Drugs, Alcohol, and Tobacco Learning About Addictive Behavior
Drugs, Alcohol, and Tobacco Learning About Addictive Behavior
Volume
2 Dro to Mi Index Rosalyn Carson-DeWitt, M.D., Editor in Chief
EDITORIAL BOARD Editor in Chief Rosalyn Carson-DeWitt, M.D. Durham, NC Advisory Editor Jan Gottschalk McDougal Middle School, Chapel Hill, NC EDITORIAL AND PRODUCTION STAFF Oona Schmid, Gloria Lam, Project Editors Nicole Watkins, Angela Pilchak, Assistant Editors Jessica Hornik-Evans, Copyeditor Jennifer Wahi, Art Director Wendy Blurton, Buyer Maria L. Franklin, Permissions Manager Lori Hines, Permissions Assistant Barbara J. Yarrow, Manager, Imaging and Multimedia Content Randy Bassett, Imaging Supervisor Robyn V. Young, Imaging Project Manager Macmillan Reference USA Frank Menchaca, Vice President Hélène G. Potter, Director, New Product Development
ii
Drugs, Alcohol, and Tobacco: Learning About Addictive Behavior Rosalyn Carson-DeWitt, M.D. © 2003 by Macmillan Reference USA. Macmillan Reference USA is an imprint of The Gale Group, Inc., a division of Thomson Learning, Inc. Macmillan Reference USA™ and Thomson Learning™ are trademarks used herein under license. For more information, contact Macmillan Reference USA 300 Park Avenue South, 9th Floor New York, NY 10010 Or you can visit our Internet site at http://www.gale.com
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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Drugs, alcohol, and tobacco: learning about addictive behavior / Rosalyn Carson-DeWitt, editor in chief. p. cm. Includes bibliographical references and index. ISBN 0-02-865756-X (set: hardcover : alk. paper) — ISBN 0-02-865757-8 (v. 1) — ISBN 0-02-865758-6 (v. 2) — ISBN 0-02-865759-4 (v. 3) 1. Drug abuse—Encyclopedias, Juvenile. 2. Alcoholism— Encyclopedias, Juvenile. 3. Tobacco habit—Encyclopedias, Juvenile. 4. Substance abuse—Encyclopedias, Juvenile. 5. Compulsive behavior—Encyclopedias, Juvenile. 6. Teenagers—Substance use— Encyclopedias, Juvenile. I. Carson-DeWitt, Rosalyn. HV5804 .D78 2003 613.8—dc21 2002009270
Printed in Canada 1 2 3 4 5 6 7 8 9 10
Preface In 1995 Macmillan Reference USA published the outstanding Encyclopedia of Drugs and Alcohol, edited by Jerome Jaffe. An extensively revised second edition, entitled Encyclopedia of Drugs, Alcohol, and Addictive Behavior, was published in 2001. Now Macmillan Reference USA is drawing from the fine work done for these prior encyclopedias to publish Drugs, Alcohol, and Tobacco: Learning About Addictive Behavior, a three-volume set targeted towards general and younger readers. Alcohol, drugs, and tobacco have myriad ill effects on the lives of children and teenagers. Babies are born addicted to crack or harmed by exposure to alcohol while in the womb. Children live in poverty and chaos, at high risk of neglect, abuse, and homelessness because of their parents’ drug and/or alcohol problems. Increased school dropout rates, a high risk of psychiatric problems, and a greater chance of severe injury or death due to violence, motor vehicle accidents, and self-injury endanger the worlds of children and teens raised amid substance abuse. Furthermore, children from substance-abusing homes are more likely to turn to smoking, drugs, or alcohol. Then comes the convergence of the genetic propensity for substance abuse, the availability of alcohol and drugs, and peer pressure, all factors that increase a child’s risk of engaging in substance abuse or addictive behaviors. Drugs, Alcohol, and Tobacco: Learning About Addictive Behavior was the brainchild of Hélène Potter, director of new product development at Macmillan Reference USA. Aware that initiating substance use prior to the age of fifteen carries a greater risk of severe problems, and aware that prevention must begin with thorough education, Ms. Potter conceived of and pushed through this valuable project. Designed to engage, interest, and educate children and teens, this work provides information on specific drugs (such as nicotine, alcohol, marijuana, and ecstasy), risk and protective factors for addiction, diagnosis and treatment of addictions, medical and legal consequences of both casual use and addiction, costs to families and society, drug v
Preface
production and trafficking, policy issues, and other compulsive disorders (including gambling, cutting, and eating disorders). Although the Encyclopedia of Drugs, Alcohol, and Addictive Behavior was used as a structural basis for this present work, the entire table of contents was revised to focus the new work on the needs and interests of young students. An impressive cadre of experts and academics was commissioned to review, revise, rewrite, and refocus every article from the original collection, or to produce new articles pertinent to the project’s goals and relevant to children and teenagers. New ancillaries provide additional resources that will be particularly helpful to children and teenagers researching topics for school or for their own personal use. The result is Drugs, Alcohol, and Tobacco: Learning About Addictive Behavior, a collection of over 190 alphabetically arranged articles intended to reach out to an audience of children and teenagers with information that can help them understand issues surrounding addictive behavior on both an academic and a personal level. The thoughtful, visually interesting design of the text includes call-out definitions in the margins of articles (so that young students do not have to flip to a separate glossary, although that is provided as well); lively marginalia that highlights interesting facts or makes reading suggestions for fiction that deals with topically similar issues; and more than 200 full-color illustrations that help young readers to organize and to compare and contrast information. Articles are followed by crossreferences. Appendices include a wide-ranging list of organizations (including their addresses, phone numbers, and web sites) from which readers can seek more information or obtain contacts for personal help; a complete glossary of terms; and an annotated bibliography that will point students toward further research, assist teachers with class preparation, and guide individuals who are struggling with the effects of addiction in their personal lives. Many fine people deserve considerable thanks for contributing to the birth of this new work, beginning with Hélène Potter, whose vision and guidance were essential throughout the production process. Editor Oona Schmid slaved over every aspect of the project and supported everyone else’s work with competence and good humor. Jan Gottschalk consulted on the project, sharing her considerable experience with middle-school students, and providing excellent input regarding relevancy of material, fit with middle-school curriculum, and appropriateness for middle-school readers. Copyeditor Jessica Hornik Evans put in countless hours to make entries suitable in length, scope, and reading level for middle-school students. Amy Buttery worked to ensure that data presented were up-to-date and pertinent to young vi
Preface
teenagers. And once again, my husband Toby, and our children Anna, Emma, Isabelle, and Sophie, graciously tolerated the presence of a fifth child in the guise of an encyclopedia in our home. In closing, I would like to acknowledge the efforts of clinicians who are working on the front line to treat families grappling with addiction in their lives; academics who teach about substance abuse and its effects on individuals, society, and the international community; researchers who are studying issues that may lead to better ways to diagnose, treat, and prevent addiction; policymakers who struggle to find ways to protect society from the crime and violence associated with addictions; and the many individuals who awaken each day to face the effects of addiction wreaking havoc on their lives and to try once again to find their way free of addiction’s stranglehold. Rosalyn Carson-DeWitt, M.D. Editor in Chief July 2002
vii
Contributors The text of Drugs, Alcohol, and Tobacco: Learning About Addictive Behavior is based on the second edition of Macmillan’s Encyclopedia of Drugs, Alcohol, and Addictive Behavior, which was published in 2001. We have updated material where necessary and added original entries that are of particular importance to the general public and younger students. Articles have been condensed and made more accessible for a student audience. Please refer to the List of Authors at the back of volume three in this set for the authors and affiliations of all those whose work appears in this reference. Here we wish to acknowledge the writers who revised entries and wrote new articles specifically for this set:
Peter Andreas
Carl G. Leukefeld
Linda Wasmer Andrews
Jill Max
Christopher B. Anthony
Thomas S. May
Samuel A. Ball
Tom Mieczkowski
Robert Balster
Cynthia Robbins
Amy Buttery
Heather Roberto
Kate B. Carey
Ian Rockett
Jonathan Caulkins
Joseph Spillane
Allan Cobb
Michele Staton Tindall
Roberta Friedman
Marvin Steinberg
Jessica Gerson
Michael Walsh
Frederick K. Grittner
Michael Winkelman
Angela Guarda
Jill Anne Yeagley
Becky Ham
ix
Table of Contents Alcohol Treatment: Medications
VOLUME 1 Preface
...................... v
Contributors
.................
ix
A Accidents and Injuries from Alcohol Accidents and Injuries from Drugs Addiction: Concepts and Definitions Addictive Personality
...
.... 4 ...
.............
Adolescents, Drug and Alcohol Use
1
7 12
..
13
Adult Children of Alcoholics (ACOA) ....................
19
.....
62
........
66
Alcoholism: Abstinence versus Controlled Drinking ...........
71
Allergies to Alcohol and Drugs
......
72
..................
73
................
78
Analgesic
......................
83
Anhedonia
.....................
84
Alcoholics Anonymous (AA)
Amphetamine Anabolic Steroids
Antidepressant Antidote
..................
84
......................
85
Antipsychotic
...................
Antisocial Personality
.............
85
.......................
87
Advertising and the Alcohol Industry . . . . . . . . . . . . . . . . . . . . .
20
Advertising and the Tobacco Industry . . . . . . . . . . . . . . . . . . . . .
24
Appetite Suppressant
Al-Anon
......................
31
Asset Forfeiture
Alateen
.......................
33
Alcohol- and Drug-Free Housing
Anxiety
Aphrodisiac
. . . . 34
.................
88
Attention-Deficit/Hyperactivity Disorder ....................
89
.....................
92
Babies, Addicted and Drug-Exposed ................
92
Barbiturates
99
Ayahuasca
Alcohol: Complications of Problem Drinking ....................
36
B
Alcohol: Poisoning
. . . . . . . 43
...............
50
Alcohol: Psychological Consequences of Chronic Abuse . . . . . . . . . . . . . .
52
Beers and Brews
Alcohol: Withdrawal
53
Benzodiazepine Withdrawal
.............
Alcohol Treatment: Behavioral Approaches ..................
....................
Betel Nut
................
103
.......
104
................
107
....................
112
Benzodiazepines 57
87 87
34
Alcohol: History of Drinking
.................... .............
..............
Alcohol: Chemistry
85
xi
Table of Contents
Bhang
.......................
112
D
112
Designer Drugs
......
119
Detoxification
Boot Camps and Shock Incarceration ................
120
Brain Chemistry
................
125
Brain Structures
................
...................
Binge Drinking
................
Blood Alcohol Concentration
Breathalyzer
................
203
.................
205
Diagnosis of Drug and Alcohol Abuse: An Overview ................
205
132
Diagnostic and Statistical Manual (DSM) . . . . . . . . . . . . . . . . . . . . .
212
139
Distilled Spirits
212
................
Dogs in Drug Detection Drinking Age
C Caffeine
......................
Cancer, Drugs, and Alcohol
213
..................
215
Driving, Alcohol, and Drugs
.......
.......
145
Photo and Illustration Credits
.................
147
Organizations of Interest
..........
147
Selected Bibliography
Childhood Behavior and Later Drug Use ..................
151
Chocolate
....................
153
Club Drugs
...................
153
Coca Plant
....................
156
......................
157
Cannabis Sativa
Child Abuse and Drugs
Cocaine
Cocaine: Withdrawal
............
161
Cocaine Treatment: Behavioral Approaches .................
165
...
231
.......
233
..........
239
...................
245
......................
261
Glossary Index
220
VOLUME 2 Preface
......................
Contributors
.................
Dropouts and Substance Abuse
v ix
....... 1
Drug and Alcohol Use Among the Elderly ......................
3
Cocaine Treatment: Medications .................
171
Drug Producers
..................
4
Codeine
173
Drug Testing in Animals: Studying Potential For Abuse . . . . . . . . . . . . .
9
Drug Testing in Humans: Studying Potential For Abuse ............
13
Drug Testing Methods and Analysis
..
15
................
24
......................
Codependence Coffee
.................
173
.......................
177
Cola Drinks
...................
177
Complications from Injecting Drugs . . . . . . . . . . . . . . . . . . . . .
177
Drug Traffickers
Conduct Disorder
181
Drug Use Around the World
..............
Drugs of Abuse
Costs of Drug Abuse and Dependence, Economic ..................
183
Crack
187
.......................
Crime and Drugs
.................
35 43
................
47
.......................
54
E
...............
190
Eating Disorders
198
Ecstasy
...........
30
............
188
Cutting and Self-Harm
.......
Drugs Used in Rituals
............
Creativity and Drugs
xii
141
..........
Table of Contents
Effects of Drugs on Sensation, Perception, and Memory . . . . . . . . 56 Ethnic, Cultural, and Religious Issues in Drug Use and Treatment . . . . . .
62
F Families and Drug Use Fermentation
...........
69
...................
76
Fetal Alcohol Syndrome (FAS)
. . . . . . 76
G Gambling
.....................
Gangs and Drugs
................
Gender and Substance Abuse
80 88
. . . . . . . 96
H
145
Law and Policy: Court-Ordered Treatment ..................
152
Law and Policy: Drug Legalization Debate . . . . . . . . . . . . . . . . . . . . .
155
Law and Policy: Foreign Policy and Drugs .....................
162
Law and Policy: History of, in the United States . . . . . . . . . . . . . . . .
169
Law and Policy: Modern Enforcement, Prosecution, and Sentencing . . . . .
174
Lysergic Acid Diethylamide (LSD) and Psychedelics . . . . . . . . . . . . . . . . .
181
................
103
Marijuana
.................
104
Marijuana Treatment
............
193
......................
107
.......................
108
Media Representations of Drinking, Drug Use, and Smoking . . . . . . . .
194
Medical Emergencies and Death from Drug Abuse .................
200
Methadone Maintenance Programs
..
206
Military, Drug and Alcohol Abuse in the United States .............
211
Photo and Illustration Credits
...
217
.......
219
..........
225
...................
231
......................
247
Hallucinogens Hashish Hemp
Herbal Supplements
.............
108
......................
112
Heroin Treatment: Behavioral Approaches .................
115
Heroin Treatment: Medications
....
120
..................
125
Heroin
Homelessness
....................
Organizations of Interest
I
Selected Bibliography
Imaging Techniques: Visualizing the Living Brain ................
132
Inhalants
133
.....................
J
Glossary Index
187
VOLUME 3
Jimsonwood
...................
139
Preface
......................
Contributors
K ........................
v
.................
ix
.....................
1
139
Moonshine
.....................
140
Morning Glory Seeds
........................
144
Morphine
Ketamine Khat
Law and Policy: Controls on Drug Trafficking . . . . . . . . . . . . . . . . . .
M
Halfway Houses
Kava
L
.............
1
......................
2 xiii
Table of Contents
Mothers Against Drunk Driving (MADD) .....................
Ritalin 3
N
........................
72
.....................
74
Rohypnol
S
Naltrexone Narcotic
.....................
5
Schools, Drug Use in
.......................
6
Sedative and Sedative-Hypnotic Drugs
Narcotics Anonymous (NA)
.........
7
Slang and Jargon
Needle Exchange Programs
.........
8
Sleeping Pills
Neuroleptic Nicotine
.............
................
87
...................
90
........................
90
11
Speed
......................
12
Street Value
...................
93
13
Students Against Destructive Decisions (SADD) ....................
94
.............
Nonabused Drugs Withdrawal
......
17
Substance Abuse and AIDS
O Opiate and Opioid Drug Abuse
.....
19
.......................
25
Tax Laws and Alcohol
...........
106
.........................
109
.............
27
Temperance Movement
........................
29
Personality Disorder
..........
109
Terrorism and Drugs
............
113
...........
117
.............
122
..............
126
Phenycyclidine (PCP)
............
30
Tobacco: Dependence
Poverty and Drug Use
............
35
Tobacco: History of
..........
37
.....................
40
Prescription Drug Abuse Prevention
Prevention Programs Prohibition of Alcohol Psychoactive Drugs Psychopharmacology
.............
47
............
51
..............
54
.............
55
Q Quaaludes
.....................
56
R Racial Profiling
. . . . . . 102
T Tea
P
Tobacco: Industry
Tobacco: Medical Complications
...
134
Tobacco: Policies, Laws, and Regulations .................
141
Tobacco: Smokeless
147
.............
Tobacco Treatment: An Overview
..
150
Tobacco Treatment: Behavioral Approaches .................
156
Tobacco Treatment: Medications
...
159
Tolerance and Physical Dependence . . . . . . . . . . . . . . . . .
163
Toughlove
....................
165
Treatment: History of, in the United States . . . . . . . . . . . . . . . .
168
174 183
.................
56
.........................
57
Relapse
.......................
59
Research
......................
60
Treatment Programs, Centers, and Organizations: A Historical Perspective .................
65
Treatment Types: An Overview
Rave
Risk Factors for Substance Abuse xiv
. . . . . . . . 97
Suicide and Substance Abuse
Peyote
. . 81
....................
Nicotine Withdrawal
Opium
76
....
....
Table of Contents
U
Z
U.S. Government Agencies Users
........
190
........................
198
. . 204
W
219
.......
221
..........
227
...................
233
Selected Bibliography Glossary
216
...
Organizations of Interest
Violence and Drug and Alcohol Use
Workplace, Drug Use in the
................
Photo and Illustration Credits
V
Wood Alcohol (Methanol)
Zero Tolerance
........
209
List of Authors
.......
210
Cumulative Index
..............
249
............
259
xv
Dropouts and Substance Use An annual survey of high school students, called the Monitoring the Future project, provides information on substance use by adolescents who remain in and graduate from high school. In contrast, much less is known about the substance use of those who drop out of high school. Nonetheless, evidence from a variety of sources suggests that high school dropouts are much more likely to have started using tobacco, alcohol, and other drugs when compared to their peers who remained in school. One recent study of 1,300 high school students found that students who have smoked marijuana at least once are more than twice as likely to quit school than those who have never smoked marijuana. Evidence also shows that dropping out of high school can increase a person’s risk of problems with alcoholism as an adult. Whether this also applies to other drugs, such as cocaine or marijuana, is not yet clear but is under study. Not only can substance use lead to dropping out, but dropping out can lead to substance use. Whether it is drugs, tobacco, or alcohol, substance use is one reason why some people drop out of school. Some schools suspend or expel students for the same reason. When students do drop out, they often begin spending more time with older youths and adults. Some of these adults and young adults may give the dropouts cigarettes or alcohol, or introduce them to drugs. Other, more complicated factors also explain the greater frequency of substance abuse among dropouts. One of these factors is the early childhood years. For example, children who frequently break rules, get into fights, and have trouble adjusting to elementary school are more likely to become heavy drug users ten or more years later. Behavior problems at school (sometimes referred to as conduct disorder) may also predict who will drop out before completing high school.
D
FICTION SPEAKS VOLUMES Poverty and drugs are the focus of this novel. In The Secret of Two Brothers (1995), Irene Beltran Hernandez tells the story of a teen who struggles with an abusive father, drops out of school and tries to create a decent life for himself and his little brother.
1
Dropouts and Substance Use
On February 7, 2002, these high school dropouts completed test one of five required tests to receive a General Education Development (GED) diploma. In the past sixty years, 2002 is the third year in which GED testing was updated to enforce higher academic standards.
2
In addition to behavior problems, academic problems might also be a factor in dropping out and drug use. When a child receives low grades and has a poor record of achievement in elementary school, he or she is more likely to drop out later on. These children might also be at greater risk for later drug use. A team of researchers decided to study whether this is so, and also whether later improvements in school achievement might decrease the risk for dropping out and drug use for children who did not do well in primary school. The researchers studied a large number of school-age youth from primary school through high school. They found a moderately strong link between early poor school achievement and later drug use. They also discovered that when children who were low achievers in primary school did much better in later school years, the risk for later drug use decreased. Based on this research, it might be possible to
Drug and Alcohol Use Among the Elderly
reduce school dropout rates and rates of teenage drug use by strengthening academic achievement early on. Several research groups are investigating whether intervention programs directed at entire classrooms of first- and second-graders might reduce their risks for later drug use, conduct problems, and dropout rates. These programs are not drug-education classes. The first- and second-grade teachers work with the students to help encourage learning and achievement in new ways and to help them behave themselves and adjust to the rules of the elementary school classroom. In addition to interventions aimed at entire first or second grades, other intervention programs target elementary and middle-school students who are most at risk for dropping out and using drugs. In these “pull-out” programs targeting smaller groups of “at-risk” students, teachers and counselors work with children and their families to develop better skills for learning and a sense of mastery over schoolwork. In some schools the programs also try to encourage a positive social environment for the children.
intervention act of intervening or positioning oneself between two things; when referring to substance abuse, it means an attempt to help an addict admit to his or her addiction, recognize the ill effects the addiction has had on the addict and on his or her relationships, and get help to conquer the addiction
Dropping out of school can have serious consequences for a person’s life. Communities and schools must develop effective stay-inschool programs as well as offer outreach programs to youths who are repeatedly absent from school or who have already dropped out. These programs may help reduce substance-use problems in the teenage years that may well carry over into adulthood. SEE ALSO Adolescents, Drug and Alcohol Use; Attention-Deficit/Hyperactivity Disorder; Prevention; Risk Factors for Substance Abuse; Users.
Drug and Alcohol Use Among the Elderly Elderly people are the fastest-growing segment of the world population, and they consume about 25 percent of all the medicines prescribed. Because aging causes changes in various systems of the body, the ability to handle medication is different in the elderly than in the young. Alcohol abuse among older people can lead to falls, fractures, and other medical complications. The addition of medications (prescription and over-the-counter) to alcohol drinking can lead to disastrous complications and even premature death. However, recent research has suggested that drinking low to moderate amounts of alcohol (one to two standard-sized drinks per day) may help protect against the development of heart disease and stroke. Because the el3
Drug Producers
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
derly are more susceptible to side effects from all types of substances (prescription and otherwise), the National Institute of Alcohol Abuse has advised people over 65 to limit themselves to and Alcoholism a single drink each day. At any rate, even this amount of alcohol should be approved by the individual’s physician, to make sure that the combination of alcohol and medical conditions or medications is safe. S E E A L S O Families and Drug Use; Treatment Types: An Overview.
☎
Drug Producers At least 80 percent of all illegal drugs used in the United States, measured by U.S. dollar value, start out in other countries. This includes all of the cocaine and heroin, and much of the marijuana, used in America. The plants from which these drugs are made are a source of cash for many parts of the world, especially isolated and impoverished areas in Latin America and Asia. To some extent, they provide support for poor farmers and political refugees living in these regions. However, they also provide a source of income for terrorist groups and organized crime networks.
Foreign Assistance Act The Foreign Assistance Act of 1961 requires the president to draw up a list each year of the major illegal drug-producing or drugtransit countries, nicknamed the majors list. The act requires that most kinds of U.S. government foreign aid to any country on the list be severely cut. Under the law, a major drug-producing country is defined as one in which a sizable amount of illegal opium, coca, or cannabis is grown or harvested each year. Opium is the source of morphine and heroin; coca, of cocaine; and cannabis, of marijuana and hashish. In the case of opium and coca, the cutoff amount of cultivated area is 1,000 hectares (2,470 acres) or more. In the case of cannabis, it is 5,000 hectares (12,350 acres) or more, unless it is found that cannabis products from a particular country are not affecting the United States. In 2001 President George W. Bush named twenty-three countries to the majors list: Afghanistan, the Bahamas, Bolivia, Brazil, Burma (Myanmar), China, Colombia, the Dominican Republic, Ecuador, Guatemala, Haiti, India, Jamaica, Laos, Mexico, Nigeria, Pakistan, Panama, Paraguay, Peru, Thailand, Venezuela, and Vietnam. The limits on aid under the Foreign Assistance Act continue until the president certifies that a country on the list has cooperated 4
Drug Producers
fully with the United States, or taken adequate steps on its own, to prevent illegal production and drug trafficking. Nations also are expected to take action against drug-related corruption and money laundering, which is the transfer of illegally obtained money through an outside party to conceal its true source.
drug trafficking act of transporting illegal drugs
Every year, the U.S. Department of State prepares an International Narcotics Control Strategy Report. This report provides the facts upon which the president decides whether or not to certify countries on the majors list. However, the decision about whether a country has “cooperated fully,” “taken adequate steps,” or made “maximum achievable reductions” is subjective. It often leads to spirited debate between the White House and Congress about which countries really are doing as much as they can to fight illegal drugs. The process also creates tension between the United States and the countries in question. There are four possible outcomes to the certification process: (1) full certification; (2) qualified certification for countries that would not otherwise qualify on the grounds that U.S. national interest requires giving the country foreign aid; (3) denial of certification; or (4) congressional disapproval of a presidential certification.
The Global Picture Despite efforts by the United States and other countries, drug production continues to flourish in several regions around the world. In 1999, according to the United Nations (UN), worldwide production of opium reached a record of 5,778 metric tons (6,367 U.S. tons), derived from 217,000 hectares (535,990 acres) of opium poppies. Global production of coca leaf reached 290,000 metric tons (319,580 U.S. tons) from 183,000 hectares (452,010 acres) of coca. In recent years, there has been a shift toward the concentration of opium poppies and coca in fewer and fewer countries. In fact, the UN estimates that well over 90 percent of illegal opium comes from Afghanistan, Laos, and Burma (also called Myanmar), while a similarly high percentage of cocaine comes from Bolivia, Colombia, and Peru. Nevertheless, several other countries play a role in drug production as well. Other source countries for heroin include Pakistan, Iran, Lebanon, Thailand, Mexico, Guatemala, and Colombia, while Ecuador is another supplier of cocaine. Major producers of marijuana include Mexico, Colombia, and Jamaica. However, according to the U.S. Drug Enforcement Administration (DEA), enough of the marijuana used in this country is grown here to make the United States 5
Drug Producers
a significant source country as well. Among the largest producers of hashish are Lebanon, Pakistan, Afghanistan, and Morocco. One problem in the past was that information about worldwide drug production came from a confusing, and not always reliable, patchwork of sources. In response, the UN has set up a Global Monitoring Programme of Illicit Crops. The program, which started in 2000, will keep track of opium and coca production by ground and air monitoring, as well as through satellite tracking. Feedback from the program should help drug-producing countries better gauge their progress in reducing drug crops. It also should help governments assess the impact of projects that aim to help farmers switch to other crops as a source of income. In addition, it should lead to faster detection of new growing trends, since the decrease of a drug crop in one area often triggers the start-up of the same crop in another region.
ecstasy designer drug and amphetamine derivative that is a commonly abused street drug
The rising popularity of drugs made from chemicals in a lab, rather than from plants, is expanding illegal drug production into developed nations as well. The major foreign source of methamphetamine is Mexico, but much also is made in underground labs within the United States itself. The vast majority of ecstasy (MDMA) used in the United States is produced in Europe, especially in the Netherlands and Belgium. Russia is a key producer of chemicals that are needed to convert the morphine made from opium into heroin.
Cocaine Production Coca, the raw material from which cocaine is made, is grown only in the Andean region of South America. In the 1990s, the governments of Bolivia and Peru made big strides in reducing coca growing within their countries. However, this success was tempered by a surge in coca growing in Colombia. In the early twenty-first century, 90 percent of the cocaine entering the United States starts out in or passes through Colombia, where the cultivation of coca has more than tripled since 1992. Terrorist groups and organized crime networks largely run this drug trade. In recent years, government conflict with these groups has reached crisis proportions. In 2000 the U.S. government passed a law that provided $1.3 billion in financial aid to help Colombia with its plan to fight illegal drugs, reform its justice system, rebuild its economy, and foster peace and social development. In addition, Operation New Generation is a joint effort between the Colombian national police, the Colombian national prosecutor’s office, and the U.S. DEA. The project is targeting some of the nation’s largest drug traffickers. At this point, however, it remains to be seen how well these efforts will work. 6
Drug Producers
C O MP AR ISO N O F D R U G E N F O R C E M E N T REGULA TI ONS BY COUNTRY - 2 0 0 1
Criminalized Record Financial Actions by Drug Money Large Intelligence Governments Laundering Transactions Unit
System for Identifying/ International Mutual Forfeiting Transportation Legal Asset of Currency Assistance
Non-Bank Disclosure Financial Protection Institutions “Safe Harbor”
Offshore Financial Centers
States Parties to 88 UN Convention
Government/ Jurisdiction Colombia India Japan United Kingdom United States SOURCE:
Y Y Y
Y Y Y
Y N Y
Y Y Y
N Y Y
Y Y Y
Y N Y
Y Y Y
N N Y
Y Y Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Bureau of Public Affairs, U.S. Department of State.
.
A major obstacle to eliminating the Colombian coca fields is the strength of the terrorist and criminal groups who control the growing areas. These groups make vast sums of money from the drug trade, so they are ready to go to great lengths to protect it. Often, they resort to violence. In 2000 for example, there were fifty-six ground-fire attacks on government planes spraying the coca fields to kill the plants growing there. The challenge ahead for the Colombian government is to regain control of its own land from these armed groups.
Drug enforcement varies considerably by country. This table shows how some countries, such as Japan and the United States, have several laws that attempt to locate and track illegal activities.
Heroin Production Unlike cocaine, heroin production is scattered around the world. Historically, most of the world’s illegal opium for heroin has been grown in southern Asia. Recently, however, Latin America also has become an important supplier of heroin to the United States. Worldwide, opium production has doubled since the mid-1980s. Greater availability and lower prices, coupled with rising purity, have helped boost the popularity of heroin. As a result, there has been a worldwide increase in heroin-related health problems and criminal activity. In 2000 the largest supplier of illegal opium was Afghanistan, which controlled over 96 percent of the world’s opium-producing land. While the United States got only about 5 percent of its heroin from this source, Afghanistan still had a huge hold on the world market. In 2001 the Taliban government of Afghanistan imposed a ban that drastically cut opium production that year. However, large shipments of opium products from Afghanistan continued to be seized in Pakistan and other neighboring countries. This indicated that drug traffickers were able to draw upon stockpiles built up over the previous years. U.S. officials noted that the ban may have been nothing more than a ploy to drive up opium prices by limiting the supply. 7
Drug Producers
Since the fall of the Taliban from power, it is unclear what stockpiles remain or how the situation in Afghanistan may change in the future. In 2001 Burma and Laos ranked as the world’s leading opium producers. In Burma, the drug trade finances the efforts of the United Wa State Army, a group seeking independence from the country’s central government. At present, the government of Burma is largely powerless in the opium-producing areas controlled by this group. While Asian heroin continues to rule the world market, Colombian heroin now makes up 60 percent of the heroin seized in the United States. Mexican heroin accounts for another 24 percent of the U.S. supply. Since the early 1990s, Colombian crime networks have dramatically increased their share of the heroin trade here by producing a high-grade drug and undercutting the price of their competition. The heroin from Colombia, like that from Asia, is sold in a white powder form. On the other hand, Mexican black tar heroin, the type most available in the U.S. west and southwest, is sold in a tar-like state. Both Colombia and Mexico have heroin-control programs. In 2001 Colombia sprayed 1,800 hectares (4,446 acres) of land in an effort to wipe out the opium poppies growing there, while Mexico has destroyed from 60 to 70 percent of its opium crop each year for the past several years. Similar programs have lowered illegal opium production successfully in Guatemala, Pakistan, Thailand, and Turkey. However, the profitability of the crop makes it very appealing to Latin American crime groups, and the rugged terrain of growing areas, along with the lack of roads there, make it hard for authorities to find and destroy poppy fields. The United States is trying to help source countries fight these problems through better law enforcement training, more information sharing, and tougher antidrug laws.
Marijuana Production Mexico is the biggest supplier of marijuana to the United States. In recent years, Mexican fields have yielded about 6,700 to 8,600 metric tons (7,383 to 9,477 U.S. tons) of marijuana per year. The price of this marijuana has stayed fairly stable since the early 1990s, while its strength has increased. As a result, seizures along the southwestern U.S. border have reached record levels. The United States and Mexico have long worked together to fight illegal drugs. Unfortunately, weakness and corruption within the Mexican government have been a major obstacle to success. Lately, however, there have been signs of improvement, including the arrests of several drug kingpins and greater cooperation with U.S. efforts. 8
Drug Testing in Animals: Studying Potential for Abuse
Meanwhile, Canada is fast becoming a source of indoor-grown, high-strength marijuana, much of which makes its way to the U.S. market. In fact, Canadian officials estimate that cannabis growing is already a billion-dollar-a-year industry in British Columbia. The marijuana, nicknamed “BC bud,” is produced with hydroponics. In this type of farming, plants are grown without soil—only water containing the necessary nutrients is utilized. Canadian growers use hightech equipment to electronically control the nutrients, temperature, and light so that they can produce up to six crops per year. Tetrahydrocannabinol (THC), the main active chemical in cannabis, makes up 15 to 25 percent of this potent marijuana. By contrast, the average THC content of naturally grown marijuana from Mexico is about 6 percent. Canada, like other countries before it, is discovering that shutting down a profitable drug trade is no easy matter. Along with coca and opium poppies, cannabis also is grown in Colombia. Jamaica is yet another source of marijuana destined for the United States. Within this country, the leading states for indoor growing are California, Florida, Oregon, Washington, and Wisconsin. The top states for outdoor growing are California, Hawaii, Kentucky, and Tennessee. Around the globe, the production of illegal drugs remains a stubborn problem. Some critics argue that U.S. money spent on stopping the supply of drugs from other countries might better be spent on curbing the demand for drugs within this one. Nevertheless, the U.S. government remains committed to a policy that targets illegal drugs not only where they are sold or used, but also where they are grown or produced. S E E A L S O Drug Traffickers; Law and Policy: Controls on Drug Trafficking; Law and Policy: Foreign Policy and Drugs; Terrorism and Drugs.
Drug Testing in Animals: Studying Potential for Abuse One of the questions that scientists must ask as they develop new drugs to treat various diseases is whether or not the new prescription drug is likely to be abused or used for the wrong reasons because of the effect it has on users. The likelihood that a drug will be abused by a patient must be carefully weighed against the benefit provided by the drug. Researchers must identify any and all reinforcing effects a drug may have that could lead to future abuse. In the past, researchers made predictions about the likelihood of abuse by observing humans 9
Drug Testing in Animals: Studying Potential for Abuse
who used the drugs, and sometimes by conducting experiments with these users. Increasingly, experiments with animals are replacing this method. Research conducted since the early 1960s has shown that animals such as monkeys and rats will, with very few exceptions, repeatedly give themselves (self-administer) the same drugs that human beings are likely to abuse. Test animals do not self-administer drugs that human beings do not abuse. Research based on animal testing is conducted in a slightly different manner and often requires laboratory procedures not needed for research using human test subjects. Test animals must be given a way to self-administer the drug. Since animals frequently are not physically able to give themselves a drug in the same way a human would, alternate methods must be used. Animals may be taught to push levers or do similar actions in order to get a dose of a drug. The results of these drug self-administration studies in animals play a critical role in predicting whether a new drug for humans is likely to be abused.
Substitution Procedure risk increased probability of something negative happening
The risk that a drug will be abused is often evaluated by what has been termed a “substitution procedure.” Such research begins by giving an animal a known drug, which is then substituted with a new drug under investigation. The first phase in the substitution procedure is designed to establish a baseline or a measure of how much effort an animal is willing to make to obtain a dose of the drug. Each day an animal is allowed to give itself a drug of known potential for abuse. The researcher notes how frequently the animal takes a dose and how much effort the animal is willing to make to get a dose of the drug. The researcher can make a lever harder to push, make the animal push it repeatedly, or make the animal follow a complicated set of actions to get a dose. This provides a point of comparison against which the effects of the new drug that will be studied. Step two in the substitution procedure begins once intake of the known drug, such as cocaine, is stable. In other words, the animal has taken about the same dosage of cocaine for several days. In step two, the liquid in which the known drug was dissolved is substituted for the baseline drug for several consecutive sessions. Since this liquid is usually neutral, with no positive or negative effects, the animal gives itself fewer and fewer injections until it hardly bothers pushing the lever at all. At the end of step two, the animal is briefly returned to baseline conditions.
10
Drug Testing in Animals: Studying Potential for Abuse
At this point the animal is ready for step three: the substitution period. In this phase, a dose of the new test drug is made available. This continues for at least as many sessions as are required for the animal to stop pushing the lever to get the neutral liquid. This process is repeated with different concentrations of the new drug until the experimenter has tested a range of possible doses of the new medicine. The rates at which the animal gives itself the test drug, neutral liquid, and known addictive drug are then compared. If the animal prefers the new drug to the neutral liquid, the new drug is said to have potential for “abuse liability.” In other words, the new substance reinforces the desire for itself and will likely cause addiction. Such substitution procedures provide information that indicates whether or not a drug is likely to be abused. The substitution procedure does not allow a comparative estimate as to whether or not a new drug is more addictive or less addictive than other known drugs. These procedures measure how frequently the animal gives itself a dose, a measure that reflects both the direct effects of the drug and the effects of the drug’s reinforcement of the desire for itself.
addiction state in which the body requires the presence of a particular substance to function normally; without the substance, predictable withdrawal symptoms are experienced
Reinforcing Efficacy Another method must be used to measure the reinforcing effect of a drug separately from its other effects. To compare drugs, it is useful to know how big the maximum reinforcing effect is—termed its “reinforcing efficacy.” Several procedures have been developed to measure reinforcing efficacy. Most tests either allow an animal to choose between the new drug and another drug or nondrug reinforcer. This kind of test is known as a choice procedure. In addition, some tests, called progressive-ratio procedures, measure how hard an animal will work to obtain an injection. In choice procedures, the measure of reinforcing efficacy is how often the new drug is chosen in preference to the other drug (or nondrug). In progressive-ratio procedures, the number of times the animal must push the lever in order to get a drug injection is increased until the animal no longer bothers to push the lever. At some point the animal determines that it is not worth the extra effort to get another dose. This point is called the “break point” and is a measure of the reinforcing efficacy of the drug. The fact that animals choose a higher dose of a drug when given a choice between different strengths of the same drug is evidence 11
Drug Testing in Animals: Studying Potential for Abuse
that these procedures are a valid way to measure reinforcing efficacy. In addition, break points are higher in progressive-ratio experiments involving higher stable doses and lower for experiments involving lower doses. Results of both the choice and the progressive-ratio procedures in animal research are consistent with what is known about the abuse of drugs in human beings. Drugs such as cocaine, a highly preferred drug in choice studies, maintain higher break points in progressive-ratio studies than other drugs, and are frequently abused. These experiments show how animals discriminate among drugs, and the extent to which they prefer certain drugs over others. The results may be used to predict potential subjective effects in human beings. Since subjective effects play a major role in drug abuse, such experiments are an important tool used to evaluate whether a new drug is likely to be abused. A new drug with subjective effects similar to those of a known, addictive, and often abused drug such as heroin is likely to be abused itself. Additionally, drug-discrimination experiments identify the potential for abuse, as well as provide important information that allows researchers to classify new drugs based on their predicted subjective effects. This cannot be done from drug self-administration experiments. Thus, drug discrimination provides additional information relevant to help compare a new drug to a known addictive drug. For example, a monkey shows a similar discrimination pattern using a new drug as it has shown previously using a known drug such as cocaine. This new drug is likely to be abused and to have subjective effects similar to those produced by cocaine. therapeutic healing or curing
If the researchers believe at this point there is a possible therapeutic use of the drug for humans, they would have to test the drugs on humans. In other words, the above drug testing on animals represent only one part of a longer and more involved process for testing drugs.
Ethical Issues in Animal Testing Some animal rights advocates object to the use of animals in drug testing and other scientific research. Most of those who oppose animal experimentation on ethical grounds believe that it is morally wrong to harm one species for the supposed benefit of another. However, most research scientists believe that the benefits of animal testing are too great to ignore. The American Psychological Association’s Committee on Animal Research and Ethics (CARE) has developed and published a document, “Guidelines for Ethical Conduct in the 12
Drug Testing in Humans: Studying Potential for Abuse
Care and Use of Animals.” The guidelines state that animal research should be adequately justified; personnel should be carefully trained to follow the guidelines; care and housing of animals should be reasonable and humane; animals should be acquired lawfully and as humanely as possible; experimental design should minimize animal discomfort whenever possible; and animals should be treated humanely after the research is concluded. Researchers who do not follow these guidelines will fail to get published in respected psychological or medical journals. This means that the data from the experiments will be essentially ignored and useless. For this reason almost all researchers follow these or similar guidelines.
Conclusion Researchers have improved methods for predicting whether or not a new drug will be abused. Using animals in substitution, choice, and progressive-ratio procedures has greatly helped researchers understand the factors involved in determining the probability that a new drug or chemical compound will be abused. Current research techniques allow the evaluation of likely preference and the reinforcing efficacy of a new compound based on experiments with animals such as monkeys and rats. This information is then used to reliably predict whether a drug is likely to be abused and to which known drugs it is likely to be similar, both in terms of how addictive it is and what its subjective effects will be. Such information is clearly valuable in deciding how much to restrict a new drug and is a critical tool in the effort to reduce the abuse of therapeutic drugs. S E E A L S O Drug Testing in Humans: Studying Potential for Abuse; Research.
Drug Testing in Humans: Studying Potential for Abuse Nearly any drug used to treat illness also poses certain risks. One such risk, generally limited to drugs that act on the central nervous system, is that the drug will be abused because of those effects. Such a drug is said to have “abuse potential” or “abuse liability.” If it has important medicinal uses, it may still be available by prescription, but legal controls will be placed on how it can be prescribed. New drugs are tested to determine their potential for abuse so that both the public and the medical profession can be warned about the need for appropriate caution when using them. Conducting tests on humans serves several purposes in the development of safer and more effective drugs. When research done on 13
Drug Testing in Humans: Studying Potential for Abuse
efficacy ability to produce desired results; effectiveness
recreational drug use casual and infrequent use of a substance, often in social situations, for its pleasurable effects
placebo substance that does not contain any active ingredient (e.g., a sugar pill)
laboratory animals shows that a drug might have abuse potential, these findings must be confirmed with tests on humans. Humans who participate in testing describe what kinds of things they notice when they take a particular drug. Testing drugs on humans can also help determine appropriate dose levels and dosage forms to ensure safety and efficacy while minimizing unwanted side effects. Finally, testing in humans helps reduce the availability of abusable drugs to those who are likely to abuse them. In most studies, the human volunteer subjects are experienced to some degree as drug users. Some studies involve people with histories of intensive drug use and abuse over extended periods. These people make good test subjects because they are similar to those most likely to abuse drugs. Other studies use students or volunteers whose misuse and abuse of drugs or alcohol has been mostly recreational. Tests in these people can determine whether certain widely available medications, such as sleeping pills or appetite suppressants, are likely to be abused. Participants are often selected on the basis of some special features (such as anxiety levels or level of alcohol consumption) in order to determine the extent to which such factors influence the outcome of the tests. The use of questionnaires has improved researchers’ ability to measure the subjective effects of drugs. Volunteers who are experienced drug users answer questions after they have taken a drug. For instance, they may be asked to describe how they feel and what they liked and disliked about the drug’s effects. Testing can also indicate whether a person is likely to keep taking a drug with abuse potential. Laboratory studies with volunteers who are experienced drug users, for example, have shown that they will perform bicycleriding exercises to obtain doses of abused drugs, which they selfadminister. These exercise studies are set up so that the volunteer can give herself or himself a higher dose of the drug being tested, if they first exercise for a certain amount of time. When a drug of abuse is tested, volunteers will choose to exercise for longer periods to obtain higher doses. However, when a placebo or a drug that is not abused is made available as a reward for bicycle riding, the subject does not choose to take it, and will not increase exercise time in order to get it. Predicting a drug’s abuse liability is complicated because drugs of abuse are often used in combination. Thus a large number of possible drug combinations need to be tested. Yet few testing procedures have been developed for assessing the interactions of substances, such as marijuana and alcohol, that abusers often use simultaneously.
14
Drug Testing Methods and Analysis
Scientists and the public set standards and regulations for conducting research and testing in human volunteers. The volunteer must understand the risks and benefits of the testing procedure and sign a consent document in the presence of a witness who is not associated with the research. S E E A L S O Drug Testing in Animals: Studying Potential for Abuse; Drug Testing Methods and Analysis.
Drug Testing Methods and Analysis There are a number of reasons for the use of drug tests. Some drug tests are requested by doctors for medical reasons, others by employers to ensure that employees are not working while under the influence of drugs. Drugs can be detected by testing samples of urine, blood, and other bodily fluids, as well as hair. The following sections explain the various reasons for drug testing, and the types of drug testing methods.
Testing for Medical Reasons Under many different conditions a physician may need to determine whether a person is using illegal drugs and, if so, what kind. A physician needs this information before deciding how to diagnose and treat a patient. For example, a person showing a reduced degree of alertness may be the victim of an illness or be intoxicated. Through drug testing, a physician can rule out drug intoxication. A series of drug tests on fluid and tissue samples (for example, blood, urine, saliva, and hair) permits the physician to more accurately determine the person’s condition and then make appropriate medical decisions regarding the patient’s care.
COMMON DRUG-TE STING ME THODS 1. Immunoassays Enzyme immunoassay (EIA) Enzyme-multiplied immunoassay technique (EMIT) Fluorescence polarization immunoassay (FPIA) Radio immunoassay (RIA) Kinetic interaction of microparticles in solution (KIMS) Cloned enzyme donor immunoassay (CEDIA) Rapid slide tests (point-of-care testing) 2. Chromatographic Methods Thin-layer chromatography (TLC) Liquid chromatography (HPLC) Gas chromatography (GC) 3. Chromatography/Mass Spectrometry Gas chromatography/mass spectrometry (GC/MS) Liquid chromatography/mass spectrometry (HPLC/MS)
Various means are used to test for the presence of drugs, most involving chemical analysis of urine, blood, hair, sweat, or saliva.
Testing in the Workplace Another circumstance that may lead to drug testing is behavior in the workplace. Workers receive drug tests for two major reasons: (1) problems with job performance and (2) liability, or risk of a lawsuit due to the worker’s actions. An employer may believe that employees involved in drug use are likely to be less productive as a result of their drug intoxication. Employees using drugs may also pose a potential safety hazard. Under the influence of drugs, a worker may be more likely to make errors that reduce efficiency or lead to workplace accidents. For example, an intoxicated equipment operator may work at a less efficient 15
Drug Testing Methods and Analysis
and accurate pace, and may endanger and even injure other workers because of impairment of perception and clouded judgment. Some research has shown that drug-using workers also take more time off and have a higher rate of accidents in the workplace than employees who do not use drugs.
liable responsible
An employer is also expected, under the law, to act responsibly and exercise due diligence in the course of operating a business. An employer who fails to act in this manner is liable for the conduct of his or her employees. For this reason, employers often require drug testing of workers. Courts have generally supported the right of employers to demand drug tests from workers when it can be shown that there are legitimate concerns about public safety and security.
Testing by the Legal System
blood alcohol concentration (BAC) amount of alcohol in the bloodstream, expressed as the grams of alcohol per deciliter of blood; as BAC goes up, the drinker experiences more psychological and physical effects
The legal system has several different reasons for drug testing. One is to determine whether a criminal offender used drugs, because intoxication is a circumstance that can affect what crime a person is charged with and the punishment that may be given. Society is most familiar with drug testing by law enforcement in the well-accepted and widely used technology of breath analysis to determine the blood alcohol concentration (BAC) of people operating a motor vehicle. It is not only a crime to operate a motor vehicle while intoxicated, but it may be a criminal aggravation of another offense, such as an injury occurring during the course of an accident. The criminal justice system may also use drug testing to estimate the amount of drug use by persons in their custody, or the general level of drug use in a community. There are several reasons for this. One is that drug use is an illegal behavior that the police are responsible for controlling. Measuring the amount of drug use and how it changes over time is a way to evaluate the effectiveness of drug control policies. Additionally, since convicted offenders are housed in jails and prisons, drug testing among arrestees and convicts can provide critical information to system administrators.
Testing During Drug Treatment and Rehabilitation
abstinence complete avoidance of something, such as the use of drugs or alcoholic beverages
16
Drug treatment and rehabilitation programs rely on drug testing for several reasons. First, it gives a measure of a client’s drug use. A second function is monitoring the client for continuing drug use while he or she is participating in treatment. Most treatment programs require abstinence from drug use to remain in treatment. Another feature of drug testing in treatment programs can be labeled a “self-help” function. Many clients in treatment admit that if
Drug Testing Methods and Analysis
they could get away with drug use, they would, but knowing that they will be tested and identified as violators adds an additional motivation for their “staying clean” in treatment. It also provides a reason to refuse drugs that are offered to them in social circumstances. Friends and peers are less likely to offer drugs to a person undergoing drug testing because they fear the drug test will catch that person’s drug use. Finally, drug testing in treatment programs that involve referrals from the criminal justice system helps to reduce public concerns that these programs are not serious, or a place where drug users can avoid prison but can continue to use drugs. The public is more likely to support policies that send offenders to treatment rather than prison if they believe that reliable drug testing is being done and that violators will be sent back to court.
Testing in Schools There is substantial evidence that young people are increasingly exposed to drugs earlier and earlier in their lives. This exposure often occurs in school settings. As a consequence, there are proposals to perform drug tests of students in schools, including “for cause” testing (also known as suspicion-based testing), random testing of some students, and comprehensive testing of all students. It is believed that drug testing will be a deterrent, or serve to discourage, student drug use. Drug testing of students will also identify drug users early in life and allow treatment while they are still young. The earlier a drug user enters treatment, the more likely the chance of success. School drug-testing programs are geared toward treatment. Students who test positive typically are not criminally prosecuted but are instead referred to drug treatment.
Types of Testing The term “drug testing” means the use of chemical technology to analyze a biological sample in order to detect the presence of a drug or drug by-product. The most common samples currently used are urine and blood, but hair, sweat, and saliva samples are becoming more popular. The single most frequently used technique for alcohol is breath analysis.
Blood. Drugs can be identified in the blood. However, using blood as a sample can create problems. For example, collecting a blood specimen, or sample, with a hypodermic needle is invasive and painful. There is the possibility of infection from the necessary puncture wound. In addition, blood can be the source of a disease such as AIDS or hepati17
Drug Testing Methods and Analysis
Concerned parent Sunny Cloud created a drug testing kit called Parent s Alert. The kit contained a plastic cup, a mailer to a lab, and a telephone number for results.
illicit something illegal or something used in an illegal manner
18
tis. Blood samples can also be difficult to transport and store (for example, they require refrigeration and the use of special additives or preservatives). Moreover, blood specimens are not very stable and may break down over time and become unusable unless special precautions are taken. Finally, when testing blood, the retrospective period, or the period of time between drug use and the collection of a sample during which a drug can be identified, is quite short for most drugs.
Urine. Urine is the single most frequently used specimen for detecting commonly used illicit drugs. The use of urine samples has many benefits. First, the collection is noninvasive, since urine is collected without any use of needles. Second, urine, unlike blood, is a concentrated fluid, so the amounts of drug materials in the urine are high compared to the levels found in blood. Third, the urine will contain high concentrations of both the drug of interest (often called the parent drug) and drug by-products, or metabolites.
Drug Testing Methods and Analysis
AP P R O XIM AT E U R I N E D E TE C T I O N PE R I ODS FOR VA RI OUS DRUGS Drug Methamphetamine Amphetamine (metabolite of methamphetamine) Heroin Morphine (metabolite of heroin) 6-Mono-acetyl-morphine (MAM) Phencyclidine (PCP) Cocaine Benzoylecgonine (metabolite of cocaine) 9 -Tetrahydrocannabinol 9
-Tetrahydrocannabinoic acid (marijuana metabolite in urine)
Benzodiazepines
Diazepam Flunitrazepam (rohypnol) Methadone Barbiturate (phenobarbital) Alcohol (ethanol)
Gamma-hydroxybutyrate (GHB)
Detection period
One advantage to testing urine over blood is it is a noninvasive procedure, not requiring the use of needles.
2–3 days
In minutes Opiates positive for 2–4 days (EIA) Few hours 2–3 days Few hours 3–5 days 90% fall in 1 hour (blood) Depending on use, few days to many weeks Days to weeks, depending on halflife 2 weeks 0.2% excreted unchanged 1–2 weeks after last use 1.5–12 hours depending on the peak blood level. Urine typically positive for an additional 1–2 hours. Less than 12 hours
The major drawback of using urine samples is that, for many drugs, it has a relatively short retrospective period. For the common drugs of abuse (with the exception of marijuana), urinalysis is unlikely to detect drugs used beyond a past forty-eight-hour “window” of time. This may be longer for marijuana users. Drugs such as cocaine, heroin, ecstasy (MDMA), and other water-soluble drugs, however, have a very small window. Additional concerns with urinalysis are the possibility of infection from the handling of urine samples, the problems of storage (such as leakage, odor, and so on), and the potential objection that collecting the sample is an invasion of people’s privacy. Another weakness of urine specimens is the ease of changing the test outcome by tampering with the sample. A person can secretly place some chemical in the urine, or dilute it with water, to mask the presence of a drug, or even substitute a “clean” sample in place of the person’s own urine. Urine is typically analyzed by a rapid method that relies on immunochemistry or a means of testing that detects the presence of the 19
Drug Testing Methods and Analysis
drug or the drug metabolite. This is usually called a screening method. These tests are very rapid and are done on a large scale by automated equipment. As a result, the cost of doing screenings is quite low. However, in many legal cases, a positive drug screen must be confirmed by a second test that is slower and more expensive.
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See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
Hair. The drugs a person consumes become trapped in the user’s hair. Laboratory analysis of hair can reveal the presence of a variety of drugs, including heroin, cocaine, amphetamines, phencyclidine, marijuana, nicotine, and barbiturates. Hair analysis is widely accepted by courts, parole boards, and police departments, and has recently been approved by the Food and Drug Administration. Employers around the country are using it for detecting long-term drug use. It is also increasingly used to determine when a pregnant mother has exposed a fetus to drugs and to validate (prove to be true) self-reports of drug use.
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Hair analysis can routinely reveal the use of drugs during the past ninety days (or more, depending on the length of the hair), a much longer period than any other test. Since hair grows at a relatively constant rate of one centimeter per month, analysis of hair strands could pinpoint the time of drug exposure to within as little as one particular week. Hair analysis has been controversial for a number of reasons. Some see it as more invasive of privacy since hair tests, as compared to other tests, can detect drug use going much farther back before the time of the test. There have also been technical controversies about hair analysis. For example, there is the possibility that various hair treatments, such as tinting and permanents, may remove some of the drugs. However, research has generally shown that detectable traces of drugs do remain in the hair in spite of treatments and vigorous washings. Another controversial area has been the possibility of hair being contaminated by materials in the environment, rather than through actual, direct use of a drug. This is known as passive contamination. Hair analysis may show exposure to a drug but not necessarily the voluntary use of it. For example, drugs can be deposited on the hair by environmental exposure, such as marijuana smoke or cocaine powder in the air. Furthermore, the materials in the environment may actually be inhaled or swallowed in small amounts. Passive contamination generally can be controlled through careful washing procedures, the use of drug metabolites to indicate true use, and appropriate minimal threshold values for both the parent drug and its metabolites.
Sweat and Saliva. In recent years, both sweat and saliva have been considered as potential samples for drug testing. These materials gen20
Drug Testing Methods and Analysis
erally have the same limitations that urine does—a short time frame during which drug presence can be identified. Additionally, saliva, if collected right after drug use, will also be influenced by the amount of possible residual drug in the mouth, so it may not work well as an estimator of blood concentration. Sweat testing has been incorporated into a “sweat patch” that is currently on the market and used as a long-term monitoring device. An absorbent pad with a tamperproof adhesive is affixed to a person’s body (typically the upper arm or upper back). This pad absorbs sweat over a relatively long period of time. If the person has used drugs, the sweat will contain both drugs and drug metabolites, which can be extracted and identified by the same methods referred to above. Both of these techniques are relatively new and have not yet been widely used, but they may become more prominent in the future. Saliva testing may offer an alternative to urine testing in circumstances that make urine collection difficult or undesirable. Sweat patches may also offer an alternative to hair analysis. However, sweat patches may be subject to the same criticisms as hair testing and may also prove difficult in terms of tampering, removal, or interference with daily routines like washing and participating in sports.
Breath. Breath testing is a technique commonly used by lawenforcement authorities to test for alcohol. Testing can be done with a Breathalyzer or other breath analysis machines. Breath tests actually rely on detecting alcohol in the water vapor that is a component of breath. To determine blood alcohol concentration, the Breathalyzer tests the exhaled breath and the water vapor in it to estimate the blood plasma alcohol concentration. This test is popular because exhaled breath is convenient to collect and is noninvasive, meaning that the skin is not pierced to collect blood or body fluids. Some devices can preserve the breath sample for later analysis if a Breathalyzer is not immediately at hand. Errors in breath analysis can be caused by the presence of residual alcohol in the mouth. Immediately after drinking, there is enough alcohol vapor in the mouth to give artificially high concentrations when the breath is analyzed. Generally this effect disappears twenty minutes after drinking, but high values for as long as forty-five minutes have been reported.
The Interpretation of Test Results Problems can occur with the interpretation of drug tests. Two common problems are a false negative and a false positive.
interpretation judgement or explanation about technical information
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Drug Testing Methods and Analysis
At the Australian Sports Drug Testing Laboratory in Sydney, Australia, a technician tests urine samples for steroids. This lab was contracted to perform tests for the 2000 Sydney Olympic Games.
dilution process of making something thinner, weaker, or less concentrated, typically by adding a diluting material, often a liquid such as water; can also refer to the result of diluting (i.e., a weakened solution)
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False Negatives. A false negative occurs when a drug is present but is not identified. The testing method being used may have too high a detection limit—that is, it cannot detect the presence of drugs below a certain level. It is also possible that the absolute quantity of the drug in the specimen is too low. There are several limits imposed on testing instruments. One is the limit of detection, or the lowest concentration the instrument can detect. The second is the threshold or cut-off value, or a value above the limit of detection that is selected based on prior tests. The threshold value is designed to accommodate small amounts of drug that may be present due to passive ingestion or contamination. Urine tests can yield false negatives if the individual has consumed large amounts of fluids prior to giving the sample. The dilution of the urine “waters down” the final concentration of the drug, reducing it below the threshold value. The result is a false negative. False negatives can be avoided in several ways. First, in testing for a particular drug, the specimen should be analyzed not only for the drug itself but also for its metabolites. Heroin use, for example, is determined by the presence of its metabolite, morphine. Increasing the amount of specimen for analysis or treating it with chemicals can also make laboratory methods more sensitive.
Drug Testing Methods and Analysis
False Positives. A false positive occurs when a drug is shown to be present but in fact is not. A test can yield a false positive if another drug or substance is present in the specimen that has a reaction to the chemical agents used in analysis. Substances other than the drug being tested for may have a metabolite that will give a positive reaction. For example, at times false positives for amphetamines occur when a person is on allergy medications. Using a second test, one that uses a different technology to confirm the results of the first, can identify false positives.
Cheating on Drug Testing The most common ways in which subjects of drug screening fool the system are switching “clean” urine for “dirty” urine, submitting urine that is not their own, or saving their own clean urine for later use. Freeze-dried clean urine samples are openly sold for just this purpose. Other measures include hiding containers of clean urine, trying to substitute other liquids for urine, or adding substances thought to mask the presence of drugs in urine. Because the addition of various substances to urine in an attempt to cover up the presence of drugs is a common practice, many laboratories routinely test for these substances in the urine.
The Ethics of Drug Testing There is considerable controversy surrounding the ethics of drug testing. Some people oppose drug testing in most or all forms, while others believe it is appropriate to drug-test individuals under most if not all social circumstances. The major points of disagreement between these two groups are over the issues of privacy, impairment, and illegality. Those opposed to drug testing generally see drug use as a private behavior, involving only the person who chooses to take drugs. These people do not believe that drug use causes public harm. Drug testing, they believe, should only be done in response to some measurable harm or evidence of a crime. This group sometimes supports limited drug testing in certain occupations that directly affect public safety, such as airline pilots or police officers. Those who support widespread drug testing argue that drug use is in itself an activity harmful to society, in addition to being illegal. Therefore, supporters say, the right to privacy is not a compelling argument, since privacy should not be a defense of illegal behavior. In addition, drug users subject others to risk because they cannot use good judgment or fully control their behavior while intoxicated. As a result, supporters argue, the public has a right to be protected from 23
Drug Traffickers
this behavior. SEE ALSO Costs of Drug Abuse and Dependence, Economic; Diagnosis of Drug and Alcohol Abuse: An Overview; Driving, Alcohol and Drugs; Schools, Drug Use in; Treatment Types: An Overview; Workplace, Drug Use in the.
Drug Traffickers Drug trafficking is the movement of illegal drugs from one location to a final destination where they will be sold to users. A drug-transit country is one through which drug shipments travel to reach local dealers and users. Most of the illegal drugs used in the United States start out in other countries, including all of the heroin and cocaine and much of the marijuana. These drugs may travel through several other countries before they reach their final destination. As a result, the U.S. government’s policy to fight illegal drugs targets not only the countries where they are grown or produced, but also those through which they are transported.
The Majors List The Foreign Assistance Act of 1961 requires the president to identify nations that are major illegal drug-producing or drug-transit countries. The president must submit a list of these countries, nicknamed the majors list, to Congress each year. The act severely limits the foreign aid that can be provided to any country on the list. In 2001 twenty-three countries made the list: Afghanistan, the Bahamas, Bolivia, Brazil, Burma (Myanmar), China, Colombia, the Dominican Republic, Ecuador, Guatemala, Haiti, India, Jamaica, Laos, Mexico, Nigeria, Pakistan, Panama, Paraguay, Peru, Thailand, Venezuela, and Vietnam. That year, President George W. Bush also identified several regions of concern. These regions were being watched closely because they either had been trouble spots in the past or looked as if they might be in the future. The regions on the watch list included Belize, Central America, Central Asia, Cuba, the Eastern Caribbean, Hong Kong, Iran, Malaysia, North Korea, Syria and Lebanon, Taiwan, and Turkey and other Balkan Route countries. In addition, Kazakhstan, Kyrgyzstan, Morocco, the Philippines, and South Africa were singled out as major sources of marijuana. However, these countries were not included on either list, because they were not shipping drugs to the United States. The only country dropped from the majors list in 2001 was Cambodia, which had been added in 1996 as a transit 24
Drug Traffickers
Netherlands United Kingdom United States
Mexico Guatemala Colombia Hawaii (U.S.)
Puerto Rico (U.S.)
Belgium
S. Korea Turkey Japan Lebanon Syria Iran Afghanistan Pakistan Egypt Boma Laos Hong Kong India Benin Philippines Thailand Nigeria Kenya Sri Ghana Togo Lanka Singapore Ivory Coast
country for heroin. In recent years, however, the flow of this heroin into the United States seems to have stopped. A quick glance at the countries named shows the worldwide scope of the problem. However, historically there are certain key hot spots. In the early 1990s, the U.S. National Narcotics Intelligence Consumer Committee estimated that Latin American countries supplied about 25 to 30 percent of the heroin reaching the United States, about 60 to 80 percent of the marijuana, and all of the cocaine. Southeast Asian and Middle Eastern countries supplied the remaining 70 to 75 percent of the heroin.
Most illegal drugs used in the United States are brought illegally into the country from places such as the Bahamas, Colombia, China, and Vietnam. This map shows the global distribution pattern of opium and heroin.
Traffic in the Americas The routes taken by drug traffickers to carry drugs from South America to the United States show the extent of the problem. These drugs pass through a 6-million-square-mile transit zone that is about the size of the mainland United States. This zone stretches from the Caribbean Sea and the Gulf of Mexico to the eastern Pacific Ocean. It might seem that Central America’s position as a land bridge between North and South America would make it a natural thoroughfare for the drug traffickers. However, the bulk of the drug traffic in the early twenty-first century has shifted to sea routes, thanks to stronger law enforcement on land. As a result, only Guatemala and Panama currently are identified as major drug-transit countries in Central America. Belize and the region as a whole, however, have a place on the president’s watch list. 25
Drug Traffickers
Suspected heroin traffickers hide their faces as the Colombian media snaps photographs in 2001. Colombia is a major heroin producer, whereas the Bahamas, located between Colombia and the United States, are a storage and transit destination.
