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C H A P T E R O B J E C T I V E S Learn the types and effects of
alcohol and various other drugs. Identify the patterns of use in
the United States. Explain the personal, inter-
personal, and societal con-
sequences of the use and abuse
of alcohol and other drugs. 1 2 3 Understand the varied social
struc tural factors that facilitate
and help perpetuate the
problem. Describe the kinds of attitudes
and ideologies that underlie
America’s problem of alcohol
and other drugs. 4 5 3 Alcohol and
Other Drugs 03-M4318.indd 56 03-M4318.indd 56 8/16/07 12:11:39 PM 8/16/07 12:11:39 PM 57 Despair and Hope Two voices illustrate the trauma of
drug abuse. The fi rst is a cocaine
addict, a man mired in despair. The
second is the parent of an alco-
holic, a mother who has hope after
years of despair. Mark, the cocaine addict, grew up in a small southern town. After
two years of college, he found a
good-paying job in a large city. For
a while, his life seemed to be on a
fast, upward track: But I lost it all because I got
hooked on crack. I wanted to
hang out with the fast people. But
crack is a double-edged sword. It
makes you feel great, but it tears
your life apart. I was always able
to meet every challenge of my life.
But I can’t beat this drug thing. My
company paid tens of thousands
of dollars to send me through two
rehabilitation programs. I didn’t get
any better, so they fi red me. I’ve had a heart operation, but I’m still smoking. Coke is a cruel mistress, man. She don’t care who
she takes from. And she doesn’t give anything back. Mark, now homeless, is resigned to a dismal existence. In his own mind, he will never be anything
other than a cocaine addict. Betty, the mother of the alcoholic, is also a victim of the drug problem. Her years of pain underscore the fact that it is not only the abusers who suffer destructive consequences. Her
son, Curt, is sober at the present time. But Betty vividly remembers the years of abuse: • • 03-M4318.indd 57 03-M4318.indd 57 8/16/07 12:11:40 PM 8/16/07 12:11:40 PM 58 part 2 • Problems of Behavioral Deviance He was only 14 when he started drinking. I don’t know why. But he began
avoiding us, and skipping school. He spent a lot of time alone in his
room when he was at home. For years I cried for my boy. But I refused to
admit that he had a drinking problem. My husband told me that Curt was
getting drunk, but I insisted it was just his allergies. When he was 18, he left home. You can’t imagine the pain I felt. But three
months later, he suddenly appeared at the kitchen door. He was dirty,
hungry, and thin. I gave him some food. He stayed home, but a year later
he came home drunk again and was foul-mouthed. My husband told him
to go to bed, and when he sobered up he should leave our house. He did,
but three months later he called. He was desperate. We got him into a
short-term treatment center, then brought him home again. My husband
died shortly after that. I was afraid Curt would go off on another binge,
but he’s stayed with me and is working now and helping support me. Betty is hopeful but also apprehensive about Curt’s long-term prospects.
Like everyone connected with a person who abuses alcohol, she can
only live day by day. The grimness on her face as she tells her story pow-
erfully expresses her uncertainty. Introduction Americans have had ambivalent feelings about alcohol and other drugs throughout their
history. In general, the colonists regarded alcoholic beverages as one of God’s gifts to
mankind. As Furnas (1965:18) noted, our forebears “clung long to the late medieval
notion that alcohol deserved its splendid name, aqua vitae, water of life.” Drunkenness
was punished, but drinking was generally considered one of life’s pleasures. Yet by the
19th century a growing temperance movement began urging its members to abstain
from all alcoholic beverages (Furnas 1965:67). Until the beginning of the 19th century, the use of opium and its derivatives was less offensive to Americans than smoking cigarettes or drinking. After the Civil War, how-
ever, some Americans began to warn about the dangers of addiction. Eventually these
warnings became part of national policy as seen in the war on drugs that began in the
1980s. This ambivalence about drugs is based partly on the distinctions among use, abuse, and addiction. The abuse of alcohol and other drugs, not the use, creates the problem.
We de ne abuse as the improper use of alcohol and other drugs to the degree that the
consequences are de ned as detrimental to the user or to society. Addiction is a form
of abuse. Addiction has been called a “brain disease” because continued abuse of a
drug causes changes in brain function that drive the addict to compulsive seeking and
use of the drug (Leshner 1998). addiction repeated use of a drug
or alcohol to the point
of periodic or chronic
intoxication that is
detrimental to the user or
society addiction repeated use of a drug
or alcohol to the point
of periodic or chronic
intoxication that is
detrimental to the user or
society abuse improper use of drugs or
alcohol to the degree that
the consequences are
defi ned as detrimental to the
user or society abuse improper use of drugs or
alcohol to the degree that
the consequences are
defi ned as detrimental to the
user or society 03-M4318.indd 58 03-M4318.indd 58 8/16/07 12:11:40 PM 8/16/07 12:11:40 PM chapter 3 • Alcohol and Other Drugs 59 Not every case of abuse involves addiction. A man may not be an alcoholic, but he may get drunk and kill someone while driving his car. A woman may not be hooked on
any drugs, but she may be persuaded to try LSD, have a “bad trip,” and commit suicide. Our focus in this chapter is on abuse, including addiction. We look at alcohol and other drugs, discussing their effects on users, patterns of use, effects on the quality of
life, multiple-level factors that create and perpetuate the problems, and ways people
have attempted to cope. Alcohol The use and abuse of alcohol is the nation’s most serious health problem. We examine rst the effects of this troublesome drug. Effects All alcoholic beverages contain the same drug, ethyl alcohol or ethanol, but the propor-
tion varies in different beverages. An individual can consume about the same amount
of alcohol by drinking a pint of beer, a glass of wine, or a shot (1.5 ounces) of whiskey.
What happens when that alcohol is ingested? The alcohol is burned and broken down
in the body at a relatively constant rate. If an individual drinks slowly, there is little or
no accumulation of alcohol in the blood; but if an individual consumes alcohol more
quickly than it can be burned in the body, the concentration of alcohol in the blood
increases. A small amount of alcohol can result in changes in an individual’s mood and behav- ior, and the effects become more serious as the concentration of alcohol in the blood
increases (National Institute on Alcohol Abuse and Alcoholism 2001). A blood alcohol
level of about 0.05 percent (one part alcohol to 2,000 parts blood) can make the individ-
ual feel a sense of release from tensions and inhibitions. This mild euphoria is the aim
of many people who drink moderately. As the alcohol level increases, however, there is
an increasing loss of control because alcohol acts as a depressant on brain functions. At
the 0.10 percent level, the individual’s motor control is affected—hands, arms, and legs
become clumsy. At 0.20 percent, both the motor and the emotional functions of the
brain are impaired, and the individual staggers and becomes intensely emotional. This
is the level at which someone is de ned as drunk. At 0.30 percent, an individual is incapable of adequately perceiving and responding to the environment and may go into a stupor. At 0.40 or a higher percent, the individual
lapses into a coma and may die. What do these numbers mean in actual drinks? Suppose you are a 150-pound individ- ual who drinks on an empty stomach. After drinking two bottles of beer or the equiva-
lent (11 ounces of wine, two highballs, or two cocktails), you will feel warm and relaxed.
After three bottles of beer or the equivalent, you will start experiencing more intense
emotions and are likely to become talkative, noisy, or morose. Four bottles of beer or its
equivalent produces clumsiness and unsteady walking and standing. At this point, you
are legally drunk in most states. If you drink four bottles of beer or the equivalent on an
empty stomach, it takes about eight hours for all the alcohol to leave your body. The damaging effects of alcohol abuse are most obvious in the alcoholic—the individual who is addicted to alcohol. Alcoholism is de ned in terms of four symp-
toms (National Institute on Alcohol Abuse and Alcoholism 2001): (1) a craving or 03-M4318.indd 59 03-M4318.indd 59 8/16/07 12:11:41 PM 8/16/07 12:11:41 PM 60 part 2 • Problems of Behavioral Deviance compulsion to drink; (2) loss of control to limit drinking on any particular occasion;
(3) physical dependence, so that withdrawal symptoms (nausea, sweating, shakiness,
anxiety) are experienced if alcohol use ceases; and (4) tolerance, the need to drink
increasingly greater amounts in order to get “high.” Because the effects can be so del-
eterious and the use of alcohol is so widespread, many experts consider alcohol abuse
the major drug problem in the United States today. Patterns of Use About 63 percent of Americans identify themselves as drinkers, 25 percent say they
sometimes drink more than they should, and 37 percent say that drinking has been a
source of trouble in their families (Maguire and Pastore 2006:269–72). A national sur-
vey found that alcohol use and impairment affects 15 percent of the workforce (Frone
2006). Some drink before work and some during work. Millions work while under the
in uence of alcohol, and millions more work with a hangover. By their own admission,
then, tens of millions of Americans have a problem with alcohol abuse. Drinking patterns vary across different groups, though all groups are affected to some extent. American Indians probably have the highest rates of use and abuse of
alcohol. Compared to the general population, they begin drinking at an earlier age,
drink more frequently and in greater amounts, and have a higher alcohol-related death
rate (May and Moran 1995). Alcohol is involved in nearly 17 percent of all American
Indian deaths. Whites drink more than African Americans or Hispanics. And across racial and ethnic lines, men drink more than women (Maguire and Pastore 2006). Gender differ-
ences are decreasing, but alcohol abuse and alcoholism are primarily male problems. Alcohol abuse is also more common among the young. A national survey reported that 44 percent of college students were binge drinkers, consuming ve drinks in a
row (or four in a row for women) on at least one occasion in the two weeks prior to the Alcohol use and abuse are
most likely to take place in
groups. 03-M4318.indd 60 03-M4318.indd 60 8/16/07 12:11:41 PM 8/16/07 12:11:41 PM chapter 3 • Alcohol and Other Drugs 61 survey (Wechsler 2002). Binge drinkers are far more likely than others to have unpro-
tected sex, to drive after drinking, to fall behind in school, to be aggressive, and to be
involved in property damage. Interestingly, going to a four-year college is associated
with higher rates of heavy drinking for whites, but with lower rates for African Ameri-
cans and Hispanics (Paschall, Bersamin, and Flewelling 2005). A substantial proportion of children and young adolescents also drink. A national survey of 8th-, 10th-, and 12th-grade students found that 75.1 percent consumed alco-
hol by the end of high school and 41 percent consumed it by eighth grade (Johnston,
O’Malley, Bachman, and Schulenberg 2006). In another national survey, 8 percent of
seventh graders and 17 percent of eighth graders admitted to binge drinking in the last
year (Guilamo-Ramos, Jaccard, Turrisi, and Johansson 2005). Such patterns are im-
portant because the earlier someone begins drinking, the more likely that person is to
become alcohol-dependent (Hingson, Heeren, and Winter 2006). Thus, the skid-row image of the alcohol abuser is false. Those most likely to drink frequently and to consume higher quantities of alcohol per drinking session are young,
white, male, and comparatively well-to-do (Moore et al. 2005). Alcohol and the Quality of Life Alcohol, like other drugs, has some medical bene ts when used in moderation. In fact,
there is evidence that moderate drinkers, compared to both abstainers and heavy drink-
ers, have a lower rate of coronary heart disease and are less likely to have a heart attack
(Mukamal and Rimm 2001). Alcohol abuse, on the other hand, is highly deleterious to
the quality of life. Physical Health. The physical consequences of alcohol abuse contradict the Ameri- can value of physical well-being. As mentioned earlier, the immediate effects of intoxi-
cating levels of alcohol include impaired motor performance. The long-range effects
of heavy drinking involve impairment of the major organs of the body, including the
heart, brain, and liver (National Institute on Alcohol Abuse and Alcoholism 2001).
