The Truth About Drugs

The Truth About Drugs

The Truth About DRUGS sECOND eDITION Robert N. Golden, M.D. University of Wisconsin–Madison General Editor Fred L. Peterson, Ph.D. University of Texas–Austin General Editor John Haley Principal Author William Kane, Ph.D. University of New Mexico Adviser to the First Edition Mark J. Kittleson, Ph.D. Southern Illinois University Adviser to the First Edition

The Truth About Drugs, Second Edition Copyright

© 2009 by DWJ Books LLC

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval systems, without permission in writing from the publisher. For information contact: Facts On File, Inc. An imprint of Infobase Publishing 132 West 31st Street New York NY 10001 Library of Congress Cataloging-in-Publication Data The truth about drugs / general editor[s], Robert N. Golden, Fred Paterson; advisor[s] to the first edition, William Kane, Mark J. Kittleson.—2nd ed.    p. cm.   Includes bibliographical references and index.   ISBN-13: 978-0-8160-7630-7 (hardcover : alk. paper)   ISBN-13: 978-1-4381-2582-4 (e-book)   ISBN-10: 0-8160-7630-8 (hardcover : alk. paper) 1. Drugs—Popular works. 2. Drug abuse—Popular works. I. Golden, Robert N. II. Peterson, Fred.   RM301.15.T78 2009   615'1.—dc22 2008053714 Facts On File books are available at special discounts when purchased in bulk quantities for businesses, associations, institutions, or sales promotions. Please call our Special Sales Department in New York at (212) 967-8800 or (800) 322-8755. You can find Facts On File on the World Wide Web at http://www.factsonfile.com. Text design by David Strelecky Printed and bound in United States of America MP MSRF 10 9 8 7 6 5 4 3 2 1 This book is printed on acid-free paper.

CONTENTS List of Illustrations and Tables Preface How to Use This Book Addictive Behaviors and Drugs

vii ix xiii 1

A to Z Entries Addiction, Biology of Club and Designer Drugs Crack Cocaine Dependence and Addiction Depression and Drugs Driving Under the Influence of Drugs Drug Abuse, Causes of Drugs and Criminal Activity Drugs and Development Drugs and Disease Drugs and Drinking Drugs and Smoking Drug Testing

9 11 16 22 31 35 39 43 50 56 68 73 76 80

Drug Use, History of Drug Use, International Families, Communities, and Drug Abuse Gangs and Drugs Homicide Illegal Drugs, Common Inhalants Injection Drugs Law on Drugs, The Marijuana Media Messages and Counteradvertising Campaigns Morbidity and Mortality Natural Drugs Over-the-counter Drugs Overdose and Drugs Peer Pressure and Drugs Rehabilitation and Treatment Risk Factors and Risk Taking School Performance and Drug Abuse Sexual Behavior and Drug Abuse Steroids, Anabolic Workplace Drug Abuse Hotlines and Help Sites Glossary Index

85 95 101 109 112 117 127 130 133 141 146 152 155 158 164 169 173 181 186 191 197 201 207 211 217

List of Illustrations and tables Perceived Availability of Drugs Among 12th Graders Percentage of Youth Gangs Involved in Street Drug Sales, by Region Motives for U.S. Youth Murder, 1976–2005 Teenagers Who Have Used Illicit Drugs Proportion of U.S. AIDS Cases Among Adults and Adolescents by Transmission Category and Year of Diagnosis, 1985–2006 Drug Schedules References to Drug and Alcohol Use in Popular Music Number of Deaths Attributed to Drug Abuse, 1999–2005 Treatment Admissions for Prescription and OTC Drug Abuse, by Sex Risk of Overdose in Combination with Other Factors Other Rehabilitation Programs Academic Performance and Substance Use Positive Results in Workplace Drug Tests vii

105 111 115 125 132 136 149 154 163 167 179 187 204

Preface The Truth About series—updated and expanded to include 20 volumes—seeks to identify the most pressing health issues and social challenges confronting our nation’s youth. Adolescence is the period between the onset of puberty and the attainment of adult roles and responsibilities. Adolescence is also a time of storm, stress, and risk-taking for many young people. During adolescence, a person’s health is influenced by biological, psychological, and social factors, all of which interact with one’s environment—family, peers, school, and community. It is a time when teenagers experience profound changes. With the latest available statistics and new insights that have emerged from ongoing research, the Truth About series seeks to help young people build a foundation of information as they face some of the challenges that will affect their health and well-being. These challenges include high-risk behaviors, such as alcohol, tobacco, and other drug use; sexual behaviors that can lead to adolescent pregnancy and sexually transmitted diseases (STDs); mental health concerns, such as depression and suicide; learning disorders and disabilities, which are often associated with school failures; serious family problems, including domestic violence and abuse; and lifestyle factors, which increase adolescents’ risk for noncommunicable diseases, such as diabetes and cardiovascular disease. Broader underlying factors also influence adolescent health. These include socioeconomic circumstances, such as poverty, unavailability of health care, and the social situations in which young people live. Although these factors can have a negative effect on adolescent ix

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health, well-being, and school performance, many of these negatives are preventable with the proper knowledge and information. With prevention in mind, the writers and editors of each topical volume in the Truth About series have tried to provide cutting-edge information that is supported by research and scientific evidence. Vital facts are presented that inform youth about the challenges experienced during adolescence, while special features seek to dispel common myths and misconceptions. Some of the main topics explored include abuse, alcohol, death and dying, divorce, drugs, eating disorders, family life, fear and depression, rape, sexual behavior and unplanned pregnancy, smoking, and violence. All volumes discuss risk-taking behaviors and their consequences, healthy choices, prevention, available treatments, and where to get help. In this new edition of the series, we also have added eight new titles in areas of increasing significance to today’s youth. ADHD, or attention-deficit/hyperactivity disorder, and other learning disorders are diagnosed with increasing frequency, and many students have observed or know of classmates receiving treatment for these conditions, even if they themselves have not received this diagnosis. Gambling is gaining currency in our culture, as casinos open and expand in many parts of the country, and the Internet offers easy access for this addictive behavior. Another consequence of our increasingly online society is the presence of online predators. Environmental hazards represent yet another danger, and it is important to provide unbiased information about this topic to our youth. Suicide, which for many years has been a silent epidemic, is now gaining recognition as a major public health problem throughout the life span, including the teenage and young adult years. We now also offer an overview of illness and disease in a volume that includes the major conditions of particular interest and concern to youth. In addition to illness, however, it is essential to emphasize health and its promotion, and this is especially apparent in the volumes on physical fitness and stress management. It is our intent that each book serve as an accessible, authoritative resource that young people can turn to for accurate and meaningful answers to their specific questions. The series can help them research particular problems and provide an up-to-date evidence base. It is also designed with parents, teachers, and counselors in mind so that they have a reliable resource that they can share with youth who seek their guidance.

Preface  xi

Finally, we have tried to provide unbiased facts rather than subjective opinions. Our goal is to help elevate the health of the public with an emphasis on its most precious component—our youth. As young people face the challenges of an increasingly complex world, we as educators want them to be armed with the most powerful weapon available—knowledge. Robert N. Golden, M.D. Fred L. Peterson, Ph.D. General Editors

How to Use This Book Note to Students

Knowledge is power. By possessing knowledge you have the ability to make decisions, ask follow-up questions, or know where to go to obtain more information. In the world of health, that is power! That is the purpose of this book—to provide you the power you need to obtain unbiased, accurate information and The Truth About Drugs. Topics in each volume of The Truth About are arranged in alphabetical order, from A to Z. Each of these entries defines its topic and explains in detail the particular issue. At the end of most entries are cross–references to related topics. A list of all topics by letter can be found in the table of contents or at the back of the book in the index. How have these books been compiled? First, the publisher worked with me to identify some of the country’s leading authorities on key issues in health education. These individuals were asked to identify some of the major concerns that young people have about such topics. The writers read the literature, spoke with health experts, and incorporated their own life and professional experiences to pull together the most up-to-date information on health issues, particularly those of interest to adolescents and of concern in Healthy People 2010. Throughout the alphabetical entries, the reader will find sidebars that separate fact from fiction. There are question-and-answer boxes that attempt to address the most common questions that youth ask about sensitive topics. In addition, readers will find special features called “Teens Speak”—case studies of teens with personal stories related to the topic in hand.

xiii

xiv  The Truth About Drugs

This may be one of the most important books you will ever read. Please share it with your friends, families, teachers, and classmates. Remember, you possess the power to control your future. One way to affect your course is through the acquisition of knowledge. Good luck and keep healthy. Note to Librarians

This book, along with the rest of The Truth About series, serves as a wonderful resource for young researchers. It contains a variety of facts, case studies, and further readings that the reader can use to help answer questions, formulate new questions, or determine where to go to find more information. Even though the topics may be considered delicate by some, don’t be afraid to ask patrons if they have questions. Feel free to direct them to the appropriate sources, but do not press them if you encounter reluctance. The best we can do as educators is to let young people know that we are there when they need us. Mark J. Kittleson, Ph.D. Adviser to the First Edition

Addictive Behaviors and Drugs Behaviors are considered addictive if one is unable to control them despite the fact that they produce significant negative physical or psychological effects. Drug addiction is the inability to stop using a drug despite negative physical or psychological effects. Addiction among teens is a topic of serious concern. Despite reductions in teen drug use in recent years, the 2007 “Monitoring the Future” study by the National Institute on Drug Abuse (NIDA) found that almost onehalf of all 12th-grade students had used illegal drugs at least once. More than one-fifth of 12th graders (22.8 percent) had used drugs in the 30 days prior to the survey. In this new edition of The Truth About Drugs, the latest facts, studies, and statistics—along with a research-based look at the issues— present a comprehensive picture of the most important dimensions of the drug problem today. All of the previous edition’s statistics have been updated to reflect the most recent information available. Key revisions include current figures on adult and teen drug use by the U.S. Bureau of Justice Statistics and the Centers for Disease Control and Prevention. New figures from the 2007 nationwide survey, “Monitoring the Future,” for example, suggest that a decadelong trend of reduced drug use among teens may be ending. This new volume also offers the latest figures on drug-related deaths and emergency room visits from the U.S. Department of Health and Human Services, new information about drug testing from the nation’s leading diagnostic workplace testing firm, and new statistics from the Federal Bureau of Investigation and the United Nations on drugrelated crime.



