Drug Abuse

The majority of people use drugs. Caffeinated soft drinks, aspirin, or prescription medications are legal, and they are consumed widely by children and adults. In addition, many people drink alcohol or smoke cigarettes despite the fact that these products are legal only for adults. Finally, some people use drugs that are illegal for everyone, such as cocaine or methamphetamine. Unfortunately, many people who use drugs also abuse them.

Drug Abuse Defined

In drug abuse, the social and health-related costs are greater than the benefits. By this definition, much drug use is abusive.

Social costs of drug abuse include the deterioration of relations with other persons such as failure to carry out responsibilities, arguments, abuse, lost income, and time spent in jail or drug treatment.

Health-related costs of drug use include addiction, a physiological or psychological need for the drug. Other health-related costs include diminished physiological capacity, illness, and death. In 1998, 19,277 deaths were caused by the use of illegal drugs.

Social benefits of drug use include enhanced capacity in relations with others, as with psychotropic drugs that reduce symptoms of mental illness. Health benefits of drugs include regulation of bodily functions, as with thyroid hormone that controls metabolism. Health benefits of drugs also include management of disease agents such as fungi, bacteria, or viruses. Studies show that for every passing year, life expectancy increases 3 months. Most of this increase is due to the effectiveness of drugs in treating disease.

The Drug Industry

Worldwide, the pharmaceutical industry produces more than 400,000 products. Together with the alcohol and tobacco industries, the worldwide drug business is worth perhaps a trillion dollars per year. Currently, world organizations are complaining that health is being degraded by widespread marketing of cigarettes to children, and the cost of prescription medicines is too high for poor nations to treat pandemics such as acquired immunodeficiency syndrome (AIDS).

Regulation Of Drug Use

Until the 20th century, laws did not regulate production, distribution, or consumption of alcohol, tobacco, or other drugs, except for a few laws against public drunkenness. Today, production, marketing, distribution, and use of most drugs are regulated. Alcohol and tobacco products are taxed, and heavy criminal penalties are imposed on illegal drugs.

Rates Of Drug Use And Abuse

Most drug abuse has its roots in adolescent experimentation with alcohol, tobacco, and other drugs. In the United States, the rates of use of alcohol, tobacco, and other drugs have been tracked by the Monitoring the Future project. In 2003, 48% of seniors in high school reported that they drank alcohol in the preceding month. In 1975, the rate was 68%. The rate for marijuana use was 21% in 2003, and in 1975 it was 27%. In 2003, the rate for smoking cigarettes by adolescents was 24%, and in 1975 it was 37%.

In 1998, there were 3.3 million hard-core users of heroin and cocaine in the United States, and as many as 7 million persons may need drug treatment. Among adults, 25% smoke cigarettes, and the rates for men and women are about equal. Smoking peaked in the 1940s, when well over half of the adult male population smoked. Currently, approximately half of persons 12 years of age or older drink alcohol. The rate for men is 57%, and the rate for women is 45%. Almost 7% of the population 12 or older are heavy drinkers who have five or more drinks 5 or more days per month.

From 1992 to 1998, deaths from the abuse of illegal drugs decreased from 24,000 to 19,000. In 2000, more than 2,500 deaths occurred from alcohol abuse and more than 13,000 persons were killed in alcohol-related traffic crashes. By far the largest killer is tobacco. In 1999, tobacco smoking killed more than 440,000 persons.

Monetary Costs Of Drug Abuse

In the United States from 1988 to 2000, the cost of buying illegal drugs decreased from $116 billion to $63 billion. However, the indirect costs of drug abuse are much higher. In 2000, they were $167 billion per year. The indirect costs include health care (drug treatment, violent crime due to drug abuse, treatment of related illnesses including drug-exposed infants, human immunodeficiency virus [HIV]/AIDS, and tuberculosis), lost productivity (premature death, illness, hospitalization, and incarceration), and other costs (police protection, spending to reduce supply, and legal fees). The indirect costs of alcohol abuse are one and one-half times higher than those for illegal drug abuse, and the costs of tobacco abuse are as high as those for alcohol abuse. Including the costs of buying these drugs, costs total perhaps a trillion dollars per year, more than $3,500 per citizen, or about half of the federal budget.

