Abstract
Background
A large portion of violence associated with drug use is due to drug dealing. These analyses sought to examine injection drug users' attitudes and experiences of drug dealer violence.
Methods
The current study used the 18-month follow up data of STEP into Action (STEP) study, an HIV prevention intervention among drug injectors and their risk network members conducted in Baltimore, Maryland. Four scales assessed acceptability of drug dealer violence, willingness to talk to drug users about avoiding drug dealer violence, social norms about reporting drug dealer violence, and intentions to report drug dealer violence to the police.
Results
Many (44%) of the 373 participants reported witnessing drug dealers' acts of violence within the prior 6 months. Although the majority of participants disagreed with statements on the acceptability of dealers using violence, only a minority indicated that they would call the police if they observed dealer violence. Most participants indicated that they would be interested in talking to drug users about how to avoid violent dealers. Males were more likely to report that violence was acceptable, whereas African Americans were less likely to condone violence. Those who were homeless and had higher incomes were more likely to report witnessing drug dealer violence.
Conclusions
These results suggest that it may be feasible to train current and former drug users and their risk network members in methods to promote violence reduction among drug dealers.
Keywords: violence, drug dealer, injection drug users
1. Introduction
Violence is strongly linked to the trade and use of illicit drugs (Boles and Miotto, 2003; Darke et al., 2010; Hoaken and Stewart, 2003), and cocaine and heroin users are often perpetrators or victims of violence (Neale et al., 2005). One study found that in New York City, between 1990 and 1998, positive drug toxicology was present in over half of all firearm death victims (Galea et al., 2002). A key aspect of the link between drug use and violence is drug dealing. In a study of youth perpetration of violence, Kuhns (2005) reported that selling illicit drugs was a strong predictor of violence. Goldstein (1985) conducted extensive qualitative and quantitative studies on heroin use and violence. He concluded that much of drug related violence was linked to the systemic factor of drug dealing. For example, in a sample from New York City during the mid 80s', about 39% of all homicides and about 74% of all drug-related homicides were related to drug trafficking. Other studies have also documented the relationship between violence and drug sales. A case-control study of repeated victims of violence who were admitted to a regional trauma center found that cases were 22 times more likely to be current drug dealers as compared to controls (Cooper et al., 2000), and a study of juvenile murders in the US, found that many youth offenders were involved in the sale and distribution of drugs (McLaughlin et al., 2000).
The effects of violence on the health of drug users extend beyond the immediate consequences of victimization. Violence shapes the environment in which a variety of drug-use related harms can occur (Rhodes, 2009). Violence or the threat of violence can also contribute to the social and economic marginalization of drug users. Violence, combined with other aspects of the risk environment may increase the likelihood of self-medicative drug use and drug relapse (Singer, M., 2004; Yang, C., German, D., Webster, D., & Latkin, C., 2011).
Drug dealing is not the only source of violence experienced by drug users. It is well documented that illicit drug users are subject to violence from police. In some countries police violence toward drug users is routine and severe (Rhodes et al., 2005). In an ethnographic study of violence experienced by injectors and non-drug users in a New York City police crackdown, Cooper and colleagues (Cooper et al., 2004) documented four categories of police violence: excessive physical violence, psychological violence, sexual violence, and neglectful violence. The last category includes requesting police assistance, but the police not responding, responding too late, or responding inappropriately. Some US jurisdictions have adopted the broken window hypothesis and arrest drug users for minor legal violations such as loitering (Dixon and Coffin, 1999). Several studies have documented how police crackdowns on drug dealing may have the unintended consequence of interfering with syringe exchange programs (Aitken et al., 2002; Martinez et al., 2007). While the goal of reducing public drug use and open air drug markets is often perceived as laudatory by the community, the common police tactics to control drug use, such as arresting drug users for loitering, is likely to lead drug users to mistrust the police and refrain from reporting crimes. However, a systematic review found increasing the intensity of law enforcement interventions to disrupt drug markets actually increased violence (Werb, D et al., 2010). Alternative models to meaningfully reduce drug-related violence need to be considered.