Cirrhosis of the liver, one of the more widely known effects of heavy drinking, is an
occupational disease of the alcoholic. A lesser-known effect is the premature aging of
the brain (Noonberg, Goldstein, and Page 1985). At any given time, the neuropsycho-
logical functioning of the alcoholic—as measured by such things as eye-hand coordi-
nation and spatial ability—will be equivalent to that of someone about 10 years older.
In terms of cognitive ability, in other words, alcoholism costs the user about 10 years
of life. Heavy drinking also may result in muscle diseases and tremors. Heart functioning and the gastrointestinal and respiratory systems may be impaired by prolonged heavy
drinking. Whereas moderate alcohol consumption protects the heart, heavy consump-
tion increases the risk of strokes (Reynolds et al. 2003). The ills of the gastrointestinal
system range from nausea, vomiting, and diarrhea to gastritis, ulcers, and pancreatitis.
Problems of the respiratory system include lowered resistance to pneumonia and other
infectious diseases. Among women, alcohol abuse can result in menstrual cycle irregu-
larity, inability to conceive, and early onset of menopause (Gavaler 1991). Among men,
alcohol can lead to impotence and sterility (Wright, Gavaler, and Van Thiel 1991). Alcohol abuse can lead to early death (Costello 2006). A study of male veterans found that the death rate among alcoholics was 2.5 times higher than that of nonalco-
holics, and that alcoholics in the 35- to 44-year-old age group were 5.5 times as likely
to die as were nonalcoholics of the same age (Liskow et al. 2000). 03-M4318.indd 61 03-M4318.indd 61 8/16/07 12:11:41 PM 8/16/07 12:11:41 PM 62 part 2 • Problems of Behavioral Deviance Alcohol plays a role in various kinds of physical trauma. Consider the following (Rivara et al. 1997; Thun et al. 1997; Greenfeld 1998; Vinson et al. 2003): Alcohol use is associated with an increased risk of injury and violent death (suicide
or homicide) in the home.
Alcohol abuse leads to higher rates of death from cirrhosis, injuries, and various
kinds of cancer.
About 35 percent of violent victimizations involve an offender who had been drinking.
Two-thirds of the victims of intimate violence report that alcohol was a factor in
the attack.
Nearly a third of fatal accidents involve an intoxicated driver or pedestrian (mostly
a driver). As in the case of other drugs, the health problems of alcohol include effects on the unborn children of pregnant women who drink. The most severe cases are called the
fetal alcohol syndrome (Burd et al. 2003). Tens of thousands of babies are born each
year with alcohol-related defects, and the most serious of them are those with the fetal
alcohol syndrome. Among the health problems of children born with fetal alcohol syndrome are head and face deformities; major organ problems that result in heart defects, ear infections,
hearing loss, poor eyesight, and bad teeth; and problems with the central nervous sys-
tem, leading to such problems as mental retardation, hyperactivity, stunted growth,
learning disorders, epilepsy, and cerebral palsy (Streissguth 1992; Aronson and Hag-
berg 1998; Burd et al. 2003). Alcohol abuse generally, and the fetal alcohol syndrome in particular, illustrate an important point—social problems have consequences at the community level as well as
the individual level. In a real sense, a community can become the victim of a problem,
for social problems can strain the community’s resources and deprive it of the positive
contributions that could otherwise be made by people caught up in the problems. This point is dramatized in American Indian communities. Alcohol is a factor in nearly 17 percent of all American Indian deaths. A study of the fetal alcohol syndrome
among American Indians pointed out some of the consequences, including an overload
on community institutions (such as sheltered care), dramatic increases in health care
costs, and problems of adoption and foster home placement (May 1991). Add to those
costs the loss to the community of positive contributions that could be made by those
who are abusing alcohol or those suffering from the fetal alcohol syndrome. Thus, the
community at large, as well as individuals, suffers. Psychological Health. The desire for psychological well-being is contradicted by the various degrees of impairment that result from alcohol abuse. Even a small amount
of alcohol can reduce the individual’s sensitivity to taste, smell, and pain. Vision can be
affected by large amounts of alcohol (one factor in the dangers of driving while drink-
ing). Such problems occur because alcohol adversely affects the brain. In the alcoholic,
the adverse effects are severe (National Institute on Alcohol Abuse and Alcoholism
2001). At least half of all alcoholics may have dif culty with problem solving, ab-
stract thinking, memory tasks, and psychomotor performance. Severe alcoholics may
succumb to alcohol amnestic disorder (short-term memory impairments) or demen-
tia (general loss of intellectual abilities, impaired memory, and possible personality
change). Some alcohol abusers take the nal solution to their despair: Alcohol abuse is
associated with a substantial proportion of suicides (Roy 2003; Mann et al. 2006). 03-M4318.indd 62 03-M4318.indd 62 8/16/07 12:11:42 PM 8/16/07 12:11:42 PM 63 g
l
o
b
a
l
c
o
mpa r
i
s
o
n One popular belief is that alcohol “releases inhibitions,” so that the person who drinks “loosens up” and may, for example, be more motivated toward sexual activity.
Actually, heavy drinking inhibits sexual performance, and alcoholics report a de cient
sex life or even impotence (Peugh and Belenko 2001). Another belief is that a drink
in the evening helps the individual to relax and thereby to sleep better. Whatever the
value of one drink, having several drinks before going to sleep decreases the amount of
dreaming, which can impair concentration and memory and increase anxiety, irritabil-
ity, and a sense of tiredness. Interpersonal Problems. Alcohol abuse leads to problems of interaction both within and outside the family. Pregnant women who drink put their unborn children
at risk even if they do not drink heavily enough to induce the fetal alcohol syndrome.
In a small study, children aged 10 to 18 who were exposed prenatally to alcohol had
lower levels of moral maturity and higher rates of delinquency than those not exposed
(Schonfeld, Mattson, and Riley 2005). Early use of alcohol by children is likely to lead to early sexual activity, with all its potential hazards, including pregnancy and disease (Rosenbaum and Kandel 1990). Al- ALCOHOLISM IN
EASTERN EUROPE In the 10th century, a Slavic prince noted that
drink was the joy of the people. “We cannot
live without it,” he asserted. Time appears
to have borne out his observation. Slavs and
other Eastern European people drink, on
the average, far more than Americans and
have high rates of alcoholism. The problem
worsened considerably after the breakup of
communism began in 1989. In Russia, for example, the average adult consumes about four gallons of pure alcohol
per person per year. In contrast, the French
drink about 3.4 gallons, and Americans drink
about two gallons per year. Russians pur-
chase 250 million cases of vodka a year. This
is three times the amount sold in all the rest of
the world and more than the total amount of
hard liquor sold in the United States. It is not surprising, then, that the average life span for Russian men is only 58. Nor that
Russia has about eight million alcoholics; the
rate is more than double that of the United
States. Other Eastern European nations face similar problems with alcoholism and con-
sequent health problems and premature
death. In Poland, the annual per capita con-
sumption of pure alcohol is around three
gallons, a fi gure twice as high as the 1987 rate. In Hungary, cirrhosis of the liver is the
leading cause of death of men age 36 to 60.
The number of alcoholics in Hungary doubled
from 1989 to 1992. Why do the Eastern Europeans drink so heavily? There is no simple answer. During
the communist era, it was popular to blame
the alcoholism on the repressiveness of the
regimes. But as we just noted, alcoholism
increased rapidly after the breakdown of
communism. A number of factors seem to be at work. In the new market economies, alcohol is
much cheaper than it was under communism.
In the mid-1980s, the average Polish worker’s
monthly salary could buy 11 liters of vodka.
By the mid-1990s, it could buy 35 liters! In the
transition to capitalism, Eastern Europeans
have also faced high rates of unemployment
and considerable insecurity about the future,
conditions that tend to breed higher rates of
alcohol abuse. Finally, the Eastern Europeans
have a long tradition—stretching back
hundreds of years—of heavy drinking. The
combination of all these factors has created
the highest rates of alcoholism in the world. SOURCES Chicago Tribune, April 23, 1995; U.S. News & World Report, April 15, 1996; McKee and
Shkolnikov 2001. 03-M4318.indd 63 03-M4318.indd 63 8/16/07 12:11:42 PM 8/16/07 12:11:42 PM 64 “I’D KILL BEFORE
I’D DRINK” We once attended a meeting of Alcoholics
Anonymous with a friend who had been
“dry” for a short time. As we drove through
the countryside to the small town where the
group met, the friend kept commenting on
the beauty of the scenery. He was enchanted
by what we thought was a fairly common
view on a warm spring evening. But his years
as an alcoholic had been a living hell, and in
the course of rediscovering what life can be
like when you are free of addiction, he was
fi nding beauty in the commonplace. “I really
think,” he told us, “that if someone tried to
force me to take a drink I would kill them.”
The thought of ever returning to alcohol
terrifi ed him. One of the best ways to understand the impact of addiction on an individual is to talk
with an ex-addict. If you do not know an ex-
alcoholic, contact Alcoholics Anonymous
and attend one of their open meetings. Ask
one or two members if they would be willing
to discuss their understanding of why they
became addicted, what their life was like
when they were addicted, and what fi nally
led them to seek the help of AA. List the adverse effects on the quality of life discussed in this chapter that apply to
your informants. Based on your interviews,
make a report, oral or written, of your recom-
mendations for dealing with the problem of
alcoholism. invo lvm e
nt cohol use is also associated with risky sexual behavior and is more of a risk factor for
sexually transmitted diseases than are other drugs (Ericksen and Trocki 1994). Adult
alcoholics have poorer relationships generally with friends, co-workers, spouses, and
children (McFarlin et al. 2001). Alcohol increases aggression for males, though not for
females (Gussler-Burkhardt and Giancola 2005). This aggression can lead to ill will
and con ict with others (Harford, Wechsler, and Muthen 2003; Verdurmen et al. 2005;
Graham, Osgood, Wells, and Stockwell 2006), and the con ict can take a violent turn.
Homes in which one or both spouses abuse alcohol have higher rates of both verbal and
physical abuse (Stuart et al. 2003, 2004; Snow et al. 2006). Even if the drinker is not
an alcoholic and is not intoxicated, serious violence can result. A study of homicides
in the state of New York reported that alcohol use was likely in homicides that arose
spontaneously from personal disputes, and in some cases the alcohol was probably a
causal factor in the killing (Welte and Abel 1989). Even if an alcoholic does not become abusive, his or her behavior is certain to cause stress within the family. Mates and children of alcoholics tend to develop physical and
psychological problems of their own. Husbands and wives endure painful frustration
(trying to cope) and guilt (blaming themselves for their spouse’s problems) and may re-
quire treatment themselves (Wiseman 1991; Asher 1992). Children tend to develop be-
havior disorders and, as compared to those from nonalcoholic homes, are more likely
to have poorer self-concepts; higher rates of drug use; and higher rates of anxiety, de-
pression, alcoholism, and other disorders when they become adults, as well as lower
rates of marriage and of marital quality when they do marry (Rearden and Markwell
1989; Tween and Ryff 1991; Tubman 1993; Obot, Wagner, and Anthony 2001; Watt
2002). The intensity of the stress in an alcoholic home is illustrated by a widow who
declared herself to be the happiest person alive because her husband had nally drunk
himself to death and thereby set her and her children free. Economic Costs. Alcohol abuse is costly to the nation. A study of underage drink- ing alone put the cost higher than the price of the drink (Miller, Levy, Spicer, and
Taylor 2006). In one year, underage drinking resulted in 3,170 deaths and 2.6 million 03-M4318.indd 64 03-M4318.indd 64 8/16/07 12:11:42 PM 8/16/07 12:11:42 PM chapter 3 • Alcohol and Other Drugs 65 other harmful events, costing around $61.9 billion in medical expenses, work loss, and
lost quality of life. The costs for adult abuse also runs into tens of billions of dollars. The costs include the expenses of the arrest, trial, and imprisonment of people who are drunk (in some
cities, more than half of all arrests are for drunkenness). They include business losses:
people with drinking problems are absent from work about two and a half times as of-
ten as others. Moreover, when they are on the job, they may have problems of interac-
tion. Costs to industry are as much as $10 billion a year because of lost work time and
lowered productivity of alcoholic employees. All these costs represent resources that
could be channeled into activities and programs to enhance the nation’s quality of life. Contributing Factors The factors that contribute to the alcohol problem both maintain demand and guaran-
tee supply. The problem is embedded in the American way of life. Social Structural Factors. Being a part of a group whose norms and behavior con- done drinking is the most powerful predictor of an individual’s drinking (Ames, Grube,
and Moore 2000; Thombs, Ray-Tomasek, Osborn, and Olds 2005). Males, in fact, use
alcohol to bond with each other and to enhance their sense of importance and power
(Liu and Kaplan 1996). Some groups establish a tradition of periodic heavy drinking.