On the other hand, Mexico and several Caribbean nations remain big concerns. The U.S. strategy for drying up the steady flow of drugs from these countries focuses on both ends of the supply chain. Take the example of cocaine. At one end of the chain are the major producing countries of Colombia, Peru, and Bolivia. At the other end are the major transit countries, such as Mexico, the Bahamas, and Jamaica. Because of its location atop the main drug route, Cuba might seem to be a logical transit point too. Yet, while there have been scattered reports of traffickers moving drugs across Cuban turf, the amount reaching the United States seems to be small. Also, in recent years, much of the suspicious air traffic that once crossed Cuban airspace now is flying over Haiti and the Dominican Republic. The U.S. policy in all these countries is similar. One aim is to strengthen the willingness and ability of their governments to tackle the illegal drug problem. A second aim is to help the countries increase the effectiveness of their law enforcement and military activities that affect the drug trade. A third aim is to work with the governments to fight directly against the major drug-trafficking organizations. In the transit countries, efforts go beyond just stopping drug shipments at sea or in the air. The U.S. stance is that these countries also need to deny safe haven to the traffickers and clean up corruption within their governments. In addition, banks within these countries should not allow money laundering—the transfer of illegally obtained money through an outside party to conceal its true source. 26
Drug Traffickers
A Tale of Two Countries Two Caribbean countries, the Bahamas and the Dominican Republic, offer a glimpse at the strengths and weaknesses of the U.S. policy. Both are still major transit routes. Yet drug trafficking is down in the Bahamas, while it is on the upswing in the Dominican Republic. The Bahamas is composed of a string of islands, including hundreds of small, deserted islands that make ideal hiding spots for drug storage and shipment. The country is located on the air and sea routes between Colombia and the southeastern United States. At its closest point, it is only forty miles from southern Florida. It is not surprising, then, that the Bahamas is a major transit country for cocaine and marijuana. In addition, drug traffickers have begun to use the country as a transit point for ecstasy (MDMA) made in Europe. Much of the drug traffic bound for the United States travels by boat. In addition, drug couriers often are arrested at the airports, which offer frequent international flights.
ecstasy designer drug and amphetamine derivative that is a commonly abused street drug
Since 1982, the United States has run Operation Bahamas and Turks and Caicos Islands (OPBAT) in cooperation with local governments. OPBAT uses radar and intelligence gathering to detect and watch drug smuggling activities. A joint strike force, flying out of U.S. funded–helicopter bases, also conducts drug-fighting patrols and missions. In addition, members of the Royal Bahamas Police Force are assigned to several U.S. Coast Guard cutters that work to stop drug shipments at sea. As a result, drug flow through the Bahamas has dropped dramatically since the peak years of the late 1980s. Of course, there is still much room for improvement. One recent focus of U.S. efforts has been money laundering there. In 2000 the government of the Bahamas enacted several important laws aimed at further stemming the tide of money laundering and drug trafficking in that country. The Dominican Republic is another transit country in the Caribbean. Cocaine is the main drug smuggled there, although heroin smuggling also is on the rise. In addition, Dominican traffickers seem to be spearheading ecstasy shipments through the region. Drugs are brought into the country by way of small boats, cargo ships, airdrops, and couriers, as well as overland from Haiti. Once in the Dominican Republic, the drugs often travel by boat to Puerto Rico and then shipped from there to the United States. The Dominican government has signed major antidrug agreements and made drug-related money laundering a crime. Nevertheless, cooperative efforts with the United States have been comparatively weak. As a 27
Drug Traffickers
result, the Dominican Republic is fast becoming a drug trafficking command and control center.
The Mexican Connection Mexico is another major trouble spot. While some cocaine is shipped to the United States by way of the Caribbean Islands, about two-thirds of it travels by boat through the eastern Pacific Ocean to the west coast of Mexico. From there, it is typically transported to the border and smuggled into the southwestern United States. Other drugs smuggled into the country from Mexico include South American and Mexican heroin, Mexican methamphetamine, and Dutch ecstasy.
Drug smugglers invent imaginative ways to transport drugs across boarders to avoid detection. A customs agent holds an X-ray showing the stomach contents of a drug trafficker and its illegal contents, as well as the recovered drugs in a plastic bag.
In addition, marijuana brought into the country from Mexico remains a huge problem. In 1998, marijuana seizures along the southwestern U.S. border totaled 743 metric tons—a massive 700 percent increase over 1991. Organized crime groups with far-reaching networks often smuggle the marijuana along with other drugs. Typically, the drugs are concealed in vehicles driven through border ports of entry or hidden in shipments of legitimate products. Marijuana also is moved across the border by rail, horse, or raft. Smaller shipments are carried by pedestrians who enter through border checkpoints or by backpackers who cross the border at remote locations. Some marijuana also is carried by boat up the coast to ports or isolated drop-off sites. The drug trafficking networks in Mexico are deeply entrenched, and routing them out has proved to be a daunting task. The biggest obstacle is long-standing weakness and corruption within the Mexican government. Nevertheless, there have been some successes in recent years, including the arrests of several drug kingpins. There also has been increased cooperation with U.S. antidrug efforts. One example is a U.S. Custom Service (USCS) program called Operation HALCON. Since 1990, this joint effort has used aircraft based in Mexico to monitor drug trafficking. In 2000 alone, the program led to the seizure of more than 5,000 pounds of cocaine, over 18,000 pounds of marijuana, twenty-seven aircraft, two boats, and two vehicles. A second joint venture, this one involving the U.S. Coast Guard and the Mexican Navy, led to the seizure of another 30,000 pounds of cocaine that same year.
Traffic Around the World Elsewhere in the world, drug trafficking is also a pressing issue. In Southeast Asia, heroin traffickers have been operating for centuries. 28
Drug Traffickers
Heroin processed there travels through China, Japan, Malaysia, the Philippines, Singapore, Taiwan, or South Korea on its way to the United States. Chinese criminal groups with sophisticated trafficking networks control much of this drug trade. In recent years, crime groups in Nigeria, Africa, also have been active in smuggling Southeast Asian heroin. In the Middle East, drug traffickers smuggle Southwest Asian heroin into the United States mainly by way of immigrant communities of the same ethnic background. Criminal groups composed of Lebanese, Pakistanis, Turks, and Afghans all have been involved. Nigerian crime groups also deal in Southwest Asian heroin. Since the September 11 terrorist attacks, increasing attention has been focused on the drug trade in Afghanistan. In 2000 that country produced 70 percent of the world’s illegal opium, from which heroin is derived. Much Afghan heroin is smuggled through Central Asian countries into Russia. Some of it is used there, but some also moves on to other countries. Afghan heroin also is smuggled through Pakistan and India on the way to other markets. However, the amount reaching the United States is relatively small. In the Netherlands and Belgium, the illegal production of ecstasy is thriving, despite government efforts to curtail it. This ecstasy is smuggled into the United States by couriers flying on commercial airlines or shipped in express delivery packages. Some of it also reaches this country by way of Canada, Mexico, or the Caribbean Islands. Israeli and Russian crime networks traffic in MDMA worldwide as well. The illegal drug market in the United States is one of the most profitable in the world. Not surprisingly, then, drug traffickers from around the globe are drawn here. The sheer length of the U.S. borders, and the volume of traffic across them, makes the task of stopping drug smugglers very difficult indeed. Consider that 60 million people enter the United States each year on 675,000 commercial and private flights, according to the Customs Service. Another 6 million come by sea and 370 million by land. In addition, 116 million vehicles drive across the borders from Mexico and Canada. More than 90,000 ships dock at U.S. ports, and another 157,000 smaller vessels visit this country’s coastal towns. Amidst all this traffic, it is little wonder that so many illegal drugs slip through. The current U.S. policy is to encourage drug-transit countries to update their laws, strengthen their law enforcement and legal systems, and tighten the net around drug trafficking, money laundering, and government corruption. Critics argue that the drug 29
Drug Use Around the World
U .S . D R U G E N F OR C E M E N T A G E N C Y S TA F F I NG A ND BUDGETS 1 9 7 5 – 2 0 0 0
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U.S. Drug Enforcement Agency. .
The total number of employees and the overall budget of the U.S. Drug Enforcement Agency increases every year in an effort to further crackdown on drug use, sales, and manufacturing.
supply can never be fully stopped, however, and money spent on this effort is largely wasted. They contend that the money could be better spent on programs aimed at reducing the demand for illegal drugs. Still, U.S. policy remains firmly committed to decreasing the flow of drugs through transit countries. Some progress has been made, but there is much more to be done. To build on its successes, the United States will have to work closely with these other nations. SEE ALSO Drug Producers; Law and Policy: Controls on Drug Trafficking; Law and Policy: Foreign Policy and Drugs.
Drug Use Around the World Drug use is a worldwide phenomenon, and drug use occurs in almost every country. The specific drug or drugs used varies from country to country and from region to region. Worldwide, the three main drugs of use are cannabis (such as marijuana), opiates (such as heroin), and cocaine. Although individual countries have their own drug laws, in general, drug possession, sale, and use are illegal. Unfortunately, laws are not always equally enforced in countries around the world. 30
Drug Use Around the World
The History of Drug Use Drugs have played a part in every culture throughout history, whether used for medical, religious, or recreational purposes. Records of cannabis use date back thousands of years; hallucinogenic drug use in religious ceremonies shows up worldwide; opium use dates back to the beginning of civilization; and the chewing of coca leaves by laborers extends back thousands of years. Drug abuse most certainly occurred in the past, but it was not until people learned how to process and refine drugs that abuse rose dramatically. During the past 100 years, advances in chemistry and pharmacology (the science of drugs) have allowed new drugs to be created from old sources. Opium was processed and refined into morphine and heroin. Coca leaves were processed and refined into cocaine and crack. Amphetamines, a new class of stimulants, were synthesized in the laboratory, as were new hallucinogenic drugs such as LSD, ecstasy, and MDA. These new drugs and refined old drugs are more powerful and addictive than any drugs in the past. While great advances have been made in the creation and use of drugs for medical
Drug use and addiction are international problems, with many countries in need of substance abuse clinics. The Kripa Counseling Centre for the Chemically Dependent is located in Bombay, the capital of India.
hallucinogenic substance that can cause hallucinations, or seeing, hearing, or feeling things that are not there
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Drug Use Around the World
purposes, drug use for religious reasons has declined, while use for pleasure has increased sharply.
Current Global Trends in Drug Use Throughout the 1990s, the use of amphetamine-type stimulants (ATS) increased dramatically worldwide. The main regions of use of ATS are in North America, Western Europe, and Asia. By the end of the 1990s, ATS use had stabilized or declined in North America and Western Europe. By contrast, use has continued to increase in Asia. Asia is the leading region for use and manufacture of ATS, and the potential for spreading the problem to other regions continues. Worldwide, cocaine use has been reported in more than twothirds of all countries. Although the use of cocaine is declining in North America, the rate of use still leads the world. In Western Europe, cocaine use has continued to rise since 1980. The lowest rates of cocaine use are found in Asia. Law-enforcement efforts have brought down the rate of production in cocaine-producing nations in recent years. The use of opiates has been increasing worldwide at an alarming rate, with more than two-thirds of the countries in the world reporting increases. Opiate use is highest in developing nations and nations in transition, while use in developed nations is stable or declining. One possible reason for the increase in use worldwide is that production of opium has increased dramatically. Production of opium has been shifting from Southeast Asia to Southwest Asia. Afghanistan leads the world in opium production, producing 79 percent of the total. Cannabis remains the most widespread drug in use worldwide. The use of cannabis is increasing overall, but in some regions, notably North America, Russia, China, and parts of Asia, use has stabilized or decreased in recent years. Cannabis will probably remain the most widely used drug because the crop is easily grown in many different climates and requires no processing for use as drugs. Opium and opiate drugs are most widely used in Asia. Opiate use is much lower in North America, Central America, South America, and Europe than it is in Asia. However, there is still enough use to consider opium a problem drug in those regions. Cocaine use is highest in the United States, but use is also high in other countries throughout the Americas and Europe. In general, rates of cocaine use are higher in more affluent countries. The use of amphetamine-type stimulants is highest in Europe and significant in selected other countries in the Americas. Africa has the lowest overall use of opium, and 32
Drug Use Around the World
African rates of cocaine use are low. African countries generally show more amphetamine-type stimulant use than use of opium and cocaine.
Worldwide Drug Production The production of amphetamine-type stimulants is a worldwide problem. ATS can be manufactured wherever the chemicals are located. In most world regions, illicit laboratories produce the drugs. In a few countries in South America and Africa, pharmaceutical companies that produce ATS for medicinal use are the primary producers. ATS production is difficult to control because of the wide range of ATS drugs available. For example, in some countries a chemical variation of a particular ATS compound can create a new ATS that is not illegal.
Opium, and drugs made from opium (e.g., heroin), are used more widely in Asia than in other parts of the world. Here Burmese women prepare opium for smoking. illicit something illegal or something used in an illegal manner pharmaceutical legal drug that is usually used for medical reasons
The leading countries that grow coca and produce cocaine are Bolivia, Peru, and Colombia. North American countries are the main market for cocaine because of easy access to the South American source. Opiates are derived from the opium poppy plant, which is grown in many parts of the world. The principal growing areas for opium 33
Drug Use Around the World
poppies are in Southwest Asia (Afghanistan and Pakistan), Southeast Asia (Laos or Lao People’s Democratic Republic, Myanmar, Thailand, and Vietnam), and Latin America (Colombia and Mexico). In 1999, Afghanistan accounted for 79 percent of world opium production, Myanmar produced 15 percent of the world opium, and the remaining 6 percent was produced by other nations. Because production of opium is centered in Southwest and Southeast Asia, the highest levels of use are found in countries close to the source. In the last decade, more than 120 nations reported cannabis growing. However, little reliable information exists on just how much is grown. The amount of cannabis seized in drug raids gives some idea of annual cannabis production, but estimates vary widely, ranging from 10,000 to 300,000 metric tons a year. The major growers of cannabis and major suppliers for the world market are Morocco, South Africa, Nigeria, Afghanistan, Pakistan, Mexico, Colombia, and Jamaica. Another trend in cannabis growing in developed nations is hydroponics and other indoor growing techniques. Improved cannabis growing techniques result in a plant with a much higher concentration of tetrahydrocannabinol, the active ingredient in marijuana and other cannabis drugs. As a result, the drugs from these crops are more powerful.
The Economic Impact of Drug Production The growing and processing of drugs usually takes place in developing nations or nations in transition. For developing nations, drug production may form the basis of the country’s economy. Drug growing and processing usually employs a large percentage of the population and may be a major source of income. The money from growing and processing drugs boosts local economies, even though most of the profits do not directly benefit the growers and production workers. The economic value of cannabis and ATS to the countries that produce them is probably just as high as opium and coca are to the countries that grow these crops.
DID YOU KNOW? The United Nations World Drug Report estimates that cannabis, or marijuana, is the most widely abused substance in all parts of the world, with around 141 million people using it.
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The economic impact of opium growing and production is dramatic. Afghanistan produced 4,565 metric tons or 79 percent of the world opium supply in 1999, with a potential economic value of $251 million (all values are in U.S. dollars). Myanmar, the secondleading producer of opium in 1999, produced 895 metric tons or 15 percent of the world opium supply, with a potential economic value of $116 million. The economic impact of coca production is also significant, based on the numbers for 1999. In that year, Colombia produced 520 metric tons of coca worth an estimated $494 million. Peru produced 305
Drugs of Abuse
metric tons of coca worth an estimated $134 million. Bolivia produced 70 metric tons of coca worth an estimated $63 million. The huge economic impact of drug production on source countries makes elimination of this production a major problem. In poor nations, people usually consider the money-making opportunities worth the risks. Many times, the risks are lessened through corrupt governments that make profits from the illicit drug production. Some countries simply lack the resources or manpower to combat illicit drug growing and production. S E E A L S O Drug Producers; Drug Traffickers; Drugs Used in Rituals; Hallucinogens; Marijuana; Opiate and Opioid Drug Abuse.
Drugs of Abuse Drugs that are used and abused by humans for nonmedical purposes can be grouped into several major categories. The drugs in each category have similar effects on the user, even though they may differ in the way they produce those effects. The major categories include: 1. alcohol (ethanol) 2. nicotine and tobacco 3. depressants (barbiturates, benzodiazepines) 4. stimulants (amphetamines, cocaine) 5. marijuana 6. opioids (morphine, heroin, methadone) 7. psychedelics (LSD, mescaline, ecstasy) 8. inhalants (glue, nitrous oxide) 9. phencyclidine (PCP) This article describes and discusses drugs from each category. The discussion begins with alcohol and tobacco, which are both legal and relatively easy to obtain. The worldwide use and abuse of these drugs is far more widespread than all the other categories of abused drugs combined. Next in the discussion is depressants used as prescription drugs. Doctors write more prescriptions for diazepam (Valium) and the related benzodiazepines each year than for any other drug. The discussion then turns to illegal, or illicit, drugs. The illicit use of heroin, cocaine, and other drugs remains a major social, legal, financial, and health problem in the United States in the twenty-first century. However, fewer people are physically dependent on illegal drugs than on the legal drugs listed above. 35
Drugs of Abuse
stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system depressant chemical that slows down or decreases functioning; often used to describe agents that slow the functioning of the central nervous system; such agents are sometimes used to relieve insomnia, anxiety, irritability, and tension blood alcohol concentration (BAC) amount of alcohol in the bloodstream, expressed as the grams of alcohol per deciliter of blood; as BAC goes up, the drinker experiences more psychological and physical effects psychosis mental disorder in which an individual loses contact with reality and may have delusions (i.e., unshakable false beliefs) or hallucinations (i.e., the experience of seeing, hearing, feeling, smelling, or tasting things that are not actually present) physical dependence condition that may occur after prolonged use of a particular drug or alcohol, in which the user s body cannot function normally without the presence of the substance; when the substance is not used or the dose is decreased, the user experiences uncomfortable physical symptoms
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It is important to remember that individuals often take several drugs from different categories. Alcoholics typically smoke cigarettes and often use benzodiazepines as well. Heroin users frequently smoke cigarettes and marijuana, drink alcohol, and take stimulants. Multipledrug use is a relatively common occurrence for those using legal and/or illegal drugs.
Alcohol Alcohol (ethyl alcohol, called ethanol) has been in use by people around the world throughout recorded history. Often a part of religious rituals or social customs, alcohol has almost no therapeutic, or medicinal, value. In fact, alcoholism is a major social and medical problem. According to the 2000 National Household Survey on Drug Abuse, almost half of all Americans 12 and older (46.6 percent) reported that they are current alcohol drinkers. About 9.7 million young people aged 12 to 20 (27.5 percent) reported drinking alcohol in the month prior to the survey. Medical complications caused by chronic alcoholism affect hundreds of thousands of individuals each year. Many die because of alcohol-related disease and accidents. Tens of thousands of innocent individuals are injured or killed each year in alcohol-related traffic accidents. Therefore, alcoholism is a far-reaching problem, affecting the lives of those who drink excessive amounts of alcohol as well as those who drink moderately or not at all. Many people consider alcohol a stimulant because it releases an individual’s inhibitions. Actually, alcohol is a powerful depressant of the central nervous system (the brain and spinal cord). The effects of alcohol on the central nervous system depend on blood alcohol concentration (BAC). Alcohol’s effects include impaired memory, a decreased ability to concentrate, mood swings, and, once a high BAC is reached, passing out. Chronic (long-term) alcoholism can result in brain damage, memory loss, sleep disturbances, psychoses, heart disease, ulcers of the stomach and gastrointestinal system, and liver diseases such as hepatitis and cirrhosis of the liver. Long-term use of alcohol can result in a state of physical dependence. When a person who is dependent on alcohol stops drinking, he or she may have withdrawal symptoms, such as problems with sleep, anxiety, weakness, and mild tremors. In more severe dependence, the alcohol withdrawal syndrome includes stronger tremors, seizures, and delirium. In some cases, this withdrawal can be lifethreatening.
Drugs of Abuse
Nicotine and Tobacco In the 1990s and into 2000, almost 30 percent of adults in the United States reported being current smokers. People have kept smoking despite scientific evidence linking cigarette smoking to life-threatening health problems, including lung cancer and heart disease. The nicotine in tobacco appears to produce effects that people desire, such as increased alertness, reduced aggression, and decreased weight gain. In nonsmokers, nicotine produces undesirable effects, such as dizziness, nausea, and vomiting. Although some damage from smoking is permanent, the chances of developing cancer, heart disease, and other health problems decrease once a person stops smoking. However, a smoker who gives up tobacco experiences a withdrawal syndrome. Withdrawal can produce unpleasant symptoms, such as cravings for tobacco, irritability, weight gain, difficulty concentrating, drowsiness, and sleep problems. Often the smoker tries to relieve these symptoms by taking up smoking again. Products such as chewing gum that contains nicotine and skin patches have been developed to help people quit smoking. Many people are able to become nonsmokers by using these products.
withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance delirium mental disturbance marked by confusion, disordered speech, and sometimes hallucinations
Depressants Depressants of the central nervous system include barbiturates and benzodiazepines. In 2000 approximately 6 to 7 percent of 12th graders abused benzodiazepines and about 6 percent abused barbiturates. Most of this abuse involves barbiturates that act quickly but whose effects last for relatively short periods, such as pentobarbital (“yellow jackets”) or secobarbital (“red devils”). Abuse also occurs with some of the shorter-acting benzodiazepines (often used to treat sleep problems), such as estazolam (ProSom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion). Individuals may take drugs with depressant effects for medical reasons, such as to relieve insomnia (inability to sleep), anxiety, or dependence on another drug. Others will cross over the line from medical use into nonmedical use. Some people go on drug binges, or periods where they remain intoxicated for several days, followed by longer periods during which they do not take the drug. Other users of barbiturates or benzodiazepines take the drugs over long periods, maintaining a low level of intoxication. Because they develop tolerance to the drugs, they do not show signs of intoxication or decreased ability to function. At higher doses, however, the user may have slurred speech, difficulty thinking, memory problems, sluggish behavior, and emotional ups and downs.
intoxicated state during which a person s physical or mental control has been diminished
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Drugs of Abuse
Withdrawal from chronic barbiturate or benzodiazepine use can range from mild symptoms, such as mild anxiety or insomnia, to stronger symptoms, such as tremors and weakness. In severe withdrawal, a person may experience delirium and seizures. This severe withdrawal syndrome can be fatal.
Stimulants Stimulants of the central nervous system include caffeine, cocaine, and amphetamine (sometimes called speed). Although they belong to the same category, these substances vary greatly in the risks they pose to health. The use and abuse of amphetamines and cocaine pose much greater risks than the use of caffeine.
Caffeine. Perhaps 80 percent of the world’s population takes caffeine in the form of tea, coffee, cola drinks, and chocolate. In the central nervous system, caffeine decreases drowsiness and fatigue and produces a more rapid and clearer flow of thought. With higher doses, however, nervousness, restlessness, insomnia, and tremors may result. People can become dependent on caffeine. Withdrawal symptoms include a long, throbbing headache, as well as fatigue, sluggishness, and anxiety. In general, chronic caffeine consumption has only minor long-term consequences for health. Cocaine and Amphetamines. Chronic use of cocaine and amphetamines has much more serious consequences. In 2000 about 1.2 million Americans reported that they currently used cocaine (powdered or crack cocaine), and 24 million reported having used cocaine at some time in their lives. Cocaine use among young people gradually rose through the 1990s but dropped somewhat in 2000 and 2001. The introduction of freebase and crack cocaine (both forms of cocaine that can be smoked) has led to a significant increase in cocaine-related medical, economic, social, and legal problems. Abuse of amphetamines has risen steadily through the 1990s as well, largely due to the recent surge in popularity of methamphetamine.
euphoria state of intense, giddy happiness and well-being, sometimes occurring baselessly and at odds with an individual s life situation
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Cocaine or amphetamine use produces an elevation of mood, an increase in energy and alertness, and a decrease in fatigue and boredom. However, some individuals experience anxiety, irritability, and insomnia. Heavy users of cocaine often take the drug in binges, only stopping when their supply runs out or they collapse from exhaustion. Immediately following injection or inhalation of cocaine, the individual experiences an intense sensation known as a rush or flash, followed by euphoria. Cocaine rapidly penetrates into the brain to produce these effects, but then is rapidly distributed to other body tissues. As a result, the intense pleasure is followed by a quick decline in the plea-
Drugs of Abuse
surable effects, or a “crash.” Often, a user will immediately seek out and use more of the drug to make the pleasurable effects last longer. Stopping cocaine or amphetamine use can produce withdrawal symptoms, beginning with exhaustion during the crash phase. This phase is followed by long periods of anxiety, depression, anhedonia (a condition in which a person does not have feelings), overeating, and strong craving for the drug. This craving may persist for several weeks. Cocaine and amphetamines are extremely toxic, or poisonous. They are toxic even when a user does not take the drugs for long periods. Some of the less severe toxic reactions include dizziness, confusion, nausea, headache, sweating, and mild tremors. Almost all cocaine and amphetamine users experience these symptoms. More severe toxic effects include irregular heartbeat, convulsions and seizures, heart attacks, liver failure, kidney failure, heart failure, respiratory depression (slowed rate of breathing), stroke, coma, and death. Even prompt medical attention is not always successful at treating the damage to the heart and cardiovascular system. Amphetamines can cause permanent damage to nerve cells. The long-term abuse of stimulants can also cause psychiatric problems. These problems include anxiety, depression, hallucinations, and, in some cases, a paranoid psychosis resembling schizophrenia.
Marijuana Marijuana, a hallucinogenic, is probably the most commonly used illicit drug in the United States. In 2000 about 18 percent of all young people aged 12 to 17 and 45 percent of young adults aged 18 to 25 reported having used the drug during their lifetimes. Smoking a marijuana cigarette can increase feelings of well-being and relaxation. However, marijuana use can lead to short-term memory problems and decrease a person’s ability to carry out goal-directed behavior. In other words, marijuana can interfere with an individual’s ability to stick to the task at hand, whether it is something as simple as completing daily homework or something somewhat more complex, such as following through over days or weeks to complete a longer-term project. Marijuana also interferes with driving skills, even after the effects of the drug have appeared to wear off. With higher doses, users may experience paranoia, hallucinations, and anxiety or panic.
psychiatric relating to the branch of medicine that deals with the study, treatment, and prevention of mental illness paranoid psychosis symptom of mental illness characterized by changes in personality, a distorted sense of reality, and feelings of excessive and irrational suspicion; may include hallucinations (i.e., seeing, hearing, feeling, smelling, or tasting something that is not truly there) hallucinogenic substance that can cause hallucinations, or seeing, hearing, or feeling things that are not there
Chronic marijuana users sometimes develop a condition called amotivational syndrome. In this syndrome, users lose a sense of good judgment and feel apathetic (lazy and indifferent). They no longer care about their personal appearance and lose interest in their 39
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personal goals. However, it is not clear whether this syndrome results from the use of marijuana alone or from other factors. Users can develop tolerance to the effects of marijuana. When marijuana smoking stops, it produces only mild withdrawal symptoms, including irritability, restlessness, nervousness, insomnia, weight loss, chills, and increased body temperature.
Opioids Opioids, such as heroin and morphine, are drugs that contain opium. The nonmedical use of opioids in the United States is much less common than the use of the other drugs discussed earlier. As of 2000, less than 0.5 percent of young people aged 12 to 17 reported trying heroin at some time during their lives; 1.2 percent of all adults aged 12 and older reported trying heroin at some time during their lives. However, opioid use, especially heroin use, rose in the 1990s before stabilizing again around 2000. The major medical use of opioids is for the relief of pain. Only a very small number of people who begin using morphine or similar drugs for pain go on to become abusers of the drugs. More commonly, people begin using opioids by experimenting with illegal drugs. Typically, this involves injecting heroin. Heroin users often progress to chronic use and become dependent. Some heroin addicts who seek treatment for their addiction take another opioid, methadone. Drug treatment centers provide methadone-maintenance programs for these individuals. Opioid users do not always fit the image of the street addict. In fact, opioid addiction occurs among some physicians, nurses, and health-care professionals who have access to these drugs. In many instances (but not all), health-care professionals who are addicted either to heroin (usually purchased illegally on the street) or to methadone (usually obtained from treatment centers) are able to hold jobs and raise a family. The effects of opioids include reducing pain, aggression, and sexual drives. Therefore, use of these drugs is unlikely to induce crime. However, those who cannot afford opioids, those who like the “drug life,” and those who are unable or unwilling to hold a job, often commit crimes to support their drug habits. Intravenous injection of morphine (or heroin, which is converted to morphine once it enters the brain) results in a warm flushing of the skin and intense pleasurable sensations in the lower abdomen. This initial rush (also known as a kick or thrill) lasts for about fortyfive seconds and is followed by a high, described as a state of dreamy 40
Drugs of Abuse
indifference. In addition to their analgesic (painkilling) effect, other effects of opioids include nausea, respiratory depression (slowed rate of breathing), and sedation. Stopping opioid use abruptly can lead to a withdrawal syndrome that varies in severity depending on the individual as well as the particular opioid used. Watery eyes, a runny nose, yawning and sweating occur within twelve hours from the last dose of the opioid. As the syndrome progresses, dilated pupils, loss of appetite, gooseflesh, restlessness, irritability, and tremors can develop. As the syndrome intensifies, the person may experience weakness; depression; nausea, vomiting, diarrhea, and intestinal spasms; and muscle cramps and involuntary kicking movements. The withdrawal syndrome usually lasts from seven to ten days and is rarely life-threatening. However, its extreme unpleasantness drives many users back to drug use.
sedation process of calming someone by administering a medication that reduces excitement; often called a tranquilizer
Psychedelics Psychedelic drugs affect the user’s thoughts, feelings, and perceptions of the world and people around them. Users become intensely aware of their sensations, often feeling as if they are flooded with sensation. This can feel overwhelming and frightening. Psychedelic drugs include lysergic acid diethylamide (LSD), mescaline, and MDMA (ecstasy). Immediately after taking LSD, the user experiences dizziness, weakness, and nausea along with the euphoric effects. Within two to three hours, visual perceptions become distorted; users describe hearing colors and seeing sounds. Users often have vivid visual hallucinations. The loss of control over one’s sensations can be troubling. The effects subside after about twelve hours. A user who takes three or four daily doses of LSD can develop tolerance to the drug’s effects. In general, however, users of psychedelic drugs do not take them repeatedly for extended periods. Occasional use is more typical. Little evidence exists that LSD produces long-term changes in personality, beliefs, values, or behavior. Psychedelic drugs do not produce withdrawal syndromes, and there are no reports of deaths directly related to the physical effects of LSD. However, taking LSD has resulted in fatal accidents and suicides, making the drug extremely dangerous. In addition, scientists have discovered that ecstasy causes nerve and brain cell damage in laboratory animals. They suspect it may cause similar damage in humans.
Inhalants Many drugs of abuse are taken by mouth or by injection. Another group of drugs, inhalants, are taken by sniffing or breathing in the 41
Drugs of Abuse
vapors of certain substances. Inhalant abuse most commonly occurs among adolescents, although doctors, nurses, and other health-care professionals have been known to inhale anesthetic gases such as nitrous oxide and ethyl ether. Adolescents may sniff glue, or inhale the vapors of toxic substances such as gasoline, paint thinners, or other industrial solvents. As of 2001, between 13 and 17 percent of young adults reported some experience with inhalants. Although seen as harmless, in fact inhalants can cause fatal toxic reactions, usually due to cardiac arrhythmias, or irregular heartbeat. • Inhalation from a plastic bag can result in hypoxia (too little oxygen) as well as an extremely high concentration of vapor. Because every organ and tissue in the body needs oxygen (especially the brain), low oxygen levels can cause injury. • Fluorinated hydrocarbons can cause the heart to beat in an abnormal rhythm, and can deprive the heart muscle of oxygen, possibly leading to heart damage. • Chlorinated solvents can slow contractions of the heart muscle. • Ketones can produce high blood pressure in the lungs, which can damage them. • Many solvents can produce nerve damage.
Phencyclidine (PCP)
catatonia psychomotor disturbance characterized by muscular rigidity, excitement, or stupor
Phencyclidine (PCP or angel dust) and related drugs can have several different effects. They can act as stimulants, depressants, hallucinogenics, and analgesics. Because PCP is well-absorbed into the body after a person takes it, even small doses produce intoxication. Effects include staggering rather than walking, slurred speech, and numbness of the feet and hands. PCP users may also experience sweating, catatonia, and a blank stare as well as hostile and bizarre behavior. Amnesia (loss of memory) during the intoxication may also occur. In higher doses, a person may have convulsions or fall into a coma. The typical high from a single dose can last four to six hours and is followed by a prolonged period of “coming down.” People may develop some degree of tolerance to the effects of PCP. Some chronic users who stop taking PCP complain of withdrawal symptoms such as cravings and difficulties with recent memory, thinking, and speech. Personality changes can range from social withdrawal (avoiding contact with other people) and isolation to severe anxiety, nervousness, and depression. Cases have occurred in which the drug’s toxic effects produced violent behavior, accidents, and death. PCP can also produce a psychosis lasting for several weeks following a single dose of the drug.
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Conclusion Abuse of any of the drugs described can have serious consequences for a person’s health and general well-being. Drugs prescribed for medical conditions must always be taken according to the doctor’s instructions. With illegal drugs, once a person starts taking a drug, he or she may find it very difficult to stop. Not starting is much easier than stopping once you start. Overwhelming evidence shows that drug abuse seriously interferes with a person’s ability to enjoy a healthy, happy life. S E E A L S O Addiction: Concepts and Definitions; Tolerance and Physical Dependence; See entries on specific drugs for more information.
Drugs Used in Rituals Certain plants have long been known to humans as having psychoactive effects—they produce changes in a person’s thoughts, sensations, and behavior. Drugs made from such plants played important roles in many societies before the modern age. People viewed these substances as sources of the sacred and spiritual realms. These plants were generally used in community rituals meant to improve health and to strengthen responsible behavior by members of the community. They were not used as drugs of abuse. Plants such as the psilocybin mushrooms, iboga, ayahuasca, datura, betel, and kava served four basic purposes: (1) to help a person achieve an experience of the sacred; (2) to help people adjust to changes in their culture; (3) to help people feel uninhibited and at ease in social situations; and (4) to treat sickness and in some cases to treat people who abused other drugs.
Mushrooms In many societies around the world, participants in community rituals use psychoactive plants to have visions as part of a healing process. For example, mushrooms that contain psilocybin, a hallucinogen, have been used. As Richard Schultes and Albert Hofmann explain in Plants of the Gods (2002), they produce such dramatic effects that people have described them as “foods of the gods” and “voices of the gods.” In many prehistoric cult practices, hallucinogenic mushrooms served to strengthen the community’s connection to nature and as a way to contact powerful spiritual forces. People who ate these mushrooms often felt intensely aware of the interconnectedness of humans, nature, and the supernatural. They felt that mushrooms increased their own personal power, leading them toward self-transformation. People also ate mushrooms to heal physical diseases and mental illness.
Mushrooms containing psilocybin can cause hallucinations when ingested.
hallucinogen a drug, such as LSD, that causes hallucinations, or seeing, hearing, or feeling things that are not there
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psychedelic substance that can cause hallucinations and/or make its user lose touch with reality
A word used by Michael Winkelman, “psychointegration,” characterizes the common effects of substances called hallucinogens and psychedelics. Psychointegration is a state in which the human brain produces brain waves in the emotional (limbic) system and frontal cortex that results in a feeling of unity. Psychointegrators were central to many shamanic practices, which were healing practices of huntingand-gathering societies around the world. Shamanistic healers often used hallucinogenic and psychedelic mushrooms to enter into altered states of consciousness and to enable them to contact spirits as part of a healing process. Community elders also used plant drugs in rituals that celebrated the entry of younger members into adult circles.
Ibogaine stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system stupor state of greatly dulled interest in the surrounding environment; may include relative unconsciousness
psychotherapy treatment of a mental or emotional condition during which a person talks to a qualified therapist in order to understand his or her problems and change his or her problem behaviors
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The root of the iboga plant (Tabernanthe iboga) is a stimulant and hallucinogen. Depending on the dose, the user’s diet, and the user’s level of activity, a person who consumes iboga will experience different effects. These effects can be dreamy visions, stupor, and unconsciousness. Or, iboga can act as a powerful stimulant. People have taken iboga to feel less tired and as an aid for hunting. Healers and sorcerers have used iboga to achieve knowledge of the divine. In Africa, the Bwiti secret societies of Gabon and Congo consumed iboga in all-night village ceremonies that included vigorous dancing. The Bwiti cult used iboga to contact and affirm their relationship with their ancestors. By experiencing this sense of the individual’s relationship to group spirit, they hoped to strengthen the bonds of their society and promote the well-being of all who belonged to it. As Juan Sanchez-Ramos and Deborah Mash found, iboga is also used as treatment for addiction to amphetamines, opiates such as heroin, and cocaine. Iboga’s effectiveness in psychotherapy is related to its ability to help patients think clearly, to reflect on their lives and experiences, and to recover “lost” memories.
Peyote In the United States, the Native American Church (NAC) uses peyote (Lophophora williamsii) in its “Peyote Religion.” This religion combines native and Christian elements. Native groups of northern Mexico (for example, the Huichol and the Tarahumara) also have a long history of peyote use. Peyote contains mescaline, a substance that has both stimulant and hallucinogenic effects. The NAC typically uses low doses of peyote that do not produce dramatic visual effects. The federal government considers peyote a legitimate religious sacrament for the NAC, and so controlled substances regulations do not apply to it. However, some states have punished people for peyote use.
Drugs Used in Rituals
NAC members consume peyote in an all-night meeting in which all members of the community, young and old, may participate. The NAC seeks to guide its members toward physical and spiritual wellbeing, to release people from feelings of guilt, and to feel a sense of purpose. The NAC sometimes recommends peyote as a treatment for drug addiction (particularly alcoholism). Peyote use brings hope to Native American communities. It encourages a moral code of devotion to family and obligation to the community and promotes feelings of spirituality and unity. One researcher, Chris Heggenhougen, suggests that for young Native Americans who feel alienated from the larger American culture, peyote rituals can encourage a positive identity with their own culture.
A mixture of alcohol and hot peppers is used in this Haitian woman s voodoo ritual on the Day of the Dead on November 2, 1999. She believes that while possessed by cemetery spirits, or Guede, she is protected from pain; to demonstrate this belief, she douses herself with the skin irritating solution.
Ayahuasca Ayahuasca is a combination of two plants, Banisteriopsis caapi and Psychotria viridis. South American tribes used ayahuasca for various purposes: contacting spirits of the dead, achieving clairvoyance, making diagnoses, making prophecies, and healing. In the early twenty-first century, groups in the rural Amazonian basin take ayahuasca in collective adult rituals to strengthen group cohesion and identity. They also use ayahuasca to help cope with rapid cultural changes in their 45
Drugs Used in Rituals
region. Ayahuasca traditions have also spread to urban areas, where many people use the drug to cope with anxiety and stress. Several Christian churches in Brazil consider ayahuasca a sacrament. In the United States, these churches are involved in legal battles over freedom of religion involving use of the drug for religious purposes. The scholars Jaques Mabit, Rosa Giove, and Joaquin Vega reviewed ayahuasca’s use in ritual treatments for rehabilitation of cocaine addicts in the Peruvian Amazon. These treatments integrate ayahuasca into traditional rituals and physical, psychological, and spiritual activities that address personal and emotional relations.
Jimsonweed
recreational drug use casual and infrequent use of a substance, often in social situations, for its pleasurable effects
Jimsonweed is the common name of datura, a plant in the nightshade family that is often added to ayahuasca. The common name was coined because of the drug’s effects on British soldiers at Jamestown. Datura is not a true hallucinogen but produces visionary experiences. Europeans were familiar with datura, as were residents of the American Southwest and Mexico. Today, the recreational drug use of datura in the United States causes deaths every year. Datura has been used to treat physical illness, as part of rituals marking the transition to adulthood, and in various ceremonies such as those to bring rain or to promote healing. Native Americans used datura to produce unusual dreams that would enable the person to learn songs, dances, and rituals from animal or other spirits. Groups who used datura in initiation rituals believed that the young participant needed to separate himself from childhood memories in order to take on adult roles. Datura produced altered states of consciousness that could last from two to three weeks, in which time all childhood memories were erased. Group male rituals using datura often involved a death-and-rebirth experience. In the altered state of consciousness produced by datura, the person is open to suggestion and readily accepts what is told to him. He or she loses touch with reality and becomes unable to think clearly or rationally. While the young participant is in this state, elders of the tribe instruct him in the ways, morals, and myths of their tribe. In Africa, the Shangana-Tsonga of Mozambique used datura in fertility initiations for girls to produce visions of the fertility god. Because of datura’s effects on reasoning and the sense of reality, the girls’ experiences while on the drug could be manipulated, or managed, by the tribe members.
Kava and Betel sedative medication that reduces excitement
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The most common traditional drugs in the Pacific Islands were kava and betel. Kava is a sedative beverage made from the root of Piper
Eating Disorders
methysticum that produces a dreamlike state similar to that produced by mild hallucinogens. Betel is a stimulant made from Piper betel and Areca catechu and other ingredients. The cultures of the Pacific Islanders carefully controlled the use of these drugs. As a result, neither were drugs of abuse. Typically, people consumed kava and betel in elaborate communal ceremonies. Individuals, including children, also consumed betel for many of the same reasons that people drink coffee. Betel stimulates social activity and work, enhances enjoyment and feelings of general well-being, and encourages peaceful and friendly social relations. In heavy doses taken after a period of abstinence from betel, betel can cause psychotic reactions. Kava was often restricted to adult males, even exclusively highstatus males. Kava was produced by women but consumed in special male-only ceremonial grounds that excluded women. These nightly ceremonies played a central role not only in community life but also in political and social dealings between communities. Hostile visitors were forced to consume large amounts of kava. Known for its ability to produce peaceful euphoria (an intense feeling of well-being), kava reduced the aggressive actions of these visitors.
Conclusion
abstinence complete avoidance of something, such as the use of drugs or alcoholic beverages psychotic periods during which an individual loses contact with reality and may have delusions (i.e., unshakable false beliefs) or hallucinations (i.e., the experience of seeing, hearing, feeling, smelling, or tasting things that are not actually present)
Drugs made from plants played important roles in religious ritual, community togetherness, and healing among pre-modern societies. Some modern drug problems may have roots in the loss of these community rituals. S E E A L S O Ayahuasca; Betel Nut; Hallucinogens; Kava; Peyote; Sedative and Sedative-Hypnotic Drugs.
Eating Disorders People with an eating disorder feel compelled to repeat certain behaviors, such as overeating or eating too little. For this reason, eating disorders are placed in the category “behavioral disorder.” Like substance abuse, another behavioral disorder, eating disorders can be very difficult to interrupt since the problem lies in what the individual does—her or his behavior and its consequences. These compelling behaviors gradually come to dominate the affected sufferers’ lives, often disturbing the functioning of their bodies, their minds, and their everyday social lives. People with behavioral disorders sometimes also
E
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compulsion irresistible drive to perform a particular action; some compulsions are performed in order to reduce stress and anxiety brought on by obsessive thoughts
have other compulsions. For example, they may be unable to control the impulse to spend money (compulsive spending) or to gamble (compulsive gambling). The eating disorders discussed below include anorexia nervosa, bulimia nervosa, and binge eating disorder. Compulsive eating can be a symptom of anorexia nervosa, bulimia, or binge eating, but it is not considered a separate disorder.
Anorexia Nervosa RECOVERING FROM ANOREXIA One day I was walking to the mail box in front of my house and I passed out. I woke up in the hospital and that s when the doctor told me that I was too thin. Too thin! I couldn t believe what he was telling me. Did everyone want me to be fat? I was so angry that I had to gain weight. . . . I was required to eat 6 times a day. I had only stayed in the hospital for about 8 days when I was released. I still had to go to the hospital every morning and they monitored my weight. I joined group therapy, because my doctor told me that it would be helpful. It was very difficult at first, trying to find the motivation to go, but once I started to connect with the other people in the group, I was starting to feel like I was a part of something. I was no longer alone. Renee, 19-year-old recovering anorexic
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Anorexia nervosa is a potentially life-threatening syndrome of selfstarvation. The Greek term anorexia means “loss of appetite.” This is actually an inappropriate name for the condition. Individuals with anorexia nervosa are starved and think constantly and obsessively about food. They refuse to eat not because they have lost their appetite but because they have an irrational fear of being fat. Anorexia nervosa affects from 0.5 to 1 percent of female adolescents and young women and occasionally occurs in males. In extreme cases, girls and women can undergo weight loss to less than 60 percent of normal weight. At these very low weights, individuals usually admit that they are too thin, yet they still feel as though some part of their body, typically their stomach or thighs, remains fat. Alternatively, they describe being unable to eat normally because they fear that they will lose control, go on an eating binge, and become overweight. Anorectic behavior includes dieting by skipping meals or severely limiting the amount of fat consumed. Eating behavior may include rituals, such as eating only certain foods and preparing foods in complicated ways. It is also common for anorexics to exercise excessively with the goal of burning calories. Individuals who lose weight solely by extreme dieting and exercising have the restricting type of anorexia nervosa. Some people with anorexia nervosa occasionally lose control of their rigid eating pattern and binge on the high-fat, high-calorie foods they have forbidden themselves to eat. After the binge, they may purge by making themselves vomit, or by taking higher than recommended doses of laxatives, diuretics, or diet pills. Individuals who binge and/or purge in addition to dieting and exercise to lose weight have the binge/purge type of anorexia nervosa.
Bulimia Nervosa The Greek word bulimia means “hunger of an ox.” People with bulimia try to prevent weight gain through a cycle of dieting, binge eat-
Eating Disorders
ing, and purging behavior. In bulimia, binge eating occurs at least twice a week for three months or more. As with anorexia nervosa, bulimia nervosa mostly affects young women, although 10 percent of cases occur in men. While 1 to 3 percent of young women and adolescents have the full syndrome of bulimia nervosa, as many as 20 percent of college-age women experiment with bulimic behaviors and experience a limited range of symptoms.
binge relatively brief period of excessive behavior, such as eating an usually large amount of food
Bulimics, like anorexics, place extreme value on thinness. The main difference between the two diagnoses is one of weight. Anorexics have starved themselves to a low body weight, while bulimics are at least normal weight. Underweight patients who binge and purge are usually diagnosed with the binge/purge type of anorexia nervosa rather than with bulimia. But the dividing line between anorexia nervosa and bulimia is not always clear. It is common for an eating disorder to start as anorexia nervosa and progress to bulimia over time, since dieting is the biggest risk factor that contributes to binge eating.
diuretic drug that increases urine output; sometimes called a water pill
laxative product that promotes bowel movements
As with anorexia nervosa, there are two types of bulimia: (1) purging type and (2) nonpurging type. In purging-type bulimia, individuals use some kind of purging behavior after a binge to get rid of the extra calories they have consumed. The most common method of purging is by self-induced vomiting, although some bulimics may abuse laxatives, diuretics, or diet pills. In nonpurging bulimia, individuals go through episodes of binge eating alternating with episodes of restricting their diet, fasting, or excessive exercise routines.
Medical Complications Anorexia nervosa has the highest death rate of any psychiatric condition. Occasionally, bulimia nervosa can also result in life-threatening complications. Both disorders seriously damage the body, and most medical complications are the result of starvation or purging behaviors. Individuals with purging-type anorexia nervosa are at highest risk, since they are both starved and regular purgers. Complications of starvation include: • slow heart rate (bradycardia) • low blood pressure and fainting or dizzy spells • intolerance to cold • thinning hair • constipation • weakness and fatigue • loss of a monthly menstrual period (amenorrhea) 49
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ulcer irritated pit in the surface of a tissue, often on the stomach lining dependence psychological compulsion to use a substance for emotional and/or physical reasons dehydration state in which there is an abnormally low amount of fluid in the body psychiatric relating to the branch of medicine that deals with the study, treatment, and prevention of mental illness depression state in which an individual feels intensely sad and hopeless; may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities; in extreme cases, may lead an individual to think about or attempt suicide anxiety disorder condition in which a person feels uncontrollable angst and worry, often without any specific cause obsessive-compulsive disorder anxiety disorder in which a person cannot prevent dwelling on unwanted thoughts, acting on urges, or repeating rituals promiscuity having many sexual partners
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Amenorrhea causes rapid bone loss and thinning of the bones, or osteoporosis. This process cannot be reversed, and may lead to hip and spinal fractures. Purging by vomiting often results in tooth decay, a swelling of the salivary glands in the cheeks that distorts the person’s face, and a risk of ulcers in the esophagus. The most dangerous risk of regular vomiting is developing electrolyte imbalances. Electrolytes are salts in the blood, such as potassium, that are necessary for the heart to function properly. Changes in electrolyte levels can result in fatally abnormal heart rhythms. Laxative abuse can cause similar electrolyte abnormalities as well as laxative dependence and dehydration. In extreme cases, kidney failure can follow severe laxative or diuretic abuse.
Psychiatric Problems and Eating Disorders Individuals with eating disorders are more likely than the rest of the population to have a second, simultaneous psychiatric problem. The most common illness that goes along with eating disorders is a mood disorder, such as depression or anxiety. Studies have found that 50 percent or more of patients with anorexia nervosa or bulimia also have depression. However, starvation alone causes a syndrome identical to major depression. As a result, it is often difficult to determine whether a patient has depression in addition to anorexia nervosa, or depressive symptoms caused by the starved state that accompanies anorexia nervosa. If the patient has a close relative with depression, it is more likely that the patient has true depression. Anorexics are also more likely to have obsessive-compulsive disorder than the rest of the population. In bulimia, as many as 30 percent of patients also have alcohol abuse problems. A small proportion of individuals with bulimia have other impulse-control problems such as substance abuse, compulsive spending or shoplifting, promiscuity, self-harm, and other risk-taking behaviors.
The Risk Factors for Eating Disorders Rates of anorexia nervosa and bulimia are much higher in Western countries, such as the United States, than in developing countries, such as those in Africa and Asia. Young women in Western cultures are exposed to strong social pressures that encourage dieting and value thinness as an ideal of female beauty. For example, 90 percent of models photographed in young women’s magazines have a body type that naturally occurs in only 10 percent of the female population. Another factor that contributes to eating disorders in the United States is the increasing average weight of Americans. Obesity has
Eating Disorders
reached epidemic proportions as a result of a decrease in physical exercise and an increase in the availability of high-calorie, oversized, and cheap fast food. As the population grows heavier, dieting tends to be viewed as a normal, healthy activity, even though evidence suggests that dieting behaviors often backfire. Adolescent girls grow up dieting, yet many become overweight adults. This is thought to be because dieting increases the risk of future binge eating. The best way to prevent both obesity and eating problems is to exercise regularly and eat three normal-sized, balanced meals daily. The pressure to be thin and actual widespread obesity contribute to the increasing rates of eating disorders in the United States. Yet these factors alone cannot explain the development of the full syndrome of bulimia or anorexia nervosa in only 3 to 4 percent of young women. Experts believe that other risk factors make some girls vul-
self-harm repeated dangerous behaviors, such as cutting the skin, head-banging, or taking pills
vulnerable at greater risk
Eating disorders, like drug addiction, often have compulsive behaviors tied to them. People with this type of disorder often have a distorted perception of their body, leading to an obsession with weight loss.
51
Eating Disorders
FICTION SPEAKS VOLUMES Isabelle Holland, in her novel, Heads You Win, Tails I Lose (1982), describes Melissa s battle with her body image, which leads her to take diet pills in the hopes that she will become thin, popular, and loved.
nerable to these disorders once they start dieting. Genes may play a role, since eating disorders run in families. Recent evidence indicates that individuals who develop bulimia nervosa have different levels of the neurotransmitter serotonin in their brains than do other individuals. Serotonin plays a role in both eating behaviors and moods. Certain personality traits are more common in individuals with eating disorders. These include: perfectionism, sensitivity to criticism, disliking change, and a tendency to be self-critical. Finally, in over 50 percent of cases a stressful life situation (such as the loss of a relationship, parental divorce, or a physical illness) occurred in the year before the eating disorder began. Efforts at preventing eating disorders have focused on educating young people about the disorders and their dangers. Yet many young girls say that they first considered vomiting as a way to prevent weight gain after a health-class lecture or reading an educational article on bulimia. Many girls believe they can control this behavior, only to discover, often very rapidly, that they have lost control of it and feel a compulsive need to continue dieting and/or bingeing.
The Treatment of Eating Disorders Both anorexia nervosa and bulimia can be treated. About 50 percent of individuals who receive treatment will eventually recover, although in many cases symptoms continue for years. The symptoms may fluctuate over time, often worsening when the person is under stress. As with all behavioral disorders, the first step in treatment is to block, or stop, the behavior. In the treatment of most kinds of substance abuse, the aim is to help the person stop using drugs, whereas in the treatment of eating disorders, the aim is to help the person reestablish a normal, nondieting eating pattern and to abstain from, or give up, the behaviors of the eating disorder. For underweight patients, treatment goals include weight gain to counteract starvation, since starvation increases these patients’ obsessive focus on food, eating rituals, and exercise. Very low-weight patients may require admission to a treatment program for eating disorders, where a team of professionals helps patients relearn healthy eating. Treatment includes behavioral therapy to help patients get over their fears of food, observation by nurses to make sure the patient is not purging, group and family therapy, and medication for other psychiatric disorders, such as depression, that a patient may have. Although sometimes used, forced tube feeding is not necessary for the treatment of anorexia nervosa in the presence of an expert behavioral program. Group therapy, led by an experienced therapist, can generate healthy peer pressure. Unfortunately, unsupervised self-help 52
Eating Disorders
groups such as those available on the Internet may be dangerous. These groups create an atmosphere in which patients compete in telling “war stories” of their eating disorders and can actually worsen symptoms. Treatment for bulimia nervosa usually begins with cognitivebehavioral therapy as an outpatient. Cognitive-behavioral therapy includes keeping a food log, identifying situations that trigger bulimic behavior, and challenging irrational thoughts that sustain these behaviors. The therapist helps the patient develop healthier eating behaviors, avoid trigger situations, and correct irrational thinking. Patients learn to eat all foods in moderation and to have regular meals. Antidepressant medications can be helpful in decreasing urges to binge or vomit, but the combination of behavioral therapy and medication is more effective than medication alone.
outpatient person who receives treatment at a doctor s office or hospital but does not stay overnight
antidepressant medication used for the treatment and prevention of depression
Most patients want to know why they developed an eating disorder. However, it is important to realize that exploring the reasons behind the disorder does not lead to recovery from that disorder. An eating disorder is like other addictions: Once a person has it, it takes on a life of its own. Knowing what led to the eating disorder does not help the individual stop dieting or bingeing.
Binge Eating Disorder Binge eating disorder affects about 2 percent of adults in the United States and is slightly more common in women than in men. A person with this disorder binges frequently and feels out of control and distressed over the amount he or she has eaten. However, unlike bulimia nervosa, binge eaters do not purge. Other possible symptoms include eating rapidly, eating till uncomfortably full, eating large amounts when not hungry, feeling embarrassed about the quantity of food consumed, and feeling disgusted or guilty about bingeing. Most people with binge eating disorder are obese, that is, more than 20 percent above normal weight. Depression is more common in binge eaters than in obese individuals who do not binge. The main complications of binge eating are those of obesity, including diabetes, high blood pressure, heart disease, and arthritis. As with bulimia, strict dieting may worsen binge eating. Treatment consists of cognitivebehavioral therapy aimed at stopping all bingeing behavior, increasing exercise, and returning to normal eating patterns, rather than immediate weight loss.
Eating Disorders, Substance Abuse, and the Brain The study of substance abuse has revealed that drugs of abuse, such as cocaine or amphetamines, increase levels of dopamine, a 53
Ecstasy
neurotransmitter chemical messenger used by nerve cells to communicate with other nerve cells
predispose to be prone or vulnerable to something
receptor specialized part of a cell that can bind a specific substance; for example, a neuron has special receptors that receive and bind neurotransmitters
neurotransmitter, in brain areas known as the reward circuit (such as the nucleus accumbens). Higher levels of dopamine may lead to drug tolerance, meaning that a person needs increasing doses of a drug to produce the same effect achieved from the initial dose, and drug dependence, when a person can no longer function normally without the drug. Recent research into eating disorders indicates that food may act on brain reward systems in the same way that drugs of abuse do. For example, in one research studies monkeys deprived of food increased their intake of any drug of abuse. This suggests that the rewarding effects of food and drugs of abuse operate in similar ways in the brain, involving the reward pathway and neurotransmitters such as dopamine. Changes in these brain systems may predispose a person to an eating disorder, or contribute to it once it has begun. Results of another recent study suggest that overeating may increase dopamine levels in the brain, leading to a decrease in the number of dopamine receptors. This change may contribute to increased cravings for food in obese individuals. Current research is studying whether weight loss corrects these changes in dopamine receptor numbers.
Conclusion Occasionally an eating disorder may not fit neatly into one of the diagnostic categories discussed here and yet may seriously affect an individual’s well-being. These atypical eating disorders may be quite severe and require treatment. Anorexia nervosa, bulimia nervosa, and other eating disorders are behavioral disorders that become consuming passions interfering with normal functioning. Treatment is necessary to help the person recover from the disorder and learn how to lead a normal, healthy life free of these harmful behaviors. SEE ALSO Addiction: Concepts and Definitions; Gender and Substance Abuse; Risk Factors for Substance Abuse; Research.
Ecstasy The drug popularly called ecstasy (MDMA) belongs to a group of drug compounds that are synthesized, or artificially formed, and sometimes sold on the street. These drugs are often called “designer drugs.” They were originally given this name because each was specifically created to imitate the effects of a known illegal substance. How54
Ecstasy
ever each was slightly altered or “designed” to be unique in an effort to avoid legal restrictions—at least temporarily. People started using ecstasy in the late 1980s and early 1990s, but its use remained fairly limited until the mid-1990s. The use of ecstasy increased sharply in 1999 and continued to rise, but the increase in its use slowed in 2001. However, ecstasy is just now becoming available in some areas of the United States. In these areas, ecstasy use may continue to increase rapidly unless information about its risks is made widely available. Overall, in 2001, 9.2 percent of 12th graders and 6.2 percent of 10th graders reported using ecstasy within the past year, compared to 4.6 percent for both ages in 1996. The structure of ecstasy is similar to that of amphetamines, and like amphetamines, it acts as a stimulant. Yet designer drugs also have properties in common with hallucinogens such as lysergic acid diethylamide (LSD) and mescaline. When designer drugs are taken at lower doses, the user experiences fewer alterations of perception and thought and a less intense emotional effect as compared to LSD. At higher doses, the user experiences illusions and other effects similar to that of LSD. Because of their mixed effects, ecstasy and the other designer drugs are sometimes referred to as stimulant-hallucinogens. Taking ecstasy can produce several unpleasant effects. Users have reported nausea, jaw clenching and teeth grinding, increased muscle tension, and blurred vision, as well as panic attacks. Ecstasy also increases blood pressure, heart rate, and body temperature. Some users describe a type of hangover the day after taking ecstasy, involving headache, inability to sleep, fatigue, drowsiness, sore jaw muscles, and loss of balance.
E CS TA S Y US E BY S T UDENTS, 2000
Ever Used Used in Past Year Used in Past Month
8thGraders
10thGraders
12thGraders
4.3%
7.3%
11.0%
3.1%
5.4%
8.2%
1.4%
2.6%
3.6%
2000 Monitoring the Future Study. Survey is funded by the National Institute on Drug Abuse, National Institutes of Health, and is conducted by the University of Michigan’s Institute for Social Research. .
SOURCE:
Among students in a 2000 Monitoring the Future Study, use of the designer drug ecstasy increased with age, with use among 12th graders more common than use among 10th graders. stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system hallucinogen a drug, such as LSD, that causes hallucinations, or seeing, hearing, or feeling things that are not there
By the early 1990s, some evidence indicated that ecstasy might damage nerve cells. Recent studies conducted by the National Institute on Drug Abuse (NIDA) have confirmed this evidence. Using advanced brain imaging techniques, one study compared people who had never used ecstasy to ecstasy users who had not used any psychoactive drug, including ecstasy, for three weeks. The researchers found that ecstasy harms certain brain cells (neurons) that release or reabsorb serotonin, a brain chemical thought to play an important role in regulating memory, mood, and many other functions. The damage to the serotonin neurons occurred throughout the brain, and people who had used ecstasy more often had more damaged serotonin neurons than those who had used the drug less frequently. In another NIDA study, researchers found that heavy ecstasy users have memory problems that persist for at least two weeks 55
Effects of Drugs on Sensation, Perception, and Memory
after they have stopped using the drug. Both studies suggest that the extent of damage is directly correlated with the amount of ecstasy use. Furthermore, studies on animals suggest that the loss of serotonin neurons in humans may last for many years and possibly be permanent. Monkeys showed signs of brain damage seven years after stopping the drug. Findings from another study conducted at Johns Hopkins through the National Institute for Mental Health now suggest that ecstasy use may lead to problems with other thinking processes besides memory, such as the ability to reason verbally or sustain attention. Researchers continue to examine the effects of ecstasy use on memory and other functions in which serotonin is involved, such as mood, the ability to control one’s impulses, and sleep cycles. Scientists believe that the drug’s effects on behavior and thinking caused by damage to nerve cells may become more apparent as current users, who are typically young, grower older. Cells die as part of the aging process. This normal cell loss might be worsened if using ecstasy kills or weakens certain nerve cells. This cell damage could have an impact on sleep, food intake, sexual behavior, anxiety, and mood. S E E A L S O Club Drugs; Designer Drugs; Hallucinogens; Rave; Speed.
Effects of Drugs on Sensation, Perception, and Memory Every behavior that a human or animal performs involves taking in information from the primary senses: vision, hearing, and touch. Many drugs of abuse change this sensory information. Mind-altering drugs can influence the way people perceive time, the way they think and behave, and their moods. Drugs also have an effect on memory. Just as people are always receiving sensory information, they are always learning things in the course of daily life. Imagine all of the sensory information—seeing, hearing, feeling—that a toddler must take in when taking a first, unassisted step. Very quickly children learn not to go near the street, that fire burns, that the fur of a kitten is soft, and that when pushed, the buttons on a remote control turn on a television. Within a few years, a young child has put thousands of pieces of information into his or her memory bank. Increasingly, the memories become more complex, involving numerous steps. For example, the very act of reading these words involves hundreds of memories, including information you stored in your brain many years ago 56
Effects of Drugs on Sensation, Perception, and Memory
about basic words and letters. Drugs can interfere with a person’s ability to remember the things they learn.
Sensation and Perception Naturally occurring drugs, such as mescaline from the peyote cactus, increase the user’s awareness of visual and auditory sensations and also produce visual illusions and hallucinations. The psilocybin mushroom (Mexican or magic mushroom) produces similar effects. Because of these sensory changes, mescaline and psilocybin have been used for centuries in religious ceremonies by the peoples of Mexico and the American southwest. Lysergic acid diethylamide (LSD), a drug first synthesized in a Swiss laboratory in the 1930s, has become well known for producing intense and colorful visual sensations. People also report changes in sensory perceptions with another class of synthetic drugs known as stimulant-hallucinogens, drugs that are chemically related to both methamphetamines and hallucinogens like mescaline or LSD. Ecstasy (MDMA) is the most popular drug of this type, but MBDB, MDE, MDA, MDEA, and 2CB are all chemical variations in circulation. The sensory effects of this class of drugs include hallucinations and “out-of-body” sensations. The active agent in marijuana, tetrahydrocannabinol (THC), can also produce hallucinations, although less commonly than with LSD or mescaline. Cocaine and amphetamines sometimes produce hallucinations and other sensory distortions, but only when they are taken for long periods of time.
hallucination seeing, hearing, feeling, tasting, or smelling something that is not actually there, like a vision of devils, hearing voices, or feeling bugs crawl over the skin; may occur due to mental illness or as a side effect of some drugs
Various names are used to describe drugs that alter sensations and perceptions. One term is “psychedelic,” which refers to mindexpansion or to experiencing events that go beyond normal boundaries. The term “hallucinogenic” refers to a substance that produces hallucinations. However, the term is slightly misleading, since not all drugs that alter sensations produce hallucinations.
Observations in Human Subjects. Most of the information about drugs and the ways in which they alter sensory behavior in people comes from individual reports (called anecdotal evidence) rather than from well-controlled laboratory studies. People have reported vivid images, changes in perception, and hallucinations after they have taken mescaline or LSD. Another alteration that sometimes occurs is synesthesia, which is a mixing of the senses. For example, people report hearing colors or seeing sounds. Although these sensory disturbances stop within a few hours after taking LSD, some people experience confusion, sensory 57
Effects of Drugs on Sensation, Perception, and Memory
distortions, or poor concentration for longer periods of time. For some people, drug effects recur long after the drugs have left their systems. These brief episodes are called flashbacks.
stimuli things that excite the body or part of the body to produce specific responses
Studies in the Laboratory. Since alterations in sensation and perception, such as hallucinations, cannot be observed directly, it is very difficult to examine these effects in laboratory animals. One way to investigate a drug’s effect on sensation is to train animals to behave differently in the presence of different types of visual or auditory stimuli. If a drug changes the animal’s behavior, it is possible that these changes in behavior are due to a change in how well the animal hears or sees the stimuli. Another type of procedure examines how intense (for example, how loud or how bright) a stimulus has to be for an animal to hear or see it. The point at which a stimulus can be seen or heard is called the threshold. In these procedures, the intensity required to hear or see a stimulus is determined before a drug is given, and then it is compared to the intensity required to hear or see the stimulus after the drug is given. In general, drugs such as mescaline, LSD, THC, and ecstasy (MDMA) do not change an animal’s ability to tell the difference between visual or auditory stimuli. In addition, they do not change visual or auditory thresholds. This lack of effect in animals suggests one of two explanations: (1) Drugs such as LSD may produce different effects in animals than they do in people. (2) The procedures used to study alterations in sensation and perception in animals given LSD and other drugs may be ineffective. The second explanation is more likely to be accurate. However, tests of the drug ecstasy in animals and humans have had similar results. Studies show that ecstasy damages memory in both animals and humans.
paranoia excessive or irrational suspicion; illogical mistrust depression state in which an individual feels intensely sad and hopeless; may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities; in extreme cases, may lead an individual to think about or attempt suicide
58
The changes in perception and sensation that occur when a person takes a drug can be very disturbing. Drug abusers often experience confusion, fear, anxiety, paranoia, and severe depression as a result of their drug experiences.
Memory In addition to their effects on sensation and perception, alcohol and abused drugs have significant effects on memory. Much of our knowledge of the effects of commonly used substances on memory is based on experiments using laboratory animals. In typical experiments, animals are first trained in a task that requires learning. For example, they may learn how to go through a maze to obtain a reward of food or water. Or they may learn to avoid
Effects of Drugs on Sensation, Perception, and Memory
or run away from an unpleasant stimulus. After a delay of one day or longer, the animals are given a test that measures how well they remember the learned task. The researchers may give the animal a drug before the training, shortly after the training, or just before the memory test. When given within a few minutes after training, drugs of many classes can improve or impair memory. The effect on memory also depends on the size of the dose. Drugs that improve memory when given in low doses may impair memory when given in higher doses.