 The Truth About Drugs

In addition to key updates, six new articles on high-interest topics appear in this second edition. The Truth About Drugs now opens by examining the biological factors that contribute to drug and alcohol abuse. “Addiction, Biology of” explores the similarities and differences between the chemical actions of various substances and shows how these chemical reactions are related to the development of psychological and physical addiction. The information here provides a biological context to enhance the reader’s understanding of the articles that follow on specific drugs. “Drug Testing” offers a look at the policy and practice of drug testing. In addition to finding the latest statistics on workplace drug examinations, the reader learns about the various types of tests used to detect drugs, their prevalence, and their effectiveness. The article also touches on employer concerns about the drug-testing process. In this edition, The Truth About Drugs also includes tobacco among the substances it examines. “Drugs and Smoking” offers insights into trends in tobacco use in the United States as a whole (down significantly since the 1990s) as well as among teens (where daily use among 12th graders is on the rise). In addition to discussing the health effects of smoking, the article examines the link between teen smoking and the use of other drugs. “Drug Use, International” takes coverage of the new edition beyond the borders of the United States to look at the worldwide dimensions of drug use and abuse. It not only offers statistics on drug use in other countries but also explores the principal sources and destinations of the most widely used illicit drugs. You might be surprised to find out which country grows most of the marijuana in the Western Hemisphere! The article also looks at the finance and transportation network that enables drugs to make their way around the world. Marijuana receives separate treatment in this new edition. “Marijuana” goes beyond the coverage of the drug that still appears the articles on “Drug Use, History of” and “Illegal Drugs, Common.” The new article features a section that explores the issue of medical marijuana, including a look at the historical use of medical marijuana—from as early as 3700 b.c.e. “Natural Drugs” details the growing popularity of substances such as ginseng and kava-kava, which are sold alone and as ingredients in other natural foods or food additives. Researchers are still unsure of the method by which many of these substances exert their effects. The article looks at what is known about them, how they can be beneficial, and also how they can be a danger.

Addictive Behaviors and Drugs   Rates of Teen Drug Abuse

The “Monitoring the Future” study shows that substance abuse in the United States is a problem as early as eighth grade. According to the survey, 27.7 percent of eighth-grade students had tried illicit drugs, and 10.1 percent had used drugs in the previous 30 days. The study also found abuse of substances other than illegal drugs. Over 70 percent of all 12th graders reported having used alcohol at least once, and 44.4 percent had used it in the previous 30 days. Among eighth graders, 38.9 percent had used alcohol at least once, and 15.9 percent admitted to using it within 30 days of the survey. Almost one-half (46.2 percent) of 12th graders had tried cigarettes, as had 22.1 percent of eighth graders. The Youth Risk Behavior Surveillance System, a national survey of teen drug behaviors completed by the Centers for Disease Control and Prevention (CDC) in 2007, showed that within 30 days preceding the survey, almost 30 percent of students rode in a car with a driver who had consumed alcohol and over 10 percent had driven a car while under the influence of alcohol. The survey also reported that 22.3 percent of students had been offered, sold, or given an illegal drug on school property within the last 12 months. Among the students surveyed, 2 percent had injected an illegal drug, just under 4 percent had used anabolic steroids (drugs used the increase strength and muscle mass), 7.2 percent had used cocaine (a highly addictive stimulant drug derived from the coca plant), 4.4 percent had used methamphetamines (drugs that stimulate the nervous system), and roughly 13 percent had used inhalants (sniffed glue, breathed aerosols, or inhaled paints). These statistics reveal that peer pressure to engage in drug use would most likely involve an inhalant, methamphetamine, or cocaine. Commonly Abused Drugs

Although statistics vary, marijuana remains the most used illicit drug among teens. The CDC reported in a nationwide study conducted in 2007 that roughly 38 percent of students in grades nine through 12 had tried marijuana. The lifetime rate of teen marijuana use is almost three times greater than that of the second most frequently used drugs (inhalants, used by about 13 percent of students). Current (last 30 days) marijuana use is six times greater than the use of cocaine and almost 10 times higher than methamphetamines. The use of sedatives, designer drugs, steroids, and opiates is less widespread among teens. A category of drugs called club drugs has become increasingly popular among teens because of drug use at raves, parties, and dance

 The Truth About Drugs

clubs. Club drugs typically include MDMA (ecstasy), ­gamma-hydroxybutyrate (GHB), Rohypnol (roofies), and ketamine. According to ­www. clubdrugs.org, an online service of NIDA, these drugs may cause serious health problems. They can be even more dangerous if taken in combination with alcohol. Some club drugs have been identified as “date rape drugs” or “predatory drugs.” These drugs can knock out a person and cause him or her to forget what happened for some time afterward. Because of this effect, these drugs have been used to render people unconscious and make them vulnerable to sexual assault. The federal government has recently passed several new laws to help protect victims of these easily disguised drugs. Causes of Drug Abuse

Researchers disagree about the causes of drug abuse. Some suggest that a tendency to engage in addictive behavior is hereditary. Others believe that factors in a person’s environment, or surroundings, may contribute to drug abuse. It seems likely that some combination of biological and environmental factors causes drug abuse. However, social scientists have closely studied several potential causes of drug abuse, including social skills, psychological health, and the family. Research has found that teens with poor social skills—those who have not succeeded in establishing good relations with others of their own age—are more likely than other teenagers to abuse drugs. So are those who show inappropriate social behaviors such as sudden and unprovoked violence toward others. Teens with poor social skills often seek support and friendship from one another. Gangs often offer the kind of acceptance that these troubled teens do not find elsewhere. Gang members may reinforce each other’s inappropriate behaviors, including drug use. Serious emotional and psychological problems are also related to drug abuse. A 2007 Substance Abuse and Mental Health Services Administration (SAMHSA) study titled “The Relationship Between Mental Health and Substance Abuse Among Adolescents” found that teens with serious psychological problems were about four times more likely to abuse drugs and twice as likely to abuse alcohol as teens with few or no emotional problems. Psychologically troubled teens were nearly nine times as likely to require treatment for drug abuse. According to a pair of 2002 NIDA studies parents exert significant influence on teen drug use. The study reported that teens whose parents displayed antidrug attitudes were less likely to use drugs than teens

Addictive Behaviors and Drugs  

whose parents were neutral or approving of drug use. Interestingly, teens with parents who expressed antidrug sentiments were less likely to use drugs even if they knew their parents had at one time experimented with drugs. Other family characteristics are related to drug use as well. SAMHSA’s 2006 National Survey on Drug Use and Health found that drug abuse is less likely among families with higher levels of income and education. Where one lives also impacts the likelihood of drug use. Teens in cities are more likely to abuse drugs than those in small towns or rural areas. Effects of Drug Abuse

Drug abuse has profound effects not only on the user but also the user’s family, friends, community, and workplace. Drug abuse is associated with a wide variety of negative consequences such as shattered families, gang activity, neighborhood decay, and crime. Law enforcement agencies spend billions of dollars per year combating drugs and drugrelated crime, and thousands of people are sentenced to prison each year for drug offenses. Scientists have noted many adverse physical and psychological effects of drugs, which vary from one drug to another. For example, marijuana can cause problems with memory and learning, distorted perception, difficulty in thinking and problem solving, and loss of coordination. Long-term complications can include lung damage and suppression of the immune system. Other drugs can cause even more serious problems. Cocaine, amphetamines, and heroin can produce psychological symptoms including paranoia, hallucinations, and delusions and physical problems such as increased heart rate, convulsions, coma, and even death. Taking a dangerous overdose (an amount high enough to cause an adverse reaction) is also a possibility with most drugs. Historically, drug and alcohol abuse can also lead to severe family disruption. According to a 1991 study, “Psychiatric Disorders in America: The Epidemiologic Catchment Area Study,” 24.2 percent of all Americans who had been divorced or separated more than once were alcoholics. Fewer than 9 percent of those in intact marriages were alcoholics. A 2006 23-city survey by the U.S. Conference of Mayors reported that 26 percent of the nation’s homeless have a substance abuse problem. In addition, the U.S. Conference of Mayors found that domestic violence was a primary cause of homelessness. This is significant because a 1999 study by SAMHSA found that substance abuse

 The Truth About Drugs

directly causes or plays a role in one-third to two-thirds of all cases of child abuse. Several studies demonstrate the negative impact of drug abuse on communities. A 1990 study titled “Drug Marketing, Property Crime, and Neighborhood Viability: Organized Crime Connections,” reported that drug sales lead to increasing crime and violence. According to the 2005 National Crime Victimization Survey, 27.8 percent of victims of violent crime reported that the offender was using drugs or alcohol at the time of the crime. More affluent residents move out, leaving those with fewer resources to deal with the problem. Increases in violent crimes such as assaults and murder and property crimes such as burglary and theft cause property values to fall, which in turn may lead to community decay. Drugs also impact the productivity and profitability of businesses. The 2002 National Survey on Drug Abuse and Health reported that 8.8 percent of all American workers used alcohol and 8.2 percent used illicit drugs at the workplace. Alcohol, marijuana, and cocaine are the drugs most frequently abused in the workplace. According to SAMHSA, alcoholics and problem drinkers are four to eight times more likely to be absent for work than sober workers. Those who abuse other substances miss an average of five days of work per month and are 33 percent less productive than sober workers. In 2001, productivity losses attributed to drug abuse in the workplace reached $110 billion. That figure does not include losses due to the use of other drugs. Despite the widespread negative effects of drug and alcohol abuse, many teens do not take the issue seriously enough. Some mistakenly think that drugs are not as harmful as they have been led to believe. Others are convinced that they can easily resist the temptation to use drugs. Such assumptions can be dangerously mistaken. Many teens have no intention of doing drugs but may end up experimenting because of curiosity or peer pressure. Once a teen starts using drugs, he or she may find it difficult to stop. This book attempts to give you the information you need about the dangers of drug abuse and help you make the wise choice to avoid using drugs. Risky Business Self-Test

The following test is designed to let you find out more about your own risk of abusing drugs. Record you answers on a sheet of paper.

Addictive Behaviors and Drugs   Are you at risk of abusing drugs?

Answer “true” or “false” to these questions to assess whether you may be at risk of abusing drugs or alcohol. ■ Many

of my friends use drugs. ■ I use drugs to help me get through the day. ■ I can stop using drugs at any time. ■ I smoke and drink regularly. ■ Marijuana is no big deal. ■ Drugs do not affect my health. ■ I have little interest in school and my grades show it. ■ I argue with my parents a lot. ■ I am often influenced by my peers to smoke or drink. ■ Drugs are available at my school. ■ I go to raves or dance parties regularly. ■ Club drugs are fun to take and have no long-term consequences. ■ Several of my friends have been arrested at least once. ■ Some of my friends sell drugs. ■ I belong to a gang or am friends with gang members. ■ I have been taking pills to control my weight for over a year. ■ Parties I attend usually have drugs and alcohol available. ■ I pass out due to drugs and/or alcohol at least once a month. ■ I don’t do drugs; I only get drunk and smoke. If you answered “true” to one or more of these statements, you may be at an increased risk for drug abuse or are already on your way to being addicted. Alcohol abuse and smoking have been shown to lead to drug use. Having friends that use drugs and having positive attitudes toward drugs also indicate a strong possibility of future drug use. Peer pressure is a very powerful force and attending parties or being in other situations where peer influence to use drugs is strong can lead to drug use. Denial of drug abuse or addiction is a major

 The Truth About Drugs

stumbling block to seeking help. Realizing that you can no longer control your drug use is critical to the recovery process. See also: Addiction, Biology of; Dependence and Addiction; Depression and Drugs; Drug Abuse, Causes of; Gangs and Drugs; Inhalants; Injection Drugs; Overdose and Drugs; Peer Pressure and Drugs; Risk Factors and Risk Taking; Steroids, Anabolic

A to Z Entries

Addiction, Biology of 11

■ Addiction, Biology of

There are chemical processes underlying addiction, a state in which a person is unable to stop a behavior despite negative physical or psychological effects. All drugs act by altering the body’s chemistry, or its levels of hormones, nutrients, and fluids, in some way. However, the effects that some drugs produce are so profound that, over time, the user becomes dependent upon the drug. Researchers have conducted extensive surveys of the chemical action of most drugs and have several compelling theories about the biological mechanisms that cause addiction. However, exactly how drug use causes addiction is still a matter of debate in the scientific community. Basic Action of Drugs

In order to understand how addiction may work, one first must understand how psychoactive drugs act on the human body. This involves a basic knowledge of the functioning of the neurons, or nerve cells, that carry information between the brain and the body. Ingestion and Absorption

After a user ingests a drug, the drug passes into the bloodstream through a process called absorption. The speed and potency of a drug’s effects depend on the speed, ease, and degree to which it is absorbed by the blood. These factors, in turn, are related to the means of ingestion. Intravenous injection usually results in the fastest and most complete rate of absorption. Other forms of injection, such as intramuscular or subcutaneous (under the skin), are slightly slower and less efficient. Absorption from smoking is less efficient than injection, and taking drugs orally is typically the slowest and least efficient means of ingestion. However, there are exceptions. For example, some stimulants, including cocaine and methamphetamine, are readily absorbed from mucus membranes, such as those that line the nose, mouth, throat, stomach, and intestines. The presence or absence of food or liquids in the stomach also can affect the speed and rate of absorption of orally administered drugs. As a drug is absorbed, the blood transports it to the various tissues and organs of the body, including the brain. Drugs affect various organs, but their addictive properties stem from the way in which they alter the communication between neurons in the brain. They do this literally by changing the user’s brain chemistry to send or block signals from one neuron to another.

