Drug Abuse and Social Policy in America

The War That Must Be Won

Barry Stimmel

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317826934
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Illicit drugs, despite the "war" waged by the United States government, remain a tremendous drain on the American economy and continue to take their toll on the lives of countless Americans. A comprehensive text with an instructor's manual, Drug Abuse and Social Policy in America analyzes why current US policy on the use of licit and illicit mood-altering drugs has failed. This groundbreaking book addresses differences between decriminalization, legalization, and "zero tolerance"--areas and philosophies that are poorly understood--and suggests a multipronged approach to diminish inappropriate drug use. Physicians, health care providers, teachers, law enforcement officers, policymakers, social service providers, and students of public policy and health will gain a better understanding of substance abuse as a societal problem, rather than an individual problem, and see that the billions of dollars spent on law enforcement would be better spent on education, prevention, treatment, and providing alternatives to drug use.Currently the leading risk factor associated with the transmission of HIV, illicit drugs continue to destroy the fabric of life in many inner-city communities. Yet, drugs are a problem for Americans from every corner of society, from suburban teenagers to pro athletes to homeless people. Author Barry Stimmel demonstrates in Drug Abuse and Social Policy in America that the drug problem is not being addressed adequately because of a lack of commitment from the majority of Americans and government leaders. The issues Drug Abuse and Social Policy in America asks readers to confront include:

• Why do we provide insufficient treatment facilities and incarcerate users, yet wonder why more prison space is needed?
  
• Why do we readily agree to build more prisons rather than community centers that provide alternatives for youths?
  
• Why are we concerned with teenage smoking and drinking, yet allow advertising of these substances?
  
• Why do we advocate rehabilitation, but not hire people in recovery?
  
• Why do we ask pregnant women with drug problems to seek help, then try to take custody of their children rather than provide social support while they receive treatment?Drug Abuse and Social Policy in America challenges academics, practitioners, and future social service providers and policymakers to rethink their entire conception of the problem of substance abuse in America with a cutting question: "Have we made any substantial progress in diminishing the sue of nicotine, the excessive consumption of alcohol, or the inappropriate use of prescription drugs, all of which are responsible for more illnesses and societal costs than all illicit drugs combined?" Identifying this as the place where all efforts to curb drug use must start, Drug Abuse and Social Policy in America offers readers many ways that individuals, communities, organizations, and society can take action and be more effective in convincing both those who consume drugs and those who profit from their sale that their actions are inappropriate and unacceptable.

Chapter 1

Addressing the Use of Mood-Altering Drugs: Defining the Problem

When President Bush announced the formal initiation of our “War on Drugs,” public concern over drug abuse was at an all-time high.¹ In polls conducted by The Wall Street Journal, NBC News, and the Gallup organization, drug abuse was listed as one of the two most important issues facing the nation.^2,3 In September 1989, 63 percent of persons surveyed by the Gallup Poll reported drug abuse as the country's most important problem, a consensus not reached on any other issue in the previous decade.⁴ Almost half of those surveyed said they knew someone who had been seriously affected by illegal drug use, with 45 percent of people between the ages of 18 and 29 reporting knowledge of specific locations where drugs were sold.

The President's plan was, in general, widely accepted, with the major criticisms being an insufficient allocation of funds and a disproportionate finding for enforcement as compared to prevention and treatment. In addition to a series of initiatives to attack illicit drug use, the plan included the establishment of a new cabinet-level office-the Office of National Drug Control Policy–to oversee and coordinate all efforts pertaining to illicit drug manufacture, sales, and use. The nation was mobilized; priorities were clearly defined.

