What is a drug? Who uses drugs? Who uses drugs? What is drug “abuse?”
DefinitionsDrug: chemical substance other than food or water that affects the mind and/or bodyAbuse: Widely defined. 2 general criteria:1. Use that goes against accepted medical practices OR…2. A non-prescription drug has harmful effects » Mentally » Physically » Socially (norms)
• Changing social definitions:• Abuse (misuse) = social reactions and consequences(Mother calls daughter an “addict” for consuming the occasional MJ cig but daughter calls mother an “addict” for having tobacco cigs, pills to sleep, alcohol, and fairly frequent use of analgesic pills)• How do we know some drug use is a social problem? Controversy/defined• Abuse = what is considered deviant or problematic by society/sub-groups• “No drug is good or bad in and of itself” (Szaz) …
Drugs/Alcohol• How have social definitions of drug use changed over the years?• Examples of changes in definitions & use…• Acceptability of drug use is culturally defined according to: – type – quantity and frequency – social status• History of drug laws tied to perceptions of social groups who use
Harm from heavy alcohol consumptionChild development • >50,000 babies born yearly • 1/4 are FAS – mental disabilities, head/face deformities, stunted growth, organ defects • Decreased school performanceHealth and Mortality • Unprotected sex • U.S. war veterans (35-44), heavy users 5.5X more likely to die early than light/moderate drinkers • Drunk drivingViolence • Aggressiveness: 2/3 of victims of family violence say alcohol was a factor in attack • Rape However, there are health benefits at low levels of consumption for adults
Alcohol: Dimensions of the Problem• ~61% of Americans ID as “drinkers” (of alcohol)• ~20% say they sometimes drink more than they should• ~36% say alcohol is a source of problems in their familyA FEW PATTERNS by SOCIAL GROUPA. Race/ethnicity: 1. American Indians (AI) highest rates (~17% of deaths involved alcohol) 2. NH whites 3. NH Blacks 4. HispanicsB. Gender: 1. Men > than women on almost every measure 2. 71% of men drank in past year vs. 62% of women (2002 NSDUH) 3. Heavy use in past year: men=11% vs. women=3% (“)
Figure 1. Percentages of Youths Aged 12 to 17 Reporting PastYear Alcohol Use, "Binge" Alcohol Use,† or Heavy Alcohol Use,†by Race/Ethnicity: 2000Fig. 1.
Percentages of Past Month Illicit Drug Use 1 among Persons Aged 12 or Older, by Race/Ethnicity*:2004/2005 -- note relatively small differences for blacks & whites, depending on the measures 1 Illegal & non-medical use of prescription drugs Sources: Substance Abuse and Mental Health Services Administration (SAMHSA), 2004 and 2005 National Survey on Drug Use in Households (NSDUH).
Alcohol: Dimensions of the ProblemPATTERNS by SOCIAL GROUPC. Age: • Binge/heavy drinking most prevalent among young adults (5+ drinks once/last 30 or 5+ on 5 or + days) • Teens: 11.4% of all alcohol in U.S. • 80% of 8th graders have consumed alcohol • Biological age is less predictive of drinking patterns than are social norms and roles across the life course…
What are the trends in ETOH use by age? (What is normative?)Current:: at least 2 drinks in past 30 days (incl. binge/heavy)Binge: 5 or + on same occasion at least once in past 30 DHeavy: 5 or + on same occasion at least 5 different days in past 30 D
SOCIAL GROUP FACTORS that decrease the likelihood of problem drinking:1. Children consume in context of strong family ties and rituals (religious ceremonies)2. Alcohol consumed at meals with family3. Consumption low-alcohol beverages: beer and wine4. Parents drink in moderation (learning/modeling)5. Drinking is a custom not a moral issue6. Abstinence is as acceptable as drinking7. Drinking not a sign of “manhood” or adulthood8. Drunkenness NOT socially acceptable (even though drinking is) Conclusions: Drinking, heavy drinking not an individual issue Group norms shaping alcohol use
Statistics don’t lie – people with vested interests do! But you can be a savvier consumer of statistics and make better choices• Range across X axis (bottom/horizontal) – number of years of data• Range across Y axis (vertical)• Definition of what is being measured: Use? Abuse? Behavior? Consequences?• Measurement itself: %, #, rate, average, median, etc.These aspects of graphics are often manipulated in the process of claims-making BUT Some data distort more than others Transparency is crucial Knowledge is power
Missing Numbers: suppression of a problem Note that the y-axis in this graph has been truncated at 40 percent, which makes thenegative slope from 73.7 % to 45.5%—so it appears steeper than if the y-axis started at 0.
*these data = “ever used” cocaine; MTF chart shows past 30 day use
What might account for differences in tobacco use across the U.S.?
Searching for markets & changing norms
Reasons for Drug Use – all involve socialization (learning)• Medicinal/curative• Social/cultural -- normative – Recreation – Bonding/celebrating – Economic • tobacco use in tobacco economies • Selling products and making profits – Political – ideology/power & genuine concern – Social roles – Reinforcing or constructing difference/inequalities • Class & race: marginalize poor Catholic immigrants (alcohol) or Mexicans (MJ) • Gender and alcohol (or smoking or other drugs) • Age – who drinks Cognac? Smokes MJ?