12 The Truth About Drugs Neurons and Neurotransmitters

Every act we take, every sensation we feel, everything we perceive or think about results from communication between billions of neurons in the central nervous system. This communication is both electrical and chemical, and it takes place in a fraction of a second. Each neuron consists of a cell body (or soma), attached to which are a long shaft called an axon and a number of branchlike structures called dendrites. The end of the axon of one neuron is aligned with dendrites of adjacent neurons. In this way, the neurons form a network through which the brain and body send messages to one another. The neurons are not in physical contact with each other, however. The dendrites of one neuron are separated from the axons of another neuron by a tiny space called the synaptic gap. Neurons are specialized; they respond to different sensations such as light, heat, pressure, and even pleasure. When a neuron is activated, it generates an electrical signal that travels along its axon. When the signal reaches the end of the axon, the neuron releases chemicals called neurotransmitters from small knobs called vesicles that are located at the tip of the axon. Molecules of neurotransmitters spill into the synaptic gap and some of them chemically bind to sites on the adjacent dendrites, called receptors. Typically, some of the neurotransmitter molecules do not bind with receptors. Any “leftover” neurotransmitters remaining in the synaptic gap are broken down into inactive ingredients or reabsorbed into the vesicles of the axon. Depending upon the type of neurotransmitter released, binding with a receptor site may either encourage or prevent the receiving neuron from generating additional electrical signals. This, in turn, will cause the body to either perform or not perform some function. For example, when presented with a dangerous situation, the brain produces a large amount of the neurotransmitter norepinephrine. This substance increases the electrical activity of neurons involved in the so-called fight-or-flight response. As a result, heart rate and lung capacity increase, and the body supplies extra energy to the large muscles to prepare you to confront or run away from the perceived danger. When the danger has passed, your body reduces its production of norepinephrine and increases the production of other neurotransmitters that reduce the excitability of the nervous system. DRUG EFFECTS ON NEUROCHEMISTRY

Psychoactive drugs exert their effects by altering the production of certain neurotransmitters or by interfering with either their binding to

Addiction, Biology of 13

receptors or their reabsorption by the vesicles (also called reuptake). Different drugs affect different neurotransmitters, and some drugs may affect several neurotransmitters at once. The neurotransmitters that seem to be most directly affected by psychoactive drugs include dopamine, the endogenous opioids, serotonin, and GABA. Dopamine

Although dopamine is important in a wide variety of functions including sleep, mood, attention, and learning, it is central to the experience of pleasure. The brain releases dopamine in response to pleasurable experiences such as eating or sexual activity. A variety of popular drugs, including alcohol, marijuana, and opiates, work by stimulating neurons to release large amounts of dopamine. The brain registers this flood of dopamine as an extremely pleasant experience and records memories of the rewarding effects produced by the drug. The stimulants cocaine and amphetamine also affect the dopamine system, but in a different manner. These drugs work by inhibiting the reuptake of dopamine. Preventing reuptake increases the concentration of dopamine in the synaptic gap and prolongs its action on adjacent neurons. Amphetamines, which are very similar in chemical structure to dopamine, actually enter the vesicles and force dopamine molecules into the synaptic gap. The amphetamine molecules then block the vesicles, preventing the reuptake of dopamine. The resulting overconcentration of dopamine in the synaptic gap stimulates the adjacent neurons to fire, producing pleasurable sensations. Endogenous Opioids

Endogenous opioids are small protein molecules chemically related to morphine and heroin that the body forms naturally. They appear to stimulate neurons involved in various physiological processes, such as relieving pain and responding to stress, as well as those related to the rewarding and reinforcing effects of some drugs. Opioids, such as opium, morphine, and heroin, work by binding to receptor sites for endogenous opioids and mimicking their action. Serotonin

Hallucinogenic drugs such as LSD and mescaline, as well as the club drug ecstasy, primarily affect the serotonin system. Serotonin regulates body temperature and metabolism, as well as mood, sexuality, and appetite. Ecstasy stimulates the release of serotonin, while both LSD and mescaline are chemically similar to serotonin, allowing them

14  The Truth About Drugs

to bind to receptor sites and mimic its effects. The resulting increased serotonin levels are associated with the rapid changes in mood that are associated with hallucinogenic drug use. Certain antidepressants called MAOIs work by preventing the breakdown of serotonin, therefore increasing concentrations of the neurotransmitter in the brain. Another class of antidepressants— the tricyclics—inhibit the reuptake of serotonin, making it stay in the synaptic gap longer. Both drugs are designed to elevate the user’s mood by increasing his or her levels of serotonin. GABA

Dopamine, serotonin, and the endogenous opioids are all excitatory neurotransmitters—that is, they work by increasing the activity of adjacent neurons. By contrast, GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter; it works by reducing the activity of adjacent neurons. It is chiefly responsible for regulating excitability in the nervous system. Researchers have associated a lack of GABA with disorders such as epilepsy and schizophrenia. Alcohol, barbiturates, and a class of antianxiety drugs called benzodiazepines (which include Valium) affect the action of GABA, producing a depressant effect on the central nervous system. Barbiturates not only bind to GABA receptors, mimicking the effect of GABA, they also block receptors for neurotransmitters that excite the nervous system. This prolongs the depressant effects of the drug. Benzodiazepines appear to change the configuration of certain GABA receptors, making it much easier for GABA to bind at those sites. Neurochemistry and Addiction

Although researchers have discovered a great deal about the chemical mechanisms by which drugs produce their effects, they are still struggling to understand the exact biological processes involved in addiction. Due to the ethical issues involved, researchers have limited their experimental studies of addiction to animal subjects. Although differences in animal and human physiology limit the conclusions we can draw from these studies, the research does suggest some possible mechanisms by which addiction might develop. Dopamine Effects

Research suggests that repeated dopamine stimulation caused by substance abuse appears to increase the user’s motivation to continue

Addiction, Biology of 15

using the substance. This does not occur with experiences that naturally increase dopamine production. This seems to be because some drugs can produce five to 10 times as much dopamine as natural triggers such as food or sex, and these effects also last much longer than those produced naturally do. Interestingly, increases in dopamine appear to occur in response to the anticipation of reward, rather than the reward itself. For example, researchers have found that just being in an environment associated with drinking or drug use, such as a club or a bar, can increase dopamine production in a substance abuser. Studies also have shown that the brain responds to the large release in dopamine triggered by alcohol or drug consumption by reducing its normal production of dopamine. Over time, this causes the user to increase his or her consumption of alcohol to trigger the same pleasurable sensations. Endogenous Opioids

Research shows that alcohol produces particularly strong effects in individuals who possess a specific variant of a gene that influences the sensitivity of receptors for endogenous opioids. Individuals with this variant of the gene experience greater feelings of intoxication, stimulation, and happiness from alcohol use. These intensified feelings may cause the individual to crave alcohol, to use it more frequently, and therefore to be more susceptible to alcohol dependence. GABA

In a 1995 study, researchers discovered that chronic, or long-term, alcohol consumption leads to a decline in the number of GABA receptors in the brain and thus reduces GABA’s ability to bind to its receptors. This ultimately leads to tolerance and dependence on alcohol in order to depress nervous system functioning. The decline of GABA receptors may also account for some of the physical symptoms of alcohol withdrawal. With too few GABA receptors, the body cannot balance the action of excitatory neurotransmitters. As a result, the brain is flooded with excitatory nerve signals with which it cannot adequately cope, leading to uncontrollable tremors and hallucinations. Genetics

Researchers estimate that 40 to 60 percent of a person’s susceptibility to addiction can be attributed to genetic factors. Genetic differences

16 The Truth About Drugs

likely play an important role in determining a person’s sensitivity to the pleasurable effects of drugs and alcohol, as well as to their susceptibility to drug abuse or dependence. Animal studies have identified several genes involved in responses to drugs and alcohol. When researchers modified these genes in experiments on animals exposed to drugs and alcohol, the subject animals reduced their intake of those substances. Some studies also indicate a possible genetic component to addiction. Additional research, however, is needed to identify the exact biological connections between drug use and addiction. See also: Club and Designer Drugs; Dependence and Addiction; Drug Abuse, Causes of; Rehabilitation and Treatment further reading

Cheever, Susan, et al. Addiction: Why Can’t They Just Stop? New York: Rodale Books, 2007. DiClemente, Carlo. Addictions and Change: How Addictions Develop and Addicted People Recover. New York: Guilford Press, 2003. Erikson, Carlson K. The Science of Addiction: From Neurobiology to Treatment. New York: W. W. Norton, 2007.

