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9Drugs, Alcohol, and Crime
gorodenkoff/iStock/Getty Images Plus
Learning Outcomes
After reading this chapter, you should be able to
• Discuss the relationship between substance use and criminal
behavior.
• Recognize the criteria for substance use disorder according to
the DSM-5.
• Examine several reasons why people use drugs.
• Explore the biological basis of addiction.
• List the types of commonly abused substances.
• Analyze the relationship between substance abuse and
criminal behavior.
• Describe strategies for reducing substance abuse and
substance-related crime.
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redistribution.

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Introductory Case Study: Greg’s Alcohol Addiction
Introductory Case Study: Greg’s Alcohol Addiction
Greg is a 47-year-old construction worker and divorced father
of two high school–aged children
(whom he rarely sees). Greg enjoys his job and has an
exemplary work record; in fact, he was
recently awarded Employee of the Month. Greg’s coworkers do
not know a lot about him due to
the fact that he is a private person and keeps to himself. But he
joins them one or two nights a
week for happy hour after work.
What Greg’s coworkers don’t know about him is that he had a
rough childhood, which has led
to him being very private and a loner. Greg’s parents were
heavy drinkers while he was growing
up, which led to Greg having very few friends and not
performing well in school. Greg’s school
troubles continued when he went to college, and he was not able
to obtain a degree.
Greg found employment, married, and became a father, so it
appeared that things were going
well for him. Greg, though, has a secret—he is a heavy drinker
himself. He enjoys going home
after work and having a couple of beers, but a couple turned
into 6 to 12 per night. This alcohol
dependence eventually led his wife to seek a divorce.
Greg continued his alcohol dependence after his wife left him.
He would become upset if there
was not enough beer in the refrigerator, and he would go out

and purchase more. In fact, one
night he went out to purchase more and, when he got to the
convenience store, realized he forgot
his wallet. Instead of going home to retrieve his wallet, Greg
chose to steal a six-pack of beer. He
was caught attempting to leave the store without purchasing the
beer. But the owner declined
to press charges against Greg since he was a regular customer
and the owner feared he might
lose Greg’s business.
Greg started a dating a woman he met at a bar 18 months ago.
She describes Greg as a warm
and caring man but notes that he can act moody and cold toward
other people on occasion. But
she also states that she believes Greg suffers from some
depression, due to not having a relation-
ship with his children (which he will not discuss). She states
that she has noticed throughout
their relationship that Greg becomes restless and has trouble
sleeping if he does not drink at
least three or four beers after work. She states that she really
cares for Greg and has considered
asking him to slow down on his drinking or quit altogether but
fears the repercussions of this
request.
As you read this chapter, consider the following questions
regarding this case:
1. Do you think Greg has an addiction to alcohol?
2. Are other people affected by his alcohol use?
3. Where did Greg get his opinions about drinking?
4. Do you think there is an underlying psychological disorder or
genetic vulnerability

that is influencing Greg’s drinking?
5. Is Greg’s current attitude about alcohol use reasonable?
6. Do you think Greg is at risk for future criminal behavior?
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167
Section 9.2 Substance Abuse and Addiction: Terminology and
Diagnosis
9.1 Introduction
There is a long-established link between substance (anything
that can alter an individual’s
cognition or mood) use and criminal behavior (Bradford,
Greenberg, & Motayne, 1992; Tonry
& Wilson, 1990). However, as we will explore in this chapter, it
is important to note that there
is no single substance use–crime relationship. In some
instances, substance use precedes the
criminal behavior. In other instances, the criminal behavior
precedes the substance use. And
sometimes both the substance use and the criminal behavior
occur around the same time.
In addition, substances also differ in their criminogenic
qualities (crime-causing potential).
For example, a substance like marijuana is less criminogenic
compared to a substance like
heroin. However, in specific individual cases, and under certain
situational conditions, mari-
juana can be a highly criminogenic substance.

Substance abuse, in all its forms, impacts an enormous number
of people, as well as their
friends and families. Understanding the nature and extent of
substance abuse allows us to
make connections between substance abuse and criminal
behavior.
9.2 Substance Abuse and Addiction: Terminology
and Diagnosis
Professionals and practitioners in a variety of fields—including
psychology, criminal justice,
health care, politics, and law—have tried to clarify terminology
and concepts in an effort to
improve public policy, professional standards, and patient care
related to substance abuse
(the hazardous or harmful use of substances) and addiction. As
discussed in Chapter 2, in the
field of psychology, the primary system that is used to diagnose
mental disorders—including
substance abuse and addiction—is the Diagnostic and Statistical
Manual of Mental Disorders
(DSM). In the DSM-5, which was published in 2013, the
American Psychiatric Association rec-
ommends that the term abuse be discontinued in favor of a more
informative and less stigma-
tizing term. However, the term substance abuse remains the
most common term in use today,
especially by state and federal governments as well as
researchers in the field. We’ll refer to
both abuse and use throughout this chapter, using the terms
interchangeably.
The DSM-5 instead characterizes substance use disorders
(patterns of symptoms resulting
from the use of a substance that an individual continues to take
despite experiencing prob-

lems as a result of the substance use) as existing on a continuum
from mild (two or three
symptoms) to moderate (four or five symptoms) to severe (six
or more symptoms). Each
specific substance is addressed as a substance use disorder (e.g.,
alcohol use disorder, opioid
use disorder), but nearly all are diagnosed based on the same
overarching criteria.
Listed below are the criteria for substance use disorder
according to the DSM-5.
1. Taking the substance in larger amounts or for longer than
you’re meant to.
2. Wanting to cut down or stop using the substance but not
managing to.
3. Spending a lot of time getting, using, or recovering from use
of the substance.
4. Cravings and urges to use the substance.
redistribution.
168
Section 9.3 Why Do People Use Drugs?
5. Not managing to do what you should at work, home, or
school because of substance
use.
6. Continuing to use, even when it causes problems in
relationships.
7. Giving up important social, occupational, or recreational

