1. Chapter 3: Alcohol and Other Drugs “Substance abuse, the nation’s number one preventable health problem, places an enormous burden on American society, harming health, family life, the economy, and public safety, and threatening many other aspects of life.” – The Robert Wood Johnson Foundation, Institute for Health Policy, Brandeis University

2. Chapter Outline The Global Context: Drug Use and Abuse Sociological Theories of Drug Use and Abuse Frequently Used Legal Drugs Frequently Used Illegal Drugs Societal Consequences of Drug Use and Abuse Treatment Alternatives Strategies for Action: America Responds Understanding Alcohol and Other Drug Use

3. The Global Context: Drug Use and Abuse What is a Drug? The term drug refers to any chemical substance that: has a direct effect on the user’s physical, psychological, and/or intellectual functioning has the potential to be abused has adverse consequences for the individual and/or society.

4. The Global Context: Drug Use and Abuse Drug Use and Abuse Around the World Globally, 4% to 6% of the world’s population between the ages of 15 and 64 (over 200 million people) reported using at least one illicit drug in the previous year (2010).

5. The Global Context: Drug Use and Abuse Drug Use and Abuse Around the World 1. Cannabis (Marijuana/Hashish) 2. Amphetamines 3. Cocaine 4. Opiates According to the most recent report, these are the most widely used illegal drugs:

6. The Global Context: Drug Use and Abuse Drug Use and Abuse Around the World Illicit drug use varies by location. For example, an estimated 6.8% of adult Europeans have used cannabis in the previous year, 2.2% in Central America, and 1.2% in Asia. Drug use varies over time. In 1974, 38% of high school seniors reported “bingeing” in the 30 days prior to the survey; by 1992, that number had dropped to a low of 28%. Today, about 21% of 12 th graders reported smoking in the previous month.

7. The Global Context: Drug Use and Abuse The Netherlands U.S. citizens visiting the Netherlands may be surprised to find people smoking marijuana and hashish openly in public. U.S. citizens visiting the Netherlands may be surprised to find people smoking marijuana and hashish openly in public. Pictured here is a tourist using a water pipe to smoke marijuana in a coffee shop. Pictured here is a tourist using a water pipe to smoke marijuana in a coffee shop. The Netherlands treats the use of marijuana as a public health issue rather than a criminal justice issue. The Netherlands treats the use of marijuana as a public health issue rather than a criminal justice issue.

8. What Do You Think?

9. Sociological Theories of Drug Use and Abuse Drug abuse occurs when acceptable social standards of drug use are violated, resulting in adverse physiological, psychological, and/or social consequences.Drug abuse occurs when acceptable social standards of drug use are violated, resulting in adverse physiological, psychological, and/or social consequences. Chemical dependency refers to a condition where drug abuse is compulsive; users are unable to stop.Chemical dependency refers to a condition where drug abuse is compulsive; users are unable to stop. Various theories provide explanations for why some people use and abuse drugs. Theories of drug use explain how structural and cultural forces as well as biological and psychological factors influence drug use and society's responses to it.Various theories provide explanations for why some people use and abuse drugs. Theories of drug use explain how structural and cultural forces as well as biological and psychological factors influence drug use and society's responses to it.

10. Sociological Theories of Drug Use and Abuse Structural-Functionalist Perspective Drug abuse is a response to weakening of societal norms (anomie).Drug abuse is a response to weakening of societal norms (anomie). Drug use is a response to the absence of a perceived bond between the individual and society.Drug use is a response to the absence of a perceived bond between the individual and society. Consistent with this perspective, in a national poll of Americans 18 years or older, peer pressure and lack of parental supervision were the two most common responses given for why teenagers take drugs.Consistent with this perspective, in a national poll of Americans 18 years or older, peer pressure and lack of parental supervision were the two most common responses given for why teenagers take drugs.

11. Sociological Theories of Drug Use and Abuse Structural-Functionalist Perspective The importance of family in deterring the use is highlighted in the national youth media campaign – “Parents, The Anti-Drug” This poster from the Office of National Drug Control Policy’s National Youth Anti-Drug Media Campaign emphasizes the importance of a close relationship between parent and child in the fight against drug use by youths.

12. Sociological Theories of Drug Use and Abuse Conflict Perspective Drug use is a response to political, social and power inequality. Drug use is an escape from alienation from work, friends and family and frustration caused by inequality. Most powerful members of society influence the legal definition of drug use.