■ Addiction and Dependence See: Dependence and Addiction

■ Alcohol and Alcohol Abuse See: Drugs and Drinking

■ Club and Designer Drugs

Synthetically produced substances from a variety of drug categories that have a range of effects from increasing alertness to dulling pain. The name “club drugs” comes from the fact that these drugs first gained popularity among young people who used them at dance clubs to heighten their sensory experiences. They are also called “designer

Club and Designer Drugs 17

drugs,” because they are not naturally occurring substances but created, or designed, in underground laboratories. Because there is little quality control in the production of these drugs, it is difficult to know exactly what chemicals are used to make them and in what dosages. That means it can be difficult to predict what effect they will have from one usage to the next. This is one of the factors that makes club drugs so dangerous. The most commonly used club drugs are ecstasy (MDMA), GHB (gamma-hydroxybutyrate), roofies (Rohypnol), and Special K (ketamine). Some of these drugs act as stimulants, increasing the user’s alertness and decreasing fatigue. Others are depressants that cause drowsiness and impair motor coordination. Still others produce effects similar to hallucinogens. When mixed, these widely varying types of drug actions can have serious negative consequences. Ecstasy

Ecstasy, or MDMA (3–4 methylenedioxy-methamphetamine), is the most popular club or designer drug. It is a synthetic drug that is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. It goes by a variety of names, including Adam, XTC, hug, beans, and love drug. The effects of ecstasy include increased alertness and energy sometimes accompanied by euphoria (a feeling of elation) and hallucinations (distorted perceptions). Ecstasy has also gained popularity because of its reputation for heightening sexual pleasure and reducing the user’s sensitivity to pain. Users of ecstasy face many of the same risks as those who use other stimulants. These include increases in heart rate and blood pressure, muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. In high doses, ecstasy can interfere with the body’s ability to regulate temperature. This can cause a sharp increase in body temperature known as hyperthermia, which can lead to liver, kidney, and cardiovascular system failure. Ecstasy can interfere with the body’s ability to break down the drug. As a result, potentially harmful levels of the drug can accumulate inside a user’s body with repeated doses over a short period of time. On rare occasions, an overdose of ecstasy can be fatal. Ecstasy works by affecting nerve cells in the brain that use the chemical serotonin to communicate with other nerve cells. Long-term use can disrupt the serotonin system, which plays an important role in regulating mood, aggression, sexual activity, sleep, and sensitivity to pain. Research in animals indicates that ecstasy may actually kill

18 The Truth About Drugs

nerve cells in the brain. Scientists are currently researching the drug to see if it has the same effects on humans. According to the National Institute on Drug Abuse (NIDA), chronic (long-term) ecstasy users may experience both cognitive and psychological disorders. Ecstasy users perform more poorly than nonusers on certain cognitive or memory tasks. However, some of these effects may be due to the use of other drugs in combination with MDMA. Psychological effects of use can include confusion, depression, sleep problems, drug cravings, and severe anxiety. These problems can occur during and sometimes days or weeks after taking ecstasy. Research in animals suggests that chronic use can damage neurons that are involved in mood, thinking, and judgment. NIDA warns that other drugs chemically similar to MDMA are sometimes sold as ecstasy. These drugs can create additional health risks to the user. Also, drugs sold as ecstasy may contain other substances in addition to MDMA, such as the stimulant ephedrine, the cough suppressant dextromethorphan, another club drug called ketamine, caffeine, cocaine, and methamphetamine. The combination of ecstasy with one or more of these drugs can be very dangerous, especially if the user also consumes substances such as marijuana and alcohol when taking ecstasy. According to the National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 2.13 million people in the United States age 12 and older used ecstasy in 2006. The University of Michigan’s 2007 “Monitoring the Future” study reported a rise in the use of ecstasy among teens after a steep decline from 2001 to 2005. According to the study ecstasy use among eighth graders remained essentially unchanged since 2005, while use among 10th graders rose from 2.6 percent to 3.5 percent, and from about 3 percent to 4.5 percent among 12th graders. These numbers are discouraging, as they indicate that young people are growing less aware of the dangers of ecstasy. GHB

Gamma-hydroxybutyrate, or GHB, is a central nervous system depressant that was widely available as an over-the-counter drug in healthfood stores until 1992. According to NIDA, GHB abuse in the United States began around 1990. Bodybuilders frequently purchased GHB to quickly reduce fat and build muscles. Other users began taking it for its sedative effects and its ability to produce a state of euphoria.

Club and Designer Drugs 19

Street names for GHB include liquid ecstasy, soap, easy lay, vita-G, and Georgia home boy. At lower doses, GHB produces a euphoria similar to alcohol, generating the feeling of being relaxed, happy, and sociable. At higher doses, dizziness, vomiting, and muscle spasms can occur. Other symptoms of GHB use include lethargy (sluggishness), extreme intoxication, impaired judgment, nausea, vomiting, and dizziness. The drug can also cause unconsciousness, depression, seizures, severe respiratory depression, and coma. Symptoms appear within 15–20 minutes of taking the drug and can last between two and three hours but may linger for an entire day. Mixing GHB with alcohol is extremely dangerous, because both drugs depress the central nervous system. Combining GHB and alcohol has resulted in a number of deaths, typically from respiratory failure. The 2007 “Monitoring the Future” study showed that use of GHB by high school students remained about the same between 2005 and 2007. In 2007, use of GHB among eighth graders was 0.7 percent, use among 10th graders was 0.6 percent, and 0.9 percent of 12th graders reported using GHB in the previous year.

Fact Or Fiction? The use of designer drugs can cause brain ­damage.

The Facts: According to a 1995 article in the Journal of Neuroscience titled “Reorganization of Ascending 5-HT Axon Projections in Animals Previously Exposed to the Recreational Drug 3,4-methelenedioxymethamphetamine (MDMA, ecstasy),” even a single dose of ecstasy may significantly damage brain cells. In the study, researchers found that monkeys who had been given ecstasy showed damage to certain nerve cells that later grew back abnormally or not at all. A 2003 article in the Journal of Neural Transmission (“Designer Drugs—How Dangerous Are They?”) reported that brain-imaging techniques such as PET scans “provide suggestive evidence the MDMA (ecstasy) is neurotoxic” to certain neurons in humans. Rohypnol

Rohypnol is the brand name for a commercially produced drug called flunitrazepam. It belongs to the class of drugs known as benzodiazepines—antianxiety drugs that include Librium and Valium. Rohypnol

20 The Truth About Drugs

is not approved for use in the United States and cannot be legally imported from other countries. Rohypnol began to appear in the United States in the early 1990s, shortly after GHB became popular as a club drug. Common names for Rohypnol include rophies, roofies, roach, and rope. The effects of Rohypnol include muscle relaxation and slowed motor responses. Rohypnol also decreases blood pressure, causes the body to retain urine, and produces an intoxicated feeling similar to that of alcohol. The most serious effect produced by Rohypnol is anterograde amnesia—the inability to remember events that take place after the drug is taken. Rohypnol may be lethal when mixed with alcohol and/or other depressants. The 2007 “Monitoring the Future” study found that 0.7 percent of eighth graders, 0.6 percent of 10th graders, and 0.9 percent of 12th graders reported using Rohypnol in the past year. Ketamine

Originally created as an anesthetic around 1970, ketamine is widely used in both human and animal medicine. About 90 percent of the ketamine sold legally in the United States is used in veterinary practice. However, ketamine is also abused because of its ability to produce euphoria, dreamlike states, and hallucinations. In high doses, ketamine can cause confusion, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems. Ketamine is also known as Special K or vitamin K.

teens speak A lot of kids seem to be trying club drugs these days, but after what happened to my friend the other day, I’m not going to be one of them. My friends and I really love to dance, and we go to clubs on the weekends. We don’t go to drink or do drugs, we just like hanging out, dancing, listening to the music, and talking. A few weeks ago, I made friends with a new girl in school named Kim. She was really cool and was also into dancing, so I invited her to come with us to the clubs that weekend. When Kim met my friends on Friday night, everyone hit it off with her. She seemed sure of herself but not cocky or anything like that. After we’d been at the club for about

Club and Designer Drugs 21 15 minutes, Kim went to the bathroom. A few minutes after she came out, I noticed she looked kind of strange. Her eyes were sort of glassy, and she seemed to be super pumped-up. For the next hour or so she was all over the dance floor—I’d never seen anybody who had so much energy. After about an hour or so, however, Kim started acting really weird. She was really thirsty and her whole body was flushed. She started shaking and feeling weak and sick to her stomach. We were all really scared because she looked terrible and was acting so sick. We got her outside and sat her down, and then one of my friends called 911. Before the ambulance got there, Kim told me she had taken some ecstasy when she went to the bathroom. At first it made her feel great, like she had all the energy in the world. Then she suddenly started feeling like she was going to die. Thankfully the emergency technicians in the ambulance were able to get her feeling better, but they took her to the emergency room just to be sure she was OK. Kim taught me a big lesson. You don’t need drugs to have a good time, and in fact they will ruin the good times you have. Kim is fine now, but I don’t think she’ll be doing ecstasy again.

Club Drugs and Date Rape

In recent years, health and law enforcement officials have become concerned about the use of club drugs known as date rape drugs (substances used to render a person unconscious and susceptible to date rape). Rohypnol, GHB, and ketamine are commonly identified as date rape drugs. When slipped into a drink, these drugs can not only cause unconsciousness but also leave the victim with no memory of what happened. If someone you know appears to be dizzy, confused, or suffering from other sudden, unexplained symptoms after having a drink, they may have been drugged. If you suspect that you or someone you know has been drugged, find medical help immediately. Rohypnol, GHB, and alcohol all depress the functioning of the central nervous system. Combining these drugs with alcohol can slow the user’s heart rate and breathing to dangerously low levels. The combination can result in coma or even death from respiratory failure.

22 The Truth About Drugs

According to the “Monitoring the Future” survey, teen use of club and designer drugs increased dramatically during the 1990s, reaching a peak around 2000. The numbers began to decline thereafter, but the percentage of teens using ecstasy in 2007 was still 50 percent, as it was just three years earlier. Although progress is clearly being made in alerting teens to the dangers of club drugs, many are still taking serious risks by using these substances. See also: Drugs and Drinking; Illegal Drugs, Common; Overdose and Drugs; Sexual Behavior and Drug Abuse further reading

Balkin, Karen F., and Louise Gerdes. Club Drugs. Portland, Oreg.: Greenhaven Press, 2004. Brennan, Kristine. Ecstasy and Other Designer Drugs. London: Chelsea House Publications, 1999. Karson, Jill. Club Drugs. San Diego, Calif.: Referencepoint Press, 2007. Knowles, Cynthia R. Up All Night: A Closer Look at Club Drugs and Rave Culture. Thousand Oaks, Calif.: Red House Press, 2001. Robbins, Paul R. Designer Drugs. London: Enslow Publishers, 1995. Swartz, Katherine. The History of Drugs: Club Drugs. Detroit, Mich.: Greenhouse Press, 2005.

■ Crack Cocaine

A concentrated and more addictive form of cocaine, an illegal drug derived from the coca plant. Crack cocaine produces more profound effects than other forms of the drug. Both cocaine and crack cocaine are stimulants, substances that tend to increase alertness, energy, and physical activity. Although cocaine has been used for more than 100 years, crack is a relatively new drug that first appeared in the United States in the early 1980s. Use of crack cocaine among youth rose steadily until the late 1990s. While use declined in the early 2000s, it has since leveled off, remaining relatively unchanged since 2004. Description and Effects

Cocaine is a white powder produced by chemically treating the leaves of the coca plant. Coca leaves contain a natural stimulant whose

Crack Cocaine 23

effects are greatly increased as a result of chemical treatment. Crack is produced by dissolving powdered cocaine in a mixture of water and ammonia or sodium bicarbonate (baking soda). The mixture is boiled until a solid substance forms. The solid is then removed from the liquid, dried, and broken into chunks (known as “rocks”) that are sold as crack cocaine. The most common methods of administering powder cocaine are by snorting (inhaling through the nose) and through intravenous injection. By contrast, crack cocaine is usually smoked in a pipe. The smoke carries the drug into the user’s lungs where it is absorbed quickly into the bloodstream. Crack gets its name from the cracking sound the drug makes when it is heated. The short-term effects of crack are similar to those of cocaine and include euphoria, stimulation of the central nervous system (the brain and the spinal cord), reduced fatigue, and a sense of mental clarity. Because crack is smoked, it is absorbed more quickly into the body and produces a more intense reaction than snorting powder cocaine. However, the faster the drug is absorbed, the shorter the duration of its effect. The short-term effects of crack typically last only about 5–10 minutes. Frequent use of crack can lead to tolerance of the drug, a condition in which the user must increase his or her intake of the drug to achieve the same effects. At higher doses crack use can lead to paranoia and trigger aggressive behavior. Long-term effects include restlessness, irritability, and anxiety. Crack also produces physical effects similar to those of cocaine, including increased temperature, elevated heart rate and blood pressure, constriction (narrowing) of blood vessels, loss of appetite, convulsions, muscle twitching, and irregular heartbeat. In rare instances, sudden death may occur directly as a result of use. According to the National Institute on Drug Abuse, crack-related deaths are often a result of heart attack or seizure followed by respiratory system failure. Statistics on medical emergency calls related to crack indicate just how serious the effects of the drug can be. In 2002, emergency rooms and emergency medical personnel across the United States reported 42,146 crack “mentions” to the Drug Abuse Warning Network (DAWN), a nationwide clearinghouse for information on drug use. A “mention” refers to a report made by the emergency patient or a third party that the patient used a particular drug prior to the emergency episode. More than one out of five cocaine mentions (21 percent of the total) during 2002 concerned crack cocaine. Despite the large number of crack mentions for 2002, the figure actually represents a decline from the previous year’s total of 46,964.

