Self-Reported High-Risk Locations Of Drug Use Among Drug Offenders - Statistical Data Included

American Journal of Drug and Alcohol Abuse, May, 2001 by Steve Sussman, Susan L. Ames, Clyde W. Dent, Alan W. Stacy

Relatively little work has described high-risk situations for drug use among adolescents or adults. Most research with adolescents or adults refers to high-risk situations as those that are stressful and for which the person does not have sufficient problem-solving or abstinence-focused coping skills (1, 2). High-risk situations also have been conceptualized as ones in which the individual experiences unpleasant emotions, physical discomfort, pleasant emotions, and testing of personal control, urges, conflict with others, social pressure to use, and pleasant times with others (3-7).

Little work has addressed high-risk situations in terms of location of use. Yet, no drug use is devoid of a location; one may be using drugs while driving, in a car, or at home, for example. In most previous work, only hypothetical situations have been utilized. For example, a subject might be asked to identify how he or she would cope in a social gathering in the evening at a friend's house with a few others present and drugs and alcohol being offered (1, 8, 9). Studies that have examined adult hard drug use as a function of environmental context generally examine city areas known for drug purchasing, such as shooting galleries (e.g., 10). Drug use across a variety of environmental contexts is not examined.

We are aware of eight published studies that have examined the relations of adult drinking and environmental contexts. Snow and Landrum (11) examined frequency of drinking among Mississippi driving-under-the-influence (DUI) offenders in seven types of drinking places. In order from most to least popularity, these locations were home, bar or lounge, friend's home, party, car, restaurant, and parking lot. They found that these seven places explained 36% of the variance in the self-reported frequency of drunkenness, and that the two best predictors were drinking in a car or at a bar or lounge (also see Ref. 12).

Hilton (13) examined reports of alcohol use among a general population sample in the United States and examined 14 situations (within seven settings: restaurants, organized club, movies, bars, party at home, sports events, beach). Highest use situations, bars and home parties, may have involved overestimates of use because use reported in these settings were of higher frequency than one's report of overall use (per month use).

Wierczorek and Miller (14) looked at several variables among New York driving-while-intoxicated (DWI) offenders, including preferred drinking locations (public bars or restaurants versus private homes). They found that preference for drinking at home might be related to available funds (those with higher income drink outside the home more). Collins et al. (15) studied heavy drinkers (mean = 22 drinks per week) in New York; the authors used ecological momentary assessment (hand-held computer) and found that most drinkers felt good right before drinking and drank during leisure times with significant others, which were generally in the home (47%), a bar (12%), or another's home (12%).

Casswell, Zhang, and Wyllie (16) also examined reports of alcohol use situations among a general population sample in New Zealand. There were 15 locations examined, and experience of problems was related to drinking in other's homes, hotels, taverns, and sports clubs, but not restaurants. These activities were not listed in full.

Finally, Stockwell, Lang, and Rydon (17) examined reports of alcohol use situations among a general population sample in western Australia; they looked at licensed premises, home, and other person's home as locations. Drinking heavily away from home, particularly on licensed premises, was associated with problem consequences of use (also see Ref. 18). In summary, popular use locations included one's home or a bar, and problem use may have been associated with use away from home, at the bar, or leaving the bar. More detailed explorations of adult drug use situations are needed.

Sussman and coworkers (19) provided a detailed, multiple-choice, self-report analysis of specific locations within the home, school, and other public locations where continuation high school youth (youth at high risk for drug abuse) use drugs. The single most frequent location of use was the subjects' bedroom with a small group of friends. Borrowing from this work (also see Ref. 20), one may infer that there are three environmental domains that adults "pass through" in the course of a day: the home, work, and public places. Home refers to one's dwelling, which includes indoor (e.g., living room) and outdoor (e.g., yard) locations on rented or owned property. Work refers to the property where one is employed outside the home, which also includes indoor (e.g., bathroom) and outdoor (e.g., outside, near the workplace doors) locations. Finally, other public locations are environmental settings other than one's home or work that might be accessed by self or others. Generally, these other settings are directly public and may be indoor (e.g., inside a church) or outdoor (e.g., empty field), although such settings also could be restricted, as in a private club or friend's home. One could ask subjects to think about time spent at home and at work and about any other public area in reference to drug use. Then, one could have subjects specify specific locations in each setting in which drug use occurs.