Alcohol. In experiments studying the effects of alcohol on rats and mice, animals given a large amount of alcohol before training usually have problems remembering the training. Overall, giving rats and mice high doses of alcohol for long periods impairs their memory. Drinking large quantities of alcohol and long term–alcohol use also cause memory problems in humans. Large amounts of alcohol taken over a short period (hours or days) may cause a severe amnesia, or “blackout.” The blackout wipes out the memory of events occurring during and/or shortly before the period of alcohol intoxication. State-dependent learning may play a role in alcoholic blackouts. When individuals become intoxicated on a later occasion, they may sometimes remember experiences that occurred during a previous blackout. Charlie Chaplin’s 1931 film City Lights illustrates this effect on memory: the character of the hard-drinking millionaire remembers Charlie only when under the influence of alcohol.
MEMORY GONE TO POT? Marijuana affects the parts of the brain that control emotions, memory, and judgment. Smoking pot habitually can weaken shortterm memory but can also prevent the brain from creating new long-term memories.
intoxication loss of physical or mental control because of the effects of a substance
Chronic, or long-term, drinking can produce three kinds of memory problems: 1. The best-known memory problem is Wernicke-Korsakoff syndrome. This syndrome is due to Vitamin B1 (thiamine) deficiency, resulting from the poor nutrition typical of heavy, long-term drinkers. Symptoms include mental confusion and difficulty with eye movements and walking. Treatment with thiamine can eliminate these symptoms. However, people who recover from Wernicke-Korsakoff syndrome may continue to have difficulties with learning and remembering new information. 2. Alcoholic dementia is a condition in which a person suffers from severe memory problems. The person also suffers from major intellectual deterioration that resembles Alzheimer’s disease. An individual with alcoholic dementia becomes confused and forgetful. He or she may have severe problems with memory, an inability to learn new things, and a hard time processing 59
Effects of Drugs on Sensation, Perception, and Memory
complex information. Eventually, severe alcoholic dementia may leave an individual unable to perform basic tasks of daily living, and unable to care for himself or herself. Patients who stop drinking often show improvement in these areas. 3. The third type of memory problem linked to heavy alcohol use involves less obvious symptoms. The person may have trouble with abstract thinking, problem solving, and memory. Typically, patients recover when they stop drinking.
anxiety disorder condition in which a person feels uncontrollable angst and worry, often without any specific cause
sedative medication that reduces excitement; often called a tranquilizer
Benzodiazepines. Benzodiazepines, which are prescribed to treat anxiety disorders and insomnia, are among the most widely used (and abused) drugs. Benzodiazepines such as diazepam (Valium), triazolam (Halcion), and chlordiazepoxide (Librium) can cause amnesia in humans. Studies using laboratory animals show that benzodiazepines impair memory when given before training. They generally do not impair memory when given after training. This is probably because benzodiazepines are absorbed slowly and are therefore slow to reach peak concentrations in the brain. This slow absorption by the brain seems to dampen memory loss. Marijuana. In studies of marijuana’s effects on laboratory animals, animals were given THC, the active agent in marijuana. Some were given high doses of THC and some were given THC over long periods of time. Both sets of animals had difficulty in learning and remembering a very wide variety of tasks. There is also some evidence that high doses or chronic use of marijuana impairs memory in humans. These effects might be due to effects of THC on the brain processes underlying memory. It is also possible that these effects are simply due to the sedative quality of the drug. Stopping marijuana use typically results in quick recovery from the drug effects. Opiates. In tests of the effects of opiate drugs on laboratory animals, morphine and heroin impaired memory when given to animals after training. No studies have been done on the effect of morphine, heroin, or other opiates on human memory. People who abuse opiates for long periods do have memory problems, but these problems may result from general poor health rather than from any specific effect of the drugs. Patients who are given opiates as anesthesia before surgery often fail to remember experiences immediately prior to surgery. This amnesia may be due, at least in part, to the effect of the opiates. Amphetamines. Laboratory animals that are given high doses of amphetamines over long periods have problems performing many types of learning tasks. These effects occur when the drug is given before
60
Effects of Drugs on Sensation, Perception, and Memory
training. Other studies show that, depending on the dose, giving amphetamines after training can improve memory. Memory also improves when the drug is administered directly into several brain regions, including the amygdaloid complex, hippocampus, and caudate nucleus. Amphetamine users often report that their ability to learn is enhanced by single doses of the drug. Since few studies have looked at the effects of amphetamine on memory in humans, it is impossible to say whether these reports show direct effects of the drug on memory. Improvements in learning might instead result from changes in the individual’s perception and mood. Long-term amphetamine use usually causes memory to deteriorate, but this effect clears up when the person stops taking the drug.
Cocaine. In studies using rats and mice, high doses of cocaine given after training impaired memory. Low doses improved memory. Like amphetamine users, users of cocaine report that high doses improve memory and that long-term use impairs memory. However, the effect of cocaine on human memory has not been adequately studied. Ectasy (MDMA). Both animal studies and human studies have found links between long term–MDMA use and memory impairment. In a recent study by the National Institute on Drug Abuse, researchers found that heavy MDMA users have memory problems that persist for at least two weeks after they have stopped using the drug. The extent of damage appears to be directly correlated with the amount of MDMA use. The changes in brain chemicals (neurotransmitters such as serotonin) thought to be responsible for this effect may be long-lasting or permanent. These changes were still present in monkeys seven years after their last exposure to MDMA. State-Dependent Learning. Drugs affect the user’s memory of things learned before the drug experience and also during the drug high. Material that a person learns while on a drug may be forgotten when the drug wears off. The person might not remember this material until he or she takes the drug again. This kind of learning is called state-dependent learning (SDL). It is also true that information a person learns while not on a drug may be forgotten when he or she takes a drug. In addition, material learned under one drug may be forgotten when another drug is used. SDL involves a “dissociation” of learning. This means that material learned while a person is on a drug is dissociated, or separated, from normal consciousness. Once it is dissociated, it cannot be retrieved—the person does not have access to the learned material. 61
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment
SDL may offer important clues into multiple personality disorder. An area of current research concerns the dramatic increase in the number of reported cases of this disorder. According to one theory, the process underlying it is similar to the process that produces SDL while a person is under the influence of a drug.
Memory and Emotions. Many drugs alter moods, and users may experience emotions very intensely while under the influence of a drug. Researchers are currently exploring the possibility that emotions act as a cue for memory—in effect, calling it to a person’s attention. They are trying to determine if memories learned in one emotional state are recalled best when that emotion occurs again and recalled less easily at other times. Overall, it is important to remember that the use of drugs and alcohol generally has a negative effect on learning and the ability to retain memories. SEE ALSO specific drug entries, such as Alcohol and Marijuana; Research.
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment In national statistics for the United States, including many national surveys on drug use, Americans are divided into four racial groups: (1) white, (2) black, (3) Asian or Pacific Islander, (4) American Indian or Alaska native. The races are often subdivided into ethnic groups. For example, people with recent or distant family origins in such countries as Spain, Portugal, Mexico, and Cuba belong to an ethnic group called Iberian, Hispanic, or Latino. People also belong to cultural groups, which share similar customs, ideas, and behaviors. Racial, ethnic, cultural, and religious backgrounds often overlap.
heritable trait that is passed on from parents to offspring
The use of drugs and alcohol differs from one ethnic, cultural, or religious group to another. Drug abuse, as well as the way in which people respond to treatment, also varies within groups. It is helpful for public health officials to be familiar with these differences, so that they know which segments of the population have a greater need for alcohol and drug treatment and prevention services. However, the evidence of racial and ethnic differences in alcohol and drug use does not mean that these differences are due to heritable, genetic factors. Conditions such as poverty and neighborhoods with high rates of crime must be taken into account to explain different rates of drug abuse among ethnic groups. This article discusses issues of drug and alcohol abuse among some major ethnic groups and treatments specifically geared toward these groups.
62
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment
African Americans In the United States, many health-care workers believe that fellowships such as Alcoholics Anonymous (AA), Narcotics Anonymous, and Cocaine Anonymous offer the best programs to help people recover from their addictions. Others believe that these programs mostly benefit white, Christian males from European backgrounds but may be less well-suited to people from other cultural backgrounds. Successful programs that use AA’s Twelve Steps do not require members to belong to a particular religion, but they do require them to believe in a power outside themselves that can guide them through recovery, even if that power is the meeting group itself.
☎
☎
☎
The concept of surrender to a higher power is difficult for some cultural groups to embrace. African Americans, for example, may feel that they have suffered from a lack of power either as individuals or as a race for many generations, and they have no desire to surrender
Members of the Jamaica Community Adolescent Program chorus, a rehabilitation program for substance abuse in Queens, meet with former New York Governor Mario Cuomo.
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL. Twelve Steps program for remaining sober developed by Alcoholics Anonymous; adopted by many other groups, such as Narcotics Anonymous
63
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment
methadone potent synthetic narcotic, used in heroin recovery programs as a non-intoxicating opiate that blunts symptoms of withdrawal
to anything else. The African-American Extended Family Program (AAEFP) is a good example of how the twelve-step recovery can be adapted to the needs of a specific community. The AAEFP pays attention to African-American cultural values and traditions and makes them central to recovery. Culturally, African Americans strongly value the sense of community. An individual’s identity is closely tied to the identity of the group. Many treatment programs targeted to AfricanAmerican populations relate drug use and addiction to slavery. For example, many African Americans see methadone, a common treatment for addiction to heroin, as a type of chemical slavery. In African-American neighborhoods, the church is often the center of community life as well as spiritual life. Churches in various cities have developed recovery programs that specifically meet the needs of African-American culture. Such programs try to overcome the resistance of people of color to participating in the twelvestep process.
Asian Americans The large category of Asian Americans includes smaller distinct groups, such as Japanese Americans, Filipino Americans, Vietnamese Americans, and Chinese Americans. Each of these groups has its distinct cultural background and its own attitudes toward substance abuse. However, in general, most Asian Americans seem to share a fear of addiction and of injecting drugs. The Asian-American community strongly disapproves of drug users. Biological factors sometimes play a role in determining a person’s preference for alcohol or particular drugs. Asian Americans, as a group, consume less alcohol than any of the other racial or ethnic groups. Their lower drinking rates may be due in part to an enzyme in their bodies. This enzyme’s action causes unpleasant side effects after drinking alcohol. Some researchers have argued that low alcohol consumption levels among Asians are related to cultural values, and that ancient Confucian and Taoist philosophies have an influence on Chinese and Japanese drinking styles. The emphasis on conformity and harmony in those philosophies is believed to promote moderate drinking. The emphasis on responsibility to others in traditional Chinese culture also helps reinforce moderate drinking and sanctions against drunkenness. Similarly, traditional Japanese culture focuses on interdependence, restraint, and group achievement, and may thereby contribute to controlled drinking. Finally, drinking in most Asian cultures takes place in prescribed social situations, which may limit the likelihood of alcohol abuse. 64
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment
P E R C E N T AG ES O F A D U L T S O V E R A G E 2 1 WHO RE P ORT US I NG A N IL L IC IT D R U G B Y E TH N I C G R O U P Percent
Demographic Characteristic White Only Black Only American Indian or Alaska Native Only Native Hawaiian or Other Pacific Islander Asian Only More Than One Race Hispanic
Percentage of People Who Report Trying Illicit Drugs at least once in their Lifetime
Percentage of People Who Report Trying Illicit Drugs once in the Past Year
Percentage of People Who Report Trying Illicit Drugs in the Past Month
1999
2000
1999
2000
1999
2000
42.0 37.7
41.5 35.5
11.4 13.2
11.2 10.9
6.2 7.5
6.4 6.4
51.0
53.9
18.3
19.8
10.4
12.6
* 20.8
* 18.9
* 6.1
* 5.2
* 3.2
6.2 2.7
42.2 31.2
49.2 29.9
15.5 11.0
20.6 10.1
10.3 6.1
14.8 5.3
According to a 2000 National Household Survey on Drug Abuse, Asian American adults report the smallest percentage of illicit drug use of any ethnic group.
2000 National Household Survey on Drug Abuse/Substance Abuse and Mental Health Services Administration. .
SOURCE:
Native Americans Native American society is organized around the tribe. Traditional tribal beliefs place great emphasis on the spiritual element of human life. For many Native Americans, treating drug and alcohol problems involves an attempt to heal the spirit. Healing may involve coming to terms with the difficult history of Native Americans since the establishment of the United States. Some in the Native American community view addiction as a crisis of the spirit caused by the suffering of their people. Researchers also suspect that high levels of stress in this population have led to an unexpectedly high use of alcohol. Studies conducted on alcohol and other drug use by Native Americans show a considerable variation in alcohol and other drug experiences from tribe to tribe, from one part of the country to another, and even from one type of residential location to another (for example, boarding school students versus other young people). Summarizing the alcohol and drug experiences of Native Americans is, therefore, difficult. For many Native American young people and adults living in urban environments, and sometimes on reservation lands as well, the use of alcoholic beverages and also inhalants has resulted in social and health problems. Public health workers and government officials have developed many programs to encourage Native Americans with alcohol abuse problems to begin treatment. Like African Americans, Native Americans have trouble with the aspect of twelve-step recovery that calls for surrender to a higher power. This requirement conflicts with tribal beliefs in the importance of self-reliance.
inhalant legal product that evaporates easily, producing chemical vapors; abusers inhale concentrated amounts of these vapors to alter their consciousness
65
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment
Different ethnic groups have different levels of access to substance abuse treatment. Although Native Americans report the highest percentages of abuse, only 2.5 percent of those receiving substance abuse treatment are of American Indian or Alaskan Native ancestry.
PE R C E NTA GES OF P EOP LE A DMI TTED TO S UBS TA NCE A BUS E PR O G R AMS BY RA CE A ND ETHNI CI TY
Amer. Indian/Alaska Native 2.5
Other 1.1 Asian/Pacific Islander 0.7
Hispanic 10.9
Black (non-Hispanic)
23.5
61.2 White (non-Hispanic)
Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.31.00. U.S. population: U.S. Bureau of the Census. .
SOURCE:
Hispanic Americans Studies show that drug use by Hispanic Americans becomes more likely the longer the person lives in the United States. There is more crack cocaine smoking among Hispanic Americans who have adopted mainstream customs (such as speaking English rather than Spanish) than among Hispanic Americans who maintain the customs of their original country (such as continuing to speak Spanish). This relationship is more pronounced among Hispanic Americans from Mexico than among those from Cuba, however, and indicates the diversity present within the large and growing Hispanic segment of the U.S. population. A survey of American high-school students found that Hispanics’ rates of use for all drugs tend to fall between that of whites and African Americans in the 12th grade, but in the 8th grade they tend to be the highest for all drugs, including alcohol. Rates of alcohol use before age 13 are higher for Hispanic youth than for African-American youth and white youth. Rates of alcohol use by adult males also tend to be higher among Hispanics than among African Americans or whites. One traditional explanation for heavy drinking patterns among Hispanic men, particularly Mexican Americans, is the concept of exaggerated machismo. This concept implies that Hispanic men strive to appear strong and masculine, and that the ability to drink large amounts of alcohol helps prove their masculinity. However, one study (using a complex measure of machismo) found that machismo was related to alcohol use among men regardless of ethnicity and could not explain the high drinking levels among Mexican Americans. 66
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Christians In addition to racial and ethnic groups, people identify with other members of their religion. Within a particular religious group, people share certain attitudes and behaviors having to do with alcohol and drugs. According to some studies, the heaviest, most frequent, and most problematic drinking in college campuses occurs among Catholics and Protestants. However, direct involvement in religious activities seems to be associated with lower use of alcohol and other drugs. For example, a survey of close to 3,000 North Carolina residents found that recent and lifetime alcohol disorders were less common among weekly churchgoers and those who considered themselves born again. Members of conservative or fundamentalist religious groups had lower recent and lifetime rates of alcohol abuse and dependence than members of other denominations. Lifetime, but not recent, alcohol disorders were more prevalent among members of Pentecostal denominations. Some other studies have suggested that Protestants consume less alcohol but perceive greater problems with the substance. In contrast, Roman Catholics consume more alcohol but do not perceive its consumption as problematic.
Jews The Hebrew Bible (which Christians call the Old Testament) mentions several alcohol-related problems, such as the drunkenness of Noah. Proverbs 23:29–35 describes several of the ill effects of intoxication. Yet Jews of Biblical times were known for their moderate drinking habits as compared to other groups of the era. Unlike their neighbors, Jews drank wine as part of their religious rituals rather than to achieve its pleasurable effects. The modern Jewish community has a low rate of alcoholism as compared to other groups. One theory says that the traditional use of wine in religious ritual continues to discourage Jews from abusing alcohol. Yet studies of alcoholism among Jews show that many cases often go unrecognized. Among Jewish adults, rates of abuse of drugs other than alcohol do not appear to differ significantly from the rates for members of other religions or people who have no religious preference. Nevertheless, as with alcoholism, denial of drug problems in many Jewish households and communities is an ongoing problem. Interest in helping Jewish alcoholics has grown, both in the United States and in Israel. The Jewish Alcoholics, Chemically Dependent Persons and Significant Others Foundation, Inc. (JACS) sponsored an extensive study of chemically dependent Jews and their families. JACS encour67
Ethnic, Cultural, and Religious Issues in Drug Use and Treatment
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
ages prevention, treatment, and the opening of synagogues and Jewish community centers to twelve-step programs such as Alcoholics Anonymous, Narcotics Anonymous, and Gamblers Anonymous.
☎
Muslims, Hindus, and Sikhs Islam, the religious faith of Muslims, forbids the consumption of alcohol or any other mind-altering substances, and observant Muslims abstain completely from taking drugs or drinking alcohol. However, some Muslims, particularly men, do drink, and there are some who abuse drugs. Among Hindus, alcohol is forbidden for members of upper-caste groups, but Indian men living in the West have a higher than expected prevalence of alcohol-related disorders. In one study, a random sample of 200 each of Sikh, Hindu, and Muslim men, as well as 200 white men, were asked about their drinking patterns. Sikhs were most likely to be regular drinkers, followed by whites and Hindus. The very few Muslim men who drank consumed the most alcohol on average. The frequently reported pattern of an inverse relationship between drinking and age (younger people drinking more, older people drinking less) was found for white men but not among Sikhs and Hindus. In both of these groups, older men reported consuming more alcohol than did young men. Among regular drinkers, Sikhs had higher average scores on the Alcohol Problem Scale than did white men or Hindus. The highest average scores were recorded for the few Muslim regular drinkers, who also consumed the most alcohol. A clear association with religious observance was found for all three Asian groups and for the white men. Religious Muslims tended not to drink alcohol at all, and a relatively small proportion of the other groups who were regular church/temple attenders drank regularly.
Treatment Issues Successful treatment requires more than prescribing medication and offering basic counseling. Counseling must be based on an understanding of the specific qualities of addiction in various groups. Counselors must also be able to speak the language of the person they are treating and understand the unique family structures and pressures of that person’s culture. The challenge is to adapt the process of treatment and recovery to all cultures and races. The experience of counselors shows that when a patient and counselor share the same ethnic background, the patient is more likely to benefit from treatment programs for drug and alcohol abuse. A coun68
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selor who shares the cultural background of the patient understands the values of that group and can tailor the treatment program based on that understanding. The counselor must consider several issues: • At what point is the use of alcohol or other drugs considered a problem in this culture? • At what point does the culture agree that the user needs treatment? • Who takes responsibility for the problem—the individual, the family, or the community? • Do members of the cultural group disapprove of the person’s drug problem? If so, how strongly do they disapprove? • Is disapproval stronger for certain individuals, such as women? The answers to these questions will help determine the best approach to treatment. S E E A L S O Adolescents, Drug and Alcohol Use; Drugs Used in Rituals; Gender and Substance Abuse; Treatment: History of, in the United States; Treatment Types: An Overview.
Families and Drug Use Have you ever questioned which came first: the chicken or the egg? That age-old question is much like the dilemma experts grapple with: Do problems in family life lead to drug addiction, or does drug addiction lead to problems in families? Professionals who work with drug abusers take different sides in this debate. Some counselors focus on treating the individual. Others believe that to treat drug addictions one must work with families in order to create more healthy environments. In the early twenty-first century, treatment of adolescents with drug problems tends to take the approach of treating the family.
F
The American family has changed significantly since the midtwentieth century. At that time, the standard view of a family was two parents and their children, with the father as the wage earner and the mother as the homemaker. Since then, different forms of families have steadily gained acceptance. Divorce, single-parenthood, childlessness, and living alone have become common, as well as more accepted. Attitudes toward the roles of men and women have also changed. Women are no longer expected to stay home with children, and fathers are expected to participate more fully in parenting. 69
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In the 1980s and 1990s the changing face of the American family became commonplace. By 1987 a quarter of all children under 18 years of age no longer lived with both of their parents. Is there a connection between these changes in the family and trends in drug abuse? Determining the role of the family in drug abuse is a continuing subject of research. One answer may be that the instability of families leads to stresses upon individuals and society, and that those stresses open the way toward drug and alcohol use. Family stability may provide more secure environments for individuals, who may then be able to cope with life’s challenges without abusing drugs. Other evidence suggests that an individual’s drug addiction may be a form of illness passed from one generation to the next.
illicit something illegal or something used in an illegal manner
Every year, 100,000 Americans die as the result of drug abuse. Needle use among drug users also causes further deaths from AIDS. Alcohol, nicotine, and illicit drug abuse are serious health problems, especially among the young. Life expectancy has steadily risen in all age groups except for youth aged 15 to 24. However, the death rate in this age group has increased because of injuries and disappearances related to drug use. Long-term substance abuse also results in depression, hostility, malnutrition, lower social and intellectual skills, broken relationships, mental illness, economic losses, and growing crime rates. Together, these take a huge toll on individuals and society as a whole. To prevent individuals from turning to drugs, we must understand the relationship between substance abuse and family dynamics, or in other words, how family members deal with one another.
Family Predictors of Drug Abuse Three factors that help predict drug use are family structure, family history, and family relationships.
Family Structure. Family structure refers to the composition of the family, such as single- or two-parent families, the number of children, the number of years between siblings, birth order, and whether the family members are males or females. Research on drug abuse has looked at single-parent, disorganized families, in which the parent is unable to clearly play the role of the head of the family in terms of caregiving, rule making, and consistent discipline. Children in these single-parent, disorganized families tend to try drugs and alcohol at an earlier age than do children in traditional nuclear families (those in which two parents are present). Drug and alcohol abuse is also more common among these children. Of course a great number of single-parent families are as secure as two-parent families, and in such 70
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cases there is no link between the single-parent structure and adolescent drug use. Children who have no siblings appear to be at least risk for drug abuse, while children from families with six or more siblings are at greater risk. There seem to be fewer cases of drug abuse involving first-born children compared with the number of cases involving subsequent, especially last-born, children. Some researchers argue that family structural factors do not add much to the understanding of drug-abuse behavior. More important risks for children, they suggest, lie in how the family operates and the quality of life within the family. For example, in a family where the husband and wife have hostile feelings for each other, divorce may be a healthy way to end the conflict and tension. If the divorce does not disturb the child’s development—the natural steps a child takes in the process of growing up—then the parents’ breakup may lead to better overall family relations. In such a case, divorce alone does not have a negative impact in terms of a child trying and using drugs. Following divorce, most children experience a brief period of adjustment. The age of the children, the gender, the parent with whom they live after the divorce, and the quality of life in the home after the divorce all affect how well and how quickly children adjust. Depending on family relationships, children being raised in singleparent households can be expected to cope with problems as well as children from two-parent households.
Family History. Family history refers to patterns of behavior among various generations. For example, if an individual abuses drugs as an adult, therapists will examine whether that person’s parents abused drugs during his or her childhood. Some well-established evidence indicates that when the parents or siblings of an adolescent use drugs, the adolescent is more likely to use drugs also. This may be the direct result of a genetic (biologically inherited) link, especially in the case of alcohol use among male members of the same family. However, many researchers think that a person’s biology or genetic makeup cannot fully explain why some adolescents use drugs and others do not. The attitudes and values of parents are key factors affecting adolescents. When parents use drugs such as cigarettes and alcohol, children receive a clear message that such use is expected— or at the very least tolerated—in the family. Heavy drug use in the family, especially by parents, also disrupts family functioning. Drug-abusing parents are less able to give care 71
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In 1996, in the United States, over 8 million children lived in households where one or more parent used an illegal drug.
E S TI M ATE D NUMBER OF CHI LDREN WHO LI V ED I N HOUS EHOLDS W H E R E ONE OR MORE PA RENT US E D A N I LLEGA L DRUG I N T HE PA S T MONTH, BY CHI LDREN’ S A GES : 1 9 9 6
Ages of Children
Under 2 years 2 years to 5 years 6 years to 9 years 10 years to 13 years 14 years to 17 years Total 0
200,000
4,000,000
6,000,000
8,000,000
10,000,000
Estimated Number of Children SOURCE:
.
and support. In such a family environment, other members of subsequent generations are more likely to take up drugs themselves. A parent on drugs is less able to supervise his or her children, thus allowing their children to mingle with peers who abuse drugs frequently. Parental drug use also interferes with communication between parent and child. These parents may lack patience or fail to take the time needed to develop a healthy relationship with their children. Not only do drug-using parents set a bad example for their children, their drug use prevents them from instilling positive values. Parental drug use is also associated with child neglect and all kinds of child abuse: emotional, physical, sexual.
Family Relationships. Family relationships refers to the dynamics among individuals, such as the quality of a marriage and how well parents and children or siblings get along. Every family has its own way of offering support to each other—giving acceptance, encouragement, security, and love—and also of controlling each other through establishing rules and practicing discipline. Concerned, involved parents can help prevent delinquent behaviors in children and adolescents. Supportive parents provide encouragement and praise, are physically affectionate, and enjoy the companionship of their children. Evidence shows that a rewarding parent-child relationship can help prevent substance abuse during childhood and adolescence. Families in which parents praise and encourage their children, offering closeness, trust, and help with personal problems, are typically families of abstainers, or people who do not use drugs. Children who feel rejected by their parents or overly controlled by them, and whose 72
Families and Drug Use
family life is marked by a great deal of conflict, are more likely to try drugs at an early age and to continue using them. The subject of control is more complex than the subject of support. It is important to distinguish between authoritative and authoritarian controls. Authoritative control combines warmth, supervision, and the opportunity for children to voice their own feelings. Children accustomed to this type of control are more likely to abstain from using drugs or to experiment only rarely with “soft” drugs. Authoritarian control, on the other hand, is based on force, threats, and physical punishment. This type of control is more typical of the families of dependent drug users, and resembles bullying more than parenting. In such families, sexual abuse and physical abuse are also more likely to occur. Conclusive evidence shows that families with inconsistent or no clearly defined rules also have adolescents who abuse drugs. The constantly changing rules in some families threaten the parents’ ability to monitor and supervise children. The children do not know what their parents expect, creating confusion. These families have not developed clear expectations for good behavior, nor clear limits regarding misbehavior. Another important element of family dynamics is the way family members communicate with each other. Communication is the essential feature of all family relations, from expressions of support to the enforcement of the rules. Good communication involves understanding the other person’s point of view. In a family where drug use is prevalent, family members often misunderstand each other to the point that communicating becomes a negative experience.
Peer Groups and School When adolescents are involved in drug abuse, not only their family but their peer group and school play important roles. Parents are with their children for limited periods of time. Adolescents pick up many of their values, attitudes, and behaviors from friends and school. Peers introduce most new drug users to drugs. Peers also help new users continue to experiment, leading them to develop regular patterns of use, including greater dependency. Researchers find consistent evidence of the relationship between drug abuse and dropping out, poor performance and underachievement in school. A low grade-point average and dropping out of school are strongly associated with a young person’s involvement with drug-abusing peers, according to some research. Parents’ involvement in schoolwork and 73
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activities reduces the chances of a child being seriously involved in drug use.
Family Violence and Substance Abuse Substance abuse in families tends to lead to increased physical abuse. In 1994 it was estimated that about 10 million American children lived in households with a substance abuser. A minimum of 675,000 children per year are neglected or abused by drug- or alcoholdependent caretakers. Drug abuse can disrupt family dynamics among the rich, the middle class, and the poor and in any ethnic group. Research shows that people whose parents were substance abusers are more likely to have marital problems and psychiatric symptoms, especially if they had experienced physical and sexual abuse. It has also been found that domestic violence commonly occurs when the violent individual is also an alcohol abuser. Studies have shown that substance abuse can lead to child abuse. Whether it does depends on family factors such as education, income, and the parents’ own histories of substance abuse, neglect, and physical abuse. Moreover, physical abuse is not the only kind of abuse. Parents who use drugs or alcohol are typically unable to fulfill some aspects of their children’s emotional or physical needs. One common factor in the family lives of substance abusers is the absent father. When the father leaves, his role in family life must be filled by someone else. Often a child must assume responsibilities inappropriate to his or her age, such as caring for younger children in the family. As a result, that child’s own needs may never be met. Domestic violence can occur when a drug abuser in the family is desperate to obtain more drugs. For example, if the drug abuser needs money to buy drugs, and a family member tries to prevent him from taking money, the drug abuser may become violent. A drug abuser might also become suspicious that a partner is informing on him or her to the police and respond violently. Some women are involved in prostitution to obtain drugs for themselves or their partners, so their risk of exposure to violent behavior is increased substantially. Studies of couples have shown that when both partners have substance abuse problems, they are more likely to become violent against each other. Alcohol problems most strongly increase the likelihood of violence. Studies have also shown that the combined use of alcohol and drugs, particularly cocaine, is extremely dangerous in terms of violent behavior. 74
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Family Treatment Treatment or intervention programs can help prevent drug addiction from being passed down from one generation to the next. Until the mid-1980s, very few drug treatment programs directly involved spouses, parents, or other family members in their treatment of the patient. After that time, family therapy became the treatment of choice for most drug abusers, especially in the area of alcoholism treatment. Family-centered drug interventions are very effective in getting family members off drugs and keeping them off. In contrast, if adolescents are treated individually and their family system has not changed, they often return home to resume the same behaviors that had earlier led them toward addiction.
intervention act of intervening or positioning oneself between two things; when referring to substance abuse, it means an attempt to help an addict admit to his or her addiction, recognize the ill effects the addiction has had on the addict and on his or her relationships, and get help to conquer the addiction
Including other family members in an adolescent’s drug treatment makes the treatment more complicated. But it also allows the family therapist to help the drug abuser maintain family love and relationships. Strengthening family relationships may eliminate an individual’s addictive behaviors. Successful alcoholism treatment is currently based on family systems. For instance, research has revealed that the spouses of alcoholics often support their spouse’s addiction in ways they themselves do not understand. Helping the spouse of the alcoholic to change his or her behavior can help the alcoholic overcome his or her addiction. Family therapy is also helpful for young adult heroin addicts. Researchers found a significant decrease in heroin use by young adults when family-focused therapy was employed. A study over several years of 136 adolescents also supports the effectiveness of a family therapy program when compared to individual counseling combined with a family education program. In this study, family therapy intervention significantly reduced drug use for 54.6 percent of the adolescents. The best drug treatment, however, may be a combined treatment. The individual should receive treatment that teaches social skills and strategies for coping with stress. The family should receive treatment in which family members learn how to nurture each other. Combining the two approaches offers creative solutions to the problem of drug abuse in the young. S E E A L S O Adult Children of Alcoholics (ACOA); Al-Anon; Alateen; Codependence; Conduct Disorder; Ethnic, Cultural, and Religious Issues in Drug Use and Treatment; Poverty and Drug Use; Risk Factors for Substance Abuse; Treatment Types: An Overview. 75
Fermentation
Fermentation metabolic describing or related to the chemical processes through which the cells of the body break down substances to produce energy
distillation process that separates alcohol from fermenting juices
Fermentation is a natural metabolic process that produces energy by breaking down carbohydrates (such as sugars) in the absence of oxygen. It occurs in many microorganisms (such as yeasts), and the end product can be either ethyl alcohol (ethanol) or lactic acid. Energy is typically given off in the form of heat. Fermentation is important to the production of many foods and beverages, the most popular of which are bread, butter, cheese, beer, and wine. The chemical reaction of this process was first described in 1810 by a French chemist. However, fermentation was first recognized in ancient times, when food that was stored or forgotten was found to have changed its form and taste, but remained edible. To make breads and porridges, ancient peoples farmed and stored wheat and barley, some of which fermented and formed brews. Since that time, the process of fermentation has been used worldwide. Industrial methods create huge quantities of fermented foods, as well as alcohol, which is obtained by distillation from fermented juices of fruits, grains, vegetables, and other plants. S E E A L S O Beers and Brews; Distilled Spirits.
Fetal Alcohol Syndrome (FAS) Fetal alcohol syndrome (FAS) is a set of birth defects that affect a child’s growth and behavior. One of the most common defects is facial abnormalities, although other defects may have a greater impact on the individual’s health. These defects occur as a result of exposure to alcohol while in the uterus. Women have been advised not to drink during pregnancy for generations. In the nineteenth and twentieth centuries, physicians undertook studies of children born to alcoholic mothers. A study of major importance was conducted in 1973, when researchers first used the term fetal alcohol syndrome to describe abnormalities in children born to alcoholic mothers. Since 1973, the lifelong effects of prenatal alcohol exposure have been recorded in detail. There is no doubt that drinking alcohol during pregnancy is extremely harmful to the fetus, leading to permanent damage.
The Occurrence of FAS An estimated 1 in 500 to 1 in 2,000 babies are born with FAS. New studies by the Centers for Disease Control (CDC) suggest that rates 76
Fetal Alcohol Syndrome (FAS)
Fetal Alcohol Syndrome has characteristic effects on facial appearance, in addition to affecting children s physical growth and mental function.
of any alcohol consumption during pregnancy declined between 1995 and 1999, while rates of binge and frequent drinking during pregnancy remained high, despite public-health information designed to prevent FAS. In other words, more women who drink occasionally are stopping alcohol use during pregnancy, but binge drinkers are not. Some estimate that FAS is now the leading cause of mental retardation in the United States, surpassing Down’s syndrome and spina bifida.
The Physical Effects of FAS Scientist believe that alcohol consumption in any amount during pregnancy may pose risks for the fetus. Individuals react very differently to alcohol. As a result, it is difficult, if not impossible, to predict which women will have a child with FAS. Drinking alcohol during the first trimester (the first three months of pregnancy) creates the risk of major physical abnormalities and central nervous system damage. Drinking during the second trimester (the middle three months) leads to an increased rate of miscarriage, damage to the brain and spinal cord, and less noticeable physical 77
Fetal Alcohol Syndrome (FAS)
abnormalities. Drinking during the third trimester (final three months) can lead to pre- and postnatal growth retardation (slowing of growth before and after birth) and brain and spinal cord damage. The common facial abnormalities of FAS include: short eye-slit fissures; a long, smooth upper lip groove; and a thin upper lip. Other common physical problems include heart malformations and defects; a hollow at the lower part of the chest; permanent curving of one or more fingers; fusion of bones at the elbow; scoliosis (curvature of the spine); kidney malformations; and cleft lip and palate (abnormal openings in the lips and/or roof of the mouth). FAS affects children’s height, weight, and head circumference. Many children with FAS are short and thin prior to puberty. As girls enter puberty, they remain short but frequently gain weight and appear plump. Boys seem to remain fairly short and slender. Children with damage to their central nervous system as a result of fetal alcohol syndrome frequently have problems with thinking and memory, sleep disturbances, delayed development, hyperactivity or distractibility, a short attention span, an inability to understand cause and effect, lower levels of academic achievement, and impulsiveness.
Social and Educational Issues Ages Birth to 5 Years. Babies with FAS startle more than normal babies, have poor sleep patterns, do not suck as well, and are excessively active. Babies and toddlers are delayed in walking, talking, and toilet training. They are irritable, have difficulty in following directions, and are unable to adapt to changes. The damage done to the brain makes it problematic for children with FAS to learn in a timely and consistent fashion. Newborns and infants with FAS often have trouble feeding. When this is coupled with a mother who abuses substances, medical crises can result. Many children with FAS are removed from the care of the biological mother owing to abuse, neglect, or the death of the mother. When the child remains with his or her mother, the child’s health must be monitored to prevent such crises. In addition, social-service personnel must ensure that the home is safe and stable, and that the parents and other family members are receiving substance-abuse treatment and parenting training as necessary.
Ages 6 to 11 Years. As the children get older, they may have trouble understanding the consequences of behavior and social rules and expectations. Children with FAS may become less able to func78
Fetal Alcohol Syndrome (FAS)
tion in school as they get older. Difficulties with abstract thinking skills, required in such third- and fourth-grade tasks as multiplication and division, also become more noticeable. As a result, educators and caregivers of children with FAS must set reasonable expectations and goals, set clear limits on behavior, give structure to leisure time, and continue to educate parents about their children’s particular needs.
Ages 12 to 17 Years. Adolescents with FAS may become depressed, have suicidal thoughts and attempt suicide, and have trouble expressing their feelings and needs. Their intellectual growth generally stops at this point. Adolescents with FAS may do better in vocational and daily-living skills training than in traditional school settings. Caregivers need to increase the youths’ responsibilities in keeping with their skills and abilities.
The brain of a normal infant (left) is a marked contrast with the stunted brain of an infant with fetal alcohol syndrome (right). This syndrome, which produces numerous birth defects, is caused by excessive drinking by the mother during pregnancy. depressed someone who has begun to suffer from depression and who feels intensely sad and hopeless
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Ages 18 through Adulthood. Difficulties in comprehending social rules and expectations, aggressive and unpredictable behavior, and depression may lead adults with FAS to suicide attempts, antisocial behavior, criminal activity, or hospitalization. They may become withdrawn and often have trouble learning job skills and/or holding onto a job. They may need a guardian to help them manage their money. Residence in communal living arrangements may be necessary.
Conclusion FAS is a preventable birth defect. Once it exists it has lifelong consequences. As early in childhood as possible, caregivers of children with FAS should plan for future vocational, educational, and residential needs. Education on the harmful effects of alcohol use, focusing on young women and men of childbearing years, is critical to help prevent, or at least reduce, this significant public-health problem. S E E A L S O Alcohol: History of Drinking; Attention-Deficit/ Hyperactivity Disorder; Babies, Addicted and Drug-Exposed; Child Abuse and Drugs; Conduct Disorder.
G
Gambling Gambling is a form of risk-taking that may be defined as risking (betting or wagering) something of monetary value on the unknown outcome of an event in order to gain possessions, such as a painting, jewelry, or money. Evidence of gambling has been found in early civilizations and throughout history. For example, many references to gambling can be found in the Old Testament (Hebrew Bible) and the New Testament. However, as with alcohol, different cultures take different views of gambling; some cultures accept or encourage gambling, while others actively reject or discourage it.
The Growth of Legalized Gambling During the last quarter of the twentieth century, legalized gambling entered its largest period of continuous growth in United States history. Gambling revenues—money that the gambling industry takes in—dramatically increased in the 1990s. For example, in 1996, gambling yielded revenues of $47.6 billion, which surpassed $40.8 billion of combined revenues from movies, recorded music, cruise ships, live entertainment, and spectator sports. The private gambling industry and state governments praise gambling as exciting entertainment that also brings the benefits of more jobs and lower taxes. By the end of 80
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the twentieth century, gambling in public opinion had moved away from being associated with immoral activity involving deviant behavior and crime. Instead, the public came to see gambling as a socially acceptable area of entertainment. Gambling may benefit society in some ways, but it also can cause serious problems.
What Kinds of Problems Can Gambling Cause? When gambling is legalized and made more available, the number of people who try it increases and a certain percentage of those new gamblers develop problems with gambling. The most widely used term for a serious gambling problem is “compulsive gambling.” Other terms currently in use are “addictive,” “chronic,” and “disordered gambling.” The term “problem gambling” usually refers to a gambling problem that is minor to moderate. In 1980, the mental health field recognized that excessive and out-of-control gambling is
Slot machines line the floors of the Mille Lacs Grand Casino in Minnesota, and offers gamblers endless opportunities to play. Increased accessibility is linked to a shorter development time in forming a gambling habit.
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psychiatric relating to the branch of medicine that deals with the study, treatment, and prevention of mental illness
productivity quality of yielding results or benefits
a psychiatric disorder, naming it “pathological gambling.” Research studies have shown that pathological gambling can lead to bankruptcy, divorce, crime, and other social costs. Thorough study of these social costs and whether they outweigh social benefits has only just begun. With funding from the federal government, the National Gambling Impact Study Commission (NGISC) conducted a national study of gambling and problem gambling in 1999. The study found that 1.2 percent (2.5 million) of the adult population were lifetime (currently or in the past) probable pathological gamblers. In addition, the commission found that 1.5 percent (3 million) were lifetime problem gamblers. An additional 15 million adults were identified as being at risk for developing a gambling problem. This study also asked questions of patrons at gambling facilities and found that 13 percent could be defined as having a lifetime gambling problem and pathological gambling. The NGISC report estimated that the annual cost for problem and pathological gambling is $5 billion. Lifetime costs—measured in terms of decreased productivity, costs for treatment and other social services, and unpaid debts from gambling—came to $40 billion.
The Prevalence of Pathological Gambling
vulnerable at greater risk
Many factors affect the prevalence of pathological gambling, which is the percentage of individuals who have gambling problems at any given time. These factors include the number of legal (and illegal) forms of gambling that are available and accessible. Prevalence rates may also be affected by the increasing availability of forms of electronic gambling. These machines can be very engaging and hard to stop playing. This form of gambling involves an interaction between person and machine that may be so compelling or attractive that it results in separation from other people or social activities. Electronic gambling gives the gambler the opportunity for more frequent play and rewards. For an individual who is vulnerable to a gambling problem, the time it takes to develop an addiction may be quite short, especially when the machines are available twenty-four hours a day. However, any form of gambling may result in a problem for an individual who is vulnerable. Even the stock market is an arena for gambling and problem gambling. While most people invest carefully in the financial markets, enormous sums are also gambled daily. In 1997, the United States Securities and Exchange Commission agreed to distribute a pamphlet on investor problem gambling, thus acknowledging for the first time that problem gambling occurs in the financial markets. However, the
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brokerage industry has not yet acknowledged problem gambling as a concern. The Internet has made gambling much more available. The number of online gambling sites and of online gamblers have been increasing rapidly. Internet gambling revenues have more than doubled from $445.4 million in 1997 to $919.1 million in 1998. Experts have predicted $2 billion in revenues by the end of 2002. People at risk for a gambling problem will find it more difficult to avoid gambling. Home computers, with easy access to the Internet, make gambling sites accessible to youths, who may find the temptation hard to resist. In addition, some online gambling sites lure people in by disguising their identities as gambling sites. As a result of all these trends, online gambling is fast becoming the area of greatest risk for youth.
Problem Gambling The National Opinion Research Center reviewed the available literature (articles and other writings) on problem gambling to determine what factors are likely to lead to problem gambling. The following are the major factors that predispose someone to a gambling problem:
predispose to be prone or vulnerable to something
• Problem gambling often occurs along with substance abuse, mood disorders, and personality disorders. • Pathological gamblers more often than nonpathological gamblers report having a parent who is a pathological gambler. • The younger someone is when he or she begins gambling, the more likely pathological gambling will occur.
Mixed Messages about Gambling. The public receives mixed messages about gambling. On the one hand, private and government sponsors of gambling encourage gambling. On the other hand, consumers receive strong but less frequent messages that gambling to excess can result in addiction and related negative consequences for their lives. Public policy regarding gambling is often confusing to both adults and youth. For example, in some states children are permitted to gamble at bingo but not at other forms of gambling; schools and parent/teacher associations sponsor Las Vegas Nights and cow chip bingo; children cannot purchase lottery tickets but can receive them as gifts. As a result of these mixed messages, many people are confused about the role of gambling in society. Who is at Risk for Problem Gambling? Evidence suggests that certain groups are at particular risk for developing problems with gam83
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WHAT ARE THE CHARACTERISTICS OF PROBLEM GAMBLERS? According to Gamblers Anonymous, people who have gambling problems may answer yes to several or more of these questions: 1. Did you ever lose time from work or school due to gambling? 2. Have you ever felt remorse (regret) after gambling? 3. After losing did you feel you must return as soon as possible and win back your losses? 4. After a win did you have a strong urge to return and win more? 5. Did you often gamble until your last dollar is gone? 6. Were you reluctant to use gambling money for other expenses? 7. Did you ever gamble longer than you had planned? 8. Did gambling cause you to have difficulty sleeping? 9. Do arguments, disappointments, or frustrations create within you an urge to gamble?
depression state in which an individual feels intensely sad and hopeless; may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities
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bling. Included in these groups are older people, youth, women, and people with low income. Seniors are gambling more frequently, and advertising and other promotions by casinos target this group. There is increasing evidence that people of low income gamble a higher percentage of their income than people of higher income. The rate of problem gambling among women increased dramatically in the 1990s, growing from a small percentage to more than 25 percent of all identified problem gamblers. Studies conducted by states of gambling prevalence have consistently identified teenagers as having a higher rate of problem gambling than adults in the same states. In a review of eleven studies, researchers found that between 9.9 percent and 14.2 percent of youth had a minor- to moderate-level gambling problem, and between 4.4 percent and 7.4 percent had a serious problem. The high rate of problem gambling among youth is not a surprise, as the current generation of youth is the first to be raised in a time when gambling is not only socially accepted but actively promoted by private industry and government.
What are Some Causes of Problem Gambling? Experts who have studied problem gambling are not in total agreement as to the exact causes of pathological gambling. However, many hold the view that there are four major types of risk factors for developing a gambling disorder: (1) biological, (2) social and environmental, (3) psychological, and (4) spiritual.
Biological Causes. Pathological gambling is increasingly viewed as an addiction resembling substance addiction. Research shows that adults and teenagers who have gambling problems tend also to abuse substances such as alcohol, cocaine, and tobacco. Research also has pointed to similarities in brain chemistry between pathological gamblers and people dependent on substances. While not as extensively researched, relationships have also been found between pathological gambling and food, sex, and work addictions. Significant connections have also been found between pathological gambling and other disorders, such as depression and other mood disorders, anxiety, attention-deficit/hyperactivity disorder (ADHD), and personality disorders such as antisocial personality disorder. Genetic research in the late 1990s provided the first evidence of a genetic link between pathological gambling and other addictive and impulse control disorders. If present, this gene may affect the neurotransmitters (brain chemicals) that control impulsivity, emotions, and the experience of pleasure. Advances in brain imaging in the late
Gambling
1990s began to identify faulty areas of brain functioning that are related to behavior problems, such as ADHD.
Social and Environmental Causes. Research has provided evidence that early environmental factors in the home, such as exposure to a parent’s excessive gambling or abuse, are linked to a later gambling problem. Further, it is likely that trauma in adulthood, including losses later in life, increase the chances that a person may develop a gambling problem. Other environmental factors may contribute to gambling problems in some communities: having a gambling casino nearby, widespread gambling advertisements, and the absence of serious education about responsible gambling and the warning signs of problem gambling. Psychological Causes. Problem gamblers seem to share certain personality traits, including low tolerance of frustration, self-centeredness, mood changes, confusing fantasy with reality, and irrational thinking. While men and women have a number of similarities in gambling behavior (such as the lottery), in some areas men and women choose different gambling activities to fulfill different psychological needs. Men tend to be “action” gamblers seeking competition and games of skill (such as cards and sports); women tend to be “escape” gamblers seeking solitary and noncompetitive activity (such as electronic gambling machines). Spiritual Causes. People who have addictions, including pathological gambling, tend to substitute quick-fix activities for intimate relationships and a spiritual life. The Twelve Step–recovery programs of Gamblers Anonymous and Gam-Anon are patterned after Alcoholics Anonymous and Al-Anon. These programs attempt to bolster the recovery process by encouraging members to search for and rely on a higher power to give new meaning to life.
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attention-deficit/hyperactivity disorder long-term condition characterized by excessive, ongoing hyperactivity (overactivity, restlessness, fidgeting), distractibility, and impulsivity antisocial personality disorder condition in which people disregard the rights of others and violate these rights by acting in immoral, unethical, aggressive, or even criminal ways impulsivity state in which someone acts before thinking through the consequences of their actions trauma injury or damage, either to the body or to the mind
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See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
How Do Gambling Problems Progress? Pathological gambling is a progressive disorder, meaning it worsens over time. At its later stages, this disorder can have very serious life consequences, such as bankruptcy, crime, and suicide. Identifying the disorder early is especially important because of the devastating impact on the gambler, the gambler’s family, and society. Gambling disorders appear to progress in three stages: 1. Winning stage: characterized by an initial large win. 2. Losing stage: losses are chased with increased gambling until a major problem occurs that is temporarily resolved by a 85
Gambling
as
Ph e
Legal Acts
se
ha
gP
uil din
eb
–R
ase
Ph
ion
t ra
pe es –D
Remorse Panic
Blaming Others
Spiritual Needs Problem Solving Examined Thinking Clearer Responsible Personal Stock Thinking Hopeful Realistic, Stops Gambling Honest Desire For Help al
e as
Ph
Delays Paying Debts Home Life Unhappy Personality Changes Unable to Pay Debts Irritable, Restless, Withdrawn Reputation Affected Heavy Borrowing/Legal & Illegal Alienation From Family & Friends Bailouts
Cri tic
ing os –L
ha
e as
Ph
Spouse/Family
Marked Increase in Amount & Time Spent Gambling
r ow th P
ing
inn
Covering Up, Lying
Losing Time From Work
–G
W
Excitement Prior to Frequent & With Gambling Winning Increased Amount Bet More Frequent Gambling Big Win Fantasies About Winning/ Gambling Alone Bigshot Thinking Only About Gambling Unreasonable Optimism Can't Stop Gambling/ Bragging About Wins Borrowing Legally Prolonged Losing Episodes Careless About
NEW WAY OF LIFE Sacrificing For Others Understanding Giving Affection to Others Self & Others Insight Into Self Facing Problems More Relaxed Promptly Less Irritating Behavior Preoccupation With More Family Time Gambling Decreases Family & Friends More Family Time Begin to Trust Less Impatience Self-Respect Returning Resolve Legal Problems Accept Self-Weaknesses Develop Goals & Strengths New Interests Restitution Plans Improved Spousal & Return to Work Family Relationships Decision Making Paying Bills, Budget se
Occasional Gambling
Hopelessness · Suicidal Thoughts & Attempts Arrests · Divorce · Alcohol Emotional Breakdown · Withdrawal Symptoms
This chart indicates the characteristics associated with a worsening problem with gambling addiction, and then the feelings and traits that occur during recovery.
financial bailout, followed by a higher level of gambling and increased crises. 3. Desperation stage: the gambler further withdraws from family and work responsibilities into gambling, often resulting in criminal and suicidal behavior. Help may or may not be sought. Some gamblers, who have lost most of what is important to them, no longer care and continue to gamble without hope of winning.
Diagnosing Pathological Gambling Diagnostic criteria for pathological gambling are specified in the Diagnostic and Statistical Manual (DSM-III). Health-care professionals who specialize in mental health and addiction diagnose a gambling disorder if a person has five or more of the following repeated and persistent (ongoing) behaviors: • is preoccupied with (thinks constantly about) gambling, such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money with which to gamble 86
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• needs to gamble with increasing amounts of money in order to achieve the desired excitement • has repeated unsuccessful efforts to control, cut back, or stop gambling • is restless or irritable when attempting to cut down or stop gambling • gambles as a way of escaping from problems or of relieving dysphoria (feelings of helplessness, guilt, anxiety, depression) • after losing money gambling, often returns another day to get even (“chasing” one’s losses) • lies to family members, therapist, or others to conceal the extent of involvement with gambling • has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling • has put at risk or lost a significant relationship, job, or educational or career opportunity because of gambling • relies on others to provide money to relieve a desperate financial situation caused by gambling
Treatment Programs for Gamblers In the United States, Gamblers Anonymous became the first organized program to deal with problem gambling. It was started in 1957 and serves as a self-help/mutual support program. The first professional treatment program for compulsive gamblers began in 1972 in an inpatient alcohol program in a Veterans Administration hospital. Funding for treatment, prevention, and research programs by state governments began gradually in the late 1970s, and by the end of the twentieth century approximately half of the fifty states funded programs. Although many research studies have identified a high rate of problem gambling among youths, there is still insufficient awareness of this problem. As a result, few treatment programs exist for adolescent problem gamblers. In addition, youths may not realize they need help or, even when they are aware of this need, do not seek it. Schools and families are not referring these adolescents to treatment. When youths who currently have gambling problems reach adulthood, the demand for adult treatment programs may rise.
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Councils on Problem Gambling. In 1972, the National Council (NCPG) was founded to meet the chalon Problem Gambling lenges that problem gambling presents to individuals and society.
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See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
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In 1980, Connecticut became the first of the current thirty-four state members of the NCPG. The NCPG was the first professional organization to educate the public about compulsive gambling as a serious public health problem and advocate for treatment services. The NCPG and many of its state members offer problem gambling help lines to the public.
Recommendations of the NGISC The National Gambling Impact Study Commission’s two-year examination of gambling in the United States resulted in seventy-four recommendations for changes in policies and practices. Some of the major recommendations that have an impact on young people include: • the elimination of convenience gambling or gambling at local businesses such as convenience stores, bars, and restaurants • no further authorizations for new convenience gambling • a minimum legal gambling age of 21 • a ban on betting on collegiate and amateur athletics • a ban on all aggressive gambling advertisements, and the creation of responsible gambling advertisement guidelines • a prohibition on Internet gambling that has not already been authorized • gambling establishment policies to ensure the safety of children and prevent underage gambling • school programs from the elementary through college level to include warnings about the dangers of gambling. Ethnic, Cultural, and Religious Issues in Drug Use and Treatment; Gender and Substance Abuse.
SEE ALSO
Gangs and Drugs Gangs are present in large and small cities in nearly every state, and their members come from a range of ethnic and racial groups. They stake claims to turf not only on city streets but in shopping malls, skating rinks, and school corridors. Gangs use graffiti and “tagging” to mark that turf and to send news and messages to other gangs and gang members. Young women have their own gangs, and fights between female gangs are common. In some gangs females fight alongside males. For many street gangs, drug selling has become a major means of making money. A few gangs have ties to adult organized crime groups. 88
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Drug and Alcohol Use among Youth Gangs As with the general population of youths, alcohol and marijuana are the two most widely used substances among gang members. Researchers have studied patterns of alcohol and drug abuse among gangs. In general, gangs use gang proceeds to buy alcohol and drugs for the group. White gang members have high rates of drinking, but black gang members drink beer only occasionally. Irish gangs rarely use illicit drugs because they reject doing business with nonwhites who control access to drugs. A study of Chicano gang members in East Los Angeles showed that through drug use—mainly alcohol, marijuana, phencyclidine (PCP), and crack cocaine—a gang member can achieve social status and acceptance. Gang members prepared for fights with other gangs by drinking and smoking PCP-laced cigarettes. During social gatherings, the gang members used the same combinations to “kick back”
This scene from Boyz N The Hood (1991), about three black teens growing up among gangs, shows actor Ice Cube in a convertible and teens crowding the streets of South Central Los Angeles. illicit something illegal or something used in an illegal manner
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sanction punishment imposed as a result of breaking a law or rule
induction process of formally admitting somebody into a position or organization expulsion act of forcing somebody out of a group or institution (e.g., a school or club)
AWARD-WINNING FICTION ADDRESSES GANG LIFE
Parrot in the Oven: Mi Vida, (1996) by Victor Martinez, won the National Book Award for Young People s Literature for describing a young man s debate over whether or not he should join a Mexican-American gang. For Manuel, gang life seems like an escape from his family s problems. The main challenge of his life is to find a reason to survive amid the negativity and hopelessness that surrounds him as he grows up in a city project.
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and feel more relaxed among one another. Gang members understood the effects of combining alcohol and PCP and had developed ways to achieve certain moods and behaviors. There is a sanction against heroin use among Chicano gangs. Heroin involvement is seen as a betrayal of the gang and the barrio, or neighborhood. Chicano gangs share a belief that members cannot be loyal to their gang while also tied to an addiction and the culture surrounding it. Studies of Latino gangs in San Francisco demonstrate three styles of drug involvement. The “fighting” style involves violent acts meant to prove one’s loyalty to the gang and claim territory and also to obtain money and drugs. The “entrepreneurial” style involves youths who want to attain social status by means of money and the things money can buy. Members of gangs of this style are very often active in small-scale illegal sales of marijuana, pill amphetamines, and PCP. In the third style, gang activities are social and recreational, with little or no evidence of fighting or violence but high rates of drinking and marijuana use. A study of a Puerto Rican gang in Chicago describes how alcohol and marijuana often accompany rituals of induction and expulsion of gang members. These ceremonies often are tearful and emotional, calling up feelings of ethnic solidarity. Drinking is a continuous process during these events. By contrast, Chinese gangs in New York City do not allow drinking or drug use. Violence in these gangs is mainly in attacks on other gangs for the purpose of protecting business territories and forcing victims to take part in the gang’s ventures. In Detroit, organizations of adolescent drug sellers prohibit drug use among their members but tolerate drinking. Leaders in these groups want to keep the business running smoothly and securely. If dealers on the street are high, that might hurt their selling skills. Breaking the rule on drug use results in expulsion from the gang or violent acts of punishment. The gangs permit the use of substances, mainly alcohol, marijuana, and cocaine, in social situations separate from dealing.
Gangs and Drug Selling A 1999 survey of gangs across the United States found that an estimated 46 percent of all gang members are involved in drug selling, mostly to make money for the gang. The survey also found that the percentage of gangs organized specifically to sell drugs increased to 40 percent in 1999. The number of these drug gangs differs depending on region. In the late 1990s, the numbers of drug gangs grew in rural,
Gangs and Drugs
suburban, small, and large cities, but the biggest increases were seen in the rural and suburban areas. The involvement of gangs in the drug trade varies by locale and ethnicity. Chicano gangs in Los Angeles do not sell cocaine but sell small quantities of other drugs. The crack and cocaine trades are dominated by African-American youths who may or may not be gang members. Crack sales began in Chicago more than five years after Los Angeles gangs began selling drugs. As in Los Angeles, both gang and non-gang youths are involved. Crack sales in New York flourished beginning in 1986, but there was little evidence of an organized street gang structure that participated in drug selling. Instead, crews of sellers provided an organizational structure for drug sales.
With her face covered, a woman thought to be connected to the gang Jungle Brothers, is escorted into a Connecticut police station. Drug trafficking is used by many gangs as a source of income.
The growth in cocaine use in the 1980s coincided with increased gang involvement in drug selling and drug-related violence. In one 91
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of the largest studies on this subject, a researcher interviewed 1,200 youths in Chicago, Los Angeles, and San Diego. Nearly one-third of the gang members interviewed reported that they were selling drugs, in contrast with fewer than 8 percent of the youths not in gangs. As the crack epidemic ended in the early 1990s, gangs in New York City, Washington, D.C., and other large cities began to sell drugs like marijuana, PCP, and ecstasy. Gang sales of heroin rose in the 1990s, particularly by Latino gangs in the western and southwestern United States. Urban gangs typically do not sell methamphetamines, or “speed,” despite the rise in popularity of this drug throughout the 1990s and into the twenty-first century. The main reason for this is that crank can be made simply, with relatively easyto-obtain ingredients. Specialized suppliers such as gangs cannot make as much of a profit on crank, compared to other illicit drugs. Chinese gangs have remained outside the cocaine and crack trades. However, some members (but not entire gangs themselves) have been involved in transporting or guarding heroin shipments from Asia. Other Asian ethnic groups, such as the Vietnamese, have moved into parts of the drug trade in cities like Los Angeles and New York, often working for more established Chinese gangs in these regions. Not all gang members sell drugs. There appears to be some choice as to whether a gang member becomes involved in drug sales, even within gangs where drug selling is common. Drug-selling cliques within gangs are responsible for gang drug sales. These cliques are organized around gang members who have contacts with drug wholesalers or importers. Among the Diamonds gang in Chicago, drug selling is a high-status role reserved for gang members who have succeeded at more basic tasks, such as theft. Despite public images of gang members using drug profits to buy and show off luxury items such as fancy cars and mansions, drug incomes in fact are quite modest for gang members who sell drugs. Drug incomes are shared within the gang, but most of the profits remain with the clique or gang member who brought the drugs into the gang. On the other hand, membership in a gang may increase the profits that an individual drug seller makes. In 1999, researchers collected reports that gang members can make about $1,000 a week by selling drugs to thirty customers, compared to non-gang drug dealers who reported making $675 a week selling to eighty customers. The study suggested that the power and size of gangs made it more likely that they could obtain more expensive and larger supplies of drugs, making them better “retailers.” 92
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Drug selling has contributed to changes in the organization and meaning of gangs. Studies of several groups show that drugs have come to play a bigger role in gang life. Detroit gangs went from streetcorner groups protecting territory to highly efficient drug-selling organizations. Puerto Rican youths in a Chicago gang refocused the gang to drug dealing as the primary source of income. Of 37 AfricanAmerican gang members in Milwaukee, 22 went on to become involved in adult drug organizations. Despite these developments, however, the stereotype of the gang as a violent group using and selling drugs is not necessarily an accurate image for all gangs. Movies and hip-hop music have depicted gang life as a stew of violence, drug money, police repression, and the exploitation of women. These perceptions were shaped by gangrelated violence in theaters at the opening of films in the 1990s depicting gang life, such as Colors and Boyz N the Hood, as well as reports of violence at rap concerts and in local clubs specializing in house and hip-hop music. The murder and arrests of former gang members and musicians such as Snoop Dogg and Tupac Shakur also reinforced the violent picture of gang life. The media painted a picture of expanding gangs involving more and more youths. But many gangs did not, in fact, fit the image of the sophisticated crime group, reaping great profits from drug distribution and specializing in lethal violence. Studies based on police arrest reports in 1985 found no evidence that Los Angeles gang members were arrested more often than youth not involved in gangs for crack sales, or that drug-related homicides were more likely to involve gang members than non-gang members. The U.S. Department of Justice’s 1999 study of gang trends noted that nonviolent crimes such as theft and breaking and entering were more prevalent among gang members than violent crimes like homicide or assault.
repression an act in which one person or group keeps another group in a lower, less advantageous position exploitation condition in which one uses another person for one s own selfish advantage
homicide murder
Gang Psychology Researchers believe that gangs recruit and keep members who see the gang as a way to gain a sense of family and acceptance that is lacking in their lives. Gang members often feel as if traditional authorities like family, school, church, and government have betrayed them in some way, leaving them powerless. Gang membership provides a sense of identity to youth and allows them to feel that they are part of something bigger than they are. To boost this feeling, gangs seek to expand their membership and territory whenever possible. The reasons that people join gangs, according to a 1992 survey of gang members themselves, include identity, recognition, belonging, 93
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love, discipline, and money. One or more of these reasons may be more important than others for any particular gang. For instance, Latino gangs in Los Angeles take pride in gang membership as it identifies them as separate from other ethnic groups, such as African-American gangs. Vietnamese youth gangs in the same city, on the other hand, may value the financial benefits that come from gang participation. Other researchers believe that the causes of gang membership can be linked to influences in the environment and media. In neighborhoods where gangs are a normal way of life, youths may feel peer pressure to join, even if they are not searching for the support or money that some members get from their gangs. In copycat gangs, particularly those outside of urban areas, local youths may create and join gangs to achieve some of the same excitement, wealth, and power that they associate with gangs on television, in movies, and in music. Psychology also affects how gang leaders control their members and force new members to join. Leaders can serve as role models, acting like fathers or mothers or big brothers or sisters. They combine the rewards of recognition and respect with punishment for behavior that reflects poorly on the gang as a “family-style” unit. Leaders may control the colors, clothing, slang, and acceptable behaviors among gang members so that each person conforms to the group’s identity. By controlling these factors, the leader creates a situation where individual expression breaks the rules of the gang. Failure to follow the rules may single people out in a way that causes other gang members to punish the individual with threats, humiliation, and in some cases violence. Gangs may demonstrate mob psychology, in which the group acts in a way that is different from how any single person might act. Group members lose their individual identity within the group, and therefore feel less responsible for anything that the group does, such as participating in violence during a turf war that may harm nongang members.
The Impact of Drugs on Gangs and Gang Culture As selling drugs became an increasingly central part of gang life, making money became the main goal. Gangs used the language of the working world, such as “getting paid” and “going to work,” to describe their drug-selling activities. Illegal and legal means of making money no longer seemed different. Drug selling was simply a way to get wealthy and to appear wealthy. Young people participating in drug selling have come to use the same language and hold the same attitudes. Money lends an individ94
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ual power and a sense of achievement. In poor areas in the inner cities, getting rich by selling drugs became the standard way to get ahead, much as many people aspire to be “self-made” businesspeople. Money became more important than the law or the good of the community or society. The emphasis on money, individual gain, and quick wealth was so strong that gang members in Detroit and Chicago looked at lowlevel drug sellers as their own “homeboys,” as “working stiffs” who could be exploited by other gang members. Street selling was no longer an “entry-level job” in which the gang member could serve the gang as a whole and prove his worth as a member. Gangs continue to be composed of particular ethnic groups, but the goal of making a profit is replacing ethnic pride as the primary bond. African-American gangs in Detroit now seem to lack interest in maintaining a sense of neighborhood or group pride. Among the Diamonds gang in Chicago, appeals to Puerto Rican solidarity were used by older gang members to maintain order and motivation within the gang, while these older members kept the lion’s share of the gang’s profits from drug sales.
Gang Migration The appearance of Crips, Bloods, Vice Lords, Black Gangster Disciples, Latin Kings, and other well-known gang names in new cities across the country has created concerns that gangs are expanding and migrating from their home cities to others. But few gangs actually operate out of multiple locations. Migration seems to take place mainly along interstate highway routes connecting cities to other communities. Drugs are sold and transported along these routes. Police and other law enforcement officers agree that most appearances of gang members outside large cities in the 1990s came from gang youth moving away from city centers. A 1999 study showed that most migrant gang members were found in rural areas, followed by small cities, suburbs, and other large cities. Most often, local gangs are composed of local youths who may have adopted the names, graffiti, and other symbols of established gangs from the larger cities. For example, a Milwaukee gang adopted the name of the Vice Lords, a Chicago gang, but in fact had little contact with them. SEE ALSO Drug Traffickers; Ethnic, Cultural, and Religious Issues in Drug Use and Treatment; Media Representations of Drinking, Drug Use, and Smoking.
