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. Author manuscript; available in PMC: 2026 Jul 30.
Published in final edited form as: Drug Alcohol Depend. 2025 Jul 30;275:112811. doi: 10.1016/j.drugalcdep.2025.112811

The Role of Community Disorder in the Association Between Drug Availability and Drug Use: A Moderated Mediation Analysis

Beidi Dong 1,*, Brianna Camero 1, David Weisburd 1,2, Clair Uding 3
PMCID: PMC12371995  NIHMSID: NIHMS2102071  PMID: 40769089

Abstract

Introduction:

Drug availability plays a crucial role in shaping drug use behavior. This study examines how reported drug presence, operationalized as living on a drug hot spot street, influences self-reported drug use through perceived drug availability and whether community disorder moderates this relationship.

Methods:

This cross-sectional study analyzed survey data from 3,738 respondents residing on 449 street segments in Baltimore, Maryland (August 2013 – June 2014), categorized as crime hot spots or non-hot spots. Logistic regression models with robust standard errors estimated the direct association between reported drug presence and self-reported drug use, as well as the indirect association mediated through perceived drug availability. Additionally, a moderated mediation analysis tested whether community disorder conditioned the indirect pathway.

Results:

The relationship between reported drug presence and self-reported drug use was primarily indirect, operating through perceived availability. When perceived availability was included, the odds ratio for reported drug presence decreased from 1.19 [95% CI: 1.00, 1.40] to 1.09 [95% CI: 0.92, 1.29], while perceived availability was strongly associated with self-reported drug use (odds ratio = 1.45 [95% CI: 1.23, 1.72]). However, this indirect pathway was statistically significant only in areas with lower levels of community disorder but insignificant in high-disorder settings.

Conclusions:

Perceptions of drug availability significantly influence drug use behavior. While reducing perceived availability may be particularly effective in lower-disorder areas, addressing drug use in vulnerable, high-disorder settings requires a comprehensive, cross-sector approach that improves environmental conditions and addresses broader socioeconomic factors contributing to disorder and drug use.

Keywords: drug use, drug availability, hot spots, community disorder, moderated mediation

Introduction

Drug use and addiction are serious social problems in the United States. According to the 2024 Monitoring the Future national survey, 42.4% and 16.6% of young adults reported cannabis use and other illicit drug use, respectively, in the past year. Among adults aged 35 to 50, annual prevalence rates were 29.3% for cannabis use and 11.3% for other illicit drug use (Patrick et al., 2024). Additionally, an estimated 9.6% of Americans aged 12 or older experienced a drug use disorder in the past year (Substance Abuse and Mental Health Services Administration, 2024).

The adverse health consequences of drug use are extensive and severe, including dependence, chronic diseases (e.g., cirrhosis, cardiovascular and pulmonary issues), blood-borne bacterial and viral infections, and mental health disorders. Drug use also contributes to increased mortality through acute effects of intoxication, such as accidental injuries, violence, higher suicide rates, and overdoses (Degenhardt & Hall, 2012). In 2022 alone, 107,941 drug overdose deaths were reported, with an age-adjusted rate of 32.6 deaths per 100,000 standard population (Spencer et al., 2023). Beyond individual health outcomes, families dealing with drug use often struggle with financial instability and disrupted family dynamics (e.g., at heightened risk of child abuse and neglect). More broadly, drug use is frequently associated with higher crime rates, weakened community bonds, and overburdened justice and healthcare systems, highlighting the far-reaching public health and social consequences of drug use and addiction (Ignaszewski, 2021; Sussman et al., 2008).

A considerable body of research has explored factors contributing to drug use. For instance, problem drug users tend to exhibit a higher prevalence of psychiatric morbidity and disorders, suggesting a bidirectional relationship between mental health issues and drug use (Rhodes et al., 2003). Additional risk factors include high impulsivity, rebelliousness, emotional regulation impairment, catastrophic pain, maltreatment or negative upbringing, low parental education, having peers who abuse drugs, and the presence of substance-using family members (Nawi et al. 2021). Moreover, drug availability plays a crucial role in usage, as access to drugs is a prerequisite for consumption. Studies have shown a strong correlation between drug availability and usage, such as the connection between local drug sales and illegal drug use (Freisthler et al., 2005). Similarly, proximity to marijuana dispensaries has been associated with a greater number of days using marijuana in the past month (Shih et al., 2019). Among probationers, greater availability of drugs in their surroundings has been associated with higher rates of positive drug tests (Wooditch et al., 2013; but see Miller et al., 2016; Houser et al., 2018).