Abuse Of Prescription Drugs

Abuse of prescription drugs has tripled in the past 2 years, and currently this form of abuse has outstripped the use of all illegal drugs except marijuana. In abuse of prescription drugs, orders are placed through a Web site outside of the United States where regulations are less stringent, or the drugs are obtained via “doctor shopping,” a process in which one who is not ill finds a physician who will write a prescription for a drug that is not indicated by the person’s medical condition.

Moral And Attitudinal Issues

Surveys show that drug use patterns are segmented into two polar opposite groups: abstainers/occasional users and heavy/problem users. This pattern has been part of the creation of a moral climate of indignation and lack of sympathy for drug abusers. Following this split, laws and other drug abuse policies have emphasized punishment for drug abuse, and they have deemphasized treatment.

This process can be seen readily in reaction to tobacco smoking. Smoking has been banned in public places because of the health risks of second-hand smoke (and because of the socially unacceptable odor associated with it). Increasingly, tobacco smokers are treated as outcasts. In addition, due to successful lawsuits against tobacco companies for marketing an unsafe product, state governments in the United States have received large monetary settlements. These settlements are intended to mitigate the costs created by smoking, but the states have put the funds to a variety of uses, including the balancing of state budgets. The greatest growth of tobacco sales has been in poor countries where the laws are not as strict.

Policies On Illegal Drugs

In an effort to address the problem of drug abuse, the War on Drugs was begun in the 1980s. It represented an attempt to limit the supply of illegal drugs in the United States that were imported or produced domestically. It involved the hiring of more police officers and stricter penalties for drug offenses. In 2000, the cost of these programs was $5.5 billion. In addition, the War on Drugs attempted to curtail the demand for drugs through drug education and by sending many drug users to jail. Current estimates show that about 30% of inmates are serving time for drug violations. The War on Drugs appears to have decreased use and abuse slightly and to have shifted the substances of choice from imported drugs such as cocaine to domestically produced drugs such as methamphetamine.

Drug Education

Since the 1980s, drug education has focused on youth.  Beginning  in  elementary  school,  programs such as the 17-week Drug Abuse Resistance Education (D.A.R.E.) have sought to delay the onset of experimentation with alcohol, tobacco, and other drugs. The tenet is that the later youth begin to experiment with drugs, the less abuse will occur. D.A.R.E. uses uniformed police officers in the classroom to deliver a message that use of alcohol, tobacco, and other drugs has negative consequences. Officers also teach youth how to resist peer pressure to use these substances. Evaluations of D.A.R.E. has shown it to have some short-term benefits in raising social skills, making attitudes toward drug use more negative, and building positive attitudes toward police. No long-terms effects have been shown.

Drug Treatment Strategies

Seven million people in the United States need drug treatment, and 1 million people receive it each year at a cost of over $6,000 dollars per case. Some individuals participate in one program after another. Alcoholics Anonymous (AA) is the most famous program for the treatment of alcohol abuse. AA uses peer pressure and support as the main mechanisms of treatment. Treatment strategies for other types of drug addiction have borrowed principles from AA. Often, treatment takes place in a residential facility, and counselors use the mechanism of resocialization. Typically, treatment lasts several months, and the self-concept of the abuser is isolated and torn down so that it can be reconstructed as a responsible adult self.

Another method of drug treatment is for an agency to administer a less addictive drug to the abuser, such as methadone treatment for heroin users. The goal of this type of treatment is to gradually decrease the dose until the person no longer is addicted. Unfortunately, this process of weaning may not be effective, and some  of  the  drugs  used  in  the  treatment  of  drug abuse are themselves addictive. Thus, programs of drug treatment can become maintenance programs for drug addiction rather than cures. Advantages of maintenance programs are that they remove addicts from the illegal drug market, and they may have indirect health benefits such as addicts no longer sharing contaminated needles.

Success Of Treatment

Results from Florida may be typical of treatment success rates. A study of nine medium-intensity drug treatment programs at 26 facilities was begun in 1991 for drug abusers who had failed in an outpatient setting. From then until 1999, almost 19,000 persons had been admitted. Fifty-three percent completed the 6-month programs. Of these persons, 54% were not recommitted to prison or supervision after 2 or more years. A parallel study that analyzed data from almost 4,000 offenders in six treatment programs of 9 to 18 months in length for extreme substance abusers who had several previous treatment failures showed that 30% of participants completed the program, and of these, 56% were not recommitted to prison or supervision after 2 or more years.