That violence from drug dealers is situated in the context of an illegal activity further decreases the recourse of drug users to use the judicial system. Addressing the harmful effects of dealer violence may be abetted by understanding the attitudes and norms of drug users regarding dealer violence. Given their limited recourse to the justice system, it is also essential to evaluate alternative methods to moderate the deleterious effects of dealer violence. In the current study, we examined 1) types of drug dealer violence witnessed by drug users; 2) drug users' attitudes toward violence perpetrated by dealers; 3) the social norms of drug dealer violence; and 4) drug users' willingness to influence drug dealer violence by either reporting violence to police or by encouraging other drug users to avoid violent dealers. Study participants were injection drug users and their network members (drug users and/or sex partners) who had volunteered for an HIV prevention intervention in Baltimore, Maryland.
At the time of the data collection and currently, Baltimore has open-air drug markets, which is the selling of drugs in public, usually on the streets. The drug markets in Baltimore have been well documented in the best seller The Corner (Simon, D. & Burns, E., 1997). Major roles in the street-level drug markets include scouts, who warn dealers about police in the area, security who are hired to protect drugs and money, touts who have the role of luring potential customs, and individuals involved in the cutting and packaging of drugs. Traditionally, the pattern of policing in Baltimore has been to make “sweeps” of drug markets, arresting individuals who are suspected of being users or involved in the drug economy with the goal of impeding the open-air drug markets, which then move to new locations often only a few blocks away.
2. Method
2.1. Study population
The study used the 18-month follow up data of STEP into Action (STEP) study, an HIV prevention intervention among drug injectors and their risk network members conducted in Baltimore, Maryland. Participants were recruited in neighborhoods with high concentrations of drug use and sales.
Eighteen-month follow up interview data were collected from April 2005 through September 2007. There were two types of study participants: primary and secondary. Eligibility for primary participants included 18 years and older, injected drugs in the prior six months, resided in Baltimore, had not participated in HIV or network studies in the past year, willing to talk to drug users about HIV prevention, and willing to recruit drug or sex partners. Primary participants were asked to recruit at least one secondary participant whom they had listed as a drug or sexual risk network member on their social network inventory. Secondary participants were eligible if they were 18 years or older and nominated by the primary participants. Of the sample, 59% were primary participants. All participants completed interviews that included both interviewer-administered sections and Audio Computer-Assisted Self-Interview (ACASI) sections for items pertaining to sex and drug behaviors. Participants were compensated with $35 for completion of the assessment. Protocols were approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board prior to study implementation.
2.2. Measures
Sociodemographic characteristics, drug use behaviors and HIV status
Sociodemographic characteristics examined in this study were race/ethnicity (African-American vs. other), age, gender, educational status, current unemployment, housing status (homeless vs. not homeless), and monthly income (median split for $500 or more). Active drug users were defined as participants who reported having used heroin or crack/cocaine in the prior 6 months. HIV status for these analyses was assessed through the self-reported HIV status using three questions, “What was the result of your last HIV test?”, “Have you ever been tested positive for HIV?”, and “Do you have HIV?” Participants were categorized as HIV positive if they answered “positive” or “yes” to any of these three questions.
Violent dealer related index
Violent dealer related index was assessed through a total of 14 items. The index was comprised of 4 hypothesized domains: (1) social norms about reporting drug dealer violence to the police, (2) intention to report drug violence to the police, (3) willingness to talk to drug users about a violent dealer, and (4) the acceptability of dealers' violence. Particularly, this index was designed to capture respondents' perception and intention to deal with the issue of drug dealer violence in the community. The 14 items included 3 items about the proportion of participants' associates who would call the police for different situations, which include “if they knew a drug dealer in the neighborhood was carrying a gun,” “if they saw someone in the neighborhood being threatened with a gun over drugs,” and “if they saw someone in the neighborhood getting shot over drugs.” The responses ranged from “none”, “a few”, “some”, “most” to “all”. Three items assessed participants willingness to call the police regarding drug violence, including “If I knew that someone dealing drugs in the neighborhood was carrying a gun, I would call the police,” “I would not call the police if I saw someone in the neighborhood being threatened with a gun about drugs,” and “If I knew that someone in the neighborhood shot another person over drugs, I would call the police to report the information,” were assessed on a 5-point Likert scale. Eight items assess the acceptability of dealers' violence, including “Most people who are beaten by drug dealers get what they deserve,” “If someone tries to steal from a dealer, the dealer has a right to beat them up,” “If someone tries to cheat a dealer, the dealer has the right to beat them up,” “If someone tries to steal from a dealer, the dealer has the right to shoot them,” “If someone tries to cheat a dealer, the dealer has the right to shoot them,” “I try to warn drug users about dealers who are violent toward customers,” “I would be comfortable encouraging drug users to avoid dealers who are violent toward customers,” and “I would be comfortable talking to drug users about how to avoid violence.”
