Preventing Drug Abuse What Do We Know? (1993) / Chapter Skim
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1 Illicit Drug Use in the United States
1 Illicit Drug Use in the United States
Pages 9-44
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From page 9... ...
on a national drug control strategy, 64 percent of respondents to a New York Times-CBS poll rated drugs as the nation's number one problem (New York Times, 1990~. Respondents to such surveys during that period typically rated crime and AIDS as the number two and number three problems both of which are associated with drugs.
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From page 10... ...
The subsequent focus on the war in the Persian Gulf, the disintegration of the Soviet empire, economic concerns, and presidential politics resulted in even lower rankings of the drug problem. Students of public health are acutely aware that the premature mortality, epidemiologic sequelae, and economic costs of illness presently associated with alcohol or tobacco separately greatly outweigh the comparable measures for cocaine, heroin, and all other drugs combined (Harwood et al., 1984; Rice et al., 19903.
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very difficult for the individual to control. The environmental model views the majority of persons using illicit drugs as having motives to use them or to remain addicted that precede or go beyond psychological disorder.
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The particular physiological properties and psychological effects of specific drugs are not viewed as irrelevant but rather as one in a series of important factors. The dose taken, the route of administration (smoking, swallowing, snuffing, injecting)
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Marked tolerance: need for markedly increased amounts of the substance in order to achieve intoxication or desired effect, or markedly diminished effect with continued use of the same amount. Substance often taken to relieve or avoid withdrawal symptoms.
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The risk for initiation of cigarette, alcohol, and marijuana use subsides for the majority of youth by age 20, and for illicit drugs other than cocaine by age 21 (Kandel and Logan, 19841. The implication for prevention is that efforts to prevent the onset of
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From page 15... ...
More effective interventions for older adolescents or adults who have already initiated consumption could focus not on preventing onset apart from cocaine use-but on encouraging cessation and on forestalling the intensification of drug use to the point of abuse and dependence. We should note that, in addition to these patterns of early onset of illicit drug use, a distinct problem has developed in the elderly with abuse of prescribed drugs.
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have suggested that between marijuana and all other illicit drugs may come a specific stage of using prescription-type pills, especially tranquilizers, while Donovan and Jessor (1985) have suggested that "problem drinking" (alcohol abuse)
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From page 17... ...
ILLICIT DRUG USE IN THE UNITED STATES TABLE 1.2 Percentage Reporting Use of Selected Drugs in the Past Month, by Age Group and Marijuana Use in the Past Month, 1990 17 Marijuana Use in the Past Month Age Group and Drugs Used in the Past Month No Yes Total Total (N = 8,644)
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From page 18... ...
Just as most alcohol users do not become dependent, most individuals who try illicit drugs do not progress beyond use; they remain at a low level or move back to abstinence (Johnston et al., 1991a)
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The underlying motivations for drug use are not static but vary by drug, and further by the degree of drug involvement (Johnston and O'Malley, 1986~. For example, smoking onset is strongly related to social factors in early adolescence but shifts to internal motivations by late adolescence (Pederson and Lefcoe, 1985~.
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: the National Household Survey on Drug Abuse (NIDA, l991a,b) , which has been administered periodically since 1972, and the annual (since 1975)
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The Substance Abuse and Mental Health Services Administration has recently begun to stimulate and support state-level household surveys and other data collection as part of treatment evaluation and assessment activities. In recent years, results from the two broad types of data collection systems data from surveys of probability samples of individuals and data collected from case contacts in clinical or criminal justice settings have been somewhat divergent, creating challenges in assessing the meaning of statistical trends in drug consumption and associated problems.
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100 90 80 70 60 ~ 50 C) AL, 40 30 20 10- - _ 0- t5 i6 47 7'8 i9 80 41 62 63 64 8'5 ~6 47 48 8'9 9'0 High School Class of: ;;B' ;EI~ I Lifetime I Annual 30-Day FIGURE 1.1 Index of Illicit Drugs: Lifetime, Annual, and 30-Day Prevalence, 1975-1990.
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. The decline in illicit drugs evident among high School students also occurred among college students: a college student in 1989 was about half as likely to use illicit drugs, compared with 1980.
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The surveys of high school seniors showed contrasting findings: in 1991, 1.4 percent of high school seniors who used in the past month were daily or almost daily users; in 1990, the corresponding figure was 1.9 percent; in 1989, 2.8 percent. Thus, even among the general populations covered by these two surveys, there is some question about the degree to which drug involvement at the level of abuse and dependence may be declining, despite the overall drop in rates of use.
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From page 25... ...