In just over one year, however, as the country's “drug czar” William Bennett resigned, it appeared that the public perception had changed considerably. In July 1990, a Wall Street Journal/NBC News poll found that only 25 percent of those polled identified drugs as the nation's leading threat. There was a shift toward a more “immediate” concern-the economy.⁵ In February 1991, only 5 percent of those surveyed in the Gallup Poll still considered drug abuse as most important. The Gulf Crisis (37 percent) and the economy (16 percent) clearly took first and second places in the public eye, and by July 1992, only 2 percent of the population listed drug use as the nation's most important problem.⁶

Despite public perception, the war continues, as do the casualties. It is, therefore, quite appropriate to question whether we are even close to winning this war, or whether the initiatives we have undertaken have had a measurable effect on either the consumption or the availability of illicit mood-altering substances. Further, have we made any real progress in diminishing the use of nicotine, the excessive consumption of alcohol, or the inappropriate use of prescription drugs, all of which are responsible for more illnesses and societal costs than all illicit drugs combined? And finally, if indeed we are making progress in diminishing drug use, is this related to any conscious effort on our part or are we merely at a point in time in the recurring cycles of drug use seen in this country since the late nineteenth century?

TRENDS IN LICIT AND ILLICIT DRUG USE

Prior to President Bush's 1989 initiatives, which were based on population surveys, drug use had already begun to markedly decrease. The 1988 National Survey of High School Seniors and Young Adults, involving approximately 16,000 students in 130 public and private schools, revealed the use of illicit drugs to be at its lowest level since 1975 despite their increased availability.⁷ Even the use of crack, the drug responsible for initiating the most recent public outcry, had diminished. Similarly, the 1990 National Household Survey on Drug Abuse found the current prevalence of illicit drug use in persons 12 years of age or older in the United States to have decreased considerably between 1985 and 1990 from 23 million (12 percent) to 13 million (6 percent), respectively.^8,9,10,11 The number of current cocaine users decreased from 2.9 million in 1988 to 1.6 million in 1990, a 72 percent decrease since 1985. In New York State, between 1983 and 1990, the percent of students using marijuana and cocaine decreased from 46 to 24 percent and 14 percent to 6 percent respectively. Among arrestees, cocaine use decreased from 69 percent in 1987 to 17 percent in 1993.¹² The 1991 National High School Senior and College Student Survey revealed the percentage of high school seniors using an illicit drug in the previous years had decreased further from 35 percent in 1990 to 29 percent in 1991. When marijuana was excluded, only 16 percent of seniors had used illicit drugs in the past year.¹³

With respect to licit drugs, many of the 1990 health objectives of the nation formulated by the Public Health Service concerning alcohol and substance abuse had already been met prior to the “kick-off” of the “War on Drugs” as had a number of the short-term objectives listed in the White House's National Drug Control Strategy.¹⁴ In fact, perhaps in recognition of these achievements, the Surgeon General's Promoting Health/Preventing Disease: Objectives for the Nation for the Year 2000 contained a series of more challenging and appropriate objectives (Table 1.1).¹⁵

Other more recent indicators of success are also available. For the first time in a decade, reports from the street suggested that the price of cocaine had started to increase and its purity diminished.¹⁶ Alcohol consumption is currently at its lowest level since 1958 and, both the mortality rates from cirrhosis of the liver and fatalities from alcohol-related motor vehicle incidents have also decreased.¹⁷ With the exception of smoking by 18 to 25 year olds, cigarette use has decreased significantly for all other age groups surveyed. Similarly, nonmedical use of psychotherapeutic agents has also significantly diminished.

CURRENT USE OF LICIT AND ILLICIT DRUGS

Despite these observations, there is no more reason for complacency with current use of either illicit or licit drugs than there was a decade ago.¹⁸ As documented by the 1993 National Household Survey on Drug Abuse, almost 12 million Americans had used an illicit drug within the past month and over 77 million reported illicit drug use at some time during their lives. In the 1994 National High School Senior, College Student, and Young Adult Survey, approximately 36 percent of high school seniors and 19 percent of eighth graders had tried some illicit drug within the past year, up by 24 and 46 percent, respectively, since 1992. Approximately 75 percent of adults had tried an illicit drug at some time by their late twenties. In fact, the American public appears more pessimistic about our ability to achieve a successful solution, with 70 percent of people surveyed thinking the problem is worse now than five years ago, and 45 percent of those surveyed in a different study knowing someone who had become addicted to a drug other than alcohol.¹⁹

TABLE 1.1. National Health Promotion and Disease Prevention Objectives 1995

• Reduce the proportion of persons using cocaine within the past month to 0.6% ages 12–17 and 2.3% ages 18–25.