Since surveys show that 70% of smokers would like to quit, smoking cessation for the 48 million tobacco smokers in the United States has become big business. Drug companies (including ones that also sell tobacco products) market products that deliver nicotine in chewing gum or through patches worn on the skin. One company even sells a pill that aims to decrease nicotine withdrawal, the intense cravings that follow a decrease in the dose of the drug. Research from over 50 studies using nicotine replacement or the pill shows that about one fourth of the research subjects receiving the drug were able to quit for 6 months or more.

The Future

A problem in trying to control the supply of illegal drugs is that poor farmers who produce the raw materials can make more money by producing illegal crops than they can by raising and selling legal crops. In response, government programs have subsidized legal crops and corporations have encouraged farming families to sew clothing or to make high-end buttons from locally produced nut shells.

Complicating the problem of illegal drug production of opium poppies in Afghanistan and coca in Colombia is the fact that the processors and exporters of the illegal drugs have armed themselves and taken over political control of drug-producing regions.

In the United States, domestic production of illegal drugs has presented additional problems. Marijuana can be grown almost anywhere, including indoors. In addition, methamphetamine can be made from commonly available chemicals in small, inexpensive, mobile laboratories. Instructions on the cultivation of marijuana and the manufacture of methamphetamine can be found easily on the Internet. In addition, many people can make more money by selling illegal drugs than they can by doing legitimate work.

A movement toward the legalization of marijuana has been underway in the United States for decades. Current laws in most states in the United States have reduced penalties for possessing small amounts of marijuana. Recently, several court decisions have made the use of marijuana legal for medical reasons such as appetite regeneration for chemotherapy patients. While the Prohibition Laws of the 1930s showed that the government could not curtail illegal behavior that was popular among adults, it is not known how legalizing a previously illegal drug, like marijuana, could affect abuse.

References:

  1. Bouchery, E., & Harwood, H. (2001). The economic costs of drug abuse in the United States 1992–1998 (Publication No. NCJ-190636). Washington, DC: Executive Office of the President, Office of National Drug Control Policy. Available from http://www.whitehousedrugpolicy.gov
  2. Centers for Disease Control and Prev (2002). Annual smoking-attributable mortality,  years  of  potential  life lost and economic costs—United States, 1995–1999. Morbidity and Mortality Weekly Report, 51(14), 300–303. Retrieved from http://www.cdc.gov/preview/mmwrhtml/mm5114a2.htm
  3. Florida Department of Corrections. (1999). Selected community corrections residential programs. Retrieved from http://www.dc.state.fl.us/pub/rop/rop99–06/program- html
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  5. Johnston, D., O’Malley, P. M., & Bachman, J. G. (2003).Monitoring the Future national survey results on drug use 1975–2002: Vol. 1.  Secondary  school  students  (NIH Publication No. 03-5375). Bethesda, MD: National Institute on Drug Abuse. See also http://www.monitoring thefuture.org
  6. National Institute on Alcohol Abuse and (2003). Databases. Bethesda,  MD.  Retrieved  from  http://www.niaaa.nih.gov/databases/qf.htm
  7. Office of National Drug Control Policy. (2004, March). The president’s national drug control strategy. Retrieved from http://www.whitehousedrugpolicy.gov/publications/ policy/ndcs04/healing_amer.html
  8. Rhodes, W., Layne, , Johnson, P., & Hozik, L. (2002). What America’s users spend on illegal drugs 1988–1998. Washington, DC: Office of National Drug Control Policy. Retrieved from http://www.whitehousedrugpolicy.gov/ publications/drugfact/american_users_spend2002/
  9. Substance Abuse and Mental Health (2003).Results from the 2002 national survey on drug use and health: National findings (NHSDA Series H-22, DHHS Publication No. SMA 03-3836). Rockville, MD: Office of Applied Studies. Retrieved from http://samhsa.gov/oca/ NHSDA