This presumption is supported by the fact that other responses to drug consumption questions have not drifted away from the self-report trend, as might occur if individuals were becoming increasingly reluctant to self-report. For example, the high school seniors survey asks respondents what proportion of their friends use a given drug.
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From page 26... ...
A fourth indication of validity is that the absolute levels of reported drug involvement are substantial; large numbers of respondents do freely admit to experiences with illicit drugs; lifetime marijuana prevalence among some age groups is well over 50 percent, demonstrating that most users do indeed admit to this on a self-report basis. Finally, the data show convergent and predictive validity.
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From page 27... ...
The household and the high school senior survey results seem to accurately represent overall trends in drug use in the general population, but not necessarily in the highest risk groups. This fact limits what the committee can conclude from existing trend data in its generalizability to the highest-risk populations, especially school dropouts, those who are unemployed and do not have permanent addresses, and those engaged in illegal activities.
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The seeming divergence between the two systems in trends related to cocaine (the household and high school senior surveys showing declines from 1985-1991 when the DAWN data showed increases) is perhaps due to their differing sensitivities to use versus abuse and dependence.
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From page 29... ...
Moreover, there is a "bias against the null hypothesis"; that is, the tendency for journals to publish results from studies that show effects more often than studies that fail to show effects (Koren et al., 1989~. Nevertheless, it is clear that widespread crack consumption among young, economically disadvantaged women has substantially exacerbated the problem of perinatal exposure to illicit drugs.
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As a consequence, these drug users have high rates of sexually transmitted diseases and are one of the largest new AIDS high-risk groups (Jonsen, 1993~. Data are not yet available on the rate of HIV infection among crack cocaine users.
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but, except for those in Washington, D.C., there does not appear to be any recent clear downturn in the proportions of arrestees who are testing positive. Reasons for the Decline in the General Population The evidence for a decline in illicit drug consumption among the general population is fairly compelling; a natural question is why the decline has occurred.
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From page 32... ...
Just as economic booms and busts are not uniformly distributed throughout the country, drug consumption is by no means uniformly distributed. To understand a particular community's drug problem in detail, it is necessary to gather more detailed information specific to that community, recognizing that an appropriate level of detailed knowledge about a single community may require as much or more information as a typical collection of national aggregate statistics.
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From page 33... ...
Since the survey data indicate that the vast majority of young black men neither use nor sell illicit drugs, these findings suggest a phenomenon of two worlds: by and large, blacks are less likely than whites to be involved with drugs, but those who do get involved are far more likely to become dysfunctional. In other words, there are extremes of abstinence and abuse/dependence in the black population (Herd, 1989~.
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From page 34... ...
The issue of ethnic variations in drug use is related to a point made above: that national statistics may not reflect the situation in any particular community. Because of major demographic changes in recent years, some geographical regions have especially high densities of specific ethnic populations.
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From page 35... ...
Limited access and limited insight restrict the quality and scope of quantitative approaches and call for qualitative research methods, such as ethnography, to contribute in their own right and as a basis for improving quantitative work. SUMMARY Research on the nature of the drug problem in America presents a picture of "two worlds." In one, measured by survey data on individuals in school classrooms and households, illicit drug use is not confined to or even
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From page 36... ...
In this world, the drug problem has a remarkably uniform appearance: the sequence of introduction to different drugs seems universal; the diagnostic categories of use, abuse, and dependence are recurrently serviceable; and with regard to the grossest patterns any use of illicit drugs versus abstinence-the major subgroups of society, in terms of race, ethnicity, and social class, are rather consistent. This world of lowintensity consumption shows steady and cumulatively very marked declines in the prevalence of marijuana use since the late 1970s and of cocaine since the middle 1980s; heroin use is so rare as to be barely measurable.
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From page 37... ...
Neighbors 1991 Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89. American .Journal of Public Health 81:372-377.
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Fritz Intravenous drug users and AIDS: risk behaviors. American Journal of Drug and Alcohol Abuse 17(3)
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Roman 1990 The sexual behavior of intravenous drug users: assessing the risk of sexual transmission of HIV. Journal of Drug Issues 20(2)
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1. Committee for the Substance Abuse Coverage Study, Institute of Medicine.
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Yamaguchi 1986 The consequences in young adulthood of adolescent drug involvement: an overview. Archives of General Psychiatry 43(8)
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Rockville, Md.: National Institute on Drug Abuse. National Institute on Drug Abuse 1991a National Household Survey on Drug Abuse: Populations Estimates 1990.
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Gersten, and T.S. Langer 1986 Early precursors and concurrent correlates of patterns of illicit drug use in adolescence.
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From page 44... ...
1989 On the accuracy of current estimates of the numbers of intravenous drug users.
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