In addition to actual drug availability, perceived availability may also play an important role in drug use. Although the relationship between actual and perceived availability requires further research in the context of drug use, insights can be drawn from alcohol research. For example, access to alcohol through social networks, such as friends or family, has been shown to increase perceived availability, which in turn raises consumption, particularly among adolescents (Stanley et al., 2011; Kuntsche et al., 2008). On the other hand, perceived availability has been correlated with higher levels of drug use (Debnam et al., 2018; Martins et al., 2016; Schleimer et al., 2019; Kazmer et al., 2019). For instance, perceived neighborhood drug selling was associated with lower peer disapproval and increased illicit drug use among high school seniors (Duncan et al., 2014). Perceived opportunities for drug use also increased self-reported urges to use drugs (Wertz & Sayette, 2001; Yamamoto et al., 2007).

These initial findings highlight the importance of estimating the progression from actual drug availability or reported drug presence to perceived drug availability and, ultimately, to self-reported drug use. However, this progression may be shaped by broader environmental conditions (see Figure 1 for the conceptual model). Neighborhood disadvantage and disorder, for instance, have been associated with both drug availability and use (e.g., Harlow et al., 2025; Mennis et al. 2016; Wagner et al. 2021). In highly disordered areas, the relationship between actual and perceived availability could be stronger than in more orderly areas due to the heightened visibility of drug activities (including being approached by someone selling drugs), or weaker due to community desensitization to pervasive drug-related issues (Storr et al., 2004). Additionally, in high-disorder environments, access to physical spaces for drug use and a reduced perception of consequences may strengthen the association between perceived availability and actual use (Furr-Holden et al., 2011). Yet, when disorder is pervasive, the specific cue of drug availability may become a less significant correlate of actual drug use, serving as just one of many interwoven risk factors in a broader context of disadvantage (Sampson & Raudenbush, 2004).

Figure 1.

Figure 1.

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Conceptual model illustrating the relationships between actual drug availability, perceived drug availability, and self-reported drug use, moderated by community disorder.

Thus, the current study aims to investigate how reported drug presence influences self-reported drug use through perceived drug availability and whether community disorder moderates this relationship. Gaining the knowledge of whether and under what neighborhood conditions addressing perceptions of drug availability is most effective to reduce drug use is crucial for shaping policy decisions and developing targeted prevention efforts in vulnerable communities.

Methods

Study Data and Sample

The data for our analyses were obtained from a study of crime hot spots in Baltimore City, Maryland, funded by the National Institute on Drug Abuse (Weisburd et al., 2011). Specifically, we used survey data from 3,738 respondents living on 449 street segments in Baltimore City, Maryland, collected between August 2013 and June 2014. A street segment was defined as both sides of the street between two intersections.

Sample selection began with the 25,045 street segments in Baltimore City. To be eligible, segments needed at least 20 occupied residences because we aimed for a minimum of 7 respondents per segment. To attain a high-risk sample, segments were classified into “crime hot spots” and “non-hot spots” based on 2012 Baltimore City Police Department (BCPD) calls-for-service data. Hot spots, in the top 3% for drug or violent offenses, were divided into drug hot spots (121 segments with 1014 respondents), violent hot spots (126 segments with 1054 respondents), and combined drug/violent hot spots (55 segments with 478 respondents). Our stratified random sampling procedure ensured no two sampled streets were within one block of each other. Non-hot spot segments (147 segments with 1192 respondents) were sampled similarly (see Figure 2 for a map of the sampled streets).

Figure 2.

Figure 2.

