Drug Involvement                     Printer Friendly

Drug Involvement

Relevance to Security

Executive Order 12564, dated September 15, 1986, establishes the U.S. Government as a drug-free workplace. It declares that "persons who use illegal drugs are not suitable for federal employment." Applicants cannot be held to a no-prior-use standard, but any illegal drug use at all by a current U.S. Government employee or member of the military is a violation of this presidential order.

Use of an illegal drug or misuse of a prescription drug raises questions about an individual’s reliability and trustworthiness for the following reasons:

National surveys of drug use show that a large percentage of the U.S. population have some history of illegal drug use. In 2003, almost 60% of Americans age 19 to 30 had used an illegal drug at some time during their lives. In 2004, 51.1% of high school seniors had used some illegal drug at some time during their life; 23.4% had done so during the previous month. 1, 2 If the cleared population is at all representative of the U.S. population as a whole, this suggests that a large percentage of applicants for security clearance have had at least some experimental drug use.

The wide prevalence of drug use presents a dilemma for adjudicators. If standards are too lax, security may not be protected. If standards are too strict, many well-adjusted, adventuresome, and creative individuals who have experimented with drugs in the past may be screened out even though they have no intention of using drugs in the future.

Relationship to Espionage

The case of U.S. Army Sgt. Roderick Ramsey is one concrete example of the relationship between drug use and espionage. Ramsey was arrested in 1990 and sentenced to 36 years in prison for spying for Hungary. During a two-year period he passed a large number of Secret and Top Secret documents containing military operational plans for the defense of Western Europe. He was part of the Clyde Lee Conrad spy ring and himself recruited at least two other American soldiers to provide classified documents.

Ramsey used drugs regularly while in the military. He saw drug use in violation of military rules and regulations as the principal qualification for selecting those who might be susceptible to recruitment as sources of classified information. He explained this as follows during an interview after his arrest:

"The people that I recruited, yes, they were involved in drugs, but it wasn't so much that they were pot smokers or hashish smokers that made them, in my opinion, more susceptible to the pitch. It was that these were people who had already shown a propensity or willingness to violate Army regulations.

Anyone in the Army who was willing to take drugs on a regular basis has to be willing to take some kind of risk and has to be willing to break the Army's regulations. That's the starting point." 3

Potentially Disqualifying Conditions

Extract from the Guideline

(a) any drug abuse (see above definition);

(b) testing positive for illegal drug use;

(c) illegal drug possession, including cultivation, processing, manufacture, purchase, sale, or distribution; or possession of drug paraphernalia;

(d) diagnosis by a duly qualified medical professional (e.g., physician, clinical psychologist, or psychiatrist) of drug abuse or drug dependence;

(e) evaluation of drug abuse or drug dependence by a licensed clinical social worker who is a staff member of a recognized drug treatment program;

(f) failure to successfully complete a drug treatment program prescribed by a duly qualified medical professional;

(g) any illegal drug use after being granted a security clearance;

(h) expressed intent to continue illegal drug use, or failure to clearly and convincingly commit to discontinue drug use.

____________

Introduction

Any use at all of an illegal drug or misuse of a legal drug as defined by the Controlled Substances Act of 1970, as amended, is potentially disqualifying. There is a great difference, however, between experimental use of marijuana a couple years before applying for a security clearance and any use of an illegal drug after obtaining a security clearance. Any attitude toward compliance with drug laws or history of drug use that suggests past drug use may continue or recur after obtaining a clearance is a serious security concern. See Example 1.

Adjudication of drug issues must be based on assessment of security risk, not whether the adjudicator personally approves or disapproves of the behavior being adjudicated. To assess the significance of different types and circumstances of drug use, see:

Expressed or implied intent to continue using drugs, or failure to complete successfully a drug treatment program, are both normally disqualifying.

Drug possession including cultivation, processing, manufacture, purchase, sale, or distribution is a serious security concern. See Example 2.

Possession of drug paraphernalia such as needles for injecting drugs, smoking devices, gram scales, or certain chemicals indicates drug involvement unless subject can present evidence to the contrary.

Which Drugs Are Used

The more dangerous the drug, the more the drug use indicates about poor judgment, propensity for irresponsible or high-risk behavior, tendency to rebel against social norms, alienation, or emotional maladjustment.

There are two aspects of a drug's dangerousness -- the risk of addiction and the adverse health and behavioral consequences. Both differ greatly from one drug to another. The most dangerous drugs are methamphetamine, cocaine, heroin, PCP, and LSD. For more information on a specific drug, go to Information on Specific Drugs, which is a group of separate files on each of the most commonly abused drugs.

Drug dependence can develop through both psychological and physical processes.

Methamphetamine is currently one of the most commonly abused drugs, and also one of the most addictive and damaging to one's health. It has spread rapidly because it can be made in home labs with chemicals that have been, until recently, readily available to the public. The essential chemicals are ephedrine and pseudoephedrine, which are common ingredients in many cold medicines. Many states are now passing laws that require every product containing even a small amount of either chemical to be kept behind a pharmacy counter. Customers do not need a prescription to buy the products, but they may need to show a photo ID and sign a log.

Cocaine is one of the most powerfully addictive drugs of abuse. Psychological dependence on cocaine, especially crack cocaine, occurs quite rapidly and physical dependence follows. Narcotics (heroin, opium, morphine) create the strongest physical dependence. Addiction occurs more slowly than with cocaine, but withdrawal is more difficult and painful. Marijuana is only mildly addictive, although regular users may develop psychological dependence on the role which marijuana plays in their lives. LSD is not physically addictive but is especially dangerous because of its health consequences.