13. Sociological Theories of Drug Use and Abuse Symbolic Interactionist Perspective If the label “drug user” is internalized drug use will continue or even escalate. Drug users learn motivations and techniques of drug use through interaction with others. Symbols may be used for political and economic agendas (e.g. the D.A.R.E. campaign against drugs).

14. Sociological Theories of Drug Use and Abuse Biological and Psychological Theories Biological Theories Genetics may predispose an individual to alcoholism. Some individuals are physiologically “wired” to get more pleasure from drugs than others.

15. Sociological Theories of Drug Use and Abuse Biological and Psychological Theories Psychological Theories Some personality types are more susceptible to drug use. Positive reinforcement: drug use results in pleasurable experience. Negative reinforcement: drug use reduces pain, anxiety, loneliness and boredom.

16. What Do You Think? Are alcoholism and other drug addictions a consequence of nature or nurture? If nurture, what environmental factors contribute to such problems, and what would you recommend in terms of prevention strategies? If nature, do you think that drug addiction is a consequence of biological factors alone? If you consume alcohol, what are some of your motivations for drinking?

17. Frequently Used Legal Drugs Alcohol: The Drug of Choice Between 2002 and 2009, the rate of heavy alcohol use in the past month among 18 to 22 year olds decreased about 2%. Still, alcohol remains the most widely used and abused drug in America. The National Survey on Drug Use and Health, reported that 130.6 million Americans age 12 and older consumed alcohol at least once in the month preceding the survey.

18. Frequently Used Legal Drugs Alcohol: The Drug of Choice The U.S. Department of Health and Human Services defines:The U.S. Department of Health and Human Services defines: Heavy Drinking as five or more drinks on the same occasion on each of five or more days in the past 30 days prior to the National Survey on Drug Use and Health.Heavy Drinking as five or more drinks on the same occasion on each of five or more days in the past 30 days prior to the National Survey on Drug Use and Health. Binge Drinking as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days prior to the National Survey on Drug Use and Health.Binge Drinking as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days prior to the National Survey on Drug Use and Health.

19. Frequently Used Drugs Alcohol: The Drug of Choice Additional results from the National Survey on Drug Use and Health (2010): The highest levels of binge drinking are among 18- to 25- year-olds; people 65 or older had the lowest rates of binge drinking. Rates of alcohol use are higher among the full-time employed; however, rates of heavy or binge drinking are higher among the unemployed. Past month binge drinking rates for full-time college students increased between 2008 and 2009; however, heavy drinking among those not enrolled full-time in college decreased between 2008 and 2009.

20. Frequently Used Legal Drugs Alcohol: The Drug of Choice For many students, tailgating at football games is an essential part of college life. But tailgating, going “downtown,” the fraternity or sorority party, happy hour, Greek initiation rituals, and all other events deemed suitable for drinking alcohol, have led to high frequency and consumption rates for college students.

21. Survey The Class I believe that underage drinking is an important social problem in our society. A.Strongly agree B.Agree somewhat C.Unsure D.Disagree somewhat E.Strongly disagree

22. Frequently Used Legal Drugs The Tobacco Epidemic Globally, over 80% of the 1.1 billion smokers in the world live in low or middle-income countries. Tobacco is one of the most widely used drugs in the United States. According to the U.S. Department of Health and Human Services survey, 69.7 million Americans – 23.3% of those 12 and older – are current tobacco users.

23. Frequently Used Legal Drugs The Tobacco Epidemic Use of all tobacco products, including smokeless tobacco (8.6 million users), cigars (13.3 million users), pipe tobacco (2.1 million users), and cigarettes (58.7 million users), is higher for high school graduates than for college graduates, males, and American Indians and Alaska Natives. In 2009, 11.6% of the 12 to 17 year old population reported use of a tobacco product in the past month. Research evidence suggests that youth develop attitudes and beliefs about tobacco products at an early age. There is also considerable evidence that cigarette advertisers target minorities

24. Frequently Used Legal Drugs The Tobacco Epidemic Tobacco Packaging: The Campaign for Tobacco-Free Kids calls the introduction of candy-flavored cigarettes and smokeless tobacco an “outrageous” tactic to lure youth into using tobacco products. Note the appeal to African-American youth and women in some of the packaging.

25. Frequently Used Illegal Drugs More than 21.7 million people in the United States are current illicit drug users, representing 8.7% of the population ages 12 and older. Users of illegal drugs, although varying by type of drug used, are more likely to be male, to be young, and to be a member of a minority group.

26. Frequently Used Illegal Drugs

27. Frequently Used Illegal Drugs Marijuana Madness Most commonly used and trafficked illicit drug. Globally, there are between 129 and 191 million marijuana users, representing 2.9% to 4.3% of the world’s 15 to 64 year old population. Regionally, marijuana is the most dominant illicit drug, particularly in North America.