Ganja See Hemp 95
Gender and Substance Abuse
Gender and Substance Abuse Does gender have an influence on whether abuse of a drug causes complications? Because many early studies of substance abuse were only of male subjects, this question long went unanswered. Later researchers, prompted by the concerns raised by the women’s movement of the 1970s regarding the lack of attention given to women’s health issues, began to study female substance abusers as a separate group as well as to compare them with male substance abusers.
Studies show that lung cancer kills more women than breast cancer. The risk of getting lung cancer is related directly to the amount of tobacco a person smokes, and it appears that women have a higher risk factor than men.
This research has yielded interesting results. First of all, the physical effects of drugs are relatively similar for men and women. For example, mortality (death) rates are about the same for men and women in a sample population of heavy drinkers and heavy smokers. However, men and women have different patterns of alcohol and drug use. In general, women drink less often and in smaller amounts than men do, and they suffer from fewer alcohol-related problems. Women also use illegal drugs less often than men do, although women have a higher rate of use of prescription tranquilizers, sleeping pills, and over-the-counter drugs. The differences between the genders in complications largely reflect the differences in the patterns of their alcohol and drug use. The sexes are also different in their social patterns of drug use. For example, alcohol- and drug-using women are more likely to have partners who are alcohol and drug users. Such women are often victims of violence: 53 percent of reported rapes involve the use of alcohol by the victim, the rapist, or both. Women who use illegal drugs frequently support their drug habits by prostitution, putting themselves at risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) and hepatitis B, even if they are not needle users. Accidents and trauma related to substance abuse are more common in men, as is substance-related homelessness. Men report drinking and driving more often than women do. Researchers in the late 1990s were moving beyond these generalizations to study more specific subgroups of men and women. Health professionals need to distinguish more precisely between the effects of gender roles on substance abuse and the effects of other social categories such as race, religion, sexual orientation, age, income, occupation, and educational level. It is now widely recognized that gender is difficult to separate from other aspects of a person’s self-image, lifestyle, and environment. Researchers are also devoting more attention to special populations, such as bisexuals or women with disabilities.
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Specific Substances of Abuse Research has shown that the alcohol, tobacco, and illegal drug use of women and girls differs in significant ways from that of men and boys. However, research also suggests that in some respects women’s substance use is becoming more like men’s.
Alcohol. On average, women drink alcohol less frequently than men do, and they also tend to drink less per occasion. Moreover, women are more likely than men to drink no alcohol at all. These same sex differences occur for the adolescent and young adult population, but they are smaller than the differences observed in the overall adult population. In a 2000 survey of high school seniors, 24 percent of girls and 37 percent of boys reported occasions of drinking five or more drinks in a row in the past two weeks. Sex differences are much smaller, however, for reports of ever drinking alcohol. For example, 44 percent of eighth-grade girls compared to 42 percent of eighthgrade boys reported ever drinking in the previous year, and among high school seniors, 72 percent of girls compared to 74 percent of boys reported drinking in the past year. The smaller sex differences in drinking patterns observed over time and among younger teens has led many observers to suggest that differences between male and female alcohol abuse patterns will disappear in the coming decades. This equality in drinking behavior could be problematic, because mounting evidence suggests that alcohol may be more damaging to the health of girls and women. Evidence suggests that it takes far less alcohol consumption to produce liver damage in women than in men. For women, cirrhosis of the liver may develop with drinking only 20 grams of alcohol (one or two drinks) per day, as compared to 80 grams (6 drinks) per day for men. Women alcoholics have death rates 50 to 100 percent higher than their male counterparts. Women develop hypertension (high blood pressure), obesity, anemia, malnutrition, and bleeding in the gastrointestinal tract at lower alcohol consumption levels and over a shorter period of drinking. Women become intoxicated after drinking smaller quantities of alcohol than do men. For an equivalent dose of alcohol corrected for body weight, women absorb alcohol faster and reach a higher peak blood alcohol concentration compared to men. These differences can be explained in part by the lower total body water of women compared to men. With a higher percentage of fat and lower water content, there is less volume in which to dilute the alcohol, and its concentration is therefore increased. Women also produce less stomach alcohol dehydrogenase, the enzyme responsible for breaking down alcohol. The effects of some hormones
malnutrition unhealthy condition of the body caused by not getting enough food or enough of the right foods or by an inability of the body to appropriately break down the food or utilize the nutrients gastrointestinal tract entire length of the digestive system, running from the stomach, through the small intestine, large intestine, and out the rectum
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immune system human body s system of protecting itself against foreign substances, germs, and other infectious agents; protects the body against illness
or the immune system in women may account for the increased liver damage.
Tobacco. Historically in the United States, men have had higher death rates from lung cancer, emphysema, and heart disease related to tobacco use. This was due to their higher rates of smoking. As with alcohol use, however, recent trends suggest that women and men are becoming more similar in their patterns of tobacco use despite the possibility that smoking takes a greater toll on women’s health. In the 2000 “Monitoring the Future” survey, 8 percent of eighth-grade and 20 percent of twelfth-grade girls reported they smoked cigarettes every day compared to 7 percent of eighth-grade and 21 percent of twelfth-grade boys. Although rates of daily cigarette smoking are almost identical for girls and boys, boys still exceed girls in their use of smokeless tobacco. For example, more than 6 percent of male high school seniors reported daily smokeless tobacco use in 2000 compared to less than 1 percent of senior girls. Women are at risk for all the same health complications of smoking as are men. The differences seen until the 1990s largely reflect the lower number of women smokers in previous generations. For example, as smoking rates have increased in women, lung cancer rates have also risen. Lung cancer now surpasses breast cancer as the leading type of cancer death among women. Due to their higher rates of smokeless tobacco use, men still far surpass women in their rates of tobacco-related oral cancers.
Illegal Drugs. Among older adolescents and young adults, males are more likely to use most illegal drugs, and the differences tend to be largest for frequent illicit drug use. For example, among high school seniors in 2000, 8 percent of males versus 4 percent of females reported daily marijuana use. Among adults aged 19 to 32 years, 5 percent of males compared to slightly less than 3 percent of females used marijuana daily. Similar patterns are observed for illegal drugs other than marijuana. In the twelfth-grade survey, 11 percent of males compared to 9 percent of females reported using an illegal drug other than marijuana in the previous month. Among eighth- and tenthgrade students, however, there are few gender differences in the use of illegal drugs, perhaps because girls tend to date and follow the lead of older boys who are more likely to use and provide drugs.
Reproductive Health A woman’s drinking pattern may be influenced by the mood changes associated with the phases of the menstrual cycle. A woman’s blood alcohol level actually measures higher during the premenstrual pe98
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riod for any given amount of alcohol. This may make it difficult for a woman to predict the effects of her drinking. Use of oral contraceptives (birth control pills) by women who smoke cigarettes increases their chance of coronary heart disease. Cigarette smoking is also correlated with a younger age of menopause (the end of menstruation). Alcohol, tobacco, and illegal drugs like cocaine and heroin all contribute to a decrease in fertility, an increased rate of spontaneous abortion (miscarriage), and decreased birth weight in the newborn. A woman who is severely dependent may stop menstruating altogether. The menstrual period resumes if the woman stops using drugs or, in the case of a heroin addict, becomes stabilized on methadone maintenance treatment. Infants born to women who used alcohol, tobacco, or other drugs during pregnancy can suffer from numerous health problems, including low birth weight, major congenital malformations (birth defects), neurological problems including cerebral palsy, mental retardation, and withdrawal symptoms. Women who drink too much alcohol during pregnancy risk giving birth to a baby with fetal alcohol syndrome, a set of problems that includes facial deformities, abnormal coordination, and behavior and learning problems. Although substance abuse at any time during pregnancy can cause birth defects, the very rapid cell division in the first weeks of the embryo’s development means the harmful effects of alcohol and drugs are generally greatest early in pregnancy before a woman may even realize she is pregnant.
correlate to link in a way that can be measured and predicted
dependent someone who has a psychological compulsion to use a substance for emotional and/or physical reasons methadone potent synthetic narcotic, used in heroin recovery programs as a non-intoxicating opiate that blunts symptoms of withdrawal withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance
As the medical and social costs of prenatal alcohol and drug exposure become more apparent, so does public pressure for action. Many call for removing an infant from the mother’s custody in cases where the newborn tests positive for drug and alcohol exposure. In some regions of the United States, mothers who used alcohol or drugs during pregnancy have been charged with crimes such as child abuse or delivering a controlled substance to a minor. Critics of these policies argue that alcohol and drug screening will discourage substanceabusing women from getting the prenatal care they need, because they fear being caught by legal authorities. Legally, it may be difficult to prove that a woman committed an intentional crime against her unborn child if the substance abuse occurred early in an unintended and unrecognized pregnancy. Further, it is often difficult to disentangle alcohol or drug effects from other harmful conditions the mother may have experienced such as poor nutrition, serious or chronic illness, and inadequate prenatal care. Currently, prenatal drug detection procedures raise important questions of fairness. Hospitals and clinics serving largely poor and 99
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PE R C E NTA GE S OF MEN A ND WOMEN A DMI TTED TO S UBS TA NCE A B U S E P ROGRA MS , 1 9 9 3 – 1 9 9 9 80
Percentage being admitted
The percentage of women and men admitted to substance abuse programs in the United States was comparable in 1999.
Male
70
Female
60 50 40 30 20 1993
1994
1995
1996
1997
1998
1999
Year Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) - 3.31.00. U.S. population: U.S. Bureau of the Census. .
SOURCE:
minority patient populations are more likely to detect prenatal substance abuse even though evidence shows that substance abuse occurs in all social and economic categories.
Addiction, Treatment, and Recovery
vulnerable at greater risk
Women are less likely to become addicted to alcohol or illegal drugs than are men because they use these substances less often than men do. However, when women do use alcohol and drugs, they may be more vulnerable to addiction and face greater obstacles to treatment and recovery compared to men who are addicted to alcohol or drugs. This greater vulnerability of women is due to a combination of factors: physical differences, sex differences in the causes and course of addiction, and social barriers to treatment and recovery.
Telescoping. Research on such varied substances as alcohol, tobacco, and heroin suggest that girls and women move more quickly along the path from experimentation to addiction than do boys or men. In other words, they progress from controlled to uncontrolled use of a substance in a shorter time. This progression is termed “telescoping.” It is unclear whether biological or social factors cause the telescoping. Research on adolescents reveals that boys and girls have very similar risk factors for developing a substance abuse problem: friends who use substances, difficulties in school, low academic goals, paid employment, and lack of closeness with and supervision by parents. However, among male and female alcoholics and drug addicts, there are gender differences in the experiences leading to addiction. Girls and women are more likely to report that their alcoholism or drug addiction developed in the course of a relationship with a substance-abusing boyfriend or husband. More female alcoholics and addicts report histories of physical and sexual abuse. Also, more women alcoholics or 100
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addicts attribute their alcohol or drug dependence to a significant loss or trauma, while males more often report their alcohol and drug dependence developed gradually from their recreational drug use.
Obstacles to Treatment. Compared to male alcoholics and drug addicts, female substance abusers face obstacles in seeking treatment and recovering from alcohol and drug dependence. Their lower rates of employment and greater likelihood of working in jobs without healthcare benefits reduce women’s access to employee assistance plans and health insurance to pay for substance abuse treatment. Women substance abusers are more likely to be solely responsible for infants and young children who would be forced into foster care if their mothers sought residential treatment. More substance-abusing men receive treatment through drug courts and the prison system. Most substance abuse treatment programs were developed for male
Men who suffer from substance abuse face fewer obstacles to treatment and recovery compared to women who are addicted to alcohol or drugs. trauma injury or damage, either to the body or to the mind recreational drug use casual and infrequent use of a substance, often in social situations, for its pleasurable effects
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codependence situation in which someone, often a family member, has an unhealthy dependence on an individual with an addiction (e.g., to alcohol or gambling); the relationship is often characterized as enabling the addict to continue his or her addiction
bulimia nervosa literally means ox hunger ; an eating disorder characterized by compulsive overeating and then efforts to purge the body of the excess food, through selfinduced vomiting, laxative abuse, or the use of diuretic medicines (pills to rid the body of water) anorexia nervosa eating disorder characterized by an intense and irrational fear of gaining weight; results in abnormal and unhealthy eating patterns, malnutrition, and severe weight loss
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clients, and therefore may not meet the unique treatment needs of female clients. Recently, treatment programs for girls and women have made greater efforts to address such issues as childcare, parenting skills, codependence with substance-abusing partners, sexual and physical abuse, and eating disorders.
Gender Issues and Substance Abuse in Special Populations Within the general categories of male and female are many subgroups. Three of these groups have particular issues related to substance abuse.
Gays, Lesbians, Bisexuals, and Transsexuals. As of 2000, more research was needed to uncover the relationship between discrimination against gays, lesbians, bisexuals, and transsexuals and substance abuse. A common belief since the early 1990s is that lesbians, gay men, and bisexuals are more likely to abuse drugs because of discrimination they experience, as well as the cultural importance of gay bars as meeting places. People in these groups have substance abuse rates about three times that of the general population. The rate of smoking among lesbians increases with age, while the rate for women in the general population declines with age. While gay people in general often do not receive substance abuse treatment at rates equal to other groups, lesbians face barriers beyond those of gay men because of their gender as well as sexual orientation. Women with Disabilities. Research done since 1996 indicates that women with disabilities have higher rates of illegal drug use than women without disabilities, but lower rates of illegal drug use than their male counterparts. Women with disabilities are at higher risk of substance abuse for several reasons: the early signs of substance abuse are often overlooked because caregivers focus on the disability; the woman is likely to be taking two or more prescription drugs that interact with alcohol; she is often socially isolated; and friends or family may excuse her substance abuse as a way to compensate or make up for the disability. Women with Eating Disorders. It has been known since the mid1980s that women with eating disorders, particularly bulimia nervosa, are at a higher risk of abusing alcohol and other drugs. One study done in the mid-1990s indicates that one in every four bulimic women abuses alcohol. However, the reasons for this overlap are not clear. It has been suggested that bulimics are more likely than women with anorexia nervosa to be impulsive, and that this character trait encourages substance abuse.
Halfway Houses
Recent Changes in Male Gender Stereotypes Substance abuse has increased among males born after 1975. A 1998 report explains this increase by noting the growing confusion about male roles. It also points to long-standing explanations of substance abuse (the importance of drugs in joining a male peer group; seeing risk-taking, aggression, and violence as masculine behaviors; and the high rate of drug use among athletes and similar role models). The report observes that young men in the late 1990s are caught between traditional models of masculinity and newer images of “sensitive” men. In addition, the rising rate of eating disorders among men, related to increased media emphasis on male physical appearance, has been linked to an increased risk of substance abuse. Among adolescents and young adults, males are more likely than females to report using anabolic steroids to increase muscle mass. The largely unregulated market of herbal supplements to enhance bodybuilding and sports performance targets male consumers. Another new substance abuse risk to males is the explosion in the diagnosis and medical treatment of attention-deficit/hyperactivity disorder (ADHD). In the 1990s prescriptions for stimulant drugs to treat ADHD increased over 1,000 percent. Boys are far more likely than girls to be diagnosed with this condition and prescribed drugs to treat it. Little is known about the long-term effects of these drugs, but they are very similar to other stimulants such as amphetamines, which are known to be highly addictive. Substantial increases in nonprescription use of these drugs have already been witnessed, as they have made their way onto the street for recreational use and self-medication (for example, to stay awake to cram for tests). According to the Monitoring the Future survey, for 12th graders the nonmedical use of one such drug, Ritalin, grew from 0.1 percent in 1992 to 2.2 percent in 2000. Since newer ADHD drugs are not specifically included in the Monitoring the Future survey, this figure probably underestimates the extent of nonmedical prescription stimulant use. S E E A L S O Attention-Deficit/Hyperactivity Disorder; Babies, Addicted and Drug-Exposed; Eating Disorders; Fetal Alcohol Syndrome (FAS); Substance Abuse and AIDS.
Halfway Houses A halfway house is a drug-free facility in which individuals recovering from drug or alcohol problems can live. These homes get the name “halfway” because people with substance abuse problems who use them are halfway between requiring full supervision and being able to live
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independently. The halfway house provides the former drug user a safe, supportive environment in which to practice living drug-free in a world filled with the temptations of drugs. These residences are located in regular neighborhoods within communities. Halfway houses vary in terms of their size, sources of financial support, and kinds of treatment they offer. Some specialize in alcohol abusers or drug abusers, while some serve both; some focus on specific groups such as criminal offenders, adolescents, or women. SEE ALSO Treatment: History of, in the United States; Treatment Types: An Overview.
Hallucinogens A hallucinogen is any substance that causes hallucinations (the experience of seeing, hearing, feeling, smelling, or tasting things that are not actually present). A variety of medicines and illegal drugs can lead to the development of hallucinations. Hallucinogenic drugs disrupt the brain’s ability to process information and perceive the real world. A person who takes a hallucinogen may experience dreamy illusions (things that are not really there) or disturbing delusions (distortions of reality). Visual hallucinations range from simple (e.g., flashes of light) to elaborate visions. Auditory (hearing) hallucinations can be noises, a voice, or several voices carrying on a conversation.
Hallucinogenic Drugs Hallucinogenic drugs can be placed in two major groups, depending on their chemical structure. The first group includes drugs made from lysergic acid, such as lysergic acid diethylamide (LSD) and dimethyltryptamine (DMT). LSD is one of the most potent hallucinogens. During an LSD “trip,” the user experiences a sense of clarity and a heightened awareness of sights, sounds, touch, lights, and colors. Unlike LSD, which is taken by mouth, DMT must be injected, sniffed, or smoked. DMT takes effect quickly, usually within one minute, and the effects last for a very brief period. DMT has never been a popular street drug. The seeds of the morning glory plant also contain a lysergic acid chemical. This group of hallucinogens also includes drugs made from the Mexican or “magic” mushroom, psilocybin and psilocin. The second major group includes mescaline (which comes from the peyote cactus) and the drug compounds DOM, MDA, and MDMA or ecstasy. DOM, MDA, and MDMA produce some stimulant effects as well as hallucinogenic effects. The street name of DOM, a drug that was part of the hippie drug culture of the 1960s, is STP. 104
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The letters stand for “serenity, tranquility, and peace.” DOM takes effect very slowly, but the effects can last for fourteen to twenty hours, much longer than those of LSD. In some cases, people took DOM expecting the quicker action of LSD. They then took more DOM and experienced a very intense and very long psychedelic experience. Hundreds of drugs similar to these compounds, such as ecstasy or MDMA, have been synthesized illegally in laboratories. These socalled designer drugs are popular street drugs. They are quite dangerous, since there is no way for the buyer to be sure what the drugs contain.
The peyote cactus contains mescaline, a hallucinogenic substance that can cause people to see, hear, or feel things that are not there.
The Effects of Hallucinogens The various hallucinogens produce similar psychological effects, but they differ in how quickly they take effect, how long the effects last, and the intensity of the effects. Physical effects include dilated pupils, exaggerated reflexes, and increases in blood pressure, heart rate, and body temperature. Some of the hallucinogens may cause nausea at first. Some people who take hallucinogens have severe, negative reactions including panic attacks and self-destructive behavior.
Side Effects of Prescribed Drugs. Some drugs used to treat certain illnesses are psychoactive. This means that, in addition to their desired medical uses, they may cause auditory (hearing) and/or visual hallucinations in some patients. For example, high doses of cortisone, a hormone prescribed to reduce swelling caused by arthritis or allergies, can 105
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produce hallucinations. Drugs made from the belladonna plant, such as atropine and scopolamine, have many medical uses but in high doses can cause memory loss and illusions.
stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system paranoid someone who is excessively or irrationally suspicious
Illegal Drugs. Many illegal drugs can alter individuals’ level of consciousness or perception of the world around them. A person who takes phencyclidine (known as PCP or “angel dust”) may experience numbness in the limbs and feel as though the limbs are removed from the body. Such distorted perceptions can lead to confusion, delusions, hallucinations, and sometimes violent behavior. High and/or frequent doses of stimulants such as amphetamine, methamphetamine (“speed” or “ice”), or cocaine can cause paranoid thoughts or delusions. High doses of marijuana or hashish can lead to dreamy illusions or hallucinations. Psychedelics. Hallucinogenic drugs such as LSD and mescaline are also called psychedelic. A person who takes psychedelic drugs sees, thinks, and feels in a way that is sharply different from normal perception. In the hallucinogenic experience, everyday reality loses its importance, and vivid sensations and perceptions absorb the person’s attention. For example, the person will recognize a door and understand its everyday function. But he or she will focus on other aspects of the door, such as the fine detail of the wood grain, which may appear to move and flow. During the hallucinogenic experience, shapes, colors, and passing thoughts or memories take on a life of their own. Another effect is the mixing of sensations, or “synesthesia.” For example, sounds may be seen, or colors heard. Individuals may feel that they have discovered some great truth. However, after the drug’s effects wear off, these perceptions and thoughts lose whatever meaning they seemed to have.
Medical and Religious Uses
A preparation consisting primarily of the poisonous Fly Agaric mushroom is ingested by the people of Siberia as a hallucinogen.
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In the 1960s doctors and scientists tried to find medical uses for hallucinogens, especially for psychiatric problems. However, no medical uses were ever found. Some groups have used hallucinogens to enhance mystical thought and belief. Certain Native American groups use the hallucinogen peyote in religious ceremonies. People take peyote to reach a higher level of thinking (to be “in the mind of God”). A leader may guide participants through the peyote experience.
Other Causes of Hallucinations Diseases and infections that affect the brain can also cause a person to have hallucinations. The diseased state may involve a high fever,
Hashish
severe brain injuries, or delirium. A patient in a delirium is said to be “out of it,” not in touch with reality. Delirium can develop in patients who have brain infections, brain injury, or conditions in which nutrients essential for brain function do not reach the brain. In addition, poisoning or other toxic reactions can produce hallucinations. People dependent on a barbiturate sedative can experience a delirium with hallucinations if they suddenly stop taking the drug. Similarly, alcoholics who stop drinking suddenly experience a withdrawal symptom called delirium tremens, in which the person has vivid hallucinations. S E E A L S O Ayahuasca; Drugs Used in Rituals; Ecstasy; Lysergic Acid Diethylamide (LSD) and Psychedelics; Morning Glory Seeds; Peyote.
Hashish Hashish is the Arabic word for the resin or thick oily material derived from Cannabis sativa, the hemp plant. The word came into English at the end of the sixteenth century. The hemp resin is usually dried and formed into a wafer or brick. It can also be used to make hashish oil. Other preparations use the resin as well as the flowering tops of the hemp plant. These are called charas in India, esvar in Turkey, anascha in areas of the former Soviet Union, and kif in Morocco and parts of the Middle East. Tetrahydrocannabinol, or THC, is the major active chemical in products of the hemp plant, including marijuana and hashish. THC is the substance that affects the brain and causes changes in behavior and feelings. Hashish is the strongest of all substances made from cannabis. Hashish can be smoked and is also often taken by mouth. One of the ways in which hashish is prepared is to boil cannabis leaves in water to which butter has been added. The THC binds with the butter, which can then be used for making various cookies and sweets. People eat these to experience the psychoactive effects of the drug.
psychoactive term applied to drugs that affect the mind or mental processes by altering consciousness, perception, or mood
Hashish was introduced to the West in the mid-nineteenth century by a French psychiatrist who experimented with the drug as a way to understand mental illnesses. His circle of friends also tried hashish, among them the famed writers Alexander Dumas and Charles Baudelaire. This group named themselves the Club of HashishEaters. Their detailed descriptions of the drug effects helped the drug gain popularity. Most of their accounts dwelled on beautiful hallucinations and a sense they had of being all-powerful. The doses they took must have been large, since the effects they described are more
hallucination seeing, hearing, feeling, tasting, or smelling something that is not actually there, like a vision of devils, hearing voices, or feeling bugs crawl over the skin; may occur due to mental illness or as a side effect of some drugs
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hallucinogenic substance that can cause hallucinations, or seeing, hearing, or feeling things that are not there
characteristic of stronger hallucinogenic drugs such as LSD than of marijuana. Hashish was introduced into England at about the same time by an Irish physician who had become familiar with it while in India. The material was soon hailed as a wonder drug and was used for all sorts of complaints: pain, muscle spasms, convulsions, migraine headaches, and swollen tonsils. Since most of the preparations were weak and the doses used were small, any beneficial effects were probably due to a placebo effect. In other words, users expected the drug to cure their ailments, and this positive thinking—not any substance from the drug itself—led the user to feel better. Most hashish users say that the drug produces a feeling of euphoria, or intense well-being, and uncontrollable laughter. The user also has altered perceptions of space, time, vision, and hearing. SEE ALSO Bhang; CANNABIS SATIVA; Creativity and Drugs; Drug Use Around the World; Hallucinogens; Hemp; Marijuana; Users.
Hemp psychoactive term applied to drugs that affect the mind or mental processes by altering consciousness, perception, or mood
The hemp plant, Cannabis sativa, native to Asia, is the source of marijuana, hashish, ganga, and bhang. These drugs contain tetrahydrocannabinol, or THC, a psychoactive substance that affects the user’s brain, changing the way the user thinks, acts, and feels. Bhang is legally used in India as a medicine, as well as in relaxed social settings for pleasure. In many parts of the world, including the United States, drugs formed from hemp are illegal. A different species or type of the hemp plant produces a fiber used to make rope, floor coverings, and cloth. SEE ALSO Bhang; CANNABIS SATIVA; Hashish; Marijuana.
Herbal Supplements Herbal supplements are products that contain herbs or other plant materials and are taken as an addition to a person’s normal diet. People usually take herbal supplements to try to achieve some sort of health goal, such as losing weight, building muscle, or improving memory. Dietary supplements may come in pills, tablets, capsules, powders, liquids, and extracts. Herbal supplements are part of a larger category of products called dietary supplements. Dietary supplements are used for the same reasons as herbal supplements but may contain 108
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different materials. These materials could include vitamins, minerals, amino acids, or enzymes. Herbal supplements are becoming more popular around the world but particularly in the United States. The number of Americans using herbal supplements tripled between 1996 and 1999. In 2001 Americans spent over $4 billion on herbal supplements. These supplements are considered to be food, not drugs, by the federal government. The government does not regulate the use of supplements in the same way that it regulates over-the-counter and prescription medicines. This means that these supplements do not have to be proven safe or effective before going on sale. Researchers are studying a variety of herbal supplements to find out how they affect the body and if they are safe to use. Although there are very few studies on the safety of herbal supplements, some supplements have been linked to an increase in sickness and death among their users.
Ginseng is one of the most revered and well-known of the plants used in Chinese herbal medicines. It is believed to bolster the immune system and increase energy.
Commonly Used Herbal Supplements In 2001 the best-selling herbal supplements in the United States were garlic, ginko biloba, echinacea, ephedra, kava, ginseng, senna, and St. John’s wort. Other popular dietary supplements include SAMe, creatine, and androstenedione. St. John’s wort and SAMe are used to treat mild depression, anxiety, and sleeplessness. The herb St. John’s wort contains chemical compounds that can be extracted and put into pills, capsules, or tea. SAMe, usually taken as a pill, is the artificial version of a chemical made by the body’s cells. The herb kava (sometimes known as kava kava) is another supplement used to treat stress and anxiety. Echinacea, also known as purple cone flower, is used to prevent colds and flu. It contains compounds that may strengthen the body’s immune system. Echinacea is sold in pills, teas, liquids, and powders. Ginseng, another herb that affects the immune system, is also used to treat colds and flu. Some people take ginseng to boost their energy levels and reduce stress. Other commonly used herbs include ephedra, senna, and ginkgo biloba. Ephedra, or ma huang, is an herb used to speed up the body’s fat-burning process and to increase energy. The compound extracted from ephedra is called ephedrine. Forms of ephedrine are also used in cold and allergy medicines. Senna is another herb used to promote weight loss. Its leaves are a natural laxative, and senna is often found in drinks labeled “dieter’s tea” or “slimming tea.” Ginkgo biloba
amino acids organic molecules that make up proteins enzyme protein produced by cells that causes or speeds up biological reactions, such as those that break down food into smaller parts compound pure substance that is made up of two or more elements, but possesses new chemical properties different from the original elements immune system human body s system of protecting itself against foreign substances, germs, and other infectious agents; protects the body against illness
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comes from the leaves of the ginkgo biloba tree. It is used to improve blood flow to the brain and to improve memory. Ginkgo is often used along with ginseng to increase overall energy and alertness.
steroid specific chemical compound; certain types of steroids are produced naturally by the body (e.g., sex and stress hormones); other types of steroids are laboratory-produced drugs used to treat a variety of illnesses and to reduce swelling
Creatine is an amino acid dietary supplement, used to help build muscle and to provide short bursts of high energy. Creatine is especially popular with young athletes, who drink powdered creatine mixed into shakes or other liquids as part of their training. Creatine experienced a surge of popularity in 1998, when baseball player Mark McGwire of the St. Louis Cardinals admitted taking the supplement during his record home-run season. McGwire also used a hormone called androstenedione, commonly known as andro. Although androstenedione is classified as a dietary supplement, some researchers think that it should be classified as a steroid. The most common supplements used by teenagers include those used to treat depression, encourage weight loss, and increase energy and strength. St. John’s wort, ephedra, and creatine and andro are among the most popular supplements used by people in this age group.
The Potential Health Risks Associated with Herbal Supplements Potential health risks related to supplements come from incorrect doses and incomplete information about how supplements might affect different types of people. Unlike over-the-counter and prescription drugs, there is no recommended dosage for specific supplements. Different brands of an herbal supplement may contain different amounts of the active herbal compounds, or other harmful ingredients. A 1998 study found that nearly one-third of 260 herbal supplements imported from Asia either contained drugs not listed on the label, or lead, mercury, or arsenic. As more people take herbal supplements, the number of negative health effects associated with some supplements has increased. For instance, reports of health problems related to ephedra use have increased sharply. In 2000 the Food and Drug Administration released a study that linked ephedra use to 134 cases of health complaints, ranging from chest pain and sleeplessness to stroke, addiction, and death. The rise in supplement users has uncovered another potential health risk: the interaction of supplements with other drugs. For instance, studies in 1996 and 2000 showed that St. John’s wort may interact with drugs used to treat HIV infection and prevent the body from rejecting transplanted organs. St. John’s wort may also interact
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Herbal supplements are products that contain herbs or other plant materials. These supplements are usually taken to try to achieve some sort of health goal, such as weight loss.
with other, prescribed drugs for depression, such as Prozac or Zoloft, and birth control pills.
The Potential for Herbal Supplement Abuse Herbal supplements, like drugs, may be abused. Supplement abuse usually happens when users take massive doses of the supplement or combine supplement use with other substances such as alcohol. Ephedra may act as a powerful stimulant (like an amphetamine) when combined with caffeine, as is often the case in weight-loss products. Some researchers believe this combination has the potential to be addictive, especially if users take massive doses of each. Other stimulants such as ginseng can be candidates for abuse as well. People with eating disorders, such as anorexia nervosa or bulimia nervosa, sometimes abuse supplements like ephedra and senna. In these cases, users abuse the supplements to carry out other behaviors associated with eating disorders, such as starvation, bingeing, and purging. Some people combine supplement use with drinking, hoping that the supplements will either allow them to drink more or drink without the side effects such as a hangover. One such combination includes energy supplement drinks such as Red Bull, which contains amino acids and caffeine, and alcohol. This pair is especially popular
anorexia nervosa eating disorder characterized by an intense and irrational fear of gaining weight; results in abnormal and unhealthy eating patterns, malnutrition, and severe weight loss bulimia nervosa literally means ox hunger ; an eating disorder characterized by compulsive overeating and then efforts to purge the body of the excess food, through selfinduced vomiting, laxative abuse, or the use of diuretic medicines (pills to rid the body of water)
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binge drinker man who consumes five or more drinks on a single occasion; or woman who consumes four or more drinks on a single occasion
with young binge drinkers who want to remain alert while drinking or who want to drink for a longer period of time.
Treating Drug Abuse with Herbal Supplements Some doctors are trying to treat illicit drug abuse with the help of herbal supplements. The Center for Addiction and Alternative Medicine Research in Minnesota is one of the leaders in this effort. Among other projects, its scientists study whether particular Chinese herbal mixes can be used to treat alcohol abuse and smoking. One recent study suggested that herbal supplements might have an opposite effect on teenagers, acting as a gateway to try substances such as tobacco, alcohol, and illicit drugs. The 1999 study of 2,000 high school students in New York State found that almost 29 percent of students said they used herbal products to either feel or perform better in activities such as sports. These same students were also much more likely to be using other drugs as well, the researchers found. S E E A L S O Adolescents, Drug and Alcohol Use; Anabolic Steroids; Eating Disorders.
Heroin Heroin and morphine belong to a group of drugs called opiates. Opiates are derived from the opium poppy. Morphine was first identified as a painkiller in 1806. The problem with morphine was that people who took it often became addicted to it. They also experienced other undesirable side effects, such as nausea. At the end of the nineteenth century, a German scientist changed the molecules of morphine, hoping to produce a new drug that, like morphine, would relieve pain but that, unlike morphine, would not be addictive. This new drug was heroin. Within a year or two of its introduction, most of the medical community knew that heroin was not only stronger than morphine but that people who used it were even more likely to become addicted. By the 1920s, heroin had become the most widely abused of the opiates.
Medical Uses for Heroin Heroin and morphine act in nearly identical ways on the body. Studies in cancer patients with severe pain show very little difference in the pain relief offered by the two drugs. They also produce similar feelings of euphoria (intense well-being). However, heroin may take effect more quickly, and it is two to three times stronger when 112
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injected. This is probably because heroin crosses from the blood into the brain more easily than does morphine. But when heroin is taken by mouth, its strength is the same as morphine’s. Because heroin offers no major advantage over morphine in treating pain, heroin has no approved medical uses in the United States.
Street Heroin Heroin is available and used only as an illegal “street” drug. The purity of street heroin varies greatly, and many other substances and drugs are “cut” (mixed with) street heroin. As a result, the user has no way to know what he or she is buying. This makes street heroin doubly dangerous.
Poppy fields along the border of Burma, Thailand, and Laos are known as the Golden Triangle, from which much of the world s opium is cultivated. After harvesting 865 tons of opium in 2001, Burma became the largest producer worldwide.
Typically, heroin is injected into the veins (intravenously). The injection provides a rapid “rush,” or an immediate feeling of eupho113
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FICTION SPEAKS VOLUMES
Smack (1999), by Melvin Burgess, is the story of two teenagers who run away and become embroiled in heroin addiction. In a life filled with sex, drugs, and rock n roll, the two struggle to return to the real world and recover from their addictions.
ria. This rush is thought to be the important factor in the addictiveness of heroin. The drug can also be injected under the skin (subcutaneously) or deep into the muscle (intramuscularly). Swelling and redness of veins due to repeated injections are called track marks. These tracks are one of the signs that a person is abusing drugs. Less commonly, heroin can be inhaled or smoked in a cigarette. According to the National Household Survey on Drug Abuse, in 2000 an estimated 308,000 people 12 and older used heroin within the past year. A survey of high school students conducted in 2001 showed that 1 percent of 8th graders and 0.9 percent of 10th and 12th graders reported using heroin at some point in the past year, representing a small but important decline from the previous year.
Heroin: Tolerance, Dependence, and Withdrawal Users of heroin develop tolerance to its effects. Chronic, or longterm, users of the drug become less sensitive to its euphoric and analgesic (painkilling) actions, as well as to its rush. Once users develop tolerance, they need to increase doses of the drug to achieve the effects they desire. Heroin users also become physically dependent on the drug, and experience withdrawal symptoms if they stop taking it. Heroin’s effects last for approximately four to six hours. As a result, addicts must take the drug several times a day to prevent the appearance of withdrawal symptoms. The need to continue taking the drug to avoid withdrawal is an important factor in heroin’s addictiveness. People who take opiate drugs for medical reasons can be taken off the drug gradually without withdrawal symptoms. The dose must be lowered by 20 to 25 percent daily for two or three days until all use is ended. However, abruptly stopping morphine or heroin has very different results. The withdrawal symptoms that occur after abruptly stopping heroin include: • eye tearing • yawning • sweating • restlessness • dilated pupils • irritability • diarrhea • abdominal cramps • waves of gooseflesh (the term “cold turkey” describes the gooseflesh that follows from abruptly stopping the drug) 114
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The heroin withdrawal syndrome reaches a peak about two or three days after stopping the drug, and symptoms usually disappear within seven to ten days. Some low-level symptoms may last for many weeks. Heroin use by a pregnant woman seriously affects the developing fetus. Babies of mothers dependent on heroin are born dependent. Special care must be taken to help them withdraw during their first weeks. Although withdrawal for the baby is miserable, heroin withdrawal is not usually life threatening.
Heroin Overdose Overdosing is a common problem among heroin addicts. One reason for frequent overdoses is the varying purity of the street drug, which makes it difficult for the addict to judge the size of a dose. Also, some substances used to cut the drug may be toxic (poisonous) themselves, contributing to a drug overdose. Furthermore, as a user becomes tolerant to the heroin rush and the euphoria, he or she may increase the dose past the point of safety in an attempt to intensify these soughtafter sensations. When a person takes an overdose, he or she falls into a stupor. It is difficult to wake the person up. The pupils are typically small and the skin may be cold and clammy. Seizures may occur. Breathing becomes slow, and the lips may darken to a bluish color. This blueness indicates that there is not enough oxygen in the blood. Most dangerously, heroin overdose causes respiratory depression, or a slowed rate of breathing. As a result, blood pressure may then fall. Most people who die after a heroin overdose die because of this respiratory failure. Typically, the heroin user has also taken other drugs—whether on purpose or because they were mixed with the heroin—and/or drunk alcohol. The presence of other substances in the body makes the heroin overdose even more dangerous. S E E A L S O Addiction: Concepts and Definitions; Heroin Treatment: Behavioral Approaches; Heroin Treatment: Medications; Opiate and Opioid Drug Abuse.
Heroin abuse and overdoses have been linked to different celebrities, including Nirvana s lead-singer Kurt Cobain, who would later die of an apparently selfinflicted gunshot wound in 1994. stupor state of greatly dulled interest in the surrounding environment; may include relative unconsciousness
Heroin Treatment: Behavioral Approaches Heroin abuse is a type of learned behavior that must be stopped and replaced by healthier behaviors. Psychological treatment helps heroin abusers to understand their feelings and behaviors and to make changes in their lives that will lead to ending drug use. A behavioral 115
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approach to the treatment of heroin abuse can be especially effective when combined with medications such as methadone.
depression state in which an individual feels intensely sad and hopeless; may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities; in extreme cases, may lead an individual to think about or attempt suicide anxiety disorder condition in which a person feels uncontrollable angst and worry, often without any specific cause dependent someone who has a psychological compulsion to use a substance for emotional and/or physical reasons withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance
benzodiazepine drug developed in the 1960s as a safer alternative to barbiturates; most frequently used as a sleeping pill or an anti-anxiety medication
In addition to their drug problem, drug abusers may have psychiatric problems, such as depression or anxiety disorder, as well as problems interacting with other people or dealing with anger and frustration. Psychological treatment can help heroin abusers cope with these problems. Many people who try to stop using heroin end up relapsing, or returning to drug use. Relapse to drug use following treatment can occur because the drug abuser spends time with drugusing friends, feels depressed or angry, and/or lacks the social skills necessary to function in daily life. Patients can learn how to cope with all of these problems by working with psychologists and other counselors trained in behavioral approaches.
The Development of Heroin Abuse People who try injecting heroin may be acting out of curiosity, hoping to use the drug without becoming addicted. An immediate “rush” follows the injection, with feelings of relaxation and well-being. As users take more of the drug, they become physically dependent on it and experience withdrawal symptoms (such as cramps and irritability) if they stop taking the drug. At this point, individuals may start using the drug both for its positive effects and to get relief from uncomfortable withdrawal symptoms. Whatever the reasons for the person’s first use, continued use soon becomes a priority. Some addicted individuals may commit crimes to get money to buy the drug. Heroin abusers usually have mixed feelings about seeking treatment, because they like taking drugs and do not see why they should stop. They are most likely to begin treatment following a crisis caused by their drug use, such as a problem with the law, their health, their family, or their job. Friends, family, or the legal system may refer them to treatment, which may also be required as a part of a criminal sentence of probation. Heroin abusers are often also addicted to alcohol and/or other drugs, including cocaine and benzodiazepines (such as Valium or Xanax) that they may have started taking before or after they began using heroin. As a result, heroin abusers have an addictive lifestyle. Treatment of heroin abuse must address these other addictions as well. The treatment approaches discussed here differ from each other in terms of the specific approaches they take and goals they set. However, all aim to eliminate the drug use of the heroin abuser and to substitute healthier behaviors.
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P E R C E N T O F A D M I S S I O N S T O S U B S TA N CE A BUS E P ROGRA MS F O R H E R O IN A S T H E PR I M A RY D R U G O F A BUS E, 1 9 9 3 – 1 9 9 8
15
The number of people in the United States who cited heroin as their primary substance of abuse rose slightly in the 1990s.
Heroin
Percent
14
13
12
1993
1994
1995
1996
1997
1998
Year SOURCE: Office
of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) 1993-1998. .
Treatment Settings for Heroin Addiction Treatment for heroin addiction is offered in publicly funded clinics that accept patients with limited resources, including those who receive public assistance. It is also treated in private programs that take patients with higher incomes and/or medical insurance. Clinics may offer treatment on an outpatient or inpatient basis. In methadone maintenance treatment, an outpatient may receive counseling and psychological treatment, but these are second in importance to daily appointments to receive doses of medication. At the opposite end of the spectrum are residential (live-in) treatment communities and selfhelp programs that use the Twelve-Step approach developed by Alcoholics Anonymous. In these programs, the treatment addresses heroin abuse as a behavior in need of change and does not make use of medications.
☎
Therapeutic Communities Therapeutic communities are long term (from 6- to 24-month) residential programs developed specifically for helping drug abusers change their values and behaviors in order to live drug-free. These communities recognize that heroin abusers have usually been involved in a drug subculture, or separate and secretive drug world, for most of their lives. These drug users need to learn how individuals who do not use drugs function in society. The goal is to rehabilitate the drug abuser into a person who can live in keeping with society’s values and goals, hold a job and maintain relationships, and make contributions to the community.
outpatient person who receives treatment at a doctor s office or hospital but does not stay overnight inpatient person who stays overnight in a facility to get treatment methadone potent synthetic narcotic, used in heroin recovery programs as a non-intoxicating opiate that blunts symptoms of withdrawal
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL. rehabilitate to restore or improve someone to a condition of health or useful activity
During treatment, the drug abuser lives in a special residential community with other drug abusers and with therapists who may be 117
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ex-addicts in recovery. A system is set up to reward the participants for desirable behaviors. These rewards might be community privileges and increased responsibilities. In addition, patients learn through observing peers and staff, who serve as role models for appropriate behavior, sometimes called “right living.” Patients progress through three stages. In the first stage, the patient learns about the therapeutic community by attending seminars. The second stage is called primary treatment, during which the patient takes on work responsibilities and attends group meetings, eventually becoming a group leader. The final stage, reentry, focuses on preparing the patient to separate from the treatment center and rejoin the outside community. It is expected that, after they leave, patients will set up their own households and get a job or continue their education. These programs attempt to rehabilitate drug abusers by helping them adopt a whole new set of attitudes and behaviors. Treatment programs modeled after therapeutic communities are becoming increasingly popular for use in prison systems.
Drug-Abuse Counseling This approach is practiced in methadone maintenance programs, where patients are required to see a counselor throughout the course of treatment. It may also be provided in outpatient community–clinic programs. Counselors are usually professionals with a college degree in counseling, although ex-addicts who have personal experience with recovery from drug abuse may also provide counseling. Counselors make sure that the patient is attending regularly and providing urine specimens for drug testing as requested. They confront any violations of program rules, and enforce penalties and privileges. Counselors also design a treatment plan that sets goals for the patient. For example, a treatment plan may contain recommendations to avoid all drug use, get a job, and participate in self-help groups. Patients learn to set reasonable goals (finding a job, starting a bank account, obtaining a driver’s license) that will lead to a responsible, drug-free life. Patients also learn how to solve everyday problems and to make good decisions. Counselors encourage patients to try new social and recreational activities that can replace their typical lifestyle of searching for drugs or hanging out with drug-using friends. Finally, counselors are expected to refer patients to other community-helping agencies for services that they cannot provide themselves. For example, patients who are unemployed may be referred to an employmentcounseling service. 118
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Motivational Incentive Therapy Heroin abusers typically find the temptation of drugs impossible to resist. The goal of motivational incentive therapy is to help patients not only resist drugs but to see that abstinence is a more desirable way of life. The treatment gives patients an incentive—a motive or reason—to remain abstinent. In the program, drug abusers can earn points that are worth money or gift certificates each time they submit a urine sample that tests negative for heroin and other drugs. In general, the more money that is offered, the more successful the incentive program. For example, in some of the most successful programs, patients have been able to earn up to $1,000 if they remained abstinent for three months.
abstinence complete avoidance of something, such as the use of drugs or alcoholic beverages
Patients like the incentive program because they can use the money earned to improve their life. For example, they can pay bills or exchange gift certificates for groceries and other items. The incentive program usually lasts for only three to six months. However, the program helps keep patients in treatment and promotes abstinence. During periods of abstinence, counselors and patients can work on making the lifestyle changes that will be necessary after the program ends.
Psychotherapy This type of treatment, usually practiced by psychologists, psychiatrists, or psychiatric social workers during one-on-one sessions with the patient, helps patients gain insight into their lives and behaviors. The therapist listens sympathetically and patiently, and tries to understand the patient’s problems without judging or criticizing. Psychotherapy can also be practiced in groups. Group treatment is popular and may be found in most treatment settings, including hospitals, outpatient programs, methadone programs, and therapeutic communities. Groups provide mutual encouragement and support among people who share similar problems. Patients in groups may benefit from the experience of others in solving these problems.
Relapse Prevention Some therapists practice an approach called cognitive-behavioral therapy. They try to change patients’ behavior and thinking without expecting to find insights into why patients began the behavior. Their main goal is to prevent relapse to drug use, rather than to identify the reasons why patients first tried drugs. Relapse is a serious problem in heroin abuse, so therapists try to teach patients the skills necessary to become and to remain drug-free.
Journalist Bill Moyers five-part series, Moyers on Addiction: Close to Home, on the PBS, was inspired by his experiences after finding out that his son was addicted to alcohol and drugs.
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Together, the therapist and the patient decide which factors (such as thoughts, places, people) are most likely to contribute to ongoing drug use or to act as triggers for relapse. Specific treatments then address these triggering situations. For instance, patients learn how to avoid drug-using friends and to stay away from places where the patient has bought and used drugs in the past. In some cases, patients may even want to change their phone numbers or move to new locations. Heroin abusers learn relaxation techniques to deal with stress, so that stress is less likely to trigger a desire for drugs. In addition, relapse-prevention therapists consider the way patients think before an episode of heroin use. These thoughts might be: “I must be loved and accepted by everybody or else I am a failure and might as well use drugs,” or “I will never be able to stop using drugs because I am an addict.” The therapist aims to change these negative ways of thinking. The patient learns new ways to think positively, such as: “I do not need everybody’s approval,” or “I can learn to gain control over my behavior.”
Effectiveness Several types of treatment for heroin abuse can be effective, but the best chances of success occur when patients remain in treatment for long periods. Studies have shown that the most effective treatment is a methadone-maintenance program combined with a variety of behavioral approaches, including counseling, individual psychotherapy, relapse prevention, and motivational incentive therapy. Drug use and crime can be reduced, and patients can improve the way they function as individuals and as part of society. S E E A L S O Heroin; Heroin Treatment: Medications; Methadone Maintenance Programs; Opiate and Opioid Drug Abuse; Tolerance and Physical Dependence; Treatment: History of, in the United States; Treatment Types: An Overview.
tolerance condition in which higher and higher doses of a drug or alcohol are needed to produce the effect or high experienced from the original dose dependent someone who has a psychological compulsion to use a substance for emotional and/or physical reasons
120
Heroin Treatment: Medications The most common way to take heroin is through injection. The rapid absorption of injected heroin into the bloodstream causes a rush and an intense high. At first, heroin users experience few lingering effects after a dose. The drug effects wear off after about six hours. Over time, however, addicts develop a tolerance to the drug’s effects and require larger and larger doses of heroin to achieve the same high or any high at all. They become physically dependent on the drug and experience withdrawal symptoms when they are not using the drug.
Heroin Treatment: Medications
Methadone, one of the most restricted drugs in the United States, acts as a substitute for heroin and relieves addicts of strong withdrawal symptoms.
After several weeks of use, an addict cannot use enough heroin to get a high but must continue to take it just to feel normal. The first and most common step in treating heroin addiction is detoxification. In the detoxification process, medications are used to treat withdrawal symptoms. Heroin withdrawal symptoms, which are similar to the symptoms of a severe flu, are rarely medically dangerous for those in good health. However, they are extremely uncomfortable. In many addicts, these symptoms make continuing to abuse heroin seem more attractive than detoxification.
detoxification process of removing a poisonous, intoxicating, or addictive substance from the body
An alternative approach to detoxification is methadone maintenance. Methadone, like heroin, is an opioid. The goal of methadone treatment is not to stop the addict from using heroin, but instead to substitute methadone for heroin. Methadone is a clear liquid, usually dissolved in a flavored drink, that is given once a day according to a
opioid substance that acts similarly to opiate narcotic drugs, but is not actually produced from the opium poppy
121
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craving powerful, often uncontrollable desire for drugs
doctor’s prescription. Methadone can ease addicts’ withdrawal symptoms and drug craving. The prescription of methadone is closely controlled by state and federal regulations.
Detoxification The simplest approach to detoxification is to substitute a prescribed opioid, such as methadone or naltrexone, for the heroin that the addict is dependent on. The dose of the opioid is then gradually reduced till the person is taking no drug at all. This method causes the withdrawal from heroin to be less severe, although the withdrawal symptoms may last longer. During detoxification, addicts are monitored to ensure that they are getting the right amount of medication. Too much may cause the person to be overly sedated; too little will not ease the withdrawal symptoms.
benzodiazepine drug developed in the 1960s as a safer alternative to barbiturates; most frequently used as a sleeping pill or an anti-anxiety medication depressant chemical that slows down or decreases functioning; often used to describe agents that slow the functioning of the central nervous system; such agents are sometimes used to relieve insomnia, anxiety, irritability, and tension dysphoria depressed and unhappy mood state
If the patient is a multiple-drug abuser, the detoxification process is more complex. If the patient has abused benzodiazepines or other depressants as well as opioids, the doctor usually treats the patient for withdrawal from these drugs first to prevent potentially fatal seizures. The medication phenobarbital is used to treat benzodiazepine withdrawal. The patient is then stabilized on methadone for the heroin addiction.
Clonidine. Prescribing an opioid to a drug addict can be a difficult and complex treatment. Another approach avoids these difficulties. This approach involves the drug clonidine (Catapres), which is prescribed to treat withdrawal symptoms. Clonidine is effective at easing many of the physical signs of heroin withdrawal, but it is less effective against other symptoms such as lethargy, restlessness, and dysphoria. Clonidine’s unpleasant side effects, such as low blood pressure, sedation, and blurry vision, make it unpleasant to take and therefore unlikely to be abused by addicts. Although clonidine has not been approved by the Food and Drug Administration for heroin detoxification, it is widely used for this purpose. Naltrexone. The drug naltrexone can help addicts detoxify quickly and help detoxified addicts stay off heroin. Naltrexone (Trexan) works by binding more strongly than heroin to the specific brain receptors to which heroin binds. If addicts who are dependent on heroin take a dose of naltrexone, the naltrexone will replace the heroin at the brain receptor. The addicts will feel as if all the heroin has been suddenly taken out of their body. This rapid reduction in heroin at the brain receptor causes withdrawal. Although this withdrawal is usually more severe than the withdrawal caused by simply stopping heroin use, it accomplishes detoxification more quickly. As a result,
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a combination treatment of clonidine to ease withdrawal symptoms and naltrexone to accelerate the pace of withdrawal has been used for rapid detoxification. After detoxification, naltrexone can prevent addicts from returning to heroin use. Because naltrexone blocks heroin’s effects, heroin addicts on naltrexone who use heroin will only be wasting their money. Naltrexone is prescribed as a pill that can be taken as infrequently as three times a week. It has few side effects. On the other hand, many addicts will not voluntarily take naltrexone because it does not satisfy cravings. In addition, naltrexone cannot be given to patients with hepatitis or liver failure.
Methadone Maintenance Methadone is the most common medication used for the maintenance treatment of heroin addicts. Methadone satisfies the heroin user’s craving for heroin. The more important effect of methadone, however, is tolerance to it. Addicts maintained on a stable dose of methadone do not get high from each dose because they are tolerant to it. (Methadone-maintained addicts can take methadone doses that would cause a first-time drug user to die of an overdose.) This tolerance extends to heroin, and methadone-maintained addicts who use heroin experience a lesser effect because of the tolerance. Generally, methadone-maintained addicts do not appear to be either intoxicated or in withdrawal. Methadone-maintained addicts may experience some of the side effects of opiates (such as constipation and excessive sweating) that they do not become tolerant to. However, methadone maintenance presents no known medical dangers.
intoxicated state in which a person s physical or mental control has been diminished
Only licensed programs can dispense methadone, usually on a daily basis. Addicts generally have a positive attitude toward methadone maintenance. The risk of withdrawal symptoms if methadone treatment is interrupted provides a strong incentive for addicts to keep appointments at methadone clinics. The ritual of daily clinic attendance also helps to bring structure to the chaotic lives of most heroin addicts. Methadone treatment is often supplemented with medical, financial, and psychological support services to address the many needs of addicts. Methadone-maintained addicts show decreases in heroin use, crimes committed, and psychological symptoms. The major drawbacks to methadone maintenance include the great difficulty of achieving detoxification from methadone, methadone side effects, and the possibility of increased use of other illegal drugs such as cocaine. 123
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An opiate addict initially coming in for treatment will usually be put through detoxification and possibly put on naltrexone maintenance. Younger addicts and adolescents are urged to try nonmethadone approaches, in order to avoid developing a methadone addiction. Methadone maintenance is usually reserved for patients who have failed at previous detoxifications. An exception is made for pregnant women. For pregnant addicts, methadone maintenance is the treatment of choice, with detoxification of the infant from methadone accomplished after birth. Heroin detoxification is risky in pregnant women because of the negative effects on fetal development in the first and second trimesters, and the risk of miscarriage.
Other Mainenance Medications Medications other than methadone for maintenance treatment of heroin addiction are coming into wider use. The drug buprenorphine (Buprenex) is safe even at high doses, and causes less severe withdrawal symptoms than methadone after a person stops taking it. Buprenorphine blocks receptors in the brain, thus interfering with heroin’s effects. One drawback of buprenorphine is that it causes drowsiness in a majority of patients. Another medication recently approved for treating heroin dependence is LAAM (levomethadyl acetate). LAAM is similar to methadone but lasts longer, so it is less expensive to use and does not require daily visits to clinics.
Medications for Heroin or Methadone Overdose Overdosing on heroin is most likely when the street drug is unusually strong or when the heroin has been mixed with a stronger opioid (such as fentanyl). The three major signs of an overdose are coma, pinpoint pupils, and depressed respiration (slowed breathing). If a large overdose has been taken, the body temperature falls, and the patient’s skin becomes cold and clammy. The muscles relax, the jaw loosens, and the tongue may fall back, blocking the patient’s airway. Death may occur due to respiratory failure (the person stops breathing). Naloxone (Narcan) is the treatment of choice for a heroin overdose. In most cases, the naloxone is given slowly in order to reverse the respiratory depression without causing a withdrawal syndrome. The side effects of naloxone given too rapidly include nausea, vomiting, and sweating. Patients treated for a heroin overdose should be kept in the hospital and observed for at least twenty-four hours, because naloxone is a relatively short-acting drug and the patient’s respiratory depression may recur within several hours. 124
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Conclusion No medication will prevent an addict who wants to use heroin from doing so. Heroin addiction is, in many ways, a physical problem as well as a psychological and behavioral problem. Heroin addicts spend most of their waking lives finding, using, and withdrawing from heroin. The medications used to treat heroin abuse are critically important to break the cycle of addiction. However, addicts whose lives are in chaos require not only medication but other treatments to help them lead normal lives. There is evidence that methadone treatment is more effective if an addict is also receiving rehabilitation and counseling. SEE ALSO Babies, Addicted and Drug-Exposed; Complications from Injecting Drugs; Heroin; Heroin Treatment: Behavioral Approaches; Methadone Maintenance Programs; Naltrexone; Opiate and Opioid Drug Abuse.
High School Senior Survey See Adolescents, Drug and Alcohol Use
Homelessness In the late twentieth century, homelessness became a serious issue in the United States. Increased numbers of men and women were living in shelters or on the street. Many viewed homelessness as a condition caused by excessive drinking and drug abuse. Although this view has a long history in American life, the picture is in fact more complicated. Other factors besides alcohol and drug abuse have contributed to the problem of homelessness in modern society.
A L C O H O L , D RU G , A N D M E N TA L H E A L TH (A DM) P ROBLE MS A M O N G H O ME L E S S C L I E N TS I N 1 9 9 6 Specific Combinations Alcohol Problem Only Drug Problem Only Mental Health Problem Only Alcohol/Drug Problems Alcohol/Mental Health Problems Drug/Mental Health Problems Alcohol/Drug/Mental Health Problems No Alcohol, Drug, or Mental Health Problems
Past Month (%)
Past Year (%)
Lifetime (%)
13 7 17 7 10 5 8 34
12 7 15 10 10 7 14 26
9 6 10 15 15 8 30 14
Homelessness is linked with alcohol and drug problems, but it is also linked to mental illness and poverty.
Interagency Council on the Homeless. “Homelessness: Programs and the People They Serve,” U.S. Department of Housing and Urban Development, 1999. .
SOURCE:
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A Historical Background of Homelessness The word “homeless” can be understood in two ways. In its most literal meaning, “houseless,” the word has been used to describe people who sleep outdoors or who live in temporary housing. In earlier generations, a homeless person was often a hobo, and the local police station was the most likely place to find temporary housing. In the second meaning of the word, “homeless” describes someone who lacks a sense of belonging to a particular place and who has little or no connection to a community. In the rural- and small-town society of the nineteenth century, family was strongly linked with place. Home was the basis for community and social order, and traditions of people helping each other and joining together to control troublesome behavior grew out of this sense of place. To be homeless was to be unattached, outside this web of support and control. It was also to be without the resources necessary for living. Many of the young men and women who moved from farm to city, or those who emigrated during the nineteenth and early twentieth centuries, were unattached in this respect. In fact, such groups as the YWCA, YMCA, and various ethnic organizations were established both to help and oversee these “homeless” people. By the 1840s, it was common for Americans to link homelessness with a habit of drunkenness. In the popular view, drunkards, usually men, drank up their wages and impoverished their families; they lost their jobs and their houses, and drove off their wives and children by cruel treatment. They became outcasts and drifters, and their wives entered poorhouses while their children became inmates of orphanages. By the 1890s, the public held the same ideas about people who abused drugs such as opium, morphine, and cocaine and the unhappy circumstances of their families.
The Effect of Homelessness on the Economy Homelessness in the United States has often been the result of conditions beyond the control of the individuals themselves. Studies of homelessness prior to the Great Depression noted that the numbers of homeless people went up and down depending on economic conditions. Severe problems with the United States economy in the latenineteenth and early-twentieth century caused large numbers of people to lose their jobs and thus their financial security. Scholars investigating the problem of homelessness before the depression also noted the importance of employers’ decisions about hiring and firing. When the economy soured, workers without families to support and workers seen as the least productive were the first 126
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to be fired. For example, employers assumed that single young women would be supported by their families and that married women did not really need a second income. Older men, single men known to drink heavily, and members of ethnic or racial minorities were more often marked for layoff. By contrast, in boom times employers relaxed their standards for hiring and job performance. All but the most seriously disabled, and the most unreliable heavy drinkers and drug users, could find some kind of work. As a result, when the economy was good, the numbers of the homeless shrank.
Homeless shelters often face overcrowding and a lack of public support. In Massachusetts, the Worthington House shelter is already at full capacity on a Thursday evening.
Working Conditions and Health Care Pre-depression observers also emphasized the impact of other factors on homelessness, including working conditions, the health and strength of the worker, and the lack of government support for people who lost their income. Working conditions were often dangerous, and diseases such as tuberculosis affected large numbers of people. Many men became disabled by disease or workplace accidents, often at a young age. There was not much in the way of welfare to support people when they had lost their jobs. In addition, medical treatment at the time was often ineffective. As a result, these men rapidly sank into terrible poverty. They were forced to beg, find a meal at soup kitchens, and sleep in shelters or the cheapest lodgings infested with vermin. (These lodgings came to be called “flophouses.”) Some of these men were heavy drinkers, and some were drug users. But these problems often grew out of the conditions of poverty and rootlessness. 127
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Scholars of homelessness also realized that the urban areas where homeless people clustered, as well as the businesses—both legal and illegal—they were involved in, reinforced a homeless way of life. In these areas, called “hobohemias” before the depression and later “skid row,” the poor and the homeless could find cheap restaurants, saloons, residential hotels and lodging houses, private and eventually public welfare agencies, and agencies that listed opportunities for “day” work. They could also find a flourishing drug trade in many corners of skid row. By the 1940s, skid row was where poor single men disabled by age, injury, and/or chronic illness wound up. They survived on private charity, small allowances from public welfare, modest pensions, and a bit of income from odd jobs. It is important to note that these men were not homeless in the sense of having no place to live. However, they were homeless in the sense of remaining outside the bounds of society. Contrary to popular belief, only a minority—perhaps onethird—were heavy drinkers and drug users.
New Government Programs and Policies The period from 1941 to 1973 was a time of prosperity in the United States. During the same period, the government increased welfare programs, such as Medicare, affordable housing, and benefits for the disabled. New programs to help heavy drinkers and drug users were created, and local governments began investing in projects to clean up urban areas and give new life to cities. Many observers believed that skid row would disappear. One important result of these changes was to improve the economic circumstances of the elderly. Today, very few of the homeless are elderly. Other results were not as people had hoped. Some cities bulldozed their skid-row area. But the people driven out of skid row did not go on to find other, better housing or better lives. In fact, homelessness became a literal condition: the poor had no houses to live in. In the early 1980s the media began to report on a new generation of younger homeless people. These people appeared to have high rates of mental illness, heavy drinking, and drug use. As a result, many observers explained the new homelessness as a result of policies that concerned mental hospitals and imprisonment for public drunkenness and minor drug offenses. During the 1960s and 1970s many states “deinstitutionalized” both mentally ill people and alcoholics and addicts. In other words, large numbers of state hospital patients were released. New laws made it much harder to commit a person involuntarily to a mental institution. 128
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PE R C E N TAG E S O F H O M E L E S S PE O PL E WHO HA D EX P E RI ENCES W IT H AL C O H OL A N D S U B S TA N C E U S E B Y A GE Age when homeless person first started drinking 3 or more alcoholic beverages per week
A significant percentage of homeless (both current and formerly) used alcohol and illicit substances while in their teens.
Before age 15
Between ages 15 and 17 0
5
10
15
20
25
30
35
40 Currently Homeless
Percent
Formerly Homeless When first started using illegal drugs Before age 15
Between ages 15 and 17 0
5
10
15
20
25
30
35
Percent SOURCE: Interagency
Council on the Homeless. “Homelessness: Programs and the People They Serve,” U.S. Department of Housing and Urban Development, 1999. .
Many states also “decriminalized” public drunkenness. People who were drunk in public were sent to places where they could sober up rather than to jail. Similarly, many minor drug offenders were kept out of jails. Homelessness was described by many as a condition in which troubled and troublesome people found themselves. They were not only houseless, they were barred from institutions that had once sheltered them.
Current Situation Some recent studies of homelessness continue to claim that perhaps 85 percent of homeless people are substance abusers and/or mentally ill. However, these studies have a serious flaw. Their estimates of substance abuse and mental illness rely on measurements of lifetime substance abuse, rather than measurements of current substance abuse. A measure of whether a person has ever had a severe mental illness or substance abuse disorder will always produce much higher rates than a measure of a current disorder (defined as occurring within the previous six months or one year of the study). Probably a more accurate estimate, provided by the Substance Abuse and Mental Health Services Administration, is that about a third of the homeless people in the United States have serious mental illness, and more than half also have an alcohol and/or drug problem. The proportion is much higher among single men and much lower among adults who are homeless in family groups, most often single women with children. 129
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Heavy drinking, drug use, and mental illness are certainly risk factors that make it more likely that some people will become homeless. Yet clearly most people with such problems never become homeless. To explain homelessness, then, other risk factors must be considered as well. These factors were first discussed a century ago, and still apply to the modern problem of homelessness. These factors include changes in the economy, the supply of available and affordable housing, the availability of support systems such as welfare and medical care, and whether a person has the support of his or her family. An additional factor contributing to homelessness in the latetwentieth century was the size of the baby-boom generation. The risk for developing mental-health, alcohol, and drug problems is greatest between the ages of 18 and 25. The huge baby-boom generation reached this age at the same time as the supply of jobs, housing, and other material goods was becoming scarce.