Past use of LSD and other hallucinogens is a concern because it may be followed by flashbacks a couple years after the last use. A flashback is a sudden, involuntary recurrence of a previous drug-induced hallucination. LSD flashbacks are predominantly visual distortions, things that one sees.  No evidence is available that an individual suffering a flashback is likely to talk about classified information or programs. Reduced conscious control during a flashback could, however, lead to loss of physical control over classified material.

There are two different types of flashback. One type goes away after a short time. If such flashbacks are going to occur, they are most likely to occur within one year after use of the hallucinogen. If an individual has gone two years without a flashback, a future flashback is unlikely. Flashbacks of this type have been compared to flashbacks that can occur with Post-Traumatic Stress Disorder and may be treated the same way. The other type is a mental illness called Hallucinogen Persisting Perception Disorder. The flashbacks are more frequent and long-lasting and cause problems in the individual's social, work, or family life. Individuals suffering from this are acutely aware of their perceptual disturbances and often seek psychiatric help. This disorder may slowly fade away but often lasts longer than five years and may affect people for the rest of their lives. 4

Frequency of Drug Use

Frequency of drug use is significant because it relates to the likelihood of psychological or physical dependency. Increasing the frequency or dosage over time suggests tolerance and physiological dependence. Regular or habitual use is predictive of continued future use. Serious, long-term drug abuse or dependence may be accompanied by an emotional, mental, or personality disorder. See Drug Use and Mental Health

There is no agreed terminology for describing the frequency of drug use. Investigators and adjudicators should avoid the use of terms such as experimental, occasional, frequent, or regular drug use whenever possible. They should be specific about which drug or drugs, how often, for how long, and how long ago. However, if some general descriptive term is required, the following is one set of terms that has been used by adjudicators to describe frequency of drug use.

Recency of Drug Use

Time elapsed since the last drug use is an important consideration in determining likelihood of future use. The longer someone has abstained from drug use, the greater the chances of continued abstinence in the future. Future Drug Use Is Unlikely discusses recency of use as a mitigating condition.

Circumstances of Drug Use

The circumstances of an individual's past drug use may also indicate whether drug use is likely to continue or recur in the future.

Age at First Use: Early initiation of drug use is one of the best indicators of future drug abuse and dependence. One study reports that in 2003, 13.3% of users who began taking drugs before age 14 reported dependence, compared to only 2.2% who began after the age of 18. Data gathered from the National Longitudinal Survey of Youth reveal that 35% of persons who used cocaine and 23.5% who smoked marijuana before age 12 became heavy cocaine users. Of those who did not use cocaine or smoke marijuana before age 12, only 5.9% and 5%, respectively, became heavy cocaine users later in life. 5

Individuals whose drug use started before high school (age 14 or younger) are atypical and are more vulnerable to drug problems later in life than those who started using drugs in high school or college. Initiation of drug use between age 15 and 18 is common and is not indicative. Drug use usually peaks during the senior year in high school or in college (age 17 to 23). Continuation of peak usage after this period suggests possible future problems. Initiation of drug use later in life is quite unusual and suggests a possibility of future problems. 6

Increased maturity and lifestyle changes that usually accompany employment, marriage, or the birth of children often lead to reduction or cessation of drug use. Continuation of the same social environment in which past drug use occurred suggests that use may continue.

Solitary Drug Use: Use of drugs to relax prior to a social event points to psychological dependence and is more indicative of future use than use at social events. Solitary drug use is more indicative of future use than is social use.

Means of Acquiring Drugs: Growing or making one's own drugs or purchase of drugs from a stranger indicate a stronger commitment to drug use than obtaining drugs from a friend.

Motivation for Drug Use: If drugs are used to reduce stress or build self-esteem, this may indicate underlying psychological problems that can persist and cause continued drug use or other problems. Rebelliousness as a motivation for past drug use does not necessarily indicate future drug use, but it may indicate a tendency toward antisocial behavior. Among the various possible motivations for drug use, peer pressure and a desire to be sociable are the least indicative of future drug problems.

Behavior While Under the Influence of Drugs: If drug use is associated with traffic violations, pranks, shoplifting, fights, etc., it may be part of a larger pattern of antisocial behavior that is itself a security concern. Drug use is frequently related to criminal behavior. 7

Example 1

Subject is a 40-year-old engineer being processed by a defense contractor for a Secret clearance. One year ago he experimented with marijuana on social occasions four or five times during a one-month period. He has not used marijuana since and does not intend to use it in the future.

If subject were a 21-year-old, recent college graduate, this would be a clear-cut case. Some experimentation with marijuana is common in that age group. It is abnormal for someone to begin experimenting with marijuana at age 39 or 40. Such behavior indicates that caution is in order. Additional information is needed before a decision can be made. One needs to understand what was going on in the subject’s life that led to this change in behavior? Are there other changes in subject’s life style, particularly changes in work performance, friends that he associates with, or indicators of developing emotional or mental problems?

Example 2

The subject is a newly selected civilian employee on whom a SSBI is being conducted for a Top Secret clearance. During the interview, the subject stated that she uses marijuana about once or twice a month or at parties if it is offered. The subject stated that she will not use marijuana at work but will continue to use it as before. She said that she does not see anything wrong with its use if it does not affect her job, and that the government has no business controlling her private life.

A stated intention to continue using marijuana is normally disqualifying, whether or not the marijuana is used at work.

Falsification of Drug Test

Any falsification of a drug test is potentially disqualifying. Although the urine test is generally reliable, as discussed below under Accuracy of Urine Testing, it can be falsified, and products for doing so are widely promoted and sold over the Internet.

