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?
Sociologically, 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, 3.6% to 6.9% of the world’s population between the ages of 15 and 64 reported using at least one illicit drug in the previous year (2013).

5. The Global Context: Drug Use and Abuse Drug Use and Abuse Around the World
Illicit drug use varies by location. For example, an estimated 25% of Europeans report using an illicit drug in their lifetimes.
Drug use varies over time. Since 1992, alcohol and cigarette use has gone down for 8th, 10th, and 12th graders, but illicit drug use has increased in 2011 and (see Figure 3.1 on p. 67)

6. What Do You Think?

7. 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.
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.

8. Sociological Theories of Drug Use and Abuse Structural-Functionalist Perspective
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.
Consistent with this perspective, a recent study on attitudes and drug use concluded that the dramatic increase in teenage use of prescription drugs is, in part, the result of:
Lax attitudes and beliefs of parents and caregivers
Parents not effectively communicating the dangers
Parents not safeguarding the prescriptions at home

9. 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.

10. 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).

11. Genetics may predispose an individual to alcoholism.
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.

12. Psychological Theories
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.

13. Frequently Used Legal Drugs Alcohol: The Drug of Choice
Between 2002 and 2012, the rate of current alcohol use among 12 to 20 year olds decreased steadily.
Still, alcohol remains the most widely used and abused drug in America.
In a recent poll (2012), 66% of US adults drink alcohol, averaging 4 drinks a week.

14. Frequently Used Legal Drugs Alcohol: The Drug of Choice
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.
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.

15. Frequently Used Drugs Alcohol: The Drug of Choice
Additional results from the National Survey on Drug Use and Health (2011):
Half of Americans age 12 and older consumed alcohol at least once in the month prior to the study.
Nearly 10 million current users of alcohol who were 12 to 20 years old (underage) and many of those got their alcohol for free from adults, many from parents.
Nearly 15.3% were binge drinkers and 4.3% were heavy drinkers.

16. Frequently Used Legal Drugs Alcohol: The Drug of Choice

17. Survey The Class
I believe that underage drinking is an important social problem in our society.
Strongly agree
Agree somewhat
Unsure
Disagree somewhat
Strongly disagree

18. Frequently Used Legal Drugs The Tobacco Crisis
Globally, over 80% of the 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, 69.5 million Americans – 26.7% of those 12 and older – are current tobacco users in 2012.

19. Frequently Used Legal Drugs The Tobacco Crisis
Use of all tobacco products, including smokeless tobacco (9 million users), cigars (13.4 million users), pipe tobacco (1 million users), and cigarettes (57.5 million users), is higher for high school graduates than for college graduates, unemployed, males, and American Indians and Alaska Natives.
In 2012, 8.6% 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.

20. Frequently Used Legal Drugs The Tobacco Epidemic
Small cigars are not regulated by the FDA, and marketing often involves youth. In 2013, legislation was introduced into the US House of Representatives that, if passed, would also exclude traditionally large and “premium” cigars from FDA oversight – flavored or not.

21. Frequently Used Illegal Drugs
More than 23.9 million people in the United States are current illicit drug users, representing 9.2% 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.

22. Frequently Used Illegal Drugs

23. Frequently Used Illegal Drugs Marijuana Madness
Most commonly used and trafficked illicit drug.
Globally, there are over 180 million marijuana users, representing 4% of the world’s 15 to 64 year old population.
Regionally, marijuana is the most dominant illicit drug, particularly in North America.
The largest producers of marijuana in the world are:
Morocco
Afghanistan
India

24. Frequently Used Illegal Drugs The US
There are more than 18.9 million current marijuana users, representing 7.3% of the U.S. population age 12 and older.
According to the Monitoring the Future (MTF) survey, daily marijuana use decreased in 8th and 10th graders, while 12th graders remained the same.

25. 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:
1.6 million Americans 12 years and older are current cocaine (including crack) users, representing 0.6% of the population.

26. 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.

27. 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.
The use of meth has steadily decreased over the last decade.
Today, use is fairly low, with about 1% of 8th, 10th, and 12th graders reporting lifetime use.

28. Frequently Used Illegal Drugs

29. 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.

30. Frequently Used Illegal Drugs Prescription Drugs
Psychotherapeutic drugs – nonmedical use of any prescription pain reliever, stimulant, sedative, or tranquilizer.
Approximately 6.8 million people, 2.6% of the US population 12 and older, reported current use of a psychotherapeutic drug in 2012.
Recent research suggests nonmedical use of prescription drugs is on the rise in recent years.

32. Frequently Used Illegal Drugs Synthetic Drugs
Synthetic drugs – a category of drugs that are “designed” in laboratories rather than naturally occurring in plant material.
Synthetic marijuana use is higher in the US than in other parts of the world.
“Bath Salts” – A.K.A. Zoom, Cloud Nine, Blue Silk, and Hurricane Charlie, bath salts are highly addictive synthetic stimulants.
Hallucinogens includes LSD and Ecstasy (MDMA)

33. Societal Consequences Children & 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

34. 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.
The relationship between crime and drug use, however, is complex. Sociologists disagree to whether drugs actually “cause” crime or whether, instead, criminal activity leads to drug involvement.

35. Societal Consequences Crime and Violence
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.

36. 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.

37. What Do You Think?

38. 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 (2013):
Half of all tobacco users, 6 million people, will die from its use.
If nothing changes, that number could rise to 8 million by 2030.
Americans who smoke are 2X as likely to develop coronary heart disease and/or have a stroke.

39. 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.

40. Societal Consequences Physical and Mental Health Costs

41. 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.

42. Treatment Alternatives
In 2012, 4 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.

43. Treatment Alternatives Peer Support Groups

44. 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.

45. 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.

46. 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.

47. Treatment Alternatives Peer Support Groups
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.

48. 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 post-adjudication programs.

49. 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 post-adjudication model, defendants must plead guilty to their charges, but their sentences are deferred or suspended while they participate in the drug court program.

50. 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.

51. 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

52. Strategies for Action: America Responds

53. 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).

54. 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.

55. What Do You Think?

56. 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.

57. Strategies for Action: America Responds Illegal Drugs

58. Strategies for Action: America Responds Illegal Drugs
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.

59. 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.

60. Quick Quiz
Which drug use is the leading preventable cause of death in the United States?
cigarette smoking
alcohol use
heroin
cocaine

61. Answer: A
Cigarette smoking is the leading preventable cause of death in the United States.

62. Quick Quiz
If the government reduced its control over various illegal drugs that would be termed:
legalization.
deregulation.
decriminalization.
interdiction.

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

64. Quick Quiz
Which substance is the most widely used and abused drug in the United States?
nicotine
cocaine
marijuana
alcohol

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

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

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

68. Quick Quiz
The most commonly used and most heavily trafficked illegal substance in the world is:
cocaine.
methamphetamines.
heroin.
marijuana.

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