CHAPTER 4 Alcohol and Other Drugs Introduction (pp. 106-107) A portion of American ambivalence toward drugs and alcohol is rooted in the
distinctions among use, abuse, and addiction. The dilemma involves the normal
consumption of a vast amount of drugs that are legal and may be secured over-the-counter
(tobacco and alcohol) or through a prescription, and either the excessive use
of those drugs or the illegal distribution of them. The dilemma also involves,
of course, such substances as marijuana and a number of hallucinogenic drugs
that possess little or questionable medicinal value. Types and Effects (pp. 107-109) Drugs may be classified into five main types: narcotics, depressants, stimulants,
hallucinogens, and cannabis. Their physiological and psychological effects vary
not only from drug to drug but also in significant ways for individuals and
social situations. Howard Becker's marijuana research bears on this point, as
does much of our knowledge concerning alcohol use. Alcohol (pp. 109-121) The use and abuse of alcohol is America's most serious health problem. Alcohol
abuse follows a number of patterns. About 61 percent of Americans identify themselves
as drinkers, 22 percent say they sometimes drink more than they should, and
30 percent say that drinking has been a source of trouble in their families.
American Indians probably have the highest rates of use and abuse of alcohol;
whites drink more than African Americans or Hispanics; men drink more than women
(in fact, alcohol abuse and alcoholism are primarily male problems); alcohol
abuse is more common among the young than the old. The skid row image of the
alcohol abuser is false. The quality of life in the group of heavy drinkers is lower than the national
average. Heavy drinkers have a relatively low life expectancy, run a higher
risk of coronary heart disease, and are more likely to have a heart attack.
Other ailments found more frequently among alcohol abusers include problems
of the respiratory system, gastrointestinal problems, premature aging of the
brain, and malfunctioning of the liver. Psychological and interpersonal problems
are also higher among alcohol abusers than the general population. The economic
costs of alcoholism include lowered worker productivity, lower family income
due to the high cost of alcohol, and the costs of the criminal justice system
that must arrest and process alcohol abusers. Contributing factors to the problem of alcoholism include both social structural
and social psychological conditions. Adolescents whose peers abuse alcohol run
a higher risk of the problem. Role conflict and the experience of a major loss
increase the probability of abuse. Three family experiences are associated with
the problem: having a parent who was an alcoholic, coming from a broken home,
and disturbed family relationships. Stress and a sense of powerlessness also
contribute to alcoholism. The way drinking is portrayed on television contributes
to a different set of attitudes toward alcohol than toward other drugs. Finally,
the ideology that transforms the issue into a personal problem from a truly
social problem helps to maintain the condition of alcoholism. There is growing recognition that instead of asking what can be done for an
alcoholic, we need to first ask what kind of alcoholic we are dealing with.
Whatever the special needs they may have, alcoholics are likely to need one
of more of the following types of therapy: individual, drug, behavior, or group
therapy. The problem of alcoholism has also been attacked through various other
programs and facilities: community-care programs, halfway houses, and programs
involving enforcement, prevention, and education. Finally, both informal and
formal measures can be taken to help those victimized by alcohol-impaired driving
and to ameliorate or prevent further victimization. Other Drugs (pp. 122-139) It is difficult 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, but in general, use is higher among males than females,
the young rather than the elderly, and the lower rather than the middle or upper
social classes. Alcohol is the most widely used drug, followed by tobacco and
marijuana. Non-narcotic drugs such as marijuana, hallucinogens, stimulants,
and depressants are more widely used than narcotics. Drug use rose rapidly after
1960 and reached a peak in 1979; after 1980, the upward trends stopped and even
reversed for most drugs; the downward trends leveled out in the early 1990s,
but still remain high. A relatively recent form of drug abuse is the use of
steroids. One frequently raised question concerns multiple-drug usage.
A number of studies support the conclusion of a "tendency" toward multiple use-the
majority of people who consume illicit drugs use, or have used, more than one
kind of drug and also consume alcoholic beverages. The stereotype of the drug
user as a ghetto or skid row resident is a misconception; the problem encompasses
people from many walks of life, including college students and physicians. However,
as a generalization, it can be asserted that the bulk of drug users are young,
male, poor, and nonwhite. The abuse of drugs involves a number of contradictions defined as incompatible
with the desired quality of life. (1) It contradicts our value of physical well-being.
Addicts do not just suffer a large number of physical illnesses; they also tend
to die at an early age, and often their deaths are associated with drug overdose.
Although the non-narcotic drugs do not have the same consequences, there may
be, nevertheless, such effects as increased pulse rate, reddening of the eyes,
and dryness of the mouth and throat. (2) Drug abuse contradicts the quest for
psychological well-being. The short-range euphoria from mild drug use can be
misleading and should not be considered in the same light as extended abuse,
which is conducive to self-destructive behavior or psychological impairment.
For example, a large number of studies are now available that demonstrate there
are both acute and chronic, and both physiological and psychological, consequences
of marijuana that are deleterious. (3) Americans value the ability to get along
with others. That value is contradicted by the interaction that tends to result
from drug abuse. (4) Old social problems such as this not only involve certain
economic costs, but they consume funds that might otherwise enhance our quality
of life. The factors contributing to this social problem possess a twofold effect:
they maintain demand by encouraging use of drugs, and they also guarantee a
supply. This effect may be viewed through examination of social structural factors,
including group norms, family experience, and political processes; or it may
be viewed through examination of social psychological factors such as attitudes
and ideology. Positive attitudes, group norms, and ideologies about drug use
reinforce one another. When combined in favor of abuse, these factors are difficult
to counter. Most efforts dealing with abuse have tended to focus on the individual, and
on treatment rather than prevention. The authors do not disparage these efforts;
however, they feel that we must not only help the individual addict but also
get at the social factors leading to those conditions. The basic problem in treating a drug addict is to reduce or eliminate his or
her drug dependence. Coercion, education, correction, and the use of alternative
drugs (for example, methadone) have been and are continuing to be tried. Some
observers believe these measures have largely failed and suggest other alternatives
such as decriminalization or concentration on high-risk patterns of use, where
drug involvement demonstrably and significantly increases the chance of self-harm.
The authors call for a focus on reducing demand rather than stopping the supply. Enforcement programs involve efforts to prevent drugs from entering the country
or from being produced within the country. The purpose of treating addicts is to reduce or eliminate their dependence
on the drug; there is no single treatment that will work for everyone. Solutions to alcoholism that have been tried include drug therapies, group
therapies, and behavior therapy. Drug therapies treat the problem with chemicals
so that the alcoholic experiences pain if he/she consumes alcohol. A very recent
form of treatment is brief intervention therapy. Group therapies are based on
meetings of alcoholics, often with a therapist; a more recent form of group
therapy involves the use of a peer-support group. Behavior therapy is based
on rewarding sobriety with such items as tokens and silver dollars. Organizational
structures supporting these kinds of therapies include halfway houses and total
institutions. The authors identify education and prevention programs as showing
the greatest promise for reducing demand. |