The Government Accountability Office (GAO) recently investigated the availability of products intended to enable users of illegal drugs to pass federal government drug tests. An Internet search on the words "pass drug test" turns up dozens of companies that advertise such products. One web site claims that "passing a urine drug test has never been easier." Another advises prospective customers that its product formulas are changed about every 6 to 9 months to stay ahead of new validity tests performed by drug testing laboratories. The masking products fall into four categories:

Web sites and sales representatives recommend different types of masking products based on which drugs are used, how frequently they are used, how recently they were used, whether tests are announced or conducted randomly, and whether testing administrators closely monitor the collection of urine samples. Some web sites provide an interactive format for prospective customers to find out which products best meet their individual needs. Some web sites provide a search mechanism to identify the nearest dealer who sells the products. The prices range from $30 to $79 dollars per package to get through one test. The GAO investigator bought such products from a dealer in the Washington, DC, area as well as from a number of web sites. The GAO only investigated the availability of these products. It did not test their effectiveness in masking drug use.

The GAO investigation concluded that "the sheer number of these products, and the ease with which they are marketed and distributed through the Internet, present formidable obstacles to the integrity of the drug testing process." 8

Current Clearance Holder or Applicant

Executive Order 12564 established the U.S. Government as a drug-free workplace. By accepting government employment, government employees have accepted voluntarily an obligation to be drug-free. It is appropriate to hold them to a higher standard than applicants who have not yet assumed this obligation.

For current government or military personnel with security clearances, any illegal drug use or misuse of a legal drug is a violation of Executive Order 12564. It is, therefore, a breach of trust and a security concern. If this behavior is part of a pattern of problematic behavior, it should be evaluated under Personal Conduct.

The situation is different for applicants, as they have not previously accepted an obligation to remain drug-free. The prevalence of drug use in the United States suggests that some prior experimental or brief recreational drug use is to be expected among many otherwise well qualified individuals. Drug use reached a peak in 1981, when 65.6% of high school seniors had used some illegal drug at some time during their lives. Drug use among high school seniors gradually declined until 1992, when 40.7% reported some previous drug use. In 2004, 51.1% of high school seniors reported using some illegal drug at some time during their life.2  Applicants who admit prior drug use may be more honest than many who have used drugs but don't admit it. See Some Prior Drug Use Is Not Abnormal and Prevalence of Drug Use.

For applicants, the question is less what they have done in the past than whether they are willing and able to remain drug-free in the future. Past drug use is a security concern if:

Some Prior Drug Use Is Not Abnormal

Given the statistics on the increasing prevalence of drug use, some experimentation with drugs, especially marijuana, cannot be considered abnormal behavior among younger Americans applying for a security clearance.

Adolescence is a time when young people differentiate themselves from parents and family and forge independent identities. Experimenting with values and beliefs, exploring new roles and identities, and testing limits and personal boundaries are normal behaviors during adolescence. Such experimentation contributes to personal growth and adjustment.

For psychologically healthy individuals, some experimentation with drugs is usually benign and does not lead to long-term or habitual drug use. For others who already have some emotional or psychological problem, drug use easily becomes part of a broad pattern of self-destructive behavior.9  For more information, see Drug Use as a Mental Health Indicator.

Drug Use as a Mental Health Indicator

Scientific evidence accumulated over the past 15 years suggests that drug abuse is more complex than previously believed. Characteristics of the individual, rather than of the drug, are now seen as playing a dominant role in vulnerability to drug abuse. The social and psychological maladjustment that characterizes most frequent drug abusers precedes the first drug use. One study that tracked children from an early age to adulthood identified predictors of future serious drug use that could be identified in children's behavior as early as age 7. 9

Psychoactive drugs do have potent addictive properties, but addiction does not follow automatically from their use. Most people who experiment with drugs or even use them regularly for a while do not become abusers or develop dependence.

Initial low-level involvement with drugs may result from curiosity, peer pressure, drug availability, or risk factors in an individual's social or family environment. Subsequent escalation to and maintenance of higher levels of drug use is likely to result from biological, psychological or psychiatric characteristics of the individual user. In some cases, vulnerability may be inherited in the form of heightened susceptibility to a certain type of drug. In most cases, however, escalation will be caused by psychological characteristics or psychiatric conditions, some of which may also be inherited.

Poorly adjusted individuals who do not become involved with illegal drugs will often become involved with some other nondrug addictive behavior that fills the same psychological need. If an individual has a history of drug abuse or dependence, the likelihood that drug use has stopped for good, or will stop if given a clearance or a second chance, can be fully understood only in the context of the individual's entire personality, life experiences, and social support networks.

Psychiatric disorders frequently occur in conjunction with drug dependence. In 2003, a national survey found that 18.1% of adults 18 years of age or older who reported illicit drug use also reported a serious mental illness in that year. By comparison, only 7.8% of nondrug users reported a serious mental illness. In other words, adult drug users were more than twice as likely to have a serious mental illness than adults who did not use drugs.10  Co-occurring mental disorders most often suffered by illicit drug users are anxiety disorders (28%), affective disorders (26%), antisocial personality disorders (18%), and schizophrenia (7%).11  The prevalence of mental disorders varies with the drug being abused, ranging from 50% of marijuana abusers to 76% of those who abuse cocaine. Almost half of drug abusers also suffer from alcohol abuse at some point during their lifetime. 12

Mitigating Conditions

Extract from the Guideline

(a) the behavior happened so long ago, was so
infrequent, or happened under such circumstances that it is unlikely to recur or does not cast doubt on the individual’s current reliability, trustworthiness, or good judgment;

(b) a demonstrated intent not to abuse any drugs in the future, such as:

(1) disassociation from drug-using associates and contacts;

(2) changing or avoiding the environment where drugs were used;

(3) an appropriate period of abstinence;

(4) a signed statement of intent with automatic revocation of clearance for any violation;

(c) abuse of prescription drugs was after a severe or prolonged illness during which these drugs were
prescribed, and abuse has since ended;

(d) satisfactory completion of a prescribed drug treatment program, including but not limited to rehabilitation and aftercare requirements, without recurrence of abuse, and a favorable prognosis by a duly qualified medical
professional.