For example, about half of those people who drink and attend fraternity or sorority
parties engage in heavy drinking in those settings (Harford, Wechsler, and Seibring
2002). Off-campus parties and bars are also settings in which heavy drinking takes
place among college students. The hazards of such drinking go beyond any immediate
effects. A national study of college and university students found that those who were
drunk prior to the age of 19 were signi cantly more likely than others to become alco-
hol dependent and frequent heavy drinkers, to report that they drove after drinking, and
to sustain injuries requiring medical attention after drinking (Hingson et al. 2003). Integration into a group in which the use of alcohol is approved does not mean the individual will abuse it. Many people use alcohol without becoming addicted. A lower
rate of alcoholism is correlated with the following characteristics (National Institute on
Alcohol Abuse and Alcoholism 2001): Children are given alcohol early in life in the context of strong family life or
religious orientation.
Low-alcohol-content beverages—wines and beers—are most commonly used.
The alcoholic beverage is ordinarily consumed at meals.
Parents typically provide an example of moderation in drinking.
Drinking is not a moral question, merely one of custom.
Drinking is not de ned as a symbol of manhood or adulthood.
Abstinence is as acceptable as drinking.
Drunkenness is not socially acceptable.
Alcohol is not a central element in activities (like a cocktail party).
There is general agreement on what is proper and what is improper in drinking. Under such conditions, a group or an entire society could have high per capita rates of alcohol consumption and relatively low rates of alcoholism. Group norms are an
important factor in alcohol use and abuse, but they need not demand abstinence to 1. 2.
3.
4.
5.
6.
7.
8.
9. 10. 03-M4318.indd 65 03-M4318.indd 65 8/16/07 12:11:43 PM 8/16/07 12:11:43 PM 66 part 2 • Problems of Behavioral Deviance prevent abuse. Both Jews and Italians in the United States use alcohol as part of a tradi-
tional way of life, but alcoholism in those groups is extremely low. The norms of many
religious groups also make abuse less likely. Thus, active participation in religion is
associated with lower levels of drinking (Bjarnason et al. 2005; Jessor, Costa, Krueger,
and Turbin 2006). Role problems that generate emotional distress can lead to alcohol abuse (Holahan et al. 2001). People trying to cope with role con ict may resort to alcohol for relief.
Those under stress at school or work and those who believe that alcohol relieves stress
are more likely to drink (Park, Armeli, and Tennen 2004; Crosnoe 2006). Undesirable
role changes also may lead to alcohol abuse. A major loss (for example, divorce or
death of a spouse) or separation can result in alcohol abuse, particularly for men (Hor-
witz and Davies 1994). Furthermore, the loneliness that accompanies moving or loss of
intimate relationships is associated with alcohol abuse (Akerlind and Hornquist 1992). Three kinds of family experiences are involved in alcohol abuse. First, alcohol abusers are more likely to come from homes where other family members are abus- ers (Jennison and Johnson 1998; Chermack et al. 2000). Second, alcohol abusers are
more likely to come from broken homes (Flewelling and Bauman 1990; Wol nger
1998; Bjarnason et al. 2003). Third, alcohol abuse is associated with various problem-
atic relationships within the family, including dysfunctional marriages and troubled
parent-child relationships (Silberg et al. 2003; Whisman, Uebelacker, and Bruce 2006).
Problem drinking among adolescents is associated with homes in which the parents
express hostility to the adolescents or in which there is severe family con ict (Conger
et al. 1991; Smith, Rivers, and Stahl 1992). The mass media also contribute to alcohol abuse. Researchers who examined 601 popular movies found that 92 percent depicted drinking (Sargent et al. 2006). The re-
searchers surveyed thousands of adolescents to determine the relationship between
watching movies and drinking. There was an association between higher exposure to
movie alcohol use and drinking by the adolescents. The researchers concluded that
exposure to movie alcohol use is a risk factor for early-onset teen drinking. Similarly,
television programs show a great deal of drinking with no negative consequences;
adolescent viewers of such drinking are more likely to drink themselves (Pinkleton,
Fujioka, and Austin 2000). Finally, a survey of alcohol advertising on radio showed
that nearly half of the ads were placed in programs for which the local audience was
disproportionately underage youth, thus adding yet another in uence of the media on
underage drinking (Centers for Disease Control 2006b). Finally, any social structural factors that increase stress levels are likely to increase the prevalence of alcoholism. In the United States, a rapidly changing structure has
been associated with increased alcoholism. Both the high rate around 1830 and the
increased consumption in the 1960s and 1970s have been associated with stresses in-
duced by a rapidly changing society (Rorabaugh 1979). Another source of stress is
a sense of powerlessness. You are not comfortable when you feel powerless. Yet the world situation, national problems, your work, and other organizations with which you
are involved may induce a sense of powerlessness. If you feel powerless, you are more
likely to drink heavily and to have a drinking problem (Seeman, Seeman, and Budros
1988). Social Psychological Factors. Attitudes toward drinking and drunkenness tend to be different from attitudes toward use and abuse of other drugs. Although alcoholism is
a major factor in death and disease, there is little public outcry. Parents who would be 03-M4318.indd 66 03-M4318.indd 66 8/16/07 12:11:43 PM 8/16/07 12:11:43 PM chapter 3 • Alcohol and Other Drugs 67 horri ed to nd their children smoking marijuana have allowed them to drink spiked
punch or other alcoholic beverages at parties. The importance of attitudes is underscored by the fact that heavy drinkers have more positive and more indulgent attitudes about the use of alcohol. They are likely
to believe that their drinking is no different from that of others in the groups to which
they belong and that their own drinking is not enough to be called a problem (Wild
2002). For example, a large proportion of college students overestimate the amount of
drinking by their peers (Perkins, Haines, and Rice 2005). And their misperceptions are
strongly related to the amount of alcohol they consume: they drink as heavily as they
believe that others are drinking. The problem of alcoholism is further complicated by ideologies—by the ideology that transforms it into a personal rather than a social problem, and the campus ideol-
ogy that heavy drinking at parties is both acceptable and the way to maximize one’s
fun. Many Americans believe that the alcoholic can recover if he or she “really wants
to change”—that alcoholism is basically a problem of individual self-control. And
many students believe that heavy drinking, drinking contests, and hangovers are all
legitimate ways to maximize their pleasure and prove their mettle. Public Policy and Private Action Instead of asking what can be done for an alcoholic, you need to ask rst what kind of
alcoholic you are dealing with. Experts are attempting to sort out the special needs of
the alcoholic with psychiatric problems, the chronically relapsing alcoholic, the alco-
holic’s family members who may be both victims of and contributors to the problem,
and addicted adolescents and women (Abbott 1987). Special programs are being devel-
oped for these special needs. For example, the chronically relapsing alcoholic may be
placed in a group with other relapsers and undergo group therapy that focuses on ways
to confront and overcome the tendency to relapse. Whatever the special needs may be, of course, the alcoholic is likely to need one or more of the following: individual therapy, drug therapy, behavior therapy, or group
therapy. Drug therapies involve administration of either a nausea-producing agent
along with an alcoholic beverage or a “deterrent agent” that causes intense headaches
and nausea when alcohol is consumed. Obviously, drug therapy requires close supervi-
sion by a physician. In group therapy, the alcoholic is in a group with other alcoholics and with a thera- pist as facilitator. The task of the group members is to attain insight into their indi-
vidual reasons for drinking and to get control over drinking. The task is achieved by
frank and open discussion of each alcoholic’s life, feelings, and thoughts. A form of
group therapy that is quite successful and does not utilize a professional therapist is
Alcoholics Anonymous (AA), which was started by alcoholics. Members gather regu-
larly in small groups to share their experiences and to sustain each other in sobriety.
Each member is available to every other member at any time help is needed—when,
for example, a member needs to talk to someone in order to resist the urge to drink.
Those who join AA begin by admitting they are powerless over alcohol and lack con-
trol of their own lives. This admission is signi cant because it opposes the ideology
discussed earlier (an ideology, incidentally, held by alcoholics as well as by others).
New members also agree to surrender to a Higher Power (as they understand it), to
make amends to those harmed by their drinking, and to help other alcoholics become
sober. 03-M4318.indd 67 03-M4318.indd 67 8/16/07 12:11:43 PM 8/16/07 12:11:43 PM 68 part 2 • Problems of Behavioral Deviance Thousands of alcoholics have sought help through AA, which is still one of the most effective ways to deal with alcoholism (Connors, Tonigan, and Miller 2001; McKel-
lar, Stewart, and Humphreys 2003; Moos and Moos 2004). Of course, not everyone
who comes to AA will break the habit; no form of help can claim 100 percent success
rates. Two spin-offs of AA that are designed to help family members of the alcoholic are Al-Anon and Alateen. Al-Anon is for the alcoholic’s spouse or signi cant other. It
helps the person both to deal with the problems caused by the alcoholic and to see his
or her own contribution to the interpersonal problems that may be a factor in the alco-
holism. Members of Al-Anon learn to take care of their own needs and to stop focusing
their lives around the alcoholic’s problems. Alateen uses the same principles to help
the teenaged children of alcoholics. Frequently, the sponsor of an Alateen group is a
member of Al-Anon. Behavior therapy is based on the principle of rewarding desired behavior in order to reinforce behavior. The reward can be quite simple, such as the pins given at Alcohol-
ics Anonymous meetings to recognize extended periods of sobriety. Or the rewards
can be more substantial, such as the vouchers or tokens given by some therapists for
each week or month of sobriety; these vouchers or tokens can be exchanged for various
kinds of retail goods or entertainment (gift certi cates for stores, restaurants, etc.). The
use of voucher or tokens is a form of behavior contracting (also called contingency con-
tracting or contingency management), which is more effective than methods designed
to educate, confront, or shock the alcoholic (Miller and Wilbourne 2002). A somewhat recent trend is the so-called brief therapy. Rather than attending therapy sessions over an extended period of time, the alcohol abuser has only a few sessions with
a therapist. At a minimum, brief therapy with alcohol abusers involves a 15-minute ini-
tial contact and at least one follow-up. A survey of research studies done of brief behav-
ioral interventions for risky and harmful alcohol use reported that twelve months after
the counseling, the clients had reduced their average number of drinks per week from
13 percent to 34 percent more than those who did not have the therapy (Whitlock et al.