Changes in the Economy. Changes in the economy have increased the number of highly skilled, well-paid technical jobs (such as those in the field of computers) and low-skilled, poorly paid service jobs (such as those in the fast-food industry). At the same time, these changes have reduced the number of semiskilled, well-paid jobs in the field of manufacturing. This shift from a manufacturing to a service economy is known as deindustrialization. Hardest hit by this shift are the younger members of the huge baby-boom generation (born between 1946 and 1964), especially Hispanics and African Americans. People in this group may lack the advantage of higher education or advanced technical training when they try to find work. They are not qualified for highly skilled work but cannot make a decent living in service jobs. People who work for low hourly wages are sometimes called the “working poor.” Although many of these people work very hard, they remain poor and vulnerable to losing their housing. Housing. Along with changes in the job market, the cost of rental housing rose sharply in the 1980s. The amounts of aid given by federal and state welfare programs and unemployment insurance did not rise enough to meet these costs. As a result, it became increasingly difficult for poor families to establish and maintain households. The 1990s were a time of economic growth. However, this prosperity did not lessen the problem of homelessness. The general prosperity of the decade had little effect on the poorest members of society. In addition, economic expansion usually has the effect of increasing rents. The number of low-rent apartments decreased by 13 percent from 1996 to 1998. At the same time, the Department of 130
Homelessness
Housing and Urban Development provided assistance to fewer households. The crisis in affordable housing became worse during the great boom. People with serious mental illness are overrepresented among the homeless population. While only 4 percent of the U.S. population has serious mental illness, five to six times as many people who are homeless (20–25%) have serious mental illness, and many more have milder forms of mental health problems. The reasons for this overrepresentation are complex. Some mentally ill people are homeless because they were released from institutions or hospitals, or have not been hospitalized despite a need. Moreover, since they have trouble keeping a job, they are often poor or financially unstable, and they receive little or no health care. Thus, their symptoms are often active and untreated, making it very difficult for them to negotiate meeting basic needs for food, shelter, and safety. Up to half of the mentally ill homeless also have substance use problems, which can make it harder to obtain a stable living situation. Also, according to the National Resource Center on Homelessness and Mental Illness, people with serious mental illnesses have greater difficulty exiting homelessness than other people. They are homeless more often and for longer periods of time than other homeless subgroups. Many have been on the streets for years. Numerous government and private agencies have proposed plans to reduce and eventually prevent the problem of homelessness among the mentally ill, but progress will likely be slow.
Conclusion Every night in the United States, about 750,000 people are homeless. In a year, between 2.5 million and 3.5 million people experience homelessness for some period of time (days to months). Among people who remain homeless for long periods, rates of heavy drinking and drug use are very high. It is not the case, however, that drinking and drugs directly cause homelessness. Drinking and drug use may cause health problems and troublesome behavior, such as criminal activity. These health and behavior problems contribute to job loss, loss of family support, or loss of housing. Problems in the economy worsen these circumstances. In addition, far fewer people who need care and treatment for mental-health and addiction problems can turn to institutions as a place to live during recovery. As a result of many factors other than drinking and drugs, the homeless became a visible problem on the streets of American cities. S E E A L S O Alcohol: History of Drinking; Alcohol- and Drug-Free Housing; Poverty and Drug Use; Risk Factors for Drug Abuse; Treatment: History of, in the United States. 131
Imaging Techniques: Visualizing the Living Brain
I noninvasive not involving penetration of the skin
Imaging Techniques: Visualizing the Living Brain Computer systems can construct images of the human brain. These noninvasive procedures are valuable for studying how abused drugs affect the brain. Imaging techniques that use nuclear medicine (radiation) are positron emission tomography (PET) and single photon emission computed tomography (SPECT). For these imaging studies, human volunteers take small amounts of radioisotopes (radioactive material). PET and SPECT provide a visualization of their brains and a measurement of biochemical processes. A more recent imaging technique is functional magnetic resonance imaging (MRI), a technique that makes it possible to construct brain images without radiation. PET scanning is most commonly used to measure brain metabolism (consumption of glucose) or blood flow in the brain. PET is also used to map and measure specific brain-cell receptors for drugs and neurotransmitters (brain chemicals). Brain metabolism and brain blood flow both reflect the activity of brain cells. Under normal circumstances, brain metabolism and blood flow are tightly coupled. The most active brain cells require the most glucose, a sugar that is the primary energy source of the adult brain. Brain regions that contain the active cells also require high rates of blood flow for the delivery of nutrients and oxygen. In some conditions, however, including those caused by some drugs, brain metabolism and blood flow rates may be uncoupled. SPECT also produces useful images using similar techniques, but the images are not as clear and precise as those produced by PET. Functional MRI produces very clear and precise brain images. Advances in MRI technology have made it possible to measure functional blood volume in the brain. Blood volume is closely related to blood flow. Activation of a brain region causes increased blood flow to that region. The activated region receives more oxygen than it requires for the increased activity. The oxygen then accumulates, as do the blood cells that carry the oxygen. MRI can measure the resulting volume of blood. Current imaging techniques can indicate the serious and longterm effects of drugs of abuse. Such information may lead to greater understanding of the causes and the consequences of substance abuse. Ultimately, imaging techniques may help researchers find more effective prevention and treatment strategies. S E E A L S O Brain Chemistry; Brain Structures.
132
Inhalants
A magnetic resonance imaging (MRI) scan of a normal human brain can help show how the brain works. The green dot is the hypothalamus, which regulates the body by monitoring factors such as blood pressure and temperature.
Inhalants Inhalants are solvents or anesthetics that are administered by being breathed in. Examples include paint thinners, glues, hair sprays, spray paints, lighter fluids, nitrous oxide, propane, and nitrites. When these substances are purposely inhaled (breathed in) for the purpose of obtaining a “high,” they become drugs of abuse. Most have a depressant effect on the central nervous system, but some cause seizures (wild discharges of electricity in the brain that can cause unconsciousness and involuntary jerking of the muscles). Inhalants are possibly the most toxic (poisonous and dangerous) of abused substances and can produce a wide range of injuries and death, depending on the chemical makeup of what is inhaled. Because inhalants are not intended for human consumption, no tests are performed to determine how safe they are, in contrast with safety testing conducted on medications intended for human use.
depressant chemical that slows down or decreases functioning; often used to describe agents that slow the functioning of the central nervous system; such agents are sometimes used to relieve insomnia, anxiety, irritability, and tension
133
Inhalants
In Cambodia, a young boy attempts to get high by inhaling glue from a plastic bag. Inhalants are popular among children and young teens because they are inexpensive and easily obtained.
Abuse of solvents involves putting the solvent in a closed container or saturating a piece of cloth and inhaling through it. Compressed gases are sometimes released into balloons and inhaled; directly releasing these substances into the mouth may freeze the larynx, causing death through choking. Once the chemical is inhaled, the speed and duration of its action are determined by how quickly it dissolves in the blood and brain, and by respiratory and cardiac actions in the body.
The Extent of the Problem Approximately 2.1 million youths aged 12 to 17 had used inhalants at some time in their lives as of 2000, according to the National Household Survey on Drug Abuse. The 2001 Monitoring the Future survey showed that 17.1 percent of 8th graders, 15.2 percent of 10th graders, and 13.0 percent of 12th graders said they had abused in134
Inhalants
halants at least once. Only marijuana, alcohol, and cigarettes are more frequently abused substances among this age group. Inhalant abuse originally came to public attention in the 1950s. The news media reported that young people seeking a cheap high were sniffing glue. The term “glue sniffing” is still widely used to refer to inhalation of a broad range of common products besides glue. With so many substances lumped together as inhalants, obtaining accurate research data for each kind of inhalant—how often it is used and by whom—is difficult. However, evidence indicates that inhalant abuse is far more common among all social and economic levels of U.S. youth than parents and the public typically recognize. For example, the 2001 Monitoring the Future survey shows that 17.1 percent of 8th graders had used an inhalant at least once in his or her lifetime. Lifetime inhalant use among 12th graders, which had increased steadily for most of the 1980s and early 1990s, gradually declined again after 1995 (probably as a result of an anti-inhalant advertising campaign) and stood at 13 percent in 2001; 10th graders reported a lifetime inhalant use of 15.2 percent. Inhalants are most commonly used by young adolescents because they are easier to obtain than most other legal or illegal substances. For example, while 4 percent of 8th graders reported using inhalants within the past thirty days, known as current use, only 1.7 percent of seniors reported current use of inhalants. Use of inhalants, unlike other drugs, declines as students grow older. Inhalant abuse shows up in short-term outbreaks in particular schools or regions. As with other fads, specific inhalant practices or products become popular for short periods. The ever-changing popularity of various products as inhalants complicates efforts to track the problem. One major obstacle to recognizing the size of the inhalant problem is the ready availability of products that are inhaled. Inhalants are cheap, or even free, and can be purchased legally in retail stores in a variety of seemingly harmless products, such as model airplane glue, hair spray, spray paint, cigarette lighter fluid, nail polish remover, and typing correction fluid, often referred to as “white out” (originally a brand name). As a result, adolescents who sniff inhalants to get high are much less likely to get caught than abusers of other drugs.
Understanding the Problem of Inhalant Abuse Inhalant abuse is a neglected front in the war on drugs. Much of the public views the abuse of inhalants, which include a broad 135
Inhalants
PE R C E NTA GES OF A DOLE S CE NTS A DMI TTED TO P ROGRA MS FOR I N H A L ANT A BUS E WHO A LS O A BUS ED OTHE R DRUGS
Both Alcohol and Marijuana
Other Drugs Abused
Although some people dismiss the issue of inhalant abuse, professionals who work with inhalant abusers disagree about its seriousness. They point out that inhalant abusers often use other drugs, and that the abuse of inhalants signals a serious problem.
Marijuana Only Marijuana and a Drug other than Alcohol Alcohol Only Alcohol and a Drug Other than Marijuana Other Drugs/Drug Combinations None (Abused Inhalants Only) 0
10
20
30 Percent
40
50
60
SOURCE: Treatment Episode Data Set-Substance Abuse and Mental Health Services Administration. .
array of cheap and easily obtainable household products, as a relatively harmless habit and not in the same high-risk category as drugs such as alcohol, cocaine, and heroin. Some adults view inhalant “sniffing,” “snorting,” “bagging” (when fumes are inhaled from a plastic bag), or “huffing” (when an inhalant-soaked rag is stuffed in the mouth) as a kind of childish fad similar to youthful experiments with cigarettes. Most troubling is adolescents’ own view of using inhalants as a fun pastime. The truth is that inhalant abuse is deadly serious. Sniffing volatile solvents, which include most inhalants, can cause severe damage to the brain and nervous system. By starving the body of oxygen or forcing the heart to beat more rapidly and unevenly, inhalants have killed sniffers, most of whom are adolescents.
Who Abuses Inhalants? The number of girls who sniff solvents is on the rise. Studies in New York State and Texas report that males are using solvents at only slightly higher rates than females. Among Native Americans, whose solvent-abuse rates are the highest of any ethnic group, lifetime prevalence rates for males and females were nearly identical, according to 1991 data from the National Institute on Drug Abuse. Low household income provides one explanation for the higher rate of use among Native Americans. There is a public perception that inhalant abuse is more common among Hispanic youth than among other ethnic groups. However, surveys have not found high rates of abuse by Hispanics in all geographic areas. Rates for Hispanics may be related to socioeconomic 136
Inhalants
conditions. Hispanic youths in poor neighborhoods may use solvents heavily, but Hispanic youths in less stressful environments do not. Children as young as 4th graders have been known to use volatile solvents. Studies show that inhalant abusers typically use other drugs as well, so 9-year-old abusers will eventually experiment with other drugs—usually alcohol and marijuana. Adolescent solvent abusers are multiple-drug users who will use whatever is available, although they show a preference for solvents. Older adolescents look down on solvent abuse as a childish habit.
Three bottles of amyl nitrite poppers, a liquid drug that is sniffed as a vapor.
Reports from the mid-1990s indicate that college-age and older adults are the primary abusers of butane and nitrous oxide. Some cases of nitrous oxide abuse have involved dentists, anesthesiologists, and medical and dental students. Because nitrous oxide has a medical use, especially in dental offices, these people have greater access to nitrous oxide. Unfortunately, not even these medical and dental personnel and students realize the hazards of inhaling too much nitrous oxide or doing so too frequently. More recently, the dental profession has 137
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IN THEIR OWN WORDS Drugs are wrong. They burn out your brain and they sear your soul. William J. Bennett, former Director of the Office of National Drug Control Policy, and U.S. Secretary of Education, 1989
sought to educate its members on the risks of nitrous oxide abuse and to get support and treatment for professionals who have trouble stopping this abuse. Unfortunately, very little documented information is available on inhalant abuse. Survey data on the prevalence of inhalant abuse are difficult to obtain, and what information does exist may underemphasize the severity of the situation. No one knows exactly how many adolescents and young people die each year from inhalant abuse, in part because medical examiners often attribute deaths from inhalant abuse to heart problems, suffocation, suicide, or accidents. In addition, no national system exists for gathering data on the extent of inhalant-related injuries. Medical journals have described the situation as serious, yet doctors and emergency medical personnel are not adequately trained to recognize and report symptoms of inhalant abuse.
The Dangers of Inhalant Abuse Inhalants do more serious damage to the central nervous system than most people realize. Injuries include: • paralysis and loss of bowel and bladder control • permanent brain damage • permanent damage to fine motor control (the ability to perform small, precise movements, such as when writing, using scissors, sewing, and so on) Despite the dangers associated with inhalant abuse, no systematic method for reporting deaths and injuries from abusing inhalants exists in the United States. Individual reports from various regions indicate that toluene-containing products, such as spray paints and lacquers, have been responsible for deaths among teenagers. Abusers who inhale toluene-containing mixtures run a very high risk of permanent brain injury. Other abused substances that often result in death when used as inhalants include gasoline and nitrous oxide. “Whippets,” small canisters of nitrous oxide used to make whipped cream, are a source for this activity. They have also been incorporated into various products, such as balloon inflators.
Preventing Inhalant Abuse epidemic rapid spreading of a disease to many people in a given area or community at the same time
138
Doctors and emergency room staffs need to be aware that the profile of the teenager who inhales volatile solvents is not limited to certain ethnic groups or the lower economic status. Many sources assert that the abuse of readily available inhalants has reached epidemic proportions, indicating an urgent need for preventive efforts.
Kava
Prevention of inhalant abuse requires educating the public, particularly young people, about the dangers of solvents. Signs of inhalant abuse include: • chemical odors on breath or clothing • paint or other stains on face, hands, or clothing • hidden items associated with inhalant abuse, such as empty spray paint cans or solvent containers and chemical-soaked rags or clothing • drunk or disoriented appearance • slurred speech • nausea or loss of appetite • inattentiveness, lack of coordination, irritability, and depression A second possible way to prevent inhalant abuse is to require manufacturers to create less toxic products. Some have attempted to minimize the abuse of their products by adding irritants to make inhaling the products unpleasant. S E E A L S O Adolescents, Drug and Alcohol Use; Ethnic, Cultural, and Religious Issues in Drug Use and Treatment.
Internet See Gambling
Jimsonweed Jimsonweed is a tall, coarse, poisonous plant that flowers, produces seed, and dies in one year. A member of the nightshade family (Solanaceae), it produces a mind-altering substance called atropine. Atropine causes the pupils of the user’s eyes to widen. It can be used to stop muscular spasms, lessen pain, and reduce bodily secretions. Native Americans in what is now Virginia and woodland tribes of eastern North America made strong intoxicating substances from jimsonweed. S E E A L S O Drugs Used in Rituals.
Kava Kava is a beverage prepared from the root of the pepper shrub Piper methysticum, native to Asia, Australia, and islands in the region. The drink is called kava, Polynesian for bitter or pungent, because of its strong peppery taste. Several variations of this drink were once commonly used for social occasions as intoxicants in the islands of the South Pacific, especially Fiji.
J
K intoxicant substance capable of diminishing physical or mental control
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stupor state of greatly dulled interest in the surrounding environment; may include relative unconsciousness
Common effects of kava include muscle relaxation, euphoria—a feeling of intense well-being—and reduced fatigue. It also has effects on seeing and hearing. In large quantities kava can lead to a loss of muscular coordination and stupor. Since the mid-1990s, kava has gained popularity as an herbal supplement, along with remedies such as St. John’s Wort and ginkgo biloba. Millions of people take kava, which can be purchased without a prescription, under the belief that it relieves stress and sleeplessness. In the United States, herbal supplements like kava are considered neither food nor drugs. As such, they may be sold without the evaluation and approval of the U.S. Food and Drug Administration. In between 2000 and 2001, there were reports of a link between high doses of kava use and liver failure. As of March 2002, the FDA advised consumers to consult their healthcare providers before taking kava or preparations that contain kava until further study determines a safe dose. In particular, people with liver problems or who are taking other medications should consult with their healthcare provider before using kava. SEE ALSO Drugs Used in Rituals; Drug Use Around the World.
Ketamine Parents in the United States have sometimes been surprised to find a picture of a breakfast cereal box on their child’s bedroom wall. The breakfast cereal is Special K, and the display may well indicate their teen’s interest in the drug ketamine, which is commonly referred to as “Special K,” although there is no relationship at all between ketamine and the cereal or its manufacturer. As ketamine abuse has become increasingly common during recent years, other slang or street names have developed, such as “Vitamin K” and just “K.” Persons under the influence of ketamine are sometimes said to be in a “K-hole” or in “K-land.”
The Medical Uses of Ketamine Ketamine is used medically to produce a brief period of anesthesia, during which the individual usually feels as if he or she is dissociated, or separated, from his or her body. This is called dissociative anesthesia. Ketamine is given by injection and is most commonly used in pediatric patients undergoing short, outpatient surgical procedures. It is also used in clinics for patients who have painful burns that require frequent changing of the dressings. When patients are anesthetized with ketamine, they usually do not respond to pain and appear very intoxicated, although they rarely actually lose consciousness. They often have their eyes open and even move their arms and legs. Patients usually do not remember what happened to them while they 140
Ketamine
Tweezers hold an ampoule containing a solution of ketamine, a drug with an anesthetic or analgesic effect.
were anesthetized with ketamine. When they recover from the anesthesia, patients often have unusual dreams and have trouble thinking clearly. As patients emerge from a ketamine-induced state, these reactions can be severe. People who abuse ketamine sometimes take high doses in order to produce a similar dissociative anesthetic state. Ketamine is also used by veterinarians to produce anesthesia for surgical procedures on pets and other animals. It can also be delivered through an injector gun to capture wild animals. Animals typically recover quickly from ketamine anesthesia or immobilization and are fine afterward. The veterinary source of ketamine is the basis for such street names as “cat Valium” and “kit kat.”
Ketamine Abuse The source of abused ketamine almost always is the theft of medical or veterinary supplies. Therefore, the drug is usually found in multi141
Ketamine
injection vials, or bottles into which a needle can be inserted and some of the contents removed. Abusers often inject themselves or their friends with ketamine from these vials, either in a vein or, more typically, in a muscle. It is also possible to drink a solution of ketamine, but this is rarely done. In some cases, sellers will remove the ketamine from syringes and dry it by evaporation or by “cooking” it in a spoon or bottle cap heated by a lighter. In this case it looks like a powder, which can then be inhaled or smoked or even made into a tablet or capsule. If ketamine is taken by injection, especially into the veins, the effects can come on very suddenly. If it is smoked or inhaled, the effects may take five to fifteen minutes to appear. People usually do not remain intoxicated on ketamine for very long, with most of the effects gone in an hour or two. Its effects are much shorter than those of PCP. Even so, as with PCP, users of ketamine can often feel strange for a day or two after using it. Although tests are readily available to measure PCP in the blood or urine of persons who use it, such analytical procedures are rarely used for ketamine. With the increase in ketamine abuse, this situation may change.
The Effects of Ketamine addiction state in which the body requires the presence of a particular substance to function normally; without the substance, predictable withdrawal symptoms are experienced tolerance condition in which higher and higher doses of a drug or alcohol are needed to produce the effect or high experienced from the original dose
142
The effects of ketamine are very similar to those of PCP. (The effects of PCP are discussed in the article Phencyclidine [PCP].) In fact, sometimes people who buy ketamine on the street are actually buying PCP, a drug that is easier to make. Like PCP, the effects of ketamine depend on the dose used. Abusers can sometimes anesthetize themselves if they take a very high dose, but usually they experience a dreamy state accompanied by changes in perception, particularly involving abnormal body feelings. It is common to experience nausea and dizziness. Reports of ketamine addiction are rare, but some tolerance to its effects can develop with repeated use.
Ketamine and the Rave Scene Because ketamine is sometimes used in raves or other party scenes, it is often referred to as one of the “club drugs.” Two other prominent club drugs are ecstasy (MDMA) and GHB. These club drugs produce very different kinds of effects and should not be confused with one another. When relatively low doses of ketamine are taken at dances, users can have a heightened experience of the music, the kinetic light displays, and their own dancing. These experiences are sometimes referred to as “K-waves.”
Ketamine
E ST IMAT E D E M E R G E N C Y R O O M V I S I TS FOR K E TA MI NE A BUS E B E T W E E N 19 9 4 A N D 2 0 0 0
263
2000
396
1999
Year
1998
Abuse of the drug ketamine, sometimes referred to as Special K, results in hundreds of emergency room visits every year.
209 318
1997 81
1996
150
1995 19
1994 0
50
100
150
200
250
300
350
400
Number of Visits SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Adminstration, Drug Abuse Warning Network, 1999 (March 2000 update). .
The Dangers of Ketamine Abuse Probably the greatest danger to ketamine abusers is that they will harm themselves or others while intoxicated. Ketamine, because of its depressant effects, interferes with coordination and produces dizziness and confused thinking, greatly increasing the risk of accidents or other harmful behaviors. Alcohol also has depressant effects and can increase ketamine intoxication when they are used together. If users vomit, the vomit can get inside their lungs, resulting in a serious medical emergency or death. Because ketamine intoxication can result in bizarre and unpredictable behavior, ketamine users often become involved in fights or other violent acts.
depressant chemical that slows down or decreases functioning; often used to describe agents that slow the functioning of the central nervous system; such agents are sometimes used to relieve insomnia, anxiety, irritability, and tension
As with PCP, ketamine abusers can also have very bad experiences, including bad trips, panic attacks, and exaggerated mood swings. They can be enjoying themselves one minute and then, with little warning, become frightened, act bizarrely, and become a danger to themselves and to others around them. People who may be at risk for mental illness may experience psychological problems as a result of ketamine use. Relatively little is known about the problems of long-term use of ketamine, but some abusers may develop personality changes and a mental illness similar to that sometimes seen in PCP abusers. Despite its clear dangers, there are people who promote the use of ketamine as a way to expand the mind and achieve a spiritual discovery. Just as the ideas of Timothy Leary, a Harvard professor, prompted many people to take LSD in the 1960s, Dr. John Lilly, a neuroscientist, advocated the use of ketamine. His book, The Scientist: A Metaphysical Autobiography (1996), is widely cited on the Internet as a source of inspiration for ketamine users. People who are
LSD lysergic acid diethylamide is a powerful chemical compound known for its hallucinogenic properties
143
Khat
thinking about trying ketamine for its effects on the mind should be aware that the drug can be extremely dangerous. S E E A L S O Hallucinogens; Phencyclidine (PCP); Rave.
Khat
stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system amphetamine central nervous system stimulant, used in medicine to treat attention-deficit/hyperactivity disorder, narcolepsy, and as an appetite suppressant; may be abused dependence psychological compulsion to use a substance for emotional and/or physical reasons withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance depression state in which an individual feels intensely sad and hopeless; may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities; in extreme cases, may lead an individual to think about or attempt suicide
144
Khat is a shrub or small tree (Catha edulis) that grows in the higher regions of Yemen and East Africa. The plant is called qat in Yemen, tschad in Ethiopia, and miraa in Kenya. Chewing the leaves, buds, and sprouts of khat releases a substance that acts as a stimulant. Khat leaves can be made into a tea, but chewing is the most common way to achieve the stimulating effects. A person chews each leaf thoroughly and swallows the juice. Fresh, young leaves produce the greatest effect. In Yemen, people often get together to chew khat in social settings, much as people in the United States or Western countries gather at coffee houses or in pubs for a beer. Use of khat is an important tradition and an essential part of a successful social life. In Yemen, many houses have a room set aside for the khat session, for which men meet almost every day. Women use khat less formally and much less frequently. In East Africa, khat is used in a more recreational way. The leaves are sometimes chewed in combination with drinking alcohol or taking other drugs. Farmers and craftspeople chew khat to improve work performance and to stay alert. Khat consumption has increased during recent decades. About 5 million portions of khat are consumed per day. Although most of this use occurs in the region where it grows, khat is also exported by air to Europe and North America, where it is sold mainly to immigrants from Yemen and East Africa.
The Effects of Khat Khat is a mild stimulant of the central nervous system (the brain and spinal cord). It produces a state of mild euphoria (a feeling of wellbeing) and excitement, often accompanied by talkativeness. Large doses may cause restlessness and highly excited behavior. Taking too much of the drug may lead to toxic psychosis. Khat also produces loss of appetite and constipation. A person who has taken a large amount of khat will have dilated pupils and a staring look. A habit of chewing often results in brownish stains on the teeth. Khat’s effects are very similar to those of amphetamines. Longterm use of khat can cause dependence, with withdrawal symptoms
Law and Policy: Controls on Drug Trafficking
that include slight trembling, lethargy, mild depression, and bad dreams. People who are dependent on khat often become obsessed with obtaining daily supplies of the drug. They often seek the drug even if it means that other important needs will not be met. In the countries where khat use is widespread, use of the drug has serious social and economic consequences. S E E A L S O Amphetamine; Drug Use Around the World.
Law and Policy: Controls on Drug Trafficking
obsessed someone who experiences repeated thoughts, impulses, or mental images that are irrational and that the person cannot control
L
The United States is one of the largest and most profitable drug markets in the world. According to the Office of National Drug Control Policy, Americans spent approximately $64 billion on illegal drugs in 2000. About $35 billion of that total was spent on cocaine, $10 billion each on heroin and marijuana, and $5 billion on methamphetamine. Major sources of heroin include Afghanistan, Pakistan, Burma, Mexico, and Colombia. Most of the cocaine supply comes from Colombia. Marijuana is grown across much of the globe, including in the United States, with Mexico currently being the most important exporter to the U.S. market. Methamphetamine supplies come primarily from Mexican and domestic sources. According to estimates from the 2000 National Household Survey on Drug Abuse, 2.8 million Americans are dependent on illegal drugs, and 1.5 million are classified under the less severe category of abuser. The Drug Enforcement Administration (DEA) reports that there are an estimated 11.5 million marijuana users in the United States, and that one-third of Americans have used marijuana at some point in their lives. The University of Michigan conducts an annual survey, “Monitoring the Future,” about drug use by young people. The most recent survey indicates that more than 50 percent of high school seniors experimented with illegal drugs at least once before graduation. Asked about their recent use, 25 percent of seniors said they had used illegal drugs in the month prior to the survey.
Controlling the Drug Supply In an attempt to combat the sizable illegal drug market, the United States drug control strategy has been based on a simple theory of deterrence. According to this theory, intense law enforcement pressure on the drug supply will reduce drug use by making drugs scarcer, more expensive, and riskier to buy. 145
Law and Policy: Controls on Drug Trafficking
Guided by a narcotics dog, an airport security guide inspects travelers luggage at an airport in Ecuador.
Following this basic logic, law enforcement targets each link in the drug trafficking chain. Pressure begins abroad at the point of production and processing of drugs. Next, efforts are made to stop drugs from entering at the U.S. border. And finally, law enforcement attempts to disrupt distribution networks and sales within the United States. The term “supply-side” strategy is used to describe this kind of attempt to reduce illegal drug use by limiting the available supply. The United States has devoted enormous resources to carrying out this supply-side strategy. Federal funding for drug control expanded from $1.5 billion in 1980 to $18.8 billion in 2002. Roughly 70 percent of the budget was devoted to law enforcement. The rest of the federal anti-drug budget focuses on “demand-side” measures that emphasize treatment, prevention, and education. The first line of defense in the strategy to control drug supply targets the countries that produce and traffic drugs. As a result, drug
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Law and Policy: Controls on Drug Trafficking
T O TAL P O U ND S O F D R U G S S E I Z E D I N 19 9 9 BY THE DRUG E NF O R C E ME N T A G E N C Y, FE D E R A L B U R E A U OF I NV E S TI GATI ONS , U . S . C U S T O M S S E R V I C E , A N D U . S . B O R D E R PAT R O L Hashish 1,681
Heroin 2,788
In twenty-five years, the Drug Enforcement Agency has doubled its number of special agents, and its budget has swelled from $141 million per year to $1.5 billion.
Cocaine 290,756
2,326,286 Marijuana
Total = 2,621,510 Drug Enforcement Administration, Federal-wide Drug Seizure System (FDSS), Sourcebook of Criminal Justice Statistics, 1999, NCJ 183727, October 2000. .
SOURCE:
control has become a major issue of U.S. relations with many of its Latin American and Caribbean neighbors. The United States uses financial aid and international support as rewards for countries that cooperate in efforts to eliminate drug crops, destroy drug-processing labs, and catch traffickers. If these countries fail to cooperate, they face sanctions, public criticism, and cuts in financial aid, trade, or other benefits. The drug strategy’s second line of defense is to seize international shipments of drugs at the point of entry into the United States. The Coast Guard, the Border Patrol, and the Customs Service have traditionally fulfilled this mission. However, since the Cold War, the U.S. military has also taken on important drug interdiction duties. The strategy’s final line of defense against the drug supply is at home. Local law enforcement agencies aim to disrupt and reduce drug distribution and sales within the United States by increasing the chances of arrest, prosecution, and punishment for those who sell and use drugs.
sanction punishment imposed as a result of breaking a law or rule
As the antidrug effort has expanded, record numbers of drugs have been seized and destroyed, and record numbers of traffickers and dealers have been imprisoned. Yet despite this substantial build-up of drug enforcement at home and in other countries, more drugs are produced and available in more places than ever before, from large urban centers to rural towns. As trafficking operations have expanded, 147
Law and Policy: Controls on Drug Trafficking
they have become more sophisticated and harder to detect. The prices of cocaine and heroin on the nation’s streets have fallen by more than half since 1981, and the purity of these drugs has been improved, making the drugs even more desirable to users. The potency of marijuana, the most widely available and popular illegal drug, has tripled since the late 1970s.
stigma shame or disgrace attached to something regarded as socially unacceptable
Heroin trends are particularly troubling. According to the Drug Enforcement Administration, the average purity levels of heroin available across the country have increased. In the early 1980s, what was sold as heroin was actually only 7 percent pure heroin. By 2002 the purity level had risen to nearly 40 percent. High-purity heroin can be snorted, meaning that users can avoid the stigma of needle use. More people are willing to use heroin if they do not have to inject it with a needle. Although in the early twenty-first century there is less casual drug use than there was two decades ago, hard-core abuse and addiction have not declined. In the case of heroin and cocaine, regular users consume most of the imported supply. In another trend, synthetic or designer drugs (drugs created artificially in labs) have become increasingly popular, especially MDMA (ecstasy). While there is heated political debate over the effectiveness of U.S. drug policy, the supply-side approach to controlling drugs has remained fairly constant over the years. When the policy yields poor results, supporters of the policy tend to blame these failures on a lack of funding or a lack of political commitment and moral resolve. In other words, supply-side supporters argue that the policy has not been forceful enough. Yet inadequate funds or weak enforcement of drug policies are not the only reason for the failure to control the drug trade. Drugcontrol policy has enormous difficulty overcoming the powerful economic logic of the drug trade.
How the Drug Trade Works The drug supply begins at the source of production, moves to the U.S. borders, and then to a network of distributors within the country. Understanding the economics of this supply chain highlights the enormous challenge to U.S. drug policy.
At the Source of Production. In a number of drug-producing countries, a major source of employment and export income is the underground drug economy. The economic importance of the drug trade severely challenges attempts to reduce drug supply. From peas148
Law and Policy: Controls on Drug Trafficking
CROP CULTIVATION (IN HECTARES) Country
1999
1998
1997
1996
1995
1994
1993
1992
1991
Mexico Colombia Jamaica Belize Others
3,700 4,000
8,300 4,000
8,600 4,133 214
11,700 4,133 356
12,400 4,133 206
5,540 4,138 208
6,280 4,125 502
7,795 1,650 263
Total Cannabis
3,500
3,500
3,500
3,500
3,500
3,500
3,500
3,500
7,775 1,650 641 49 3,500
11,200
15,800
16,447
19,689
20,239
13,386
14,407
13,208
13,615
SOURCE: Inter national
Narcotics Control Strategy Report, 1999. .
ant producers to traffickers, those involved in the drug trade are driven by one or both of two motives: (1) profit, and/or (2) the lack of other ways to make money. As long as demand for drugs and drug profits remain high, production and trafficking in poor nations will likely continue. Drugs are relatively easy to produce, process, and transport. Growing coca, marijuana, or opium poppy produces more income than any legal export crop. As a result, campaigns to eliminate drug crops in one area have simply encouraged peasants to replant them elsewhere. Peasants often find new and more remote areas previously untouched by the illicit trade. And the potential for crop expansion is massive. For example, the U.S. Department of Agriculture estimates that there are 2.5 million square miles in South America alone that are suitable for growing coca, the plant used to produce cocaine. Only a small percentage of this land is currently used to grow coca crops.
In countries that lack other ways to make money, coca leaf production has not decreased despite American efforts at reducing cocaine production.
illicit something illegal or something used in an illegal manner
Just as trying to eliminate drug crops has been difficult, efforts to break up the operations of trafficking organizations have proven equally frustrating. When antidrug efforts target one group of traffickers, new traffickers enter and fill the gap. For example, after Colombia’s infamous Medellin and Cali drug trafficking groups were dismantled, a larger number of smaller trafficking organizations quickly took their place, with no reduction in drug exports. In other words, even successful efforts at targeting individual traffick-
WORLDWIDE COCA LEAF PRODUCTION, 1992–2000 (IN HECTARES) 1992
1993
1994
1995
1996
1997
1998
1999
2000
Bolivia Colombia Peru Ecuador
13,400 583,000 54,400 -
22,800 521,400 69,200 -
52,900 437,600 95,600 -
70,100 347,000 130,200 -
75,100 302,900 174,700 -
85,000 229,300 183,600 -
89,800 35,800 165,300 -
84,400 31,700 155,500 100
80,300 29,600 223,900 100
Total Coca
650,800
613,400
586,100
574,300
552,700
497,900
290,000
271,700
333,900
SOURCE:
International Narcotics Control Strategy Report, 1 March 2001. .
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ers and trafficking organizations have not resulted in less drugs being trafficked. While U.S. drug policy has so far largely failed to reduce the drug supply at the source of production, some observers also argue that the policy has brought about negative side effects. For example, one aspect of the drug policy is to encourage foreign militaries to take on drug control tasks, such as in some South American drug-producing countries. Military involvement increases the potential for corruption and human rights abuses. In addition, a military role can weaken civilian control in countries that lack strong democratic institutions.
At the Border. People who transport drugs into the United States have proven to be as adaptable and innovative as foreign drug producers. For example, in the mid-1980s U.S. law enforcement increased efforts to stop the flow of drugs through southern Florida and the Caribbean. Smugglers responded by finding new shipping routes through Central America and Mexico. Smugglers have also switched to forms of transport that are more difficult to detect. For example, when law enforcement stepped up interdiction of drugs coming in by air in the 1980s, smugglers turned to cargo ships and other transport methods to camouflage their drug shipments. In short, smugglers adapt in ways that make their illicit commerce difficult to detect and prevent. As a result, despite increased efforts at the border, U.S. border enforcers are able to intercept only a small percentage of the imported drug supply. Because of the high profits of the drug trade, smugglers view these lost drug loads as an affordable business expense. Weeding out drug shipments along the border is like searching for a needle in an ever-growing haystack. Because current U.S. trade policy aims to increase levels of legal trade, an enormous amount of goods comes into the country. Each year, 116 million vehicles cross the land borders with Canada and Mexico, and more than 900,000 merchant and passenger ships dock at U.S. ports. In the face of this much traffic at the borders, trying to enforce laws against the illegal drug trade is an extremely frustrating task.
At Home. Drug dealers on U.S. streets and peasants who grow drug crops in drug-producing countries share the same economic incentives: the potential for large profits, and the lack of other attractive ways to make money. Law enforcement within U.S. borders concentrates on catching, prosecuting, and convicting drug distributors and dealers. But these efforts fail to take the profit out of the trade. 150
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In the drug trafficking chain, the most easily replaceable links are street dealers. When one street dealer goes to jail, there is always a new recruit to replace him. As a result, making more arrests does not necessarily lead to fewer dealers. And disrupting dealing in one neighborhood can simply move it to another. All too often, dealing is moved rather than removed. Meanwhile, drug-related arrests have helped give the United States the highest rate of imprisonment in the developed world. In 1980, 25 percent of the inmate population in federal prisons were drug offenders. In the early twenty-first century, more than 60 percent of inmates are drug offenders. The criminal justice system is so swamped with drug-related cases that investigations and prosecutions of other serious crimes sometimes suffer. Despite the high imprisonment rate, the threat of punishment does not appear to deter hard-core drug users from buying and abusing drugs. The United States deals with drug abusers mainly by punishing them rather than by helping them get treatment. The funding of research on addiction and the best forms of treatment has taken a back seat to law enforcement. Treatment remains unavailable for a large percentage of the nation’s addict population. And many who need help avoid treatment because they fear they will face criminal prosecution. Although a focus on treatment will not by itself solve the drug problem, researchers believe that it is well worth the investment. A well-known 1994 study concluded that investing $34 million in treatment results in the same reduction in cocaine use as investing $366 million in interdiction or spending $783 million in programs to reduce drug production in source countries.
In Summary The record to date suggests that U.S. supply-side efforts to cut production, transport, and distribution of drugs have had little success in reducing the availability of drugs. If the past is any predictor of the future, the drug trade will continue to adapt to law enforcement initiatives in order to satisfy the nation’s seemingly endless demand for illegal drugs. S E E A L S O Adolescents, Drug and Alcohol Use; Law and Policy: Court-Ordered Treatment; Law and Policy: Foreign Policy and Drugs; Law and Policy: Modern Enforcement, Prosecution, and Sentencing; Users. 151
Law and Policy: Court-Ordered Treatment
Law and Policy: Court-Ordered Treatment When substance abusers are arrested and appear in court, judges sometimes order the person to go through drug treatment. Courtordered treatment is also known as coerced treatment. The theory behind court-ordered treatment is that substance abusers lack internal, or personal, motivation necessary to stop using drugs. The judge’s order provides an external motivation for the person to enter treatment in order to change his or her behavior. This behavior change may reduce the number of crimes committed and the number of arrests, and it may lead to the end of drug use. In the criminal justice system, the emphasis of court-ordered treatment is getting people to remain drug-free in order to reduce crime overall. Court-ordered treatment has its roots in the idea of community treatment. An important element of court-ordered treatment is a program called Treatment Accountability for Safer Communities (TASC). TASC helps link local, community efforts to deal with substance abuse offenders with the larger drug-abuse treatment system. When an offender who is dependent on drugs or alcohol is accused or convicted of a nonviolent crime, TASC provides several services, including referral to drug-treatment programs and supervision of the offender’s case. If local law enforcement has a conflict with a drug-treatment program, TASC helps resolve that conflict. TASC is now operating in over 125 communities. Overall, TASC has been effective at reducing drug abuse and keeping drug abusers in treatment. An important development in court-ordered treatment has been separating it into categories in order to meet different needs. For example, some paroled offenders are supervised through urine testing. Others receive treatment from community drug-abuse treatment centers. And some drug offenders receive treatment while in prison. More than half of all inmates in federal and state prisons were regular drug users before their arrest; approximately one quarter of inmates reported being on drugs at the time of their arrest, according to the U.S. Department of Justice.
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PE R C E NTA GE OF FEDE RA L A ND S TA TE P RI S ON I NMA TE S WHO H A V E US ED DRUGS Usage Ever used drugs Ever used drugs regularly Used drugs in the months before offense Used drugs at the time of offense
Percent in Federal Prison
Percent in State Prison
72.9 57.3 44.8 22.4
83.0 69.6 56.5 32.6
SOURCES: Bureau of Justice Statistics, “Substance Abuse and Treatment, State and Federal Prisoners, 1997”; U.S.Department of Justice; Bureau of Justice Statistics, “Profile of Jail Inmates, 1996.” .
Law and Policy: Court-Ordered Treatment
Condition of sentence
P E R C E N TAG E O F PR O B AT I O N E R S W H O HA D TO MEET DRUGR E L AT E D C O N D I TI O N S I N O R D E R TO G ET OFF P ROBATI ON Any condition, drug or non-drug related
98.6%
Alcohol/drug restrictions Mandatory drug testing
38.2% 32.5%
Remain alcohol/drug free
8.1%
Substance abuse treatment Alcohol Drug
A large percentage of probationers have to receive treatment for drug- or alcoholrelated problems, take drug tests, or remain completely drug and alcohol free in order to get off probation.
41% 29.2% 23% 0
20
40
60
80
100
Percent of all probationers SOURCE: BJS, Characteristics of Adults on Probation, 1995, NCJ 164267, December 1997. .
Controversies Over Court-Ordered Treatment Court-ordered treatment and the use of court authority from the criminal justice system has sparked controversy. Community treatment providers often think about drug treatment and law-enforcement control of drug use as opposites. In this view, treatment stands on one side as “the good guys,” and law-enforcement control stands on the other side. In fact, many community treatment providers believe that law-enforcement authorities disrupt the relationship between the drug offender and the program offering treatment. However, research shows a much different picture. Drug offenders under criminal justice authority generally remain in treatment longer and as a result have better treatment outcomes. Another reason for controversy is that many community drugtreatment providers believe that substance abusers should enter treatment voluntarily. They believe that a person must want to stop using drugs, and that forcing a reluctant person to enter treatment has little chance of ending drug use. Others have felt uneasy about the reliance of health agencies on the criminal justice system to change drug abusers’ behavior. Another concern is that drug testing may in some cases violate the civil rights of someone on probation for a drug offense. Despite controversy, drug treatment provided in the criminal justice system has had enough success to justify a continuing effort to improve the policy.
Adult Drug Courts Beginning in the late 1980s, some states and local areas rethought their approach to drug offenders and developed drug courts in response to the overlap between substance abuse and crime. Drug courts provide and supervise treatment for defendants. They target 153
Law and Policy: Court-Ordered Treatment
individuals whose major problems are related to drug abuse. The costs of this kind of drug intervention are lower than the costs of processing defendants through the criminal justice system. Drug courts have had several benefits: recidivism tendency to relapse into previous criminal behavior
• reduced recidivism • decreased drug use • increased birth rates of drug-free babies • high program retention (people stay in treatment longer) • reduced rates of relapse (return to drug use during or after treatment) • cost-efficient treatment
Juvenile and Family Drug Courts The overall success of adult drug court programs has encouraged development of other programs such as juvenile drug courts and family courts. Juvenile and family drug courts began in 1995. Since then, approximately 12,500 juveniles have enrolled in juvenile drug courts, with 82 percent of participants being male. Adolescents involved in juvenile drug court programs have extensive histories of drug use, often beginning between the ages of 10 and 14. Drugs of choice include crack cocaine, heroin, methampethamines, and poisonous inhalants. Working with juveniles requires different strategies from those used in adult drug courts. For example, juvenile drug courts focus on the family of the drug offender. They work more closely with community agencies to keep the young offender off drugs. Also, juvenile drug courts offer closer judicial supervision of young offenders than the supervision typically available by traditional courts. The goals of juvenile drug courts include helping adolescents become drug-free, reducing rates of repeat criminal activity, improving school performance, and helping the young offender form a productive and healthy relationship with members of his or her community.
Chronic Drug Abuse and the Problem of Relapse relapse term used in substance abuse treatment and recovery that refers to an addict s return to substance use and abuse following a period of abstinence or sobriety
154
It is important to remember that drug abuse is often chronic (longterm). In addition, many drug abusers go through one or more periods of relapse. Without follow-up and treatment, substance abusers often return to drug use. Recovery from drug addiction—with or without court-ordered treatment—is a difficult process. Intervention and treatment efforts need to focus on those factors that keep sub-
Law and Policy: Drug Legalization Debate
stance abusers drug-free. These options can range from urine testing to methadone maintenance treatment. Nevertheless, many people believe that substance abuse treatment is ineffective. They mention cases of individuals who immediately returned to drug use during treatment and/or supervision. Treatment does not work for everyone, but treatment combined with follow-up supervision, relapse prevention, and self-help groups like Alcoholics Anonymous increases the chances for success.
☎
Finally, there are no instant cures for substance abuse. Recovery for many can be a lifelong process. Court-ordered treatment can help match substance abusers with the most appropriate treatment services. In addition, those who work with substance abusers must seek a better understanding of the role of both external motivation (coerced treatment) and internal motivation (a personal desire to quit). Clearly, coercion can bring a drug offender to treatment, but it cannot force a drug offender to be motivated to remain drug-free. S E E A L S O Boot Camps and Shock Incarceration; Crime and Drugs; Law and Policy: Modern Enforcement, Prosecution, and Sentencing.
methadone potent synthetic narcotic, used in heroin recovery programs as a non-intoxicating opiate that blunts symptoms of withdrawal
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
Law and Policy: Drug Legalization Debate A key policy question concerning drugs is whether it should be legal to produce and use a drug. The answer can vary by drug. In the United States, anyone can legally consume the caffeine in soda or chocolate, but no one can legally consume heroin. Alcohol and cigarettes can be consumed legally by adults but not by children. Drugs such as Ritalin and Valium are legal only with a prescription. Cocaine cannot legally be used as a recreational drug, but it can be used as a medicine. (It is useful for certain types of eye and nose surgery.) The drug legalization debate concerns whether the legal status of one or more drugs should be changed. It would be possible for someone to argue that a substance that is now legal should be prohibited, or made illegal. In fact, some think tobacco should be prohibited since it kills so many people (about 400,000 per year). However, the drug legalization debate most often concerns whether one or more of the currently illegal drugs should be made legal, at least for certain uses. It is important to understand that arguing for legalization is not the same as simply arguing against aspects of current U.S. drug pol155
Law and Policy: Drug Legalization Debate
TO TA L P OUNDS OF DRUGS S EI ZE D, 1 9 9 6 THROUGH 1 9 9 9 3,000,000 2,621,510
Pounds of Drugs
The total amount of drugs seized by the U.S. government rose steadily over the late 1990s.
2,500,000 2,051,783 2,000,000
1,796,863 1,718,552
1,500,000 1996
1997
1998
1999
Year Drug Enforcement Administration, Federal-wide Drug Seizure System (FDSS), Sourcebook of Criminal Justice Statistics, 1999, NCJ 183727, October 2000. .
SOURCE:
icy. Many informed observers are sharply critical of U.S. drug policy, often arguing that drug sentences are too long or that government does not spend enough money on drug treatment programs. Yet most do not think that legalizing drugs is a good idea. Of those who do, the vast majority argue only for changing the legal status of marijuana, not of all drugs. Merely reducing the punishment for violators of drug laws is not the same as making the drug legal for sale or use. One can favor a wide range of reforms, including shorter sentences, without favoring legalization.
The Special Case of Medical Marijuana The case of medical marijuana is especially tricky. Cocaine is already available for medical use, yet few would say that the United States has legalized cocaine. So clearly there are ways of making marijuana available for medical use without legalizing it. However, medical exceptions to a general law prohibiting marijuana could be written in such a way that the effect would be to legalize the drug. For example, if the decision as to whether marijuana is medically necessary is, by law, left to the users themselves, then anyone who wanted to use marijuana for whatever purpose could simply claim to have a medical condition. Some recent medical marijuana laws have been written quite broadly to apply to a large number of cases in which marijuana might be medically useful. One reason for this is that supporters of medical-marijuana use claim that marijuana can eliminate or reduce a wide range of illnesses and conditions that do not go away. In contrast, cocaine has very specific medical benefits: it numbs pain and slows bleeding for certain types of operations. Since no one wants to 156
Law and Policy: Drug Legalization Debate
have surgery every day, there is little risk of a cocaine user faking a medical condition in order to obtain the drug. A second reason medical marijuana laws have been written broadly is that some supporters want to use the medical marijuana issue to promote greater availability of marijuana for nonmedical uses. They realize that many people who oppose legalizing marijuana for recreational drug use would not deny a terminally ill cancer patient the chance to use a drug that may help relieve side effects of chemotherapy. In this way, medical marijuana could be used as a wedge to help open the door for marijuana use by the general public.
In a New Mexico rally for the legalization of marijuana, this young girl joins over 200 people in a mass smoke out.
recreational drug use casual and infrequent use of a substance, often in social situations, for its pleasurable effects
The Argument over Principle The medical use of currently prohibited drugs is only one issue in the debate over legalization. The larger debate can be separated 157
Law and Policy: Drug Legalization Debate
into two distinct types of arguments. The first is an argument over principle.
civil libertarian person who believes in the right to unrestricted freedom of thought and action
Some argue for or against legalization as a matter of principle. For example, civil libertarians may argue that people should be free to consume whatever they want, even if it hurts them, as long as their use does not hurt others. On the other side, some people argue that it is morally wrong to use certain drugs and that an appropriate role for government is to prohibit immoral behavior even if no other people are being hurt. (Consider, for instance, that the government has laws against public nudity and prostitution.)
The Argument over Tradeoffs
black market sale and purchase of goods that are illegal (e.g., heroin)
The second argument looks at the harmful and beneficial consequences of either legalizing or prohibiting drugs. The basic tradeoff concerns the amount of drug use and the amount of harm that each unit of use, or each episode of use, will have on society. In contrast to legalization, prohibition sharply reduces drug use. But prohibition of drugs also increases the severity and cost of drug use. The most obvious way that prohibition increases harm is by creating a black market. Much of the violence related to drugs stems from its sale in black markets, not directly from its use. The high price of drugs is an essential issue. Drugs such as cocaine and heroin are just agricultural products like flour or coffee, yet prohibition makes them very expensive. High prices hold down use. It was once mistakenly believed that drug users are unaffected by the prices of the drugs they use, meaning that they would use them no matter what the cost. But there is now clear evidence that use goes down when prices rise and vice versa. However, the high prices make drug use expensive. A heavy user can easily spend $10,000 a year on cocaine or heroin. While well-to-do users can afford this, poorer users may commit crimes to pay for their drug use. One way to summarize this tradeoff is that “You can choose to have a problem with drug use (legalization), or you can choose to have a problem with drug markets (prohibition), but you cannot choose not to have a drug problem.” Advocates of legalization emphasize that we could easily eliminate all of the problems associated with drug markets just by legalizing the use of drugs. What they forget is that drug use would almost certainly increase. The accompanying figure illustrates what might happen under the two opposing positions: prohibition of drugs (current status) or legalization of drugs. For example, you can see that under a policy of prohibition, the price of drugs remains high, while it drops under a policy of legalization.
158
Law and Policy: Drug Legalization Debate
G E NE R AL C ON SE QU EN CE S O F D R UG PO LIC Y Policy Outcome Price Use Harm per unit of use Total Harm
Prohibition High Low High ?
Legalization Low High Low ?
Drug use is relatively low under a policy of prohibition, but lawmakers fear use would rise significantly if drug legalization went into effect.
Some legalization advocates suggest that we could eliminate the black markets without reducing prices by legalizing the drug and then imposing very high taxes on it. But this suggestion is probably unrealistic. High tax rates encourage smuggling and black markets for the purpose of avoiding the taxes. When the Canadian province of Ontario tried to sharply raise taxes on cigarettes, black markets quickly grew to dominate cigarette sales, and the tax had to be repealed. Tax rates sufficient to keep legalized drugs at their current prices would need to be even higher. Most likely, many people would ignore or avoid these taxes. Most people who favor legalizing drugs say they should be legal only for adults. But this is also unrealistic. Legalizing use by adults almost certainly makes a drug more available to minors. This is because every adult is a potential supplier, whether intentionally (for example, adults buying alcohol for minors) or unintentionally (for example, minors stealing cigarettes from adults).
Measuring the Total Harm of Legalization How would legalization affect the total harm related to drugs? The answer depends on (1) what value is placed on the problems related to drug use and the problems related to prohibition and black markets, and (2) how much legalization would increase use. Those who favor legalization tend to believe that a drug’s legal status has little impact on its use. They also tend to emphasize three problems of prohibition: (1) problems created by black markets (stereotyped as drug dealers shooting people in battles over turf), (2) problems created by drug enforcement (such as enforcement tactics that may unfairly target minorities), and (3) problems created by the damage per episode of drug use (such as the increasing spread of AIDS by needle sharing because drug laws make drug paraphernalia, such as needles, illegal). Those who favor prohibition tend to believe that prohibition greatly decreases use (tobacco and alcohol are used far more than cocaine or heroin) and that many problems stem directly from drug use (such as the damage addiction can do to families), not from the drug’s illegal status.
AIDS stands for acquired immunodeficiency syndrome, the disease caused by the human immunodeficiency virus (HIV); in severe cases it is characterized by the profound weakening of the body s immune system paraphernalia equipment that enables drug users to take the drugs (e.g., syringes and needles)
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Even legal drugs such as caffeine, tobacco, and alcohol have serious risks and complications associated with their usage.
D R U G US E RI S K S A ND COMP LI CATI ONS
Risk
Caffeine
Acute health risk Chronic health risk Use affects health of others Problems caused by withdrawal Intoxication leads to accidents Intoxication leads to violence Likelihood of addiction given use [as observed in the U.S. in last 30 years] Addiction disruptive to daily functioning
None None No
Tobacco None Huge Yes
Alcohol
Heroin
Cocaine
Minimal Some Possibly
High Minimal No
High Some Fetuses
Minimal Unpleasant Physical risk
Minimal
Physical risk
No
No
Yes
Some
Moderate
Extremely unpleasant Unclear
No
No
Yes
No
No
Some
Minimal High
Moderate
Moderate
High
High
No
Yes
Somewhat Yes
No
High High Fetuses
Marijuana
Yes
Unfortunately, the debate about the consequences of legalization is clouded with false arguments. For example, those who favor legalization point to statistics showing that illegal drugs such as cocaine and heroin kill only thousands of people per year, whereas alcohol and cigarettes kill hundreds of thousands. What they neglect to point out is that far more people use cigarettes and alcohol, so the death rates per user are not so different. Furthermore, the death statistics for illegal drugs are limited to direct, severe effects of drug use (such as from overdose), while the cigarette and alcohol figures include indirect effects (such as deaths caused by drunk drivers) and effects of use over a lifetime (such as from lung cancer).
How Dangerous are Different Drugs? sedate process of calming someone by administering a medication that reduces excitement; often called a tranquilizer intoxicating a food or drink capable of diminishing physical or mental control
Different drugs have different effects. Some drugs, like phenycyclidine (PCP), can trigger violent outbursts. Others, like heroin, sedate the user. Cigarettes are highly addictive, but they are not intoxicating. Heroin can be deadly if a person takes an overdose, but use of the drug itself leads to almost no long-term health damage. Heroin addicts are usually in bad health because they are poor, spend money on heroin rather than on food or shelter, and inject with dirty needles. But the heroin itself does not damage organs the way alcohol abuse destroys the liver or smoking causes lung disease. Because a substance can be very threatening in one way but not in others, it is impossible to rank substances from the most to the least dangerous.
Issues for Each Type of Drug The drug legalization debate is complicated, with each substance requiring a separate approach. For purposes of the drug legalization 160
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debate, there are three basic groups of illegal substances: (1) cocaine, heroin, and methamphetamines, (2) marijuana, and (3) all other drugs.
Cocaine, Heroin, and Methamphetamine. These drugs have different chemical makeups, but they are alike in several ways: (1) they are expensive, (2) they are subject to strict drug-law enforcement, (3) they can dominate the lives of an abuser, and (4) they have large, established black markets. If these drugs were legalized, use would mostly likely rise a great deal and a number of problems would follow. These drugs are very simple to produce but sell for incredibly high prices because they are illegal. Those who manufacture, sell, or use these drugs are subject to severe penalties. Cocaine, heroin, and methamphetamine are also the source of most of the corruption, violence, and crime associated with drug markets, so legalization would bring many benefits. However, most observers believe that legalizing these drugs would be a good example of jumping “out of the frying pan and into the fire.” At a minimum, legalizing these substances is a high-stakes gamble that would be difficult to reverse. There are other, safer alternatives to try first (such as changing the laws that affect these drugs but not eliminating them). Marijuana. Marijuana is quite different. Prohibition makes marijuana more expensive than it otherwise would be, but a daily habit is still only modestly more expensive than a two-pack-a-day cigarette habit. So, if it became legal, marijuana use would be less likely to increase greatly than cocaine use. In addition, daily marijuana use is not anywhere near as damaging as is daily use of other drugs, such as cocaine. Even if use of marijuana did jump after legalization, the outcome would be less disastrous in terms of the health and daily functioning of users. On the other hand, the benefits of legalizing marijuana are far smaller than the benefits of legalizing cocaine, heroin, and methamphetamines. This is because marijuana markets are less violent and marijuana users generally do not commit crimes to support their habit. There is no general agreement as to whether legalizing marijuana is wise. Some say yes. Most say no. What is clear, though, is that the risks, uncertainties, and potential benefits are all much smaller when considering legalizing marijuana than when considering legalizing cocaine, heroin, and methamphetamines.
Other Drugs. This third category is so big and varied that it is difficult to make general statements about it. The category includes 161
Law and Policy: Foreign Policy and Drugs
RELATED READING People are not only addicted to drugs that they buy in dark alleys at night. In Buzz: The Science and Lore of Alcohol and Caffeine (1997), author Stephen Braun looks into America s love affair with and addiction to the legal substances coffee and alcohol, what he calls the world s most widely consumed mind altering drugs.
drugs that can be used in sexual assault (such as Rohypnol, which can make a victim unconscious and unable to stop or remember an attacker) and drugs used not for their “high” but to enhance athletic performance (such as anabolic steroids). Two general observations are possible: (1) Prohibitions are more effective and less costly when preventing the spread of substances that are not commonly used than they are at reducing the use of an established, popular drug. (2) Changing the legal status of drugs that are now rare would have the undesirable effect of increasing availability and, hence, probably use as well. It is hard to predict how the legalization debate will evolve. A diverse and vocal minority calls for legalization or, more commonly, consideration of legalization. The vast majority of politicians and the public firmly oppose legalization for all drugs except marijuana. One scenario might relax the current strict prohibition by adopting a harm reduction approach, which focuses on reducing the negative consequences of drug use to the users rather than reducing the amount of use—or a “public health” approach (that addresses the problem from a medical rather than a criminal justice perspective). Such strategies respond to many of the complaints about the current U.S. drug prohibition without most of the risks and problems that legalization would create. SEE ALSO See specific drugs, such as Cocaine, Heroin, and Marijuana; Drugs of Abuse; Law and Policy: Controls on Drug Trafficking; Law and Policy: Modern Enforcement, Prosecution, and Sentencing.
Law and Policy: Foreign Policy and Drugs
cartel group that controls production and/or price of a good (e.g., diamonds, oil, or illegal drugs) money laundering activity in which a person or group hides the source of money that has been illegally obtained
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Since the 1980s, the control of illegal drugs has played an important role in the U.S. government’s foreign policy, or dealings with other governments. The use of drugs in the United States has led to addiction, crime, family violence, and social disintegration in some communities. The United States has fought to stop the production, trafficking, and sale of illegal drugs that fuels these social problems through agreements with other countries, the funding of crop elimination efforts, and aggressive efforts to stop drugs from crossing U.S. borders. During the 1990s it became apparent that drug cartels gained unofficial control in some countries and sometimes used money from the production and sale of drugs to fund terrorist activities. Analysts began to see connections between drugs, money laundering, and in-
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ternational terrorism. These developments have forced the United States to find new ways to work together with other nations to reduce the production and sale of illegal drugs. At the same time, the United States is supporting alternatives that will provide permanent solutions to this global economic and social problem.
Requirements for Foreign Aid On the international front, the U.S. government pressed hard for members of the United Nations to approve the U.N. Convention on Psychotropic Drugs and created the United Nations Fund for Drug Abuse Control. Later, this organization became the United Nations Drug Control Program (UNDCP). Drug control gained full acceptance as a factor in relations among countries during the 1980s, after cocaine use became widespread among entertainers, athletes, and stockbrokers. Because the United States could not stop the use and spread of drugs at home, Congress tried to gain control of the problem by working with countries that produced and shipped drugs abroad. In 1986, in the first of a series of comprehensive international anti-drug laws (the Anti-Drug Abuse Act of 1986), Congress placed the burden of halting drug flows on the governments of the drug-producing countries. The United States began to use a traditional “carrot-and-stick” approach (rewarding countries that cooperated and punishing those that did not). The new law required the major drug producing and transit countries to cooperate fully with the United States in drug matters in order to receive American foreign aid. Half of all assistance was withheld every year until the president certified that the country concerned had met the standard requirements for controlling production and shipment of illegal drugs. Subsequent laws have expanded the requirement, forcing the major drug-producing and transit countries also to comply with the 1988 United Nations Convention Against Illicit Traffic in Narcotics Drugs and Psychotropic Substances. Countries that do not comply not only lose U.S. assistance but also have a very difficult time getting loans from the World Bank and other international financial institutions. For many countries in the developing world, losing access to these loans is an even greater hardship than losing U.S. assistance. Though the certification process has raised tensions with some foreign governments, by 2000 it had become an accepted part of U.S. foreign policy. However, critics noted that the United States has recertified countries such as Mexico and Colombia, even when political corruption in these nations has seriously limited their narcotics enforcement efforts. 163
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Diplomacy (the relations among countries) concerns different issues at different times. Drug control, like other global issues, such as human rights or control of the spread of nuclear weapons, has had to overcome obstacles to become a legitimate, or accepted, subject for diplomacy. Some U.S. foreign-policy experts view drug control as a law enforcement issue, and they do not believe that law enforcement should be as important as concerns about national security or foreign trade in determining U.S. dealings with other nations. Congress, however, has left no doubt that it intends to keep drug control high on the list of U.S. foreign-policy issues. Congress has denied virtually all forms of aid—with the exception of humanitarian (food and medicine) and drug-control assistance—to countries that refuse to cooperate with U.S. drug policies. In doing this, Congress has devised an effective form of control over countries that produce, ship, or support illegal drugs. Because the law also allows the president to waive (lift) sanctions when clearly stated national interests are at stake, Congress has made it difficult for foreign-policy agencies to avoid their drug-control responsibilities.
Agencies Responsible for Drug Policy The U.S. Department of State is responsible for creating international drug policy. Its Bureau for International Narcotics and Law Enforcement Affairs (INL) oversees the annual certification process and prepares an annual report. The INL narcotics control program has two primary goals: to convince foreign governments that narcotics control is an important consideration in international relations and to promote cooperation with the United States. Second, the INL uses the bureau’s various programs to help stop the flow of illegal drugs into the United States. The international crime program has three major goals: (1) to combat the growing threat to U.S. national security posed by international organized crime; (2) to help emerging democracies strengthen their national law enforcement institutions; and (3) to strengthen efforts by the United Nations and other international organizations to assist member states in combating international criminal activity. Since 1989, the White House Office of National Drug Control Policy and the National Security Council have coordinated U.S. drug policy with other countries. However, a broad spectrum of government agencies are also involved, including the Central Intelligence Agency, the Department of Defense, the U.S. Customs Service, the Coast Guard, the Department of Treasury, the Justice Department, the Drug Enforcement Administration, and the Department of Health and Human Services. A small percentage of the U.S. drug-control budget is spent on international programs. The bulk of the money goes to domestic law enforcement, drug treatment, and public education. 164
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Then U.S. Secretary of Defense, William Cohen, attended the Summit of the InterAmerican Defense Board in October 2000. There, South American leaders discussed the U.S. backed war on Colombian drug traffickers.
One innovative international program is the International Law Enforcement Academy (ILEA), which opened in 1995 in Budapest, Hungary. The ILEA serves as a law enforcement training center for officers from Eastern Europe, Russia, Ukraine, and the Baltic states. Instructors at the academy represent a cross-section of federal law enforcement agencies, including subject experts from the Federal Bureau of Investigations, the Drug Enforcement Administration, the Bureau of Alcohol, Tobacco, and Firearms, the United States Customs Service, and the Federal Law Enforcement Training Center. They work on attacking organized crime, which depends on narcotics trafficking as a source of income.
The Realities of Drug Control An effective drug policy is easier to design than to carry out. The drug issue is a typical “chicken-and-egg” problem. Does the supply of drugs 165
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drive the demand for them, or vice versa? The drug-consuming countries traditionally blame the suppliers for drug epidemics, while drugproducing countries charge that without foreign demand, local farmers would not grow drug crops at all. Planners of drug control policies must therefore strike the right balance between reducing drug supply and demand. In theory, eliminating drug cultivation in the source countries is the most economical solution, since it keeps drugs from entering the system and acquiring any value as a finished product. However, few source-country governments—all of which are in developing nations—will deprive farmers of a way to make a living unless foreign governments provide substantial compensation. And the price they seek is usually more than the U.S. government is prepared to pay.
