The epidemiology of drug abuse: current issues. Ecological studies of narcotic addiction

Narcotic addiction is concentrated in certain places and among particular social groups. Heretofore it has not been possible to assess which environmental factors are critical for the initiation of narcotic use, its transition to narcotic addiction; and subsequently, entry into treatment or whether there are environments which select those particularly prone to social deviancy while others migrate out. There are few systematic descriptions of the social and environmental distribution of narcotic addicts. This paper describes the initial results of assessing the characteristics of the social environment (1970 Federal Census) of 3,000 individual narcotic addicts from the Lower East Side of Manhattan who were treated at the Beth Israel Medical Center. Pearson correlations between treated addiction ratios and 1970 Census characteristics were calculated for 13 health areas. Out of 103 socio-economic characteristics from the NIMH Mental Health Demographic Profile System, 29 were statistically significant at p less that 0.01 and 28 at 0.01 less than p less than 0.05. Highly significant correlations were found for households with children, female headed (r = .94, F= 90.3) and population in poverty (r = .89, F = 41.7). Correlations with density (over 1.01 persons per room) or population mobility (residing in different house five years ago) were not statistically significant. This paper has outlined some of the methodological and theoretical problems of ecological studies of narcotic addiction, and emphasized the need for concentration on the socio-dynamics of diffusion. Methodological problems include consideration of the time and place of onset; demographic standardization; ascertainment differentials; clinical characterization; and assessment within individuals of ecological correlations.