24 The Truth About Drugs

Q & A Question: What is a crack baby? Answer: A crack baby is an infant that experiences physical and behavioral problems as a result of the use of crack by his or her mother during pregnancy. A 1996 article titled “Maternal exposure to crack cocaine produces stressed newborns” (Brown University News Bureau) reported that babies exposed to crack while in the womb showed abnormal patterns of both excitability and lethargy (sluggishness) compared with nonexposed infants. In addition, babies exposed to crack appeared more stressed. They often were unable to follow certain stimuli such as a rattle or bell compared with nonexposed infants. According to the article, crack babies “were more jittery, had more muscle tension, and were harder to move because they were stiff.” Some were also drowsier and had a weaker crawl than nonexposed babies. Some experts dispute the idea that crack is responsible for these developmental difficulties. A 2001 report by the Journal of the American Medical Association suggested that most of the problems experienced by these infants were related to other risk factors such as cigarettes, alcohol, and poverty. The research found no consistent link between crack exposure before birth and childhood physical growth or development. The researchers did discover that motor skill problems linked to crack exposure typically disappeared by the time the child was seven months old. However, the report also concluded that more research was needed on the drug’s effects on an infant’s nervous system. One of the authors of the report remarked, “Although it would be inaccurate to say that we’re absolutely sure that there are no adverse physical or mental effects of prenatal cocaine exposure, I think we can say that the popular stereotype of the distraught child who is unable to love and unable to learn is absolutely inaccurate.”

Incidence of Use

Although the use of crack cocaine has declined slightly in recent years, government- and university-sponsored studies indicate that crack cocaine use remains a serious problem in the United States. The Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the Department of Health and Human Services, compiles an annual report on drug use titled the “National Survey on Drug Use and Health.” According to SAMHSA’s 2006 findings, 8.5 million Americans age 12 and older reported trying crack at

Crack Cocaine 25

least once. This figure represents 3.5 percent of the population age 12 or older. Some 702,000 of those who smoked crack in 2002 reported using it in the month prior to the survey. The University of Michigan’s 2007 “Monitoring the Future” study, which tracked drug use among eighth-, 10th-, and 12th-grade students, suggests that crack use is a problem among teens. However, the study also found that teen crack use has declined slightly in recent years. According to the study, in 2006 some 2.3 percent of eighth graders, 2.2 percent of 10th graders, and 3.5 percent of 12th graders reported using crack cocaine at least once. The figures for eighth and 12th graders fell slightly in 2007, but the study found that crack use rose to 2.3 percent among 12th graders. The 2007 study also reported that 1.3 percent of eighth and 10th graders and 1.9 percent of 12th graders had smoked crack in the previous year. Students who responded to the 2007 “Monitoring the Future” study reported that they had little difficulty in obtaining crack cocaine. A significant percentage of students from all three grades also reported that they did not consider using crack once or twice to be extremely risky behavior. According to the study, 29.7 percent of eighth graders, 29 percent of 10th graders, and 37.5 percent of 12th graders surveyed in 2003 said that crack cocaine was “fairly easy” or “very easy” to obtain. The study found that fewer than half of eighth graders and 12th graders (47.3 percent in both cases) agreed with the statement that trying crack once or twice represented a “great risk.” Over half of 10th graders (56.4 percent) agreed that using crack even once was a “great risk.” Crack is also strongly linked to criminal behavior. According to the National Institute of Justice’s Arrestee Drug Abuse Monitoring Program (ADAM), 17.2 percent of adult males arrested for criminal offenses in 2002 and 24.5 percent of adult female arrestees reported using crack cocaine at least once in the year before being arrested. In 2002, the Drug Enforcement Administration (DEA) made 5,166 arrests involving crack cocaine, which represented 20.2 percent of all drug arrests for the year.

teens speak My name is Erin, and I want to warn you about a drug that many kids don’t think is a serious problem: crack. I live in

26 The Truth About Drugs a middle-class neighborhood and go to a good school. I always though of crack as something that was only found in the poorest parts of the inner city. I never imagined that kids in the suburbs were doing it, especially kids that I knew. I found out differently a few weeks ago. Jim is a guy in many of my classes. He’s not really a close friend, more of an acquaintance. I knew he liked to party; I’ve seen him drinking beer and smoking weed a couple of times. I also heard that he did some harder drugs like cocaine, but I never believed those stories. He seemed like a pretty level-headed guy and never struck me as someone who would risk messing himself up with cocaine. Then one week I noticed that I hadn’t seen Jim around school for several days. I asked a friend who also knew Jim if she had any idea where he was. She told me she had heard that he was in the hospital. When I asked what was wrong with him, she said he had a heart attack. I was shocked. Jim is only 16, and he is in good shape—he is even on the basketball team. How in the world did someone like that suffer a heart attack? My friend said it happened after Jim smoked crack. Someone who was there told her that Jim collapsed after smoking a single “rock” of crack. The other kids were really freaked out, but they called 911, and the emergency crew was able to get Jim to the hospital in time to save his life. My friend said the kids with Jim were all scared to death, and they have all sworn off smoking crack again. Unfortunately it was too late for Jim. I hear he’s going to recover, but he’ll never be the same, and I’ll never again think of crack as someone else’s problem.

The Crack Epidemic

According to the DEA, an oversupply of powder cocaine in the Bahamas in the early 1980s led to the introduction of crack in the United States. At that time most of the cocaine shipped to the United States came through the Bahamas, and by 1980 the price on the islands had dropped by as much as 80 percent as a result of an oversupply. Dealers there needed to find a way to convert the powder into a form that was cheap, easy to produce, ready to use, and profitable. The result was crack, and by 1981 the drug was appearing in Los

Crack Cocaine 27

Angeles, San Diego, and Houston. Later, Caribbean immigrants taught dealers in Miami how to produce crack, and before long the drug had spread throughout the United States. Crack cocaine had advantages for both the user and the dealer. It was not only purer than powder cocaine (which often contains other substances to increase the volume) but also cheaper. It also produced an instant and much stronger “high” than powder cocaine. For the user, this new form of cocaine meant a more intense experience; for the dealer, it meant that users became addicted more quickly, resulting in increased demand. Users needed to smoke more and more frequently to achieve the same effects. At first, law enforcement officials did not consider crack to be a serious problem, mainly because it was popular primarily among middle-class users rather than cocaine addicts. In fact, many were convinced that crack use was confined largely to Miami until it appeared in New York City in December 1983. As in Miami, crack in New York was largely a middle-class drug at first. The DEA estimated that more than 75 percent of early crack users in New York were white professionals, middle-class teens from Long Island and New Jersey, or users from upper-class Westchester County. However, because of its extremely low price, crack soon spread to lower-class and poor neighborhoods. By early 1986, crack was firmly entrenched in the inner city and by the end of the year had spread to 28 states and the District of Columbia. By 1987, crack was available in all but four states and by the following year it had replaced heroin as the biggest drug problem in Detroit. The crack epidemic had two serious negative social effects: it substantially increased the number of cocaine addicts in the United States and it led to a wave of drug-related violence. According to SAMHSA’s National Household Survey on Drug Abuse, the number of people who admitted using cocaine on a routine basis increased from 4.2 million in 1984 to 5.8 million in 1985. DAWN reported that cocaine-related hospital emergencies increased by 12 percent from 1984 to 1985 and by 110 percent between 1985 and 1986. Between 1984 and 1987, the number of cocaine-related emergency incidents increased some 400 percent. As selling crack became more profitable, both the number of traffickers and the violence associated with its sale increased. By the late 1980s, the DEA reported that more than 10,000 gang members were dealing drugs in the United States and that crack was a significant source of their income. According to a 1988 study by the Bureau of

28 The Truth About Drugs

Justice Statistics, crack use was related to 32 percent of all homicides and 60 percent of drug-related homicides in New York City. On a nearly daily basis, the news broadcasters reported drive-by shootings related to crack dealing.

Fact Or Fiction? The Central Intelligence Agency (CIA) is responsible for bringing crack cocaine to the United States.

The Facts: A series of news reports published in the San Jose Mercury newspaper in 1995 claimed that during the 1980s rebels attempting to overthrow the Nicaraguan government were introducing massive amounts of crack cocaine into the United States with the approval and even support of the CIA. According to Gary Webb, author of the articles, profits from crack sales funded the revolution being carried out by the rebels, known as the contras. The U.S. government has strongly disputed Webb’s claims, but Webb stands by his story, which was told to him by drug dealers heavily involved in the San Francisco-area crack trade in the 1980s. Webb later published a book titled Dark Alliance: The CIA, the Contras, and the Crack Cocaine Explosion, which laid out his case against the CIA. Law Enforcement Responses to Crack

By 1986, the crack problem in the United States had become so serious that Congress passed the Anti-Drug Abuse Act, which included $8 million to help law enforcement combat domestic cocaine trafficking. The bill also called for $1.5 million in funding to establish crack task forces in Los Angeles, Houston, Minneapolis, Denver, and Detroit. At the same time, the DEA embarked on a program to reduce the amount of cocaine entering the country by attacking major international drug trafficking rings. By the late 1980s, the DEA, the Department of Justice, and state and local law enforcement agencies all boasted crack task forces. Cocaine became the main focus of the DEA’s activities, and cocaine arrests accounted for nearly 65 percent of the DEA’s total arrests in 1988. One of the more controversial features of the Anti-Drug Abuse Act of 1986 was that it created a legal distinction between “cocaine