The Drug Trade as Criminal Threat Today’s illegal drug trade is one of the most profitable and, therefore, powerful criminal enterprises in history. Drugs create profits on a scale never before seen—especially given their abundance and low production costs. These financial resources, which are well beyond those of most national budgets, give drug traffickers the means to buy sophisticated weapons, aircraft, and electronic and technical equipment available to few countries. More important, illegal drug revenues allow trafficking organizations to buy themselves protection through bribes and other means at almost every level of government in the drug-producing and drug-transit countries. Drug-related corruption remains the single largest obstacle to effective control programs. As for the drugs themselves, there is a huge abundance. Opium is in especially great supply. In Southeast Asia, Myanmar (formerly Burma) could supply the world’s needs several times over, with 257.5 metric tons annually. Estimates of heroin consumption in the United States range only between 6 and 20 metric tons, less than 10 percent of Myanmar’s potential output. In South America, coca production dropped in the 1990s, yet it is enough to satisfy the world demand for cocaine twice over. This surplus is so large that the drug trade easily absorbs losses inflicted by drug-control authorities and still makes enormous profits. Traffickers also have the option of expanding cultivation of drug crops into new areas. For example, although coca plants are currently confined to Latin America, coca once flourished in Indonesia and could do so again if market conditions were right. Opium poppy cultivation is spreading into areas where it was not previously grown, including South America. South American cocaine-trafficking organizations have been cultivating the opium poppy as well, because they 166
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expect a new surge in heroin use. Without active government antidrug programs, production will grow until the demands of new expanding markets are satisfied.
Current Policy The U.S. government’s first priority is to stop the flow of cocaine, which still poses the most immediate threat to potential drug users. Because of rising heroin use promoted by the new, cheaper Latin American producers, the United States must also focus on opiumproducing countries. The United States’ goal is to limit the cultivation of drug crops to the amount necessary for international medical uses. Since all the cocaine that enters the United States comes from coca plantations in Peru, Bolivia, and Colombia, the U.S. government has active drug-control programs in the three countries. During the 1990s, the United States assisted Bolivia and Peru in their efforts to reduce coca cultivation. While these efforts have dramatically reduced production, drug traffickers increased coca production in Colombia. This resulted in increased political corruption and political destabilization. In 2000 the United States approved a $1.3 billion emergency assistance package to Colombia to help the Colombian government. The aid package contains money for police and military training, administration of justice programs, and economic development programs. The United States has also increased its military assistance to Latin America to help fight narcotics trafficking, yet many critics question the effectiveness of this approach. Others have expressed concern that Colombia may request direct U.S. military involvement. Such involvement could lead to problems similar to those the United States faced in the Vietnam War and other conflicts in Southeast Asia in the 1960s and 1970s. Controlling opium is more difficult than controlling coca. This is because most of the world’s opium poppy grows in countries where the United States has very limited diplomatic influence (Myanmar, Afghanistan, Laos, Iran, and so on). There also appears to be increasingly important opium poppy cultivation in China, Vietnam, and the Central Asian countries. Left unchecked, this opium expansion will make effective heroin control virtually impossible in drugconsuming countries. Many nations in Europe have already begun to experience this problem.
Terrorism and Narcotics In the 1990s analysts began to see links between terrorist organizations and narcotics trafficking. Drug trafficking raises enormous sums
drug trafficking the act of transporting illegal drugs
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of money, which terrorist organizations can use to achieve their political goals. The term “narcoterrorist” entered the language to explain the intertwining of terrorism and drug trafficking. The 1988 United Nations (UN) Convention recognizes the links between illegal drug traffic and organized criminal activities that threaten the stability and rule of law in independent nations. A 1993 UN report documented these links and warned of future threats to stability. The Revolutionary Armed Forces of Colombia (known by its Spanish acronym, FARC) is the country’s largest and oldest insurgent (rebel) group. FARC has used the drug trade to finance its opposition to the Colombian government. In Afghanistan, the Taliban government proclaimed that it sought to get rid of opium, but U.S. analysts came to believe that the Taliban used drug trafficking proceeds to fund both its regime and the terrorist organizations headed by Osama bin Laden. Programs between two countries alone (bilateral programs) rarely provide solutions to global problems. For this reason, the United States has been an active supporter of collective (joint) action by nations under the 1988 UN Convention. This latest agreement includes traditional aspects of drug production and trafficking in keeping with the UN Convention of 1988. It also requires members to control chemicals used to process drugs and outlaws drug-money laundering. The outlawing of money laundering is an extremely important new control, since it targets the enormous international cash flows that support the drug trade. As astronomical as drug profits may be, drug money is useless unless it can enter the international banking system. The major industrialized countries are pressing for uniform laws and regulations to exclude the use of drug money in all key financial centers. Combined with existing drug-control programs, strict money-laundering controls that are honestly carried out have the potential to reduce the drug trade from an international threat to a manageable concern. The UNDCP’s Global Program against Money Laundering helps member states introduce laws against money laundering and to develop means of combating this crime. Unfortunately, as a UN report has noted, the development and use of modern telecommunications has made it easier to move money around the world in complex and anonymous transactions. The link between drug trafficking and international terrorism, which became apparent in the 1990s, is forcing the United States, its allies, and international organizations to increase enforcement actions. Limiting and preventing money laundering remains a serious international challenge in the twenty-first century. S E E A L S O Drug Producers; Drug Traffickers; Law and Policy: Controls on Drug Trafficking; Terrorism and Drugs. 168
Law and Policy: History of, in the United States
Law and Policy: History of, in the United States Americans have always used drugs that affect the mind, especially alcohol. And for as long as there has been drug use, there have been attempts to regulate, control, and even prohibit this use through law. Many changes have occurred in drug and alcohol regulation over time, but certain basic impulses behind control have played a continuous role in the history of drug policy in the United States.
Alcohol: The Road to Prohibition On January 16, 1920, the Eighteenth Amendment to the United States Constitution took effect, one year after its final ratification by the states. The amendment read in part: “the manufacture, sale, or transportation of intoxicating liquors within, the importation thereof into, or the exportation thereof from the United States . . . for beverage purposes is hereby prohibited.” This experiment in national alcohol prohibition lasted nearly fourteen years, until the Twenty-first Amendment repealed the eighteenth. Prohibition was not an isolated event. In fact, it was the culmination of many decades of efforts to control alcohol. These efforts were rooted in three impulses common to all efforts at drug control: medical, moral, and social.
Medical Reasons for Control. The medical aspects of alcohol control date back to the eighteen century, when physicians were among the first advocates of what came to be known as temperance. Although temperance was eventually thought of as a movement to ban alcohol altogether, in its early forms it usually emphasized the health benefits of moderate consumption. Drinkers were advised to avoid drunkenness, and to consume less powerful fermented beverages such as beer and wine, while avoiding hard liquors such as rum or whiskey. As temperance grew into a mass movement in the nineteenth century, it continued to draw support from medical and scientific research. Physicians discovered a great deal about the action of alcohol on the human brain and its influence on memory, perception, and motor function (movement). The new field of public-health research found statistical links between heavy (and even moderate) alcohol consumption and disease. In the end, organized medicine joined the fight against alcohol: in 1918, the American Medical Association passed a resolution opposing the use of alcohol as a beverage.
Moral Reasons for Control. A second impulse, at least as old as the first, was the moral opposition to drinking and drunkenness. Religious revivals during the early 1800s turned the fight against 169
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alcohol into a popular crusade. Evangelical Protestantism spread a message of abstinence and sobriety, coupled with a belief that laws could be used to create a more moral society. In this last respect the anti-alcohol movement made a critical step: it went beyond merely redeeming, or saving, an individual drinker and instead worked toward larger social change through public policy.
This political cartoon, Woman s Holy War, shows a woman on horseback carrying a shield of stars and stripes while she wields an ax to smash barrels of alcoholic beverages. The contents pour out in rivers against a backdrop of banners, one of which reads Temperance League. abstinence complete avoidance of something, such as the use of drugs or alcoholic beverages narcotic addictive substance that relieves pain and induces sleep or causes sedation; prescription narcotics includes morphine and codeine; general and imprecise term referring to a drug of abuse, such as heroin, cocaine, or marijuana
Social Reasons for Control. Efforts to control alcohol reflected concerns about the social impact of drinking. The focus of these social fears was the saloon. The saloon was a product of the newly industrializing nation of the early nineteenth century and was the center of leisure activity for working-class males. To critics, the saloon was a breeding ground for vice (immoral behavior), crime, and disorder. The Woman’s Christian Temperance Union (WCTU), formed in 1874, fought alcohol with the slogan “Protect Our Homes.” The AntiSaloon League (ASL), formed in 1895, organized itself under the slogan “The Saloon Must Go.” These organizations had impressive political skills. Their efforts brought prohibition first to many local communities and several states, then finally to the entire United States in 1920.
The Origins of Narcotic Control In 1919, as the final states prepared to ratify the Eighteenth Amendment, the federal government was also strengthening its control over narcotic drugs, especially cocaine and opiates. (At the time the term “narcotics” was used to apply to opiates and cocaine and, later, to marijuana as well.) As with alcohol, the road to control on the national level was a long one, and it reflected some of the same basic impulses.
Medical Reasons for Control. Developments in trade and technology in the nineteenth century changed the face of drug use in the United States. Standard preparation of drugs during the lateeighteenth century and early-nineteenth century made opium widely available to the American consumer. Advances in chemistry gave consumers powerful new drugs made from plants. Commercial production of morphine (from opium) began in 1827, and of cocaine (from the coca plant) in 1884. As more and more people were exposed to opiates and other drugs, use and abuse increased. This led doctors to focus on the subject of drug addiction. The American Association for the Cure of Inebriates, founded in 1870, was one of the first organizations to raise medical awareness of addiction. Medical concerns were closely related to professional concerns about the control of the drug supply. Drug manufacturing was chang-
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ing dramatically, as small operations selling plant and herbal medicines gave way to large corporations with more aggressive approaches to drug development, research, and promotion (advertising). At the same time, makers of patent medicines marketed a wide range of medicines directly to the general public. Doctors and druggists (pharmacists) feared that the drug industry’s desire for profit would overwhelm concerns for public health and safety. They sought to limit the supply of drugs to a quantity necessary for “legitimate” purposes. By this they meant the quantity that physicians used themselves or that they recommended to their patients. Medical and professional impulses came together in the passage of the Pure Food and Drugs Act of 1906, which set the first national rules for drug promotion (advertising), packaging, and distribution.
opiate derived directly from opium and used in its natural state, without chemical modification (e.g., morphine, codeine, and thebaine)
Social and Moral Reasons for Control. The social and moral impulses behind alcohol control were just as important to drug control. Opium smoking, a practice that originated in China and spread widely in the United States in the 1870s and 1880s, first raised these concerns. While people addicted to opium through medical use were often seen as deserving of sympathy, pleasure-seeking opium smokers were seen as suspicious characters who cared only for their own satisfactions. Opium smoking was not a product of medical use at all; smokers purposely sought what they saw as opium’s recreational pleasures. Smokers gathered in opium dens, places that the general public strongly disapproved of. The public’s response to opium smoking was repeated in the response to cocaine in 1884 and to heroin in 1898.
The Crime Control Model The first antidrug legislation was an 1870 San Francisco law that sought to eliminate opium dens. During the decades that followed, numerous communities and states passed their own drug laws, restricting the use of opiates and cocaine. In 1914, Congress passed the Harrison Narcotic Act, signaling the start of national drug control. The Harrison Act was a tax measure, requiring doctors and druggists who dispensed opiates and cocaine to register with the federal government and pay a special tax. The purpose of the 1914 Harrison Narcotic Act seemed to be to limit opiates and cocaine to medical practice, not to regulate that practice or to cut addicts off from medical supply. By 1919, however, it became clear that the federal government intended to use the Harrison Act as a means to prohibit all drug use related to addiction. The year 1919 began with two Supreme Court decisions. These decisions confirmed that three aspects of the Harrison Act were 171
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constitutional: (1) the act’s tax on physicians, (2) limiting distribution to legitimate medical practice, and (3) the government’s view that the maintenance of addicts was not a legitimate medical practice. In the fall, Congress rejected an ambitious public-health measure that would have approved the construction of a large system of publicly funded treatment institutions. At the close of the year, federal narcotics enforcement shifted to the newly formed Prohibition Bureau. The leadership of the new narcotic division immediately determined to investigate and close the city drug maintenance clinics that had been created to assist addicts in the aftermath of the Harrison Act. As the next decades unfolded, the government became involved in a flurry of activity aimed at crime control and law enforcement. Drug addicts were seen as diseased law breakers, social misfits, and failures. Then a doctor interested in the treatment of addicts, Dr. Lawrence Kolb, made a distinction between the “normal” addict who had been accidentally “hooked” through medical practice, and “psychopathic” addicts who took drugs for pleasure and suffered from some sort of personality flaw. Kolb was the first director of a combination federal prison/hospital for addicts in Lexington, Kentucky. The institution opened in 1935 to serve addicts from around the country. Although the creators of the prison/hospital hoped it would operate more as a hospital, Lexington in fact followed a crime-control approach, with patients kept in prisonlike cells. All patients received similar, rather than individualized, treatment, showing that the staff had little optimism that patients could be cured or reformed.
Legislation, 1920 1960 Most new legislation of this period emphasized the crime-control approach to drug policy. Three federal laws stand out in this regard: the 1937 Marijuana Tax Act, the 1951 Boggs Act, and the Narcotic Control Act of 1956. All three reflected the influence of the Federal Bureau of Narcotics (FBN) and its director, Harry J. Anslinger. Anslinger had been picked to be the first head of the FBN when it replaced the old narcotic division of the Prohibition Bureau in 1930. For the next thirty years, both the public and politicians approved of Anslinger’s belief in a strict law-enforcement approach to drug policy. The 1937 Marijuana Tax Act introduced the first federal penalties on the cultivation, sale, and possession of marijuana, while the Acts of 1951 and 1956 increased penalties for federal drug law violations. The FBN viewed drug users and addicts as criminals whose antisocial behavior threatened public safety. Formal regulation of the legal drug supply expanded in 1938 with passage of the Food, Drug, and Cosmetic Act, which created a large 172
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class of drugs that would from that time forward be available only with a physician’s prescription. For the first time, the Food and Drug Administration began to try to limit the distribution of certain nonnarcotic drugs of abuse, especially amphetamines and barbiturates. In 1951, the Durham-Humphrey Amendment created two classes of drugs—prescription and nonprescription—into which all drugs had to be placed.
New Approaches to Modern Drug Control In the 1970s, an important period of policy development began that led to the modern drug control system. In 1969, the administration of U.S. President Richard M. Nixon saw a “triple threat” coming from the youth drug culture, ghetto heroin use, and drug use among soldiers in Vietnam. It reacted by beginning a dynamic period of policy making both at home and internationally.
Reducing Demand. Under President Nixon, the federal government made a decision to reduce the demand for drugs through the public funding of addiction treatment and prevention programs. The most important aspect of Nixon’s policy was a full-scale commitment of federal money to drug treatment, especially methadone maintenance for heroin addicts. Methadone maintenance grew out of the work of doctors Vincent Dole and Marie Nyswander, who determined that regular maintenance doses of methadone reduced craving for heroin and allowed addicts to function normally in their daily lives. Federal funding for treatment increased more than tenfold between 1970 and 1973. In 1974 the creation of the National Institute on Drug Abuse expanded the focus on treatment, education, and prevention, and funded a new generation of addiction research.
methadone potent synthetic narcotic, used in heroin recovery programs as a non-intoxicating opiate that blunts symptoms of withdrawal
Treating All Types of Addiction. Another important change in national policy was the increased recognition that drug policies could no longer focus only on opiates. For decades the drug problem had been seen as a heroin addiction problem. The growing diversity of drugs of abuse led to the Comprehensive Drug Abuse Prevention and Control Act of 1970. This act created five categories (known as schedules) of drugs, based on their potential for abuse, degree of harmfulness, and the potential for legitimate medical use.
The Continued Importance of the Crime-Control Approach The crime-control approach has remained at the core of drug policy. Crime control in modern America concentrates on the sale and 173
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distribution of illegal drugs through four basic approaches: (1) international control of drug supply, (2) interdiction (seizure of drugs at the borders), (3) disrupting drug traffickers, and (4) enforcement at the level of street sales. Since 1970, the effort to control the supply of drugs has grown to extraordinary levels. In the last year of the FBN (1968), the agency had about one dozen foreign agents in the field. By 1978, the Drug Enforcement Administration (DEA) fielded 228 agents in sixty-eight overseas offices. In the early twenty-first century, the DEA influences drug control programs in countries around the world. According to one estimate, the United States spent a total of $28 billion in 1990 for all aspects of drug control. Drug arrests also indicate the enormous scope of control efforts, with over one million arrests annually for drug-law violations in the United States. On the state level, these higher numbers meant higher prison populations, placing a strain on prison systems and state budgets. In California, the number of drug offenders sent to prison increased from approximately 1,500 in 1980 to 22,600 in 1990.
Conclusion As drug policy enters the twenty-first century, it builds on a history featuring both change and continuity. Historical changes include the end of alcohol prohibition, the rise in popularity of some drugs and the disappearance of others, and higher or lower levels of enforcement. These changes are reminders that drug policies can be altered and improved on. The continuities, especially in the basic impulses for control, are evidence that the control and regulation of drugs and alcohol are a fundamental part of U.S. public policy. S E E A L S O Law and Policy: Controls on Drug Trafficking; Law and Policy: Court-Ordered Treatment; Law and Policy: Drug Legalization Debate; Law and Policy: Foreign Policy and Drugs; Law and Policy: Modern Enforcement, Prosecution, and Sentencing; Prohibition of Alcohol; Temperance Movement; Tobacco: Policies, Laws, and Regulations.
Law and Policy: Modern Enforcement, Prosecution, and Sentencing The enforcement of U.S. drug and alcohol laws has been a major priority for police and prosecutors since the 1980s. Law enforcement has devoted considerable resources to the prevention of drug 174
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In 2000 the U.S. Law Enforcement Agency spent the largest percentage of its budget on cocaine-related enforcement. Heroin accounted for the second largest portion, followed by marijuana and methamphetamine.
Dollars in billions spent Methamphetamine $2 3.63%
Marijuana $10 17.16%
Cocaine $36 59.57%
Heroin $12 19.64%
Total: $61 billion National Household Survey on Drug Abuse 1988, 1990 through 1998; Drug Use Forecasting Studies 1988 through 1998; Uniform Crime Reports (UCR) 1988 through 1997. SOURCES:
trafficking. People who drink and drive and people who use illegal drugs face increasingly strict punishments for violations of criminal law.
drug trafficking act of transporting illegal drugs
Modern methods for enforcing drug laws and prosecuting offenders have changed in several ways: • State legislatures have increased the penalties for drug trafficking and for operating a motor vehicle under the influence of alcohol or drugs. • The U.S. Congress has made drug trafficking penalties more severe. • Congress passed a law in 2000 that requires states to lower the legal limits of alcohol in the blood as a way to discourage drunk driving and to increase arrests of drunk drivers. States that fail to do so will lose federal highway funds. • Sentencing laws requiring prison terms for violators have aided the enforcement effort. Under these laws, judges do not determine sentencing. This gives more power to prosecutors, who can influence the severity of the punishment based on the criminal charges they bring. 175
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ARE CRACK AND POWDER COCAINE THE SAME? A number of offenders have claimed that race is an unfair factor in the laws and in the application of mandatory sentences. They point out, for example, that sale and possession of crack cocaine are treated more harshly than sale and possession of powder cocaine. People of color are charged more frequently with crack cocaine offenses, while whites have been mainly charged with the sale and possession of powder cocaine. Despite these claims, most courts have dismissed these charges of unfairness based on race.
• Because legislatures have become dissatisfied with the juvenile justice system, many juvenile violators have been brought into the adult criminal justice system.
Arresting and Charging Drug Offenders Drug arrests in the United States can be made for possession of drugs (such as marijuana, cocaine, or heroin), dealing (selling) drugs, and conspiracy (an organized, joint plan) to sell drugs. After arrest, the prosecutor (who in some states is called a district attorney) decides whether to bring a charge and for what activity. Drug offenses can violate either federal or state laws. People charged with federal crimes face more severe consequences, such as stiffer penalties. To determine what charges should be filed against the offender, the prosecutor looks at many factors: the criminal history of the defendant, the seriousness of the drug involved, and the quality of the evidence. A repeat offender (someone who has been arrested more than once) may be charged with an enhanced-penalty crime, meaning that the offender faces stiffer penalties. In most states, the district attorney makes the decision about such a charge. The vast majority of cases lead to guilty pleas, through some form of plea bargaining between the prosecutor and the defense attorney. In these agreements, which must be approved by the court, the defendant pleads guilty, often in return for a reduced punishment, such as a fine, court-ordered counseling, or a shorter prison term. Repeat offenders are at a disadvantage in plea bargaining and are less likely to get reduced punishment. Another important factor in charging arrestees involves the level of cooperation provided by the defendant. The district attorney often accepts a more lenient agreement for defendants who assist lawenforcement officers and/or testify in court concerning who sold them the drugs they possessed or resold. These plea agreements allow the police to target other offenders and also relieve the pressure on the courts. Plea-bargaining does, however, raise serious questions about the dangers of leniency. Citizens may worry that a person who deserves a strict punishment is “getting off easy.” Plea bargaining also raises questions, among defendants and their attorneys, about fairness. For example, a defendant may wonder whether he has gotten as good a “deal” as another defendant.
Sentencing Drug Offenders If a person is convicted of a drug offense, the judge must apply a criminal sentence. However, judges now have little discretion (authority to make a decision) in applying a sentence based on the individual offender. Instead, judges must either apply a mandatory sentence or use 176
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E ST IMAT E D NU M B E R O F A R R E S T S , B Y T Y P E OF DRUG LA W V IO L AT IO N , 19 8 2 – 1 9 9 9 Year
Sale/Manufacture
Possession
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
135,200 145,500 155,800 194,700 206,000 243,700 311,900 435,700 348,600 333,300 341,200 337,900 364,900 369,000 376,600 324,600 330,500 300,300
540,800 515,900 552,600 616,700 618,100 693,700 843,300 926,000 740,900 676,700 725,200 788,400 986,500 1,107,100 1,129,700 1,259,000 1,228,600 1,231,900
Arrests for drug possession are far more common than arrests for drug sales or manufacturing, although all drugrelated crimes violate both federal and state laws.
SOURCE: FBI, "Crime in the United States," annual Uniform Crime Reports. .
sentencing guidelines to determine whether a person will go to prison and for how long. Under mandatory sentencing laws, people convicted of particular crimes receive particular sentences. For example, people convicted of selling heroin or cocaine within 1,000 yards of a school receive at least a three-year prison term. People convicted of selling more than four ounces of heroin or cocaine receive at least a five-year prison term. These prison terms are called mandatory minimum sentences. Some mandatory sentencing laws require life sentences. Since the 1980s, state and federal judges have had to follow sentencing guidelines, which shift the focus of sentencing from the offender to the offense. The guidelines place offenses in various categories. Once a person is convicted, there is a sentence for each category. Judges are allowed to increase or decrease sentences. These changes in sentencing are known as departures. Judges must have good reasons for a departure and must explain these reasons in the trial record. Upward departures—longer than usual sentences—are easy to achieve, as judges are allowed to consider any conduct by the defendant that is related to the crime. This conduct can include the circumstances surrounding the crime, offenses that were committed at the same time as the charged offense but were not charged, prior convictions, and acts for which the defendant was previously tried but acquitted. Judges have a more difficult time making downward departures. Decreasing a sentence is acceptable if the defendant accepts responsibility for the crime, or committed the crime to avoid a more serious offense. Prosecutors often successfully challenge decreased sentences on appeal. 177
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Enforcement of Alcohol Laws
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See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
The penalties for drinking and driving have been increased since the founded in 1980s. Mothers Against Drunk Driving (MADD), 1980, has led the call for tougher penalties for offenders and repeat offenders. Currently, MADD is the largest anti-drunk-driving organization in the United States (and the world), with over 2 million members and supporters nationwide. MADD advocates canceling the licenses of drunk drivers, taking away their license plates and vehicles, increasingly stiff penalties for repeat offenders, and mandatory jail time for repeat offenders. The organization wants drunk drivers to pay for the cost of the system that arrests, convicts, and punishes them. MADD also wants businesses that serve alcohol to act more forcefully to prevent customers from becoming drunk. Many states have embraced these recommendations.
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Prosecutors have become more aggressive in prosecuting private homeowners and businesses selling liquor when they serve drunk drivers. Adults who serve alcohol to underage drinkers in their homes also risk prosecution if these drinkers are charged with driving under the influence or driving while intoxicated, or are involved in a serious traffic accident. Under most state laws, businesses that sell liquor to intoxicated people can be sued in civil court for doing so. If the police suspect a person is driving while intoxicated, they have the authority to stop the driver and ask the driver to submit to a breath test analysis on the spot. The driver is free to decline taking the test, but this usually results in an automatic suspension of the driver’s license. This suspension is based on implied consent laws, which are civil rather than criminal. Under these laws, holding a state driver’s license is a privilege, and with that privilege comes the driver’s agreement (consent) to take such a test. The failure to take the test breaks this implied consent.
blood alcohol concentration (BAC) amount of alcohol in the bloodstream, expressed as the grams of alcohol per deciliter of blood; as BAC goes up, the drinker experiences more psychological and physical effects
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Drivers who have been pulled over by police on the suspicion of driving while intoxicated face two alternatives: They can take a breath test, risking that a high reading will lead to criminal charges. Or, they can refuse the breath test and lose their driving privileges immediately. In the late 1990s, some states, including New York and California, enacted laws that made refusing a breath analysis test a crime. In these and several other states, legislators concluded that the penalty of license suspension was not severe enough. Prosecutors can make more serious charges if the blood alcohol concentration (BAC) of the individual is above a certain figure. In addition, if the person has been convicted of previous drunk driving charges, the person can be charged in some states with a felony, the
Law and Policy: Modern Enforcement, Prosecution, and Sentencing
During a sobriety test, a police officer may ask the person to walk a straight line, check eye coordination, or utilize a breathalyzer to determine the person s level of intoxication.
most serious type of crime. If convicted, repeat offenders now face long jail sentences. Many jurisdictions also place convicted drunk drivers under house arrest. These offenders must wear electronic monitoring devices to make sure they are not driving a motor vehicle or using alcohol.
The Prosecution of Juveniles Since the early 1900s the juvenile justice system has tried to treat juvenile offenders differently than adult criminals. The juvenile system’s goal was to rehabilitate young offenders rather than punish them. The law defines a juvenile as a person who is not old enough to be held responsible for criminal acts. In most states and at the federal level, this age threshold is set at 18. However, some states set the threshold at 17 and a few go as low as 16. Depending on their age, young people accused of a crime are charged in adult court or are required to appear in juvenile court.
rehabilitate to restore or improve someone to a condition of health or useful activity
However, when a juvenile commits a serious violent crime, different rules apply. In most jurisdictions, the juvenile is automatically 179
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The number of adults and juveniles arrested for drugrelated crimes consistently rose from 1980 through 2000, with adults being arrested far more often than juveniles, according to an FBI Uniform Crime Report.
E S TI M ATED A RRES TS FOR DRUG-RELATE D CRI ME S (S UCH AS PO S S E S S I ON OF I LLI CI T DRUGS , GROWI NG, OR S ELLI NG DRUGS) B Y A D ULTS A ND JUV E NI LES , 1 9 8 0 – 2 0 0 0
1,500,000 Adult Juvenile
Estimated number of arrests
1,200,000
900,000
600,000
300,000
0 1980
1985
1990
1995
2000
Year Crime in the United States, annual, Uniform Crime Reports. . SOURCE:
referred to adult criminal court. Another possibility is that the prosecution will be allowed to ask to have the youth tried in adult court. Therefore, if a juvenile commits a serious drug crime, it is likely that prosecutors will seek to charge the juvenile as an adult. If a young person causes the death of another person while driving drunk, it is very likely that the juvenile will treated as an adult. This means that, if convicted, the juvenile will be subject to the same mandatory sentences and sentencing guidelines as an adult.
Conclusion State and federal governments have strengthened their enforcement of drug and alcohol laws by increasing the penalties for many criminal violations and by making these penalties mandatory. As a result of mandatory sentencing and sentencing guidelines, the number of drug offenders in U.S. prisons has risen sharply. Penalties for drunk 180
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drivers and repeat drunk drivers have become more strict, while the amount of alcohol in the body necessary to trigger a criminal violation has been steadily lowered. S E E A L S O Crime and Drugs; Driving, Alcohol, and Drugs; Drug Testing Methods and Analysis; Law and Policy: Court-Ordered Treatment; Law and Policy: History of, in the United States; Prohibition of Alcohol; Violence and Drug and Alcohol Use.
Lysergic Acid Diethylamide (LSD) and Psychedelics Lysergic acid diethylamide, or LSD, is a powerful hallucinogenic drug. When an individual uses a hallucinogenic drug, he or she experiences hallucinations—vivid sights, sounds, smells, tastes, or other sensations that are occurring only within the user’s mind but seem to be real. LSD is also sometimes called a psychedelic drug because of its ability to cause hallucinations and to make the user lose touch with reality. In fact, LSD can sometimes have such profound effects on a user’s ability to distinguish what is real from what is happening inside his or her own head, that it can make the user appear to be suffering from psychosis, a state of mind that robs an individual of the ability to think clearly, reason effectively, exercise good judgment, and understand reality. LSD crystals, discovered in 1938, are clear, odorless, and often distributed in tablets or capsules.
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The History of LSD LSD was originally synthesized at a Swiss pharmaceutical company in 1943. Chemists were working on a project to develop medicines from a fungus that infects grasses. Some of the compounds they created are useful for the treatment of migraine headaches and for certain problems of childbirth. These medications do not have hallucinogenic properties. The chemist in charge of this drug development project was Albert Hofmann. He called the compound he formed in the lab LSD25. Hofmann accidentally swallowed some of the substance, and within forty minutes he had the first LSD “trip.” Later, he carefully described the vivid flood of perceptions that a person experiences when taking a psychedelic drug. The drug and various versions of it were tested for medical uses in the late 1940s and in the 1950s. After World War II, some professionals became excited by LSD’s potential uses for psychiatric patients. However, no specific medical use for LSD, or the psychedelic drugs related to it, has been found. In the nineteenth century, artists and writers such as the French poets Charles Baudelaire and Arthur Rimbaud smoked hashish, a potent form of the hallucinogen marijuana, to enter altered, dreamy, states of consciousness and euphoria (an intense feeling of wellbeing). In the 1960s, LSD became the drug of choice for those searching for meaning and insight by way of altered states. Those who participated in the “acid culture” in the 1960s believed that LSD could help them unlock the mystery and power of the human mind. Then Timothy Leary, a young psychology instructor at Harvard, explored the uses of LSD, claiming that criminals who took it became loving and peaceful and others more creative. After he promoted this idea on campus, the college decided not to keep him as a faculty member. Leary called himself a martyr to his cause and became famous for his views on LSD. Increasing numbers of people began experimenting with LSD and other psychedelics such as mushrooms, mescaline, and peyote. Rock musicians, hippies, flower children, and many in the various protest movements against the “establishment” and the Vietnam War joined with Leary in trying to attract upperand middle-class youth to the drug scene. Leary’s challenge was for youth to “turn on, tune in, and drop out” with acid. More and more youth were curious to try experiences their parents had never dreamed of. They not only experimented with LSD but tried many other drugs as well, especially marijuana. Hundreds 182
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There have been modest decreases in LSD use among 8th grade students between 1997 and 2001.
L SD U SE AM O N G 8 TH G R A D E R S , 1 9 9 7 – 2 0 0 1
5
4.7 Lifetime 4.1
4.1
4
3.9 3.4
3.2 Percent
Annual
2.8
3
2
1.5
2.4
2.4
1.1
1.1
1
1998
1999
30-day
2.2
1
1
0 1997
2000
2001
Year Monitoring the Future Study. Conducted by the University of Michigan's Institute for Social Research and funded by the National Institute on Drug Abuse, National Institutes of Health. .
SOURCE:
of so-called designer drugs, such as MDMA (ecstasy), were synthesized as the desire for new and different drugs increased. Users of psychedelics often had “bad trips” (these were usually panic reactions to the drug’s effects) and were rushed to emergency rooms. Public concern grew that American youth would all become “acid heads.” In 1966, the Swiss laboratory stopped distributing the drug because of public concern. No evidence was ever found to support the claim that LSD produced lasting insights, and research with LSD in humans ended. According to the National Household Survey on Drug Abuse, in 2000 an estimated 1,749,000 people 12 and older used LSD within the past year. The same survey found that in 2000, 0.8 percent of people 12 and older and 2.2 percent of people aged 12 to 17 reported having used LSD in the past year. A survey of high school students found that in 2001, 6.6 percent of 12th graders and 4.4 percent of 10th graders reported having used LSD within the past year.
How is LSD Taken? LSD is one of the most potent hallucinogens. One-billionth of a gram of LSD per gram of brain produces profound mental changes. The typical street dose of LSD ranges from 10 to 300 micrograms. LSD can be taken in pill form. It can also be applied to paper blotters, then dissolved and swallowed. Some drug sellers take grocery store mushrooms and sprinkle them with LSD, selling them as “magic” mushrooms. LSD can also be taken by accident. For example, a drug seller may offer a substance as THC, the active ingredient in marijuana, 183
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when it is really LSD. The user then faces the danger of an unexpected acid trip.
The Effects of LSD LSD is quickly absorbed into the brain and all body tissues from the gastrointestinal tract and other mucous membranes. The psychological and behavioral effects occur approximately 30 minutes after the drug is swallowed. The effects peak in the next 2 to 4 hours, depending on the dose, with gradual return to normal by 10 to 12 hours. The first 4 hours after a 200-microgram dose are called a “trip.” In the next 4 to 8 hours, when over half the drug has left the brain, the most intense effects appear to end, and users think the drug is no longer active. However, they later realize that certain effects—the feeling of being at the center of things and being extremely alert— lingered in the last 4 to 8 hours of the trip. From 12 to 24 hours after the trip, the user sometimes feel a slight letdown or feeling of fatigue—as if he or she had been on a long, steep roller coaster ride. After these intense and even frightening moments, the ordinary world might for a time seem drab. There is no craving to take more LSD to relieve this boredom, although some may want to repeat the experience. People remember the trip very clearly. Despite promises that LSD inspires creativity or lasting profound thoughts, no evidence has ever shown that this is true. When people recall their experiences and perceptions while they were on LSD, they conclude that the drug did not offer any lasting insight or creativity. All drugs, including alcohol, make a person feel different. Some people become livelier, more talkative, less inhibited, and more daring. Others may become more reserved or withdrawn after using alcohol or another drug. What people expect from the drug experience, and where and when they take the drug, influence the kind of effects they feel. This is especially the case with psychedelics. For some, the trip may simply be funny and odd. For others it will have special meanings related to events in their lives. Taking the drug in an insecure or tense environment can produce a bad trip. Some users are aware that the trip is not quite real and feel as if they are watching their own experiences. The kind of trip varies greatly depending on the person who takes the drug and in what situation. LSD produces a sense of clarity and awareness of sensory signals—of sights, sounds, touch, lights, and colors. Thoughts, memories, or conversations take on special significance. For example, gestures or the tone of someone’s voice appear to be more important 184
Lysergic Acid Diethylamide (LSD) and Psychedelics
than what a person is saying. Small background details that people normally ignore suddenly capture their attention. As the person’s awareness increases, the sense of control decreases. The user may panic at this loss of control. It is impossible to predict who will have an LSD panic experience. One trip without panic does not guarantee that the next trip will also be without panic. Often, people take LSD in groups or with a guide to help lessen the feeling of losing control. Some effects of LSD are alike in every user. The first sign of feeling different is like butterflies in the stomach or slight nausea. Some describe it as the moment before a roller coaster ride. Parts of the body simultaneously feel strange or different. The cheeks become slightly flushed and pupil size begins to increase. The person feels that things to the side of his field of vision become as clear as things at the center. The user becomes tense and laughs or cries as a way to reduce the tension. Next comes the period of intense and changing perceptions and feelings. People describe having several feelings simultaneously. A common observation is, “I don’t know if I’m anxious, thrilled, or terrified.” Throughout the trip, people feel as if they
Because LSD is very potent, it may be applied to absorbent paper (called blotter paper), and divided into one dose decorated squares.
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are on the brink of an exciting but also dangerous experience. This intensity dies down about 4 hours after the usual dosage. In some cases, people on LSD have acted out dangerous or strange impulses and even committed suicide. Any kind of trip, good or bad, can result in dangerous behavior. For example, users have reported that while on LSD, they believed they could fly off buildings or walk in front of cars without getting hurt, sometimes acting on these beliefs. Also, LSD may cause a lack of muscle coordination, which can combine with distorted perceptions to make normally safe behaviors, such as driving, much more dangerous. Bad trips can make the user feel terror, panic, or despair. For example, one user described her belief that she was in someone else’s dream and would fade away when that person awoke. Some users have described a feeling of being in an unending maze or hall of mirrors. Terror can lead to unpredictable and dangerous behavior. There is no way to know that a bad trip will occur. It may happen at any time when LSD is taken. Effects depend very much on the mood of the users, where they are, and who they are with, as well as the dose taken. Large doses are more likely to produce bad trips. Because the amount of LSD needed to produce an effect is very small, it is difficult to control or predict the dose in any preparation.
The Aftereffects of LSD Use Some LSD users experience aftereffects, or drug effects that occur days, months, or years after the trip. These LSD aftereffects are called “flashbacks.” During flashbacks, people suddenly and without warning feel that they are back on the drug. They also may see flashing lights and other optical illusions. These flashbacks may be very disturbing. Flashbacks can occur after only a single drug experience. Scientists do not know why or how flashbacks occur. Another aftereffect is a change in perception that occurs long after the person has taken the drug. One scientist who took LSD described an aftereffect that lasted for several months. He noted that, while riding a train to work, he was unable to concentrate on reading his newspaper because of the telephone poles the train was whizzing past. The telephone poles were normally outside the center of his attention as he was reading. But after LSD, he could no longer avoid paying attention to them.
LSD Tolerance People who take LSD, mescaline, and other psychedelic drugs can develop tolerance to the drugs’ effects. After daily doses of 200 mi186
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crograms of LSD, the person feels its effects less intensely and for a shorter period. However, after three or four days without LSD, the person can again achieve the full effects of that dose. Thus tolerance both develops and disappears quickly. A common sign of tolerance is when the person’s pupils do not enlarge after taking the drug. Stopping LSD after several days of use does not produce withdrawal symptoms.
The Long-Term Risks of LSD Use
tolerance condition in which higher and higher doses of a drug or alcohol are needed to produce the effect or high experienced from the original dose.
For people at risk for mental disorders, hallucinogenic experiences may lead to some form of mental illness. For others, the experience may lead to “dropping out”—becoming unconcerned with the real world rather than trying to cope with its challenges. There is no evidence that LSD causes permanent damage to brain cells. However, the drug does have risks. The major risks are the unpredictable effects of intense, uncontrollable perceptions and feelings, and how people will manage the memory of the drug experience in their subsequent life. S E E A L S O Creativity and Drugs; Designer Drugs; Hallucinogens; Marijuana.
Marijuana In the United States, “marijuana” is the most common term for the hemp plant (Cannabis sativa) and the drug derived from hemp. The hemp plant is native to Asia, where it is grown legally. One species of the plant is grown for its fiber content (it is used to make strong rope) and another for its drug content. In various Asian countries, drugs derived from hemp are called bhang, ganja, and hashish.
M
The History of Marijuana Cannabis has been used for several thousand years. The earliest references to the plant are in ancient Chinese and Indian writings. From India, the use of cannabis spread eastward to Persia (now Iran) and the rest of the Near East. The Arabs adopted and spread it through North Africa as they conquered those lands for Islam from the seventh to the fifteenth centuries. In Arabic, cannabis is called hashish, meaning grass. Islam forbids the use of alcohol but not hashish, since it was adopted after the Prophet Muhammad established Muslim law. Although the Arabs ruled in parts of Portugal and Spain until 1492, use of cannabis did not spread to this area. However, the Spanish conquistadors (conquerors) introduced cannabis into the New World, where it was adopted by African slaves. 187
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Tetrahydrocannabinol (THC) is the active ingredient in marijuana. Its property as an antiemetic has led to much debate over whether or not marijuana should be legalized.
The Chemistry of Marijuana The active substance in marijuana that produces its mind-altering effects is tetrahydrocannabinol (THC). The amount of THC varies greatly depending on the genetic type of the plant, the part of the plant involved (for example, the leaves or the flowers), and whether the plant is young or old. Plants used for hemp fibers, such as those that grow wild in the U.S. Midwest, contain no THC or only very small traces. Other plants, such as sensemilla, have a high THC content.
Who Uses Marijuana? After caffeine, alcohol, and nicotine, marijuana is probably the most widely used drug in the world. It is estimated that between 200 and 300 million people use cannabis in one way or another. In the United States alone, according to the 2000 National Household Survey on Drug Abuse, about 86 million people report having used marijuana at some time in their lives, and about 18 million report using it in the past year. The number of regular users in the United States may be around 10 million. In 2001, 49 percent of all 12th graders and 40 percent of 10th graders reported having used marijuana at least once; 37 percent of 12th graders reported having used it within the past year. In the United States, marijuana is a drug preferred by young people and those who think of themselves as young. In a survey of students about their drug use, 20.5 percent of high school students reported at least a single use of marijuana during the thirty days before taking the survey. By comparison, 27.6 percent of high school 188
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students said they had smoked at least one cigarette, and 37 percent said they had had at least one drink of alcohol. Among junior high school students, 5.3 percent report having used marijuana in the past thirty days, 9 percent report smoking cigarettes, and 11 percent report having had at least one drink. Marijuana is still not as widely used as nicotine and alcohol, but the trends for alcohol and tobacco use show a decline, while marijuana use continues to increase slowly. A number of factors seem to increase the likelihood that some young people will use marijuana. Those most likely to use the drug are males who smoke cigarettes, drink alcohol, and engage in problem behaviors. Young people who come from homes in which there is only one parent and who perform poorly in school are also more likely to use marijuana. Overall, social factors, such as the individual’s home and general environment, appear to be more important in leading to marijuana use than an individual’s performance in school.
The Effects of Marijuana Use Marijuana has a wide range of effects. These effects resemble those of stimulants such as amphetamines, hallucinogens such as LSD, and depressants such as alcohol. As a result, marijuana cannot be placed in any one class of drugs. The most common way to use the drug is by smoking it in a marijuana cigarette. The experienced smoker of marijuana is usually aware of a drug effect after two or three inhalations. As smoking continues, the effects increase, reaching a peak about twenty minutes after the user stops smoking. Most effects of the drug usually disappear after three hours. At that point concentrations of THC in the body’s plasma are low. When a user eats marijuana, peak effects may be delayed for three to four hours, but may then last for six to eight hours. In the early stage of the marijuana high, the user may feel euphoria (intense well-being), uncontrollable laughter, alteration of one’s sense of time, sharpened vision, and depersonalization (a sense that one is detached from one’s environment, and is watching oneself from a distance). Because marijuana stimulates the appetite, users often feel hungry, and they report that food tastes especially satisfying or enjoyable. Later, the user becomes relaxed and experiences a dreamlike state. Thinking or concentrating becomes difficult, although by force of will the person can concentrate to some extent. Two signs of marijuana intoxication are increased pulse rate and reddening of the whites of the eyes. Blood pressure may fall, especially when the user is in an upright position. The user may also feel a decrease in nausea, muscle weakness, tremors, unsteadiness, and in-
stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system hallucinogen a drug, such as LSD, that causes hallucinations, or seeing, hearing, or feeling things that are not there depressant chemical that slows down or decreases functioning; often used to describe agents that slow the functioning of the central nervous system; such agents are sometimes used to relieve insomnia, anxiety, irritability, and tension
intoxication loss of physical or mental control because of the effects of a substance
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creased reflexes (such as the knee jerk). At high doses, marijuana can impair performance of almost any task.
tolerance condition in which higher and higher doses of a drug or alcohol are needed to produce the effect or high experienced from the original dose withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance
depression state in which an individual feels intensely sad and hopeless; may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities; in extreme cases, may lead an individual to think about or attempt suicide schizophrenia psychotic disorder in which people lose the ability to function normally, experience severe personality changes, and suffer from a variety of symptoms, including confusion, disordered thinking, paranoia, hallucinations, emotional numbness, and speech problems
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Heavy long-term users of marijuana can develop tolerance to some of the drug’s effects. A mild withdrawal syndrome has been noted following very high doses.
The Health Risks of Marijuana Use There is little agreement about the health risks of using marijuana. To begin with, marijuana is used mainly by young persons in good health. Medical complications may not affect these users. In addition, marijuana is often used in combination with tobacco and alcohol as well as with a variety of other illegal drugs. As a result, it is difficult to separate marijuana’s effects from the effects of the other substances. The issue of marijuana use tends to arouse strong debate as to whether the drug is a hazard or a benefit to health. Being on one side of the debate or the other may influence the way experiments are conducted and affect the conclusions drawn from results. The following lists some known and some possible medical complications of marijuana use.
Psychiatric Consequences. Marijuana can directly produce mental disturbances, including panic, severe confusion, paranoia (a state in which an individual feels as if the world is plotting against him or her), or mania (a speeded-up state in which an individual does not behave or speak rationally). Experts are much less certain as to whether marijuana can directly cause other psychiatric problems, such as depression or schizophrenia or antisocial criminal behavior. Some claim that marijuana use produces changes in the basic personality of users so that they lose the will to work and to strive for success. This condition is called amotivational syndrome. Other experts strongly question whether marijuana causes this condition. One certainty is that marijuana use can worsen symptoms of schizophrenia in a person who already has this mental disease. Automobile Driving. Much public debate has focused on whether marijuana, like alcohol, should become an accepted social drug. This debate must take into account the effects of marijuana use on driving abilities. It is known that half of all fatal car accidents involve alcohol. Marijuana users have decreased alertness, increased drowsiness, longer reaction times, eye-hand coordination impairment, poor perception of speed of travel, and problems judging distance, all of which could obviously interfere with safe driving. In fact, some studies have shown that young people who frequently drive while under the in-
Marijuana
fluence of marijuana are twice as likely to be in an automobile accident as young drivers who have not used marijuana. Furthermore, using marijuana and alcohol together before driving creates a greater risk than either drug used alone.
Cardiovascular Problems. For people with heart disease caused by hardening of the arteries or by congestive heart failure, certain effects of marijuana smoking could be harmful. These include increased heart rate and decreased blood pressure. For people with angina (frequent chest pains caused by reduced blood supply to the heart), smoking of any kind is harmful, but marijuana is especially so because of the effect of increased heart rate. Lung Problems. Inhaling any foreign material into the lung can have negative consequences. This is well proven in the case of tobacco. A study has shown that very heavy marijuana smoking for six to eight weeks causes mild but significant blockage of airways in the lungs. Reproductive System. In men, studies show that marijuana use can decrease sperm production. In women, studies show that marijuana use can decrease the production of eggs (ovulation) and a hormone related to ovulation. However, there is no evidence that using the drug causes infertility.
Medical Uses of Marijuana For many centuries, cannabis was used as a treatment for various ailments. In the nineteenth century a lively interest in its healing powers developed. Cannabis was used to treat tetanus, convulsions, migraine, menstrual problems, psychoses following childbirth, insomnia in the aged, depression, and other problems. In addition, it was used to increase appetite and to relieve the pain and anxiety of patients terminally ill with cancer. Although few studies have been conducted to test marijuana’s effectiveness for treating these various illnesses, research indicates several potential medical uses.
Uses for Cancer Patients. A substance that suppresses vomiting is called an antiemetic. Cancer chemotherapy, especially with the drug cisplatin, can produce severe nausea and vomiting, which is extremely difficult to treat with ordinary antiemetic drugs. Many patients avoid effective cancer chemotherapy because of the severe nausea and vomiting.
psychosis mental disorder in which an individual loses contact with reality and may have delusions (i.e., unshakable false beliefs) or hallucinations (i.e., the experience of seeing, hearing, feeling, smelling, or tasting things that are not actually present)
In 1972 it became clear that marijuana has antiemetic effects. In that year, a synthetic (not naturally occurring) drug similar to THC, nabilone, was developed. Tests show that nabilone is an extremely 191
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effective antiemetic, although it has not been approved for use in the United States. However, since 1972 new, effective antiemetic drugs have been developed. These drugs may eliminate the role of THC as a potential antiemetic for chemotherapy patients.
Glaucoma. Glaucoma is a disease of the eyes in which pressure in the eyeball increases greatly. If untreated, it can lead to blindness. Marijuana’s ability to decrease pressure inside the eyeball was discovered by chance in a study of the effects of long-term, high-dose marijuana smoking. It may be possible to apply marijuana topically (in this case, on the eyeball) for treatment of glaucoma. A great deal of further research must first determine how long the effects on the eye will last and whether topical applications would have any side effects. Pain Relief. Marijuana has been shown to be useful for relieving pain. Efforts are being made to create new chemical compounds that would produce the painkilling effect but none of the other effects of marijuana.
Treatment Associated with Marijuana Use The hemp plant Cannabis sativa (shown here) is cut down and chopped into small pieces for harvesting.
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See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
In general, marijuana users, even those who use it heavily, do not feel the need to seek treatment. In some cases, users who take other drugs, such as cocaine or alcohol, in combination with marijuana seek treatment for the medical complications of those other drugs. Treatment programs directed specifically at marijuana use are rare. One group hoping to treat marijuana use is Marijuana Anonymous, which uses a Twelve-Step approach similar to that of Alcoholics The effectiveness or usefulness of this group has not Anonymous. been tested.
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The Gateway Effect of Marijuana Statistics show that marijuana smoking is linked to the use of other illegal drugs, such as heroin and cocaine. Most observers note that individuals who seek out new experiences through drugs are likely to try more than one drug. Marijuana is often the first drug they try. This first use puts the individual in contact with dealers and other people who have access to a wide range of drugs. Because marijuana can lead to the use of “harder” drugs in this way, marijuana has been referred to as a “gateway” drug. Some programs aim to prevent experimentation with marijuana in the hope of preventing an individual’s movement toward other more dangerous drugs.
Legal Status Despite its widespread use, marijuana remains illegal. In some areas, possession and use of small amounts of the drug are civil crimes pun192
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ishable only by a small fine. In other areas, the laws controlling possession, use, and sale of marijuana call for more severe punishments, but these laws are not consistently enforced. In some cases the law permits the medical use of drugs that contain THC or that are similar to THC. For example, Marinol, a drug that contains THC, can be used to control the nausea and vomiting associated with cancer chemotherapy. Because of this medical use, THC was moved from Schedule 1 (no medical use) of the government’s list of controlled substances to Schedule 2 (medical use despite potential for abuse). Nabilone, the synthetic drug similar to THC used to treat nausea and vomiting, is also a Schedule 2 substance. The question of whether or not to legalize the use of marijuana for either medical or social purposes continues to create controversy and debate. Further research may help medical and legal experts reach agreement about how, if at all, this substance should become available for use. S E E A L S O Adolescents, Drug and Alcohol Use; Cannabis Sativa; Driving, Alcohol, and Drugs; Law and Policy: Drug Legalization Debate.
Marijuana Treatment Despite the popularity of marijuana in the United States, fairly little is known about how to treat individuals who become dependent on this drug. In addition, many heavy users of marijuana do not feel that they need treatment. Many research studies are investigating possible approaches to treatment. Currently, the most common form of treatment is through support groups. Marijuana Anonymous, (MA) a self-help fellowship based on the principles and traditions of Alcoholics Anonymous, exist in a number of states and around the world. In addition to in-person meetings, MA sessions are also held online.
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dependent someone who has a psychological compulsion to use a substance for emotional and/or physical reasons
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See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
Biological Factors Advances in the scientific understanding of brain chemistry have provided considerable evidence that marijuana dependence is determined by biological factors. Scientists have identified a specific area of the brain that the active chemicals in marijuana attach to and affect. Knowing this information will make it possible to study the effects of long-term marijuana use. There is some evidence that genes determine whether a marijuana user will become dependent. In a study of more than 8,000 male twins, 193
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The number of people admitted to substance abuse programs who named marijuana as their primary drug of abuse rose steadily throughout the mid-1990s.
PE R C E NTA GE S OF P E OP LE A DMI TTE D TO S UBS TA NCE A BUS E PR O G R A MS WHO LI S T MA RI JUA NA A S THE I R P RI MA RY DRUG O F A B US E , 1 9 9 3 THROUGH 1 9 9 8
15 12.9%
13.3%
12.0%
Percent admitted
10.5% 10 8.5% 7.0%
5
0 1993
1994
1995
1996
1997
1998
Year SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) 1993-1998. .
genes were shown to influence whether a person finds the effects of marijuana use pleasant. A study of females had similar findings. While factors in an individual’s social environment (such as whether someone’s friends, roommates, or family members use marijuana) clearly influence whether he or she ever tries marijuana, becoming a heavy user or abuser may be more determined by biological factors, perhaps involving a part of the brain known as the limbic system. Research in this area may eventually identify who is most at risk for marijuana dependence. People may be able to use this information to make decisions about their own use of this drug. As knowledge of human biology expands, the treatment of marijuana dependence is also likely to take new paths. S E E A L S O Adolescents, Drugs and Alcohol Use; Brain Structures; Marijuana.
Media Representations of Drinking, Drug Use, and Smoking media means of mass communication, such as newspapers, magazines, radio or television.
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Researchers study how drugs, alcohol, and tobacco are portrayed on television, in movies, in songs, and in other forms of media. According to some studies, media containing scenes or conversations
Media Representations of Drinking, Drug Use, and Smoking
HOW FILMS DEAL WITH DRUGS Filmmakers have struggled with how to show drug use, striving neither to hide nor to glorify the dark sides of drug use. Here are a few movies that portray drug use.
Traffic (2000) looks at the U.S. drug scene, from police officers to dealers and users. One teenager s downfall is shown as a struggle against her family. We see the consequences of her growing addiction, especially her inability to pay for drugs, and, eventually, her search for recovery. Requiem for a Dream (2000) is a story of four individuals who turned into addicts. The film illustrates how drugs can take over the lives of anyone, from young adults to parents, and how addicts desperately search for something worthwhile in those substances. Trainspotting (1996) takes an explicit look at Scottish teens who use heroin and the costs of their drug abuse, both to their personal relationships and their own health. One user fights peer pressure and his own growing physical dependence to remain drug-free. The Basketball Diaries (1995) follows a high school basketball star as he becomes addicted to heroin and his life spins out of control. He eventually ends up on the streets, earning money any way he can to feed his addiction.
about these substances can affect drinking, smoking, and illicit drug use, especially among children and young adults. Some organizations are trying to reduce or eliminate the appearance of these substances in the media. They also encourage actors, musicians, writers, and producers to portray substance use in a realistic—not a glamorous—way.
illicit something illegal or something used in an illegal manner
Alcohol, Tobacco, and Drugs in Movies
☎ ☎ See Organiza-
In 1999 a research and advocacy organization called Mediascope completed a study about substance use in movies and music. Mediascope researchers wanted to compare the public’s impression of how often alcohol, drugs, and tobacco were mentioned or seen in movies and music to the actual number of times these substances appeared in these media. The study looked at how often alcohol, tobacco, and illicit drugs appeared in the 200 most popular movie rentals and 1,000 most popular songs from 1996 to 1997. It also examined how the substances were portrayed in each song or movie.
tions of Interest at the back of Volume 2 for address, telephone, and URL.
The study found that 98 percent of the 200 movies showed or mentioned alcohol, tobacco, or drugs. Alcohol appeared most often, 195
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followed by tobacco. Illicit drug use appeared in only 22 percent of the movies. Statements suggesting that substance use was wrong or should be avoided were found in 31 percent of the movies in the study. Statements suggesting that substance use was good, or something that the actors wanted, appeared in 29 percent of the movies. Most of these positive statements were about alcohol. The Mediascope group found that most movies did not show the long-term consequences of drinking, smoking, or drug use. In many cases, the movies did not explain why the adult or young adult characters were using these substances. Alcohol and tobacco were associated with different kinds of situations in the movies. Alcohol often played a part in humorous scenes, party scenes, or scenes associated with wealth and luxury. A smaller percentage of scenes showed alcohol and some sort of risky behavior, such as crime, violence, or driving a car. Nearly 20 percent of the movie scenes with alcohol also involved sexual activity. The study also found that few young adult characters were shown using substances by themselves. Smoking is associated with more negative activities than drinking in movies, according to the study. It is linked more often to crime and violence, and less often with wealth, parties, or humor. The Mediascope researchers also discovered that Budweiser drinks and Marlboro cigarettes were the most popular brands shown in the movies. Each of these brands appeared five times more than any other brand.
opiate derived directly from opium and used in its natural state, without chemical modification (e.g., morphine, codeine, and thebaine)
proportional properly related in size; corresponding
Illicit drugs appeared less often than alcohol and tobacco in the movies. Of all these drugs, marijuana was the most popular. It appeared in 57 percent of all drug scenes. Heroin and other opiates, and powdered cocaine followed marijuana as the next most popular movie drugs. Other drugs such as crank, crack, and LSD appeared less often. Overall, more white than African-American characters used illicit drugs in the movies surveyed. However, when the fact that fewer African Americans appeared in these movies was taken into account, African-American characters’ proportional drug use was higher than among white characters. The study showed that most movie drug scenes do not emphasize that drugs are illegal. Only 28 percent of these scenes showed drugs as part of a criminal or violent activity. Just as with alcohol and tobacco, most movies do not show the long-term consequences or reasons for illicit drug use.
Alcohol, Tobacco, and Drugs in Music The 1999 Mediascope study also looked at substance use in several types of popular music, including Top 40, country, rap, alternative 196
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rock, and heavy metal. Twenty-seven percent of the songs studied by the researchers directly mentioned alcohol, tobacco, or illicit drugs. Whereas alcohol was shown most often in movies, illicit drugs appeared most often in these songs. Alcohol references came in a close second, followed by few tobacco references. The researchers also noticed that drug-related phrases, such as “I’m high on you,” were often in songs even where drugs were not mentioned specifically. Substances appeared in 74 percent of all rap songs studied, followed by 20 percent of Top 40, 20 percent of alternative rock, 20 percent of country, and 12 percent of heavy metal songs. Rap contained the most lyrics about illicit drugs (63 percent of all rap songs) and alcohol (47 percent of songs). Alternative rock, country, and Top 40 music contained similar amounts of lyrics about alcohol, while heavy metal songs mentioned alcohol the least. Only one country song in the survey mentioned illicit drugs. Marijuana was the drug that appeared most often in these songs, with other references to crack and powdered cocaine, heroin, and hallucinogens. In songs with references to illicit drugs, drug use was associated most often with sexual or romantic activity, wealth or luxury, and crime and violence. Songs with alcohol references also linked drinking with sex and romance, wealth, crime, and power. Alcohol brand names were mentioned in 30 percent of the songs studied. Some of the brands mentioned included Remy Martin, Hennessy, and Dom Perignon.
Recording artists, like rapper Kid Rock, have been accused of glamorizing drug use in their music. hallucinogen a drug, such as LSD, that causes hallucinations, or seeing, hearing, or feeling things that are not there
Very few of the songs contained antidrug messages, messages about drug treatment, or consequences of substance use. Just as with the movies surveyed, most song lyrics did not provide any clues about why the substance users were drinking, smoking, or using drugs.
Alcohol, Tobacco, and Drugs on Television In 2000 Mediascope followed up its study of substance use in movies and music with a look at drugs, alcohol, and tobacco on prime-time television. The study covered several episodes from forty-two situation comedy and drama shows in the fall 1998–1999 television season. The shows studied by the researchers included the twenty most popular shows among teenagers and among adults. The study also included the twenty most popular shows for African-American teens, Hispanic teens, and white teens. Alcohol was seen or mentioned most often on television, appearing in 77 percent of the shows in the study. Tobacco appeared in 22 percent of all shows. Illicit drugs appeared in 20 percent of all episodes. Of all substances, alcohol was portrayed in the most 197
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positive way on television, often associated with humor. Scenes and conversations about tobacco use were mostly negative. Alcohol use appeared in many shows popular with teenagers. However, teenage drinkers or smokers seldom appeared on these shows. There were few scenes of illicit drug use among the shows in the study. Most episodes containing scenes of drug use linked the drug use to negative consequences, unlike in the movies. The television shows also contained fewer portrayals of illicit drugs and alcohol, and much less mention or scenes of tobacco, than in movies. The study found few differences in substance use among the shows most popular with different teen ethnic groups. In general, episodes popular with African-American teens showed less smoking. Shows popular with white teens contained more conversations about heavy drinking. The frequency of illicit drug use was very similar in shows popular with African-American, Hispanic, and white teens. Mediascope’s research revealed that 59 percent of all commercials shown during shows popular with teens contained alcohol. Only 9 percent of those commercials directly promoted an alcohol product; the rest showed alcohol in advertising for things like hotels, restaurants, and credit cards.
Alcohol, Tobacco, and Drugs in Other Media Alcohol, drug, and tobacco use in magazines, comic books, music videos, and video games has not been studied as much as in other forms of media. One study, in 1994, examined alcohol and tobacco use in music videos shown on several television channels, including MTV, VH1, CMT, and BET. The study found that tobacco was seen most often on MTV. Alcohol appeared almost equally across all the channels. The study also found that tobacco and alcohol use appeared most often in rap videos. In most cases, the lead singer or musician in the video was the one shown drinking or smoking. In the case of video games, researchers who study violence in these games also look at how often drugs are shown or mentioned. The Entertainment Software Ratings Board (ESRB) is one organization that provides information on substance use in video games, online games, and some web sites.
Changing Media Portrayals of Substance Use Several organizations work to change how drugs, alcohol, and tobacco are portrayed in the media. These groups encourage actors, musicians, writers, and other artists to work toward more realistic portrayals of substance use in their particular type of media. Some 198
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organizations support media with an antidrug message. These groups usually believe that the media has a powerful influence on drinking, smoking, and drug use among young people.
☎
is The Office of National Drug Control Policy (ONDCP) probably the largest and best-known of these types of groups. The ONDCP is a national government agency that was created to stop illicit drug sales and use in the United States. One of the goals of the ONDCP is to make sure that substance use is portrayed in a realistic way in the media. As part of that goal, the ONDCP helped pay for the Mediascope studies on television, music, and movies.
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
In 1998, this government group started a program called the National Youth Anti-Drug Media Campaign. The Media Campaign provides information about illicit drugs to television and movie writers. It also organizes discussions between these writers and experts on drug use. In some cases, the Media Campaign partners directly with a company to create media with a particular portrayal of substance use. For instance, the campaign works with Marvel Comics to create a special Spider Man comic book series designed to teach antidrug messages to youth. Advertising plays a large part in the Media Campaign program. The Media Campaign pays for antidrug ads shown on television, in movie theaters, in magazines, and advertising banners on web sites. These media outlets must match each ad that the campaign buys with a service that costs as much as the ad itself. These services include things like other advertisements, or sponsorship of a community event that supports the campaign’s goals. In some cases, media companies may count television episodes or magazine articles with an antidrug message as part of their matching service. The Media Campaign uses media to send its own message about drugs directly to young people and their parents. For instance, the Media Campaign has two web sites (www.theantidrug.com and www.freevibe.com) that talk about different drugs and that encourage youths to stay away from drug use. These web sites mix information with entertainment, such as online games, cartoons, and stories. The Media Campaign sends out drug information and advertisements in many languages. Mediascope also works to change media portrayals of alcohol, drugs, and tobacco. Along with its research, Mediascope offers advice to the creative artists who produce music, movies, and television. It suggests ways that these artists can show or speak about substance use responsibly, especially in media directed at children and teens. It also 199
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provides information about substance use in the media to parents, teachers, reporters, and politicians. The Entertainment Industries Council (EIC) is another group that promotes responsible portrayals of substance use. The EIC is made up of people who work in television, movies, and music. The group looks for ways that the entertainment industry can help solve problems like drug abuse, along with other problems such as violence, gun and traffic safety, and health issues. One of the EIC’s best-known programs is the Prism Awards. The Prism Awards recognize media that portray substance use and addiction in an accurate way. Winners receive awards in many categories, including television primetime comedies or dramas, talk shows, children’s shows, soap operas, news specials, movies, comic books, songs and music videos, web sites, and community service. Well-known actors and musicians present the awards each year on a televised show.
philanthropy acts performed with the desire to improve humanity, especially through charitable activities
EIC sponsors these awards with its partners, the National Institute on Drug Abuse and the Robert Wood Johnson Foundation. The National Institute of Drug Abuse is the main center of drug abuse and addiction studies in the world. The Robert Wood Johnson Foundation is a philanthropy that gives money to organizations or researchers working on health issues. S E E A L S O Advertising and the Alcohol Industry; Advertising and the Tobacco Industry; Prevention; Prevention Programs.
Medical Emergencies and Death from Drug Abuse Each year, thousands of individuals of all ages visit hospital emergency departments due to medical problems stemming from drug abuse. Sometimes they die as a result of these problems. Efforts to keep track of these visits give scientists a clue as to the scope of drug abuse in the United States and which drugs are responsible for medical emergencies. These figures can also help experts spot emerging trends in the use of new drugs.