activities because of sub-
stance use.
8. Using substances again and again, even when it puts you in
danger.
9. Continuing to use, even when you know you have a physical
or psychological prob-
lem that could have been caused or made worse by the
substance.
10. Needing more of the substance to get the effect you want
(tolerance).
11. Development of withdrawal symptoms, which can be
relieved by taking more of the
substance. (APA, 2013)
9.3 Why Do People Use Drugs?
In general, any substance that alters the
nervous system (network of nerve cells
and fibers that transmit signals between
different parts of the body; essentially, the
body’s electrical wiring) and mind is con-
sidered a drug. (Throughout the chapter,
we’ll refer to the terms drug and substance
interchangeably.) Certain drugs have the
capacity to distort, inhibit, or enhance an
individual’s thoughts or feelings, which
impacts patterns of social functioning
and other behaviors. Drugs are classified
as either licit (legal) or illicit (illegal). For
example, coffee, tobacco, and alcohol are
considered licit drugs, as are popular over-
the-counter drugs (e.g., Tylenol, Advil).
When used infrequently or in moderation, these drugs are
generally deemed acceptable

by society. On the other hand, drugs like cocaine, heroin, and
ecstasy are considered illicit
drugs, which are illegal to use or possess in the United States.
In general, there are four primary reasons why people use drugs.
1. To feel good: Certain drugs can produce a feeling of well-
being or elation, known as
euphoria. This feeling of pleasure or euphoria can also be
accompanied or followed
by feelings of self-confidence, power, increased energy,
satisfaction, or relaxation.
2. To feel better: Some individuals who suffer from depression,
stress, or anxiety begin
using certain drugs in an effort to eliminate or reduce those
feelings. While people
tend to dismiss the impact of stress, it has been found to play a
strong role in indi-
viduals starting and continuing substance use, as well as in
relapse—a return to
substance use after a period of improvement.
3. To perform better: Some individuals feel pressure to improve
their performance in
school, at work, or in a variety of other settings (e.g., athletics).
Efforts to improve
performance are a common reason that some people initially try
or continue using
stimulants, which will be described later in the chapter.
ookawaphoto/iStock/Getty Images Plus
When tobacco is used infrequently or in
moderation, society generally considers its use
acceptable. Tobacco is considered a licit drug.

redistribution.
169
Section 9.4 Addiction
4. To conform to peer pressure and satisfy curiosity: These are
common reasons for
teenagers, as many teens become familiar with drugs and
experience curiosity to try
them. Social pressure from peers can also be a very powerful
factor.
For many drugs, a user can be at risk of moving from occasional
use to regular use. Similarly,
a user can be at risk of moving from regular use to heavy use,
and then from heavy use to
chronic (constantly recurring or long-lasting) use. A chronic
substance user may then be at
risk of becoming addicted to the substance, as well as
experiencing withdrawal symptoms
(physical and mental symptoms that occur when a substance is
absent from the body) when-
ever the particular substance is not available.
9.4 Addiction
Why do some people become addicted to certain substances
while others do not? Why might
someone feel sick from a certain drug that makes other people
feel good? As with other mental
health disorders, the likelihood of developing an addiction or
substance abuse problem dif-

fers from individual to individual. Moreover, there is no single
factor that determines whether
an individual will develop an addiction in the future.
People use the terms addiction and addict in everyday speech
over a wide range of domains.
For example, have you ever heard anyone refer to themselves as
a shopaholic, chocoholic,
or workaholic? Perhaps you have heard someone accuse
themselves (or others) of having a
television addiction or a social media addiction. Interestingly,
the term addiction is included
as a category in DSM-5 and contains both substance use
disorders and non–substance use
disorders, such as gambling disorder.
The American Society of Addiction Medicine published the
following definition of addiction
in 2011:
Addiction is a primary, chronic disease of brain reward,
motivation, memory
and related circuitry. Dysfunction in these circuits leads to
characteristic bio-
logical, psychological, social and spiritual manifestations. This
is reflected in
an individual pathologically pursuing reward and/or relief by
substance use
and other behaviors.
Addiction is characterized by inability to consistently abstain,
impairment in
behavioral control, craving, diminished recognition of
significant problems
with one’s behaviors and interpersonal relationships, and a
dysfunctional

emotional response. Like other chronic diseases, addiction often
involves
cycles of relapse and remission. Without treatment or
engagement in recov-
ery activities, addiction is progressive and can result in
disability or prema-
ture death. (paras. 1–2)
Addiction is a chronic disorder with environmental, biological,
social, and psychological fac-
tors that influence its development and maintenance.
redistribution.
170
1. Environmental factors: Society’s views of substance use have
a significant effect on
people’s initial and continued use of certain substances.
2. Biological factors: The pharmacology of alcohol and other
drug use centers on how
the ingredients of a particular substance affect the body and
nervous system and
thus the individual’s experience with the substance.
3. Social factors: The motivation for using a particular
substance can be influenced by
a variety of social influences, including peer pressure, deviant
peer relationships,
social alienation, bullying, popularity, and association with

gangs. The norms and
expectations within families, communities, and subcultures are
also strong social
factors.
4. Psychological factors: Researchers have discovered
consistent predictors of initial and
continued substance use, including learning factors, personality
variables, and higher
order cognitive processes. Alcohol and other drug abuse is
highly associated with
affective disorders and other psychiatric diagnoses, although as
noted earlier, some
psychological problems (e.g., anxiety and depression) may be
effects of the substance
use as well as causal factors. (See Figure 9.1.) Many people
who abuse substances
have a history of low self-esteem, impulsivity, deviance,
nonconformity, and antisocial
behavior. However, these psychological factors can all be the
effects (as opposed to
the causes) of substance abuse.
Figure 9.1: Substance use disorder and mental illness among
adults aged 18 or
older: numbers in millions, 2017
Substance use disorder and addiction may cause mental
disorders or other psychiatric diagnoses, but
they also may be the effects of the mental disorders. This graph
shows the overlap of mental illness
and substance use disorder of adults in 2017.
From Key Substance Use and Mental Health Indicators in the
United States: Results From the 2017 National Survey on Drug
Use

and Health (p. 41), by J. Bose, S. L. Hedden, R. N. Lipari, and
E. Park-Lee, 2018, Rockville, MD: SAMHSA
(https://www.samhsa.gov
/data/report/2017-nsduh-annual-national-report).
8.5
million
38.1
million
Mental illness,
no SUD
SUD,
no mental
illness
SUD and mental illness
18.7 million
adults had SUD
46.6 million adults
had mental illness
10.2
million
Many people deem addiction to be an issue of personal
weakness that originates out of self-
gratification and continues because of an unwillingness or lack
of sufficient willpower to stop.
However, within the scientific and medical communities, the
theory that addiction is driven

solely by pleasure-seeking behavior has decreased in popularity.
Instead, scientists and
redistribution.
https://www.samhsa.gov/data/report/2017-nsduh-annual-
national-report
https://www.samhsa.gov/data/report/2017-nsduh-annual-
national-report
171
medical experts now believe that people engage in potentially
addictive behaviors to escape
emotional and/or physical discomfort. In other words, people
commonly use alcohol or drugs
to feel good (or feel better), as we learned in the previous
section. Accordingly, the roots of
addiction reside in behaviors associated with self-medicating
and sensation seeking.
Emerging evidence suggests that addiction is functional. In
other words, addictive behaviors
serve while they also destroy. Addiction is a relationship
between a person and an activity or
an object. With addiction, the activity or object becomes
increasingly more important, while
previously important activities become increasingly less
important. Ultimately, addiction
is about the complex and common struggle between acting on
impulse and resisting that
impulse.