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Sampled streets in Baltimore City, Maryland

Face-to-face surveys were then conducted at a random sample of residences on the sampled streets. After accounting for abandoned housing, the contact rate was 71.2%. The cooperation rate was 60.5%, which is above average for door-to-door surveying. Each survey took approximately 20 minutes, and respondents received $15 for their participation. This compensation amount was a modest and appropriate acknowledgment of participants’ time and effort, without posing undue influence on economically disadvantaged participants. An average of eight surveys were completed per street (min = 6; max = 14). The study was approved by the institutional review board of George Mason University.

Measures

Actual drug availability or reported drug presence was measured dichotomously by whether a respondent resided on a drug hot spot street (including the combined type). The high volume of drug-related calls-for-service indicated that drugs were indeed available and represented a significant concern for residents living on those streets. The validity of this measure was cross-validated using drug-related crime incident data and systematic social observation data collected by our research team. Perceived drug availability was measured by asking respondents if any of the following drugs—marijuana, powder cocaine, crack cocaine, heroin, methamphetamine, ecstasy, or prescription drugs—were being sold on their block. Self-reported drug use was measured by asking respondents if they used any of the aforementioned drugs in the last 12 months.

Community disorder was measured using a 7-item scale, asking respondents if there were “none”, “one or two”, or “many” of the following on their block: building with broken windows, places where graffiti is a problem, vacant lots, abandoned or boarded-up buildings, abandoned cars, places with litter and broken glass, and areas in need of better lighting. Principal component analysis confirmed that all seven items loaded onto a single factor. An average score was calculated for the scale, with a Cronbach’s alpha of 0.75, indicating good internal consistency for this measure. This scale aligns with well-established criminological perspectives, particularly broken windows theory (Wilson & Kelling, 1982), which suggests that visible signs of disorder (e.g., abandoned properties, graffiti, and litter) signal lawlessness and social breakdown, potentially inviting further criminal activity and diminishing collective efficacy (Sampson et al., 1997; Sampson & Raudenbush, 1999). Additionally, we adjusted for respondent characteristics, including age, gender, being Black, marital status, home ownership, length of residence at the current address, and highest level of education.

Statistical Analysis

First, we estimated the direct association between reported drug presence and self-reported drug use. Second, to establish the mediation pathway, we examined the relationship between reported drug presence and perceived drug availability, and the indirect association between reported drug presence and self-reported drug use via perceived drug availability. Given the binary nature of these measures and to account for clustering of respondents by street, logistic regression models with robust standard errors were used. Moreover, to assess the conditional indirect effect of perceived drug availability, moderated by community disorder, we performed a moderated mediation analysis using the “mediation” package in R. Statistical tests were two-sided, with a significance threshold of p < 0.05. All analyses were conducted in 2024 using Stata Version 17.0 and R Version 4.3.1.

Results

Table 1 presents descriptive information on drug availability, drug use, and key demographic variables. Approximately 40% of the respondents in our sample lived on a drug hot spot street (including the combined type), while 38% perceived that drugs were being sold on their block. In this context, about 23% of the respondents reported drug use in the past 12 months. The mean age of the study sample was 44.5 years, with approximately 42% of the respondents being male. The vast majority of the sample were black, and most individuals had a high school diploma or some college education.

Table 1.

Descriptive statistics for drug availability, drug use, and key demographic variables (N = 3,730)

Variables Mean (% Yes) S.D. Min Max
Self-reported drug use 23% 42% 0 1
Actual drug availability (reported drug presence) 40% 49% 0 1
Perceived drug availability 38% 49% 0 1
Age (in years) 44.49 15.67 21 95
Male 42% 49% 0 1
Black 76% 43% 0 1
Married 23% 42% 0 1
Home ownership 38% 49% 0 1
Length at current address (in months) 119.27 155.92 2 936
Some middle school or high school 19% 39% 0 1
High school diploma 34% 48% 0 1
Some college 24% 43% 0 1
Associate’s degree 5% 23% 0 1
Bachelor’s degree 10% 30% 0 1
Graduate or professional degree 7% 26% 0 1
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Model 1 in Table 2 shows that actual drug availability or reported drug presence was significantly correlated with self-reported drug use in a bivariate analysis. Living on a drug hot spot street increased the odds of drug use by 23% compared to those not living on a drug hot spot street [OR=1.23, 95% CI: 1.05, 1.43]. Model 2 in Table 2 demonstrates that the association remained significant after adjusting for key demographic variables, though the effect size was slightly reduced [OR=1.19, 95% CI: 1.00, 1.40]. As expected, being male was associated with a higher likelihood of drug use, while being older, married, and having a higher level of education (compared to having only some middle school or high school education) were associated with a lower likelihood of drug use.

