Chapter Summary

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.

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.

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.

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.