Genetics
Numerous scientific advances have shaped our current
interpretation of addiction. For exam-
ple, genetic research has demonstrated that approximately half
of the risk for addiction is
biological or genetic, and that some people are predisposed to
addiction but not to a specific
type of addiction (Betz, Mihalic, Pinto, & Raffa, 2000; Blum et
al., 2000; Potenza, 2001). Genes
influence the degree of reward an individual experiences when
initially using a substance
(e.g., cocaine) or engaging in certain behaviors (e.g., gambling).
In other words, it may be
more difficult for some people with certain genes to quit using
substances compared to other
people. (See Case Study: Joanne.) In addition, some people may
experience more severe with-
drawal symptoms if they try to quit compared to other people.
Case Study: Joanne
Joanne is a 51-year-old female who is in court-ordered
treatment for depression and sub-
stance use disorder. While she is not currently using drugs, she
acknowledges that her use of
cocaine and alcohol had spiraled out of control in the past year.
Over the past several years,
Joanne has been in and out of multiple jails and voluntary
treatment programs, and she has
become an expert in rationalizing her drug use.
Joanne had a very difficult upbringing. When she was 3 years
old, her father committed sui-
cide, and she was raised by a single mother who had a similar
inability to control her drinking
and drug use. Joanne was drinking and using drugs on a daily

basis by the time she reached
adolescence. By age 20 her drug use had moved from
recreational to the dependent stages of
addiction. Her cravings were so strong that she would skip any
social or occupational activity
to get drugs.
For the past year, Joanne has been secretly selling marijuana
and antidepressant medication
to several of her son’s classmates. She recognizes that her
behavior is wrong, and this is one of
many examples in which she is unable to use sound judgment.
Joanne’s recurrent drug use has resulted in a failure to fulfill
major role obligations at work
and at home. In fact, her most recent arrest stemmed from a
DUI, which she received while
driving to pick up her 14-year-old son from school. During
treatment, Joanne learned that
people with a first-degree relative (such as a parent) who has
addiction problems are more
likely to develop an addiction, and her greatest fear is that her
son and 12-year-old daughter
will inherit her problems with substance use.
redistribution.
172
Genes also affect the way in which the body processes
substances. An intensified desire to

reexperience the use of a substance can lead to regular use and
exposure, with chronic use
and chronic exposure potentially leading to changes in brain
chemistry. These changes may
include negative impacts to impulse control, judgment, memory,
and motivation. Moreover,
these changes can lead to increases in cravings for a substance,
as well as impairments in the
ability to regulate the impulse, despite the experience and
knowledge of the negative conse-
quences associated with addiction.
The Brain and Addiction
Most drugs associated with addiction affect
the release of dopamine (a chemical in
the brain that helps regulate emotional
responses, learning, attention, and move-
ment) in the brain’s reward system, which
contains a set of neural pathways that are
involved in the experience of pleasure. In
addition, brain-imaging technologies have
shown that our brains respond similarly to
different pleasurable experiences, whether
the pleasure is derived from ingesting alco-
hol or other drugs or from engaging in behav-
iors such as shopping, gambling, or exercise
(Werme, Lindholm, Thoren, Franck, & Brene,
2002; Werme, Thoren, Olson, & Brene, 2000).
Syndrome Model of Addiction
While most past research has focused on chemical objects of
addiction, there is increasing
evidence showing that behavioral objects of addiction (e.g.,
gambling, exercising) have a sim-
ilar influence over the reward system. This indicates that
seemingly disparate patterns of

addiction, such as heroin addiction and sex addiction, might
actually stem from a common
cause. This emerging view among clinicians and addiction
experts is known as the syndrome
model of addiction (Shaffer et al., 2004), which supports the
philosophy that there is only
one addiction disorder, as opposed to many different addictions.
Furthermore, the syndrome model categorizes addiction as a
complex condition with a vari-
ety of symptoms and signs that are not always present for every
person with the disorder. As a
result, addiction gets expressed in many different ways,
including a drug or drug-free activity
(such as exercising, gambling, shopping, etc.). For addiction to
develop, the activity or drug
must shift a person’s subjective experience in a personally
desirable direction.
These findings suggest that the specific behavior or substance
of addiction is less important
than previously thought.
©iStockphoto/Thinkstock
Brain-imaging technologies have shown that
our brains respond similarly to different
pleasurable experiences.
redistribution.
173

Section 9.5 Major Types of Commonly Abused Substances
9.5 Major Types of Commonly Abused Substances
Drugs of abuse can generally be described in four different
categories: depressants, stimu-
lants, opiates, and hallucinogens. From a biological standpoint,
marijuana has depressant,
stimulant, and hallucinogenic effects, and thus it will be
considered separately.
Depressants
Depressants reduce nervous system activity, resulting in
reduced anxiety and an overall
sense of relaxation. At higher doses, brain activity becomes
more disrupted, and these sub-
stances can produce stupor or insensibility. Motor skills and
logical reasoning are affected,
and fatigue may also result.
Alcohol is the most common depressant, and it is one of the
most widely abused drugs in
the United States. Moreover, alcohol abuse is the third leading
preventable cause of death in
the United States (CDC, 2014). Alcohol abuse is implicated in
many homicides (for both the
victim and perpetrator), automobile accidents, and hospital
admissions. Excessive amounts
of alcohol often cause blurred vision, loss of coordination,
slurred speech, impaired motor
skills, memory impairment, sudden mood swings, irregular
pulse, vomiting, dizziness, and a
progressive loss of inhibitions. One of the main effects on
logical reasoning is the inability to
think about possible outcomes of one’s actions, creating a short-
sighted view of the world due
to intoxication known as alcohol myopia. Long-term