Table 2.

Relationship between self-reported drug use and actual drug availability via perceived drug availability

Model 1
DV: Self-reported drug use		 Model 2
DV: Self-reported drug use		 Model 3
DV: Perceived drug availability		 Model 4
DV: Self-reported drug use
Predictor variable Odds Ratio (95% CI) Odds Ratio (95% CI) Odds Ratio (95% CI) Odds Ratio (95% CI)
 Perceived drug availability -- -- -- 1.45 (1.23, 1.72)
 Actual drug availability (reported drug presence) 1.23 (1.05, 1.43) 1.19 (1.00, 1.40) 2.82 (2.44, 3.25) 1.09 (0.92, 1.29)
 Age -- 0.96 (0.95, 0.97) 0.99 (0.99, 1.00) 0.96 (0.95, 0.97)
 Male -- 2.11 (1.79, 2.49) 0.83 (0.72, 0.96) 2.16 (1.83, 2.55)
 Black -- 1.00 (0.82, 1.23) 0.91 (0.77, 1.08) 1.01 (0.82, 1.24)
 Married -- 0.50 (0.40, 0.64) 0.97 (0.81, 1.15) 0.50 (0.39, 0.64)
 Home ownership -- 0.99 (0.80, 1.22) 0.89 (0.75, 1.06) 1.00 (0.81, 1.24)
 Length at current address -- 1.00 (1.00, 1.00) 1.00 (1.00, 1.00) 1.00 (1.00, 1.00)
 High school diploma -- 0.73 (0.58, 0.92) 0.86 (0.71, 1.06) 0.74 (0.59, 0.93)
 Some college -- 0.93 (0.73, 1.18) 1.32 (1.06, 1.64) 0.90 (0.71, 1.15)
 Associate’s degree -- 0.68 (0.44, 1.06) 1.00 (0.70, 1.41) 0.68 (0.44, 1.06)
 Bachelor’s degree -- 0.68 (0.49, 0.95) 1.10 (0.83, 1.45) 0.67 (0.49, 0.94)
 Graduate or professional degree -- 0.33 (0.21, 0.54) 0.93 (0.67, 1.29) 0.33 (0.20, 0.54)
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Model 3 in Table 2 shows that reported drug presence was a strong predictor of perceived drug availability. Living on a drug hot spot street increased the odds of perceiving drug sales by 182% compared to those not living on a drug hot spot street [OR=2.82, 95% CI: 2.44, 3.25]. In addition, males were less likely than females to perceive drug sales on their block. While engaging in higher levels of drug use behavior, males may normalize or be less sensitive to environmental cues of drug-related activities, including drug transactions, on their block. Moreover, Model 4 in Table 2 suggests complete mediation of the association between reported drug presence and drug use through perceived drug availability, highlighting the importance of addressing the indirect pathway. When perceived drug availability was included in the regression model, reported drug presence was no longer a statistically significant predictor of drug use, and the effect size was further reduced [OR=1.09, 95% CI: 0.92, 1.29]. The demographic variables showed comparable effects to those observed in Model 2.

Table 3 demonstrates that this indirect pathway was conditional on the contextual environment, specifically community disorder. The average causal mediation effect (ACME) is reported across various levels of community disorder. The patterns observed for the demographic variables in Table 2 hold in these final models. At very low, low, and average levels of community disorder, the indirect effect of perceived drug availability was statistically significant. However, at high and very high levels of community disorder, the mediation effect diminished, with no significant indirect effect observed. In other words, the progression from actual drug availability or reported drug presence to perceived drug availably and, ultimately, to self-reported drug use did not hold in higher-disorder areas. Statistical tests comparing the ACME between low and high levels of community disorder (p=0.048), and very low versus very high levels (p=0.004), showed significant differences. Overall, these findings indicated that the mediation pathway through perceived drug availability was stronger in lower-disorder environments and weakened as community disorder increased. As a robustness check, we replicated the analysis by excluding respondents living on violent hot spot streets from the sample. The same substantive findings were observed, confirming the validity of the results.

