drug addiction and drug abuse
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drug addiction and drug abuse
drug addiction and drug abuse, chronic or habitual use of any chemical substance to alter states of body or mind for other than medically warranted purposes. Traditional definitions of addiction, with their criteria of physical dependence and withdrawal (and often an underlying tenor of depravity and sin) have been modified with increased understanding; with the introduction of new drugs, such as cocaine, that are psychologically or neuropsychologically addicting; and with the realization that its stereotypical application to opiate-drug users was invalid because many of them remain occasional users with no physical dependence. Addiction is more often now defined by the continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society and includes both licit and illicit drugs, and the term “substance abuse” is now frequently used because of the broad range of substances (including alcohol and inhalants) that can fit the addictive profile. Psychological dependence is the subjective feeling that the user needs the drug to maintain a feeling of well-being; physical dependence is characterized by tolerance (the need for increasingly larger doses in order to achieve the initial effect) and withdrawal symptoms when the user is abstinent.
Definitions of drug abuse and addiction are subjective and infused with the political and moral values of the society or culture. For example, the stimulant caffeine in coffee and tea is a drug used by millions of people, but because of its relatively mild stimulatory effects and because caffeine does not generally trigger antisocial behavior in users, the drinking of coffee and tea, despite the fact that caffeine is physically addictive, is not generally considered drug abuse. Even narcotics addiction is seen only as drug abuse in certain social contexts. In India opium has been used for centuries without becoming unduly corrosive to the social fabric.
The United States has the highest substance abuse rate of any industrialized nation. Government statistics show that about 40% of the United States population has tried marijuana or illicit drugs. By comparison, nearly 90% has tried alcoholic beverages. Marijuana is the most commonly used drug.
Types of Abused Substances
Motivations for Drug Use
Effects of Substance Abuse
On the Individual
Effects on the Family
Effects on Society
Treatment of substance abusers depends upon the severity and nature of the addiction, motivation, and the availability of services. Some users may come into treatment voluntarily and have the support of family, friends, and workplace; others may be sent to treatment by the courts against their will and have virtually no support system. Most people in drug treatment have a history of criminal behavior; approximately one third are sent by the criminal justice system.
Both pharmacological and behavioral treatments are used, often augmented by educational and vocational services. Treatment may include detoxification, therapy, and support groups, such as the 12-step groups Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous. Nonresidential programs serve the largest number of patients. Residential facilities include hospitals, group homes, halfway houses, and therapeutic communities, such as Phoenix House and Daytop Village; most of the daily activities are treatment-related. Programs such as Al-Anon, CoAnon, and Alateen, 12-step programs for family and friends of substance abusers, help them to break out of codependent cycles.
Some treatment programs use medicines that neutralize the effects of the drug. Antabuse is a medicine used in the treatment of alcoholism. It causes severe and sudden reaction (nausea, vomiting, headache) when alcohol is present. Naltrexone, to treat alcohol and heroin abuse, and acamprosate, used to treat alcoholism, both reduce cravings. Other programs use stabilizing medications, e.g., methadone or buprenorphine maintenance programs for heroin addiction. Acupuncture has been successful in treating the cravings that accompany cocaine withdrawal and is being used with pregnant substance abusers to improve the health of their babies.
For every person in drug treatment there are an estimated three or four people who need it. Many who attempt to get treatment, especially from public facilities, are discouraged by waits of over a month to get in. Evaluating the effectiveness of treatment is difficult because of the chronic nature of drug abuse and alcoholism and the fact that the disease is usually complicated by personal, social, and health factors.
Fighting Substance Abuse
Reduction of Demand for Drugs
Legalization and Decriminalization
The concept of controlling drugs is a relatively recent phenomenon, and one that has been met with limited success despite the billions of dollars spent. Some people argue that if drugs were legalized (as occurred with the repeal of Prohibition), drug trafficking and the violence it engenders would disappear. Some contend also that with government regulation dosages would be standardized and dangerous contaminants eliminated, making drugs safer. It has also been suggested that resulting lower prices for drugs would preclude the need for criminal activity to raise money for their purchase, and that billions of dollars saved from supply reduction programs could be put toward education and treatment. Nevertheless, a substantial majority of Americans polled have thought legalization a bad idea. Those opposed to legalization believe that removal of deterrents would encourage drug use, that people would still steal to buy drugs, and that many drugs are so inexpensive to produce that there would still be a black market.