consequences of chronic heavy use may
lead to ulcers, pancreatic damage, cirrhosis (liver failure),
arrhythmia (irregular heartbeat),
and high blood pressure.
Barbiturates—highly addictive drugs that act as a nervous
system depressant—have been
used historically as sleep aids and anxiety-reducing
medications. Recently, they have been
replaced in popularity by benzodiazepines, which are less prone
to overdose. Benzodiazepine
is a nervous system depressant that is often used to promote
sleep and reduce anxiety; the
most common benzodiazepine is diazepam (Valium). Similar to
alcohol, both of these drugs
can cause a sense of mild euphoria or relaxation. However,
these drugs are highly addictive
and can result in coma or death if taken with alcohol.
Stimulants
Stimulants cause an increase in arousal in the nervous system.
They increase blood pressure,
pulse rate, alertness, euphoria, and excitation. Loss of appetite
and insomnia are also common
effects of stimulant use. Typically, the stimulant user
experiences pleasant outcomes initially,
such as a state of euphoria (“on a high”) with increased energy.
It is also common for users to
be talkative, feel restless, be hypervigilant (“on edge”), and
have difficulty falling asleep.
Prolonged use of high doses of stimulants can result in brain
damage or stroke and may
produce significant personality changes. Other psychological
effects associated with long-
term stimulant use include anxiety, delusions of grandeur,

confusion, paranoia, and violent
behavior.
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174
Major stimulants include cocaine, crack, amphetamine,
methamphetamine, and ecstasy.
Minor stimulants include sugar, caffeine, and nicotine, which
are (in addition to alcohol) the
most commonly used psychoactive substances in the United
States. Moreover, some stimu-
lants are considered to be gateway drugs that, while not
necessarily addictive, may lead to
the use of more or other addictive drugs.
Cocaine
Cocaine is a highly addictive illegal stimulant drug of abuse
that can be administered in one
of four ways.
• Orally: Users may rub the drug onto
their gums.
• Intravenously: Users may dissolve
the drug in water and inject it.
• Intranasally: Users may snort the
drug.

• Inhalation: Users may smoke the
drug by inhaling its vapor into the
lungs.
Cocaine use ranges from occasional to
repeated or compulsive use. Any of the
routes of administration listed previously
can potentially lead to absorption of toxic
amounts of the drug, causing strokes, sei-
zures, respiratory failure, and heart attacks.
Crack is a form of cocaine that can be
smoked, and it can be especially dangerous
due to its fast and potent effects. It produces
an immediate rush within 5 to 10 seconds
of ingestion, and the high lasts only for a
total of 5 to 15 minutes. This cycle of rapid
“rush” and “crash” creates a cycle of craving
the drug.
Amphetamines and Methamphetamines
Amphetamines cause increased arousal, reduced appetite, and a
decreased need for sleep.
Physiological effects include an increase in blood pressure and
heart rate, while psychologi-
cal effects may include anxiety, hypervigilance, euphoria, and
paranoia. Prolonged use of high
doses of amphetamines can result in brain damage or stroke, and
users commonly suffer from
withdrawal after discontinuation, leading to irritability,
depression, and fatigue.
Similarly, methamphetamines are highly addictive illegal
stimulant drugs that are com-
monly used to help people stay awake. Acute effects include
loss of appetite, increasing heart

Brookhaven National Laboratory/Thinkstock
PET scans of a normal brain (top) and a
cocaine abuser’s brain 10 days (middle)
and 100 days (bottom) after using cocaine.
Bright red and yellow indicates normal
metabolic activity.
redistribution.
175
rate, difficulty breathing, irritability, hyperactivity, and
insomnia. Long-term effects may
include intense drug cravings and psychotic symptoms,
including hostility, paranoia, or audi-
tory hallucinations.
Ecstasy
Ecstasy is a drug with both hallucinogenic (discussed later) and
stimulant effects. Physiologi-
cally, ecstasy causes increased blood pressure and heart rate, as
well as nausea, chills, sweat-
ing, teeth clenching, and blurry vision. Psychologically, ecstasy
can cause feelings of increased
alertness, euphoria, and an overwhelming sense of
connectedness and well-being. While
ecstasy commonly enhances sexual desire, it is also known to
impair sexual performance.

Caffeine
Believed to be the most popular drug in the world (it is
consumed by approximately 90% of
people), caffeine is a legal nervous system stimulant that occurs
naturally in chocolate, tea,
coffee, and other products. It is also artificially added to
products like soda.
The effects of caffeine vary based on an individual’s sensitivity
to the drug, and it does have
addictive properties. When people who regularly consume
caffeine stop abruptly, they can
experience withdrawal symptoms like headaches, irritability,
and fatigue. (Sugar has also
been found to be an addictive substance with physiological and
psychological effects similar
to those of caffeine.) Fortunately, consumption of neither
caffeine nor sugar has been found
to be connected to criminal behavior.
Nicotine
While nicotine—a potent stimulant that is found in tobacco—is
highly addictive and con-
sidered a gateway drug, its use has also not been found to be
connected to criminal behavior.
Nicotine use is often maintained because it helps reduce
negative emotional states, including
anger, fear, and anxiety; however, unlike certain other
stimulants and substances discussed
in this chapter, heavy use of nicotine has not been found to
result in significant psychological
disturbances.
Opiates and Opioids
Opiates consist of naturally occurring, pain-reducing, and
highly addictive drugs that are

used in recreational and medical settings. Popular examples of
opiates include morphine and
codeine.
Opioids are similar to opiates, except opioids are the synthetic
versions of these drugs.
Heroin, hydrocodone, and oxycodone are among the most well-
known opioids. These drugs
depress the nervous system and produce a sense of euphoria and
decreased reaction to pain.
If taken in a high enough quantity, opioids can lead to stupor,
insensibility, and possibly death
by respiratory suppression. See Spotlight: The Opioid Crisis to
learn about the problems that
opioids—specifically prescription opioids—have caused in the
United States.
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176
Spotlight: The Opioid Crisis
The United States has an opioid crisis. Nearly 130 Americans
die every day from an overdose
of opioids, the class of drugs that includes heroin, hydrocodone,
oxycodone, morphine, and
codeine. In 2017 more than 70,000 Americans died from drug
overdose. In that same year,
opioids killed more than 47,000 people, and 68% of those
deaths involved prescription opioids.
Deaths involving prescription opioids in 2017 were 6 times

higher than in 1999 (CDC, 2018).
It is estimated that prescription opioid abuse in the United
States costs $78.5 billion a year,
including health care and addiction treatment costs, lost
productivity, and law enforcement
involvement (Florence, Feijun, Xu, & Zhou, 2016). Drug
overdose is now the leading cause of
accidental death in the United States, and opioid addiction is
driving this crisis. (See Figure 9.2.)
So, what can be done? Reducing the number of deaths connected
to opioid use will require
addressing the issue from multiple angles. For example, in many
treatment facilities, clinicians
are attempting to reduce or eliminate patients’ exposure to
opioid pain medications.
(continued)
Figure 9.2: U.S. opioid overdose deaths over past 20 years
Opioid overdose deaths continue to increase in the United
States. From 1999 to 2017,
nearly 400,000 people died from an overdose involving an
opioid.
From “Understanding the Epidemic,” by the Centers for Disease
Control and Prevention, 2018 (https://www.cdc
.gov/drugoverdose/epidemic/index.html).
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17
20