2004). During the counseling, the patient receives an assessment of his or her health
status, advice, help in goal setting, a motivational message, and other kinds of help. The problem of alcoholism also has been attacked through various other programs and facilities. Among these are community care programs, which allow alcoholics to
remain in their homes and communities while undergoing treatment. Other programs
remove alcoholics from their environments. Throughout the nation, there are hundreds
of halfway houses for alcoholics, places where they can function in a relatively nor-
mal way while receiving therapy. Most of these locations have Alcoholics Anonymous
groups, counseling, and other services available to the alcoholics. Alcoholics who are
acutely ill may have to be hospitalized for a period of time before going to a halfway
house or returning to their homes. Ultimately, to resolve the problem, the social bases of alcoholism must be attacked through public policy. As with other drugs, enforcement as well as prevention and
education programs are needed. Research has shown that raising the minimum le-
gal drinking age to 21, increasing alcohol taxes, and intensifying the enforcement of
drinking-and-driving laws all reduce the number of alcohol problems (Moskowitz 1989;
Hollingworth et al. 2006). Prevention and education programs face dif culty because group norms and alterna- tive means of coping with stress are involved. Nevertheless, there is evidence that educa-
tional programs can help reduce the negative effects of alcohol (Flynn and Brown 1991). 03-M4318.indd 68 03-M4318.indd 68 8/16/07 12:11:43 PM 8/16/07 12:11:43 PM chapter 3 • Alcohol and Other Drugs 69 Educational programs must help people understand not only the dangers of alcohol but also ways they can deal with the pressure to drink. For instance, adolescents, who
are most likely to give in to peer pressure, can resist drinking even in high-pressure
situations by using a number of cognitive and behavioral techniques (Brown, Stetson,
and Beatty 1989). These techniques include de ning themselves as nondrinkers and
de ning drinkers in negative terms (e.g., drinkers are weak), developing strong refusal
skills, nding alternative activities (such as volunteering or religious activities), and
limiting direct exposure to high-risk situations (such as not going to a party at which
heavy drinking will occur and may even be expected) (Weitzman and Kawachi 2000;
Brown et al. 2001; Guo et al. 2001). Finally, both informal and formal measures can be taken to help those victimized by alcohol-impaired driving and to ameliorate or prevent further victimization. At an
informal level, peer intervention—trying to stop a friend or acquaintance from driving
drunk—has been shown to be effective in the bulk of cases (Collins and Frey 1992). At a formal level, campaigns against alcohol-impaired drivers began in the 1980s when a California woman founded Mothers Against Drunk Drivers (MADD). She took
action after her teenaged daughter was killed by a man who was not only drunk but
out on bail from a hit-and-run arrest for drunken driving just two days prior to the ac-
cident. Within two years, the group had chapters in more than 20 states. Other groups
formed as well—Students Against Driving Drunk (SADD) and Remove Intoxicated
Drivers (RID). As a result of the work of these organizations, a number of states have
taken measures to reduce the risks to citizens from alcohol-impaired drivers, includ-
ing raising the drinking age, using roadside sobriety tests, and suspending licenses of
offenders. In some states, a driver with a blood-alcohol content of more than 0.10 au-
tomatically loses his or her license for 90 days, regardless of the outcome of the court
case. As a result of these varied formal and informal measures, the proportion of fatal
crashes that were alcohol-related declined from 60 percent of all fatal crashes in 1982
to 40 percent in 2003 (Maguire and Pastore 2006:278). Follow-Up. Has anyone close to you—a family member or friend—ever had a prob- lem with alcohol? How did it affect the person’s behavior and relationship with you?
Describe any efforts or programs that didn’t help, and any that did. Other Drugs Although alcohol abuse is the major drug problem, the use and abuse of other drugs
affect nearly all Americans directly or indirectly. We begin our examination of the
problem by looking at the different kinds of drugs and their effects. Types and Effects Seven main types of nonalcoholic drugs and some of their possible effects are sum-
marized in gure 3.1. We should note that these do not include all drugs, only some of
those that are more commonly abused. New designer drugs continue to appear, some
of which are performance-enhancing drugs for athletes while others are used for their
intoxication effects. We will discuss the health consequences of drug abuse later in this
chapter. Here we want to focus on the intoxication effects. For some drugs, the intoxication effects vary depending on the chemical composi- tion, the amount taken, the method of administration, and the social situation in which 03-M4318.indd 69 03-M4318.indd 69 8/16/07 12:11:44 PM 8/16/07 12:11:44 PM 70 part 2 • Problems of Behavioral Deviance FIGURE 3.1 Some Commonly Abused
Drugs and Their Effects Substance: Cat-
egory and Name Examples of Commer-
cial and Street Names Intoxication Effects/
Potential Health
Consequences Cannabinoids Hashish Marijuana Boom, chronic, hash,
hemp, gangster Dope, grass, joints, pot,
weed Euphoria, slowed
thinking and reaction
time, confusion,
impaired balance and
coordination/cough,
frequent respiratory
infections; impaired
memory and learning;
increased heart rate,
anxiety; panic attacks;
addiction. Depressants Barbiturates Benzodiazepines Flunitrazepam* Amytal, Seconal,
Phenobarbital; barbs,
reds, yellows, yellow
jackets Ativan, Librium, Valium,
Xanax; candy, downers,
tranks Rohypnol; Mexican
valium, R2, roofi es, rope Reduced anxiety; feeling
of well-being; lowered
inhibitions; slowed
pulse and breathing;
lowered blood pressure;
poor concentration/
fatigue; confusion;
impaired coordination,
memory, judgment;
addiction; respiratory
depression and arrest;
death. Also, for barbiturates—
sedation, drowsiness/
depression, unusual
excitement, fever,
irritability, slurred
speech, dizziness, life-
threatening withdrawal For benzodiazepines—
sedation, drowsiness/
dizziness For fl unitrazepam—
visual and gastro-
intestinal disturbances,
urinary retention,
memory loss for the
time under the drug’s
effects 03-M4318.indd 70 03-M4318.indd 70 8/16/07 12:11:44 PM 8/16/07 12:11:44 PM chapter 3 • Alcohol and Other Drugs 71 Substance: Cat-
egory and Name Examples of Commer-
cial and Street Names Intoxication Effects/
Potential Health
Consequences Hallucinogens Altered states of per-
ception and feeling;
nausea/persisting
perception disorder
(fl ashbacks) LSD Mescaline Psilocybin Lysergic acid
diethylamide; acid,
boomers, cubes,
yellow sunshines Buttons, cactus, mesc,
peyote Magic mushroom, purple
passion, shrooms Also, for LSD and
mescaline—increased
body temperature,
heart rate, blood
pressure; loss of
appetite, sleepless-
ness, numbness,
weakness, tremors For LSD—persistent
mental disorders For psilocybin—
nervousness, paranoia Opioids and
Morphine
Derivatives Codeine Heroin Morphine Oxycodone HCl Hydrocodone
bitartrate Empirin with Codeine,
Robitussin A-C; Cody,
schoolboy Diacetylmorphine; brown
sugar, dope, H, smack Rosanol; M, Miss Emma,
monkey Oxy, O.C., killer Vicodin; vike Pain relief, euphoria,
drowsiness/con stipa -
tion, confusion,
seda tion, respira -
tory depres sion and
arrest, addiction,
uncon scious ness,
coma, death Also, for heroin—
staggering gait Stimulants Increased heart rate,
blood pressure,
metabolism; feelings of
exhilaration, energy, FIGURE 3.1 Continued (continued) 03-M4318.indd 71 03-M4318.indd 71 8/16/07 12:11:44 PM 8/16/07 12:11:44 PM 72 part 2 • Problems of Behavioral Deviance Substance: Cat-
egory and Name Examples of Commer-
cial and Street Names Intoxication Effects/
Potential Health
Consequences Amphetamine Dexedrine; bennies, black
beauties, speed , uppers increased mental
alertness/rapid or irreg-
ular heart beat; reduced
appetite, weight loss,
heart fail ure, nervous-
ness, insomnia Cocaine MDMA
(methylenedioxy-
methamphetamine) Methamphetamine Methylphenidate Nicotine Cocaine hydrochloride;
blow, bump, C, candy,
coke, crack, snow Adam, clarity, ecstasy,
Eve, lover’s speed, X, XTC Desoxyn; chalk, crank,
crystal, glass, ice, speed Ritalin; JIF, R-ball, Skippy,
the smart drug Cigarettes, cigars, smoke-
less tobacco, snuff, chew Also, for amphetamine—
rapid breathing/tremor,
loss of coordination,
irritability, anxiousness,
restlessness, delirium,
panic, paranoia,
impulsive behavior,
aggressiveness,
addiction, psychosis For cocaine—increased
temperature/chest pain,
respiratory failure,
nausea, abdominal
pain, strokes, seizures,
headaches, malnutrition,
panic attacks For MDMA—mild
hallucinogenic effects,
increased tactile sen-
sitivity, empathic
feelings/ impaired
memory and learning,
hyperthermia, cardiac
toxicity, renal failure,
liver toxicity For methamphetamine—
aggression, violence,
psychotic behavior/
memory loss, cardiac
and neurological dam-
age; impaired memory
and learning, addiction FIGURE 3.1 Continued 03-M4318.indd 72 03-M4318.indd 72 8/16/07 12:11:44 PM 8/16/07 12:11:44 PM chapter 3 • Alcohol and Other Drugs 73 Substance: Cat-
egory and Name Examples of Commer-
cial and Street Names Intoxication Effects/
Potential Health
Consequences For nicotine—adverse
pregnancy outcomes,
chronic lung disease,
cardiovascular disease,
stroke, cancer, addiction Other Compounds Anabolic steroids Inhalants Anadrol, Oxandrin,
Equipoise; roids, juice Solvents (paint thinners,
gasoline, glues), gases
(butane, propane, aerosol
propellants), laughing
gas, poppers, snappers For anabolic steroids:
No intoxication effects/
hypertension, blood
clotting and cholesterol
changes, liver and kidney
cancer, hostility and
aggression; in males,
prostate cancer, reduced
sperm production,
shrunken testicles, breast
enlargement; in females,
menstrual irregularities,
development of
masculine characteristics
(e.g., a beard) For inhalants
Stimulation, loss of
inhibition/headache;
nausea or vomiting;
slurred speech,
loss of motor
coordination; wheezing/
unconsciousness, cramps,
weight loss, muscle
weakness, depression,
memory impairment,
damage to cardiovascular
and nervous systems,
sudden death *A rape drug, associated with sexual assaults.
SOURCE: National Institute on Drug Abuse, “Commonly Abused Drugs,” NIDA Web site, 2006. the drug is administered. In other words, you need to know more than the physiologi-
cal effects of a drug to understand the experience of the individual taking it. There are no intrinsic and automatic effects of a particular drug on every individual who takes it. Rather, the effects vary according to how they are de ned (Becker 1953).