____________

Evaluating Mitigation

In considering mitigating conditions, adjudicators should evaluate whether:

Criteria for judging that past drug use is not likely to continue or recur are discussed under Future Drug Use Is Unlikely.

Successful completion of a drug treatment program may mitigate past drug use if that use was not too advanced. If past use meets the medical definition of abuse or dependence, however, even successful completion of a treatment program may not be sufficient. Despite recent advances in treatment, "drug abuse remains a chronic relapsing condition usually requiring prolonged or repeated treatment."13  See Types of Treatment for Drug Abuse and Effectiveness of Treatment for Drug Abuse.

Future Drug Use Is Unlikely

Past drug use may be mitigated by evidence that future drug use is very unlikely. In judging the likelihood of future drug use, the adjudicator should consider the subject's expressed intentions but know that good intentions may not last. Expressed intentions are more believable if they are accompanied by specific changes in lifestyle, such as moving from a college to a work environment, disassociation from drug-using associates, or avoiding the environment where drugs were used.

 The adjudicator also considers recency of last drug use, frequency of past drug use, which drugs were used, circumstances of past drug use, and a whole person evaluation of the individual's reliability and trustworthiness.

The strongest indicator of a person’s true intent and ability to abstain from future drug use is time elapsed since last drug use. The Adjudicative Guidelines do not provide any formula for evaluating the period of time that is relevant. This is a matter for informed judgment of the trained and experienced adjudicator. The following examples of time periods that might mitigate various types and frequencies of past drug use are based on a 1992 Defense Department study.14  They are provided for consideration in the context of all the other information available about the person. They are not a formula to be applied mechanically in all cases.

At Least Six Months: The only drug use was experimental or occasional use of marijuana, and there are no aggravating circumstances.

At Least One Year: Marijuana was used frequently, or any other drug was used experimentally, and there are no aggravating circumstances.

At Least Two Years: Marijuana was used regularly, or any other drug was used occasionally, and there are no aggravating circumstances. There was no evidence of psychological or physical dependence at the time subject was using drugs, and subject has demonstrated a stable lifestyle with satisfactory employment record since then.

At Least Three Years: Any drug other than marijuana was used frequently or regularly, or marijuana was used regularly with signs of psychological dependence. There are no other aggravating circumstances. Subject has maintained a stable lifestyle, satisfactory employment record, and a completely clean record in all other issue areas during the past three years. See Example 4.

At Least Five Years: A minor involvement in drug trafficking for profit or failure to complete a drug treatment program. Subject has maintained a stable lifestyle, satisfactory employment record, and a completely clean record in all other issue areas during the past five years.

Every case has unique factors that must be considered in addition to these time guidelines. Adjudicators should adjust the time periods in order to take into account circumstances of past drug use and whether the individual is a current clearance holder or an applicant. When in doubt, ask the following question: Has subject demonstrated "strength of character, trustworthiness, honesty, reliability, discretion, and sound judgment" as required by Executive Order 12968? If so, access may be approved. If not, it may be denied.

Example

Subject is a 32-year-old technician with a defense contractor. He is being processed for a Secret clearance. He was arrested four years ago for driving under the influence of marijuana; he was weaving across the center line of the road. He was given one year probation, drivers license suspended for six months, ordered into drug counseling, and fined $200.

Subject said he used marijuana two to four times a week for three years, mostly at parties. He was never involved in cultivating or selling marijuana and never used any other drug. Subject completed the 40-hour drug counseling program. He says he has not used marijuana or any other drug since his arrest and does not intend to use drugs in the future. "Drugs aren't worth the trouble they cause you," he explains. Subject's employer reports that his work performance has improved during the four years since his arrest. There is no other derogatory information on subject.

The employer's report that subject's work performance improved after his arrest supports subject's statement that he did, indeed, stop using drugs. It also suggests, however, that before the arrest his drug problem was serious enough to affect work performance. The severity of subject's penalty for a first-time offense also suggests he had a serious drug problem. However, four years of abstention from marijuana is a strong indicator of intent. There appears to be strong evidence of continuing intent to abstain from drugs, so approval may be appropriate.

Types of Treatment for Drug Abuse

Drug abuse treatment includes detoxification, management of drug dependence, and prevention of relapse. Since drug abuse is a complex disorder with multiple causes, there are also multiple treatment methods that are more or less effective with, or acceptable to, different patients. Ideally, assessment of the drug abuse history and personal characteristics of individual patients would permit matching the patient with the treatment method most likely to be successful for that person. This is not possible with the present state of knowledge, however, so treatment programs are varied and usually multifaceted. Treatment methods are of two general types:

Drugs that Affect Physiological Processes: Prescribed medications may provide a substitute drug that has similar physiological effects (i.e., methadone treatment of heroin addiction and nicotine chewing gum for treatment of tobacco dependence); may block the physiological effects of the abused drug; or may treat the symptoms of the abused drug (i.e., reduce the craving or treat the insomnia and anxiety often associated with withdrawal from drug use). 15

Examples:

Therapies that Aim to Modify Behavior: Treatments that aim to change behavior include a variety of counseling and psychotherapy approaches based primarily on talking: peer support self-help groups modeled after Alcoholics Anonymous; behavioral conditioning to alter one's response to drug stimuli; skill development (i.e., teaching job or social skills, assertiveness, or relaxation/stress management); or relatively long-term (typically 6 months or longer) treatment in a closed residential setting emphasizing drug abstinence and learning of new attitudes and behaviors. 13

Examples:

Effectiveness of Treatment for Drug Abuse

The most comprehensive study of the effectiveness of drug abuse treatment is the Drug Abuse Treatment Outcome Study (DATOS) sponsored by the National Institute on Drug Abuse. This study collected data on 10,000 patients who entered drug treatment in 1991, 1992 and 1993 and followed a sample of these patients for five years after completion of their treatment. There have been notable advances in treatment methods since this study was done, but the general findings of the DATOS study are still considered valid. 16

DATOS and other studies have shown that treatment is effective, but that relapse remains common and repeated treatments are often required. It confirmed previous findings that the amount of time spent in the treatment program was more important than the nature of the treatment program, and was the single most important factor in determining the amount of improvement gained from the program. Three months of treatment was sufficient for positive outcomes in a number of cases, but  those who remained in a program for one year were significantly less likely to return to regular drug use than those in treatment less than one year. 17

In addition to length of the treatment program, chances of relapse, most notably for cocaine users, are influenced by the severity of the problem and by the same biological, psychological, behavioral, social and environmental risk factors that influence the onset of drug use and the escalation to drug abuse in the first place. It is speculated that the number of risk factors for an individual may serve as a measure of relapse risk for that individual.17  Conversely, a stable family, work and social environment, the absence of severe psychological problems, and strong motivation to be cured are associated with successful treatment outcomes.

Individuals who suffer from a psychiatric disorder as well as drug abuse are especially difficult to treat and have higher than normal relapse rates after treatment. Historically, treatment response has been directly related to severity of the psychiatric disorder; the more severe the psychiatric problem, the lower the chances for successful treatment. Treatment is particularly ineffective with drug abusers who also suffer from antisocial personality disorder.3  Recent advances have provided more effective approaches to treating co-occurring drug abuse/dependence and mental disorders, but the fact remains that drug abusers with other mental disorders are at a disadvantage when it comes to successful rehabilitation. 18

According to the DATOS study, Outpatient Methadone Treatment was the least successful, while Outpatient Drug Free Treatment was the most successful. This may be because individuals in the Outpatient Drug-free Treatment group are most likely to have the familial and social support to help them cope throughout their time in rehabilitation.

In the DATOS study, 48%-69% of the heroin and cocaine abusers significantly reduced their drug use during the year after treatment. Abstinence after one year varied depending on type of treatment. Patients in Outpatient Methadone Treatment only achieved 26% abstinence, compared to 71% of patients in Long-term Residential Treatment.

For marijuana, abstinence rates averaged only about 20% and improvement rates about 60% for the various treatment programs. One-year improvement rates for marijuana were the lowest for any drug. The persistence of marijuana use may be explained by the fact that almost 30% of patients in the study were multiple drug users. Treatment focused on the harder drugs, with marijuana considered more benign. Treatment is considered partially successful if patients shift to less serious drugs and less complex patterns of use. Thus, marijuana may act as a substitute for harder drug use.

Drug abuse treatment, as well as drug abuse itself, is a recurrent phenomenon. Twenty to 74% of all patients returned to treatment within the first year after completing the treatment, depending on treatment method, and substantial numbers returned each year during the five-year monitoring period. Additionally, more than 60% of those treated for addiction to cocaine, heroin, or other opiates had received prior treatment, and of those, more than half had received at least three months of prior intensive treatment.

Regarding treatment for abuse of a specific drug, click on that drug in the Contents frame on the left.

Reference Materials

Definitions of Drug Use,
Abuse, and Dependence

When categorizing extent of drug involvement, medical personnel use three terms: drug use, abuse, and dependence.19  This medical usage differs substantially from the way the terms "use" and "abuse" are used in the Adjudicative Guidelines.

These terms are defined in medical usage as follows:

Use: Any taking in of a psychoactive substance. A psychoactive substance is a substance which affects a person's perceptions, mood, way of thinking and behavior. The term "simple use" is sometimes used to describe experimentation or occasional recreational use that does not reach the point of abuse or dependence. Note: The distinction between use and abuse is not meant to imply that simple use is benign or that there is any level of drug involvement that is not potentially dangerous. The Adjudicative Guidelines define any illegal use of a drug or use of a legal drug in a manner that deviates from approved medical direction as drug abuse.

Abuse: Use becomes abuse when it continues despite persistent or recurrent social, occupational, psychological or physical problems caused by or made worse by this use. Use before driving a car or engaging in other activities that are dangerous when under the influence of a psychoactive substance also qualifies as abuse. The transition from use to abuse is often gradual, and there is no clear threshold for defining the point at which use becomes abuse. Frequency and quantity of use are important considerations, as is the extent to which drug use has become a regular feature of one's lifestyle.

Dependence: Habitual, compulsive use of a substance over a prolonged period of time. The substance may be taken in larger amounts or over a longer period than intended. Increased amounts of the substance may be needed to achieve the desired effect. There may have been unsuccessful efforts to cut down on the amount of use. A great deal of time may be spent in obtaining the substance or recovering from its effects. There may be a significant impact on one's work, home or social life, or mental or physical health.

Abuse and dependence are both medical diagnoses that require certain criteria to be met before they are applied. The diagnosis should be made by a physician or other qualified substance abuse professional.

