Reading – Chapter #1 An Introduction to Drug Use and Abuse
CHAPTER SUMMARY
Drugs can be grouped into one of three categories—depressants, stimulants, and hallucinogens—depending on their effect on the central nervous system, although some, such as cannabis and MDMA, have more than one effect. There is no definitive way to measure the amount of drug use, which is complicated by polydrug use. Most information on the drug problem in the United States is derived from two indicators:
1. National Survey on Drug Use and Health (NSDUH)
2. Monitoring the Future (MTF)
While the drug use continuum ranges from nonuse to dysfunctional use, what we know about those who use psychoactive drugs is skewed toward compulsive users. The term “drug use continuum” helps in defining the slippery term “drug abuse”, but the important point is how society defines drug abuse determines how society responds to drug use. While statutes distinguish between lawful drugs such as nicotine and alcohol, and illegal drugs such as heroin and cocaine, biology recognizes no such distinction. They all have abuse potential, and nicotine and alcohol are responsible for serious behavior health problems. The terms “drug” and “abuse” lack precision, a problem that is compounded by a tendency to moralize and politicize pressing social issues.
The connection between drugs and crime can be pharmacologically driven, particularly with respect to alcohol, or based on the need to secure drugs; or crime and drugs might not be connected—criminals simply also use drugs. The sequence of drugs and crime—which came first—is not clear, and if alcohol is included, even more unclear.
Now that we have introduced the topic, in Chapter 2 we will examine the history of drugs and drug abuse
Reading – Chapter #2 The History of Drug Use and Legislation
CHAPTER SUMMARY
Policy decisions have frequently been based on perceptions, beliefs, and attitudes with little empirical foundation, and they have often reflected popular prejudices against a variety of racial and ethnic groups. U.S. opposition to alcohol was often intertwined with nativism, and efforts against alcohol and other psychoactive drugs were often a thinly veiled reaction to minority groups.
The 1905 Pure Food and Drug Act effectively ended the patent medicine problem, but federal antidrug legislation—the Harrison Act—was the result of U.S. efforts at improving our trade relationship with China. Implementation of the Harrison Act was given to the Treasury Department that shaped U.S. drug policy in favor of a strict enforcement approach to the problem of drugs.
At the end of World War II, there was fear of an epidemic of drug use as U.S. soldiers began to return from Far Eastern locations where opiate use was endemic. The epidemic failed to materialize. In 1950 and 1951, a spate of news stories on drug abuse reported that the use of heroin was spilling out of the ghetto and into middle-class environs, where it was poisoning the minds and bodies of America’s (white) youth. New federal laws increased penalties, and drug enforcement was given over to the Justice Department. At the same time, rehabilitation of addicts gained momentum. Prominent among the new approaches was the use of methadone and the therapeutic community.
During the late 1960s and early 1970s, attitudes toward recreational drug use became more liberal because of the wide acceptance of marijuana. Cocaine soon became associated with a privileged elite, and the new demand was sufficient to generate new sources, leading to the development of major international cocaine organizations.
The drug scare of the 1980s brought the issue back into the political arena with a “war on drugs” and creation of the Office of National Drug Control Policy. The 1990s saw an absence of drugs as a political issue along with increased penalties for crack cocaine and the rising use of methamphetamine.
Now that we have completed our review of the evolution of the problem of drug abuse in the United States, in the next chapter we will examine the neurology of psychoactive substances.
Reading – Chapter #3 The Biology of Psychoactive Substances
CHAPTER SUMMARY
According to the disease model, a drug-dependent person is a victim of forces beyond his or her control. Some neurological theories describe the drug abuser as a person whose body is malfunctioning with respect to the production of crucial neurotransmitters, making drug use self-medicating. Drugs are not automatically pleasurable, and not everyone responds to the experience in the same way. An individual’s genetic makeup is a major factor in vulnerability to drug abuse. Our ability to research the effect of drugs on humans is limited by legal and ethical considerations. It is further confounded by the phenomenon of polydrug use.
By definition, all psychoactive substances affect the central nervous system. Reward pathways located in the brain are activated by a variety of psychoactive substances through the release of the neurotransmitter dopamine, a common element in continued use. Some psychoactive chemicals alter the central nervous system, creating what appears to be a compulsion to use the drug to restore a sense of well-being.
A neuron is the basic working unit of the central nervous system, a specialized cell designed to transmit information from the brain to other nerve, muscle, or gland cells. Communication is achieved by way of neurotransmitters, each having its own specific receptor site. After their impact, neurotransmitters are subject to reuptake, a mechanism with which drugs often interfere.