A famous experiment by Schachter and Singer (1962) found that individuals who have FIGURE 3.1 Continued 03-M4318.indd 73 03-M4318.indd 73 8/16/07 12:11:44 PM 8/16/07 12:11:44 PM 74 part 2 • Problems of Behavioral Deviance a physiological experience for which there is no immediate explanation (e.g., you nd
your heart racing but don’t know why) will label the experience with whatever infor-
mation is available. Thus, one person may label a sensation as joy, while another labels
the same sensation as anger or fear. In this experiment, some students received an injection of the hormone epinephrine, and others received a placebo. Among the physiological effects of epinephrine are palpi-
tation, tremor, and sometimes accelerated breathing and the feeling of being ushed. All
the students were told they had received the drug in order to determine its effects on their
vision. Some were given no information on any side effects, some were correctly in-
formed of those effects, and others were misinformed about the effects. While waiting
for the effects, each student was sent to a room where a student who was an accomplice
of the experimenter created a situation of euphoria for some of the students and of anger
for others. Students who had been injected with the epinephrine and who had received
either no information or misinformation about side effects “gave behavioral and self-
report indications that they had been readily manipulable into the disparate feeling states
of euphoria and anger” (Schachter and Singer 1962:395). Similarly, based on 50 interviews, Becker (1953) found that de ning the effects of marijuana as pleasurable is a learning process. First, the person must learn the tech-
nique of smoking marijuana. Then he or she must learn what the effects of the drug are
and learn to associate those effects with its use. For example, if intense hunger is an ef-
fect, the user must learn to de ne that hunger as a sign of being high. Finally, the person
must learn to de ne the effects as pleasurable rather than undesirable. Effects such as
dizziness, thirst, and tingling of the scalp can be de ned as undesirable or as symptoms
of illness. Yet by interacting with others who de ne those effects as desirable, the user
can learn to de ne them as desirable. Legal drugs can harm or kill you just as effectively as illicit ones. In addition to alcohol, tobacco is one of the deadliest drugs in American society. In 1997 the Liggett
Group, the maker of Chester eld cigarettes, openly acknowledged that smoking is both
addictive and deadly (Vedantam, Epstine, and Geiger 1997). Being legal does not mean
that a drug is harmless. Patterns of Use It is dif cult to know the number of drug users in the United States. Not all users are
addicts, and not all addicts are known to the authorities. There is wide variation in
use, depending on such factors as the type of drug and the age, sex, race/ethnicity, and
social class of the user. Alcohol is the most widely used drug, followed by tobacco and
marijuana. About 25 percent of adult Americans use tobacco, a considerable decline
from the more than 40 percent who smoked in the 1960s (Centers for Disease Control
2006). Non-narcotic drugs such as marijuana, hallucinogens, stimulants, and depres-
sants are more widely used than are narcotics. Drug use is higher among the young. The highest usage rates of marijuana, cocaine, hallucinogens, and stimulants, including methamphetamine, occur among people 18
to 25 years of age (Maguire and Pastore 2006:263). They also have the highest rates
of usage of legal drugs such as painkillers, tranquilizers, and sedatives. In addition to
age differences, rates are higher among men than women. However, gender differences
are lessening. Since 2002, more adolescent girls than boys started using marijuana and
more of them misuse prescription drugs (Of ce of National Drug Control Policy 2006).
Use also varies by race/ethnicity. American Indians have the highest rates of abuse, fol- placebo any substance having no
physiological effect that
is given to a subject who
believes it to be a drug that
does have effect placebo any substance having no
physiological effect that
is given to a subject who
believes it to be a drug that
does have effect 03-M4318.indd 74 03-M4318.indd 74 8/16/07 12:11:45 PM 8/16/07 12:11:45 PM chapter 3 • Alcohol and Other Drugs 75 lowed by whites and Hispanics. African Americans and Asian Americans tend to have
lower rates (Johnston, O’Malley, Bachman, and Schulenberg 2006). Finally, drug use
is higher in the lower than in the middle or upper social classes (Substance Abuse and
Mental Health Services Administration 2003; Barbeau, Krieger, and Soobader 2004).
In general, then, the highest rates of drug use and abuse occur among those who are
young, male, and poor. Table 3.1 shows the proportion of current users of various drugs. These proportions, of course, are smaller than the proportions of those who have ever used the drugs.
For example, compared to the current users in table 3.1, the proportion who have ever
used the drugs are: any illicit drug, 46.4 percent; marijuana and hashish, 40.6 per-
cent; cocaine, 14.7 percent; crack, 3.3 percent; inhalants, 9.7 percent; hallucinogens,
14.5 percent; and methamphetamine, 5.2 percent (Maguire and Pastore 2006:262). Trends. Drug use rose rapidly after 1960 and peaked in 1979 (U.S. Department of Health and Human Services 1995). During the 1980s, the upward trend stopped and
even reversed for most drugs. Since then, drug use has uctuated. For example, the
proportion of 8th graders who are current users of any illicit drug was 5.7 percent in
1991, rose to 14.6 percent in 1996, and fell back to 8.5 percent in 2005 (Johnston,
O’Malley, Bachman, and Schulenberg 2006:52). For 12th graders, the proportions were
16.4 percent in 1991, 26.2 percent in 1997, and 23.1 percent in 2005. To some extent, the variation in rates of usage may re ect changing de nitions of the effects. For instance, when cocaine became popular during the 1980s, one of the appeal-
ing aspects was the claim that it gave users a great “high” without undesirable physical
effects. However, most people now seem to realize that cocaine and crack (an especially
dangerous form of cocaine that can be smoked) may lead to both physical and mental
health problems, including chronic sore throat, hoarseness, chronic coughing, shortness
of breath, depression, hallucinations, psychosis, and death from overdose (Smart 1991). Multiple Use. A question often raised is whether the use of one drug leads to the use of others. A number of studies have investigated the question, and in general they
support the conclusion that there is a tendency for multiple use (Martin, Clifford, and
Clapper 1992; National Center on Addiction and Substance Abuse at Columbia Univer-
sity 1998). The likelihood of using marijuana, for instance, is 65 times higher for those
who have ever smoked or drank than for those who have done neither, and the likeli- Age Group 12–17 18–25 26 Years Substance Total Years Years and Older Any illicit drug 8.2 11.2 20.3 5.6 Marijuana and hashish 6.2 7.9 17.0 4.0 Cocaine 1.0 0.6 2.2 0.8 Crack 0.3 0.1 0.2 0.3 Inhalants 0.2 1.3 0.4 0.1 Hallucinogens 0.4 1.0 1.7 0.1 Methamphetamine 0.3 0.3 0.6 0.2 SOURCE: Maguire and Pastore 2006:263. TABLE 3.1 Use of Selected Drugs
(percent who used in last 30
days) 03-M4318.indd 75 03-M4318.indd 75 8/16/07 12:11:45 PM 8/16/07 12:11:45 PM 76 part 2 • Problems of Behavioral Deviance hood of using cocaine is 104 times higher for those who have smoked marijuana than
for persons who have not (Leshner 1998:4). Nevertheless, we cannot say that the use of one drug causes the individual to experi- ment with another drug. To do so would be the fallacy of non sequitur. At this point,
we can only say that whatever leads an individual to experiment with one substance
may lead that individual to experiment with others. Because of the expense,
many cocaine users are
relatively well-to-do. 03-M4318.indd 76 03-M4318.indd 76 8/16/07 12:11:45 PM 8/16/07 12:11:45 PM chapter 3 • Alcohol and Other Drugs 77 Age of Initiation. Drug use is beginning at an increasingly earlier age (Johnson and Gerstein 1998). Among those born in the 1930s, for example, only alcohol, cigarettes,
and marijuana were used by more than 1 percent of people before the age of 35. For
those born between 1951 and 1955, 10 drugs were used by more than 5 percent of
people before the age of 35. In both rural and urban areas, children begin experimenting with drugs as early as the third grade (McBroom 1992). Periodic news stories dramatize the problem. For
example, two third-graders in Florida were caught with 12 bags of marijuana, and a
four-year-old in Massachusetts brought her Head Start teacher a small bag of marijuana
as a gift (Sausner 2003). Inhalants are more likely the rst drugs with which children
experiment (Fritz 2003). As many as 6 percent of American children have tried an in-
halant by the fourth grade. A dramatic change occurs, however, between ages 12 and 13 (National Center on Addition and Substance Abuse at Columbia University 1998). The proportion of those
who say they can buy marijuana if they want more than triples (from 14 to 50 percent),
and the proportion who say they know a student at their school who sells illegal drugs
almost triples (from 8 to 22 percent). Throughout the teen years, then, young people have increasing exposure to, and op- portunities for, drug use. Few users begin experimenting as adults. Adults who smoke,
for example, typically become daily smokers before the age of 20 (Centers for Disease
Control 1995b). Similarly, adults who use other kinds of drugs, including heroin, typi-
cally begin at an early age (Epstein and Groerer 1997). Drugs and the Quality of Life It is clear that drug abuse is a widespread problem in America and affects both abusers
and nonabusers. Residents in drug-traf cking neighborhoods are often terrorized by
and fearful of dealers and users. As we discuss the effects of abuse on the quality of
life of individuals, keep in mind how whole communities are impacted. Physical Health. Drug abuse contradicts the American value of physical well-being. A person may experiment with drugs because they seem to hold the promise of ful ll-
ment, but the ful llment is elusive; greater and greater quantities are consumed, and
ultimately the person suffers physical and psychological deterioration. The physical harm resulting from the use of illegal drugs includes (U.S. Depart- ment of Justice 1992:10): Death.
Medical emergencies from acute reactions to drugs or toxic adulterants.
Exposure to HIV infection, hepatitis, and other diseases resulting from
intravenous drug use.
Injury from accidents caused by drug-related impairment.
Injuries from violence while obtaining drugs in the drug distribution network.
Dependence or addiction.
Chronic physical problems. This list is greatly abbreviated, of course. For example, consider the multiple conse- quences of using a drug such as methamphetamine (National Institute on Drug Abuse
2005). Even small amounts can result in increased wakefulness, decreased appetite,
increased respiration, hyperthermia, irritability, insomnia, confusion, tremors, convul-
sions, anxiety, paranoia, and aggressiveness. Methamphetamine also can cause irre- 1.
2.
3. 4.
5.
6.
7. 03-M4318.indd 77 03-M4318.indd 77 8/16/07 12:11:46 PM 8/16/07 12:11:46 PM 78 part 2 • Problems of Behavioral Deviance versible damage to blood vessels in the brain, producing strokes, irregular heartbeat,
and, ultimately, cardiovascular collapse and death. The point is, drug use involves a
long list of physical, psychological, and social consequences that are destructive. Drug abuse is now the main preventable cause of illness and premature death in the United States. Each year hundreds of thousands of Americans die from smoking,
alcohol abuse, and the use of illicit drugs. Early death from illegal drugs is often as-
sociated with an overdose of the drug. Heroin slows the vital functions of the body, and
if a suf cient amount of the drug is ingested, those vital functions will completely stop.
The addict can never be sure how much of the drug constitutes an overdose, nor can
he or she be sure about the purity of the drug. Also, the addict’s tolerance level can
vary from one day to another, depending on how much of the drug has been used. If
the addict manages to avoid death by overdose, he or she still may die from infections
carried by the needle. Thus, the user is at risk not merely from the drug itself but from
other factors associated with drug use. Crack cocaine use, for example, is spreading
the AIDS virus because addicts sell sex for drugs (Edlin et al. 1994). The health consequences go beyond the addict herself in the case of a pregnant woman. Cocaine and tobacco use are both associated with a signi cant risk of spon-
taneous abortion (Ness et al. 1999). Children who survive the risk and are born to
addicted mothers have a signi cant number of perinatal medical problems, behav-
ioral problems in early infancy, and developmental de ciencies in their cognitive and
psychomotor skills (Singer et al. 2002). In later childhood, the children may exhibit
disturbances in their activity levels, attention spans, and sleep patterns (Householder
et al. 1982). Cocaine addiction has a devastating effect, including “strokes while the
baby is still in the womb, physical malformations, and an increased risk of death dur-
ing infancy” (Revkin 1989:63). Tobacco use is a global problem. In the United States, it causes more physiological damage than any nonalcoholic drug and is the leading cause of preventable death (Fel-
lows et al. 2002; Bombard et al. 2004). Worldwide, tobacco dependence is responsible
for about 4 million deaths each year (Prokhorov et al. 2006). And the number of users
increase each year, particularly in developing nations. Among the known consequences
of smoking are increased probability of lung cancer and other respiratory diseases, in-
creased risk of heart disease, and increased probability of complications during child-
birth. Mortality rates of older adults from all causes are highest among current smok-
ers (LaCroix et al. 1991). As many as 85 percent of lung cancer deaths and a third or
more of deaths from heart and blood vessel disease are directly related to smoking.