Experiences of and witnessing drug dealer-related violence
Experiences with violent drug dealers were assessed by asking participants if they had any of the following interactions with drug dealers, “I have been intimidated by drug dealer enforcers to buy drugs exclusively from them,” “I have been forced to buy my drugs from certain dealers,” “In my neighborhood there are many dealers that I can choose from to buy my drugs,” “I usually buy from the same dealer,” and “Has a dealer ever offered you shorts, that is allowed you to pay less, to keep your business?”
Participants were also asked “When was the last time you saw a drug dealer being violent?” on a 7-point response scale from “never” to “today.” The response was dichotomized as having seen a drug dealer being violent “within the last 6 months” versus “more than 6 months ago or never.”An open-ended question of “What was the drug dealer doing?” was asked to those participants who reported witnessing drug dealers' violence to describe types of drug dealer violence.
2.3. Data analysis
Data analysis was limited to those participants who were administered the survey questions on violent dealers, of whom 98% reported a history of heroin or cocaine use, with 96% reporting use within the prior six months at the baseline survey. Frequency distributions were calculated to examine the distribution of the variables and to generate a profile of this sample of the participants. The construct validity and reliability of violent dealer index were evaluated by exploratory factor analysis (EFA) of the correlation matrix of the original 14 items (Jennrich, 1973) and Cronbach's alpha coefficients. To verify the dimensionality of the violent dealer index items, principle factor analysis was performed as EFA. Two criteria were used to determine the number of factors to be extracted in the EFA model: 1) the number of eigenvalues greater than one and 2) the scree plot (Netemeyer et al., 2003). Sizes of the loading, cross loadings and uniqueness were examined to determine the quality of the variables measuring the factors. Oblique rotation was specified as factors were hypothesized a priori to be correlated. Items from each retained factor were added to create a composite score. A binary variable for each factor was dichotomized at the median of the composite score for the final analysis.
The primary outcomes of interest included 1) having seen a violent drug dealer during the past 6 months, 2) norms favoring reporting violent drug dealers to the police, 3) willingness to talk to drug users about violent drug dealers, and 4) high acceptability of drug dealers' violence. Bivariate and multivariate logistic regressions were conducted to assess the relationship between independent variables and the outcome variables. Given the exploratory nature of the current study, all sociodemographic backgrounds and violent drug dealer factors have been included in both bivariate and multivariate logistic regression models. Since network participants were recruited by primary participants, the independent observation assumptions may be violated. Generalized Estimating Equations (GEE) modeling was used with participants nested within recruitment networks. All analyses were performed using Stata Version 10.0 (Stata Corporation, College Station, TX).
3. Results
Out of 14 items, a total of 12 items were retained in the violent drug dealer index (Table 1). Results of principle component analysis and scree plots suggested a five-factor solution. We combined factor 1 and 2 because of their similar domain on the acceptance of violent dealers. Table 1 presents Cronbach's alpha coefficients and factor loadings of 12 items. Four factors related to violent drug dealer index were used for the final analysis, which included (1) the acceptability of dealers' violence with Cronbach's alpha of 0.78, (2) intention to report drug violence to the police with Cronbach's alpha of 0.74, (3) norms favoring reporting violent drug dealers to the police with Cronbach's alpha of 0.82, and (4) willingness to talk to drug users about a violent dealer with Cronbach's alpha of 0.77.
Table 1.