Crack Cocaine 29

base” (crack and the liquid mixture from which crack is created) and other forms of cocaine. The act also introduced mandatory minimum penalties for federal drug trafficking offenses that were based on the type and quantity of drug sold. Together, these developments resulted in harsher penalties for selling crack than for other drug offenses. Under the law, a defendant convicted of dealing 1.75 ounces, or 50 grams, of crack would receive the same sentence as someone who sold 100-times as much (11 pounds, or five kilograms) powder cocaine. According to a 1995 report by the U.S. Sentencing Commission, crack is the only drug for which a first-time offender can receive a mandatory minimum sentence. In the 1990s, the federal sentencing guidelines concerning crack were under attack by those who claimed the law was racially discriminatory. These claims stemmed from research that showed that, following passage of the law, black drug offenders were much more likely to receive tougher sentences than white offenders. According to a 1992 Federal Judicial Center report, “The General Effect of Mandatory Prison Terms: A Longitudinal Study of Federal Sentences Imposed,” the difference in the average sentences for blacks and whites convicted of drug offenses increased dramatically after passage of the 1986 act. Prior to 1986, black offenders convicted of federal drug offenses received sentences that averaged 11 percent longer than those given to white offenders. By 1990, the average sentence for black drug offenders was 49 percent higher than those for whites. The perception among many observers was that crack offenders were being punished more harshly than powder cocaine offenders, because crack was associated in the public mind with lower-class blacks while powder cocaine was seen as a drug used by middle-class whites. In a special report to Congress in 1997, the U.S. Sentencing Commission agreed with many of the race-based criticisms of the 1986 act. For example, the commission found that although the majority of crack users were white, nearly 90 percent of convicted crack dealers were black. The commission concluded that “sentences appear to be harsher and more severe for racial minorities than others as a result of this law.” The commission also noted problems with the way law enforcement officials investigated and prosecuted cases involving crack. The commission was concerned that even when law enforcement agencies were aware that a suspect possessed powder cocaine, they may wait to arrest the suspect until he or she

30 The Truth About Drugs

had converted it into crack because of the stiffer sentences given to convicted crack dealers. The report suggested that such law enforcement practices seemed more likely to occur when the suspect was African American. The 1997 U.S. Sentencing Commission report also found that convicted crack dealers received average sentences as harsh or harsher than those for many violent crimes. Defendants convicted for crack offenses under the 1986 act received an average sentence of 10 years and six months. That sentence was longer on average than those given to defendants convicted of weapons offenses (average sentence seven years and seven months) and rape (six years and seven months) and only slightly shorter than the average sentence given to convicted murderers (12 years and nine months). Despite these criticisms, the mandatory minimum sentencing guidelines established in the 1986 act are still in force today. Continuing Questions

Since its introduction to the United States, crack has been one of the most dangerous and controversial of all drugs. While there is no dispute as to the dangers of using crack, reactions to the drug by lawmakers and law enforcement officials have caused considerable concern among those concerned with the rights of defendants and racial discrimination in sentencing for drug offenses. However, disagreements about the appropriate response to crack use cannot overshadow the fact that crack can lead to serious physical and behavioral problems for the user. The crack epidemic that began in the early 1980s is still claiming victims today. See also: Dependence and Addiction; Drugs and Criminal Activity; Gangs and Drugs; Illegal Drugs, Common; Law on Drugs, The; Morbidity and Mortality further reading

Bayer, Linda N., and Steven L. Jaffe. Crack & Cocaine (Junior Drug Awareness). London: Chelsea House Publications, 2000. Cooper, Edith Fairman. The Emergence of Crack Cocaine Abuse. New York: Novinka Books, 2002. Karch, Steven B. A Brief History of Cocaine. Boca Raton, Fla.: CRC Press, 1997.

Dependence and Addiction 31

Reinarman, Craig and Harry Gene Levine. Crack in America: Demon Drugs and Social Justice. Berkeley: University of California Press, 1997. Roleff, Tamara L. Cocaine and Crack. San Diego, Calif.: Referencepoint Press, 2007. West, Krista, and Ronald J. Brogan. Cocaine and Crack. New York: Chelsea House, 2008.

■ Dependence and Addiction

Dependence, the craving for and the compulsive use of a drug despite harmful psychological, physical, or social consequences; and addiction, the inability to stop using a substance despite significant negative physical or psychological effects. No one can predict exactly when a person becomes dependent on a drug because of the many variables involved. Dependence is a very individual situation and it affects people from all walks of life. Its severity varies with the individual, the situation, and the substance. The National Institute on Drug Addiction points out that other issues, such as poor mental health, illness, and occupational or social problems can affect one’s ability to overcome a dependency. Why would a teen choose to take drugs? The truth is that teens may initiate drug use for a variety of reasons. Some of those reasons may include peer pressure, avoiding a difficult family situation, escaping from an abusive relationship, overcoming fears of not meeting expectations, a longing to be accepted in a group, or simple curiosity. Many teens may struggle with some or all of these issues. However, since drug dependence often stems from such difficult emotional or psychological issues, the two need to be dealt with together. Types of Dependence

There are several different types and levels of drug dependence. Physical dependence occurs when a person comes to depend on a drug to function physically or psychologically. A person who is physically dependent on a drug typically experiences withdrawal symptoms when they stop using the substance. These might include nervousness, irritability, trembling, nausea, and even false or distorted

32 The Truth About Drugs

sensations known as hallucinations. Repeated use of a drug can lead to tolerance, a condition in which the user requires ever larger doses of the drug to produce the desired effect.

Q & A Question: Which drugs have the greatest potential for abuse? Answer: According to the National Institute on Drug Abuse, almost 70 percent of the people who said they had tried alcohol at least once had used it within a month of the study. Just under 30 percent of those who had experimented with marijuana had smoked it within the previous month.

Not all drugs produce physical dependence. A person also can crave a drug without developing a tolerance for it. Psychological dependence is the term for an intense craving for a drug that may or may not be accompanied by physical dependence. When physical and psychological dependence begins to negatively affect a person’s life, it is called addiction. Someone who shows three or more of the following behaviors during the same 12-month period is considered addicted: ■ Taking

larger and larger amounts of the drug ■ Taking the drug for a longer period than intended ■ Unsuccessful efforts to cut down or control use despite a strong desire to do so ■ Spending a great deal of time trying to obtain or use the substance, or recovering from its effects ■ Reducing or giving up important activities such as work, school, or recreation because of use ■ Continuing to use the drug even though doing so causes physical or psychological problems or makes existing problems worse The potential for dependence or addiction is related to the physical and psychological properties of the individual drug. Some drugs, including heroin, LSD, PCP, cocaine, opium, and marijuana can

Dependence and Addiction 33

easily lead to psychological dependence. Some of these, particularly cocaine, opium, and heroin, also have a high potential for physical dependence. Other drugs have a lower potential for physical dependence, but all can result in psychological dependence and addiction.

teens speak My Best Friend Got Hooked on Drugs When Joe got hooked on drugs, I was really ticked off. I knew he smoked cigarettes and had tried some “weed” occasionally but I never thought he would try crack cocaine, let alone get hooked on it. We both knew about gateway drugs and how using cigarettes or drinking beer can lead to more dangerous drug use, but we never thought it would happen to us. After all, we never did drugs. What really makes me angry is that he never talked with me about it and we were best friends. We shared so much together. Maybe he never talked to me about it because he knew how much I despised drugs. I would tell him that people who use drugs are playing Russian roulette and eventually they will get burned. Joe would tell me about these kids he knew who would go to raves and do drugs like X, Special K, and even coke. He told me that these guys used these drugs and never had any problems. But I know kids who did drugs at the raves were having trouble at home and in school. Joe never realized that some of these kids who used drugs at the raves actually ended up in the hospital because they were drinking while taking drugs. I know these club drugs can cause problems but with alcohol they become really dangerous. One guy even attempted suicide. I heard one of the teachers say that this guy was having some problems with depression because his parents were breaking up and that the drugs and alcohol could have prompted the suicide attempt. I hope Joe’s okay.

34 The Truth About Drugs Codependence

When a teen is addicted, the drug becomes the single greatest source of pleasure in his or her life. Getting an addicted teen off drugs requires denying him or her this pleasure. This process can be so difficult that professional assistance is required to beat the habit. Drug dependence does not usually happen overnight but rather is the result of a progression of use over time. However, the progression of drug dependence not only involves the users themselves but also their families and friends. Family and friends can become codependent. Codependence is a set of compulsive behaviors learned by persons close to an addict in order to survive in an emotionally painful and stressful environment. People who are codependent often behave in ways that unconsciously support the addict’s habit. They may even actively hinder the addict’s attempt to beat his or her addiction. Codependent friends or loved ones build their own self-esteem by supporting and caring for the addict. They fear that, without the addiction, he or she may not need them and may even abandon them. Codependence springs from a person’s inability to take care of his or her own emotional needs and a failure to set appropriate emotional boundaries. The codependent person tries to control the feelings and behaviors of others, which can lead to taking responsibility for another person’s drug dependence. At the same time, people who are codependent ignore their own needs and wishes. As a result they may experience other psychological problems, including developing addictive behaviors. Because codependence is a mental disorder, treatment is often required to face these problems. Children exposed to an environment marked by drug dependence and codependence are at risk of modeling the behaviors they witness. They may imitate the behavior of the drug addict and experiment initially with substances like alcohol, cigarettes, or marijuana. These are gateway drugs, substances that can lead to the use of increasingly addictive drugs. Some children may copy the behaviors of the codependent family member. Modeling codependence may result in a selfdefeating situation, in which children question their personal identity, disregard their feelings, and rely on ineffective coping skills. Codependence is an example of how drug dependence can affect not only the drug user but also his or her family and friends. It also shows just how difficult it can be to deal with drug dependence. If

Depression and Drugs 35

you think you know someone who may be using drugs, it is much better to approach them before they become dependent. By offering support you can help them avoid making the mistake of becoming involved with drugs. See also: Drug Abuse, Causes of; Families, Communities, and Drug Abuse; Peer Pressure and Drugs further reading

Hoffman, John, and Susan Froemke (eds). Addiction—Why Can’t They Just Stop? New York: Rodale Books, 2007.

■ Depression and Drugs

Depression, a mental condition caused by a chemical imbalance in the brain, characterized by feelings of profound sadness, hopelessness, and worthlessness. In 2006, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that one in every 12 adolescents suffered from depression. When teens suffer setbacks or frustrations in meeting challenges, they may feel depressed. Typically these feelings last only a limited period of time and diminish quickly. However, when feelings of sadness and hopelessness persist and become increasing difficult to overcome, these feelings may indicate the onset of depression. Depression can be treated with prescription drugs that are safe and effective. However, some teens turn to illegal drugs or alcohol to deal with their depression. They do not understand the difference between healthy and unhealthy ways of dealing with depression. Symptoms and Risk Factors

Feeling down is a normal reaction to experiences that result in sadness, disappointment, and rejection. Screwing up on an important exam, needing to put your pet down because of illness, or having your job application rejected are all situations that can leave you feeling blue. However, even when confronted with a terrible tragedy like the untimely death of a loved one, the human spirit usually begins the process of healing and hope, including the feeling that better times are ahead.

36 The Truth About Drugs

When sad feelings persist and begin to affect one’s ability to function normally, then a serious condition called depression may be setting in. Depression is characterized by a wide range of feelings that may include dejection, focus on negative thoughts, guilt, low self-esteem, hopelessness, inability to concentrate, loss of appetite, withdrawal from friends, insomnia, and lack of interest in favorite activities. Depression often develops into a cycle in which feelings of worthlessness, helplessness, and loss of control are continually reinforced. A particularly cruel aspect of depression is that it can return unexpectedly when a person is exposed to stressful or difficult situations.