28. Frequently Used Illegal Drugs The largest producers of marijuana in the world are: 1. MEXICO 2. PARAGUAY 3. UNITED STATES

29. Frequently Used Illegal Drugs There are more than 16.7 million current marijuana users, representing 6.6% of the U.S. population age 12 and older. According to the Monitoring the Future (MTF) survey, daily marijuana use increased dramatically in 8 th, 10 th, and 12 th grades, with daily use estimated to be 1.2%, 3.3%, and 6.1%, respectively.

30. What Do You Think?

31. Frequently Used Illegal Drugs

32. Frequently Used Illegal Drugs Cocaine: From Coca-Cola to Crack Cocaine is classified as a stimulant and, produces feelings of excitation, alertness, and euphoria. Cocaine, made from the coca plant, has been used for thousands of years. According to the National Survey on Drug Use and Health: Globally, cocaine use has decreased, particularly in North America where the largest number of cocaine users is found. Currently, 1.9 million Americans 12 years and older are current cocaine users.

33. Frequently Used Illegal Drugs Cocaine: From Coca-Cola to Crack Crack is a crystallized product made by boiling a mixture of baking soda, water, and cocaine. The result, also called rock, base, and gravel, is relatively inexpensive and was not popular until the mid-1980s. Crack dealers often give drug users their first few “hits” free, knowing the drug’s intense high and addictive qualities are likely to produce returning customers.

34. Frequently Used Illegal Drugs Cocaine: From Coca-Cola to Crack  An addiction to crack can take 6–10 weeks to fully develop An addition to pure cocaine can take 3–4 years. According to the National Survey on Drug Use and Health, the number of people 12 and older who used crack cocaine for the first time decreased from 337,000 to 94,000 between 2002 and 2009.

35. Frequently Used Illegal Drugs Methamphetamine (meth, speed, crank) is a central nervous system stimulant that can be injected, snorted, smoked, or ingested orally and is highly addictive. Today, meth is relatively inexpensive and easily obtained, with more than 36.8% of high school seniors reporting that “crystal meth” in its crystalline form, is “fairly easy” or “very easy” to get.

36. Frequently Used Illegal Drugs

37. Club drugs A general term for illicit, often synthetic, drugs commonly used at nightclubs or all-night dances called “raves.” Examples include LSDEcstasyHeroin “bath salts” prescription drugs and inhalants.

38. Frequently Used Illegal Drugs Date-rape drugs Drugs that are used to render victims incapable of resisting sexual assaults. Examples Include: GHBRohypnol

39. Frequently Used Illegal Drugs Heroin is a painkiller and is the most commonly abused opiate drug. Highly addictive, heroin can be injected, snorted, or smoked. If intravenous injection is used, the euphoric effects are felt within 7–8 seconds; if heroin is snorted or smoked, the effects are felt within 10–15 minutes.

40. What Do You Think? According to Jeffrey Reiman on the “basis of available scientific evidence, there is every reason to suspect that we do our bodies more irreversible damage by smoking cigarettes and drinking liquor than by using heroin.” How would a social constructionist explain the legality of alcohol and tobacco products? Why do you think alcohol and tobacco products are legal, whereas heroin continues to be a target of the war on drugs?

41. Frequently Used Illegal Drugs

42. Societal Consequences Family Costs of Drug Use It is estimated that 1 in 10 U.S. children live with at least one parent in need of treatment for drug or alcohol dependency. Children raised in such homes are more likely to: Live in an environment riddled with conflict Have a higher probability of physical illness including injuries or death from automobile accidents Are more likely to be victims of child abuse and neglect

43. Societal Consequences Crime and Violence The drug behavior of individuals arrested, incarcerated, and in drug treatment programs also provides evidence of a link between drugs and crime. For example, surveys indicate that about 27 percent of victims of violent crime report that the offender was involved with alcohol or drugs.

44. Societal Consequences Crime and Violence The relationship between crime and drug use, however, is complex. Sociologists disagrees to whether drugs actually “cause” crime or whether, instead, criminal activity leads to drug involvement. In addition to the hypothesized crime–drug use link, some criminal offenses are defined by use of drugs: possession, cultivation, production, and sale of controlled substances; public intoxication; drunk and disorderly conduct; and driving while intoxicated.