Cronbach's alpha coefficients and factor loadings of the index of violent drug dealer and reporting violence
| Item statement | Factor coefficient | |||||
|---|---|---|---|---|---|---|
| Cronbach's alpha | Factor 1 | Factor 2 | Factor 3 | Factor 4 | Factor 5 | |
| Scale one: the acceptability of dealers' violence | 0.78 | |||||
| If someone tries to steal from a dealer, the dealer has a right to beat them up | 0.795 | 0.011 | 0.005 | −0.008 | −0.042 | |
| If someone tries to cheat a dealer, the dealer has the right to beat them up | 0.760 | 0.150 | 0.019 | 0.030 | 0.037 | |
| If someone tries to steal from a dealer, the dealer has the right to shoot them | 0.112 | 0.787 | −0.043 | −0.046 | −0.016 | |
| If someone tries to cheat a dealer, the dealer has the right to shoot them | 0.004 | 0.835 | 0.037 | 0.003 | 0.001 | |
| Scale two: intention to report drug violence to the police | 0.74 | |||||
| If I knew that someone dealing drugs in the neighborhood was carrying a gun, I would call the police | 0.024 | −0.025 | 0.587 | 0.207 | −0.022 | |
| If I knew that someone shot another person over drugs, I would call the police | 0.038 | 0.020 | 0.573 | 0.216 | −0.054 | |
| Scale three :Norms favoring reporting violent drug dealers to police | 0.82 | |||||
| How many of your associates would call the police if they knew a drug dealer in the neighborhood was carrying a gun | 0.052 | 0.015 | 0.083 | 0.555 | 0.015 | |
| How many of your associates would call the police if they saw someone in the neighborhood being threatened with a gun over drugs | 0.005 | −0.013 | −0.018 | 0.856 | −0.012 | |
| How many of your associates would call the police if they saw someone in the neighborhood getting shot over drugs | −0.007 | 0.023 | 0.067 | 0.773 | −0.034 | |
| Scale four:Willingness to talk to drug users about violent dealer | 0.77 | |||||
| I try to warn drug users about dealers who are violent toward customers | 0.032 | −0.004 | 0.006 | 0.022 | 0.595 | |
| I would be comfortable encouraging drug users to avoid dealers who are violent toward customers | −0.027 | −0.004 | −0.057 | 0.015 | 0.798 | |
| I would be comfortable talking to drug users how to avoid violence | 0.008 | −0.005 | 0.031 | −0.013 | 0.710 | |
The participants tended to be male (64%), African American (82%), and had less than a high school education (48%) (Table 3). Almost two-thirds of the participants (62.7%) reported having used heroin or crack/cocaine in the prior 6 months (Table 3). Over one-quarter of the participants (26.5%) injected speedball, about one-thirds (34.3%) injected heroin, one-fifth (20.9%) injected cocaine, and 41.3% smoked crack or cocaine in the prior six months.
Table 3.
Participant characteristics and odds ratios with 95% confidence intervals from unadjusted and adjusted logistic regressionsa of dealer violence-related outcomes
| Characteristics (n, %) | Total (n=373) | Witnessing violent drug dealers during the past 6 months | High acceptability of dealers' violence | Norms favoring reporting violent drug dealers to the police | Willingness to talk to drug user about violent dealer | ||||
|---|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | AOR (95% CI) | OR (95% CI) | AOR (95% CI) | OR (95% CI) | AOR (95% CI) | OR (95% CI) | AOR (95% CI) | ||
| Age: Mean (SD) | 45 (8.16) | 1.01 (0.99,1.04) | 1.01(0.98,1.04) | 0.98(0.95,1.00+ | 0.98(0.95,1.01) | 1.03(1.01,1.06)* | 1.03(1.00,1.06)* | 1.02 (0.99,1.05)+ | 1.01(0.99,1.04) |
| Male | 239 (64.1) | 0.80 (0.53,1.20) | 0.85(0.55,1.30) | 1.97(1.27,3.05)** | 2.01(1.24,3.24)** | 0.61(039,0.95)* | 0.61(0.37,0.98)* | 1.07(0.70,1.62) | 0.92(0.58,1.45) |
| African American | 304 (81.5) | 1.12 (0.65,1.93) | 1.17(0.66,2.09) | 0.50(0.29,0.89)* | 0.60(0.33,1.12) | 1.99(1.16,3.41)* | 1.56(0.86,2.83) | 1.53 (0.86,2.73) | 1.27(0.69,2.34) |
| Education (at least 12th/high school diploma) | 179 (48.0) | 1.18 (0.80,1.74) | 1.10(0.73,1.66) | 1.28(0.85,1.93) | 1.24(0.79,1.92) | 0.71(0.47,1.08) | 0.73(0.46,1.14) | 0.74 (0.49,1.13) | 0.73(0.47,1.14) |