Social Policy: Responding to the Drug ProblemStrategies to Control Drug Use• Interdiction – stopping drugs from entering our country » DEA » U.S Customs Service » Border Patrol » U.S. military• Prosecution: drug dealers and users• Incarceration/Mandatory sentencing » Punishing the poor and minorities• Education – Dare (Drug Abuse Resistance Education) – Public advertisement campaigns• Treatment – In and out patient treatment – AA – Narcotics Anonymous Changing laws? Rarely discussed
Some Data on the “War on Drugs” Overdose Drug-related Arrests for drug law deaths murders violations Teens Adults All Teens Adults1980 (before "War on Drugs") 260 6,600 407 205,000 375,0001998 (10+ years after "WOD") 300 15,000 891 412,000 944,000Source: Drug Abuse Warning Network (DAWN) http://dawninfo.samhsa.gov/
Marijuana Laws worldwide
Percentage of Adult Population Using Cannabis Source: United Nations Drug Reporthttp://www.unodc.org/pdf/WDR_2005/volume_2_chap8_drugabuse.pdf
Percentage of Adults Using Cocaine in Past Year Source: United Nations World Drug Reporthttp://www.unodc.org/pdf/WDR_2005/volume_2_chap8_drugabuse.pdf
Decriminalization vs. legalizing drugs• Decriminalization: Removing the current criminal penalties that punish drug users (fine, like a parking ticket) http://www.newsbatch.com/drug-statemari1.html
Image from: Good, Erich. 1999/2005. Drugs in American Society, 5th and 6th editions
Federal Prisoners in 2003 by Most Serious Offense Source: Bureau of Justice Statistics http://www.ojp.usdoj.gov/bjs/abstract/p05.htm
Crime Sentence (in months)• murder 296• kidnapping 180• marijuana* 120 (minimum)• sexual abuse 67• marijuana ** 60 (minimum)• avg MJ sentc 42• assault 34• manslaughter 27• Fraud 13*growing more than 1000 plants**growing more than 100 plantsSource: US sentencing Commission, 1996 Sourcebook of Federal Sentencing Statistics, pg 22.]
Prohibition of Alcohol: 1920-1933*• Prohibitionist policies: control alcohol-related problems by banning alcohol • Sometimes called “abstinence only” policies • Most alcohol control strategies in the U.S. follow this model (AA, and federal and state “prohibition” laws) • Usually based on a disease model of drinking – cure requires quitting• National Prohibition “The Great Experiment” (18th Amendment) • Prohibited the manufacture, sale and transportation of intoxicating beverages • Did not prohibit possession or consumption• Anticipated and unintended consequences • Consumption • Alcohol consumption decreased in the years following enactment (at least reported consumption) • Reported deaths from alcohol-related diseases declined • But overall, the “Great Experiment” of federal prohibition in the U.S. was not considered successful*Some states banned alcohol before the Jan. 1920 federal law began
Federal Prohibition of Alcohol in U.S.: 1920-1933*• Some Unintended Consequences of Prohibition • Changes in perceptions of alcohol • Public perceptions of alcohol did not change much and consumption crept up over time (proportionately more women began to drink in that era) • Legal • More law breakers/black market – strain on law enforcement • Erosion of civil liberties – zeal to inspect and control • Health • Quality control – not regulated dosage and purity unknown • “Product displacement” - intended to reduce beer consumption but increased production of hard liquor (required less space to make and easier to conceal) • Economic • Costs of law enforcement high • Taxes could not be levied on sales of an illegal substance (NY: 75% of tax revenues were from alcohol sales prior to prohibition) • Many legal businesses went under & business did not increase elsewhere • Other • Wine at church services legal – church enrollment increasedView the two clips (~3.5 & 1.5 minutes long, respectively)• http://www.pbs.org/kenburns/prohibition/prohibition-nationwide/#detail=2086033109• http://www.pbs.org/kenburns/prohibition/prohibition-nationwide/#detail=2085990910*Some states banned alcohol before the Jan. 1920 federal law began
Harm Reduction• Most decriminalization & legalization based on “Harm reduction models”• HR assumes people will always use drugs• Public health approach aimed at minimizing the harm caused by drug use & laws against it – E.g., costs to taxpayers; health risks: overdose, tainted drugs, unknown dosage; exposure of non-users to the drug and drug culture;• Emphasizes treatment/prevention rather than incarceration• Emphasis on human dignity and rights• Should maximize benefits of drugs• Intervention based on relative harmfulness of a drug (not based on hearsay or propaganda)• Measures of success: – Lower costs; lower rates of death, disease, crime, suffering
Harm Reduction model for heavy alcohol usershttp://www.cnn.com/2011/HEALTH/05/11/minneapolis.wethouse.alcoho lics/index.html
Study Materials for Wet House TBL Video Clips [4 min. & 6 min.] http://www.cnn.com/2011/HEALTH/05/11/minneapolis.wethouse.alcoholics/ind ex.html (Dr. Drew) http://www.hlntv.com/video/2011/05/12/wet-houses-alcoholics-solution In-class Lecture and Discussion • Within unit on drug problems – harm reduction vs. prohibition Readings • Shaw articles in Star Tribune on wet house in Minneapolis • Szalavits on Seattle program inTime Magazine • Leshner (critique of term “harm reduction”) • Text chapter on drug problems • Marlatt and Witkiewitz (excerpts) [optional]
