training, and which The lack of specific units of the agencies provide these services. skill training units may also be determined by the use of this scale model. Client Skills Assessment Scale A community assessment is one approach to identifying ser- vices presently available in the community as well as possible gaps in services. But determining the relevance of such services is yet For example, a community may have within its agen- another task. cies many social skill training agencies and units delivering train- But are these skills the specific ing in many social skills. skills needed by the community citizenry, or especially by the Clients of the agencies, individually and collectively? 292 6.55 5532;“ 25%. 3.58 3533.3 953“. n u u m _ m _ u m n _ . . _ u h M _ _ H . . _ _ u . w _ n u h u u u . .mvaoamwmu _ .338; M a n 23: 3 _ chomhwn _. _ _ COHuNDOhm mafia—“om vcm _ _ m we cowuoavwx .m _ wcaxwaucmvu _ u u _ :a w _ m .muwvcwwmo _ ceamaucou .c . _ . mauMum .>=n _ .3237. misom __ _ u no 3326.; .a _, .wBoHnona awanoua noam>mn .m" _ _ " zauamM “ _ .mmovcwwwo msumuw _ w=«%w«ucwv« wEoAnouo chom u a m can Emw>wkumu _ 5 Lea 3253 .i “ ___ mo 5226...“ .m . c3328 .n ._ u W W .mmuuDOm " n _ .uwvcwwwo :wuvaunu nu» xuucse .mnuMum we ucws new 1500 xuwucmvu .m ” “IufiEEou a defiu mucmuma H _ Icwuwv mzu «0 cu“: mucuumoficse _ _ :ofiumuaewam .N .amH may uumuucza nsoo w>ouaEH .N nacho . swan uuHHw [Eco cu wcfiawmcaoo zfiwfimm .m .Lusoz yew «coo aw uaou >uwa«nmcw .N .vcfix vcm uuaou oawcw>sn AOu uaonm wumv wousom "mama wcfiawmczou wfimwuo .N wzu Scum aw wEou u>mn :owu zucwauh inoua AHHEMW Mcwammcsoo :onuw>Hv mamuwoum 0;: muowuwm Imooum Hoosum .H xmwucwvu .H wxmucw .H zfiaamma Haummwuusm .H cowmuw>fin .H .>=h umwmm< .H waaam>nh III: uwuauo neu>azon uou>mzom nacho nan: nacho x>ucww< acouunaouch, ucouwnaoo wcacfimup Hawxm wcficfimuh aaaxw mamoo wcucfimuw mu>auuwmno wawawmuh zaacwoom adaaauow _ hucvw< .Hafixm m n o m a w A .H 293 A survey of the specific abilities and disabilities of representative (randomly selective) clients of each agency may provide this important information. Mean scores in the disability areas may be registered in a scale suggested in Figure 20, and the results compared to columns 7 and 8 in Figure l9. Relevance or irrelevance to client needs may then be ascertained to a reasonable degree of accuracy. Places of residence, ages, item scores, as well as agencies providing specific skill training activity can be recorded on a chart as displayed in easily constructed charts. The controlling variable is the specific social disability, or socially incompetent behavior. This approach may be helpful in planning geographic locations of specifically designed social skill units or agencies. A basic client treatment plan is contained in Appendix A. Writing across the page, beginning at the left with each social disability noted in the Skills Assessment Scale, the competent behavior training needed by the client, and where this training may be obtained, is entered as the counselor writes toward the right on the page. It is important to note that the treatment plan may be rewritten as often as client needs indicate (daily, if necessary, especially in a residential facility). Changing Clients-—Changjng Systems Throughout the model, the emphasis remains on community and agency responsiveness to individual need-~a responsiveness in 294 _IIlllM__—___—_-‘___---‘TIIIIIII .mmucsommm vcm mmwpwpwnmmwo mo cowqugummo -n.o~ mczawm w M u m a. . . _ _ . _ . . . _ _ _ . . _ .4 ---|::4----:+:;ll- --- .l. a: m _ _ u . _ _ . _ _ b I. llll Illllllll ilr i. n w as it i _i _ . . _ . u . u l H. .u-l:ia all.:L.l- --::l--::;c- .( fl _ . . _ _ . _ _ . . _ _ fl . _ . M II lTlllllllllunlllalllllL)llull[lulli'lilliulull I)._+ullll ”l a . i l l I f L lllllfilllllri; F fl _ w % " zwbmz . D 33 . u V. wdficfimub Hfiaxm a“ mama oofi>pom nwmwu asepc mucou< . (11‘4Illlilllrl- - o _‘ FRI fl [l-ll’ll ; .H r-——— - --y—--—H—-a—— ——_9-— ~— ~-—+- ~— _ .11'. all]! lI.l|l(II(((l.(lliulll|)' ) . . c _ i T l l l l 1 ..... +lol-lllvl ll- uvulllilrilIlTlllllill ”Cuzco 3m aw- mm _ _ no mm mm mm _ _ so Km am Hm “ r -—-0- o—(Lfi——J%—_-—Jb—a—-— Jr.~—-———J — -— --- J{ - ——— ~-<)— .— -— +— —- -— «L— - - 4 — -----——4 lflw< mmcou QMN -nL--:--iliJw:pH mHHme. .:,eh Hawaom navamx » mpoum muwawnmmwo Hmfiuom cam: _ --»._ _-.-._._-_..~ ..-—g—— — s—o —- -- _— —— .— .~--—-. __‘- -— - — -- _- vfl......——.— —. H --— 295 specific skill training to needs defined in socially competent terms. Agency evaluation can then take place in terms of respon- siveness to individuals. And individual expectancies can be verbalized in very precise behavioral terms. Communication to funding sources and governmental bodies is enhanced because the concept of ”cure“ is translated into terms of socially functioning citizens. Agency needs can be more easily identified in terms mutually understood among the agencies. And agencies' collaboration is both a necessity and an outcome of the community approach to rehabilitation. Much has yet to be done, in theory and in practice. But a beginning has been made. Communities can respond to citizens in need and people and communities can be ”diagnosed” in “people terms,” in their needs and in their success in social living. \!~\‘\\.I\\~ W.‘»\.~.n....~.\ u\‘~‘* ~.:1‘. ‘ .111: 1\‘ \\1\ \xx‘: ‘\!1‘.\\ v \.5.- . ~ . . .fo.....