16
Year
D
ea
th
s
p
er
1
0
0,
0
0
0
p
o
p
u
la
ti
o
n
Commonly prescribed opioids
Natural and semi-synthetic opioids and Methadone

Heroin
Other synthetic opioids
e.g., Tramadol and Fentanyl, prescribed or illicitly
manufactured
Wave 1: Rise in
prescription opioid
overdose deaths
Wave 2: Rise in
heroin overdose
deaths
Wave 3: Rise in
synthetic opioid
overdose deaths
redistribution.
https://www.cdc.gov/drugoverdose/epidemic/index.html
https://www.cdc.gov/drugoverdose/epidemic/index.html
177
Hallucinogens
Hallucinogens frequently cause enhancement of sensory
experiences and distortions of real-
ity. In other words, these drugs produce a very intense
alteration of feelings, thoughts, and

perceptions. Physiological effects include sweating, dilation of
pupils, and increased blood
pressure, body temperature, and heart rate. Tolerance to
hallucinogens builds rapidly, which
means that people need to take steadily increasing amounts of
these drugs to experience
similar effects. LSD and ecstasy are among the most common
hallucinogens.
Interestingly, most research indicates that use of hallucinogens
does not increase criminal or
violent behavior, although people’s emotional responses can
vary greatly. For example, for
some people use of hallucinogens can increase the effects of
preexisting psychopathology,
including aggression or violent behavior.
Marijuana
Marijuana is the most widely used illicit
drug, although an increasing number of
states are moving (or have already moved)
toward legalizing the drug. The pros and
cons of this movement continue to be
debated, particularly from public health,
social justice, and law enforcement per-
spectives. In addition, there are still many
unanswered questions about the economic
impact of legalization.
What does science tell us about the risks
and benefits of marijuana use? Marijua-
na’s popularity is tied to its mood-altering
effects. Specifically, marijuana produces an
altered state of consciousness characterized
by relaxation and euphoria. It also produces

Spotlight: The Opioid Crisis (continued)
Additionally, there has been a dramatic rise in community-based
education efforts. These ini-
tiatives are typically aimed toward educating people about
opioids while helping reduce the
stigma associated with seeking treatment and resources for
opioid use disorder.
Community-based education has also assisted local leaders and
decision makers in utilizing
resources and building capacity for multifaceted community
conversations and policy actions
related to opioid use.
Finally, several states are working to introduce legislation to
expand rehabilitation and inter-
vention services for those impacted by the growing opioid
crisis. For example, in the state of
Florida, legislation passed in 2019 restricts opioid prescriptions
to no more than a 3-day sup-
ply (Regulation of Professions and Occupations, 2019).
Seth Michael/iStock/Getty Images Plus
A marijuana farmer examines his plants. A
number of states—including Washington,
Oregon, California, Nevada, Colorado,
Michigan, Alaska, Maine, Massachusetts, and
Vermont—and the District of Columbia have
fully legalized the drug.
redistribution.

178
Section 9.6 Relationship Between Substance Abuse and
Criminal Behavior
physiological effects, including fatigue, lowered blood pressure,
and increased appetite, as
well as perceptual alterations such as impairments to reaction
time, motor skills, and short-
term memory. In addition, there is a significant linkage between
heavy marijuana use and
criminal involvement.
9.6 Relationship Between Substance Abuse and Criminal
Behavior
Research consistently demonstrates a strong connection between
substance abuse and crimi-
nal behavior. Most people entering the criminal justice system
have substance use problems
and/or are using illicit substances at the time of their arrest
(Belenko & Peugh, 2005; Chan-
dler, Fletcher, & Volkow, 2009). In addition, many individuals
engage in criminal behavior to
get money to purchase drugs, and the sale of drugs is often
likely to take place in situations in
which other crimes may occur. And stimulants such as
methamphetamines have psychologi-
cal and physiological effects that can increase the likelihood of
engaging in criminal behavior
(Cartier, Farabee, & Prendergast, 2006).
Table 9.1 provides statistics on how many state and local
prisoners are reported to have used
drugs during a crime and a month before a crime. Drug use in
the month before and at the
time of property and drug offenses among sentenced jail

inmates was slightly higher than for
state prisoners. A third to half of all state and local prisoners
had used drugs during or soon
before committing the crimes for which they were arrested.
Table 9.1: Drug use among state prisoners and sentenced jail
inmates,
2007–2009
State prisoners Sentenced jail inmates
Characteristic
Month before
offense
At time of
offense
Month before
offense
At time of
offense
All inmates 39.3% 42.0% 54.5% 37.2%
Most serious offense
Violent 34.4% 39.9% 53.6% 37.2%
Property 47.0% 50.1% 63.4% 46.4%
Drug 47.1% 50.2% 66.6% 50.6%
DWI/DUI 33.5% 27.5% 24.2% 16.8%

Source: From Drug Use, Dependence, and Abuse Among State
Prisoners and Jail Inmates, 2007–2009 (p. 6), by J. Bronson, J.
Stroop,
S. Zimmer, and M. Berzofsky, 2017. Washington, DC: Bureau
of Justice Statistics.
redistribution.
179
Criminal Behavior
While it’s not feasible to summarize the entire body of research,
there have been two note-
worthy meta-analyses (systemic reviews on the literature) and
several research studies with
particularly interesting results.
Noteworthy Reviews and Studies
Derzon and Lipsey (1999) conducted a review and an analysis
of existing evaluation stud-
ies that examined the relationship between marijuana use and
problem behaviors, including
juvenile delinquency (i.e., behavior by a young person that is
illegal or wrongful; discussed in
Chapter 6). Their review was based on 63 reports that
summarized 30 independent studies
and found a significant association between marijuana use and
various forms of delinquency,
including property crimes, aggressive behavior, and crimes
against a person.