Observable Indicators of Drug Use

Drug abuse and other substance abuse often affects a person's performance, behavior, and appearance. This is the basis for a number of indicators that can alert supervisors and coworkers to the possibility that an individual may be abusing drugs, but they certainly do not "prove" the abuse of drugs. These indicators are significant only if they represent a change from the person's normal behavior. Some of these changed behaviors may be caused by a death in the family, a new medical problem, a divorce, or any other source of emotional stress. It is important to keep these caveats in mind when considering these indicators. Any sudden change for the worse in a person's performance, behavior, or appearance should be a source of concern, but drug abuse is just one of the possibilities.

Prevalence of Drug Use

Trends in high school drug use predict how many future job applicants will have previously used drugs. There was a strong trend toward reduced drug use from 1981 to 1992, but this trend reversed in 1993. In 1981, 65.6% of high school seniors had used some illegal drug at some time during their lives. This was down to 40.7% in the graduating class of 1992. It has increased steadily since then. In 1996, 50.8% of high school seniors admitted using an illegal drug at some time during their life; 24.6% admitted doing so during the previous month. In 2003, 51% reported using drugs in their lifetimes, with 24.1% reporting use in the past month. Daily (at least 20 times during the month prior to the survey) use of marijuana was reported by 5.8%. 1

For information on prevalence of other drugs, click on the specific drug in the Table of Contents.

Statistics that apply to the overall population, as reported here, will generally be higher than frequency rates found in a select and prescreened pool of persons undergoing security processing.

Prevalence of drug use, which drugs are favored and how they are administered are all subject to rapid change. Drug education programs, changes in public attitudes, high-profile cases of drug deaths, rumors and facts regarding the dangers of specific drugs, new developments in methods of administering drugs, and changes in the cost or purity of drugs all affect the nature and extent of drug use and abuse.

Updated information on prevalence of drug use is available from two annual surveys sponsored by the National Institute on Drug Abuse: the National Household Survey on Drug Abuse, and the Monitoring the Future survey of drug use by high school seniors. Information is broken down by type of drug, frequency of use, and many demographic variables. Information on prevalence of drug use among military personnel is available from the Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel. To obtain the most current information, see Sources of Additional Information.

Glossary of Drug Terms

Slang terminology for illegal drugs and drug use is extensive, differs from one locality to another, and is constantly changing. The Office of National Drug Control Policy (ONDCP) maintains an extensive glossary of drug terms. It is available at the ONDCP site at www.whitehousedrugpolicy.gov/streetterms/Default.asp. It has over 2,300 street terms and is updated periodically. It can be searched alphabetically or by topic.

Effectiveness of Drug Screening Programs

Although the urine test procedure yields accurate results when done properly, preemployment drug screening generally detects only the careless user or the strongly dependent person. One can generally avoid detection simply by abstaining from drug use prior to the test.

For most drugs, evidence of drug use at levels detectable by the initial screening remains in the system for only two or three days, although heavy marijuana use can sometimes be detected up to three weeks later. The length of time that detectable evidence of drug use remains in the urine depends upon which drug is used, amount taken, the individual's physical condition and metabolism, fluid intake since taking the drug, and the sensitivity of the drug test. 29

Unscheduled random testing has a better chance of detecting the occasional user than pre-employment screening, but even random testing has limitations that are more or less severe, depending upon how it is conducted. For example, current U.S. Navy policy directs all commands to test approximately 10% to 20% of their personnel each month on a random basis.30 (Army and Air Force testing is less extensive.)

If a randomly selected sample of 10% of personnel is tested once a month, on a randomly selected day, a user with drugs in his or her system 6 days of the month has only a 2% chance of detection during any given month. This probability is greatly reduced if a drug user refrains from drug use until after the monthly test.

If only 1% of personnel were to be tested on each of 10 randomly selected days each month, the statistical probability of detection would be marginally reduced, but the deterrent value of testing would be greatly enhanced, as it would become more difficult to plan drug use around the monthly test schedule. 31

Drug testing programs vary in the number of drugs that each urine sample is tested for. Navy policy is to test each urine sample for five drugs, with the fifth drug in the test rotated among several possibilities. Army and Air Force test each urine sample for only three drugs -- marijuana and cocaine, with the third drug rotated among heroin, amphetamine, LSD, etc. 32

Accuracy of Urine Testing

Testing a urine sample is the standard means to determine current use of an illegal drug. A positive drug test shows only that a substance or some of its residue was present in a person's body. It does not provide any information about the frequency of use or whether the individual is an abuser or drug dependent, and it does not prove intoxication or impaired on-the-job performance.

The standard urine test is judged to be reliable only if test procedures follow the Technical and Scientific Guidelines issued by the U.S. Department of Health and Human Services.21 Requirements of these guidelines include:

These procedures protect against some but certainly not all methods that individuals can use to falsify a drug test. The Government Accountability Office (GAO) investigation described above, under Falsification of Drug Tests, concluded that products promoted and distributed via the Internet "present formidable obstacles to the integrity of the drug testing process." 8

The standard procedure used in mass drug-screening programs is an immunoassay test, of which there are a number of different versions. The great advantage of immunoassay urinalysis technologies is that they are quick and not too expensive. The weakness is that 1% to 2% of negative urine specimens will test positive. And many positive urine specimens will test negative, as the procedure is not as sensitive to low concentrations of drugs in the urine as one might prefer. 22

The only way to ensure full reliability is to conduct a second confirmatory test, using the more time-consuming and expensive GC/MS technique. This is required by the Technical and Scientific Guidelines in all cases when the initial test is positive. The GC/MS technique is extremely accurate and sensitive to relatively small traces of drug use. There is almost no chance of error with a GC/MS test as long as the test is conducted and interpreted properly. 21

The evidence does still need to be interpreted by a qualified medical professional. Legitimate medical treatment, and even some foods such as poppy seeds, can lead to detectable levels of drugs in urine during an initial drug screening; the confirmatory GC/MS test can generally identify the specific substance involved.