Table 3.

Conditional indirect effect of perceived drug availability on the relationship between actual drug availability and self-reported drug use moderated by community disorder

Indirect effects 95% bootstrap confidence interval p-value
ACME at different levels of community disorder
 Very low (mean – 2*SD) 0.017 (0.007, 0.030) p <0.001***
 Low (mean – 1*SD) 0.015 (0.007, 0.020) p <0.001***
 Average (mean) 0.011 (0.005, 0.020) p<0.001***
 High (mean + 1*SD) 0.004 (−0.001, 0.010) p=0.130
 Very high (mean + 2*SD) 0.000 (−0.006, 0.010) p =1.000
Statistical significance tests
 Test of ACME (low) – ACME (high) 0.010 (0.000, 0.022) p=.048*
 Test of ACME (very low) – ACME (very high) 0.016 (0.004, 0.030) p=0.004**
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ACME: average causal mediation effect; SD: standard deviation

Discussion

Given the high prevalence of drug use in the U.S. and its associated health risks and increased mortality (Substance Abuse and Mental Health Services Administration, 2024; Degenhardt & Hall, 2012), understanding the contributing factors is crucial. While addressing the root causes of drug use, such as poverty and socio-economic inequality, mental health issues, and inadequate support systems, is critical, there is also a pressing need for solutions that offer more immediate benefits. From an opportunity perspective, drug availability is a key factor influencing usage patterns.

Although prior research has examined the relationship between drug accessibility and use, few studies have investigated the mediating role of perceived availability and even fewer, if any, have considered how this relationship may be moderated by the community environment. This study provides empirical evidence that, while reported drug presence was significantly associated with drug use, this relationship appears to be mainly indirect, operating through perceived drug availability. Specifically, actual availability had a strong association with perceived availability, which, in turn, was linked to self-reported drug use. Once this mediating effect of perceived drug availability was accounted for, the direct pathway from reported drug presence to drug use became insignificant. This highlights the important role that perceptions of availability play in shaping drug use behaviors—it is not merely the physical presence of drugs, but how accessible individuals perceive these substances to be that influences their decision to use. By altering how accessible drugs are perceived to be, even in environments where drugs are readily available (and sometimes challenging to control), it may be possible to reduce drug use without entirely eliminating the supply.

More importantly, this study found that the indirect pathway was conditional on the contextual environment, specifically community disorder. The indirect effect was statistically significant only at the lower end of the community disorder continuum, whereas the mediation effect was not significant at the higher end. Several factors may explain this moderated mediation relationship. In high-disorder areas, as routine activities theory suggests (Basta et al., 2010; Cohen & Felson, 1979; Dong et al., 2020; Hindelang et al., 1978), residents may perceive their surroundings as too dangerous or unpleasant to spend time outdoors, resulting in a less accurate understanding of drug availability on the street. As a result, their inaccurate perception of drug accessibility is less likely to correlate with self-reported drug use. In addition, fear of neighborhood crime and disorder has been associated with increased drug use, suggesting that individuals in high-disorder areas may engage in drug use regardless of perceived availability (Theall et al., 2009; Pederson et al., 2002). Moreover, prolonged exposure to pervasive community disorder (including drug-related issues) may already signal a breakdown in lawfulness and social control, resulting in desensitization and the normalization of deviant behaviors such as drug use, as suggested by broken windows theory (Wilson & Kelling, 1982). This further contributes to a less accurate assessment of drug accessibility and weakens the relationship between perceived drug availability and self-reported drug use.