Q & A Question: How do I know if I am depressed? Answer: The Web site Psychology Information Online (http://www. psychologyinfo.com) identifies symptoms of depression in teens. If a teen has shown several of these symptoms over several weeks, or if the symptoms cause a significant change in daily life, the teen should talk to someone who can help. The symptoms include: ■ Feeling

sad or crying often; the sadness doesn’t go away

■ Feeling

guilty for no reason; losing confidence

■ Deciding

that life seems meaningless or feeling as if nothing good will happen again

■ Having

a negative attitude much of the time or feeling

numb ■ No

longer doing things one used to like such as music, sports, being with friends, or going out; wanting to be left alone most of the time

■ Having

trouble making up one’s mind; forgetting things and having difficulty concentrating

■ Getting

irritated often; losing one’s temper over little things; overreacting

■ Sleeping

more or having trouble falling asleep at night; waking up early in the morning and being unable to go back to sleep

■ Losing ■ Feeling

one’s appetite or eating a lot more restless and tired

Depression and Drugs 37 ■ Thinking

about death; feeling as if one is dying; having thoughts about committing suicide

A number of factors can increase one’s risk of depression. Some of these factors are related to biology, while others are related to the environment. Some recent research has focused on the hormonal or endocrine system—a system of small glands that regulate bodily functions through hormones released into the bloodstream. Hormones are chemical substances produced in the body. They regulate reaction to stress and sexual development. In a 2004 study in the journal Behavioral Neuroscience, researchers suggested that exposure to stress hormones may cause depression. Conditions caused by hormonal imbalances that can lead to depression include Cushing’s disease, Addison’s disease, and disorders of the thyroid gland. Chronic (long-term) disease can also be a risk factor for depression. The National Cancer Institute reports that about 15 to 25 percent of cancer patients suffer from depression. In a 2007 report in the medical journal Lancet, researchers found that patients suffering from chronic diseases such as asthma, arthritis, and diabetes are significantly more likely to develop depression. Other chronic medical conditions that may increase the risk of depression include vitamin deficiency, Parkinson’s disease, kidney disease, arthritis, HIV, AIDS, and chronic pain. Environmental causes for depression can include both negative experiences and ongoing stress. In a 2007 study at Emory University, researchers found that people who experience more difficulties in childhood are at greater risk of becoming depressed than those who do not suffer as many childhood setbacks. Traumatic experiences such as the death of a loved one, loss of a job, or the end of a relationship can cause a great deal of stress, which may lead to depression. Although research has not proven that stress directly causes depression, those who experience higher levels of stress seem to be at a higher risk for developing depression than those who do not. Certain psychological disorders can also lead to depression. For example, some people suffer from a condition known as bipolar disorder, a mental disorder that causes unusual shifts in mood, energy, and ability to function; people affected with the disorder experience periods of euphoria followed by periods of extreme depression. Depression can also be caused by the lack of sunlight experienced during the winter months especially in the northern sections of the

38 The Truth About Drugs

country. This condition—known as seasonal affective disorder, or SAD—can be remedied with special lighting or by packing up and moving to sunnier destinations. Treating Depression

How can you assist a friend who may be depressed? One simple thing you can do is to encourage your friend to seek appropriate medical or psychological help. You may also want to advise him or her to avoid using illegal drugs or alcohol, which can make the symptoms of depression even worse.

Fact Or Fiction? A positive attitude can pull a teen out of depression.

The Facts: Depression is not just a short-term reaction to a temporary disappointment. It is a serious medical condition that can be caused by many factors including stress, chronic disease, and drug or alcohol abuse. Research has shown that optimistic people are healthier than pessimistic ones, and that pessimism is related to depression. However, there is no evidence that pessimism causes depression or that optimism relieves it. Overcoming depression requires counseling and medication. Some teens feel that illicit drugs and alcohol are helpful in overcoming feelings of sadness and hopelessness. They hope that “getting high” will lift their spirits. There are serious concerns with taking drugs and alcohol to deal with depression. The first is that alcohol and some drugs, such as barbiturates, are depressants. Their use can intensify feelings of depression rather than help relieve them. In addition, drinking to cope with depression can often lead to later problems with alcohol and drug abuse. Another concern is that alcohol and drugs only mask the problem. When their effects wear off, the problem is still there. Sooner or later more alcohol or drugs will be needed to counter feelings of depression. A variety of legal drugs are available to help people in overcoming their depression. Because researchers believe that depression is caused by a chemical imbalance in the brain, they have developed

Driving Under the Influence of Drugs 39

medications known as antidepressants to restore that balance. These antidepressants include Prozac, Luvox, and Zoloft. Another type of medication, lithium (also produced under the brand names Eskalith and Lithane), is often prescribed for those with a bipolar disorder. Medication in conjunction with therapy can successfully treat most forms of depression. Suicide

Suicide is the act of taking one’s own life. It is often the result of long periods of depression. In 2006, the National Adolescent Health Information Center (NAHIC) reported that suicide was the thirdleading cause of deaths among 10- to 24-year-olds. A study of data collected by the U.S. National Comorbidity Survey during the early 1990s found that people who were dependent on drugs or alcohol were more likely to attempt suicide. The study noted that drug use, even without dependence, was closely associated with suicidal thoughts and impulsive suicide attempts. All drugs seemed equally likely to cause suicidal feelings or attempts. More recent studies have confirmed these results. For example, a 2004 study from the University of South Wales, Australia, found that 31 percent of cocaine users had attempted suicide at least once. What teens who attempt suicide often fail to consider is that there is almost always a solution to their problem. Time is a great healer, but suicide robs a person of that valuable time. Feelings of hopelessness may seem impossible to overcome but working through problems can instill a renewed self-confidence. Seeking professional help, staying away from illegal drugs and alcohol, and avoiding negative self-talk are all positive steps in overcoming depression. See also: Drugs and Drinking; Morbidity and Mortality further reading

Wilkinson, Beth. Drugs and Depression. Center City, Minn.: Hazelden Publishing, 1997.

■ Driving Under the Influence of Drugs

Operating a motor vehicle while impaired by drugs or alcohol. Learning to drive is tough, especially as the roads become increasingly

40 The Truth About Drugs

congested with cars, trucks, traffic signals, and pedestrians. It’s even more difficult to drive safely with all the distractions of the modern world, including cell phones. The one thing, however, that makes driving not only tough but also extremely dangerous is driving while using alcohol or drugs. Trying to drive under the influence of these substances can even kill you and others. Rates of Injuries and Deaths

Teens in the United States are more likely to be killed as the result of a motor-vehicle crash than by any other single activity. Although little is known about what percentage of teens drive under the influence of drugs, the statistics for the percentage of teenagers who drive after drinking alcohol are well established. According to the Centers for Disease Control and Prevention (CDC), in 2007 10.5 percent of teens nationwide drove a car or other vehicle after drinking. The rate for males (12.8 percent) is significantly higher than the rates for females (8.1 percent). Seniors are more likely to drink and drive than juniors, juniors more likely than sophomores, and sophomores more likely than freshman. Drinking and driving behaviors seem to vary by sex and ethnicity. White males (13.9 percent) and Hispanic males (13 percent) were shown to have the highest rates of driving after drinking. By contrast, the rate for African-American males was 7.5 percent. Females were significantly less likely to drink and drive than males, with about 9 percent of white females and 7.7 percent of Hispanic females engaging in such behavior. African-American females (just under 4 percent) were the least likely of all groups to drink and drive. Additionally, the CDC found that about 29 percent of teens nationwide had been a passenger in a car driven by someone who had been drinking alcohol.

Fact Or Fiction? Seat belts don’t prevent injuries.

The Facts: In 2000, 80 percent of the teen drivers who were killed in motor vehicle crashes after drinking and driving were not wearing seat belts. Overall, some 14 percent never or rarely wear seat belts when another person is driving. The CDC statistics from 2007 also show that males are

Driving Under the Influence of Drugs 41

half again as likely as females (13.8 percent compared to 8.5 percent) to rarely or never wear seat belts. This difference is reflected in death rates among teen car accident victims. According to the CDC, the motor vehicle death rate for males aged 16 to 19 was 19.4 per 100,000. The rate for females was 11.1 per 100,000. The National Highway Traffic Safety Administration reported in 2006 that 24 percent of older teen drivers (age 15–20) who died in motor vehicle crashes had been drinking. The same study reported that 23 percent of older teen drivers who died in auto crashes were legally drunk, defined as a blood alcohol concentration of 0.08 g/dL (grams of alcohol per deciliter of blood). A number of factors contribute to teenage alcohol-related fatal motor vehicle crashes, including the time of day, day of the week, and driving experience. The hours between 12 midnight and 3 a.m. are the time of greatest potential risk for an accident. Also, the risk of being killed on a weekend is significantly higher than on a weekday. According to the U.S. Department of Transportation, most alcohol-related fatal motor vehicle crashes occur at night and on the weekends. The use of marijuana and other drugs has also been found to affect the ability of teens to drive safely. In a 1996 study by the National Institute on Drug Abuse (NIDA), researchers found that marijuana impairs functions like balance and coordination, which are essential to safe driving. A compounding problem is driving under the influence of both marijuana and alcohol. NIDA researchers point out that a large number of people who test positive for alcohol also test positive for THC (the active ingredient in marijuana), making it difficult to determine the actual role each drug plays in motor vehicle crashes. A 2004 study of traffic accidents in the Canadian province of Quebec found drugs other than alcohol present in more than one-third of all fatally injured drivers. Almost 20 percent of the victims had used marijuana and more than 10 percent had taken benzodiazepines—a family of antianxiety drugs that includes Valium. The researchers estimated that 5 to 12 percent of Canadian drivers are under the influence of marijuana. Males under 25 years old accounted for more than 20 percent of those driving while on marijuana.

42 The Truth About Drugs

Q & A Question: How much alcohol intake impairs one’s ability to drive? Answer: The law defines drunk as having a blood alcohol concentration (BAC) of 0.10 grams of alcohol per deciliter of blood (g/dL). However, according to the counseling services department of the University of Wisconsin at Eau Claire, considerably smaller doses of alcohol can impair driving skills: ■ At

0.02 g/dL, light to moderate drinkers begin to feel the intoxicating effects of alcohol

■ At

0.04 g/dL, most people start to feel relaxed

■ At

0.06 g/dL, most people are less able to make a rational decision about their ability to drive

■ At

0.08 g/dL, muscle coordination and driving skills are clearly impaired

■ At

0.10 g/dL, your reaction time and ability to control a car deteriorate rapidly (this is legally drunk in all states)

A 160-pound male who consumes five drinks over a three-hour period will have a BAC of about .76. A 140-pound female who consumes four drinks in the same time will have a BAC of .80. Legal Issues

Accidents are the most obvious danger associated with driving while on drugs, but driving after using drugs or alcohol can result in legal problems as well. A teen who is convicted of DUI—driving under the influence of drugs or alcohol—will usually lose his or her license for six months to a year. Younger teen drivers may have the conviction erased from their record after completing various judicial requirements including attending traffic school, learning about alcohol abuse, and parole. However, if a DUI conviction cannot be removed from one’s record, it becomes a permanent mark that could impact future employment opportunities. Some employers will not hire people who have a DUI on their record. Other potential employers may view the infraction as an indication of poor decision-making skills and hire someone with a clean record. Can a teen be cited for DUI if he or she was not driving drunk? Even if teens do not drive under the influence they can still be

Drug Abuse, Causes of 43

arrested for underage drinking and driving. The penalties may vary according to a variety of factors, including local and state ordinances, prior convictions, willingness to cooperate, and other circumstances surrounding the event. Often underage drinking and driving will result in the temporary loss of driving privileges. According to a 2006 NHTSA study, alcohol-related traffic fatalities among older teens rose from 2,442 in 2002 to 3,467 in 2005. However the CDC states that about 1.4 million arrests for DUI are still made yearly. In the future, increased efforts to prevent teen alcohol related motor-vehicle crashes might include: ■ Suspending

the driver’s licenses of those driving while intoxicated ■ Lowering the permissible levels of blood alcohol for adults to 0.08 g/dL and zero tolerance for those under 21 ■ Establishing sobriety checkpoints where police stop drivers to check for those who may be driving while under the influence ■ Continued public education and media campaigns The most important preventative measure, however, is one’s own judgment. The best first step is to avoid alcohol and illegal drugs altogether. Those who do drink or use drugs should never drive while under the influence. No one should ride with a driver that he or she knows or suspects is under the influence of drugs. If you know someone who has been drinking or using drugs, try to prevent them from driving; perhaps you can even offer to drive them home. Keep in mind that driving, drugs, and alcohol never mix well. See also: Drugs and Drinking; Law on Drugs, the; Morbidity and Mortality further reading

Van Tuyl, Christine (ed). Drunk Driving. Detroit: Greenhaven Press, 2006.