Hair Testing

Hair testing is approved by the Federal Drug Administration, has been admitted in court as scientifically acceptable evidence of drug use, and is now being used in place of urine testing by many large corporations and leading police departments. It is, however, still controversial and subject to legal challenge. Studies have found that dark-haired people are more likely to test positive for drugs because they have higher levels of melanin, which allows drug compounds to bind more easily to their hair. 23

Drug traces get into the hair via the blood that circulates in the body to nourish hair as well as other tissues. The drug enters the hair below skin level, so it takes about seven days for hair to grow out enough for drug use to be detectable in hair cut from the scalp.

Head hair grows approximately 1.3 centimeters, or 1/2 inch, per month and provides a chronological record of drug use. In other words, hair that is 1 1/2 inches long would represent about three months' growth. The section of hair nearest the scalp would show drug use during the previous month, while the section nearest the end of the hair would reflect drug use two to three months earlier. If insufficient head hair is available, pubic hair or other body hair may be used.

Hair testing is currently available for the following drugs: cocaine, opiates, marijuana, PCP, and methamphetamine or amphetamine.

As compared with urine testing, hair testing has some significant advantages. 24, 25, 26

As compared with urine testing, hair testing also has several disadvantages. 27

As with urinalysis, rigorous procedures must be used to guide and document the collection, preservation, shipping, laboratory handling, testing, and eventual destruction of the hair sample. Procedures unique to hair testing include washing the hair sample to remove any external contaminants prior to testing. The washing is repeated until the wash water tests negative for any evidence of drugs. This ensures that a positive hair test shows only chemicals that were in the hair, not on the hair.

Sweat Testing

New research has shown that body sweat provides accurate indices of drug use. Using sweat testing, drug use can be monitored over a span of time, usually a week, to provide a record of drugs used. Sweat testing consists of an individual wearing a sweat patch. The patch resembles a band aid with an absorbent cellulose pad attached. The cellulose pad is designed to trap drug constituents excreted through the sweat, while allowing water, oxygen, and carbon dioxide to escape. Over several days as sweat saturates the pad, the excreted drug slowly concentrates. The patch is then removed and the cellulose pad analyzed for drug content. 28

Advantages of the sweat patch:

Disadvantages of the sweat patch:

Research is under way to develop a new approach to sweat testing that would allow a police officer, school official, or doctor to administer a test and have the results in a few minutes. 25

Sources of Additional Information

A catalog of publications on drugs, drug abuse, and prevention of drug abuse may be obtained from the National Clearinghouse for Alcohol and Drug Information, phone 1-800-729-6686. It is on the Internet at http://store.health.org/catalog/. There is no charge for most of the publications.

The prevalence of all forms of substance abuse is monitored annually by two major national surveys. The National Survey on Drug Use and Health (http://www.oas.samhsa.gov/
nhsda/2k3nsduh/2k3ResultsW.pdf) is based on a national probability sample of persons age 12 and older living in U.S. households. The Monitoring the Future survey (http://www.drugabuse.gov/DrugPages/MTF.html) interviews high school seniors in public and private schools, with annual follow-up questionnaires mailed to a sample of previous participants from each high school graduating class since 1976. Both surveys are sponsored by the National Institute on Drug Abuse. Results are published annually with information broken down by type of drug, frequency of use, and many demographic variables. Each report encompasses several volumes. Hard copies of these reports may be obtained without charge from the National Clearinghouse for Alcohol and Drug Information.

Several web sites provide detailed information on specific drugs of abuse, problems resulting from the widespread use of drugs in the United States, and measures that are being taken to correct these problems and treat drug addiction. These include:

Footnotes

1. Johnston, L.D., O'Malley, P.M., Bachman, J.G., & Schulenberg, J.E. (2004). Monitoring the Future national survey results on drug use, 1975-2003. Volume II: College students and adults ages 19-45 (NIH Publication No. 04-5508). Bethesda, MD: National Institute on Drug Abuse. Retrieved July 2005 from http://www.monitoringthefuture.org/
pubs/monographs/vol2_2003.pdf

2.  Johnston, L.D., O'Malley, P.M., Bachman, J.G., & Schulenberg, J.E. (2005). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2004 (NIH Publication No. 05-5726). Bethesda, MD: National Institute on Drug Abuse. Retrieved July 2005 from http://www.monitoringthefuture.org/
pubs/monographs/overview2004.pdf

3. Fischer, L.F. (1997). A wasted life: The case of Roderick Ramsey. Security Awareness Bulletin, 1-97. Richmond, VA: Department of Defense Security Institute.

4. HPPDonline. (nd). Hallucinogen persisting perception disorder: Internet resource. Retrieved October 25, 2005, from http://hppdonline.com.