| Unemployed | 275 (73.7) | 1.21 (0.75,1.94) | 1.32(0.77,2.26) | 0.85(0.53,1.36) | 0.99(0.56,1.74) | 1.20(0.74,1.95) | 1.12(0.63,1.97) | 0.97(0.60,1.57) | 0.86(0.50,1.47) |
| Monthly income>=$500 | 200 (53.6) | 1.59 (1.05,2.41)* | 1.76(1.08,2.89)* | 1.32(0.88,1.98) | 1.26(0.78,2.05) | 0.81(0.54,1.23) | 0.86(0.53,1.38) | 1.11 (0.74,1.68) | 0.98(0.60,1.60) |
| Homeless | 88 (23.6) | 1.83 (1.12,3.00)* | 1.82(1.08,.06)* | 0.99(0.60,1.63) | 1.03(0.60,1.76) | 0.86(0.54,1.38) | 0.77(0.48,1.18) | 0.95 (0.58,1.57) | 0.86(0.50,1.47) |
| Active drug use | 234(62.7) | 2.09(1.36,3.22)** | 1.86(1.20,2.88)** | 1.24(0.80,1.92) | 1.23(0.77,1.98) | 0.82(0.54,1.23) | 0.74(0.47,1.18) | 1.67(1.07,2.58)* | 1.65(1.03,2.63)* |
| HIV positive | 57 (15.3) | 0.90 (0.51,1.59) | 0.92(0.50,1.71) | 0.94(0.53,1.66) | 0.96(0.52,1.79) | 0.94(0.52,1.70) | 0.81(0.45,1.18) | 1.31 (0.75,2.30) | 1.33(0.76,2.33) |
| Witnessing violent drug dealers | 165 (44.2) | 0.92(0.61,1.39) | 0.95(0.60,1.51) | 1.33 (0.87,2.02) | 1.29(0.82,2.04) | 1.97 (1.30,3.00)** | 1.86(1.19,2.90)** | ||
| High acceptability of dealer violenceb | 149(40.0) | 0.39(0.26,0.59)*** | 0.46(0.30,0.71)*** | 0.86(0.57,1.31) | 0.98(0.63,1.55) | ||||
| Norms favoring reporting violent drug dealers to policec | 214(57.4) | 0.39(0.26,0.59)*** | 0.46(0.30,0.71)*** | 1.76 (1.14,2.72)* | 1.65(1.03,2.64)* | ||||
| Willingness to talk to drug users about violenct dealerd | 143(38.3) | 1.76(1.14,2.72)* | 1.66(1.03,2.66)* | ||||||
Generalized estimating equations with participants clustered within recruitment networks.
The acceptability of dealers' violence scale was assessed by participants' levels of agreement on four statements, which include “If someone tries to steal from a dealer, the dealer has a right to beat them up,” “If someone tries to cheat a dealer, the dealer has the right to beat them up,” “If someone tries to steal from a dealer, the dealer has the right to shoot them,” and “If someone tries to cheat a dealer, the dealer has the right to shoot them.”
Norms favoring reporting drug violence to the police was assessed by 3 items about the proportion of participants' associates who would call the police under different situations, which include “if they knew a drug dealer in the neighborhood was carrying a gun?” “if they saw someone in the neighborhood being threatened with a gun over drugs,” and “if they saw someone in the neighborhood getting shot over drugs.”
Willingness to talk to drug users about violent dealer scale was evaluated by participants' levels of agreement on three statements, which include “I try to warn drug users about dealers who are violent toward customers,” “I would be comfortable encouraging drug users to avoid dealers who are violent toward customers,” and “I would be comfortable talking to drug users how to avoid violence.”
p<.10,
p<.05,
p>.01,
p<.001
A large percentage (44%) had witnessed drug dealers' violence in the prior six months. The largest category of types of drug dealer violence witnessed was physical assault (77%), followed by verbal assaults or threats with violence (13%). Six percent witnessed a person being shot or killed by a drug dealer. Four percent witnessed other acts such as chasing or pursuing someone or asking others to commit a violent act. Of the physical assaults, 24% reported that a weapon, such as knife, stick, or bat was used. Few participants (10%) reported that they had been forced to buy drugs from certain dealers or they were “intimidated by drug dealer enforcers to buy drugs exclusively from them” (12%), and most (83%) agreed with the statement “in my neighborhood there are many dealers that I can choose from to buy my drugs.” The majority (55%) reported that they “usually buy from the same dealer” and most (73%) responded affirmatively to the statement “Has a dealer ever offered you shorts, that is allowed you to pay less, to keep your business.”