45. Societal Consequences The High Price of Alcohol and Other Drugs A report by the National Center on Addiction and Substance Abuse at Columbia University (CASA 2009) set the total annual cost of substance abuse and addiction in the United States at $467.7 billion. The report contends that, for every dollar spent on drug abuse by federal and state governments: 95.6 cents went to shoveling up the wreckage and only 1.9 cents on prevention and treatment, 0.4 cents on research, 1.4 cents on taxation or regulation and 0.7 cents on interdiction.

46. What Do You Think?

47. Societal Consequences Physical and Mental Health Costs Cigarette smoking is the leading preventable cause of disease and death in the world. According to the World Health Organization (2008), there are six state initiatives which, if adopted, could potentially reverse the worldwide tobacco crisis by: (1) developing policies that prevent tobacco use (2) protecting people from tobacco smoke by developing smoke-free laws (3) providing help to people who want to quit using tobacco products (4) publicizing the dangers of tobacco products (5) banning, and enforcing existing bans, which prohibit “tobacco advertising, promotion, and sponsorship” (6) increasing the cost of tobacco products by raising taxes

48. Societal Consequences Physical and Mental Health Costs Annually, alcohol abuse is responsible for over 2.5 million deaths, 4 percent of all deaths worldwide. Alcohol kills more people than AIDS, tuberculosis, or violence, and is annually responsible for 80,000 deaths in the United States. Maternal prenatal alcohol use is associated with one of the leading preventable causes of birth defects and developmental disabilities in children, fetal alcohol syndrome, a syndrome characterized by serious physical and mental handicaps, including low birth weight, facial deformities, mental retardation, and hearing and vision problems.

49. Societal Consequences Physical and Mental Health Costs Drunk Driving Get-tough policies and increased domestic law enforcement is not just limited to illicit drug control. Recent campaigns by MADD and the National Highway Traffic Safety Administration (NHTSA) have focused on “cracking down” on drunk driving.

50. Societal Consequences Physical and Mental Health Costs

51. Societal Consequences The Cost of Drug Use on the Environment Although not something usually considered, the production of illegal drugs has a tremendous impact on the environment. Much of the impact is a consequence of the cultivation of marijuana, cocaine, and opium. For example, the Colombian government estimates that during the decades of 1988 to 2008, nearly 5.4 million acres of rainforest (an area the size of New Jersey) were destroyed because of illegal drug production.

52. Treatment Alternatives In 2009, 4.3 million people aged 12 or older were treated for some kind of problem associated with the use of alcohol or illicit drugs. Individuals seeking treatment have several options: family therapy, counseling, private and state treatment facilities, community care programs, pharmacotherapy (i.e., use of treatment medications), behavior modification, drug maintenance programs, and employee assistance programs.

53. Treatment Alternatives Inpatient and Outpatient Treatment Inpatient treatment refers to treatment of drug dependence in a hospital and, most importantly, includes medical supervision of detoxification. The longer patients stay in treatment, the greater the likelihood of a successful recovery.

54. Treatment Alternatives Inpatient and Outpatient Treatment Offenders who were the least likely to complete treatment: (1) had a history of significant problems with their mothers (2) had problems with their sexual partners in the 30 days prior to admission to the program, (3) had longer periods of incarceration (4) had used heroin in the 30 days prior to admission to the program (5) were younger in age than those who successfully completed the program.

55. Diseases Caused by Smoking Diseases Caused by Second-Hand Smoke

56. Treatment Alternatives Peer Support Groups Twelve Step Programs: Both Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are voluntary associations whose only membership requirement is the desire to stop drinking or taking drugs. AA and NA are self-help groups in that nonprofessionals operate them, offer “sponsors” to each new member, and proceed along a continuum of 12 steps to recovery.

57. Treatment Alternatives Peer Support Groups Some have argued that AA and NA members trade their addiction to drugs for feelings of interpersonal connectedness by bonding with other group members. In a survey of recovering addicts, more than 50% reported using a self-help program in their recovery. AA boasts over 115,000 groups where over 2.1 million members meet in 150 countries. Women make up about 35% of AA membership. Symbolic interactionists emphasize that AA and NA provide social contexts in which people develop new meanings.

58. Treatment Alternatives Peer Support Groups

59. Therapeutic Communities: In therapeutic communities, which house between 35 and 500 people for up to 15 months, participants abstain from drugs, develop marketable skills, and receive counseling. Symbolic interactionists argue that behavioral changes appear to be a consequence of revised self-definition and the positive expectations of others.

60. Treatment Alternatives Drug Courts Drug courts are special courts that divert drug offenders to treatment programs in lieu of probation or incarceration. In a recent report by The Sentencing Project, entitled Drug Courts: A Review of the Evidence, identifies two types of drug courts—deferred prosecution programs and postadjudication programs.