• Increase to at least 50% estimated proportion of all injectioned drug users in treatment programs.

• Reduce drug abuse-related hospital emergency department visits by at least 25%.

• Increase to at least 75% the proportion of acting injecting drug users who use new or properly decontaminated syringes, needles, or other drug paraphernalia.

• Reduce cigarette smoking to no greater than 15% among adults aged 20 or older.

• Reduce smokeless tobacco use by males age 12–14 to no more than 4%.

• Reduce cigarette smoking during pregnancy to at least 40% of women who are smokers when they become pregnant.

• Reduce alcohol, marijuana, and cocaine consumption among people aged 12 to 25 by 50%.

• Increase social disapproval by high school seniors by 70% for heavy alcohol consumption, 85% for occasional marijuana use, 95% for occasional cocaine use, and 95% for regular cigarette use.

Although the widespread use of cocaine appears to be diminishing, over 30 percent of young adults have tried cocaine by the age of 27, with 1.6 million having used cocaine in 1991, 625,000 being weekly users.²⁰ Because the likelihood of drug use is related to it being perceived as dangerous, the most recent finding that the proportion of high school seniors viewing illicit drugs as dangerous has decreased since 1991 is also of concern. Marijuana use, which is far from inconsequential, was perceived as being risky by only 65 percent of seniors as compared to 1991 when 79 percent felt such use was associated with risk. Among 1994 high school seniors, approximately 19 percent had smoked marijuana within 30 days of the survey, an increase of 35 percent since 1991, with annual prevalence rates of 31 percent. In contrast to the quality of marijuana used in the 1980s when over 37 million Americans acknowledged smoking this drug, potency of marijuana today is quite high and carries with it a greater dependency-producing potential. Although most marijuana use is experimental or occasional, frequent use carries with it the likelihood of progressing to other illicit substances. It has been estimated that the use of marijuana twice a week for a year is associated with a 70 percent probability of progressing to the use of cocaine.²¹

Perhaps most relevant in convincing one that complacency is folly are the findings of Johnston in his 1994 survey concerning drug use among eighth, tenth, and twelfth graders. In this population, marijuana use rose sharply by 13 to 31 percent, with use of any other illicit drug among seniors rising from 17 to 18 percent.²² The use of licit or “gateway” drugs is even more impressive, with 15 percent of eighth graders, 24 percent of tenth graders, and 28 percent of twelfth graders having five or more drinks in a row in the two weeks preceding the survey. Cigarette smoking increased in all groups with current smoking seen in 19 percent of eighth, 25 percent of tenth, and 31 percent of twelfth graders.

In short, heroin, cocaine, and marijuana are still readily available in all major cities at a greater purity than existed a decade ago, and the number of “hard-core” users estimated at 2.7 million, threefold that of five years ago.¹⁹ Clearly, there remains a cause for considerable concern...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Author
• Table of Contents
• Preface
• Acknowledgments
• Chapter 1. Addressing the Use of Mood-Altering Drugs: Defining the Problem
• Chapter 2. Alcohol, Tobacco, and Sports: That's Entertainment
• Chapter 3. The Pharmaceutical Companies: Profits versus Responsibility
• Chapter 4. Physicians and Pharmacists: Potential Unrealized
• Chapter 5. The White-Collar Crowd
• Chapter 6. The Federal Strategy: A Blueprint for Failure
• Chapter 7. Accepting Individual Responsibility
• Chapter 8. An Agenda for Action I: Diminishing Supply
• Chapter 9. An Agenda for Action II: Diminishing Demand
• Chapter 10. An Agenda for Action III: Treatment, Evaluation, and Research
• Chapter 11. An Agenda for Action IV: Protection of Those Who Do Not Use Mood-Altering Drugs
• Index