5. Office of National Drug Control Policy. (2004). Predicting heavy drug use (Publication No. NCJ 208382). Washington, DC: Executive Office of the President . Retrieved July 2005 from http://www.whitehousedrugpolicy.gov/
publications/predict_drug_use/predict_drug_use.pdf

6. Substance Abuse and Mental Health Services Administration. (2004). Substance dependence, abuse and treatment. In Results from the 2003 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-3964). Rockville, MD. Retrieved July 2005 from http://www.oas.samhsa.gov/
nhsda/2k3nsduh/2k3ResultsW.pdf

7. Zhang, Z. (2003). Drug and alcohol use and related matters among arrestees: 2003 (Arrestee Drug Abuse Monitoring Program, Contract No. 2001C-003). Washington, DC: National Institute of Justice, Office of Justice Programs, National Opinion Research Center. Retrieved July 2005 from http://www.ojp.usdoj.gov/nij/adam/welcome.html

8. Government Accountability Office. (2005, May). Products to defraud drug use screening tests are widely available (GAO-05-653T). Washington, DC: Author

9. Shedler, J., & Block, J. (1990). Adolescent drug use and psychological health. American Psychologist, 45, 612-630. Newcomb, M., & Bentler, P. (1988). Consequences of adolescent drug use: Impact on the lives of young adults. Newbury Park, CA: Sage. Hogan, R., Mankin, D., Conway, J., & Fox, S. (1970). Personality correlates of undergraduate marijuana use. Journal of Consulting and Clinical Psychology, 35, 58-63. Bentler, P.M. (1987). Drug use and personality in adolescence and young adulthood: Structural models with nonnormal variables. Child Development, 58, 65-79.

10. Substance Abuse and Mental Health Services Administration. (2004). Prevalence and treatment of mental health problems. In Results from the 2003 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-3964). Rockville, MD. Retrieved July 2005 from http://www.oas.samhsa.gov/
nhsda/2k3nsduh/2k3ResultsW.pdf

11. Farrel, M., Howes, S., Taylor, C., Lewis, G., Jenkins, R., Bebbington, P., Jarvis, M., Brugha, T., Gill, B., & Meltzer, H. (2003). Substance misuse and psychiatric comorbidity: An overview of the OPCS National Psychiatric Morbidity Study. International Review of Psychiatry, 15, 43-49.

12. Regier, D.A. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the epidemiologic catchment area (ECA) study. Journal of the American Medical Association, 264, 2511-18.

13. National Institute on Drug Abuse. (1991). Drug abuse and drug abuse research: The Third Triennial Report to Congress from the Secretary, Department of Health and Human Services (pp. 66-75). Rockville, MD: Author.

14. Bosshardt, M.J., & Crawford, K.S. (1992). Revision of adjudicative guidelines for alcohol abuse, drug abuse, and mental/emotional disorders (PERS-TR-92-003). Monterey, CA: Defense Personnel Security Research Center.

15. National Institute on Drug Abuse. (1999). Principles of drug addiction treatment: A research-based guide. Bethesda, MD: Author.

16. Drug Abuse Treatment Outcomes Survey. (n.d). One year outcomes: Overview of 1-year follow-up. Bethesda, MD: National Institute on Drug Abuse.  Retrieved September 2003 from
http://www.datos.org/adults/adults-1yrout.html

17. Hubbard, R.L., Craddock, S.G., Flynn, P.M., Anderson, J., & Etheridge, R.M. (1997). Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 261-278.

18. Leshner, A.I. (1999). Drug abuse and mental disorders: Comorbidity is reality. NIDA Notes, 14(4). Retrieved September 2003 from the NIDA web site: http://www.drugabuse.gov/
NIDA_notes/NNVol14N4/DirRepVol14N4.html

19. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th edition, rev.). Washington, DC: Author.

20. OHS Health & Safety Services, Inc., a provider of employee drug testing services. Web site section on "Known Indicators. Retrieved December 2005 from http://www.ohsinc.com/drug_abuser_physical_
behavioral_indicators.htm

21. Department of Health and Human Services. (1994). Substance abuse and mental health administration: Mandatory guidelines for federal workplace drug testing programs. Rockville, MD: Substance Abuse and Mental Health Services Administration.

22. Visher, C., & McFadden, K. (1991). A comparison of urinalysis technologies for drug testing in criminal justice (NCJ 129292). Washington, DC: U.S. Department of Justice, Office of Justice Programs.

23. Lavoie, D. (2005, August 24). Officers sue over use of hair drug tests. San Francisco Chronicle. Retrieved August 24, 2005, from http://sfgate.com/cgibin/article.cgi?
f=/n/a/2005/08/24/national/a111818D51.DTL

24. Rouen, D., Dolan, K., & Kimber, J. (n.d.).  A review of drug detection testing and examination of urine, hair, saliva, and sweat (Tech. Rep. 120). Sydney: National Drug and Alcohol Research Centre. Retrieved September 2003 from http://ndarc.med.unsw.edu.au/ndarc.nsf

25. Associated Press. (2006, January 31). Research gives reason to sweat drug tests.

26. Omega Laboratories. (2003). Hair Testing FAQ. About Hair Testing. Retrieved September 2003 from 
http://www.omegalabs.net/
abouthairtesting/hairtestingfaq/hairtestingfaq.aspx

27. DuPont, R.L., & Baumgartner, W.A. (1995). Drug testing by urine and hair analysis: Complementary features and scientific issues. Forensic Science International, 70, 63-76. Also telephone conversation for clarification of this article between Dr. Werner A. Baumgartner, Psychemedics Corporation, and R.J. Heuer, PERSEREC, on August 15, 1996.

28. Cone, E.J. (1998). Testimony of federal workplace drug-testing. Rockville, MD: National Institute on Drug Abuse.

29. National Institute on Drug Abuse. (1988). Employee drug screening: Detection of drug use by urinalysis (PHD09). Washington, DC: Author.

30. OPNAVINST 5350.4C, Drug and Alcohol Abuse Prevention and Control, October 15, 2003.

31. Thompson, T.J., & Boyle, J.P. (1992). Probability of detection of drug users by random urinalysis in the U.S. Navy (TN-93-2). San Diego, CA: Navy Personnel Research and Development Center.

32. Information provided by Capt. Rich Hildebrand, DoD Drug Coordinator, to PERSEREC by telephone on January 18, 1994.