There are, of course, people who smoke regularly and live to a “ripe old age,” but using
them to counter the systematic evidence is the fallacy of dramatic instance. What mat-
ters is not the few exceptions, but the great numbers who support the conclusions. Moreover, nonsmokers who are exposed to a smoking environment also may suffer. Nonsmokers who live or work in a smoking environment are more likely than those not
in such an environment to develop coronary heart disease (Howard et al. 1998; He et al.
1999). Thus, thousands of nonsmokers die each year as a result of inhaling secondhand
smoke. Researchers also have found that babies are more likely to develop a respiratory
tract infection and to die of sudden infant death syndrome when they are exposed to
smoke (Pollack 2001; Blizzard et al. 2003). Smoking parents also increase the chances
of their children developing asthma and, in later life, lung cancer (Scott 1990b; Sturm,
Yeatts, and Loomis 2004). As a result of such ndings, smoke-free environments at
work and in public places are becoming common. 03-M4318.indd 78 03-M4318.indd 78 8/16/07 12:11:46 PM 8/16/07 12:11:46 PM chapter 3 • Alcohol and Other Drugs 79 Some consequences of other drugs are brie y noted in gure 3.1. We need to ex- amine in more detail, however, the effects of marijuana, which have been a matter of
controversy. Marijuana. Early in the controversy over the use of marijuana, some people insisted that it causes nothing more than slight physiological changes in the user and that it is
not as dangerous a drug as alcohol, but numerous studies underscore the fact that mari-
juana has undesirable consequences that are both acute (brief and severe) and chronic,
and both physiological and psychological (National Institute on Drug Abuse 1998; Of- ce of National Drug Control Policy 2003b). In brief, those consequences are Acute effects of marijuana intoxication: Impaired memory, thinking, speaking, and problem solving.
Impaired time perception.
Increased heart rate (as high as 160 beats per minute).
Reddening of the eyes.
Impaired psychomotor performance (resulting in automobile accidents and
deaths). Chronic effects: Adverse effects on the respiratory system, similar to those of cigarettes.
Reduced sperm count in males.
Possible adverse effects on children when the mother uses the drug, including
lowered birth weight and more fetal abnormalities.
Interference with the normal pattern of sex hormones, impairing their release
from the brain. Although it appears that marijuana poses a greater threat to well-being than was once believed, it also may have more medical uses than previously thought—including
treating glaucoma patients, relieving the pain of cancer patients, ameliorating the side
effects of chemotherapy, and relieving the suffering of asthmatics. Undoubtedly, re-
search on the effects of marijuana will continue. Psychological Health. Americans value psychological as well as physical health. The search for “happiness,” “peace of mind,” or “contentment” is common. The short-
range euphoria that follows drug use is misleading because the long-range effects of
drug abuse contradict the quest for psychological well-being. For example, the high
that is produced by a drug such as crack can be followed by severe depression. You
need only listen to the stories of addicts or ex-addicts to realize the devastation to psy-
chological health that results from drug abuse (Engel 1989). You also should note that,
in contrast to the common belief that people turn to drugs for relief from distress, a
study of adolescents found that users did not start drugs because of preexisting psy-
chological distress; rather, the drug use led to both physical and psychological impair-
ments (Hansell and White 1991). The greater the use, the more intense the problems. A study of 161 adolescents re- ported that increased drug use was associated with increased depression, decreased
self-esteem, and a deterioration of purpose in life (Kinnier et al. 1994). Even smok-
ing is associated with psychological problems. Nicotine-dependent individuals are
more likely to have problems with depression, anxiety, and lower self-esteem (Croghan 1. a.
b.
c.
d.
e. 2. a.
b.
c. d. 03-M4318.indd 79 03-M4318.indd 79 8/16/07 12:11:46 PM 8/16/07 12:11:46 PM 80 part 2 • Problems of Behavioral Deviance et al. 2006; Hu, Davies, and Kandel 2006). By midlife, heavy smoking can lead to cog-
nitive impairment and decline (Richards et al. 2003). And a mother who smokes while
pregnant can decrease her baby’s IQ by as many as four points (Olds, Henderson, and
Tatelbaum 1994). Similarly, there are serious mental health consequences of using marijuana (Of ce of National Drug Control Policy 2003b). Regular use by adolescents impairs memory,
attentional ability, learning, and psychomotor performance (U.S. Department of Justice
1992; Solowij et al. 2002). Workers who use marijuana are 1.6 times as likely as nonus-
ers to quit or be red, 1.5 times as likely to have an accident, and 1.8 times as likely to
be absent (U.S. Department of Justice 1992:14). A study of Italian men who used only
marijuana found that 83 percent were dependent on the drug, 46 percent abused it, and
29 percent of occasional users had at least one emotional disorder (Troisi et al. 1998). The dangers of marijuana have increased because the drug is stronger than it used to be (Of ce of National Drug Control Policy 2003b). Marijuana with 2 percent tetra-
hydrocannabinol (THC) can result in severe psychological damage, including paranoia
and psychosis. Currently, however, average levels are 6 percent THC, or three times the
amount that can cause serious damage to the user. Interpersonal Difficulties. In addition to a sense of physical and psychological well- being, the desired quality of life for Americans demands harmonious relationships.
That is, Americans value the ability to “get along well” with others. This value is con-
tradicted by relationship problems that tend to result from drug abuse. A variety of interpersonal problems are associated with drug use and abuse (U.S. Department of Justice 1992; Of ce of National Drug Control Policy 2003b). They in-
clude arguing with family and friends, feeling suspicious and distrustful of people, en-
countering troubles at school or work, and getting into trouble with the police. Among
adolescents, the greater the involvement with drugs, the higher the rate of delinquent
behavior, including felony crimes (Johnson et al. 1991). Young adults who are heavy
marijuana users have unstable lives and work histories (Bourque et al. 1991). Married
men who abuse drugs have higher rates of wife abuse (Kantor and Straus 1989). Chil-
dren whose parents abuse drugs are almost three times more likely to be abused and
more than four times more likely to be neglected than are children of nonabusing par-
ents, and they are also likely to have emotional, academic, and interpersonal problems
(Reid, Macchetto, and Foster 1999; Wilens et al. 2002). Interpersonal problems may continue for addicts even after they no longer abuse drugs. The ex-addict may attempt to compensate for past failures and assume a role
of leadership. The outcome may be a power struggle between the ex-addict and his or
her mate. In other cases, there may be unrealistic expectations about the outcome of
treatment. The mate of an ex-addict may expect immediate and dramatic changes, and
when such changes do not appear, the result can be disillusionment or bitterness. Also,
the ex-addict may nd that long-term or permanent damage has been done to his or her
relationships. The fear and resentment built up over years of coping with an addicted
individual may preclude healthy interpersonal relationships. Economic Costs. All social problems involve certain economic costs, and these af- fect the quality of life. The more money required to deal with a social problem, the less
money there is for other desired services and programs. Determining the exact dollar cost of any social problem is dif cult. The costs of the drug problem include some that can be measured and some that can only be estimated. 03-M4318.indd 80 03-M4318.indd 80 8/16/07 12:11:47 PM 8/16/07 12:11:47 PM chapter 3 • Alcohol and Other Drugs 81 There is, of course, a cost to the user: the expense of maintaining the habit (for some,
hundreds of dollars a week or more) and the loss of earnings over their life span (Kan-
del, Chen, and Gill 1995). The measurable costs to the nation are staggering. Federal funding for various drug control programs is nearly $13 billion a year (Maguire and Pastore 2006:17). State and
local expenditures and other costs cannot be easily estimated. They include (U.S. De-
partment of Justice 1992:127): Criminal justice expenditures on drug-related crime.
Health care costs of injuries from drug-related child abuse and accidents.
The cost of lost productivity due to absenteeism and inef ciency and errors of users
at the workplace.
Loss of property values due to drug-related neighborhood crime.
Property damage from drug-related activities.
Loss of agricultural resources, which are used for cultivation of illegal drugs.
Toxins introduced into public air and water supplies by drug production.
Emotional and physical damage to users as well as their families, friends, and co-
workers. Overall, estimates of the economic cost of drug abuse in the nation amounted to $180.9
billion in 2002 (Of ce of National Drug Control Policy 2004). And the costs continue
to rise. Contributing Factors The various contributing factors have a double-barreled effect: They maintain demand
by encouraging use of drugs, and they guarantee a supply. Social Structural Factors. As with alcohol, group norms are one of the most impor- tant factors in the problem of other drugs, creating peer pressure that leads individuals
to drug use. For the most part, young people do not take drugs to relieve emotional dis-
tress but to be accepted by their peers—and the pressure begins in elementary school. Group Norms. Group norms are important for adults as well. Being integrated into a group in which drug use is approved is one of the strongest factors associated with
drug use at all ages (Leatherdale, McDonald, Cameron, and Brown 2005; Kilmer et al.
2006). The “group” may be your family, your friends, or your peers at school or work.
A survey of 1,802 fourth- and fth-grade pupils found perceived family use to be the
strongest in uence on the children’s drug use (Bush, Weinfurt, and Iannotti 1994). A
study of employees who abused drugs reported that they tended to come from fami-
lies with substance abuse problems and that they, in turn, associated with substance-
abusing friends (Lehman et al. 1995). Some Americans who regard themselves as respectable citizens nd it dif cult to imagine following group norms when those norms are illegal. They need to realize
that people all follow the norms of their groups and follow them for basically the same
reasons. The respectable citizen who abides by the norm that the appearance of one’s
house and yard should be neat and clean derives satisfaction and a sense of accep-
tance from that normative behavior. Similarly, the youth who uses drugs nds certain
rewards—including admiration, respect, and acceptance—in that usage when it is the
norm of his or her group. 03-M4318.indd 81 03-M4318.indd 81 8/16/07 12:11:47 PM 8/16/07 12:11:47 PM 82 part 2 • Problems of Behavioral Deviance Role Problems. Role problems are a second social structural factor in the drug prob- lem. Role problems create stress in the individual, who may then use drugs to deal
with the problems and their consequent stress (Goeders 2003). Indeed, when you con-
sider that the rst use of a drug like tobacco is likely to be a highly unpleasant experi-
ence, it is reasonable that strong forces are at work to develop the habit. Once a youth
tries a cigarette, either peer pressure or stress can lead to subsequent tries, but stress
seems to lead the individual more quickly to develop the habit (Hirschman, Leventhal,
and Glynn 1984). What kinds of role problems create such stress? One type of role problem is role con ict. Two or more roles may be contradictory—as, for example, when a woman ex-
periences a contradiction between her role as a physician and her role as a wife because
she does not have time to meet the expectations of both her patients and her husband.