The Drug Abuse Warning Network The Drug Abuse Warning Network (DAWN) was created in 1972 by the U.S. Department of Justice as a surveillance system for new drugs of abuse. It is a voluntary national data collection system that gathers information on substance abuse resulting in visits to hospital emergency departments in the continental United States. DAWN 200
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An ambulance is dispatched from a nearby hospital. Reactions caused by users mixing drugs often results in a need for medical attention.
does not measure prevalence, or the frequency of drug use in the population. Instead, it relies on a number of hospitals that give a representative sample of emergency department visits due to drug use. This data can than be interpreted for the population at large. DAWN uses drug episodes and drug mentions to organize the information it provides. A drug-related episode is an emergency department visit that was caused by or related to the use of an illegal drug or the nonmedical use of a legal drug. This is when individuals take prescription or over-the-counter medications for uses for which they were not intended, and they become ill as a result. A drug mention refers to a substance that an individual mentioned during a drug-related visit. Since up to four drugs are sometimes reported for each drug abuse episode, there are more mentions than episodes reported. It is important to keep in mind that while DAWN data are widely used to monitor patterns and trends of drug abuse, the information represents only individuals who go to an emergency department because of their drug use. These are the most serious cases. There are many individuals who take drugs and become ill but do not visit a hospital emergency department. However, they are not represented in the DAWN report. In addition, DAWN keeps track of different types of cases. Many cases are due to overdose, but also included are cases where the individual is seeking detoxification (treatment to help stop drug abuse), or those suffering from medical problems brought on by chronic drug use. DAWN cases do not include accidental inhalation or ingestions of a drug, or negative reactions to prescription or over-the-counter drugs that were taken at the proper dosage.
chronic continuing for a long period of time
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Trends in Emergency Department Visits In 2000 the most recent year for which data are available, there were 601,563 drug-related emergency department episodes reported through DAWN. On average, 1.8 drugs were reported per episode for a total of 1,099,306 drug mentions. These figures are similar to results for 1999. From 1999 to 2000, mentions of heroin increased 15 percent, mentions of amphetamines increased 37 percent and those for methamphetamines increased by 29 percent. Cases of alcohol in combination with other drugs, cocaine and marijuana, were unchanged. Several newer substances of abuse had substantial increases from 1999 to 2000: ecstasy (MDMA) went up 58 percent and PCP went up 48 percent. By looking at these numbers, one can begin to see how DAWN helps health experts and policymakers understand emerging trends in drug abuse.
antidepressant medication used for the treatment and prevention of depression
In addition to the major substances of abuse mentioned above, DAWN tracks nonmedical use of prescription and over-the-counter drugs. These accounted for 43 percent of total drug mentions in 2000. It is not known whether these visits were for the person for whom the drug was prescribed or for someone else. The drugs that fall into this category were mainly of two types in 2000: drugs used to treat psychological problems (such as antidepressants, drugs that treat addiction, and drugs for panic disorder) and central nervous system drugs (such as analgesics, or pain relievers).
narcotic addictive substance that relieves pain and induces sleep or causes sedation; prescription narcotics includes morphine and codeine; general and imprecise term referring to a drug of abuse, such as heroin, cocaine, or marijuana
From 1994 to 2000, mentions of narcotic analgesic drugs rose 85 percent. This represents a 40 percent increase from 1998 to 2000 and a 19 percent increase from 1999 to 2000. The most frequently mentioned narcotic analgesics were: hydrocodone (Vicodin), oxycodone (OxyContin), methadone (used to treat heroin addiction), propoxyphene (Darvon), codeine, and meperidine (Demerol). In particular, use of hydrocodone, oxycodone, and methadone has increased substantially not just over the last two years, but over the last several years. Since 1994, use of these drugs has increased 100 percent or more. The majority of drug-related episodes (56%) involved more than one drug. In nearly half the episodes involving heroin, it was the only drug used, whereas cocaine and marijuana episodes tended to involve other drugs. By far the most common reason for an emergency department visit was overdose, which involved 44 percent of these cases. About half of drug-related emergency department visits resulted in admission to the hospital. While visits to emergency departments due to alcohol use by itself are not included in DAWN, alcohol in combination with other
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According to the Drug Abuse Warning Network (DAWN), drug overdose is the most common reason for drug-related visits to hospital emergency departments.
E ME R G E N C Y R O O M O R D E PA R TM E N T V I S I TS , 2 0 0 0
Cocaine
Heroin/Morphine
Marijuana
Methamphetamine/Speed
Overall
0
50
100
150
200
250
Visits SOURCE:
The DAWN Report. .
drugs was mentioned in 34 percent of drug episodes in 2000. Alcohol remains the most common substance reported. Its use in combination with other drugs was virtually unchanged between 1998 and 2000. The most frequently mentioned illegal substance in emergency department visits is cocaine, accounting for 29 percent of episodes, followed by marijuana and heroin. Almost one-quarter of the cocaine mentions in 2000 were attributed to crack cocaine, which showed no significant change since 1994. It is possible, however, that since most cocaine episodes are reported as simply cocaine, a portion of these might in fact be due to crack. From 1999 to 2000, there was a 20 percent increase in emergency department visits due to drug use for patients age 12 to 17. Patients between the ages of 18 and 34 had the highest rates of emergency department visits, followed by those in the 12- to 17-year-old range. Patients in this group had the lowest rates of cocaine and heroin mentions. Among adolescents aged 12 to 17, there was a sharp increase in mentions of marijuana or hashish (a drug related to marijuana) between 1990 and 1999. In addition, long-term data suggest that methamphetamine (speed), cocaine, heroine, and morphine use is on the rise in this age group.
What do the Trends Indicate? For the period between 1994 and 2000, there has been a 16 percent rise in drug-related emergency department visits and a 22 percent increase in drug mentions. Among illegal substances of abuse, several 203
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showed increased usage from 1999 to 2000: heroin, amphetamines, methamphetamines, ecstasy, PCP, and combinations of these. In 1994, emergency department mentions of so-called club drugs such as ecstasy and GHB were extremely low, but recently they have shown tremendous growth. This probably indicates an important emerging trend, which has already been documented in the media.
tranquilizer drug that decreases anxiety and tension stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system sedative medication that reduces excitement; often called a tranquilizer
Although emergency department visits are an important factor to keep in mind when tracking drug abuse, they do not necessarily give the whole picture. Individuals who seek treatment at a hospital may be quite different from other drug-using individuals in the rest of the community. According to the 2000 National Household Survey on Drug Abuse (NHSDA), 8.8 million Americans over the age of 12 have used prescription drugs in the previous year for purposes other than those for which they were intended. The types of drugs they used were pain relievers, tranquilizers, stimulants, and sedatives. By tracking uses of particular drugs, DAWN is an indicator of which drugs are declining in use and which are on the rise. For example, certain types of antidepressants and codeine played a role in emergency department visits more often several years ago than they are today. Other drugs, such as the club drugs and certain analgesics, have seen a dramatic rise, suggesting a growing problem. While some of these, for example OxyContin, have received considerable media attention, others, such as Vicodin, have not.
Common Reasons for Hospital Visits Individuals seek treatment for drug abuse because of overdoses or because of the chronic effects of habitual drug use. Below are some of the commonly abused drugs and the intoxication effects that might prompt a hospital visit. • Marijuana/hashish: respiratory infections, cough, increased heart rate, anxiety, panic attacks • Depressants, such as barbiturates, GHB, methaqualone (Quaalude), benzodiazepines (such as Valium, Xanax, and Halcion): slow pulse and breathing, lowered blood pressure, respiratory depression and arrest (slowed or stopped breathing), loss of consciousness, dizziness, nausea/vomiting, coma • PCP: Increased heart rate and blood pressure, impaired motor functioning (uncoordination), numbness, nausea/vomiting • LSD, mescaline: sleeplessness, numbness, weakness, increased heart rate and blood pressure • Codeine, heroin, morphine, opium, fentanyl: respiratory depression and arrest, nausea, loss of consciousness, coma
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• Amphetamine, cocaine, ecstasy, methamphetamine, methylphenidate (such as Ritalin): increased heart rate and blood pressure, rapid or irregular heart beat, respiratory failure, heart failure • Inhalants: headache, vomiting, nausea/vomiting, loss of motor coordination, loss of consciousness
Deaths Due to Drug Abuse
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According to the Centers for Disease Control and Prevention, almost 17,000 people died of drug-induced causes in the United States in 1998. This excludes accidents, homicides, newborn deaths due to a mother’s drug use, and other causes indirectly related to drug use. DAWN also collects data on both drug-induced and drug-related deaths. In 2000 overdose deaths accounted for more than half of all deaths reported to DAWN in thirty cities. In some cities, however, deaths were more commonly drug-related rather than actual overdoses. Individuals under twenty-five accounted for fewer than 20 percent of DAWN cases across all metropolitan areas. In about half the cities, this group accounted for fewer than 10 percent of drug abuse deaths.
☎
See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.
Since multiple drugs are commonly involved in a drug death, it is often impossible to attribute it to any particular substance. The most common combinations of drug use that resulted in death were alcohol and cocaine, alcohol and heroin/morphine, cocaine and heroin/morphine, or all three, sometimes in combination with narcotic analgesics. Narcotic analgesics, which include drugs such as methadone, oxycodone, and codeine, were almost always mentioned in connection with other drugs. These substances were rarely the sole cause of death in reported cases. Typical cases in 2000 and previous years involved between two and four different drugs, with the majority of cases involving three substances. The most common ones were heroin, cocaine, and alcohol. In many cities, these three drugs accounted for 40 percent or more of all drug deaths. Club drugs accounted for very few deaths in any of the DAWN metropolitan areas. Clearly, medical problems and death due to drug abuse represent a major problem in American society. While data tracking systems such as DAWN give a numerical value to the toll of drug abuse in terms of medical issues, they cannot convey the pain and suffering of drug abuse victims, including the friends and family of those who take drugs and are harmed by them. However, by tallying hospital records of medical visits and deaths related to drug use, it is hoped that experts will gain a better understanding of the cost to 205
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society. SEE ALSO Accidents and Injuries from Alcohol; Accidents and Injuries from Drugs; Alcohol: Poisoning; Costs of Substance Abuse and Dependence, Economic; Driving, Alcohol, and Drugs; Suicide and Substance Abuse.
Mescaline See Peyote
Methadone Maintenance Programs Methadone is an analgesic (painkiller) that was first created in Germany during World War II. Its actions on the body are similar to those of morphine, which, like heroin, is an opiate, or a drug made from the opium poppy. Methadone was approved by the U.S. Food and Drug Administration in August 1947 for use in the treatment of pain. epidemic rapid spreading of a disease to many people in a given area or community at the same time relapse term used in substance abuse treatment and recovery that refers to an addict s return to substance use and abuse following a period of abstinence or sobriety withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance receptor specialized part of a cell that can bind a specific substance; for example, a neuron has special receptors that receive and bind neurotransmitters
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Methadone maintenance treatment for heroin addiction was developed in the mid-1960s by doctors Vincent Dole and Marie Nyswander. These doctors were responding to concerns about epidemics of heroin addiction, related health problems, deaths (especially among young people 15 to 35), and a high relapse rate among addicts. Methadone was able to ease the withdrawal symptoms of heroin addicts. Later, scientists determined that methadone could be used in long-term maintenance treatment. In other words, methadone use is maintained, or kept going continuously, rather stopped after a limited period. Through this ongoing treatment, addicts are able to stay off heroin. At first, many addiction specialists hoped that methadone could be used to help addicts quit heroin and then stop taking the methadone. However, research eventually indicated that less than 20 percent would be able to stop taking methadone and remain drugfree. Dole and Nyswander held the view that there was something unique about heroin addiction that made it especially difficult for patients to remain drug-free. Dole began to suspect that long-term use of heroin may do damage to the brain’s receptors. It is not currently known how to reverse these permanent changes in brain function. New brain imaging technology holds the promise of better understanding and perhaps more effective treatment. In the meantime, it appears that methadone can correct but not cure a severe addiction. Studies show that as much as 80 percent of heroin addicts who discontinue methadone treatment relapse to drug use. This is true even
Methadone Maintenance Programs
of patients who have received counseling and therapy to change their lifestyles.
Benefits of Methadone Treatment Methadone provides a safe and effective way to eliminate drug craving, withdrawal, and drug-seeking behavior (when addicts spend most of their time and energy finding drugs). As a result, methadone can help free patients from their drug habit, allowing them to lead productive lives. When combined with educational, medical, and counseling services, methadone can enable patients to discontinue or reduce heroin use and the criminal activity that often goes along with it. Their physical and mental well-being improves, they become responsible family members, and they are able to get and keep a job or pursue an education. Another important aspect of long-term methadone use is that it does not result in any physical or psychological impairment, or damage, of any kind. Specifically, there is no impairment of balance, coordination, mental abilities, eye-hand coordination, depth perception, or psychomotor functioning. This means that people on methadone maintenance can perform the actions necessary for their jobs or other daily activities. Recently, some people receiving methadone treatment have been identified through workplace drug testing and have been threatened with negative consequences. Supporters of methadone treatment have worked to protect these people from what they view as discrimination.
craving powerful, often uncontrollable desire for drugs
psychomotor referring to processes of muscular movement directly influenced by mental processes
Common Misunderstandings Despite three decades of research showing the value of methadone maintenance treatment, this treatment has been a source of conflict and disagreement among treatment providers, the public, and government officials. This ongoing controversy is not simply a difference of opinion among informed parties. Instead, the debate about methadone usually involves several common misunderstandings about the drug and its uses. Much of the uneasiness about methadone stems from the idea that it is “just substituting one drug for another.” Although this is technically correct, an explanation of how methadone treatment works shows why this is in fact a misunderstanding.
How Treatment Works. Methadone treatment is a therapy in which one drug (heroin) is replaced with another (methadone). Heroin is a short-acting drug that is usually injected. Methadone is a long-acting drug that a person takes by mouth. Methadone can prevent heroin withdrawal symptoms. Because of its long action (24–36 hours), it 207
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At a San Francisco clinic, patients wait in line for their daily dose of methadone, which can ease the symptoms of heroin withdrawal.
allows most patients to receive a dose and function in a stable manner. Without methadone, they would go through the four-hour cycles of euphoria (a feeling of intense well-being) and withdrawal that are typical of heroin use. Heroin addicts on methadone treatment can in fact become well-functioning individuals, meaning that they may be able to hold down a jobs, improve relationships, and manage money more effectively.
The Importance of the Right Dose. A stable blood level of methadone must be maintained at all times for the treatment to produce good results. Unfortunately, state or local regulations have often placed restrictions on methadone doses without regard to medical criteria. This means that doctors are not allowed to prescribe a dose higher than a set limit, even if they feel that the patient needs a higher dose for specific medical reasons. A common policy has been to give 208
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as little of the drug as possible, rather than to give the amount needed to accomplish the goal of reducing withdrawal symptoms and helping a person remain free of heroin. This policy was based partly on the (unproven) belief that lower doses would make it easier to discontinue methadone. It has been common to have dose maximums of 40 milligrams (mg) per day. It is now known that the effective range is between 60 and 120 mg per day for most patients, with some needing less than 60 and others a great deal more than 120 mg. Getting the right dose is of crucial importance in ending drug use and keeping addicts in treatment. The low-dose policy has had troubling results. Patients on low doses who complain that “my dose isn’t holding me”—or preventing their cravings—may be dismissed from treatment programs because treatment providers believe these people are simply looking for more drugs, just as they had once devoted all their energies to looking for heroin. When these patients then supplement the methadone dose with heroin, the patient may be seen as lacking the will to quit, or the treatment may be seen as ineffective.
Dependence versus Addiction. A second objection to methadone treatment is that methadone, like heroin, is addicting. Critics question the idea of giving an addicting drug as a form of treatment. But there is a difference between dependence and addiction. Like the heroin it replaces, methadone leads to physical dependence. Unlike heroin, it does not lead to addiction. Addiction is different from dependence because addiction involves behavior that is out of control, driven by compulsions, and that continues no matter what the negative consequences might be (such as poor health, the loss of a job or housing, or the chance of being caught and punished for illegal activity). Several prescription drugs produce dependence but not addiction in this way. For example, patients given morphine to treat long-term pain will develop dependence on morphine. But once their condition improves and medication is stopped, they do not seek more of the drug—they have not become addicted.
dependence psychological compulsion to use a substance for emotional and/or physical reasons compulsion irresistible drive to perform a particular action; some compulsions are performed in order to reduce stress and anxiety brought on by obsessive thoughts
Physical dependence must be considered when treating any patient, whether for a medical condition or addiction. For specialists in the field of addiction, the key is to determine whether the improvements in the person’s functioning and quality of life outweigh the costs of physical dependence. Many providers of treatment for heroin addicts believe that the benefits do in fact outweigh the costs.
Methadone and a Drug High. Another criticism is the belief that “methadone keeps you high.” This belief reflects a misunderstanding about the effects of a properly adjusted dose. When a person begins 209
Methadone Maintenance Programs
methadone treatment, it takes time for a doctor to determine the right dose. The goal is to stabilize the patient on a consistent dose that will prevent the craving for heroin. At first, the dose may be large enough to produce some effects that the user experiences as a high. Once stabilized, however, most patients experience little or no effects of the drug—that is, they do not feel high. Heroin addicts often say that they seek methadone to avoid getting sick (to prevent withdrawal effects), not to get high.
Methadone and Other Drug Use Heroin addicts are often addicted to other drugs as well, such as alcohol and cocaine. Methadone patients may continue to abuse these drugs while being treated for heroin abuse. It is important to remember that methadone cannot prevent other kinds of drug use. However, it does make many patients more willing to try other kinds of treatment. Patients must come to the clinic at least once a week, and in most cases more often, to get their methadone dose. As a result, the patient is exposed to educational presentations and materials and to counseling efforts that are part of individual treatment plans. In fact, methadone maintenance programs require that the patient get counseling and learn about addictions. By participating in these aspects of the program, addicts may be encouraged to stop their use of cocaine and alcohol.
HIV/AIDS and Hepatitis C Methadone treatment has played an important role in reducing the spread of HIV/AIDS. This success has lessened some of the criticisms of methadone programs. Methadone clinics offer AIDS prevention and education services, screening, testing, and counseling. Methadone patients often discuss life issues with counselors, who may be able to persuade patients to practice safe sex and to avoid other high-risk behaviors. The hepatitis C virus (HCV), which affects liver function, has emerged as a major problem among addicts receiving treatment at clinics. Among those with HIV, the rate of simultaneous infection with HCV is high. Methadone maintenance provides an organized system in which the patient can be supervised for good medical care, informed of emerging treatments, and educated about health practices to reduce the burden on the liver.
What the Future Holds Methadone maintenance has been effective at reducing illegal drug use and guiding addicts toward productive lives. A scientific review 210
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of studies in the middle to late 1990s concluded that the treatment’s effectiveness has been reduced by two factors: (1) too much government regulation, and (2) negative opinions held by the public and policy makers. Attitudes toward methadone treatment are changing. The federal government is preparing to permit patients to receive treatment in doctor’s offices affiliated with clinics rather than only in clinics. This will help patients by bringing them into the mainstream of medical practice, rather than separating them in addiction clinics. Regulations that control how clinics operate are being eased, and clinics have more freedom to determine the best treatments for individual patients. Slowly, patients are coming forward to serve as examples of success and to be role models for others. Researchers have developed other medications to treat heroin addiction, particularly LAAM and buprenorphine, expanding the possibilities for effective treatment. As researchers continue to investigate addiction and treatment, they will consider two important questions: (1) Could a condition that existed before heroin use make some patients more likely to become severely addicted than others? (2) Can long-term addicts ever recover normal functioning without methadone maintenance therapy? S E E A L S O Heroin Treatment: Behavioral Approaches; Heroin Treatment: Medications; Opiate and Opioid Drug Abuse.
Methamphetamine See Speed
LAAM Levo-AlphaAcetylmethadol, a synthetic opiate used to treat heroin addiction by blunting the symptoms of withdrawal for up to seventy-two hours buprenorphine new medication that has proven to reduce cravings associated with heroin withdrawal; may also be helpful in treating cocaine addiction
Military, Drug and Alcohol Abuse in the United States Drug and alcohol use have historically been common among military personnel. Soldiers have used drugs to reduce pain, lessen fatigue, increase alertness, cope with boredom, or cope with the panic that accompanies battle. During the U.S. Civil War, the medical use of opium resulted in addiction among some soldiers. In the modern U.S. military, drug use became a problem during the Vietnam War in the late 1960s and early 1970s. Approximately 20 percent of Vietnam War veterans reported having used narcotics (such as heroin and opium) on a weekly basis, and 20 percent also showed signs of being addicted. Although few personnel continued using heroin when they returned home, concerns about addiction continued. Since 1981, the military has conducted regular, random drug 211
Military, Drug and Alcohol Abuse in the United States
McDonald-Douglas pilots relax in a bar after work. In comparison to civilians, research indicates that military personnel are more likely to drink heavily.
testing of all personnel. Illicit drug use has declined significantly since the 1970s, and heavy alcohol use has declined slightly among military personnel. Heavy drinking has long been an accepted custom and tradition in the military. In the past, military authorities believed that alcohol was necessary as a part of servicemen’s diet and as a boost for morale, and provided it in the daily rations of sailors and soldiers. More recently, alcoholic beverages have been available at reduced prices to military personnel and during “happy hours” at clubs on military bases. In addition, alcohol has been used to reward hard work, to ease tensions between personnel, and to promote friendship and the cohesion of units. In the mostly male population of the U.S. military, heavy drinking and being able to “hold one’s liquor” serve as proofs of masculinity
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and strength. A common stereotype has been to characterize hardfighting soldiers as hard-drinking soldiers. The U.S. military strongly opposes the abuse of drugs and alcohol because of the negative effects of that abuse on the health and well-being of military personnel. The military also disapproves of drug and alcohol abuse as detrimental to military readiness and the maintenance of high standards of performance and military discipline. In the U.S. military, drug abuse is defined as the wrongful use, possession, distribution, or introduction onto a military installation of a controlled substance (such as marijuana, heroin, or cocaine), prescription medication, over-the-counter medication, or intoxicating substance (other than alcohol). Alcohol abuse is defined as alcohol use that has negative effects on the user’s health or behavior, on the user’s family or community, on the Department of Defense (DoD), or that leads to unacceptable behavior.
Military Policy In response to public concern about reports of serious drug addiction among U.S. forces in Southeast Asia, President Richard M. Nixon in 1971 directed the DoD to address the drug problem. The DoD established mandatory urine testing for service members leaving Southeast Asia and mandatory, random urine testing for all U.S. forces worldwide. The program was discontinued for a time because of the difficulties and high costs of running the testing program, and also because of legal challenges to the policy. Some charged that the policy of drug testing violated the Fifth Amendment protection against self-incrimination. The reaction to the crash of a jet on the aircraft carrier Nimitz in 1981 again focused public attention on the military’s drug abuse problem, particularly marijuana use. Autopsies of fourteen Navy personnel killed in the crash showed evidence of marijuana use among six of the thirteen sailors and of over-the-counter antihistamine use by the pilot. As a result, the armed forces again began urine testing for drugs in 1981. Stricter testing procedures overcame earlier legal objections. The DoD maintains that urine tests, conducted either randomly or when a person is suspected of using drugs, are a major tool for detecting and deterring drug use. Currently, the U.S. military has a zero tolerance policy toward substance use. This means that no exceptions are made for any member of the military found to be using or selling illegal drugs. Automatic dismissal from the military is the standard punishment. Detection and prevention of drug use are high priorities. While drug 213
Military, Drug and Alcohol Abuse in the United States
abusers are discharged, first-time alcohol abusers are given an opportunity for treatment and rehabilitation.
Worldwide Survey Series
stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system tranquilizer drug that decreases anxiety and tension
To help monitor the extent of drug and alcohol abuse, the DoD began a series of worldwide surveys among active-duty military personnel in the Army, Navy, Marine Corps, and Air Force. Civilian (nonmilitary) researchers first randomly selected a sample of about sixty military installations to represent the armed forces throughout the world. At these installations, they randomly selected men and women of all ranks to represent all active-duty personnel. Participants in the surveys answered questions about their use of illegal drugs (marijuana, cocaine, heroin); about the misuse of prescription drugs (stimulants such as Ritalin or other amphetamines), tranquilizers such as Valium); about the frequency and amount of alcohol use; and about health and other problems resulting from drug or alcohol use.
Trends in Drug and Alcohol Use Between 1980 and 1998, illicit drug use declined sharply from just under 28 percent in 1980 to about 3 percent in 1998. Heavy drinking declined significantly from approximately 21 percent in 1980 to just above 15 percent in 1998, although the decrease was less dramatic than for drug use. Heavy drinking by itself does not always indicate alcohol abuse, but it does indicate that the person’s drinking habits are likely to result in negative consequences.
The Effects of Changes in Who Serves In the 1990s, military analysts reviewed data that showed declines in drug and alcohol use. They wanted to determine whether the declines were due to military programs and policies or to some other explanation. One possible explanation for the declines in drug and alcohol abuse is a general change in the types of people who served in the armed forces between 1980 and 1998. For example, members of the military in 1998 were more likely to be older, to be officers, to be married, and to have more education than members of the military in 1980. These characteristics are also associated with less substance use. Military analysts compared the data for 1998 with the data for 1980. They found that the decline in heavy alcohol use was largely a result of changes in the characteristics of the military population. However, the decline in illicit drug use was not a result of these changes. 214
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Percentage of persons who used in the past 30 days
CI VI L I A N A N D M I L I TA RY SU B STA N CE A B U SE 25 23.4
20 15.9 15 12.8 10
8.8
5.2 5
4.8
4.2 1.2
0 Age 18–25
Age 26–older
Illicit Drug Use SOURCE:
Civilian Military
Although military personnel report lower illicit drug use than civilians, they report much higher use of alcohol, especially among military personnel aged 18 to 25.
Age 18–25
Age 26–older
Heavy Alcohol Use
National Household Survey on Drug Abuse, 2000. <www.samhs.gov/oas/nltsda/zknhsda/chapter2.htm>.
Comparing the Military to Civilians Comparing military and civilian populations offers another possible explanation for the downward trends in drug and alcohol use in the military. These trends in the military may simply mirror similar trends among civilians. Survey data for the military were compared to civilian data taken from the 1997 National Household Survey on Drug Abuse, a nationwide survey of drug abuse. Comparisons showed that military personnel (about 3%) were significantly less likely than civilians (about 11%) to have used any illicit drugs during the past 30 days. However, military personnel (about 14%) were significantly more likely than civilians (about 10%) to have been heavy drinkers. Heavy drinking was nearly twice as high among younger (18 to 25) military personnel compared to younger civilians, but it was about the same among the older age groups (26 to 55). Results of the 2000 National Household Survey on Drug Abuse show a continuing gradual decline in illicit drug use and no change in heavy alcohol use among civilians, but until a more current survey of military personnel is conducted, more recent trends in use of drugs or alcohol cannot be compared between the two populations. Comparing the two populations indicates that substance use trends in the military do not simply mirror similar changes among civilians. The lower rates of drug use among military personnel than among civilians suggest that the military’s policy of zero tolerance for drug use and the urine testing program used to enforce it have been 215
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effective. In contrast, the higher rates of heavy drinking by military personnel as compared with civilians suggest that certain aspects of military life may encourage heavy drinking. In addition, it appears that military policies and programs directed at reducing heavy alcohol use have not been as effective as similar efforts among civilians.
Conclusion The military has made steady progress in combating illicit drug use, but has had less success at reducing heavy drinking. In 1998 nearly one in six active-duty personnel drank heavily, a proportion much higher than among civilians. The military needs to develop a plan to reduce heavy drinking that will be as effective as its policy to reduce drug use. S E E A L S O Diagnosis of Drug and Alcohol Abuse: An Overview; Workplace, Drug Use in the; Zero Tolerance.
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Photo and Illustration Credits
Bergman/Corbis: 188; © David Atlas: 197; © Patrick Bennett/Corbis: 201; © George Hall/Corbis: 212.
Volume 3 © Annie Griffiths Belt/Corbis: 9; © Michael S. Yamashita/Corbis: 20; © Corbis: 26; Custom Medical Stock Photo: 33, 85, 118; American Cancer Society: 41; AP/Wide World Photos, Inc.: 45, 58, 95, 103, 115, 127, 144, 149, 178; © James Marshall/Corbis: 46; CorbisBettmann: 52, 110, 124; © Albert Matti:
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Organizations of Interest Adult Children of Alcoholics (ACOA) ACA WSO PO Box 3216 Torrance, CA 90510 310-534-1815 (message only) [email protected] African American Parents for Drug Prevention (AAPDP) 4025 Red Bud Avenue Cincinnati, OH 45229 513-961-4158 513-961-6719 (fax) AIDS Hotline American Social Health Association PO Box 13827 Research Triangle Park, NC 27713 800-342-AIDS [email protected]
Alcoholics Anonymous (AA) General Service Office PO Box 459 New York, NY 10163 212-870-3400 American Council for Drug Education 164 West 74th Street New York, NY 10023 800-488-3784 [email protected] BACCHUS Peer Education Network and GAMMA PO Box 100043 Denver, CO 80250 303-871-3068 [email protected]
AIDS National Information Clearinghouse CDC NPIN PO Box 6003 Rockville, MD 20849-6003 800-458-5231 [email protected] (reference services) [email protected] (web site)
Bureau of Alcohol, Tobacco, and Firearms Office of Liaison and Public Information 650 Massachusetts Avenue, NW Room 8290 Washington, DC 20226 202-927-8500 [email protected]
Alcohol Treatment Referral Hotline 107 Lincoln Street Worcester, MA 01605 800-ALCOHOL 508-798-9446 [email protected]
Clearinghouse of the National Criminal Justice Reference System Bureau of Justice Assistance PO Box 6000 Rockville, MD 20849 800-688-4252 219
Organizations of Interest
Bureau of Justice Statistics 810 7th Street, NW Washington, DC 20531 202-307-0765 800-732-3277 [email protected] Center for Mental Health Services Knowledge Exchange Network PO Box 42490 Washington, DC 20015 800-789-2647 [email protected] Center for Substance Abuse Prevention 5600 Fishers Lane Rockwall II Building, Suite 800 Rockville, MD 20857 301-443-8956 [email protected] Center for Substance Abuse Treatment National Treatment Hotline 1-800-662-HELP Centers for Disease Control and Prevention Office on Smoking and Health 4770 Buford Highway, NE, MS-K50 Atlanta, GA 30341-3724 800-CDC-1311 [email protected] Child Help USA Childhelp USA National Headquarters 15757 N. 78th Street Scottsdale, Arizona 85260 800-4-A-CHILD CoAnon Family Groups PO Box 12722 Tucson, AZ 85732 800-898-9985 (Leave your name, number, and a brief message and someone will call you back.) 220
Cocaine Anonymous (CA) 3740 Overland Ave., Suite C Los Angeles, CA 90034 310-559-5833 [email protected] DARE America PO Box 512090 Los Angeles, CA 90051-0090 800-223-3273 Drug Enforcement Administration (DEA) Information Services Section 2401 Jefferson Davis Highway Alexandria, VA 22301 202-307-1000 Employee Assistance Professional Administration 2101 Wilson Blvd., Suite 500 Arlington, VA 22201 703-387-1000 [email protected] Families Anonymous PO Box 3475 Culver City, CA 90231-3475 800-736-9805 [email protected] Food and Drug Administration (FDA) 5600 Fishers Lane Rockville, Maryland 20857 888-463-6332 Gamblers Anonymous International Service Office PO Box 17173 Los Angeles, CA 90017 213-386-8789 [email protected] Girls and Boys Town National Hotline 13943 Gutowski Road Boystown, NE 68010 800-448-3000 (English and Español)
Organizations of Interest
[email protected] Higher Education Center for Alcohol and Other Drug Prevention 55 Chapel Street Newton, MA 02458-1060 800-676-1730 617-928-1537 Indian Health Service The Reyes Building 801 Thompson Avenue, Suite 400 Rockville, MD 20852-1627 301-443-2038 [email protected] Institute for Social Research University of Michigan 426 Thompson Street PO Box 1248 Ann Arbor, MI 48106 734-764-8354 [email protected] Juvenile Justice Clearinghouse PO Box 6000 Rockville, MD 20849 800-638-8736 [email protected] March of Dimes 1275 Mamaroneck Avenue White Plains, NY 10605 914-428-7100 Marijuana Anonymous PO Box 2912 Van Nuys, CA 91404 800-766-6779 [email protected] Mediascope 12711 Ventura Boulevard, Suite 440 Studio City, CA 91604 818-508-2080 [email protected]
Mothers Against Drunk Driving (MADD) National Headquarters PO Box 541688 Dallas, TX 75354 800-438-6233 Nar-anon Family World Service Office PO Box 2562 Palos Verdes, CA 90274 310-547-5800 Narcotics Anonymous (NA) PO Box 9999 Van Nuys, CA 91409 818-773-9999 National Alliance for Hispanic Health 1501 Sixteenth Street, NW Washington, DC 20036 800-725-8312 National Alliance for the Mentally Ill Colonial Place Three 2107 Wilson Boulevard, Suite 300 Arlington, VA 22201 703-524-7600 National Association for Children of Alcoholics 11426 Rockville Pike Suite 100 Rockville, MD 20852 888-554-2627 [email protected] National Association for Native American Children of Alcoholics (NANACOA) 1402 Third Avenue Suite 1110 Seattle, WA 98101 800-322-5601 [email protected] National Association of Alcoholism and Drug Abuse Counselors 1911 North Fort Myer Drive Suite 900 221
Organizations of Interest
Arlington, VA 22201 800-548-0497 [email protected] National Association of Anorexia Nervosa and Associated Disorders PO Box 7 Highland Park, IL 60035 847-831-3438 [email protected] National Association of State Alcohol and Drug Abuse Directors 808 17th Street NW Suite 410 Washington, DC 20006 202-293-0090 [email protected] National Center for Victims of Crime 2111 Wilson Boulevard Suite 300 Arlington, VA 22201 800-211-7996 National Clearinghouse on Child Abuse and Neglect Information 330 C Street, SW Washington, DC 20447 800-394-3366 [email protected]
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National Crime Prevention Council Online Resource Center 1000 Connecticut Avenue, NW 13th floor Washington, DC 20036 202-466-6272 National Domestic Violence Hotline PO Box 161810 Austin, TX 78716 800-787-3224 [email protected] National Eating Disorders Association 603 Stewart St., Suite 803 Seattle, WA 98101 206-382-3587 [email protected] National Health Information Center PO Box 1133 Washington, DC 20013 800-336-4797 [email protected] National Inhalant Prevention Coalition 2904 Kerbey Lane Austin, TX 78703 800-269-4237 [email protected]
National Council on Alcoholism and Drug Dependence, Inc. 20 Exchange Place Suite 2902 New York, NY 10005 800-NCA-CALL [email protected]
National Institute of Mental Health (NIMH) NIMH Public Inquiries 6001 Executive Boulevard, Rm. 8184, MSC 9663 Bethesda, MD 20892-9663 301-443-4513 [email protected]
The National Council on Problem Gambling, Inc. 208 G Street, NE Washington, DC 20002 800-522-4700 (hotline) [email protected]
National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard Willco Building Bethesda, MD 20892 301-443-3860
Organizations of Interest
National Institute on Drug Abuse (NIDA) 6001 Executive Boulevard Room 5213 Bethesda, MD 20892 301-443-1124 [email protected] National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, MD 20892 301-496-4143 National Maternal and Child Health Clearinghouse Health Resources and Services Administration U.S. Department of Health and Human Services Parklawn Building 5600 Fishers Lane Rockville, MD 20857 [email protected] National Organization on Fetal Alcohol Syndrome 216 G Street, NE Washington, DC 20002 800-666-6327 [email protected] National Resource Center on Homelessness and Mental Illness Policy Research Associates, Inc. 345 Delaware Avenue Delmar, NY 12054 800-444-7415 [email protected] National Safety Council 1121 Spring Lake Drive Itasca, IL 60143 800-621-7615 National Women’s Health Information Center 8550 Arlington Boulevard Suite 300 Fairfax, VA 22031
800-994-9662 Office for Victims of Crime Resource Center Department of Justice 810 7th Street, NW Washington, DC 20531 800-627-6872 Office of Minority Health Resource Center PO Box 37337 Washington, DC 20013 800-444-6472 Office of National Drug Control Policy (ONDCP) Executive Office of the President 750 17th Street, NW Washington DC 20503 202-395-6700 [email protected] Office on Smoking and Health (see Centers for Disease Control and Prevention) ONDCP’s Drug Policy Information Clearinghouse PO Box 6000 Rockville, MD 20849 800-666-3332 Overeaters Anonymous PO Box 44020 Rio Rancho, NM 87124-4020 505-891-2664 [email protected] Partnership for a Drug-Free America 405 Lexington Avenue Suite 1601 New York, NY 10174 212-922-1560 PRIDE 4684 S. Evergreen Newaygo, MI 49337 223
Organizations of Interest
800-668-9277 [email protected] Psychomedics, Inc 5832 Uplander Way Culver City, CA 90230 800-522-7424 Rational Recovery PO Box 800 Lotus, CA 95651 800-303-2873 [email protected] Safe and Drug-Free Schools Department of Education Federal Building No. 6 400 Maryland Avenue, SW Washington, DC 20202 202-260-3954 for information on grant applications 800-624-0100 for drug prevention materials 202-260-3954 [email protected] Secular Organizations for Sobriety SOS Clearinghouse 5521 Grosvenor Boulevard Los Angeles, CA 90066 310-821-8430 Self-Help and Information Exchange Network (SHINE) c/o Voluntary Action Center Suite 420
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538 Spruce Street Scranton, PA 18509 570-961-1234 570-347-5616 Skyshapers University 157 Chambers Street 10th floor New York, NY 10007 800-759-9675 800-SKYSHAPERS [email protected] Students Against Destructive Decisions (SADD) Box 800 Marlboro, MA 01752 800-787-5777 Substance Abuse and Mental Health Services Administration (SAMHSA) 5600 Fishers Lane Rockville, MD 20857 301-443-6315 Working Partners for an Alcohol- and Drug-Free Workplace Department of Labor Office of Public Affairs 200 Constitution Ave., NW, Room S-1032 Washington, DC 20210 202-693-4650
Selected Bibliography General Texts About Alcohol and Drug Abuse Alcohol and drug abuse take a terrible toll on teenagers. Unfortunately, studies show that more and more teenagers are using drugs and alcohol and suffering the consequences of that use. Substance abuse puts teenagers at a much greater risk for a wide variety of problems, including: • school problems • criminal behavior • traffic accidents • sexual activity at a young age
LSD, PCP, Hallucinogen Drug Dangers Marijuana Drug Dangers Speed and Methamphetamine Drug Dangers Steroid Drug Dangers Tobacco and Nicotine Drug Dangers Tranquilizer, Barbiturate, and Downer Drug Dangers Gofen, E. “Alcohol in the Life of a Teen.” Current Health 2, vol. 17, no. 2 (Oct. 1990). “Illicit Drug Use by Teens Rising.” Alcoholism Report 22, no. 2 (Feb./Mar. 1994). Kuhn, Cynthia, et al. Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy. New York: Norton, 1998. Roza, Greg, ed. Encyclopedia of Drugs and Alcohol. New York: Franklin Watts, 2001.
• depression and other psychiatric conditions
Schuckit, Marc Alan. Educating Yourself About Alcohol and Drugs: A People’s Primer. New York: Plenum Press, 1998.
• victimization
“Survey Illustrates Wide Reach of Drugs in Teens’ Lives.” Alcoholism and Drug Abuse Weekly 10, no. 26 (June 29, 1998).
• death by suicide, murder, drowning, fire Articles and Nonfiction Books “Alcohol: How It Affects You.” Current Health 1, vol. 21, no. 5 (Jan. 1998). Drug Dangers Series (Berkeley Heights, NJ: Enslow Publishers, 2001), including: Alcohol Drug Dangers Amphetamine Drug Dangers Crack and Cocaine Drug Dangers Diet Pill Drug Dangers Ecstasy and Other Designer Drugs Drug Dangers Herbal Drugs Drug Dangers Heroin Drug Dangers Inhalant Drug Dangers
“Teens’ Steroid Use Linked to Their Use of Other Drugs.” Addiction Letter 11, no. 11 (Nov. 1995). “Teens Who Do Not Try Drugs Are Better-Adjusted, Study Says.” Alcoholism and Drug Abuse Weekly 8, no. 21 (May 20, 1996). “Withdrawal Symptoms May be Worse for Teens.” Addiction Letter 12, no. 1 (Jan. 1996). “Young Teens and Drugs Use.” Current Health 1, vol. 17, no. 2 (Oct. 1993).
Fiction of Interest Anonymous. Go Ask Alice. Minneapolis: Econo-Clad Books, 1998. Childress, Alice. A Hero Ain’t Nothin’ but a Sandwich. New York: Avon, 1995.
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Selected Bibliography
Draper, Sharon M. Tears of a Tiger. New York: Simon and Schuster, 1996. Glovach, Linda. Beauty Queen. New York: HarperCollins, 1998. Greene, Shep. The Boy Who Drank Too Much. New York: Bantam Doubleday Dell, 1981. Keizer, Garrett. God of Beer. New York: HarperCollins, 2002.
Web Sites “For Tweens and Teens.” National Center on Addiction and Substance Abuse at Columbia University. . “Mind Over Matter: The Brain’s Response to Marijuana, Opiates, Inhalants, Hallucinogens, Methamphetamine, Nicotine, Stimulants, Steroids.” National Institute on Drug Abuse, National Institutes of Health. Last updated September 14, 2001. .
Overcoming Substance Abuse Many substance users think they will never get addicted. But once substance abuse becomes a stranglehold, it can be exceedingly difficult for the user to struggle free. Although a wide variety of treatments are available, researchers are constantly searching for ways to help users break their addiction and to help former addicts avoid slipping back into substance abuse. Articles and Nonfiction Books “Alcohol and Drug Interventions for Teens Should Consider Peer Use, Peer Pressure.” DATA: The Brown University Digest of Addiction Theory and Application 14, no. 5 (May 1995). “Alcohol Interventions for Teens Should Address Social Factors.” DATA: The Brown University Digest of Addiction Theory and Application 14, no. 7 (July 1995).
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Moe, Barbara A. Drug Abuse Relapse: Helping Teens to Get Clean Again. Drug Abuse Prevention Library. New York: Rosen Publishing Group, 2000. Roos, Stephen. A Young Person’s Guide to the Twelve Steps. Center City, MN: Hazelden Information and Educational Services, 1993. “Youth Treatment Study Shows Good Results, Parallels Findings for Adult Outcomes.” Alcoholism and Drug Abuse Weekly 13, no. 27 (July 16, 2001).
Web Site “Principles of Drug Abuse Treatment: A ResearchBased Guide.” National Institute on Drug Abuse, National Institutes of Health. .
When Parents Abuse Alcohol or Drugs Most studies show that having a substanceabusing parent can affect children from birth on into adulthood. Babies of substance abusers can be born addicted to drugs or suffering from fetal alcohol syndrome. Children living in a home with substanceabusing parents are more likely to suffer from anxiety, depression, and behavior problems. Rates of child abuse and neglect are higher in homes with substance-abusing parents. Teenage children of substance abusers have a higher risk of themselves turning to drugs or alcohol. Adults from alcoholic homes or homes where drugs were used have more problems with anxiety and depression, greater difficulties with relationships, and a high risk of becoming addicted to alcohol or drugs. Articles and Nonfiction Books
Chiu, Christina. Teen Guide to Staying Sober. New York: Rosen Publishing Group, 1995.
“Depression in Children Linked to Parents’ Alcoholism.” Alcoholism and Drug Abuse Weekly 8, no. 27 (July 1, 1996).
“Gender-Specific Substance Abuse Treatment Promising.” DATA: The Brown University Digest of Addiction Theory and Application 20, no. 7 (July 2001).
Emshoff, James G., and Ann W. Price. “Prevention and Intervention Strategies With Children of Alcoholics” (part 2 of 2). Pediatrics 103, no. 5 (May 1999).
Landau, Elaine. Hooked: Talking About Addiction. Brookfield, CT: Millbrook Press, 1995.
Foltz-Gray, Dorothy. “An Alcoholic in the Family.” Health 11, no. 5 (July/Aug. 1997).
Selected Bibliography
Hornik-Beer, Edith Lynn. For Teenagers Living with a Parent Who Abuses Alcohol/Drugs. iUniverse.com, 2001. Johnson, Jeannette L., and Michelle Left. “Children of Substance Abusers: Overview of Research Findings” (part 2 of 2). Pediatrics 103, no. 5 (May 1999). Leite, Evelyn, and Pamela Espeland. Different Like Me: A Book for Teenagers Who Worry about Their Parents’ Use of Alcohol/Drugs. Center City, MN: Hazelden Information and Educational Services, 1989. Price, Ann W., and James G. Emshoff. “Breaking the Cycle of Addiction: Prevention and Intervention With Children of Alcoholics.” Alcohol Health and Research World 21, no. 3 (1997).
uals (increased risk of murder, suicide, and motor vehicle accidents) to its effects on entire nations. In recent years, many events have brought the link between drug trafficking, money laundering, and terrorism to the world’s attention. Articles and Nonfiction Books “Alcohol Most Common ‘Date-Rape’ Drug: Study.” Alcoholism Report 26, no. 3 (March 1998). Grosslander, Janet. Drugs and Driving. New York: Rosen Publishing Group, 2001.
Shuker, Nancy. Everything You Need to Know About an Alcoholic Parent. New York: Rosen Publishing Group, 1998.
Hyde, Margaret O. Drug Wars. New York: Walker and Company, 2000.
“Substance Abuse Programs for Parents.” Brown University Child and Adolescent Behavior Letter 11, no. 2 (Feb. 1995).
“Let’s Redefine U.S. Drug Policy to One of Harm Reduction.” DATA: The Brown University Digest of Addiction Theory and Application 16, no. 2 (Feb. 1997 supplement).
Tomori, Martina. “Personality Characteristics of Adolescents with Alcoholic Parents.” Adolescence 29, no. 116 (winter 1994).
Levine, Herbert M. The Drug Problem: American Issues Debated. New York: Raintree/Steck Vaughn, 1997.
Ullman, Albert D., and Alan Orenstein. “Why Some Children of Alcoholics Become Alcoholics: Emulation of the Drinker.” Adolescence 29, no. 113 (spring 1994).
Fiction of Interest Bauer, Joan. Rules of the Road. New York: Putnam, 1998. Gantos, Jack. Joey Pigza Loses Control. New York: HarperTrophy, 2002.
Leviton, Susan, and Marc A. Schindler. “Drug Trafficking and the Justice System” (part 2 of 2). Pediatrics 93, no. 6 (June 1994). “SAMHSA Study Links Treatment to Drops in Drug Use, Crime.” Alcoholism and Drug Abuse Weekly 8, no. 36 (Sept. 16, 1996). Stewart, Gail B. Drug Trafficking. Detroit: Gale Group, 1990.
Web Sites
“Study of Probationers Reveals High Drug Use.” Alcoholism and Drug Abuse Weekly 10, no. 15 (April 13, 1998).
“Alateen: Hope and Help for Young People Who Are the Relatives and Friends of a Problem Drinker.”
Fiction of Interest
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Kehret, Peg. Cages. New York: Pocket Books, 1993.
National Association for Children of Alcoholics.
Smith, Roland. Zach’s Lie. New York: Hyperion Books, 2001.
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Web Sites
Alcohol and Drug Policy, Drug Trafficking, and Crime The United States and other concerned countries work to rewrite policy and law in an effort to regulate alcohol and tobacco use, to decrease drug production and drug trafficking, and to cut down on drug-related crime. The dangerous consequences of drug use range from its effects on individ-
Drug Enforcement Administration. . Office of National Drug Control Policy. .
Smoking It has been known for years that smoking is deadly. Studies show that if the current 227
Selected Bibliography
rate of tobacco use holds steady, five million U.S. children who were aged 18 or under in 2000 will die prematurely as adults due to complications of the smoking habit they started during their teen years. Articles and Nonfiction Books “African-American Teens at High Risk from Smoking.” Alcoholism and Drug Abuse Weekly 13, no. 10 (Mar. 5, 2001). Hyde, Margaret O. Know About Smoking. New York: Walker and Company, 1995. Kowalski, Kathiann M. “Tobacco’s Toll on Teens.” Current Health 2, vol. 23, no. 6 (Feb. 1997). McMillan, Daniel. Teen Smoking: Understanding the Risk. Berkeley Heights, NJ: Enslow Publishers, 1996.
Gambling is spreading among younger teens and even children, mainly because of the ever-increasing number of online gambling web sites. For those people who are susceptible to becoming addicted to gambling, the ease of gambling online is a particular danger. The social costs of gambling problems among adults include increased rates of crime, financial downfall leading to bankruptcy, higher divorce rates, and a greatly increased chance of becoming addicted to alcohol or drugs. Articles and Nonfiction Books Cozick, Charles P., and Paul A. Winters. Gambling. Detroit: Greenhaven Press, 1995.
“Restricting the Movies Teens Watch May Impact Tobacco Use.” Brown University Child and Adolescent Behavior Letter 18, no. 5 (May 2002).
Dolan, Edward F. Teenagers and Compulsive Gambling. New York: Franklin Watts, 1994.
“Study: Parents and Peers Influence Smoking, Drinking.” Alcoholism and Drug Abuse Weekly 13, no. 6 (Feb. 5, 2001).
“Gambling Common Among Marijuana-Smoking Teens.” Brown University Child and Adolescent Behavior Letter 17, no. 12 (Dec. 2001).
“Teens: Smoking Isn’t Good. Quitting Isn’t Easy.” Current Health 2, vol. 20, no. 8 (Apr. 1994). “Teen Smoking May Hint at Other Risky Behavior.” Health Letter on the CDC, December 22–December 29, 1997.
Haddock, Patricia. Teens and Gambling: Who Wins? Berkeley Heights, NJ: Enslow Publishers, 1996. Rafenstein, Mark. “Why Teens Are Becoming Compulsive about Gambling.” Current Health 2, vol. 26, no. 8 (Apr./May 2000).
“Teens Who Exhibit Problems More Likely to Smoke.” Alcoholism and Drug Abuse Weekly 14, no. 10 (Mar. 11, 2002).
“Teens and Gambling.” Current Health 2, vol. 26, no. 8 (Apr./May 2000 teacher’s edition).
Williams, Mary E. Teens and Smoking. Detroit: Gale Group, 2000.
Fiction of Interest
Fiction of Interest
Hautman, Pete. Stone Cold. New York: Simon and Schuster, 1998.
Cossi, Olga. The Magic Box. New York: Pelican, 1989.
Web Sites Campaign for Tobacco Free Kids. .
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Gambling
Web Sites “Questions and Answers About the Problem of Compulsive Gambling and the Gamblers Anonymous Recovery Program.” Gamblers Anonymous. .
“The Surgeon General’s Report for Kids About Smoking.” National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.
“Youth Problem Gambling.” International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, Canada.
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Selected Bibliography
Other Conditions That May Influence Substance Abuse A number of other psychiatric conditions may occur along with substance abuse, including depression, bipolar disorder, obsessive-compulsive disorder, eating disorders, cutting (self-harm or self-mutilation), anxiety, and conduct disorders. Why are these conditions associated with each other? Is there something similar genetically about people with substance abuse and other psychiatric problems? Is there something about the brain structure or the brain chemistry of some individuals that makes them more susceptible to these disorders, as well as to substance abuse? Do people begin using alcohol or taking drugs in order to treat the symptoms of other psychiatric illnesses? Articles and Nonfiction Books Cobain, Bev, et al. When Nothing Matters Anymore: A Survival Guide for Depressed Teens. Minneapolis: Free Spirit Publishing, 1998. Costin, Carolyn. The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders. New York: McGraw Hill, 1999. Farley, Dixie. “On the Teen Scene: Overcoming the Deficit of Attention.” FDA Consumer 31, no. 5 (July/ Aug. 1997). Hallowell, Edward M., and John J. Ratey. Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood Through Adolescence. New York: Simon and Schuster, 1995. Levonkron, Steven. Cutting: Understanding and Overcoming Self-Mutilation. New York: Norton, 1999. McLellan, Tom, and Alicia Bragg. Escape from Anxiety and Stress. Broomall, PA: Chelsea House Publishing, 1988. Normandi, Carol Emery, and Lauralee Roark. Over It: A Teen’s Guide to Getting Beyond Obsession With Food and Weight. Novato, CA: New World Publishing, 2001. Rapoport, Judith L. The Boy Who Couldn’t Stop Washing: The Experience and Treatment of Obsessive Compulsive Disorder. New York: New American Library, 1997. “Study Finds Co-morbid Eating Disorders among Women Who Abuse Substances.” DATA: The Brown
University Digest of Addiction Theory and Application 20, no. 1 (Jan. 2001). “Study: Use of Ritalin for ADHD Reduces Substance Abuse Risk.” Children’s Services Report 3, no. 16 (Aug. 23, 1999). “Teens with Depression Gravitate to Smoking.” Mental Health Weekly 7, no. 1 (Jan. 6, 1997).
Fiction of Interest Gantos, Jack. Joey Pigza Swallowed the Key. New York: Farrar Straus Giroux, 1998. (Concerns ADHD.) Hesser, Terry Spencer. Kissing Doorknobs. New York: Bantam Books, 1999. (Concerns obsessive-compulsive disorder.) Jenkins, A. M. Damage. New York: HarperCollins, 2001. (Concerns depression.) Levonkron, Steven. The Best Little Girl in the World. New York: Warner Books, 1979. (Concerns eating disorders.) Levonkron, Steven. The Luckiest Girl in the World. New York: Penguin, 1998. (Concerns cutting.) McCormick, Patricia. Cut. New York: Scholastic, 2002. (Concerns cutting.) Newman, Leslie. Fat Chance. New York: Putnam, 1996. (Concerns eating disorders.) Willey, Margaret. Saving Lenny. New York: Bantam Books, 1991. (Concerns depression, codependence.)
Web Sites “Attention Deficit Hyperactivity Disorder.” National Institute of Mental Health, National Institutes of Health. . “Eating Disorders: Facts about Eating Disorders and the Search for Solutions.” National Institute of Mental Health, National Institutes of Health. . “Let’s Talk about Depression,” National Institute of Mental Health, National Institutes of Health. .
Prevention of Alcohol or Drug Abuse The issue of preventing substance abuse is as complicated as it is important. Effective prevention seems to involve helping young 229
Selected Bibliography
people learn how to manage peer pressure and develop a strong and confident sense of self. Articles and Nonfiction Books Alexander, Ruth Bell. Changing Bodies, Changing Lives: A Book for Teens on Sex and Relationships. New York: Times Books, 1998. Benson, Peter L., et al. What Teens Need to Succeed: Proven, Practical Ways to Shape Your Own Future. Minneapolis: Free Spirit Publishing, 1998. Covey, Sean. Seven Habits of Highly Effective Teens: The Ultimate Teenage Success Guide. New York: Simon and Schuster, 1998.
Articles and Nonfiction Books Babbit, Nikki. Adolescent Drug and Alcohol Abuse: How to Spot It, Stop It, and Get Help for Your Family. Sebastopol, CA: Patient-Centered Guides, 2000.
“Improving Substance Abuse Prevention, Assessment, and Treatment Financing for Children and Adolescents.” Pediatrics 108, no. 4 (Oct. 2001).
Biederman, Joseph, et al. “Patterns of Alcohol and Drug Use in Adolescents Can Be Predicted by Parental Substance Use Disorders.” Pediatrics 106, no. 4 (Oct. 2000).
Palmer, Pat, and Melissa Alberti Froehner. Teen Esteem: A Self-Direction Manual for Young Adults. Atascadero, CA: Impact Publishers, 2000.
Cappello, Dominic, and Xenia G. Becher. Ten Talks Parents Must Have with Their Children about Drugs and Choices. New York: Hyperion, 2001.
Scott, Sharon. How to Say No and Keep Your Friends: Peer Pressure Reversal for Teens and Preteens. Amherst, MA: Human Resource Development Press, 1997.
“Does Your Child Have a Gambling Problem?” Brown University Child and Adolescent Behavior Letter 12, no. 3 (Mar. 1996).
Web Sites
“‘Hands-On’ Parenting Reduces Teens’ Substance Abuse Risk.” Nation’s Health 31, no. 4 (May 2001).
“CASA’s Tips for Staying Drug-Free.” National Center on Addiction and Substance Abuse at Columbia University.
Kuhn, Cynthia. Just Say Know: Talking with Kids about Drugs and Alcohol. New York: Norton, 2002.
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Nolen, Billy James. Parents, Teens, and Drugs. Baltimore: American Literary Press, 2000.
“A Guide for Teens: Does Your Friend Have an Alcohol or Drug Problem?” National Clearinghouse for Alcohol and Drug Information, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services.
“Parents Can Influence When, How Teens Use Alcohol and Marijuana.” DATA: The Brown University Digest of Addiction Theory and Application 19, no. 6 (June 2000).
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For Parents and Teachers Parents have a lot of influence over their children. While parents cannot fully control their children’s behavior, studies have shown that close-knit families provide some protection against alcohol and drug abuse in children. It is also clear that the use or abuse of substances by a child’s parent or parents can increase that child’s risk of beginning to use or abuse substances. Still,
230
some children who come from warm, supportive homes and whose parents do not themselves abuse substances may stumble into alcohol or drug use. How can parents (and teachers) identify such problems and get their child the help he or she so desperately needs?
“Program Helps Parents Cope with Substance-Abusing Teens.” DATA: The Brown University Digest of Addiction Theory and Application 20, no. 7 (July 2001). Wood, Barbara. Raising Healthy Children in an Alcoholic Home. New York: Crossroad/Herder and Herder, 1992.
Web Sites Mothers Against Drunk Driving (MADD). . Safe and Drug-Free Schools Program, U.S. Department of Education. .