The continued use of certain drugs, particularly depressants, produces tolerance, and with some drugs there is cross-tolerance that is linked to withdrawal symptoms. Addicted individuals are influenced by drug cues, which can help to explain reversion to drugs after abstinence. Now that we have examined the neurology of drug abuse, in the next chapter we will apply this dimension to depressants.
Chapter 4 Summary – Stimulants
In moderation, stimulants enhance mood, increase alertness, and relieve fatigue. Short-term euphoria may result in a desire to ingest again. Powerful stimulants, such as cocaine and methamphetamine, have limited medical use and in large doses can produce irrational behavior and paranoia. Discontinuing their use can cause depression as a result of a dopamine depletion. Cocaine is a blood vessel constrictor, and heavy use can lead to heart failure.
Although chemically quite different than cocaine, amphetamine has similar effects. Methamphetamine is easy but dangerous to produce; the chemicals are toxic and highly combustible. In addition to being used for the euphoric effects, amphetamines have been used as diet aids and by long-haul truck drivers to ward off sleepiness. Methamphetamine poisoning or overdose can cause brain hemorrhage, heart attack, high fever, coma, and occasionally death.
Nicotine is a highly addictive substance whose methods of ingestion—smoking and chewing—are associated with secondary dangers such cancer and emphysema. Smoking serves as a gateway drug for heroin and cocaine. As with other psychoactive chemicals, use of nicotine may be a form of self-medication to ward off depression. In contrast to cocaine and amphetamine, nicotine can also exert a sedative effect, depending on the level of the smoker’s nervous system arousal and the dose of nicotine taken. Tolerance develops to nicotine, and those who are addicted must start each day with a cigarette to ward off withdrawal symptoms.
Caffeine is the most widely used stimulant and has all of the characteristics of other stimulants but in much milder form. There do not appear to be any long-term dangers to its use.
Reading – Chapter #5
The central nervous system contains endorphins, neurotransmitters that have the characteristics of morphine. An endorphin deficiency would place a person at risk for drug abuse, as would difficulties dealing with stress.
Morphine and heroin have analgesic and euphoric properties. Heroin users experience different effects: the rush, the high, and the nod. Tolerance develops to the high but not to the rush.
Heroin has no lawful uses in the United States, but the heroin analogs fentanyl and oxycodone are available for medical use. Heroin depresses the respiratory centers in the brain, and an overdose can result in respiratory arrest and death from lack of oxygen to the brain. Withdrawal from heroin is similar to a bad case of the flu, and symptoms subside in about a week.
Barbiturates have limited medical use, and although they produce euphoria, they do not ease pain. Tolerance develops, and in contrast to opiates, there is a fatal dosage level. In medicine, barbiturates have largely been replaced by benzodiazepines.
Alcohol is a depressant that initially acts as a stimulant and affects the part of the brain that controls inhibitions. In addition to the dangers imposed by alcohol itself—such as cirrhosis of the liver and damage to the heart muscle—behavior problems that result from ingestion include violence and impaired driving. Alcohol produces tolerance, and withdrawal symptoms range from the morning-after hangover to life-threatening delirium tremens
Reading Chapter #6
CHAPTER SUMMARY
Hallucinogens, which occur both naturally and synthetically, overwhelm the ability of the central nervous system to modulate sensory input, changing a person’s perception so that he or she sees images, hears sounds, and feels sensations that seem real but do not exist. LSD, the best-known hallucinogen, is an odorless and tasteless substance whose impact depends largely on the user’s expectations. LSD has no accepted medical use. Tolerance develops rapidly, and there are no withdrawal symptoms.
PCP was developed as a surgical anesthetic but produces extreme distortions of reality that mimic mental illness, and some people become violent under its influence. There is a lack of tolerance or withdrawal symptoms.
Certain mushrooms and plants have hallucinogenic qualities. Peyote (from cactus) continues to be used by certain Native American cultures in religious rituals.
“Club drugs” include MDMA (ecstasy), ketamine, GHB, GBL, and Rohypnol. MDMA, which has both stimulant and hallucinogenic properties, is associated with dance parties. It has no lawful uses in the United States, and there is controversy over its long-term effects. Rohypnol combined with alcohol causes impaired judgment, and the user might have no memory of what transpired; Rohypnol is sometimes referred to as the “date rape drug.”
Marijuana has stimulant, depressant, and hallucinogenic properties and, like other psychoactive drugs, has specific receptor sites in the brain. Depending on the environment and how much is ingested, marijuana can produce a sense of well-being and a dreamy state of intoxication. High doses produce hallucinogenic effects. The active chemical in cannabis, THC, is available by prescription for limited medical use, and in certain state, products using the cannabis leaf are now legal. THC has a long half-life and therefore a relatively mild withdrawal, similar to that of cigarette smoking. Although short-term effects are limited, there is controversy over long-term effects. Impairments are similar to those of nicotine and alcohol.