Table 2 presents the response distributions to each retained items in the violent drug dealer index. Findings of the individual scale items regarding the acceptability of dealers' violence revealed that there were low levels of endorsement of violence. The vast majority of respondents disagreed with statements that dealers have the right to be violent if drug users cheat them or steal from them. Approximately two-thirds (65%) disagreed or strongly disagreed with the statement that “If someone tries to steal from a dealer, the dealer has a right to beat them up” and three quarters (75%) disagreed or strongly disagreed that “Most people who are beaten by drug dealers get what they deserve.”
Table 2.
Response distribution to the index of violent drug dealer and reporting violence
| Items | Response: n(%) | ||||
|---|---|---|---|---|---|
| Scale one: the acceptability of dealers' violence | strongly agree | agree | neither agree nor disagree | disagree | strongly disagree |
| If someone tries to steal from a dealer, the dealer has a right to beat them up | 15(4.1) | 73(19.6) | 52(13.9) | 189(50.6) | 44(11.8) |
| If someone tries to cheat a dealer, the dealer has the right to beat them up | 9(2.4) | 63(16.9) | 60(16.1) | 200(53.6) | 41(11.0) |
| If someone tries to steal from a dealer, the dealer has the right to shoot them | 4(1.1) | 9(2.4) | 29(7.8) | 226(60.6) | 105(28.1) |
| If someone tries to cheat a dealer, the dealer has the right to shoot them | 2(0.6) | 12(3.5) | 24(6.4) | 231(61.9) | 103(27.6) |
| Scale two: intention to report drug violence to the police | very likely | likely | neither likely nor unlikely | unlikely | very unlikely |
| If I knew that someone dealing drugs in the neighborhood was carrying a gun, I would call the police | 81(21.7) | 99(26.5) | 50(13.4) | 79(21.2) | 64(17.2) |
| If I knew that someone shot another person over drugs, I would call the police | 53(14.2) | 82(22.0) | 43(11.5) | 117(31.4) | 78(20.9) |
| Scale three :Norms favoring reporting violent drug dealers to police | none | a few | some | most | all |
| How many of your associates would call the police if they knew a drug dealer in the neighborhood was carrying a gun | 188(50.4) | 99(26.6) | 52(13.9) | 18(4.8) | 16(4.3) |
| How many of your associates would call the police if they saw someone in the neighborhood being threatened with a gun over drugs | 142(38.1) | 115(30.8) | 56(15.0) | 31(8.3) | 29(7.8) |
| How many of your associates would call the police if they saw someone in the neighborhood getting shot over drugs | 91(24.4) | 117(31.3) | 63(16.9) | 48(12.9) | 54(14.5) |
| Scale four: Willingness to talk to drug users about violent dealer | strongly agree | agree | neither agree nor disagree | disagree | strongly disagree |
| I try to warn drug users about dealers who are violent toward customers | 28(7.5) | 135(36.2) | 49(13.1) | 137(36.7) | 24(6.5) |
| I would be comfortable encouraging drug users to avoid dealers who are violent toward customers | 44(11.8) | 192(51.5) | 39(10.4) | 82(22.0) | 16(4.3) |
| I would be comfortable talking to drug users how to avoid violence | 47(12.6) | 214(57.4) | 38(10.2) | 61(16.3) | 13(3.5) |
Although most drug users disagreed with statements about the acceptability of dealers' violence, a large proportion of participants reported low likelihood of calling the police about drug-related violence. About half (48%) reported that they were unlikely or very unlikely to call the police if they knew that someone dealing drugs in the neighborhood was carrying a gun, and only about half (53%) reported that they were likely or very likely to call the police if they knew that someone in the neighborhood shot another person over drugs.
The scale items assessing social norms about reporting drug dealer gun violence to the police suggested that participants believed that the majority of their peers would not report drug dealer violence to the police. Over two-thirds (69%) reported that none or only a few of the associates would call the police “if they saw someone in the neighborhood being threatened with a gun over drugs,” over three-quarters (77%) reported that none or only a few of the associates would call the police “if they knew a drug dealer in the neighborhood was carrying a gun,” and over half (56%) reported that none or only a few of the associates would call the police “if they saw someone in the neighborhood getting shot over drugs.”