Glossary abstinence complete avoidance of something, such as the use of drugs or alcoholic beverages abstinent to completely avoid something, such as drug or alcohol use abuse related to drug use, describes taking drugs that are illegal, or using prescription drugs in a way for which they were not prescribed; related to alcohol use, describes drinking in a fashion that is damaging to the drinker or to others abuse potential chance, or likelihood, that a drug will be abused acute having a sudden onset and lasting a short time addiction state in which the body requires the presence of a particular substance to function normally; without the substance, the individual will begin to experience predictable withdrawal symptoms advocate to support or defend a cause or a proposal aesthete one who has a deep appreciation for beauty, especially in the arts or nature aggression hostile and destructive behavior, especially caused by frustration; may include violence or physical threat or injury directed toward another aggressive hostile and destructive behavior agonist chemical that can bind to a particular cell and cause a specific reaction AIDS stands for acquired immunodeficiency syndrome, the disease caused by the human immunodeficiency virus (HIV); in severe cases, it is characterized by the profound weakening of the body’s immune system alcoholism disease of the body and mind in which an individual compulsively drinks alcohol, despite its harmful effects on the person’s career, relationships, and/or health; leads to dependence on alcohol, and the presence 231
Glossary
of withdrawal symptoms when alcohol use is stopped; can be progressive and fatal; research indicates the disease runs in families, and may be genetically inherited
alkaline similar in chemical composition to the alkali chemicals; possessing a pH greater than 7 amino acids organic molecules that make up proteins amphetamine central nervous system stimulant, used in medicine to treat attention-deficit/hyperactivity disorder (ADHD), narcolepsy (a sleep disorder), and as an appetite suppressant analgesic broad drug classification that includes acetaminophen, aspirin, ibuprofen, and addictive agents such as opiates analog a different form of a chemical or drug structurally related to a parent chemical or drug androgenic effects effects on the growth of the male reproductive tract and the development of male secondary sexual characteristics anesthetic an agent or event that causes anesthesia, or the loss of sensation and/or consciousness anorectic a substance that decreases a person’s appetite anorexia nervosa eating disorder characterized by an intense and irrational fear of gaining weight, resulting in abnormal and unhealthy eating patterns, malnutrition, and severe weight loss antagonist an agent that counteracts or blocks the effects of another drug anticonvulsant drug that relieves or prevents seizures antidepressant medication used for the treatment and prevention of depression antipsychotic drugs drugs that reduce psychotic behavior, but often have negative long-term side effects antisocial personality disorder a condition in which people disregard the rights of others and violate these rights by acting in immoral, unethical, aggressive, or even criminal ways antitrust relating to laws that prevent unfair business practicies, such as monopolies anxiety disorder condition in which a person feels uncontrollable angst and worry, often without any specific cause archaeological relating to the scientific study of material remains from past human life and activities 232
Glossary
attention-deficit/hyperactivity disorder ADHD is a long-term condition characterized by excessive, ongoing hyperactivity (overactivity, restlessness, fidgeting), distractibility, and impulsivity; distractibility refers to heightened sensitivity to irrelevant sights and sounds, making some simple tasks difficult to complete autopsy examination of a body after a person has died, to determine the cause of death or to explore the results of a disease ayahuasca an intoxicating beverage made from Banisteriopsis caapi plants, which contain dimethyltriptamine or DMT barbiturate highly habit-forming sedative drugs that decrease the activity of the central nervous system behavioral therapy form of therapy whose main focus is to change certain behaviors instead of uncovering unconscious conflicts or problems benign harmless; also, noncancerous benzodiazepine drug developed in the 1960s as a safer alternative to barbiturates. Most frequently used as a sleeping pill or as an anti-anxiety medication binge relatively brief period of excessive behavior, such as eating an usually large amount of food binge drinker a man who consumes 5 or more drinks on a single occasion; or a woman who consumes 4 or more drinks on a single occasion biopsy procedure in which a body tissue, cells, or fluids are removed for examination in a laboratory black market sale and purchase of goods that are illegal, such as drugs like heroin blood alcohol concentration (BAC) amount of alcohol in the bloodstream, expressed as the grams of alcohol per deciliter of blood; as BAC goes up, the drinker experiences more psychological and physical effects borderline personality disorder condition in which a person consistently has unstable personal relationships, negative self-image, unclear self-identity, recurring impulsivity, and problems with mood bulimia nervosa literally means “ox hunger”; eating disorder characterized by compulsive overeating and then efforts to purge the body of the excess food, through self-induced vomiting, laxative abuse, or the use of diuretic medicines (pills to rid the body of water) buprenorphine new medication that has proven to reduce cravings associated with heroin withdrawal, and may also be helpful in treating cocaine addiction 233
Glossary
cannabis plants and/or drug forms of the Indian hemp plant, Cannabis sativa, also known as marijuana carcinogen substance or agent that causes cancer cartel group that controls production and/or price of a good such as diamonds, oil, or illegal drugs catatonia psychomotor disturbance characterized by muscular rigidity, excitement, or stupor central nervous system comprised of brain and spinal cord in humans cerebellum a large part of the brain, which helps with muscle coordination and balance cerebral cortex surface layer of gray matter in the front part of the brain that helps in coordinating the senses and motor functions chronic continuing for a long period of time cirrhosis chronic, scarring liver disease that can be caused by alcohol abuse, toxins, nutritional deficiency, or infection civil libertarian person who believes in the right to unrestricted freedom of thought and action cleft palate congenital (present at birth) cleft or separation in the roof of the mouth clinical trial scientific experiment that uses humans, as opposed to animals, to test the efficacy of a new drug, medical or surgical technique, or method of diagnosis or prevention clitoris small erectile organ in females at front part of the vulva club drug group of drugs commonly reported to be used by young people at clubs or “raves” to increase stamina and energy and/or extend the euphoric effects of alcohol codependence situation in which someone (often a family member) has an unhealthy dependence on an individual with an addiction; the dependent relationship allows the addicted individual to be manipulative, and is often characterized as “enabling” the addict to continue his or her addiction codependent person who has an unhealthy dependence on another person with an addiction coma state of very deep and sometimes prolonged unconsciousness comorbid two or more disorders that occur at the same time in a person compensation an amount of money or something else given to pay for loss, damage or work done 234
Glossary
completed suicide suicide attempt that actually ends in death compound pure substance that is made up of two or more elements, but possesses new chemical properties different from the original elements compulsion irresistible drive to perform a particular action; some compulsions are performed in order to reduce stress and anxiety brought on by obsessive thoughts condom covering worn over the penis, used as a barrier method of birth control and disease prevention conduct disorder condition in which a child or adolescent exhibits behavioral and emotional problems, often finding it difficult to follow rules and behaving in a manner that violates the rights of others and society convulsion intense, repetitive muscle contraction correlate to link in a way that can be measured and predicted correlation relation of two or more things in a way that can be measured and predicted corroborate to independently find proof or support corticosteroid medication that is prescribed to reduce inflammation and sometimes to suppress the body’s immune responses crack cocaine a freebase cocaine, or a cocaine that is specially processed to remove impurities; crack cocaine is smoked and is highly addictive craving a powerful, often uncontrollable desire debilitating something that interferes with or lessens normal strength and functioning deficiency having too little of a necessary vitamin or mineral deflect to cause somebody to change from what he or she usually does or plans to do dehydration a state in which there is an abnormally low amount of fluid in the body delirium mental disturbance marked by confusion, disordered speech, and sometimes hallucinations delusion unshakable false belief that a person holds onto even when facts should convince the individual otherwise dementia type of disease characterized by progressive loss of memory and the ability to learn and think denial psychological state in which a person ignores obvious facts and continues to deny the existence of a particular problem or situation 235
Glossary
dental dam piece of latex used to protect the mouth; can be used in dentistry, or can be used to prevent the oral transmission of sexually transmitted diseases dependence psychological compulsion to use a substance for emotional and/or physical reasons dependent someone who has a psychological compulsion to use a substance for emotional and/or physical reasons depletion state of being used up or emptied depressant chemical that slows down or decreases functioning; often used to describe agents that slow down the functioning of the central nervous system; such agents are sometimes used to relieve insomnia, anxiety, irritability, and tension depressed someone who feels intensely sad and hopeless depression state in which an individual feels intensely sad and hopeless, may have trouble eating, sleeping, and concentrating, and is no longer able to feel pleasure from previously enjoyable activities; in extreme cases, it may lead an individual to think about or attempt suicide deprivation situation of lacking the basic necessities of life, such as food or emotional security detoxification process of removing a poisonous, intoxicating, or addictive substance from the body dietary supplement product used to supplement an individual’s normal diet, by adding a specific vitamin, mineral, herb, or amino acid, or by increasing the general caloric intake; often available without a prescription; usually not subjected to rigorous clinical testing dilution process of making something thinner, weaker, or less concentrated, typically by adding a diluting material (often a liquid such as water); can also refer to the result of diluting, a weakened solution disordered state characterized by chaotic, disorganized, or confused functioning; may refer to problems with a person’s individual thought processes or problems within a system, such as a family distillation process that separates alcohol from fermenting juices diuretic drug that increases urine output; sometimes called “water pill” divine relating to or proceeding from God or a god Down syndrome form of mental retardation due to an extra chromosome present at birth often accompanied by physical characteristics, such as sloped eyes 236
Glossary
downers slang term for drugs that act as depressants on the central nervous system, such as barbiturates drug traffickers people or groups who transport illegal drugs drug trafficking act of transporting illegal drugs dysphoria depressed and unhappy mood state ecstasy designer drug and amphetamine derivative that is a commonly abused street drug efficacy ability to produce desired results endocrine system cells, tissues, and organs of the body that are active in regulating bodily functions, such as growth and metabolism enthusiast supporter enzyme protein produced by cells that causes or speeds up biological reactions, such as those that break down food into smaller parts epidemic rapid spreading of a disease to many people in a given area or community at the same time euphoria state of intense, giddy happiness and well-being, sometimes occurring baselessly and at odds with an individual’s life situation euphoric someone who experiences a state of intense, giddy happiness and well-being, sometimes occurring baselessly and out of sync excise tax tax that a government puts on the manufacture, sale, or use of a domestic product expertise expert advice or opinions expressed by a person with recognized skill or knowledge in a particular area exploitation condition in which one uses another person for one’s own selfish advantage export to send merchandise to another country as part of commercial business expulsion act of forcing somebody out of a group or institution, such as a school or club felony very serious crime that usually warrants a more severe punishment than those crimes considered misdemeanors gastrointestinal tract entire length of the digestive system, running from the stomach, through the small intestine, large intestine, and out the rectum half-life amount of time it takes for one-half of a substance to undergo a process, such as to be broken down or eliminated 237
Glossary
hallucination seeing, hearing, feeling, tasting, or smelling something that is not actually there, like a vision of devils, hearing voices, or feeling bugs crawl over the skin; may occur due to mental illness or as a side effect of some drugs hallucinogen a drug, such as LSD, that causes hallucinations, or seeing, hearing, or feeling things that are not there hallucinogenic describing a substance that can cause hallucinations, or seeing, hearing, or feeling things that aren’t there heritable trait that is passed on from parents to offspring homicide murder hormone chemical substance, produced by a gland, that travels through the blood or other body fluids to another part of the body where it causes a physiological activity to occur hyperactivity overly active behavior hypersensitivity state of extreme sensitivity to something hypnotic drug that induces sleep by depressing the central nervous system illicit something illegal or something used in an illegal manner immune system human body’s system of protecting itself against foreign substances, germs, and other infectious agents; protects the body against illness impair to make worse or to damage, especially by lessening or reducing in some way impotence inability to get or maintain an erection impotency condition in which one is unable to get or maintain an erection impulsive acting before thinking through the consequences of the action impulsivity state in which someone acts before thinking through the consequences of their actions incentive something, such as a reward, that encourages a specific action or behavior induce to bring about or stimulate a particular reaction induction process of formally admitting somebody into a position or organization infertility inability to have children ingenuity inventive skill or imagination 238
Glossary
inhalant legal product that evaporates easily, producing chemical vapors; abusers inhale concentrated amounts of these vapors to alter their consciousness inpatient person who stays overnight in a facility to get treatment interpret to explain the meaning of or make a judgment about technical information or data interpretation judgment or explanation about technical information intervention act of intervening or positioning oneself between two things; when referring to substance abuse, the term means an attempt to help an addict admit to his or her addiction, recognize the ill effects the addiction has had on the addict and on his or her relationships, and get help to conquer the addiction intoxicant food or drink capable of diminishing physical or mental control intoxicated someone whose physical or mental control has been diminished intoxicating a food or drink capable of diminishing physical or mental control intoxication loss of physical or mental control because of the effects of a substance invasive in the context of medical actions, describing a procedure in which a part of the body is entered; relating to an infection or a cancer, describing a disease that has spread from its original site in the body LAAM (Levo-Alpha-Acetylmethadol) a synthetic opiate used to treat heroin addiction by blunting the symptoms of withdrawal for up to 72 hours laxative product that promotes bowel movements legitimate meeting or conforming to legal or recognized standards lethargy state of being slowed down, sluggish, very drowsy, lacking all energy or drive liable responsible licit legal; permitted by law lobbying activities aimed at influencing public officials, especially members of the legislature logo an identifying symbol (as for advertising) that a company uses as a way of gaining recognition LSD lysergic acid diethylamide, known for its hallucinogenic properties lucrative something with the potential to make a lot of money 239
Glossary
malaria disease caused by a parasite in the red blood cells, passed to humans through the bite of mosquitoes malnutrition unhealthy condition of the body caused by not getting enough food or enough of the right foods or by an inability of the body to appropriately break down the food or utilize the nutrients marijuana dried leaves and flowers of female Cannabis sativa plants, smoked or eaten for its intoxicating effect market share percentage of the total sales of a product that is controlled by a company media means of mass communication, such as newspapers, magazines, radio or television mescaline hallucinogenic drug that is the main active agent found in mescal buttons of the peyote plant metabolic describing or related to the chemical processes through which the cells of the body breakdown substances to produce energy metabolism chemical processes through which the cells of the body break down various substances to produce energy and allow the body to function methadone potent synthetic narcotic, used in heroin recovery programs as a non-intoxicating opiate that blunts symptoms of withdrawal misdemeanor crime that is treated in the courts as a less serious crime than a felony money laundering activity in which a person or group hides the source of money that has been illegally obtained monopoly situation that exists when only one person or company sells a good or service in a given area morphine primary alkaloid chemical in opium, used as a drug to treat severe, acute, and chronic pain narcotic addictive substance that relieves pain and induces sleep or causes sedation; prescription narcotics includes morphine and codeine; can refer to a drug of abuse, such as heroin, cocaine, or marijuana neuroleptic one of a class of antipsychotic drugs, including major tranquilizers, used in the treatment of psychoses like schizophrenia neurological relating to the nervous system neuron nerve cell that releases neurotransmitters neuropathic relating to a disease of the nerves neurotransmitter chemical messenger used by nerve cells to communicate with other nerve cells 240
Glossary
nicotine alkaloid derived from the tobacco plant that is responsible for smoking’s addictive effects noninvasive not involving penetration of the skin norm behavior, custom, or attitude that is considered normal, or expected, within a certain social group obscene morally offensive; describes something meant to degrade or corrupt obsessed someone who experiences repeated thoughts, impulses, or mental images that are irrational and that the person cannot control obsession repeating thoughts, impulses, or mental images that are irrational and that an individual cannot control obsessive-compulsive disorder anxiety disorder in which a person cannot prevent dwelling on unwanted thoughts, accting on urges, or repeating rituals opiate drug derived directly from opium and used in its natural state, without chemical modification; examples of opiates are morphine, codeine, thebaine, noscapine, and papaverine opioid substance that acts in a way similar to opiate narcotic drugs, but is not actually produced from the opium poppy oppositional defiant disorder psychiatric condition in which a person repeatedly shows a pattern of negative, hostile, disobedient, and/or defiant behavior, without serious violation of the rights of others optimism a positive outlook outpatient person who receives treatment at a doctor’s office or hospital but does not stay overnight overdose excessively high dose of a drug, which can be toxic or even lifethreatening paranoia excessive or irrational suspicion, illogical mistrust paranoid someone who is excessively or irrationally suspicious paranoid psychosis symptom of mental illness characterized by changes in personality, a distorted sense of reality, and feelings of excessive and irrational suspicion; may include hallucinations (seeing, hearing, feeling, smelling, or tasting something that is not truly there) paraphernalia equipment that enables drug users to take the drugs, such as syringes and needles periodic occuring at regular intervals or periods peyote a cactus that can be used to make a stimulant drug 241
Glossary
pharmaceuticals legal drugs that are usually used for medical reasons pharmacology branch of science concerned with drugs and how they affect bodily and mental processes philanthrophy acts performed with the desire to improve humanity, especially through charitable activities physical dependence condition that may occur after prolonged use of a particular drug or alcohol, in which the user’s body cannot function normally without the presence of the substance; when the substance is not used, or when the dose is decreased, the user experiences uncomfortable physical symptoms physically dependent someone who takes drugs for relief of uncomfortable physical symptoms, rather than for emotional or psychological relief physiological relating to the functions and activities of life on a biological level physiology branch of science that focuses on the functions of the body placebo effect improvement in an individual’s symptoms that is not due to the specific treatment offered; for example, a patient may report that his or her pain has improved after taking a sugar pill, which contains no active medicinal ingredients placenta in most mammals, the organ that is attached to the mother’s uterus and to the fetus’s umbilical cord; it is responsible for passing nutrients and oxygen from the mother to the developing fetus predispose to be prone or vulnerable to something predisposition condition in which one is vulnerable or prone to something prenatal existing or occurring before birth; refers also to the care a woman receives while pregnant problem drinking when a person’s drinking disrupts life and relationships, causing difficulties for the drinker productivity quality of yielding results or benefits prohibit to forbid promiscuity having many sexual partners proportional properly related in size; corresponding prostate gland located near the bladder and urethra in men, it secretes the fluid that contains sperm psychedelic substance that can cause hallucinations and/or make its user lose touch with reality 242
Glossary
psychiatric relating to the branch of medicine that deals with the study, treatment, and prevention of mental illness psychiatry branch of medicine that deals with the study, treatment, and prevention of mental illness psychoactive drugs that affect the mind or mental processes by altering consciousness, perception, or mood psychology scientific study of mental processes and behaviors psychometric relating to the technique of measuring mental abilities psychomotor referring to processess of muscular movement directly influenced by mental processes psychosis mental disorder in which an individual loses contact with reality and may have delusions (unshakable false beliefs) or hallucinations (the experience of seeing, hearing, feeling, smelling, or tasting things that are not actually present) psychosocial relates to both life experiences as well as mental processes psychostimulant medication that is prescribed to control hyperative and impulsive behaviors psychotherapeutic drugs drugs used to relieve the symptoms of mental illness such as depression, anxiety and psychosis psychotherapy treatment of a mental or emotional condition during which a person talks to a qualified therapist in order to understand his or her problems and change problem behaviors psychotropic substance that affects mental function quinine substance used to treat malaria rave organized gathering of young people that includes loud, pulsing “house” music and flashing lights receptor specialized part of a cell that can bind a specific substance; for example, a neuron has special receptors that receive and bind neurotransmitters recidivism tendency to relapse into previous criminal behavior recreational drug use casual and infrequent use of a substance, often in social situations, for its pleasurable effects regulate to bring under the control of law or authorized agency rehabilitate to restore or improve someone to a condition of health or useful activity 243
Glossary
rehabilitation process of restoring a person to a condition of health or useful activity reinforced to make something stronger by repeating an activity or by adding extra support relapse term used in substance abuse treatment and recovery that refers to an addict’s return to substance use and abuse following a period of abstinence or sobriety repeal to revoke or cancel repression the effort of the mind to block unpleasant or painful thoughts or desires; or, an act in which one person or group keeps another group in a lower, less advantageous position resent to feel anger, bitterness or ill will towards someone or something residue the quantity of some substance or material left over at the end of a process; a remainder of something resuscitation revival from unconsciousness; restoring energy, vitality risk an increased probability of something negative happening Rohypnol medication that causes sleep, banned in the United States but used illegally as a club drug; also known as a “date rape” drug sanction punishment imposed as a result of breaking a law or rule schizophrenia psychotic disorder in which people lose the ability to function normally, suffer from severe personality changes, and suffer from a variety of symptoms, including confusion, disordered thinking, paranoia, hallucinations, emotional numbness, and speech problems sedated describing someone who took a medication that reduced excitement sedation process of calming someone by administering a medication that reduces excitement, often called a tranquilizer sedative a medication that reduces excitement, often called a tranquilizer sedative-hypnotic drug that has a calming and relaxing effect; “hypnotics” induce sleep self-harm repeated dangerous behaviors, such as cutting the skin, headbanging, or taking pills self-medicate when a person treats an ailment, mental or physical, with alcohol or drugs rather than see a physician or mental health professiona serotonin neurotransmitter associated with the regulation of mood, appetite, sleep, memory, and learning 244
Glossary
shamanism religion whose leaders perform rituals of magic, divination, and healing and act as intermediaries between reality and the spirit world skeletal system the bones and related parts that serve as a framework for the body sober in relation to drugs and alcohol, refers to abstaining from alcoholic beverages or intoxicants; describes a state in which someone is not under the influence of drugs or alcohol sociologist someone who studies society, social relationships, and social institutions sophisticated knowledgeable about the ways of the world, self-confident specimen a sample, as of tissue, blood, or urine, used for analysis and diagnosis spina bifida one of the more common birth defects in which the backbone never closes or its coverings stick out through the opening sterility condition in which one is unable to conceive a child steroid specific chemical compound; certain types of steroids are produced naturally by the body (such as sex and stress hormones); other types of steroids are laboratory-produced drugs used to treat a variety of illnesses and to reduce swelling stigma the shame or disgrace attached to something regarded as socially unacceptable stimulant drug that increases activity temporarily; often used to describe drugs that excite the brain and central nervous system stimuli things that excite the body or part of the body to produce specific responses stimulus anything that excites the body or part of the body to produce a specific response stupor state of greatly dulled interest in the surrounding environment; may include relative unconsciousness synapse the gap between communicating nerve cells through which impulses pass from one nerve cell to another synthesize to produce artificially or chemically testimonial statement that backs up a claim or support a fact testosterone hormone produced in higher amounts in males that is responsible for male characteristics such as muscle-building and maintaining sexual organs, and during puberty causes hair growth and a deepening voice tetanus rare but often fatal disease that affects the brain and spinal column 245
Glossary
therapeutic healing or curing tic repetitive, involuntary spasm that increases in severity when it is purposefully surpressed; may be motor (such as muscle contractions or eye blinking) or vocal (such as an unintended yelp or use of an expletive) tolerance condition in which higher and higher doses of a drug or alcohol are needed to produce the effect or “high” experienced from the original dose Tourette s syndrome chronic tic disorder involving multiple motor and/or vocal tics that cause distress or significant impairment in social, occupational, or other important areas of functioning toxic something that is poisonous or dangerous to people toxicity condition of being poisonous or dangerous to people toxicology study of the nature, effects, and detection of poisons and the treatment of poisoning trance state of partial consciousness tranquilizer drug that decreases anxiety and tension trauma injury or damage, either to the body or to the mind trivialize to treat something as less important or valuable than it really is Twelve Steps program for remaining sober developed by Alcoholics Anonymous; adopted by many other groups, such as Narotics Anonymous ulcer irritated pit in the surface of a tissue, often on the stomach lining unethical something that is morally questionable uppers slang term for amphetamines, drugs that act as stimulants of the central nervous system variable something that can change or fluctuate vascular relating to the transport of fluids (such as blood or lymph fluid) through tubes in the body; frequently used to refer to the system of blood vessels vulnerable at greater risk withdrawal group of physical and psychological symptoms that may occur when a person suddenly stops the use of a substance or reduces the dose of an addictive substance
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Volume 2 Index Page numbers in boldface type indicate article titles, and italics indicate an image. Numbers followed by a “t” indicate the presence of a table; “f” indicates an illustration. A cumulative index, which combines the terms in all volumes of Drugs, Alcohol, and Tobacco: Learning About Addictive Behaviors, can be found in volume 3 of this series.
A AAEFP (African-American Extended Family Program), 64 Abstinence defined, 16 incentives for, 119 Abuse potential, of new drugs, 9–15 Academic achievement, drug abuse and, 2–3, 73–74 Accidents from alcohol, 96 from drug abuse, 96 with elderly and alcohol, 3 from ketamine abuse, 143 “Acid culture,” 182 Acquired immune deficiency syndrome. See AIDS Addiction defined, 11 federally funded treatment programs, 173 vs. dependence, 209 See also Alcoholism; Dependence; Drug abuse
Addictive gambling. See Pathological gambling Adolescents alcohol use by, 36 anabolic steroid use by, 103 antidrug media and, 199–200 barbiturate abuse by, 37 benzodiazepine abuse by, 37 Christians, alcohol use and, 67 death rate, drug-related, 70 drug courts for, 154 drug experimentation by, 182–183 drug use by, 145 eating disorders in, 48–54 ecstasy use by, 55, 55t families, drug use and, 70–75 family therapy for, 75 with FAS, 79–80 gambling by, 84, 87 in gangs, 88–95 gender differences in substance abuse, 97–98 herbal supplements and, 110, 112 heroin use by, 40 Hispanic American, drug use by, 66 homelessness, substance abuse and, 129f inhalant use by, 42, 134–139, 136f juvenile justice system, 179–180 LSD use by, 182–183, 183f marijuana use by, 39, 188–189
medical emergencies, drugrelated, 203 peer groups, drug use and, 73–74 television and substance abuse, 197–198 Adult drug courts, 153–154 Advertising antidrug, 199 gambling, 88 Affordable housing, 130–131 Afghanistan cannabis from, 34 hashish from, 6 heroin from, 145 income from opium, 34 opium from, 5, 7–8, 29, 32, 34 Africa cannabis in, 34, 187 current drug use trends, 32–33 iboga rituals in, 44 jimsonweed use in, 46 khat in, 144 African-American Extended Family Program (AAEFP), 64 African Americans deindustrialization and, 130 drug treatment for, 63–64 drug use in movies, 196 in gangs, 89, 91, 93–95 Aging, drugs and, 3–4 AIDS defined, 159 methadone maintenance and, 210
247
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Alcohol, 35–36 Asian Americans and, 64 Christians and, 67 death from, 205 elderly and, 3–4 fermentation and, 76 gender comparisons, 96, 97–99 with herbal supplements, 111–112 Hispanic Americans and, 66 Jews and, 67 with ketamine, 143 media portrayal of, 194–200 medical emergencies from, 202–203 memory and, 59–60 in movies, 195–196 in music, 197 in music videos, 198 Native Americans and, 65 prohibition of, 169–170, 170 on television shows, 197–198 See also Alcoholism Alcoholic dementia, 59–60 Alcoholism among elderly, 3–4 with bulimia, 50 domestic violence and, 74 dropouts and, 1 gangs and, 89–95 gender comparisons, 100–101 homelessness and, 125–126, 125t, 128–131, 129f in the military, 211–216, 212, 215f problem gambling and, 84 Altered states of consciousness with LSD, 182 in plant rituals, 46 Amenorrhea, 49–50 American Association for the Cure of Inebriates, 170 American Medical Association, 169 American Psychological Association, Committee on Animal Research and Ethics, 12–13 Amino acids, defined, 109 Amnesia, from alcohol, 59
248
Amotivational syndrome, 39–40, 190 Amphetamines, 38–39 defined, 144 gangs and, 90 history of use, 31–32 medical emergencies from, 204, 205 memory and, 60–61 See also Stimulants Amphetamine-type stimulants (ATS), 32–33 Amyl nitrite poppers, 137 Anabolic steroids, 103 Analgesics marijuana as, 192 medical emergencies from, 202 opioids as, 40–41 Anascha. See Hashish Androstenedione, 110 Anesthesia gases, 42 ketamine in, 140–141 “Angel dust.” See Phencyclidine Animal testing for drug abuse potential, 9–13 for memory effects of drugs, 58–61 for sensations with drugs, 58 Animals, ketamine for, 141 Anorexia nervosa, 48, 49–54, 102 Anslinger, Harry J., 172 Anti-Drug Abuse Act of 1986, 163 Anti-Saloon League (ASL), 170 Antidepressants for bulimia, 53 defined, 53 Antidrug legislation, 171–173 See also Laws and regulations; specific laws Antiemetics, marijuana as, 191–192 Antipsychotics, medical emergencies from, 202 Antisocial personality disorder, defined, 85
Anxiety barbiturates for, 37 benzodiazepines for, 37 herbal supplements for, 109 Anxiety disorders, defined, 50 Areca catechu. See Betel Arrests, 176, 177t Arrhythmias, cardiac, 42 Asia current drug use trends, 32, 33 heroin production in, 7–8 opium production in, 33–34 Asian Americans, 64 Asian gangs, 90, 92 ASL (Anti-Saloon League), 170 At-risk students, 3 Atropine, 106, 139 ATS. See Amphetamine-type stimulants Attention-deficit/hyperactivity disorder (ADHD) defined, 85 in males, 103 Australian Sports Drug Testing Laboratory, 22 Authoritative control, vs. authoritarian, 73 Ayahuasca, 45–46
B Babies, addicted and drug-exposed, 99, 115 Baby-boom generation, homelessness and, 130 BAC. See Blood alcohol concentration Bahamas, drug trafficking and, 26, 26–27 Banisteriopsis caapi. See Ayahuasca Barbiturates, 37–38, 204 Bars, drinking laws and, 178 The Basketball Diaries, 195 Baudelaire, Charles, 107, 182 BC bud (marijuana), 9 Behavioral disorders, 47–54 Behavioral therapy for eating disorders, 52–53 for heroin abuse, 115–120 Belgium, ecstasy from, 6, 29
Volume 2 Index
Belladonna plant, 106 Bennett, William J., 137–138 Benzodiazepines, 35, 37–38 defined, 116 with heroin, 116, 122 medical emergencies from, 204 memory and, 60 Betel, 46–47 Bhang, 108 Binge drinkers, defined, 112 Binge eating disorder, 53 Binge/purge syndromes anorexia nervosa, 48 bulimia nervosa, 49 Binges alcohol, 112 cocaine, 37 defined, 49 depressants, 37 Biological causes of marijuana dependence, 193–194 of problem gambling, 84–85 Birth defects, 77–80, 99 Bisexuals, 102 BJS. See Bureau of Justice Statistics Black markets defined, 158 in drug legalization argument, 158–162 Blackouts, 59 Blood alcohol concentration (BAC) central nervous system and, 36 defined, 36 driving laws and, 178, 181 testing, 16, 21 Blood flow, brain, 132 Blood tests, 17–18 Blotter paper, for LSD, 183, 185 Boggs Act of 1951, 172 Bolivia coca and, 6, 33, 167 cocaine from, 5, 26, 33 income from coca, 35 Border drug trade, 150
Boyz N the Hood, 89, 93 Brain diseases of, 106–107 eating disorders and, 54 effect of ecstasy on, 55–56 effect of heroin on, 206–207 FAS and, 77–80, 79 imaging techniques for, 132 problem gambling and, 84–85 Braun, Stephen, 162 Brazil, ayahuasca in, 46 Break point, for reinforcing efficacy measurement, 11–12 Breathalyzer, 21, 178 British Columbia, marijuana from, 9 Bulimia nervosa, 48–54, 102 Buprenex. See Buprenorphine Buprenorphine defined, 211 for heroin withdrawal, 124, 211 Bureau for International Narcotics and Law Enforcement Affairs (INL), 164 Bureau of Justice Statistics (BJS) on drug offenders in prison, 152t on drug-related probation requirements, 153f Burgess, Melvin, 114 Burma. See Myanmar Bush, George W., 4, 24 Butane abuse, 137 Buzz: The Science and Lore of Alcohol and Caffeine (Braun), 162 Bwiti cult, 44
C Caffeine, 38, 111 Cambodia, heroin from, 24–25 Canada, marijuana from, 9 Cancer, marijuana with chemotherapy, 191–192, 193 Cannabis sativa current global trends, 32, 192 global production of, 5, 34 hashish and, 107 hemp and, 108 history of use, 31–32, 187
on majors list, 4 worldwide production of, 149t See also Marijuana Cardiovascular system, 191 CARE. See Committee on Animal Research and Ethics Cartel, defined, 162 “Cat Valium.” See Ketamine Catapres. See Clonidine Catatonia, defined, 42 Catha edulis. See Khat Catholics, alcohol and, 67 2CB, sensory perceptions with, 57 Center for Addiction and Alternative Medicine Research, 112 Centers for Disease Control (CDC) on alcohol during pregnancy, 76–77 on drug-related deaths, 205 Central America current drug use trends, 32 drug trafficking in, 25–26 Central nervous system alcohol and, 36 inhalant abuse and, 138 Certification, for foreign aid, 163 Chaplin, Charlie, 59 Charas. See Hashish Charges, criminal, 176 Cheating, on drug testing, 23 Chemistry, of marijuana, 188, 193 See also Brain Chemotherapy, marijuana with, 191–192, 193 Chicago gangs, 90–93, 95 Chicano gangs, 89–90 Child abuse drugs and, 74 prenatal drug use as, 99 Children, behavior and later drug use, 1 China current drug use trends, 32 drug trafficking in, 28–29 gangs in, 90, 92
249
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Chinese herbal medicine, 109, 112 Chlorinated solvents, 42 Choice procedures, 11–12 Christians, alcohol and, 67 Chronic, defined, 201 Chronic gambling. See Pathological gambling Cirrhosis, in women, 97 City Lights, 59 Civil libertarians, defined, 158 Clonidine, for heroin withdrawal, 122 Cloud, Sunny, 18 Club drugs, 142, 204 See also Designer drugs Club of Hashish-Eaters, 107 Cobain, Kurt, 115 Coca abundant supply of, 166 controlling production of, 167 economic impact of sales, 34 history of use, 31–32, 170 on majors list, 4 production of, 4, 6–7, 33, 149t Cocaine, 38–39 current global trends, 32–33 death from, 205 drug trafficking and, 5, 6–7, 25–28 gang sales of, 91–92 global trends in, 32 with heroin, 116 history of use, 31–32 legalization of, 161 medical emergencies from, 202–203, 205 memory and, 61 in United States, 145 Codeine, 202, 204 Codependence, defined, 102 Coerced treatment. See Courtordered treatment Cognitive-behavioral therapy for eating disorders, 53 for heroin abuse, 119–120 Cohen, William, 165 Colds, herbal supplements for, 109
250
Colombia, 26 cannabis in, 34 coca and, 33 cocaine from, 5, 26, 33, 145, 167 heroin from, 5, 8, 145 income from coca, 34 marijuana from, 5, 9 Colors (movie), 93 Committee on Animal Research and Ethics (CARE), 12–13 Communication, family, 73 Community drug treatment, 152–153 Community rituals. See Rituals Compounds, defined, 109 Comprehensive Drug Abuse Prevention and Control Act of 1970, 173 Compulsions, defined, 48 Compulsive gambling. See Pathological gambling Conduct disorder, dropouts and, 1 Congo, 44 Constitutional amendments, on alcohol control, 169 Contraceptives, oral. See Oral contraceptives Copycat gangs, 94 Coronary heart disease, smoking and, 99 Correlation, defined, 99 Corruption, drug-related, 166 Cortisone, 105–106 Costs, economic of drug law enforcement, 146 for drug purchasing, 158 of pathological gambling, 82 Counseling, for heroin abuse, 118 Counterculture, LSD and, 182–183 Court-ordered treatment, 152–155, 152t, 153f Courts, drug, 153–154 Crack cocaine, 38 gangs and, 89–90, 91–92 Hispanic Americans and, 66 history of use, 31–32 medical emergencies from, 203
vs. powder cocaine, 176 Crash, from cocaine withdrawal, 39 Craving cocaine, 39 defined, 122 heroin, 122 See also specific drugs Creatine, 110 Creativity, LSD and, 182, 184 Crime control, 171–174 See also Drug trafficking; Law enforcement Cuba, drug trafficking and, 26 Cultural issues, in drug use and treatment, 62–69 Cuomo, Mario, 63
D Dalmane. See Flurazepam Darvon. See Propoxyphene Datura. See Jimsonweed DAWN (Drug Abuse Warning Network), 200–205, 203f DEA. See Drug Enforcement Administration Deaths adolescent, drug-related, 70 drug-related, 70, 205–206 from eating disorders, 49 of female alcoholics, 97 from inhalants, 138 Dehydration, defined, 50 Deindustrialization, 130 Delirium defined, 37 hallucinations from, 107 Delirium tremens, 107 Demand-side measures, 146 Demerol. See Meperidine Department of Defense (DoD), 213 Department of State, 164 Departures, from sentencing guidelines, 177 Dependence on caffeine, 38 defined, 50 on heroin, 40
Volume 2 Index
on khat, 144–145 on marijuana, 193–194 See also Physical dependence Depressants, 37–38 defined, 36 medical emergencies from, 204 Depression defined, 50 with eating disorders, 50 herbal supplements for, 109 Designer drugs, 54–55, 148 Deterrence, law enforcement for, 145–146 Detoxification defined, 121 for heroin abuse, 121, 122–123 Detroit gangs, 90, 93, 95 Diagnosis, of problem gambling, 86–87 Diagnostic and Statistical Manual of Mental Disorders (DSM), 86–87 Diamonds gang (Chicago), 92, 95 Diazepam, prescriptions for, 35 See also Benzodiazepines Dietary supplements, 108–109 Dieting, eating disorders and, 48, 49–51 Dilution, defined, 22 Dimethyltryptamine (DMT), 104 Disabilities, women with, 102 Discrimination racial, in drug laws, 176 sexual orientation and, 102 Diseases, brain, 106–107 See also Health problems; specific diseases Disordered gambling. See Pathological gambling Dissociative anesthesia, 140–141 Distillation, defined, 76 Diuretics, defined, 49 Divorce, children of, drug use and, 71 DMT. See Dimethyltryptamine DoD. See Department of Defense
Dole, Vincent, 173, 206 DOM, 104–105 Domestic violence, 74 Dominican Republic, 26–27 Dopamine, eating disorders and, 54 Doral. See Quazepam Dosage, in methadone maintenance, 208–210 Drinking and driving, 179 breath tests, 16 gender differences in, 96 laws on, 178–179 Driving licenses, suspension of, 178, 224–225, 226 Dropouts, substance abuse and, 1–3, 2, 73–74 Drug abuse brain imaging techniques and, 132 chronic, 154–155 domestic violence and, 74 eating disorders and, 53–54 ethnicities and, 62–69, 65t, 66f family life and, 69–75 gangs and, 89–95 gender comparisons, 96, 100–101 herbal supplements, 111–112 homelessness and, 125–126, 125t, 128–131, 129f ketamine, 141–144 in the military, 211–216, 212, 215f in movies, 195–196 problem gambling and, 84 worldwide, 30–35, 31, 33 Drug Abuse Warning Network (DAWN), 200–205, 203f Drug courts, 153–154 Drug Enforcement Administration (DEA) on heroin purity levels, 148 Operation New Generation, 6 staffing and budgets, 30f, 147f, 174, 175f on U.S. marijuana use and production, 5–6, 145 Drug gangs, 90–93
Drug policy, U.S. on drug legalization, 155–162 on drug trafficking, 145–151, 162–168 history of, 169–174, 170 Drug producers, 4–9, 7t Drug testing (drug abuse), 15–24, 18, 19t, 22, 211–213, 215–216 Drug testing (research) in animals, abuse potential, 9–13 in humans, abuse potential, 13–15 Drug therapy for ADHD, 103 barbiturates for, 37 benzodiazepines for, 37 defined, 12 hashish for, 108 for heroin abuse, 120–125, 121 ketamine for, 140–141 marijuana for, 156–157, 191–192, 193 opiates for, 112–113 opioids for, 40 Drug trafficking, 4, 24–30, 25, 26, 28, 30f Colombia and, 6–7 defined, 5 by gangs, 90–93, 91, 94–95 legal controls on, 145–151, 146, 147f, 149t, 174–177, 175f terrorism and, 6–7, 162–163, 167–168 Drug-transit countries, 24–26, 25 Drugs of abuse, 35–43 abuse potential of, 9–15 discrimination between, 12 effects on sensation, perception and memory, 56–62 elderly and, 3–4 gangs and, 88–95, 89, 91 legalization of, 155–162, 156f, 157, 159t, 160t in rituals, 43, 43–47, 45 See also Drug abuse
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Drunk driving. See Drinking and driving Drunkenness. See Intoxication DSM. See Diagnostic and Statistical Manual of Mental Disorders Dumas, Alexander, 107 Durham-Humphrey Amendment, 173 Dysphoria, defined, 122
E Eating disorders, 47–54, 51 herbal supplement abuse, 111 men with, 103 women with, 102 Echinacea, 109 Economy drug trade and, 34–35, 148–151 homelessness and, 126–127, 130 Ecstasy, 41, 54–56, 55t, 148 countries producing, 6 defined, 6 drug trafficking and, 27–28 gangs and, 92 as hallucinogen, 104–105 history of use, 31–32 medical emergencies from, 202, 204, 205 memory and, 61 sensory perceptions with, 57–58 vs. ketamine, 142 Ecuador, cocaine from, 5 Efficacy, defined, 14 EIC (Entertainment Industries Council), 200 Eighteenth Amendment, 169 Elderly drug and alcohol use among, 3–4 gambling and, 84 social programs and, 128 Electrolyte imbalances, 50 Electronic gambling, 82 Emergencies, medical. See Medical emergencies Emotions, memory and, 62 Employee drug testing, 15–16
252
Entertainment Industries Council (EIC), 200 Entertainment Software Ratings Board (ESRB), 198 Environment gangs and, 94 problem gambling and, 85 Enzymes, defined, 109 Ephedra, 109, 110, 111 Ephedrine, 109 Epidemics, defined, 138 ESRB (Entertainment Software Ratings Board), 198 Estazolam, 37 Esvar. See Hashish Ethanol, 36 See also Alcohol Ethics of animal testing, 12–13 of drug testing, 23–24 Ethnicities drug use and treatment issues, 62–66, 63, 65t, 66f, 68–69 gangs and, 89–94 Ethyl alcohol. See Ethanol Ethyl ether, 42 Euphoria from cocaine, 37–38 defined, 38 Europe current drug use trends, 32 ecstasy from, 6 Evangelical Protestantism, on alcohol prohibition, 170 Exploitation, defined, 93 Expulsion, gang, defined, 90
F Facial abnormalities, from FAS, 76–78 False negatives, 22 False positives, 23 Family drug courts, 154 Family life drug use and, 69–75, 72f problem gambling and, 85 Family therapy for eating disorders, 52–53 for substance abuse, 75
FARC (Revolutionary Armed Forces of Colombia), 168 FAS. See Fetal alcohol syndrome FBI. See Federal Bureau of Investigation FBN (Federal Bureau of Narcotics), 172 FDA. See Food and Drug Administration Federal Bureau of Investigation (FBI), 147f Federal Bureau of Narcotics (FBN), 172 Federal-wide Drug Seizure System (FDSS), 147f, 156f Fentanyl, medical emergencies from, 204 Fermentation, 76 Fertility, substance abuse and, 99 Fetal alcohol syndrome (FAS), 76–80, 77, 79, 99 Flashbacks, 58, 186 Flu, herbal supplements for, 109 Fluorinated hydrocarbons, 42 Flurazepam, 37 Fly Agaric mushrooms, 106 Food, Drug, and Cosmetic Act of 1938, 172–173 Food and Drug Administration (FDA) early controls of, 173 on hair analysis, 20 on herbal supplements, 110 on kava, 140 on methadone maintenance, 206 “For cause” drug testing, 17 Foreign aid, drug trafficking and, 4, 24, 163–164, 244 Foreign Assistance Act of 1961, 4, 24 Foreign policy, drugs and, 145–151, 162–168, 165 Freebase. See Crack cocaine Freedom of religion, 46
G Gabon, 44 Gam-Anon, 85 Gamblers Anonymous, 84, 85, 87
Volume 2 Index
Gambling, 80–88, 81, 86f Gangs, drugs and, 88–95, 89, 91 Ganja. See Hemp Gasoline, inhaling, 42, 138 Gastrointestinal tract, defined, 97 Gateway drugs, marijuana as, 192 Gays, 102 GED diploma, 2 Gender, substance abuse and, 96, 96–103, 100f, 101 General Education Development (GED) diploma, 2 Genetics marijuana dependence and, 193–194 problem gambling and, 84–85 GHB, 142, 204 Ginkgo biloba, 109–110 Ginseng, 109, 109–110, 111 Giove, Rosa, 46 Glaucoma, marijuana for, 192 Global drug production, 5–6 Global Monitoring Programme of Illicit Crops (U.N.), 6 Glue sniffing, 42, 135 Golden Triangle, 113 Government programs, homelessness and, 128–129 Group therapy for eating disorders, 52–53 for heroin abuse, 119 Guatemala as drug-transit country, 25–26 heroin from, 5, 8 “Guidelines for Ethical Conduct in the Care and Use of Animals,” 12–13 Guilty pleas, 176
H Hair analysis, 20 Halcion. See Triazolam Halfway houses, 103–104 Hallucinations defined, 57 from drug use, 57, 104 from LSD, 41, 57, 181
Hallucinogens, 57, 104–107, 105, 106 defined, 31 history of use, 31–32 mushrooms as, 43–44 Harrison Narcotic Act of 1914, 171 Hashish, 107–108 countries producing, 6 hallucinations with, 106 medical emergencies from, 203, 204 HCV (hepatitis C), 210 Heads You Win, Tails I Lose (Holland), 52 Health care homelessness and, 127 Health-care professionals addiction of, 40, 42 inhalant abuse by, 137–138 Health problems from alcoholism, 36, 169 from amphetamines, 39 from cocaine, 39 from drug abuse, 170–171 drug testing for, 15 from eating disorders, 49–50 from ecstasy, 41 from herbal supplements, 110–111 from inhalants, 42 from marijuana, 190–191 medical emergencies, 204–205 from smoking, 37 in women, from substance abuse, 97–100 Healthcare benefits, female, 101 Healthy lifestyle, for eating disorders, 52–53 Heggenhougen, Chris, 45 Hemp, 108 See also Marijuana Hepatitis C (HCV), 210 Herbal supplements, 108–112, 109, 111 See also specific supplements Heredity, defined, 62 Hernandez, Irene Beltran, 1
Heroin, 40–41, 112–115, 113, 115 behavioral therapy, 115–120, 117f, 119 countries producing, 5, 6, 7–8, 24–25 death from, 205 drug therapy, 120–125, 121 drug trafficking and, 27–29 gangs and, 90, 92 history of use, 31 legalization of, 161 medical emergencies from, 202–204 purity level of, 148 in the United States, 145 See also Methadone maintenance; Opiates Hindus, drug use and, 68 Hispanic Americans, 66 deindustrialization and, 130 inhalant abuse and, 136–137 History, family, 71–72 HIV (human immunodeficiency virus), 96 Hofmann, Albert, 43, 182 Holland, Isabelle, 52 Homeless shelters, 127 Homelessness, 125–131, 125t, 127, 129f Homicides, defined, 93 Housing costs of, 130–131 halfway, 103–104 Human immunodeficiency virus. See HIV Hydrocodone, 202 Hydroponics Canadian marijuana and, 9 in cannabis cultivation, 34 Hypoxia, 42
I Iboga, 44 Ibogaine, 44 “Ice.” See Speed Ice Cube, 89 ILEA (International Law Enforcement Academy), 165
253
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Illicit drugs defined, 18 media portrayal of, 194–200 in movies, 196 in music, 197, 197 on television shows, 197–198 See also Drug abuse; specific drugs Imaging techniques, for brain visualization, 132, 133 Immune system defined, 98 herbal supplements and, 109 Impulsivity, defined, 85 Incentives, for heroin abstinence, 119 India, cannabis in, 187 Induction, gang, defined, 90 Industrial solvents, 42 Inhalants, 41–42, 133–139, 134, 136f, 137 defined, 65 medical emergencies from, 205 Native Americans and, 65 Initiation rituals, 45–46 INL (Bureau for International Narcotics and Law Enforcement Affairs), 164 Inpatients, defined, 117 See also Residential treatment communities Insomnia barbiturates for, 37 benzodiazepines for, 37 herbal supplements for, 109 Interagency Council on the Homeless, 125t, 129f International crime, 164 International Law Enforcement Academy (ILEA), 165 International Narcotics Control Strategy Report, 5, 149t Internet, gambling on, 83, 88 Interpretation, defined, 21 Intervention defined, 3 elementary school, to prevent drug abuse, 3 Intoxicants, defined, 139
254
Intoxication from alcohol, 59 from barbiturates, 37 from benzodiazepines, 37 defined, 37 from ketamine, 143 from marijuana, 189 from phencyclidine, 42 in women, 97 Intravenous injections, of heroin, 40–41, 113–114, 120 Investors, gambling and, 82 Iran, heroin from, 5 Islam drug use and, 68 hashish use and, 187 Israel, ecstasy from, 29
J JACS (Jewish Alcoholics, Chemically Dependent Persons and Significant Others Foundation), 68–69 Jamaica cannabis in, 34 as drug-transit country, 26 marijuana from, 5, 9 Jamaica Community Adolescent Program chorus, 62 Jewish Alcoholics, Chemically Dependent Persons and Significant Others Foundation (JACS), 68–69 Jews, drug use and, 67–68 Jimsonweed, 46, 139 Juvenile drug courts, 154 Juvenile justice system, 179–180
K Kava, 46–47, 109, 139–140 Ketamine, 140–144, 141, 143f Ketones, 42 Khat, 144–145 Kid Rock, 197 Kif. See Hashish “Kit kat.” See Ketamine Kolb, Lawrence, 172 Kripa Counseling Centre for the Chemically Dependent, Bombay, India, 31
L LAAM defined, 211 for heroin withdrawal, 124, 211 Laboratory testing, for sensory perceptions with drugs, 58 See also Animal testing Laos, opium from, 5, 8 Latin America control of drugs from, 146 heroin production in, 7–8 illicit drug production in, 24–26, 25 opium production in, 33–34 See also specific countries Latino gangs, 90, 92, 94 Law enforcement, 174–181, 175f, 177t, 179, 180f breath analysis, 21 court-ordered treatment, 152–155, 152t, 153f drug testing in, 16 drug trafficking controls, 145–151, 146, 147f, 149t drugs seized, 156f international training program, 165 Laws and regulations on drinking and driving, 178–179, 179 drug legalization, 155–162, 156f, 157, 159t, 160t, 192–193 global drug enforcement, 7t history of, 169–174, 170 See also specific laws Laxatives abuse of, 49–50 defined, 49 Leary, Timothy, 182 Lebanon hashish from, 6 heroin from, 5 Legalization, of drugs, 155–162, 156f, 157, 159t, 160t, 192–193 Legalized gambling, 80–81 Lesbians, 102 Levomethadyl acetate. See LAAM
Volume 2 Index
Liability, defined, 16 Lilly, John, 143 Limbic system, marijuana dependence and, 194 Liquor stores, drinking laws and, 178 Liver damage, in female alcoholics, 97–98 Lophophora williamsii. See Peyote Los Angeles gangs, 89–91, 93–94 Low birth weight, from prenatal drug use, 99 Low income, gambling and, 84 LSD (lysergic acid diethylamide), 41, 104, 181, 181–187, 183f, 185 animal testing of, 58 defined, 143 hallucinations with, 57 history of use, 31–32 medical emergencies from, 204 Lung cancer, 96, 98 Lung problems, from marijuana, 191 Lysergic acid diethylamide. See LSD
M MA. See Marijuana Anonymous Ma huang. See Ephedra Mabit, Jacques, 46 Machismo, 66 MADD (Mothers Against Drunk Driving), 178 Magnetic resonance imaging (MRI), 132, 133 Majors list, 4–5, 24–25 Malnutrition, defined, 97 Mandatory sentencing, 176–177, 180 Marijuana, 39–40, 187–193, 188, 192 countries producing, 5, 8–9, 25 dropouts and, 1 drug trafficking and, 27–28 gangs and, 89–90, 92 gender differences in using, 98
hallucinations with, 57, 106 legalization of, 156–157, 157, 161 medical emergencies from, 202–204 memory and, 59, 60 in the military, 213 treatment for, 193–194, 194f in United States, 145 Marijuana Anonymous (MA), 192, 193 Marijuana Tax Act of 1937, 172 Marinol, 193 Martinez, Victor, 90 Mash, Deborah, 44 MBDB, 57 McGwire, Mark, 110 MDA. See Methylene dioxyamphetamine MDE, 57 MDEA, 57 MDMA. See Ecstasy Media defined, 194 gangs and, 93, 94 representations of drinking, drugs and smoking, 194–200, 197 Mediascope, 195–200 Medical emergencies from drug abuse, 200–206, 201, 203f from ketamine abuse, 143f Medical professionals. See Health-care professionals Memory ecstasy and, 55–56 effects of drugs on, 56–62 Men stereotype changes for, 103 substance abuse by, 96–103, 101 Menopause, smoking and, 99 Menstruation, 99 Mental disorders from amphetamines, 39 from cocaine, 39 with eating disorders, 50 with FAS, 77–80 gambling as, 81–82
homelessness and, 125t, 128–131 from ketamine abuse, 143 LSD and, 187 from marijuana, 190 from phencyclidine, 42 problem gambling and, 84–85 Mental retardation, from FAS, 77–78 Meperidine, 202 Mescaline, 41 medical emergencies from, 204 in peyote, 44, 104, 105 sensation and perception with, 57–58 Metabolic, defined, 76 Metabolism, brain, 132 Methadone defined, 64 medical emergencies from, 202 overdose of, 124 Methadone maintenance, 117, 118, 120–122, 121, 123–124, 206–211, 208 federally funded, 173 for opiate withdrawal, 40 Methamphetamine. See Speed Methaqualone, 204 Methylene dioxyamphetamine (MDA), 104 history of use, 31–32 sensory perceptions with, 57 Methylphenidate for ADHD, 103 medical emergencies from, 205 Mexico cannabis in, 34 as drug-transit country, 26, 28 ecstasy from, 28 heroin from, 5, 8, 28, 145 marijuana from, 5, 8–9, 28, 145 methamphetamine from, 6, 28 peyote in, 44 ritualistic use of drugs in, 57
255
Volume 2 Index
Middle East, drug trafficking in, 29 Migration, of gangs, 95 Military assistance to drug production countries, 167 drug and alcohol abuse in, 211–216, 212, 215f in drug enforcement, 150 Mille Lacs Grand Casino, Minnesota, 81 Milwaukee gangs, 93, 95 Miraa. See Khat Miscarriages, 99 Mixed messages, about gambling, 83 Mob psychology, in gangs, 94 Money laundering, 26–27, 162–163, 168 “Monitoring the Future: A Continuing Study of American Youth” on ADHD treatments, 103 on adolescent drug use, 145 on ecstasy use by students, 55t on inhalant abuse, 134–135 on LSD use, 183f Mood disorders, with eating disorders, 50 See also Mental disorders Morality alcohol prohibition and, 169–170 drug controls and, 171 Morocco cannabis in, 34 hashish from, 6 Morphine, 40–41 history of use, 31–32 medical emergencies from, 204 vs. heroin, 112–113 See also Opiates Mothers Against Drunk Driving (MADD), 178 Motivational incentive therapy, 119 Motor vehicle accidents, marijuana and, 190–191
256
Movies alcohol, tobacco and drugs in, 195–196 gangs in, 93 Moyers, Bill, 119 “Moyers on Addiction: Close to Home,” 119 Mozambique, jimsonweed use in, 46 MRI (Magnetic resonance imaging), 132 Multiple drug use, 36 death from, 205 by gangs, 89–90 heroin in, 115, 116, 122 inhalants in, 137 marijuana in, 189, 192 medical emergencies from, 202 with methadone maintenance, 210 new drug abuse testing and, 14 Multiple personality disorder, 62 Mushrooms, 43, 43–44, 106 Music, alcohol, tobacco and drugs in, 196–197 Music videos, 198 Muslims drug use and, 68 hashish use by, 187 Myanmar heroin from, 145 income from opium, 34 opium from, 5, 8, 34, 113, 166
N Nabilone, 191–192, 193 NAC. See Native American Church Naloxone, for heroin overdose, 124 Naltrexone, for heroin withdrawal, 122–123, 124 Narcan. See Naloxone Narcoterrorists. See Terrorism Narcotic Control Act of 1956, 172 Narcotics defined, 170
history of control, 170–171 medical emergencies from, 202 See also Illicit drugs; specific drugs National Council on Problem Gambling (NCPG), 87–88 National Gambling Impact Study Commission (NGISC), 82, 88 National Household Survey on Drug Abuse (NHSDA) on alcohol use, 36 civilian vs. military drug use, 215 on drug abuse, 145 on drug abuse, by ethnicities, 65t on heroin use, 114 on inhalant abuse, 134 on law enforcement expenses by drug, 175f on LSD use, 183 on marijuana use, 188 on prescription drug abuse, 204 National Institute on Alcohol Abuse and Alcoholism, 4 National Institute on Drug Abuse (NIDA) on ecstasy and memory, 61 on ecstasy use by students, 55t establishment of, 173 on inhalant abuse, 136 Prism Awards and, 200 National Narcotics Intelligence Consumer Committee, 25 National Resource Center on Homelessness and Mental Illness, 131 National Security Council, 164 National Youth Anti-Drug Media Campaign, 199 Native American Church (NAC), 44–45 Native Americans drug treatment for, 65 inhalant abuse and, 136 jimsonweed use by, 46, 139 peyote use by, 44–45, 106
Volume 2 Index
NCPG (National Council on Problem Gambling), 87–88 Netherlands, ecstasy from, 6, 29 Neurotransmitters, problem gambling and, 84–85 See also Brain New York City gangs, 90–92 NGISC. See National Gambling Impact Study Commission Nicotine, 35, 37 NIDA. See National Institute on Drug Abuse Nigeria cannabis in, 34 drug trafficking in, 29 Nimitz, 213 Nirvana (rock group), 115 Nitrous oxide, 42, 137–138 Nixon, Richard M., 173, 213 Noninvasive, defined, 132 North America, current drug use trends, 32 See also United States Nuclear families, 70–71 Nuclear medicine, for brain imaging, 132 Nyswander, Marie, 173, 206
O Obesity, 50–51, 53–54 Obsessed, defined, 145 Obsessive-compulsive disorder, defined, 50 Office of National Drug Control Policy (ONDCP), 145, 199 ONDCP. See Office of National Drug Control Policy Online gambling, 83, 88 OPBAT (Operation Bahamas and Turks and Caicos Islands), 27–28 Operation Bahamas and Turks and Caicos Islands (OPBAT), 27–28 Operation HALCON, 28 Operation New Generation, 6 Opiates current global trends, 32 defined, 171 memory and, 60
Opioids, 40–41 defined, 121 for heroin detoxification, 122 Opium abundant supply of, 166 controlling production of, 167 countries producing, 7–8, 33–34 current global trends, 32, 33 economic impact of sales, 34 global production of, 5 history of, in the United States, 170–171 history of use, 31 on majors list, 4 medical emergencies from, 204 Oral contraceptives, smoking and, 99 Organized crime Colombian, cocaine and, 6–7 international, 164–165, 167–168 Osteoporosis, from amenorrhea, 50 Outpatients, defined, 53 Over-the-counter medications elderly and, 3 medical emergencies from, 202 Overdoses death from, 205 of heroin, 115, 124 medical emergencies from, 202 Oxycodone, 202 OxyContin. See Oxycodone
P Pacific Islands, kava and betel in, 46–47 Painkillers. See Analgesics Paint thinners, 42 Pakistan cannabis in, 34 hashish from, 6 heroin from, 5, 8, 145 Panama, as drug-transit country, 25–26
Panic attacks, with LSD, 185 Paranoia, defined, 58 Paranoid psychosis, defined, 39 Paraphernalia, defined, 159 Parent-child relationships, 72–73 Parental drug use, 71–72, 72f “Parent’s Alert,” 18 Parrot in the Oven: Mi Vida (Martinez), 90 Passive contamination, of hair, 20 Patches, sweat, 21 Pathological gambling, 81–88 PCP. See Phencyclidine Peer groups, 73–74 Pentobarbital, 37 Perception effects of drugs on, 56–58 effects of hallucinogens on, 104–106 effects of LSD on, 185–186 Personality eating disorders and, 52 problem gambling and, 85 Peru coca and, 6, 33, 167 cocaine from, 5, 26, 33 income from coca, 34–35 PET (Positron emission tomography), 132 Peyote, 44–45, 105, 106 Pharmaceuticals benzodiazepines as, 35 defined, 33 early laws on, 172–173 elderly and, 3–4 hallucinogenic effects from, 105–106 with herbal supplements, 110–111 medical emergencies from, 202, 204 Phencyclidine (PCP), 42 gangs and, 89–90, 92 ketamine and, 142 medical emergencies from, 202, 204 perceptual problems from, 106
257
Volume 2 Index
Phenobarbital, for benzodiazepine withdrawal, 122 Philanthropy, defined, 200 Physical abnormalities, from FAS, 76–78 Physical dependence on alcohol, 36 defined, 36 on heroin, 114, 120–121 on methadone, 209 See also Dependence Piper betel. See Betel Piper methysticum. See Kava Placebo, defined, 14 Plants, in rituals, 43–47 See also specific plants Plants of the Gods (Schultes & Hoffman), 43 Plea bargaining, in drug arrests, 176 Poisoning from amphetamines, 39 from cocaine, 39 from inhalants, 42, 133 Positron emission tomography (PET), 132 Poverty, homelessness and, 126–127, 130–131 Predisposition, defined, 54 Pregnancy alcohol during, 76–80, 99 drugs during, 99 heroin during, 115 methadone maintenance during, 124 Prenatal alcohol use. See Pregnancy, alcohol during Prescription drugs. See Pharmaceuticals Prevalence rates, for pathological gambling, 82–83 Prevention, of inhalant abuse, 138–139 Prism Awards, 200 Prisons drug offenders in, 151, 152t, 174 drug testing in, 16 Privacy, drug testing and, 23 Probation, drug-related requirements for, 153f
258
Problem gambling. See Pathological gambling Productivity, defined, 82 Profits, from gang drug trafficking, 94–95 Progressive disorders, gambling as, 85–86, 86f Progressive-ratio procedures, 11–12 Prohibition (alcohol), 169 Prohibition (drugs), vs. legalization, 158–159, 159t Promiscuity, defined, 50 Proportional, defined, 196 Propoxyphene, 202 ProSom. See Estazolam Prostitution, 96 Protestants, alcohol and, 67 Psilocybin, 43, 57, 104 Psychedelic drugs, 41, 57 defined, 44 hallucinogenic properties of, 106, 181–183 See also LSD (lysergic acid diethylamide) Psychiatric disorders, defined, 39 See also Mental disorders Psychoactive drugs, defined, 107 Psychointegration, 44 Psychology, of gangs, 93–94 Psychomotor skills, defined, 207 Psychosis, defined, 36 Psychotherapy defined, 44 for heroin abuse, 119 iboga in, 44 Psychotria viridis. See Ayahuasca Puerto Rican gangs, 90, 93, 95 Pure Food and Drugs Act of 1906, 171 Purging. See Binge/purge syndromes Purple cone flower. See Echinacea
Q Qat. See Khat Quaalude. See Methaqualone Quazepam, 37
R Racial discrimination, in drug laws, 176 Radiation, for brain imaging, 132 Random drug testing, in the military, 211–213 Rape, alcohol and, 96 Rave parties, ketamine at, 142 Receptors, defined, 54 Recidivism, defined, 154 Recreational drug use defined, 14, 46 jimsonweed in, 46 See also Drug abuse Red Bull, 111–112 “Red devils.” See Secobarbital Reentry, in heroin treatment facilities, 118 Rehabilitation, defined, 117 Reinforcing efficacy, in animal drug testing, 11–12 Relapses defined, 154 heroin, 116, 119–120, 206–207 preventing, 154–155 Religious beliefs of African Americans, 64 of Asian Americans, 64 in drug use and treatment, 63, 67–69 of Native Americans, 65, 106 ritualistic plants in, 43–47, 45 Rental costs, homelessness and, 130–131 Repeat offenders drugs, 176 drunk driving, 178–179 Repression, defined, 93 Reproductive health drug abuse and, 98–100 marijuana use and, 191 Requiem for a Dream, 195 Residential treatment communities, 117–118 Respiratory depression, 115 Restoril. See Temazepam Retardation, from FAS, 77–78
Volume 2 Index
Retrospective period, in urinalysis, 19, 19t Revolutionary Armed Forces of Colombia (FARC), 168 Rimbaud, Arthur, 182 Risk factors for eating disorders, 50–52 family life and, 70–73 gender comparisons, 100 for homelessness, 126–128, 130–131 for marijuana use, 189 for problem gambling, 83–86 Risks defined, 10 with drug use, 160t of new drugs, abuse potential, 9–15 Rituals drugs in, 43, 43–47, 45, 57 gang, 90 Robert Wood Johnson Foundation, 200 Russia current drug use trends, 32 ecstasy from, 29 heroin and, 6
S Safety, workplace, drug testing and, 15–16 Saliva analysis, 20–21 Saloons, 170 SAMe, 109 San Francisco gangs, 90 Sanchez-Ramos, Juan, 44 Sanctions, defined, 90 Schizophrenia, defined, 190 Schools, drug testing in, 16–17 Schultes, Richard, 43 The Scientist: A Metaphysical Autobiography (Lilly), 143 Scopolamine, 106 Screening tests, in urinalysis, 19–20 SDL. See State-dependent learning Secobarbital, 37 The Secret of Two Brothers (Hernandez), 1
Securities and Exchange Commission, 82–83 Sedation, defined, 41 Sedatives, defined, 46 See also specific drugs Self-administration in animal drug testing, 10 in human drug testing, 14 Self-harm, defined, 51 Self-help groups drug testing and, 16–17 for eating disorders, 52–53 Gamblers Anonymous, 84, 85, 87 Marijuana Anonymous, 192, 193 Senna, 109, 111 Sensation effects of drugs on, 56–58 effects of hallucinogens on, 104 effects of LSD on, 184–185 Sentencing drug offenders, 176–177 Serotonin eating disorders and, 52 ecstasy and, 55–56 Sexually transmitted diseases (STDs), 96 Shakur, Tupac, 93 Shamans, 44 Shangana-Tsonga, 46 Shelters, homeless, 127 Side effects of amphetamines, 39 of cocaine, 39 of eating disorders, 50 of ecstasy, 55 of hallucinogens, 105 of khat, 144 of marijuana, 39, 189–190 of phencyclidine, 42 Sikhs, drug use and, 68 Single-parent families, 70–71 Single photon emission computed tomography (SPECT), 132 Skid row, 128 Slavery, drug use and, 64 Sleeplessness. See Insomnia
Smack (Burgess), 114 Smoking, 37 gender differences in, 96, 98 marijuana, 189 media portrayal of, 194–200 in movies, 195–196 in music, 197 in music videos, 198 opium, 171 on television shows, 197–198 Sniffing glue, 42 Snoop Dogg, 93 Sobriety tests, 179 Social norms, eating disorders and, 50 Social problems from drug abuse, 70 FAS and, 78–80 Social welfare, homelessness and, 128–129 South Africa, cannabis in, 34 South America ayahuasca in, 45–46 coca from, 166 cocaine production in, 6 current drug use trends, 32–33 See also specific countries Southeast Asia drug trafficking in, 28–29 opium production in, 33–34 Southwest Asia, opium production in, 33–34 Southwest (U.S.), ritualistic use of drugs in, 57 “Special K.” See Ketamine SPECT (Single photon emission computed tomography), 132 Speed, 38 countries producing, 6 drug trafficking and, 28 gangs and, 92 legalization of, 161 medical emergencies from, 202–204, 205 in United States, 145 See also Stimulants Spiritualism, ritualistic plants and, 43–47 St. John’s wort, 109, 110–111
259
Volume 2 Index
Starvation, in anorexia nervosa, 48–50 State-dependent learning (SDL), 59, 61–62 STDs. See Sexually transmitted diseases Steroids, defined, 110 Stigma, defined, 148 Stimulant hallucinogens, 55, 57 Stimulants, 38–39 for ADHD, 103 defined, 36 perceptual problems from, 106 Stimuli, defined, 58 Stock market, gambling and, 82 STP. See DOM Stress management, for heroin abuse, 120 Structure, family, 70–71 Stupor, defined, 44 Substance abuse, gender and, 96, 96–103, 100f, 101 See also Alcoholism; Drug abuse Substance Abuse and Mental Health Services Administration on adolescent inhalant abuse, 136f on drug treatment, by ethnicity, 66f on drug treatment, by gender, 100f on heroin treatment, 117f on homelessness, 129 on marijuana and treatment, 194f Substitution procedure, in animal drug testing, 10–11 Summit of the Inter-American Defense Board, 165 Supply-side strategy, 146, 148 Suspicion drug testing. See “For cause” drug testing Sweat analysis, 20–21 Sweat patches, 21 Symptoms of barbiturate withdrawal, 38 of benzodiazepine withdrawal, 38
260
of drug-related medical emergencies, 204–205 of heroin overdose, 115, 124 of heroin withdrawal, 114–115 of inhalant abuse, 139 of opioid withdrawal, 41 of starvation, 49 Synesthesia, 57, 106
T Tabernanthe iboga. See Iboga Taliban, 168 TASC (Treatment Accountability for Safer Communities), 152 Taxes drug legalization and, 159 on medical drugs, 171–172 Telescoping, 100–101 Television, alcohol, tobacco and drugs in, 197–198 Temazepam, 37 Temperance, 169 Temperance League, 170 Terrorism Colombian, cocaine and, 6–7 drug trafficking and, 167–168 money laundering, drugs and, 162–163 Tetrahydrocannabinol (THC), 9, 34, 57, 188 animal testing of, 58 in hashish, 107 in hemp, 108 memory and, 60 See also Marijuana Thailand, heroin from, 5, 8 THC. See Tetrahydrocannabinol Therapeutic use, of drugs. See Drug therapy Thiamine, for Wernicke-Korsakoff syndrome, 59 Threshold value, in drug testing, 22 Tobacco, 35, 37 Tolerance to barbiturates, 37 to benzodiazepines, 37 defined, 120
to heroin, 114, 120 to ketamine, 142 to LSD, 186–187 to marijuana, 40, 190 to methadone, 123 to phencyclidine, 42 Toluene abuse, 138 Track marks, 114 Tradeoffs, over drug legalization, 158–159 Traffic, 195 Trainspotting, 195 Tranquilizers, defined, 204 Transsexuals, 102 Trauma defined, 85 from substance abuse, 96 Treatment of alcoholism, 45, 75 of amphetamine abuse, 44 of cocaine abuse, 44, 46 court-ordered, 152–155, 152t, 153f drug testing during, 16–17 of eating disorders, 52–53 ethnic and cultural issues in, 68–69 family, 75 gender comparisons, 100f, 101, 101–102 with herbal supplements, 112 of heroin abuse, 40, 44, 75 of heroin abuse, behavioral, 115–120, 117f, 119 of heroin abuse, drug therapy, 120–125, 121 of marijuana abuse, 192, 193–194, 194f for pathological gambling, 87–88 vs. imprisonment, 151 Treatment Accountability for Safer Communities (TASC), 152 Trexan. See Naltrexone Triazolam, 37 See also Benzodiazepines Trips, LSD, 184 Tschad. See Khat Turkey, opium from, 8
Volume 2 Index
Twelve Steps African Americans and, 63–64 defined, 63 for heroin abuse, 117 Jews and, 68 for marijuana abuse, 192 Native Americans and, 65 for problem gambling, 85 Twenty-first Amendment, 169
U Ulcers, defined, 50 U.N. Convention. See United Nations Convention UNDCP (United Nations Drug Control Program), 163, 168 Uniform Crime Reporting Program (FBI), 180f United Nations on cannabis abuse, 34 on global drug production, 5 Global Monitoring Programme of Illicit Crops, 6 United Nations Convention Against Illicit Traffic in Narcotics Drugs and Psychotropic Substances, 163, 168 United Nations Drug Control Program (UNDCP), 163, 168 United States current drug use trends, 32 drug dealers in, 150–151 as drug market, 145 drug policy, 145–151, 155–162, 162–168, 169–174 drug trafficking deterrence programs, 24–30 eating disorders in, 50–51 herbal supplements in, 109 marijuana from, 5–6, 9 methamphetamine from, 6 United States Securities and Exchange Commission, 82–83 United Wa State Army, 8 Urban gangs, 90–92
Urinalysis, 18–20, 19t, 22 See also Drug testing U.S. Border Patrol, 147f U.S. Custom Service (USCS), 28, 28, 147f U.S. Drug Enforcement Administration. See Drug Enforcement Administration USCS. See U.S. Custom Service
V Valium. See Diazepam Vega, Joaquin, 46 Veterinary medicine, ketamine in, 141 Vicodin. See Hydrocodone Video games, 198 Vietnam War, drug abuse in, 211, 213 Vietnamese gangs, 94 Violence from black market sales, 158 in Colombian drug trade, 7 domestic, 74 gangs and, 93 substance abuse and, 96 Vitamin B-1. See Thiamine Volunteers, for drug testing research, 13–15 Vomiting, with eating disorders, 48–50 Voodoo, 45 Vulnerability defined, 51 of women to drug abuse, 100
Western Europe, current drug use trends, 32 White House Office of National Drug Control Policy, 164 Winkelman, Michael, 44 Withdrawal syndrome from alcohol, 36, 107 from amphetamines, 39 from barbiturates, 38, 107 from benzodiazepines, 38 from caffeine, 38 from cocaine, 39 defined, 37 from heroin, 114–115, 120–122 from khat, 144–145 from marijuana, 40, 190 from nicotine, 37 from opioids, 41 from phencyclidine, 42 Women gambling by, 84 substance abuse by, 96, 96–102 Woman’s Christian Temperance Union (WCTU), 170 Working conditions, homelessness and, 127–128, 130 Workplace, drug testing in, 15–16 World Bank loans, 163 World Drug Report (United Nations), 34 Worldwide surveys, on military drug use, 214 Worthington House, Massachusetts, 127
W Washington, D.C. gangs, 92 WCTU (Woman’s Christian Temperance Union), 170 Web sites, antidrug, 199 Weight gain, for anorexia, 52 Weight loss, herbal supplements for, 109–110 Wernicke-Korsakoff syndrome, 59
Y “Yellow jackets.” See Pentobarbital Yemen, khat in, 144
Z Zero tolerance policy, 213–214, 215–216
261