In a subsequent review, Bennett, Holloway, and Farrington
(2008) examined the results of
30 studies that presented findings on the relationship between
measures of substance use
and measures of crime. The results showed that the likelihood
of engaging in criminal behav-
ior was approximately 3 to 4 times greater for substance users
than non-substance users. In
addition, the researchers discovered that the relationship
between substance use and crime
varied widely depending on the substance that was used. For
example, crack cocaine use
displayed the strongest relationship with criminal behavior,
followed by heroin and powder
cocaine. Recreational substance use was also found to be
connected with criminal behavior,
but at a much lower level than frequent use. In addition,
marijuana users were found to be
1.46 times more likely to commit crimes compared to non-
marijuana users, and amphetamine
users were 1.93 times more likely to engage in crime compared
to non-amphetamine users.
In addition to these meta-analyses, three distinct types of
research have also helped establish
the relationship between substance use and criminal behavior:
general surveys of substance
use, studies of criminal behavior in substance-abusing
populations, and studies on substance
abuse in criminal populations.
General Surveys of Substance Use
As an example of a general survey, the CDC’s 2017 Youth Risk
Behavior Surveillance consisted
of a nationally representative sample of thousands of students

enrolled in private and public
high school students throughout the United States. According to
this survey, 5.5% indicated
that they had driven a car under the influence of alcohol, and
13% indicated that they had
driven a car under the influence of marijuana. In addition,
compared to other students, more
than 2 times as many students who reported significant
substance use also indicated that
they carried a weapon or had gotten into a fight in the past 30
days. Take a look at Tables 9.2
and 9.3 for a breakdown of the statistics for males and females
according to race and grade
level.
redistribution.
180
Criminal Behavior
Table 9.2: Percentage of high school students who drove
after drinking alcohol*
Category Female Male Total
Race/Ethnicity
White 3.8 6.3 5.0
Black 4.2 4.1 4.1

Hispanic 5.4 8.5 7.0
Grade
9 2.4 4.0 3.2
10 2.4 4.9 3.2
11 4.1 6.9 5.5
12 5.9 10.4 8.1
*In a car or other vehicle, one or more times during the 30 days
before the survey, among
the 62.6% of students nationwide who had driven a car or other
vehicle during the 30 days
before the survey.
Source: From “Youth Risk Behavior Surveillance—United
States, 2017,” by the Centers for
Disease Control and Prevention, 2018, Surveillance Summaries,
67.
Table 9.3: Percentage of high school students who drove
after using marijuana*
Category Female Male Total
Race/Ethnicity
White 10.2 13.7 11.9
Black 13.3 14.1 13.7
Hispanic 13.6 15.9 14.8

Grade
9 4.5 10.2 7.3
10 8.9 13.5 11.3
11 11.7 12.8 12.3
12 16.5 20.1 18.3
*In a car or other vehicle, one or more times during the 30 days
before the survey, among
the 62.6% of students nationwide who had driven a car or other
vehicle during the 30 days
before the survey.
Source: From “Youth Risk Behavior Surveillance—United
States, 2017,” by the Centers for
Disease Control and Prevention, 2018, Surveillance Summaries,
67.
redistribution.
181
Criminal Behavior
Studies of Criminal Behavior in Substance-Abusing Populations
There is a vast amount of research regarding criminal behavior
in substance-abusing popula-
tions. For example, a study involving more than 200 heroin
users determined that more than

95% of those heroin users were engaged in other illegal
activities (Johnson, Maher, & Fried-
man, 2001). A separate study determined that approximately
99% of those heroin users had
committed at least one crime in the past year (Inciardi, 1986).
While the majority of crimes
included drug sales and property offenses, thousands of
burglaries, robberies, and assaults
also occurred. Additionally, a study focused on opiate abusers
reported that nearly 95% of
heroin users were engaged in other criminal behaviors and that
their participation in crimes
was highest during their periods of heaviest heroin abuse
(Nurco, Hanlon, Kinlock, & Slaght,
1989).
As you can see, there is a significant amount of research that
has investigated the relation-
ships between criminal behaviors and types of substance use.
This is true both in the United
States and internationally. In an Australian study, Makkai
(2001) found that arrestees testing
positive for opiate use were more than 4 times as likely to be
charged with a property offense
compared to arrestees who were non-opiate users. Additionally,
arrestees who tested posi-
tive for cocaine use were more than 2 times as likely to be
charged with a violent offense.
In a study conducted in the United States, Johnson, Natarajan,
Dunlap, and Elmoghazy (1994)
conducted interviews with more than 1,000 substance abusers
and found differences between
the abuser types. For example, crack users were found to be
more likely than non-substance
abusers to report shoplifting offenses (21% compared to 9%). In

a separate study, Johnston,
O’Malley, and Eveland (1978) found a strong relationship
between substance abuse and dif-
ferent types of criminal behavior, includ-
ing interpersonal violence. Specifically, the
drugs that were most strongly correlated
with interpersonal violence were cocaine,
heroin, amphetamines, and barbiturates.
More recently, Bennett and Holloway
(2005) found that users of cocaine and
heroin were nearly 5 times more likely to
commit shoplifting offenses than nonusers.
Also, marijuana users were nearly twice as
likely to commit nonresidential burglar-
ies compared to non-marijuana users and
approximately 3 times as likely to commit
drug-supply offenses.
Studies on Substance Abuse in Criminal Populations
Studies on substance abuse with incarcerated offender
populations have also yielded infor-
mative results. For example, Karberg and James (2005)
surveyed more than 600,000 prison-
ers and found that 68% of them met criteria for substance abuse.
The results of this study also
indicated that more extensive substance use by prisoners was
correlated with a more exten-
sive history of criminal behavior. In addition, the Arrestee Drug
Abuse Monitoring Program
was an excellent resource in establishing the prevalence of
substance use among arrestees.
vchal/iStock/Getty Images Plus
Bennett and Holloway (2005) found that users

of cocaine and heroin were nearly 5 times
more likely to commit shoplifting offenses.
redistribution.
182
Criminal Behavior
In 2001 the research program identified several key findings
related to substance use and
criminal behavior, including the following.
1. Urine tests of people arrested indicated that 65% tested
positive for at least one
illegal substance.
2. Cocaine or opiate use was found in 29% of people arrested.
3. Repeat offenders accounted for 15% of those arrested; they
indicated regular use of
crack or heroin.
4. Users of crack and heroin represented less than 25% of the
sample yet were respon-
sible for more than 60% of the illegal income reported.
5. Of those arrested, 40% acknowledged a relationship between
their own substance
use and criminal behavior. (National Institute of Justice, 2006)
Research conducted on substance abuse in both criminal