Conversely, in areas with lower levels of disorder, residents may be more likely to spend time outside, providing them with a more accurate understanding of drug availability on the street. In these well-maintained and orderly environments, any signs of drug activity or availability may stand out more starkly, making the perception of drug availability a more potent signal. This sharp contrast with the otherwise orderly surroundings could make the presence of drugs seem more alarming or significant, potentially amplifying the indirect effect on drug use, especially given the robust association between perceived drug availability and drug behavior (Schleimer et al., 2019; Kazmer et al., 2019). Moreover, witnessing drug use or sales in low-disorder neighborhoods may increase curiosity or shift perceived peer norms, such as reducing peer disapproval of drugs, which could indirectly encourage drug use (Duncan et al., 2014). This is particularly relevant in low-disorder neighborhoods, where stronger social ties may make residents more susceptible to peer influence from neighbors (Hipp, 2016; Kleinhans & Bolt, 2016).

Public Health Implications

The findings of this study have important public health implications. Addressing actual drug availability remains fundamental to mitigating the direct link between access to drugs and drug use, as well as its strong relationship with perceived drug availability. Reducing the physical presence of drugs in communities through targeted law enforcement efforts (e.g., hot spot policing), improved drug regulation, and disruption of supply chains can directly lower opportunities for drug use (Braga et al. 2019; Mazerolle et al. 2007; Strang et al. 2012; Weisburd & Green, 1995). Yet, such punitive or restrictive approaches must carefully consider principles of procedural justice (e.g., see Weisburd et al., 2022) and be complemented by community-based initiatives that tackle the underlying social and structural causes of drug use, such as poverty and inadequate health care systems.

Moreover, reducing people’s perception of drug availability is crucial. Research indicates that individuals are less likely to use drugs if they believe that drugs are not easily accessible (Kazmer et al., 2019; Wertz & Sayette 2001). However, the discovery of a moderated mediation relationship suggests that nuanced and context-specific strategies may be necessary to effectively reduce drug use across different environments.

In low-disorder areas, city government and police should emphasize the safety of streets and encourage residents to spend time outside. Community policing has long emphasized the importance of engaging residents in activities such as block parties and related communal activities (Gill et al., 2014). This will have an impact not only on perceptions of drug availability, but also on crime more generally. “Eyes on the street” have long been recognized as a key element in enhancing public safety (Jacobs, 1961; Linning & Eck, 2021). Informed by the social disorganization perspective, organizing local events that build collective efficacy, encouraging social cohesion and trust, and active participation in neighborhood maintenance and improvement, can strengthen prosocial bonds and empower residents to take ownership of keeping their community drug-free (O’Brien & Kauffman Jr. 2013; Rice et al. 2015; Sampson et al., 1997; Weisburd et al., 2020). Informal social controls have previously been shown to reduce drug-related crime and address broader community challenges (Dong, White, & Weisburd, 2020; Dong et al., 2024; Weisburd et al., 2013; Weisburd et al., 2021). Moreover, public awareness campaigns should promote positive narratives, led by local leaders, that emphasize safety, health, and resistance to drug-related activities (e.g., norms regarding peer disapproval of drug use). These narratives foster a sense of pride and commitment in maintaining a drug-free environment. When implemented together, these strategies create a sustainable public health approach to reducing the perception of drug availability and preventing drug use in low-disorder areas.

The moderated mediation analysis suggests that such approaches may be less beneficial on streets with high levels of disorder. On these streets, hot spots policing programs that seek to reduce crime and drug markets should form a first step in a process leading to community policing and programs that emphasize improvements in collective efficacy (Sampson et al., 1997). For example, evidence-based drug-related crime control efforts like third-party policing could be helpful (Mazerolle & Ransley, 2019). Such programs often seek to engage residents in reducing crime and drug use on their streets, and would, with successes in prevention, also encourage collective efficacy among residents. In addition to directly reducing the physical presence of drugs, efforts should also consider addressing the disordered environment itself and the broader socioeconomic factors that contribute to it. In supplementary analysis not shown here, community disorder was significantly associated with self-reported drug use when actual and perceived drug availability were included in the same regression model.