Participants were favorably inclined to talk to other drug users about dealer violence and avoiding violent dealers. Over two-thirds (70%) agreed or strongly agreed with the statement “I would be comfortable talking to drug users about how to avoid violence” and almost two-thirds (63%) agreed or strongly agreed with the statement “I would be comfortable encouraging drug users to avoid dealers who are violent toward customers.”
The mean of the acceptability of drug dealers' violence scale was 15, with a standard deviation of 3 and range from 4 to 20. The mean for the scale of social norms about reporting drug violence to the police was 4, with a standard deviation of 3 and range from 0 to 12. The mean for the scale of intention to report violent drug dealers to the police was 6, with a standard deviation of 2 and range from 2 to 10. The mean for the scale of willingness to talk to other drug users about dealer violence and avoiding violent dealers was 8 with a standard deviation of 3 and range from 3 to 15.
Table 3 presents the findings of univariate and multivariate logistic regression models. In a multivariate analysis of having witnessed a violent drug dealer during the past 6 months, participants who had monthly income more than $500 (OR=1.76, 95% CI=1.08–3.06) and were homeless (OR=1.82, 95% CI=1.08–3.06) and were active drug users (OR=1.86, 95% CI=1.20–2.88), were more likely to witness a violent drug dealer in the past 6 months. In a multivariate analysis of acceptability of dealers' violence, males (OR=2.01, 95% CI=1.24–3.24) were more likely to accept dealer violence. Those who scored lower on the scale of social norms to call the police ((OR=0.46, 95% CI=0.30–0.71) were more likely to accept dealer violence. In the multivariate analysis of social norms favoring reporting violent drug dealers to the police, older age (OR=1.03, 95% CI=1.00–1.06), males (OR=0.61, 95%CI=0.37–0.98), lower acceptance of violent drug dealers (OR=0.46, 95% CI=0.30–0.71), and greater willingness to talk to drug users about dealers' violence (OR=1.66, 95% CI=1.03–2.66) were associated with norms favoring reporting violent drug dealers to the police. In the multivariate analysis of willingness to talk to drug users about avoiding dealer violence, the significant associations were with being active drug users (OR=1.65, 95% CI=1.03–2.63), having witnessed violence by a drug dealer during the past 6 months (OR=1.86, 95% CI=1.19–32.90) and social norms favoring reporting violent drug dealers to the police (OR=1.65, 95%CI=1.03, 2.64).
4. Discussion
The current study found that a large proportion of participants, majority of whom reported a history of heroin or cocaine use, had witnessed drug dealer violence within the prior six months. Although the majority of participants reported that drug dealer violence was unacceptable, the perceived social norm was that most peers were unlikely to call the police about drug dealer violence. Many participants also reported that they themselves were unlikely to call the police about drug dealer violence.
Two potential alternative approaches to reduce drug dealer violence are to alter social norms by increasing willingness to engage police in the event of drug dealer violence and to encourage drug buyers to boycott and condemn those dealers who engage in violence. The results from the current study suggest that the perceived norms among drug users are to refrain from reporting violence to the police. Several studies have found that in many impoverished communities there is a high level of distrust of the police (Brunson, 2007). Moreover, many drug users have been harassed by the police and arrested for loitering and drug possession (Cooper et al., 2004). By definition, illicit drug use is illegal which sets up a dynamic for drug users to avoid assisting the police even when they witness drug violence.