populations and their victims sup-
ports a strong relationship between criminal behavior and
substance abuse. For example, the
National Crime Victimization Survey presents national data on
an annual basis about crimi-
nal victimization in the United States. One of the questions
asked on this survey to victims is
whether they believed the perpetrator was under the influence of
alcohol or drugs at the time
of the crime. Consistently, victims have indicated that
approximately 50% of the perpetrators
appeared to be under the influence at the time of the crime
(Bureau of Justice Statistics, 2018).
The results of research in this area are highly consistent in
determining that people who com-
mit crimes are far more likely to abuse substances than people
who do not commit crimes.
Consequences of Criminal Behavior Related to Substance Abuse
The use of illicit substances exposes people to criminal
prosecution by local, state, and fed-
eral authorities. Immediate penalties can include fines, loss of
driving privileges, and possible
time in prison. Moreover, people who abuse substances in early
adulthood may establish pat-
terns of behavior that later disrupt their careers and limit their
ability to maintain healthy
family and social lives.
Substance abuse undoubtedly constitutes a major problem in the
United States and around
the world. Substance abuse can lead to a variety of negative
outcomes, including a long-
lasting decrease in occupational and social functioning, as well
as rates of greater morbidity

and early mortality. Out of every 100,000 people around the
world, 33 are estimated to die
from alcohol-related causes, and 7 are estimated to die from
illegal drug use (Peacock et al.,
2018). The Bureau of Justice Statistics (2018) reports that 3.9%
of the 14,831 homicides
that were committed in 2007 were substance related. From 2000
to 2010, the CDC (2012)
reported a 55% increase in heroin-related deaths.
Overall, the consequences of criminal behavior related to
substance abuse are astounding.
The emotional costs to individuals with substance use disorders,
their families, and the vic-
tims of their crimes are incalculable. In addition, substance
abuse involves great financial
costs for societies, including direct and indirect costs associated
with criminal activity, law
enforcement, accidents, hospitalization, and treatment. The
National Institute on Drug Abuse
(NIDA, 2017) estimates that the total crime-, work-, and health
care–related costs of sub-
stance abuse were more than $740 billion annually.
redistribution.
183
Section 9.7 Strategies for Reducing Substance Abuse and
Substance-Related Crime
9.7 Strategies for Reducing Substance Abuse and

Substance use disorders are among the most preventable health
issues in the United States.
Strong empirical evidence over the past several decades has
consistently demonstrated that
substance abuse treatment reduces criminal behavior. Treatment
might include individual
counseling and/or family-based treatment. For some people in
need of alcohol or other drug
treatment, contact with the criminal justice system can
sometimes represent their first oppor-
tunity for treatment. Moreover, legal incentives (e.g.,
consequences) may motivate someone
to get treatment who was otherwise resistant.
For other people, getting arrested or incarcerated is part of a
recurring cycle of substance
abuse and criminal behavior. People with ingrained patterns of
maladaptive beliefs and cop-
ing skills may require a more intensive treatment approach,
particularly among people with
a prolonged history of substance abuse and criminal behavior.
Illicit substance abuse also
increases the likelihood of continued involvement in crime, with
high rates of relapse and
criminal recidivism among offenders. In fact, research has
shown that 68% of substance-
related offenders are rearrested within 3 years of release from
jail (Levin, 2006). Fortunately,
there are effective treatment models for prisoners and, in
addition to beneficial effects for
public health and safety, substance abuse treatment has been
shown to improve outcomes for
substance-abusing offenders.
The NIDA (2014) has been a key supporter of research on
substance abuse treatment for

individuals involved in the criminal justice system, and findings
have shown that providing
comprehensive substance abuse treatment is effective in
reducing both substance abuse and
recidivism. Moreover, based on a comprehensive review of the
research literature, as well as
consensus from experts in substance abuse research and
practice, the NIDA has developed a
monograph summarizing several key principles for effective
treatment. Specifically, the NIDA
recommends the following.
1. Treatment must be long enough to produce stable behavioral
changes.
2. Services should be tailored to fit the needs of the individual.
3. Treatment should be carefully monitored.
4. Continuity of care is critical as criminals make the transition
back into the community.
Supply, Demand, and Harm Reduction Treatment Model
Additionally, the U.S. government has developed several
important strategies for reducing
substance abuse, including supply reduction, demand reduction,
and harm reduction. The
most effective way of tackling the substance abuse problem and
crime problems in the United
States involves a comprehensive, coordinated, and balanced
approach, in which supply reduc-
tion, demand reduction, and harm reduction all reinforce each
other.
redistribution.

184
Section 9.7 Strategies for Reducing Substance Abuse and
The supply reduction approach attempts
to put actions and policies in place that
are designed to reduce the production and
supply of illicit substances. One example
of an effective supply reduction policy is
interdiction, which involves intercepting
or destroying supplies of illicit substances
across U.S. borders.
The demand reduction strategy involves
minimizing the actual demand for illicit
substances. A prominent example of the
demand reduction approach is educational
youth programs that are designed to rein-
force attitudes, behaviors, skills, and values
associated with resisting substance use.
Finally, harm reduction is a set of ideas and public health
strategies aimed at reducing nega-
tive consequences associated with substance abuse.
Philosophically, harm reduction accepts
that a continuing level of substance use (both legal and illegal)
in society is inevitable. Thus,
its objectives are reducing negative economic, social, and health
outcomes. An example of
harm reduction is to provide individuals with information aimed
at reducing the harmful
consequences of the behavior when it occurs.
Biopsychosocial Model of Treatment
In terms of treatment, the most successful substance abuse and

addiction treatment programs
utilize strategies to manage triggers, reduce cravings, enhance
coping, and prevent relapse.
Recovery requires an approach that systematically considers the
biological, psychological,
and social aspects of substance abuse. In psychology, this is
referred to as the biopsychosocial
model of treatment.
Consider the following example. One of the coauthors of this
textbook had a colleague who
once suffered a workplace injury that required long-term pain
management. This colleague
had a social circle of friends that encouraged the use (and
abuse) of alcohol and opiates, which
ultimately resulted in a life-changing drug addiction.
The most effective treatment for this individual would be one
that explores the biopsychoso-
cial factors involved in the abuse of and ultimate addiction to
alcohol and opiates. As noted in
Figure 9.3, some of these factors may have been financial
stress, a negative life event (work-
place accident), age, and poor social support.
mofles/iStock/Getty Images Plus
Interdiction involves intercepting or destroying
supplies of illicit substances across U.S. borders.
redistribution.
185