Recent evidence from public health interventions on violence prevention shows that place-based interventions, such as vacant lot remediation, abandoned building restoration, and “clean and green” programs, can reduce disorder and increase informal social control in surrounding areas (e.g., Branas et al. 2018; Hohl et al., 2019; Zoorob & O’Brien 2024). A similar logic can be applied here. For instance, organizing community clean-ups, graffiti removal, and infrastructure repair projects in high-disorder areas can help reduce visible signs of disorder and improve neighborhood aesthetics, which, in turn, shift perceptions of safety, deter the normalization of drug activity, and limit access to physical spaces for drug sales or use. Beyond these immediate efforts, long-term investments in housing, infrastructure, and public services are essential to addressing the structural causes of disorder and reducing conditions that foster drug markets and related behaviors (Ramey & Shrider 2014; Velez et al. 2012; MacDonald 2015). In summary, cross-sector partnerships between law enforcement, public health agencies, urban planners, and social services should ensure a multi-faceted approach that addresses both the environmental and social drivers of drug use.

Limitations

This study has several limitations. First, actual drug availability, or more precisely, reported drug presence, was measured by whether a respondent resided on a drug hot spot street, identified using drug-related calls-for-service data. While these calls provide valuable insight, they cannot conclusively establish the physical presence of drugs or drug sales on a street and are subject to reporting biases (e.g., citizens’ unwillingness to call the police). However, the high volume of calls suggests that drugs were indeed present and represented a significant concern for residents living on those streets. Additionally, areas with high drug use do not always coincide with the locations of drug supply (Freisthler et al., 2005), meaning some streets identified as drug hot spots could have high usage but low drug availability due to limited drug selling activity. Future research should explore more precise measures of actual drug availability, including geospatial analysis and qualitative neighborhood assessments (e.g., ethnographic fieldwork), to better capture these dynamics. Moreover, the outcome variable of drug use was self-reported, potentially subjecting it to social desirability bias.

Furthermore, this study is cross-sectional, which limits our ability to make causal inferences. Although we controlled for key sociodemographic variables that may affect both living on a drug hot spot street and self-reported drug use, omitted variable bias remains a possibility. Other contextual factors (e.g., economic hardship, mental health conditions, perceptions of police legitimacy and practices, or fear of crime) might also moderate the progression from actual to perceived availability and, ultimately, subsequent drug use. However, our examination of moderated mediation by community disorder represents an important first step, particularly given recent evidence showing the potential of place-based interventions targeting community disorder to improve community health (McGowan et al. 2021; Hsueh et al. 2022). In addition, future research employing longitudinal designs should explore potential bidirectional relationships—for example, how drug use may in turn contribute to increased community disorder. Lastly, the results were derived from a predominantly Black, urban sample in Baltimore, Maryland. To assess the broader applicability of the findings, it is important to replicate the study in more racially and geographically diverse settings.

Conclusion

To our knowledge, this is the first study to estimate the progression from actual to perceived drug availability and, ultimately, to self-reported drug use, while also exploring how this indirect pathway is moderated by the contextual environment. Our findings suggest that, from an opportunity perspective, while addressing actual drug availability remains fundamental to reducing drug use, reducing people’s perception of drug availability and reinforcing the belief that the community is largely drug-free is also crucial, especially in lower-disorder areas. In vulnerable, high-disorder communities, though, focusing primarily on perceptions may not be sufficient. Cross-sector partnerships between law enforcement, public health agencies, urban planners, and social services must address both the physical presence of drugs and the broader social and environmental factors driving drug use to achieve lasting impact.

Highlights.

  • Drug availability plays a crucial role in shaping drug use behavior

  • Actual drug availability influences drug use indirectly via perceived availability

  • The indirect pathway varies by community disorder levels

  • Tailored strategies must consider social and environmental dynamics in communities

Funding

This research was supported by the National Institute on Drug Abuse [R01 DA032639].

Appendix A. A visual flow diagram of the sample selection process

graphic file with name nihms-2102071-f0003.jpg

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Footnotes

Declaration of Interest Statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Data Availability Statement

The data used in this study contain sensitive information and are not publicly available due to ethical and privacy considerations. However, researchers may request access by contacting the corresponding author. All requests will be reviewed in accordance with established data-sharing policies and ethical guidelines.

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