Inhalants are non-drug products that are usually abused by youngsters for their intoxicating effects. Short-term use does not cause permanent damage, although long-term use is associated with certain cancers and cognitive impairment.
CHAPTER SUMMARY
The focus of psychology is on the individual, and the field of psychology is divided into clinical and behavioral. The first of these is largely influenced by Freudian theory, which explains human behavior as being driven through processes that are largely unconscious. Drug abuse is seen as a manifestation of unresolved developmental issues related to oral, anal, or genital stages. While experiencing these stages, the person develops an id, ego, and superego, deficiencies in which can be connected to adult drug use.
Drug abuse in adolescence is explained as an immature response to the stress typical of this period. The adolescent drug user circumvents the demands of maturity. Although users reach chronological adulthood, they remain psychologically preadolescent.
Behaviorism has its roots in the laboratories of experimental psychology and is based on learning theory. According to behaviorism, forms of behavior are conditioned, i.e., the result of learned responses to certain stimuli. Behavior is strengthened by its consequences and can be modified by operant conditioning: positive and negative reinforcement. Drugs can serve as powerful reinforcers, while withdrawal symptoms provide negative reinforcement.
Sociological theory examines drug use in its social context and often views drug use as the product of social conditions and relationships that cause despair, frustration, hopelessness, and general feelings of alienation in society’s most disadvantaged segments. Many sociological studies have found that drug use among adolescents is motivated by intermittent feelings of boredom and depression and that, like other aspects of adolescence, drug use is typically abandoned on reaching adulthood.
Sociology has determined that drug users typically pass through several stages on the way to addiction or alcoholism, from social or experimental use to dependency and dysfunction. Anomie explains drug abuse as a form of retreatism by people who are unable to deal with the disconnect between society’s economic expectations and an individual’s ability to achieve them. Differential association explains that drug use is a learned behavior that is transmitted through intimate personal groups. The effectiveness of learning depends on the degree of intensity, frequency, and duration of the association.
Social control theorists focus on why only relatively few people engage in deviant behavior such as crime and drug abuse. Their answer is the strength of an individual’s bond to conventional society.
Subcultures are patterns of values, norms, and behavior that have become traditional among certain groups, and deviant behavior is the result of people conforming to subcultures to which they belong. A person without important bonds to conventional society but with strong ties to a drug-using subculture would be more likely to abuse drugs.
According to labeling theory, people make their own reality, so if a person who uses certain psychoactive substances is labeled—by lawmakers and society—as “bad,” he or she will be dealt with accordingly, no matter the reality. Once attached, the label has a strength of its own that can lead to secondary deviance.
With these explanations in mind, in the next chapter we will examine the variety of methods that are used to treat drug abusers and prevent drug abuse.
Reading: Chapter 7 Psychology & Sociology of Drug Use
Effective prevention has proven to be as elusive as effective treatment. Prevention programs should be designed to enhance protective factors and move toward reversing or reducing known risk factors. School-based efforts at prevention have been dominated by three models: information, affective, and social influence.
Research has found that although it is relatively easy to increase knowledge and change attitudes, it is difficult to bring about long-term sustained behavior change. Drug education efforts can sometimes actually be thinly disguised propaganda, and since there is a correlation between knowledge and use, poorly designed drug education could encourage use.
Drug antagonists, used for detoxification or as part of a treatment regimen, displace drugs at their receptor sites in the human body but do not affect drug craving. Methadone, the best-known agonist for opioid addiction, is a powerful narcotic that lasts much longer in the body than heroin does and is effective if administered orally. It can be used for heroin withdrawal or maintenance. Buprenorphine is a partial agonist approved for use with heroin addicts in medical practice. No drug has emerged as effective for the cocaine-dependent.
Although psychoanalysis is not used to treat drug abuse, there is short-term therapy based on a psychoanalytic model that seeks to aid the patient in dealing with repressed emotions without reverting to drugs.
Behavior modification can be difficult to apply, since the strength of psychoactive substances as positive reinforcers and the negative reinforcement associated with abstinence are difficult to compete with. Some therapists use aversion therapy to reduce the value of drug reinforcement, and because cues can trigger craving, these therapists use techniques that counter or neutralize the cues. Cognitive approaches take advantage of the human ability to bridge delays between behavior and subsequent reinforcement. Contingency management uses point systems for modifying behavior.