Examples of Decriminalization: 1. Oregon (1973—fine was $100): • % of drug abuse admissions to state hospital due primarily to marijuana was 6.7% in 1970 and 2.5% in 1975.1 • Use of marijuana did not change significantly. 1. California: The state of California saved nearly $1 billion dollars from 1976 to 1985 by decriminalizing the personal possession of one ounce of marijuana, according to a study of the state justice department budget.2 2. General: Citizens who live under decriminalization laws consume marijuana at rates less than or comparable to those who live in regions where the possession of marijuana remains a criminal offense.31 Blachly, Paul. 1976. "Effects of Decriminalization of Marijuana in Oregon." Annals of the New York Academy of Sciences, 282: pp. 405-415.2 M. Aldrich and T. Mikuriya. 1988. “Savings in California Marijuana Law Enforcement Costs attributable to the Moscone Act of 1976.” Journal of Psychoactive Drugs, 20: 75-81.3 E. Single et al. 2000. “The Impact of Cannabis Decriminalization in Australia and the United States.” Journal of Public Health Policy 21: 157-186.
Examples of Legalization: 1. Zurich (1987): Form of “legalization” that Failed1 – Following legalization of narcotics in one public park (not full legalization– isolation of injection drug users & clean needles): • Health problems related to needle sharing • Drug overdoses • Crowding (people migrated to “needle park”) • RESPONSE: closed park but opened clinics to monitor users 2. Netherlands: Legalization that Works1 Following legalization of MJ in designated coffee shops: • "drug tourism" from neighboring countries increased • Ever use of marijuana among Dutch youth initially decreased, then increased but did not exceed initial rates. [no relationship] • Regular use of MJ decreased among youth. Reinarman, Craig (1997), The drug policy debate in Europe: The case of Califano vs.The Netherlands. 1 International Journal of Drug Policy, volume 8 (1997), no 3.
• Film: GRASShttp://mediasite.apps.fsu.edu/ttsg/flash/2007/102830/grass.h tml• written and directed by Ron Mann (1999) Documentary While its unlikely to change the United States drug policy, Ron Manns entertaining documentary chronicling the bizarre 100-year history of laws against the use of marijuana is likely to prompt outrage, countless discussions and a perverse sense of nostalgia. Actor and pro-hemp activist Woody Harrelson narrates this spirited and often hilarious retrospective of past anti-drug campaigns, propaganda films and publicity crusades which often linked marijuana use to insanity, sexual promiscuity, homicide and permanent brain damage. More provocative is screenwriter Solomon Vestas thesis suggesting that much anti-marijuana legislation reflected a form of institutionalized racism against marginalized communities; first Mexican laborers and blacks, then communist subversives and finally the hippie counterculture. An unapologetic advocacy film, GRASS makes the case that the governments long and costly war against marijuana has been manipulated by politicians like the Federal Bureau of Narcotics chief Harry J. Anslinger; President Nixon, who memorably deputized Elvis in the war on drugs; and President Reagan, who branded marijuana "the most dangerous drug in America." New York Times. R (AC, AL, BN) Stereo/Letterbox (2000) Color (79 mins).• Source: Sundance channel website.Get book and DVD at http://bookstore.autonomedia.org/index.cgi?cart_id=1864658.13236&pid=218Publisher: Autonomedia/Warwick, ISBN: 1570271070
“Grass” Video• During film• Identify 3 claims made about marijuana• Marijuana was claimed to be troublesome because of the issues or groups with which it was paired in the claims-making process. Name two of those issues or groups.• Whose claims were/are taken most seriously?• Based on what you saw in the movie, what is some evidence in support of using “harm reduction?
Solutions & Thoughts1. Should we be consistent in our drug policy (make everything legal or illegal). Rationale?2. What objective data should we collect to illuminate drug use and problems with drugs?3. Should adults have the freedom to use a drug they would like to use? Rationale?4. What data show on consequences of legalizing MJ? Decriminalization?5. Do you predict that any illegal drug will become legal in your lifetime? Might any legal drug become illegal?Source for more information about global use, production and laws about drugs:http://www.unodc.org/unodc/en/world_drug_report_2005.html
• Marijuana Timeline (similar to storyline in “Grass”)http://www.pbs.org/wgbh/pages/frontline/shows/dope/etc/cro n.html• Video (44 min.) from CNBC called “Marijuana, Inc.” on MJ growers in Mendocino, CA. NOT required viewing but might be of interest (a student sent it to me). Includes claims-making, touches on harm reduction, etc.http://www.hulu.com/watch/54312/cnbc-originals-marijuana- inc