Contradictory expectations may impinge upon a single role, as when a physician’s pa-
tients demand the right of abortion and his or her peers and friends de ne abortion as
illegal and immoral. An individual may de ne the expectations of a role as somehow
unacceptable or excessive, as when a physician feels overwhelmed by the multiple de-
mands made upon his or her time and professional skills. Physicians have been deliberately used in the examples here because of the high rate of drug addiction among doctors. The actual cause of addiction is not known, but
it probably is rooted in a combination of easy access to drugs and the stresses of the
role. Drug abuse is a symptom of stress, and role problems do generate stress in the
individual. To the extent that particular roles are especially likely to create problems,
people who occupy those roles will be particularly vulnerable to stress and perhaps to
using drugs to deal with stress. An important point here is that role con ict is a social phenomenon, not an indi- vidual phenomenon. It is not a particular doctor who is oppressed by the demands of
the role; rather, all doctors must come to terms with the role of a physician in American
society. The expectations attached to the role tend to create the same problems for ev-
eryone who occupies the role. Another role problem that can generate stress and increase the likelihood of drug abuse is a role change that is de ned as undesirable. Such a role change occurs when a
spouse dies. Suddenly a person is no longer a husband or a wife—that role has been lost. After the loss (which may be the result of separation or divorce as well as death), the individual must work through the grief process. A person copes with a signi cant loss
by passing through a series of emotional phases. The process may take as long as two
or more years. Typically, the initial phase is shock, followed by a period of numbness,
or lack of intense emotion. In the next phase, the individual wavers between fantasy
and reality, overcomes fantasies, and then experiences the full impact of the loss. A
period of increasing adjustment follows, punctuated sporadically by episodes of pain-
ful memories. Finally, if the full grief process has been experienced, the individual
accepts the loss and reaf rms his or her life. The grief process is painful, and some
individuals may resort to drugs. Family Experiences. Family experiences also are involved in the use and abuse of drugs. Families that are strong, healthy, and highly cohesive tend to inhibit the use
and abuse of drugs (Wilens et al. 2002; Dorius et al. 2004). Family values and prac-
tices such as religious involvement and eating dinner together are associated with less
likelihood of drug abuse (Hardesty and Kirby 1995; National Center on Addiction and
Substance Abuse at Columbia University 1998). role confl ict a person’s perception that
two or more of his or her
roles are contradictory,
or that the same role has
contradictory expectations,
or that the expectations of
the role are unacceptable or
excessive role confl ict a person’s perception that
two or more of his or her
roles are contradictory,
or that the same role has
contradictory expectations,
or that the expectations of
the role are unacceptable or
excessive 03-M4318.indd 82 03-M4318.indd 82 8/16/07 12:11:47 PM 8/16/07 12:11:47 PM chapter 3 • Alcohol and Other Drugs 83 However, the three kinds of family experiences that contribute to the alcohol prob- lem also are involved in the abuse of other drugs. First, as noted earlier in this chapter,
drug abusers are more likely to come from homes in which other family members are
abusers (Petoskey, Van Stelle, and De Jong 1998; Kilpatrick et al. 2000). Second, drug abusers are more likely to come from broken homes than are non- abusers. Adolescents who grow up in single-parent homes are more likely to use to-
bacco and illegal drugs than those who live with both parents (Flewelling and Bauman
1990). Looking at overall drug involvement (including alcohol), rates are higher among
those whose homes are disrupted by divorce than those who grow up in intact homes
(Wol nger 1998). Third, drug abuse is associated with various problematic relationships within the family. The problems may be severe, such as sexual abuse (Kang, Magura, and Shap-
iro 1994). Even parental con ict and alienation between youth and their parents can
lead both to the use and abuse of drugs. In their study of adolescents, Simcha-Fagan,
Gersten, and Langner (1986) looked at factors associated with the use of marijuana, of
drugs other than marijuana, and of heroin. Youths in a home with a traditional mar-
riage and a traditional, restrictive type of mother were less likely than others to use
marijuana. Those who used drugs other than marijuana were more likely to come from
a home with an unhappy marriage, to report parental coldness, and to have con ict
with their parents. Another study reported that adolescents with authoritarian fathers
(which typically results in parent-child con ict) are more likely to use drugs (Bronte-
Tinkew, Moore, and Carrano 2006). Heroin users also reported an unhappy parental
marriage, parental coldness, and con ict with parents. In addition, they were likely to
have mothers with some kind of physical or emotional illness. Thus, the use and abuse
of all kinds of drugs are likely to be associated with disturbed family relationships. Of course, the sense of rejection and alienation from parents can follow from drug use rather than precede it. Even if it is true, for instance, that a young person rst uses
drugs because of his or her group’s norms and then becomes alienated from his or her
parents, this alienation is likely to perpetuate the drug use. Thus, even if alienation is
not one of the causes of initial use, it is likely to be a cause of continuing use. Government. A fourth structural factor is the government, and especially the govern- ment’s de nition of drug use as illegal. For some drugs, the illegal status is the con-
sequence of social and political processes rather than of scienti c evidence. Why, for
example, is tobacco legal while other drugs are not? Once a drug is declared illegal,
criminal elements enter the drug traf c in order to pro t from black-market dealings.
In essence, illegality raises the cost of maintaining the drug habit, deeply involves
criminals in the drug traf c, strains the criminal justice system, and leads the addict to
undesirable behavior. Criminal involvement results from the potential for high pro ts.
For example, the street value of heroin may be 50 times or more its wholesale cost and
10,000 times the amount paid to the farmer who supplies the opium! Similar pro ts
are realized in the sale of other illicit drugs and is one reason pushers risk prison to ply
their trade. Economy. A fth structural factor is the economy. The economy supports the drug problem in at least two ways. First, many people who get involved in the distribution,
sale, and/or use and abuse of drugs come from the margins of the economy. That is, they
are from the more impoverished families and have little hope of achieving any kind of nancial success apart from that which drugs appear to offer them. Second, the legal drugs—alcohol and tobacco—are marketed freely and openly, and the industries are so 03-M4318.indd 83 03-M4318.indd 83 8/16/07 12:11:48 PM 8/16/07 12:11:48 PM 84 part 2 • Problems of Behavioral Deviance pro table that they exert enormous pressure on the government to remain a legitimate
part of the economy. The success of the marketing efforts is underscored by the fact that
ads are more in uential than peers on adolescents’ decisions to start smoking (Evans et
al. 1995). Research over a three-year period in California concluded that a third of all
experimentation with smoking resulted from advertising (Pierce et al. 1998). Supply. Although the structural factors that create the demand for drugs are cru- cial, there is also a powerful organization of supply. Massive amounts of coca, mari-
juana, and opium, for example, are grown in Latin America, processed in re neries,
and smuggled into the United States. Hundreds of tons of cocaine alone are produced
and smuggled into the United States each year (Of ce of National Drug Control Pol-
icy 2003a). About three-fourths of the coca grown for processing the cocaine is from
Colombia. Of all the cocaine that enters the nation, 72 percent passes through the
Mexico/Central America corridor, 27 percent moves through the Caribbean, and the
other 1 percent comes directly from South America. The main ports of entry are cen-
tral Arizona, El Paso, Houston, Los Angeles, Miami, and Puerto Rico. Some of the drug suppliers have their own armies and use terrorist activities to in- timidate of cials. In addition, smugglers exploit the massive corruption that exists at
all layers of government (including law enforcement agencies) and among business-
people (who may “launder” drug money) in the United States and Latin America. The supply network in Latin America and elsewhere is so powerful and the poten- tial pro ts are so enormous that efforts to cut off supplies have been fruitless. Cut off
at one point, smugglers nd alternatives. Efforts to stop the supply should not be aban-
doned, but many experts agree that as long as there is demand and pro ts are high, the
suppliers will nd a way to provide drugs. Social Psychological Factors. People who have positive attitudes toward drug use are more likely to become users. Both adolescents and adults underestimate their risks
from using legal or illegal drugs (Strecher, Kreuter, and Kobrin 1995; Ayanian and Ads portray drug users
as happy people leading
glamorous lives. 03-M4318.indd 84 03-M4318.indd 84 8/16/07 12:11:48 PM 8/16/07 12:11:48 PM chapter 3 • Alcohol and Other Drugs 85 Cleary 1999). Other attitudes are noted in table 3.2. Keep in mind that the data in this
table only represent cases of abuse that have resulted in a crisis. Among those people
who reached a crisis, a number of different motivations for abuse were reported. Some
abusers sought certain psychic effects—euphoria, pleasure, and change of mood. Some
were dependent on the drug, and some intended to commit suicide. As table 3.2 shows, 38 percent of the cases involved the quest for psychic effects, especially by the younger abusers and those using marijuana and speed. The quest
for psychic effects, incidentally, may be rooted in problems of low self-esteem, low
self-con dence, and lack of purpose in life (Dukes and Lorch 1989). In other words,
for some users it isn’t just a matter of seeking quick grati cation through drugs, but of
grasping at the one source of grati cation that appears to be available. Two motivations not speci cally noted in table 3.2 are boredom and curiosity; these are likely to be factors particularly among adolescents (De Micheli and Formigoni
2002; Adams et al. 2003). Adolescents with too few demands on their time may nd
themselves attracted to experimenting with drugs simply to relieve the boredom. Oth-
ers may have a natural curiosity that spurs them to want to know what the drug experi-
ence is like. Unfortunately, if they de ne that rst experience as highly gratifying, they
may continue to use and ultimately abuse the drug. Motivations may change over the years. A study of 60 clients of a clinic reported that most said they began drug use because of its popularity during their school years
(Johnson and Friedman 1993). Once they reached the point of using heroin, however,
the motivation became mainly physiological survival. Finally, ideology is a factor in the drug problem. In fact, positive attitudes, group norms, and ideologies about drug use reinforce each other. Friedenberg (1972) identi- ed the following ideology about marijuana: TABLE 3.2 Motivation for Drug Abuse
by Age, Race, and Sex of
Abuser and Selected Drugs
(percent of mentions) SOURCE: U.S. Department of Justice, Drug Enforcement Administration, Drug Abuse Warning
Network, Phase II Report, July 1973–March 1974 (Washington, DC: Government Printing Offi ce). Psychic Self- Effects Dependence Destruction Other All mentions 38 22 33 7 Age
15 and under 60 7 22 10 16–19 57 17 20 6 20–29 36 28 30 7 30–39 23 24 46 9 40–49 16 21 53 10 50 and over 13 14 61 12 Race
White 39 18 35 8 Black 33 35 24 7 Other 41 27 26 6 Sex
Male 46 29 19 6 Female 31 15 45 9 03-M4318.indd 85 03-M4318.indd 85 8/16/07 12:11:48 PM 8/16/07 12:11:48 PM 86 part 2 • Problems of Behavioral Deviance People who are enjoying themselves without harming others have an inalienable
right to privacy.
A drug whose effect is to turn its users inward upon their own experience,
enriching their fantasy life at the expense of their sense of need to achieve or
relate to others, is as moral as alcohol, which encourages a false gregariousness
and increasingly pugnacious or competitive behavior.