The advantage of group treatment is the peer interaction, which is more powerful than therapist-patient interactions in the one-to-one situation. Treatment groups are typically formed around one basic trait that all members share and from which the group derives its descriptive label.
Treatment programs in the criminal justice system have shown an impressive level of success, as have therapeutic communities that provide a resocialization process for particular types of drug abusers. Private chemical dependency programs, some located in health care facilities, depend on clients who have adequate resources, such as medical insurance. These programs often fail to develop theory-centered treatment responses or to incorporate the results of research into their approach to clients.
Many programs use the twelve-step approach developed by Alcoholics Anonymous, according to which alcohol or drug dependence is a disease that can be controlled only by abstinence. Although AA and groups based on this approach are quite popular, conclusive research on effectiveness remains elusive. Evaluation of drug treatment effectiveness, in general, presents difficulties because there is no standard or benchmark.
Reading: Chapter #9 The Drug Business
Trafficking in illegal drugs at the highest wholesale levels is controlled by international organized crime syndicates from Colombia, Mexico, and other countries. Headquartered in a foreign country, leaders maintain tight control of their workers through highly compartmentalized cell structures.
Control of most of the world’s cocaine industry remains in the hands of Colombian organizations, which have expanded into heroin. Colombia has a violent history, with a drug culture to match. The country is wracked by leftist insurgencies and right-wing militias, both using drug trafficking to finance their efforts. For distribution in the United States, Colombian organizations are aligned with Mexican and Dominican organizations.
Mexico has a long history of political corruption that has affected law enforcement, and leading drug traffickers are publicly celebrated. Mexican drug organizations have cells operating in the United States, and in addition to dealing Mexican-produced heroin they have partnered with Colombians to distribute cocaine. Although they are latecomers to the trade, Mexican drug organizations have also become dominant in the manufacture and distribution of methamphetamine.
The Golden Triangle of Southeast Asia encompasses parts of Laos, Thailand, and Myanmar (formerly Burma). Myanmar accounts for about 90 percent of the total heroin production of the Golden Triangle, is the world’s second largest source of opium and heroin, and is a major producer of methamphetamine. The region has a history of colonialism and opium production, and it uses the heroin trade to finance political efforts. At the center of much of the traffic in Southeast Asian heroin are Chinese Triads, which have extensive connections in overseas Chinese communities throughout the world.
The Golden Triangle of Southwest Asia includes Iran, Afghanistan, and Pakistan. Tribal groups in Afghanistan, which extend across the border into Pakistan, have a long martial history supported by opium production. As in the Golden Triangle, politics intersects with opium and hampers efforts to deal effectively with drug trafficking.
Drug trafficking has connections to terrorism. Terrorists may use the business to finance their efforts, and/or personnel in drug and terrorist groups may overlap. Terrorists can offer military skills and weapons, while traffickers provide a source of revenue and expertise in illicit transfer and laundering of proceeds.
The profit potential in a business in which transactions must be accomplished without recourse to the formal mechanisms of dispute resolution leads to the creation of private mechanisms of enforcement and, consequently, boundless violence. Drugs have provided lucrative opportunities to African American criminals who had been locked out of other areas of criminal success by the same prejudice that their legitimate counterparts endured.
Below the wholesale level, selling drugs is an easy-entry business, requiring only a source and funds, leading a variety of groups to enter the trade, such as street gangs in many urban areas. At the lowest retail levels are people who, while taking significant risks from law enforcement and other criminals, barely eke out a living. There is less specialization farther down the “food chain,” and at the lowest levels of the drug trade can be found the “walking drugstore,” a dealer who retails a variety of illegal substances.
Methamphetamine production has blossomed in rural parts of the United States, where in farming communities there is easy access to anhydrous ammonia, a fertilizer. Meth labs contain toxic chemicals, and cleanup of a seized lab can cost the government thousands of dollars.
At the wholesale levels, drugs generate large amounts of cash whose source must be disguised—hence the term “money laundering.” There are many schemes to accomplish this, some relatively simple and others involving complex overseas financial transactions.
Our examination of the business of illegal drugs provides a framework for understanding the problems that confront law enforcement officials who are trying to constrain trafficking in dangerous drugs, the topic of the next chapter.
Reading: Chapter #10 Drug Laws and Law Enforcement
Drug abuse results from a combination of susceptibility and availability, and law enforcement can affect availability. Law enforcement efforts are constrained by constitutional due process, in particular the Fourth Amendment, jurisdictional limitations, and corruption, both domestic and foreign. The necessary use of informants and undercover work in the fight against drug trafficking is particularly prone to corruption.