Decriminalization is the elimination or reduction of criminal penalties for using or dealing in small amounts of certain drugs. Attitudes toward decriminalization change with the times and with actual and perceived dangers involved. Many localities decriminalized marijuana in the 1970s—and many reinstituted stricter laws in the 1980s. Since the mid-1990s the number of states with medical marijuana laws has gradually increased, so that about three fifths of the states have some sort of medical marijuana legislation, and beginning in the 2010s a smaller number of states legalized possession of marijuana.
Humans have used drugs of one sort or another for thousands of years. Wine was used at least from the time of the early Egyptians; narcotics from 4000 B.C.; and medicinal use of marijuana has been dated to 2737 B.C. in China. But not until the 19th cent. A.D. were the active substances in drugs extracted. There followed a time when some of these newly discovered substances—morphine, laudanum, cocaine—were completely unregulated and prescribed freely by physicians for a wide variety of ailments. They were available in patent medicines and sold by traveling tinkers, in drugstores, or through the mail. During the American Civil War, morphine was used freely, and wounded veterans returned home with their kits of morphine and hypodermic needles. Opium dens flourished. By the early 1900s there were an estimated 250,000 addicts in the United States.
The problems of addiction were recognized gradually. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts; many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s. The spirit of temperance led to the prohibition of alcohol by the Eighteenth Amendment to the Constitution in 1919, but Prohibition was repealed in 1933.
In the 1930s most states required antidrug education in the schools, but fears that knowledge would lead to experimentation caused it to be abandoned in most places. Soon after the repeal of Prohibition, the U.S. Federal Bureau of Narcotics (now the Drug Enforcement Administration) began a campaign to portray marijuana as a powerful, addicting substance that would lead users into narcotics addiction. In the 1950s, use of marijuana increased again, along with that of amphetamines and tranquilizers. The social upheaval of the 1960s brought with it a dramatic increase in drug use and some increased social acceptance; by the early 1970s some states and localities had decriminalized marijuana and lowered drinking ages. The 1980s brought a decline in the use of most drugs, but cocaine and crack use soared. The military became involved in border patrols for the first time, and troops invaded Panama and brought its de facto leader, Manuel Noriega, to trial for drug trafficking.
Throughout the years, the public's perception of the dangers of specific substances changed. The surgeon general's warning label on tobacco packaging gradually made people aware of the addictive nature of nicotine. By 1995, the Food and Drug Administration was considering its regulation. The recognition of fetal alcohol syndrome brought warning labels to alcohol products. The addictive nature of prescription drugs such as diazepam (Valium) became known, and caffeine came under scrutiny as well.
Drug laws have tried to keep up with the changing perceptions and real dangers of substance abuse. By 1970 over 55 federal drug laws and countless state laws specified a variety of punitive measures, including life imprisonment and even the death penalty. To clarify the situation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, or updated all previous federal laws concerned with narcotics and all other dangerous drugs. While possession was made illegal, the severest penalties were reserved for illicit distribution and manufacture of drugs. The act dealt with prevention and treatment of drug abuse as well as control of drug traffic. The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy. Its director, often referred to as the drug “czar,” is responsible for coordinating national drug control policy. The 21st cent. has seen penalties for marijuana use ease in some states. At the same time there was a significant increase in opioid addiction, in many cases originating with addiction to prescription painkillers and subsequently involving illicit synthetic opioids and heroin when the prescription drugs were no longer available. In 2017, a record 72,000 people died from drug overdoses, and 29,000 of those deaths were due to the synthetic opioid fentanyl, which is often combined into heroin.
See H. Abadinsky, Drug Abuse (1989); H. T. Milhorn, Jr., Chemical Dependence (1990); D. Baum, Smoke and Mirrors: The War on Drugs and the Politics of Failure (1996); M. Massing, The Fix (1998); J. Jonnes, Hepcats, Narcs, and Pipe Dreams: A History of America's Romance with Illegal Drugs (1999); publications of the Drugs & Crime Data Center and Clearinghouse, the Bureau of Justice Statistics Clearinghouse, and the National Clearinghouse for Alcohol and Drug Information.