1. What is a drug?
Who uses drugs? Who uses drugs?
What is drug “abuse?”

2. Definitions
Drug: chemical substance other than food or water that affects
the mind and/or body
Abuse: 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)

3. • 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)
…

4. 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

5. Alcohol Equivalents

6. Harm from heavy alcohol consumption
Child development
• >50,000 babies born yearly
• 1/4 are FAS – mental disabilities, head/face deformities, stunted
growth, organ defects
• Decreased school performance
Health and Mortality
• Unprotected sex
• U.S. war veterans (35-44), heavy users 5.5X more likely to die early
than light/moderate drinkers
• Drunk driving
Violence
• 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

8. Objective conditions
http://www.monitoringthefuture.org/

9. 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 family
A FEW PATTERNS by SOCIAL GROUP
A. Race/ethnicity:
1. American Indians (AI) highest rates (~17% of deaths involved
alcohol)
2. NH whites
3. NH Blacks
4. Hispanics
B. 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% (“)

10. Figure 1. Percentages of Youths Aged 12 to 17 Reporting Past
Year Alcohol Use, "Binge" Alcohol Use,† or Heavy Alcohol Use,†
by Race/Ethnicity: 2000
Fig. 1.

12. 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).

13. Alcohol: Dimensions of the Problem
PATTERNS by SOCIAL GROUP
C. 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…

14. 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 D
Heavy: 5 or + on same occasion at least 5 different days in past 30 D

15. 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 family
3. Consumption low-alcohol beverages: beer and wine
4. Parents drink in moderation (learning/modeling)
5. Drinking is a custom not a moral issue
6. Abstinence is as acceptable as drinking
7. Drinking not a sign of “manhood” or adulthood
8. Drunkenness NOT socially acceptable (even though drinking is)
 Conclusions:
 Drinking, heavy drinking not an individual issue
 Group norms shaping alcohol use

17. 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

18. Missing Numbers: suppression of a problem
Note that the y-axis in this graph has been truncated at 40 percent, which makes the
negative slope from 73.7 % to 45.5%—so it appears steeper than if the y-axis started at 0.

19. Percent of College Freshmen Who Drink Beer Occasionally
(using "0" as starting point)
80
75
70
65
60
55
50
Percent
45
40
35
30
25
20
15
10
5
0
1985
1990
1992
1998
2004
1982
1983
1984
1986
1987
1988
1989
1991
1993
1994
1995
1996
1997
1999
2000
2001
2002
2003
Year

21. What about methamphetamine?

22. Methamphetamine Use in 8,10,12th graders

24. *these data = “ever used” cocaine; MTF chart shows past 30 day use

25. What might account for differences in
tobacco use across the U.S.?

26. Searching for markets & changing norms

27. 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?

28. Social Policy: Responding to the Drug Problem
Strategies 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

29. Some Data on the “War on Drugs”
Overdose Drug-related Arrests for drug law
deaths murders violations
Teens Adults All Teens Adults
1980 (before "War
on Drugs") 260 6,600 407 205,000 375,000
1998 (10+ years
after "WOD") 300 15,000 891 412,000 944,000
Source: Drug Abuse Warning Network
(DAWN) http://dawninfo.samhsa.gov/

30. Marijuana Laws worldwide

31. Percentage of Adult Population Using Cannabis
Source: United Nations Drug Report
http://www.unodc.org/pdf/WDR_2005/volume_2_chap8_drugabuse.pdf

32. Percentage of Adults Using Cocaine in Past Year
Source: United Nations World Drug Report
http://www.unodc.org/pdf/WDR_2005/volume_2_chap8_drugabuse.pdf

33. 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

34. Image from: Good, Erich. 1999/2005. Drugs in American Society, 5th and 6th editions

35. Federal Prisoners in 2003 by Most Serious Offense
Source: Bureau of Justice Statistics
http://www.ojp.usdoj.gov/bjs/abstract/p05.htm

36. 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 plants
Source: US sentencing Commission, 1996 Sourcebook of Federal Sentencing
Statistics, pg 22.]

37. 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

38. 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 increased
View 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

39. 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

40. Harm Reduction model for heavy alcohol users
http://www.cnn.com/2011/HEALTH/05/11/minneapolis.wethouse.alcoho
lics/index.html

41. 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]

42. 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.3
1
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.

43. 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.

44. • Film: GRASS
http://mediasite.apps.fsu.edu/ttsg/flash/2007/102830/grass.h
tml
• written and directed by Ron Mann
(1999) Documentary
While it's unlikely to change the United States' drug policy, Ron Mann's 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 Vesta's
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 government's 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=218
Publisher: Autonomedia/Warwick, ISBN: 1570271070

45. “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?

46. Solutions & Thoughts
1. 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

47. • 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

48. Classes (types) of drugs:
• Stimulants:
– Caffeine, nicotine, cocaine and crack, amphetamines, Ritalin
• Depressants:
– Analgesics (pain killers; Motrin), narcotics/opiates (e.g., morphine,
codeine, heroin)
– Sedatives:
• Hypnotics, alcohol
• Antipsychotics:
– Lithium (bipolar)
• Hallucinogens
– LSD, peyote, Mescaline, angel dust
• Cannabis
• Steroids
• Prescription drugs