61. Treatment Alternatives Drug Courts In a deferred prosecution or diversion setting, defendants who meet certain eligibility requirements are diverted into the drug court system prior to pleading to a charge. Alternatively, in the postadjudication model, defendants must plead guilty to their charges, but their sentences are deferred or suspended while they participate in the drug court program.

62. Strategies for Action: America Responds Because society sends mixed messages about the acceptability of drug use, many programs, laws or initiatives may be unrealistic. Nevertheless, numerous social policies have been implemented or proposed to help control drug use and its negative consequences with various levels of success.

63. Strategies for Action: America Responds Alcohol and Tobacco There are a number of promising strategies aimed at reducing alcohol and tobacco use including the following: Economic Incentives Government Regulations Legal Action Prevention

64. Strategies for Action: America Responds Illegal Drugs The War on Drugs: In the 1980s, the federal government declared a “war on drugs,” which was based on the belief that controlling drug availability would limit drug use and, in turn, drug-related problems. This “zero-tolerance” approach advocates get-tough law enforcement policies, and is responsible for the dramatic increase in the jail and prison population. The contrasting idea to the “war on drugs” is a harm reduction position, which focuses on minimizing the costs of drug use for both user and society (e.g., distributing clean syringes to decrease the risk of HIV infection).

65. Strategies for Action: America Responds Illegal Drugs Effects of the “War on Drugs” In 1980, there were an estimated 40,000 drug offenders in jail or prison; in 2009, there were more than half a million. Required prison sentences for almost all drug offenders – first time or repeat – and limited judicial discretion in deciding what best served the public’s interest. Is it working? Is it stopping the flow of illegal drugs into the U.S. and lowering drug-related problems? There are also concerns that present policies are not only ineffective but create collateral damage.

66. Survey the Class… A 2010 survey of 1,003 U.S. adults echoes politicians’ concerns about the effectiveness of the “War on Drugs.” 63% of Democrats, 64% of Republicans, and 70% of Independents believe that the “War on Drugs” has been an abject failure. What do you think? Why?

67. What Do You Think?

68. Strategies for Action: America Responds Illegal Drugs Deregulation or Legalization: Deregulation is the reduction of government control over certain drugs. Legalization is making prohibited behaviors legal; for example, legalizing drug use or prostitution. Decriminalization, which entails removing state penalties for certain drugs, promotes a medical rather than criminal approach to drug use that encourages users to seek treatment and adopt preventive practices.

69. Strategies for Action: America Responds Illegal Drugs There are many across the United States who support the legalization of marijuana.

70. Strategies for Action: America Responds Illegal Drugs

71. State Initiatives: Several initiatives have resulted in statewide referendums concerning the cost effectiveness of government policies. Over the past decade, voters and state governments have enacted significant drug policy reforms.

72. Understanding Alcohol and Other Drug Use In summary, substance abuse—that is, drugs and their use—is socially defined. As the structure of society changes, the acceptability of one drug or another changes as well. There are two issues that need to be addressed in understanding drug use. The first is at the micro level—why does a given individual use alcohol or other drugs? Many individuals at high risk for drug use have been “failed by society.” The second question, related to the first, asks why drug use varies so dramatically across societies, often independent of a country’s drug policies.

73. Quick Quiz 1.Which drug use is the leading preventable cause of deaths in the United States? A.cigarette smoking B.alcohol use C.heroin D.cocaine

74. Answer: A Cigarette smoking is the leading preventable cause of deaths in the United States.

75. Quick Quiz 2.If the government reduced its control over various illegal drugs that would be termed: A.legalization. B.deregulation. C.decriminalization. D.interdiction.

76. Answer: B If the government reduced its control over various illegal drugs that would be termed deregulation.

77. Quick Quiz 3.Which substance is the most widely used and abused drug in the United States? A.nicotine B.cocaine C.marijuana D.alcohol

78. Answer: D Alcohol substance is the most widely used and abused drug in the United States.

79. Quick Quiz 4. A conflict theorist would argue that the war on drugs: A.all of these choices. B.unfairly targets minorities. C.has resulted in the changing of definitions and labels. D.contributes to society by providing thousands of jobs for people.

80. Answer B A conflict theorist would argue that the war on drugs unfairly targets minorities.

81. Quick Quiz 6.The most commonly used and most heavily trafficked illegal substance in the world is: A.cocaine. B.methamphetamines. C.heroin. D.marijuana.

82. Answer: D The most commonly used and most heavily trafficked illegal substance in the world is marijuana.