Much of the solicitude of the older generation for the welfare of the young merely
expresses a desire to dominate and control them for the sake of adult interests and
the preservation of adult status and authority. This ideology, like all ideologies, serves the purpose of explaining and validating cer-
tain behavior, thereby reinforcing the behavior. The attitudes and ideology that support drug use may themselves nd support in popular movies and music (Chen, Miller, Grube, and Waiters 2006). A study of 200
popular movies and 2,000 popular songs reported that illicit drugs appeared in 22 per-
cent and alcohol and tobacco appeared in more than 90 percent of the movies (Roberts,
Henriksen, and Christenson 1999). A fourth of the movies that included illicit drugs had
explicit information about the preparation and use of the drugs. Illicit drugs or alcohol
was mentioned in 27 percent of the songs. References to drugs were particularly heavy
in rap lyrics: 63 percent mentioned illicit drugs and almost half mentioned alcohol. The researchers did not look at the effects that the movies and music had on ac- tual drug usage, but you have seen in other chapters that the mass media do in uence
people’s behavior. Furthermore, a study of adolescents who took up smoking found that
a third of the adolescents nominated a movie star who smoked on-screen as one of their
favorites (Distefan, Pierce, and Gilpin 2004). At least some experimentation with, and
continued usage of, drugs, then, stems from popular music and the movies. Public Policy and Private Action Is it possible to eliminate the drug problem? No society we know of has completely
solved the problem. Even China, which seemed to have eradicated the problem, has
experienced renewed drug traf cking (Tyler 1995). Still, progress can be made, and the severity of the problem can be lessened. For that to happen, programs must attack the social bases as well as treat individual addicts and
also focus on reducing demand rather than stopping the supply. For example, as noted
in this chapter, demand and use are highest in the lower social classes. Public policy
that enables those in the lower strata to better their lot will also reduce the demand for
illegal drugs. We are not saying that enforcement is useless but only that treatment as
well as programs of education and prevention must be given at least as much, and per-
haps more, attention and support. Enforcement Programs. Enforcement programs involve efforts to prevent drugs from entering the country or from being produced within the country. It also includes
the capture, prosecution, and imprisonment of users, dealers, and pushers. A contro-
versial form of enforcement is mandatory testing of employees at the workplace. Some
people feel that such testing is a violation of an individual’s civil liberties. Yet federal
law now requires railroads, airlines, and trucking companies to develop and administer
drug-testing programs, and many other rms are setting up programs on their own.
Federal law also bans smoking on all domestic airplane ights. Many states have passed
laws restricting smoking in restaurants and regulating smoking in private workplaces. 1. 2. 3. 03-M4318.indd 86 03-M4318.indd 86 8/16/07 12:11:48 PM 8/16/07 12:11:48 PM chapter 3 • Alcohol and Other Drugs 87 Some local-level strategies are enforcing the laws on drugs other than tobacco (Ma- zerolle, Kadleck, and Roehl 2004). In street enforcement programs, police watch the
hot spots for drug sales and arrest both the seller and the buyer. In some cases, police
will seize the assets of a buyer, such as the buyer’s car. They also may use a reverse
sting. Undercover police pose as dealers and arrest users who ask to buy drugs. Some communities use citizen policing. Knowing that the police alone cannot solve the problem, citizens organize to eliminate conditions that facilitate drug sales. For ex-
ample, citizens in Seattle set up a drug hotline, lobbied for new abatement laws and jail
space, and engaged in neighborhood cleanup projects (Hayeslip 1989). Treating Addicts. The purpose of treating an addict is to reduce or eliminate his or her dependence on the drug. Because there is no single cause for all addictions, however,
there is no single treatment that will work for everyone (Rodgers 1994). One method
that has claimed some success with cocaine addicts is a form of behavioral therapy—
contingency contracting (Petry and Martin 2002). In contingency contracting, the ad-
dicts make an agreement with the therapist to pay a severe penalty if urine tests reveal
that they have ingested any of the drug during the week. For instance, a nurse signed
a contract in which she agreed that she would write a letter to her parents confessing
her drug habit and asking that they no longer give her any nancial support. She would
write a second letter to the state board of nursing in which she would confess her habit
and turn in her license. A Jewish man agreed to write out a check to the American Nazi
party. Some cocaine addicts have broken the habit through such contracts. With heroin addicts, a rst step is detoxi cation (see page 93), the elimination of de- pendence through supervised withdrawal. One of the more common methods of treat-
ing heroin addiction is methadone maintenance. In methadone maintenance, the addict
orally ingests the drug methadone, which is considered less dangerous than heroin and detoxifi cation supervised withdrawal from
dependence on a drug detoxifi cation supervised withdrawal from
dependence on a drug Group therapy can be
effective in the treatment of
some addicts. 03-M4318.indd 87 03-M4318.indd 87 8/16/07 12:11:49 PM 8/16/07 12:11:49 PM 88 part 2 • Problems of Behavioral Deviance has a number of properties that allows the addict to lead a more normal life than is
possible with heroin. Methadone may also be used in the detoxi cation program, but
detoxi cation involves the elimination of all drug use—including the methadone after
it helps mitigate withdrawal symptoms. Although there is some disagreement as to whether methadone maintenance is more effective than drug-free treatment programs, it is clear that the methadone program re-
duces the use of heroin (Marsch 1998). Unfortunately, methadone cannot be prescribed
by a physician but must be dispensed at a licensed clinic (Wren 1997). A number of
states have no such clinics and thus make methadone harder to obtain than heroin. In
addition, methadone is itself becoming an abused drug (Belluck 2003). The number of
cases of overdose and death is increasing. A more recent form of treatment is brief intervention therapy (Rodgers 1994). In a relatively few sessions, the therapist seeks to establish a warm and supportive re-
lationship with the addict, while giving advice, exploring various ways to deal with
the addiction, and helping the addict see that he or she must take responsibility for
getting free of the addiction. The therapist also instills a sense of empowerment in the
addict—not only “I have to do this,” but “I can do this.” Addiction is more than physiological, of course. Relationships are involved. Con- sequently, successful treatment must enable the individual to cope with the conditions
that led to the addiction. For many people, this treatment involves group therapy. One type of group therapy is family therapy. Because, for example, adolescent drug abuse is a symptom of family problems in many cases, family therapy may be the
most effective mode of treatment (Reilly 1984). For adults, small-group therapy may be
helpful. Cocaine Anonymous emerged in the 1980s (Cohen 1984). It is run by former
addicts and provides group support to the addict as a means of breaking the habit. Another variation of group therapy that may be combined with individual therapy is the drug-treatment center. The ef cacy of the centers is a matter of debate. However,
one study showed that 80 percent of the treated addicts were off hard drugs after com-
pleting a program at an inpatient or an outpatient center (Biden 1990). A form of group therapy that is effective for some people involves religious or religious-type experiences. A religious orientation enables many people to abstain from
experimenting with drugs or to stop using drugs. Adolescents who are high in religi-
osity are less likely to use drugs (Bahr et al. 1998; National Survey on Drug Use and
Health 2004). In a nationwide survey, the National Center on Addiction and Substance
Abuse at Columbia University (1998) found that 8 percent of teenagers who attend ser-
vices at least four times a month, compared to 22 percent of those attending less than
once a month, smoked cigarettes. For marijuana, the gures were 13 percent of those
attending at least four times a month and 39 percent of those attending less than once
a month. Finally, a more recent form of group therapy involves the use of peer support (Levy, Gallmeier, and Wiebel 1995). Peer support is not new, of course, but the program—
“outreach-assisted peer support”—is unique in that it targets active addicts who are
not in treatment and who may decide to continue drug use while in the group. Whether
they opt for total abstinence or for reduced or controlled usage, addicts may join the
group. Education and Prevention Programs. Most of the money allocated to the drug problem goes into enforcement, but many people believe that education and prevention
are as important—if not more so—because they reduce the demand. Signi cant de- 03-M4318.indd 88 03-M4318.indd 88 8/16/07 12:11:49 PM 8/16/07 12:11:49 PM chapter 3 • Alcohol and Other Drugs 89 clines in tobacco use have occurred in cities and states that have implemented tobacco
prevention and education programs, including an increase in the tax on cigarettes, re-
quiring smoke-free work sites, and placing antismoking ads in the mass media (Bauer
et al. 2005; Frieden et al. 2005; Netemeyer, Andrews, and Burton 2005; Sung et al.
2005). Programs in schools, of course, must begin early because drugs are available
even in elementary schools. In fact, the National Institute on Drug Abuse (2004) rec-
ommends that prevention programs begin in preschool. It recommends that programs
from rst grade through high school increase the academic and social competence of
students so that they gain the skills needed to resist drug use. Much of what young people learn, of course, occurs outside the schools. Antidrug advertising has helped make youth attitudes less favorable toward drugs and less likely
to use them (Johnston, O’Malley, and Bachman 2003). Pressure can be exerted on the
media to portray drug use, if at all, negatively. For example, smoking shown in movies
declined from 1950 to the early 1980s, but in 2002 it was at the same level it was in
1950 (Glantz, Kacirk, and McCulloch 2004). Decriminalization of drug use is an additional step that can be taken to attack the social bases of the problem. Although decriminalization would reduce the demand for
illegal drugs, it is a controversial issue. Advocates claim that it would resolve many
aspects of the problem; drug traf c would no longer be pro table (making it useless for
organized crime), the courts would not be overwhelmed with cases of drug violators,
addicts would not be required to engage in criminal activity to support their habits, and
the money now spent on enforcement could be used for better purposes. Opponents
claim that decriminalization would only exacerbate the problem: cheap, readily avail-
able drugs would increase the rate of addiction; the health costs of dealing with abuse
would skyrocket; and the citizenry would get the wrong message (namely, that drug
use is OK). Some state laws regarding marijuana already have been revised. Have the changes resulted in massive increases in the use of the drug, as critics of decriminalization
anticipated? Studies of the situation in three states that decriminalized marijuana
usage—Oregon, California, and Maine—show that while some of cials and citizens
believe the problem has worsened, there was little increase in the number of users
(Maloff 1981; Petersen 1981). Follow-Up. Do you favor the decriminalization of drugs as a way to ease the prob- lem? Why or why not? Summary 03-M4318.indd 89 03-M4318.indd 89 8/16/07 12:11:49 PM 8/16/07 12:11:49 PM 90 part 2 • Problems of Behavioral Deviance Summary The problem of alcohol and other drugs is one of abuse
and not merely of use. Various drugs have various ef-
fects, and the effects depend on the method of admin-
istration, the amount taken, and the social situation as
well as the chemical composition of the drug. Alcohol
is the most widely used drug, and its effects can be
extremely deleterious. Many experts consider alcohol
abuse much more serious than abuse of other drugs. Around 1980, drug use of all kinds began to decline for the rst time in two decades. In the 1990s, patterns
of use uctuated. Although less than in the peak years,
use and abuse are still quite high. More than one-half
of all Americans drink, and more than a third say that
drinking has been a source of trouble in their families.
Millions of Americans indicate that they are current
users of marijuana. Many users tend toward multiple
drug use. Most alcohol abusers are young and male but
not poor, whereas other drug addicts tend to be young,
male, and poor. The meaning of the drug problem for the quality of life is seen in the consequences for physical health, psy-
chological health, interpersonal relationships, and eco-
nomic costs. Abusers suffer various undesirable effects
in all areas, and they in ict suffering on others. The
nation as a whole also suffers great economic cost be-
cause billions of dollars per year are involved in lost ser-
vices and in efforts to combat the deleterious effects of
abuse. Various structural factors contribute to the problem. An important one is group norms. Integration into a
group that approves drug use is one of the most reliable
predictors of use. Role problems, including role con ict
and undesirable role change, create stress in the individ-
ual and that stress can lead to abuse. Abusers are more
likely to come from homes in which family members
are abusers, from broken homes, or from homes with
problematic relationships. The government’s de nition
of many drugs as illegal has several implications: more
people are classi ed as criminal; previously classi ed
criminals become deeply involved in the drug traf c;
the criminal justice system is strained; and users and
abusers are led into various kinds of undesirable be-
havior. Finally, the suppliers of illegal drugs are orga-
nized effectively and take advantage of corruption, so
that a supply will always be available when there is a
demand and pro ts are high. Among social psychological factors is the alienation of users from the larger society. Many people believe
drug use produces desirable psychic effects. These
positive attitudes toward drug use combine with group
norms and various ideologies that develop in groups.
The ideologies explain and validate drug use. In treating the problem, efforts to help the indi- vidual abuser or reduce the supply available to users
have far exceeded efforts to get at the social roots of
the problem. If it is to be dealt with effectively, both
approaches are needed—attacks on the social factors
as well as treatment of individual abusers. Key Terms

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