The legal foundation for federal drug law violations is the Controlled Substances Act, which places a substance in one of five schedules, and states have largely followed the federal model. People who are involved in the illegal drug business can be arrested and prosecuted for such offenses as manufacture, importation, distribution, possession, and sale. Particularly useful are conspiracy statutes that obviate the need for proving a substantive crime and permit the prosecution of an entire organization. Since money laundering is a crucial element in wholesale drug dealing, there is a specific statute that outlaws efforts to conceal the source of funds. More controversial are civil forfeiture statutes because of the possibility of harming innocent third parties.
Local law enforcement efforts are typically directed against midlevel or street-level dealers; federal efforts focus on large-scale wholesalers, many of whom operate on a transnational basis. While several federal agencies have some responsibility for drug enforcement, it is the DEA and Immigration and Customs Enforcement that have the largest roles. Military involvement in drug law enforcement is limited by the Posse Comitatus Act, and military officials have traditionally opposed even a supportive role.
Street-level drug law enforcement can result in displacement but disrupts connections between retailers and consumers. Intensive street-level operations are expensive and can have the effect of reducing competition and increasing profits of remaining dealers. The increased arrests can also overburden the justice system.
Measuring “success” in drug law enforcement is elusive because of a lack of standards regarding arrests, seizures, and purity levels. Law enforcement that reduces the available supply of a particular drug may cause substitution, and the profits that can result with such market conditions may encourage new players to get involved.
In the next chapter, we will examine our policy for responding to drug abuse.
Reading: Chapter #11 US Drug Policy
The United States has two basic models of responding to the use of dangerous substances: the disease model and the moral-legal model, which utilizes three methods: regulation, medical auspices, and law enforcement. The response—regulation or law enforcement—determines the manner in which the user is viewed: the alcoholic according to the disease model, the user of illegal drugs as criminal. These responses are not based on the relative dangers inherent in psychoactive substances, and drug use is not necessarily drug abuse.
Although reducing the supply of drugs should, in theory, drive up the price and reduce consumption, there is an absence of support for this proposition. Increasing enforcement does increase the profits of the more resilient drug organizations and contributes to a problem with prison overcrowding. When drug abusers are unable to secure their preferred substance, they frequently switch to other substances that might be even more harmful. Insofar as drug abuse is caused by societal deficiencies in education, housing, and other quality-of-life-variables, the more we expend on law enforcement, the less we have available to deal with these social ills.
Efforts against drugs at their source can generate a balloon effect and citizen antagonism when carried out by governments with human rights violations, and poppy and coca crops are often important economic assets in areas of extreme poverty. Crop eradication and substitution programs have met with only limited success and U.S. efforts against drug trafficking are often secondary to foreign policy considerations.
Efforts to reduce drug use include drug testing and prosecution for fetal liability, but most promising is the expansion of treatment programs. Mandatory treatment has shown success with drug abusers.
Because there is no way to accurately determine changes in the number of people using illegal drugs, evaluating policy changes is difficult.
Now that we have examined drug policy in the United States, in the next chapter we will consider more radical changes, some of which are being or have been adopted by European countries.
Reading: Chapter #12 Global Drug Policy
Most of the harmful aspects of heroin use are the result of its being illegal. We permit a wide assortment of dangerous behaviors such as cigarette smoking, drinking alcohol, skydiving, and football, acknowledging freedom to enjoy activities that may be injurious to health. Why do we single out psychoactive chemicals—but only some of them?
On the “pro” side of the argument, decriminalization would allow drug criminal justice resources to be used elsewhere, curtail secondary criminality, weaken or destroy drug-trafficking organizations, and allow drug users to lead healthier and more normal lives by using pharmaceutical-quality substances.
The “con” side argues that greater availability would mean that more people would be tempted to use drugs and would signal a societal acceptance of drug use. There would be no incentive for addicts to enter drug treatment, and drug use might continue beyond the typical age of remission.
Offering intelligent policy alternatives requires understanding the cause(s) of drug use: is it biological, psychological, sociological, or a combination of these? Although medical maintenance using opiates or methadone has been suggested for heroin addicts, cocaine is more problematic.
A number of countries have decriminalized marijuana, but even its medical use is a federal crime in the United States (although it is legal in some states).
In Western Europe, official and unofficial harm reduction policies have become popular, most notably in the Netherlands. Dutch drug abuse prevention efforts treat alcohol and tobacco, as well as heroin and cocaine, as dangerous drugs; legal versus illegal is not considered a sound basis for differentiation. Despite U.S. objections, Canada has been experimenting with harm reduction.
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