Summary and Conclusion
The relationship between substance abuse and crime is complex.
There are four primary
reasons why people use drugs and other substances: to feel
good, to feel better, to perform
better, and to conform to peer pressure or satisfy curiosity.
There is always a risk that an
individual may move from regular to chronic substance abuse
and develop an addiction.
Substance use and addiction are influenced by broad cultural,
economic, environmental,
social, and situational contexts that influence the likelihood of
crime occurring. While the
exact mechanisms underlying addiction are not fully
understood, it is hypothesized that
the contribution of differing factors (biological, psychological,
social) varies between indi-
viduals. The current classification system that is primarily used
to diagnose addiction and
substance use disorders is the DSM.
Figure 9.3: Biopsychosocial model of health
The biopsychosocial model considers biological, psychological,
and social factors and their complex
interactions in understanding substance use and abuse.
Engle’s biopsychosocial model of health and disease adapted for
our study by Tesfa Dejenie Habtewold, used under CC BY /
Adapted from original.

Health
Biological factors:
Age, sex, comorbid disease,
genetics, physical health,
personality/temperament
Social factors:
Socioeconomic status,
educational status,
marital status, major
family conflict, poor
social support
Psychological factors:
Unemployment,
financial stress,
negative life event,
pill burden, smoking,
lack of regular
physical exercise
redistribution.
https://ijmhs.biomedcentral.com/articles/10.1186/s13033-016-
0106-2
https://orcid.org/0000-0003-4476-518X
https://creativecommons.org/licenses/by/4.0/

186
This chapter also provided a brief overview of the major types
of commonly abused
substances—depressants, stimulants, opiates and opioids,
hallucinogens, and marijuana—
and their links to criminal behavior. Alcohol and drugs are
commonly found in both offend-
ers and victims of crimes. Substance abuse is highly associated
with criminal behavior; there
is strong evidence that substance abusers are more likely than
non-substance abusers to
engage in criminal behavior and that people who commit crimes
are more likely to be sub-
stance abusers than people who do not commit crimes.
Major strategies for reducing substance abuse and substance-
related crime include supply
reduction, demand reduction, and harm reduction. Supply
reduction involves implementing
policies that are designed to reduce the production and supply
of illicit substances. Demand
reduction involves reducing the actual demand for illicit
substances, primarily by working
with youth and teaching them to resist drug use. Harm reduction
aims to reduce negative
economic, health, and social consequences associated with
substance abuse.
Critical Thinking Questions
1. If a person abuses an illicit substance, should she or he be
treated as a criminal? Or
should the person be treated as someone who has a disease?

2. Is the relationship between substance use and mental illness
important when think-
ing about crime? Why or why not?
3. Do you think parents should be prosecuted when their
children (under the age of
18) abuse illicit substances? Why or why not?
Key Terms
addiction A chronic disorder with
environmental, biological, social, and
psychological factors that influence its
development and maintenance.
alcohol myopia The inability to think about
possible consequences of one’s actions due
to alcohol intoxication.
amphetamine A nervous system stimulant
that causes physiological effects such as
increased arousal, a reduction in appetite, a
decreased need for sleep, and psychological
effects such as anxiety, euphoria, and
paranoia.
barbiturate A highly addictive drug that
acts as a nervous system depressant and is
often used for insomnia and anxiety.
benzodiazepine A nervous system
depressant that is often used to promote
sleep and reduce anxiety.
caffeine A legal nervous system stimulant
naturally occurring in chocolate, tea, coffee,

and other products.
chronic Constantly recurring or persisting
for a long time.
cocaine An addictive stimulant drug that
increases arousal in the nervous system and
results in a euphoric high.
crack A powder form of cocaine that can
be smoked. Produces an immediate “rush”
within 5 to 10 seconds of ingestion and a
subsequent “crash.”
demand reduction A drug reduction policy
that involves actions and strategies designed
to decrease or eliminate an individual’s
desire to use illicit substances.
redistribution.
187
depressant Any substance that reduces
functioning of the nervous system. Produces
reduced anxiety and an overall sense of
relaxation.
dopamine A chemical in the brain that
helps regulate emotional responses,
learning, attention, and movement.

drug Any substance that alters the
functioning of the nervous system and mind.
ecstasy An illegal drug with stimulant and
hallucinogenic effects.
euphoria A feeling of well-being or elation.
gateway drugs Habit-forming drugs that,
while not necessarily addictive, may lead to
the use of more or other addictive drugs.
hallucinogens A diverse group of
drugs that alter feelings, thoughts, and
perceptions.
harm reduction A set of ideas and
strategies aimed at reducing negative
consequences associated with substance
use.
interdiction An effective supply reduction
policy that involves intercepting or
destroying supplies of prohibited items.
marijuana A drug that produces mood-
altering effects such as relaxation and
euphoria. Though illegal in some states,
an increasing number of states are moving
toward legalizing it for recreational or
medical use.
methamphetamine A highly addictive and
potent nervous system stimulant commonly
used to help people stay awake.

nervous system The network of nerve cells
and fibers that transmit signals between
different parts of the body. Essentially the
body’s wiring.
nicotine A potent stimulant that is found in
tobacco.
opiates Naturally occurring, pain-
reducing, and highly addictive drugs used in
recreational and medical settings.
opioids The synthetic versions of opiates.
relapse A return to substance use after a
period of improvement.
reward system The set of neural pathways
in the brain that are involved in the
experience of pleasure.
stimulant A drug that causes an increase in
arousal of the nervous system. These include
cocaine, amphetamines, methamphetamines,
ecstasy, caffeine, and nicotine.
substance Anything that can alter an
individual’s cognition or mood.
substance abuse The hazardous or
harmful use of substances. This term is no
longer included in the DSM-5; however, it
is still commonly used by researchers and
government officials.

substance use disorders Patterns of
symptoms resulting from the use of a
substance that an individual continues
to take despite experiencing problems as
a result of the substance use. This is the
current terminology used in the DSM-5.
supply reduction A drug reduction policy
that involves actions and strategies designed
to reduce the production and supply of illicit
substances.
syndrome model of addiction A theory
that suggests there is one addiction that is
associated with multiple expressions.
withdrawal symptoms Physical and/or
psychological symptoms that occur when a
substance is absent from the body.
redistribution.
redistribution.

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