Developing new social norms for interactions between police and drug users may be feasible, but such changes would need to be reciprocal, with police ceasing to arrest drug users for loitering and possession and drug users providing information on violent crimes. Such a major change in behavior is not likely to occur without a fundamental change in how the police perceive their role in the community and their relationship to drug users. Any individual drug user who decides to cooperate with the police and report on violent dealers may endanger their own well-being as they may be perceived to be an informant. Consequently, there would be a need to change the social norms with specific types of violence becoming socially unacceptable and violations of this social norm would result in notifying the police. Although this approach may be viable through community organizing and concomitant changes in policing philosophy, a more feasible approach to reducing violence would be for users to boycott drug dealers who are violent. This approach would be both a sanction to violent dealers and a de facto reward for those who do not engage in violence. Such an approach would require organization among drug users and methods of diffusing information and encouraging drug users to purchase their drugs from non-violent dealers. It would also require an agreement on definition of unacceptable violence. For example, violence that ensues from someone robbing a drug dealer is likely to be perceived differently from violence targeting a drug user who does not have sufficient funds to pay back a dealer. Moreover, mobilizing drug users is also not an easy task due to their competing needs and negative life events, including being victims of violence, which may interfere with developing and maintaining drug user organization. Certainly, some drug users have successfully organized (Friedman et al., 2007). It is interesting to note that men were more likely to accept drug dealer violence and less likely to report favorable intensions of calling the police regarding drug dealer violence. These findings suggest the importance of involving women drug users in any program to prevent violence among drug users as they may be more incline to act against drug dealer violence.
This study is subject to limitations based on sampling and self-report biases. This study also did not focus on the role of the participants in perpetrating violence. Consequently, we did not ask participants about their own drug dealing violence; however, it is likely that there would be less social desirability biases in participants reporting the violence of others as compared to their own violent acts. It is likely that some of the participants, based in part on their roles in the drug economy, had been involved in perpetrating violence. However, with the exception of low level drug selling, it is unlikely that typical drug dealers would have volunteered for this study. Moreover, some of the drug violence reported may not have been caused by drug dealers. We also do not know if their intentions to report violence would lead to actions. The high level of violence witnessed by drug users mirrors the level of violence reported in the city in terms of homicides, which are predominately located in areas of the city with frequent drug-related arrests. The generalizability of study findings are also limited by the cultural and social characteristics of Baltimore drug markets and policing tactics.
The study also did not address the reasons for the drug dealer violence nor did it differentiate the different roles and relationships in the drug economy and how they may be linked to dealer violence. For example, if a drug dealer ordered a member of his or her organization to perpetrate violence, respondents may or may not view this as drug dealer violence. It is also likely that the level of violence is also a function other unmeasured factors such as of the number of dealers in a geographic area, types of drugs sold, and location of sales. Regardless of the potential for underreporting drug dealer violence and other study limitations, the reported rates were exceedingly high with almost half (44%) reporting that they had witnessed drug dealer violence in the prior 6 months. Future research on drug violence should focus on obtaining more detailed information about violent drug dealing events.
Clearly drug users often witness, experience, and perpetrate violence (Marshall et al., 2008). A key question is what are the potential roles of drug users in reducing drug-related violence? As they have little political power to influence key factors in controlling violence such as the availability of guns and programs for violence prevention, one of their only recourses to address violence may be to utilize their economic clout within the drug economy. Approaches to encouraging the development of drug enforcement and police policies that lead to just and equitable treatment of drug users should not be abandoned; however, many jurisdictions may not be willing to take the political risks in promoting a public health perspective to the link between substance use and violence, as it may be perceived as being “soft on drugs.” Given the high rates of crime associated with the drug economy, more effective approaches to reduce drug-related crime are needed. Engaging drug users as active participants in developing crime prevention programs is a potentially important approach to addressing this issue.
After the collection of the data for this study, a community-based program to reduce violence was implemented in several Baltimore neighborhoods (Webster, DW, Whitehill, JM, Vernick, JS, & Curriero, FC, 2012) . As part of this program, street outreach workers work with youth ages 14 to 25 years and help to mediate conflicts. The preliminarily results from this program indicate a reduction in gun violence in some of the neighborhoods targeted by the intervention. This program however did not specifically address drug dealing related violence or the violence experienced by drug users.
In addition to the role of drug dealing in facilitating urban violence, it is important to address structural factors as well. The physical decay of neighborhoods as indicated by abandoned and poorly maintained housing, litter, and rats may also contribute to community level factors that foster violence (Yonas, MA, O'Campo, P., Burke, JG, & Gielen, AC, 2007). Moreover, the dearth of quality education, legal employment opportunities, and positive social roles in the community may help to perpetuate the drug economy and concurrent violence. Consequently, without the implementation of programs that provide meaningful opportunities to US inner-city residents, violence prevention interventions are likely to face great difficulties in addressing the issue drug violence.
Footnotes
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