■ Drug Abuse, Causes of

The nonmedical use of a substance in order to affect one’s mental processes, satisfy a dependence (an intense physical or psychological

44 The Truth About Drugs

need for a substance), or attempt suicide. Nonmedical means that use of the drug was not prescribed by a medical professional (such as a doctor, a dentist, a nurse practitioner, or a pharmacist). If a person takes a prescription drug that was prescribed for someone else, he or she is also engaging in nonmedical use of a substance. If a person doubles the prescribed dosage of a painkiller, he or she is also engaging in nonmedical use of a drug. So are those who take an over-the-counter cough suppressant without following the instructions on the label. Not all nonmedical use of drugs is drug abuse. In order for a nonmedical use to be classified as drug abuse, the user must intend to affect the way his or her brain functions, satisfy a previously established drug dependence, or attempt suicide. What causes people to abuse drugs? What leads one teenager to experiment with drugs and another to refuse to have anything to do with drugs? What leads one experimenter to abuse drugs for years and another to quickly outgrow his or her interest in experimentation? Many scientists do not agree on the answers to those questions. Some believe the answer lies in a person’s genetics, the study of how particular qualities or traits are passed from parents to their offspring. Other scientists believe the answer lies in one’s environment, or surroundings. Those scientists examine aspects of family life, culture, and society that appear to increase the likelihood that a person will abuse drugs.

Q & A Question: Are adolescent males more likely to use drugs than adolescent females? Answer: Gender makes a big difference. Among males over age 12, 12.3 percent are likely to be classified as dependent on or abusing drugs. Among females over age 12, the percentage drops to 6.3 percent. Among teens between the ages of 12 and 17, however, the difference is not nearly as significant—8.0 percent of the male population and 8.1 percent of the female population abuse drugs.

Most likely, a combination of factors causes drug abuse. Four factors that have especially interested social scientists are social skills, psychological health, family and peers, and society.

Drug Abuse, Causes of 45 Social Skills

Social scientists define social skills as the behaviors that determine whether one is popular, accepted by his or her peers, and liked by family members and authority figures (such as teachers). Individuals acquire—and fine-tune—social skills throughout their lives, but childhood and adolescence are crucial to their acquisition. The degree to which teens master social skills may affect any number of behaviors. Research indicates, for example, that teenagers who have not succeeded in establishing good relations with their peers are more likely than other teenagers to do poorly in school, cut classes, engage in delinquent behavior, hang around with peers who get into trouble, drop out of school—and abuse drugs. Children with attention deficit disorder—an inability to concentrate on a task for sustained periods of time—and those who exhibit aggressive-impulsive behavior, such as striking out suddenly and violently with little provocation, are also at greater risk of abusing drugs. It is important to understand, however, that being at risk of abusing drugs does not mean one will actually become a drug abuser. Being at risk means that researchers have found statistical evidence linking one thing (in this case, deficient social skills) with another thing (in this case, drug abuse) in a significant number of cases. Many other factors—including teacher or parental involvement in one’s life, or one’s ability and determination to assess a situation and weigh its consequences—can reduce the likelihood of abuse. On the other hand, deficient social skills can snowball. Teenagers with deficient social skills may find themselves isolated or accepted only by other teenagers in the same situation. Gangs hold particular attraction to such teens, and in gangs drug use may be the expectation. Using drugs may seem to alleviate the pain of social rejection, so much so that it turns into abuse. Researchers seeking to minimize the incidence of drug abuse among teenagers have created programs that teach social skills. In particular, teenagers learn to evaluate the medical and social consequences of drug use. They also learn the dynamics of peer acceptance, and how to assert themselves in the face of peer pressure. (One’s peers are people of the same age and social group.) Psychological Health

Not surprisingly, researchers have found a statistical relationship between serious emotional and behavioral problems and drug abuse.

46 The Truth About Drugs

As noted previously, teenagers with attention deficits are more likely than other teenagers to abuse drugs. In 1999, the Substance Abuse and Mental Health Services Admin­ istra­tion (SAMHSA), an agency of the Department of Health and Human Services, released a study titled “The Relationship Between ­Mental Health and Substance Abuse Among Adolescents.” The authors reported that teenagers who have chronic (long-term) difficulty concentrating on schoolwork, on chores at home, work, and even sports activities may be experiencing depression or the early signs of a mental illness. SAMHSA’s 2006 National Survey on Drug Use and Health found that those who experienced major depression in the previous year were more than twice as likely to have used an illicit drug than those who did not use drugs. For such teenagers, drug use is a seemingly attractive answer to problems that feel insurmountable. The emotional distress that naturally results from school failure, family discord, and neighborhood violence may also lead a teenager to seek comfort in drugs. On the other hand, drug use and drug abuse can cause or exacerbate (increase or heighten) psychological difficulties. Sometimes a teenager will use drugs to counteract the symptoms of depression even though drugs can trigger depression or deepen it. Similarly, one teen may abuse drugs in response to school failure, while another teenager may experience school failure after drug abuse overtakes his or her life. The SAMHSA study found that teenagers whose psychological problems resulted in behaviors like stealing, showing physical aggression, or running away from home were seven times more likely to abuse drugs or alcohol than were teenagers who had minimal or no emotional problems. The psychologically troubled teenagers were nearly nine times as likely as their minimally troubled or untroubled peers to need treatment for drug abuse. Early intervention (action by others to help resolve a problem) is the key. The SAMHSA study reports that two-thirds of young people in the United States with diagnosable mental disorders do not get help. If family members, teachers, health-care professionals, and friends recognize signs of psychological distress or depression in a teenager, they should get help for him or her. In so doing, they may be able to save that person from emotional turmoil and the consequences of drug abuse.

Drug Abuse, Causes of 47 Family and Peers

Researchers have wondered about the degree to which the influence of parents and peers determines a teenager’s use and abuse of drugs. They have also asked whether parents or peers are the more influential. The authors of “Parental Influences on Adolescent Marijuana Use and the Baby Boom Generation,” a SAMHSA study released in 2001, report that parental influence may be far stronger than was previously thought. The SAMHSA study noted that parents’ attitudes toward drug use (in this case, marijuana use) were far more influential than the parents’ own experiences with drugs.

Fact Or Fiction? Children whose mothers smoke cigarettes and use alcohol are more likely to abuse drugs than children whose fathers do so.

The Facts: The 2001 SAMHSA report “Parental Influences of Adolescent Marijuana Use and the Baby Boom Generation” declares that cigarette smoking and alcohol use by fathers had no impact on their children’s substance use. In contrast, mothers’ cigarette smoking and alcohol use had a significant influence. Children whose mothers smoked cigarettes and used alcohol were likely to be lifetime users of marijuana. From an early age, long before they have much exposure to their peers, children pick up on their parents’ attitudes toward drugs. They not only observe how their parents use a variety of substances—prescribed drugs, over-the-counter medications, nicotine (in cigarettes), alcohol—but also listen to the way their parents talk about these substances. They also evaluate the extent to which their parents’ actions match their words. Not surprisingly, teens whose parents abuse drugs or alcohol are significantly more likely to abuse drugs or alcohol themselves. What role, then, do peers play in drug abuse by teenagers? According to those social scientists that believe drug use is a learned behavior, peers play a significant role. Those researchers contend that a person comes to abuse drugs by copying, or modeling, the behaviors of those around him or her, including drug abuse. When someone

48 The Truth About Drugs

takes a drug for the first time and receives positive reinforcement from friends for doing so or acceptance by a perceived in-group, he or she is encouraged to continue the behavior.

teens speak At the First Dance of the Year I’m Billy. My friend Bobby and I were disappointed when summer ended, but we were looking forward to the first school dance of the year. School dances are lame, but they’re something to do, and the first one of the school year is a way of catching up with everybody after the summer. So Bobby and I went to the dance. When we saw some of our buddies heading outside, Bobby and I joined them. Everybody was talking about a rave downtown. Justin, a senior, had his mother’s car. He piled a bunch of kids into the car and headed downtown. Everyone in the car yelled for the rest of us to come too. Bobby and I looked at each other, and we both nodded at the same time. I have my own car, an SUV. So I got it and drove back to pick up the rest of the gang. I’d never been to a rave before. It was way cool. Bobby and I were digging the music. Then, without warning, one of our buddies gave Bobby and me each a white tablet. I looked closely. The letters XTC were printed on mine. Our buddy said, “Take this, and you’ll party all night.” Bobby wasn’t sure. He was looking to me for guidance. He said, “Should we?” Our buddy was reassuring. He said, “It won’t hurt you. All that happens is that you won’t need to eat or drink or sleep for a while.” I started feeling uncomfortable. It bothered me to take something I really didn’t know anything about. Bobby looked at me again, but now he was excited. He said, “Let’s try it.” So I was squirming. I didn’t want to be a wimp, but I also didn’t want to get screwed up on some crazy drug. Then I

Drug Abuse, Causes of 49 thought of a way out. “Thanks, but I’m driving,” I said to our buddy. I didn’t want Bobby taking it either, so I said to him, “I have to get the car back, or I’ll be grounded for the rest of the millennium.” An excellent move. I grabbed Bobby and we got out of there. In a way, I would’ve liked to have stayed. The rave was cool. But I think it’s stupid to take a drug you know nothing about just because some guy who’s probably already high recommends it. Besides, Bobby and I hardly knew the guy. No. I have too much respect for myself—and my life—for that.

Related to both parental influence and peer influence is the family’s socioeconomic status—how much education parents have had and how much income the family has. According to SAMHSA’s report on the results of the 2006 National Survey on Drug Use and Health, less-educated adults were more likely to abuse drugs than college graduates. As for employment—an important indicator of family income—8.8 percent of adults working full-time suffered from drug dependence; 9.4 percent of those working part-time were drug dependent; and 18.5 percent of those who were unemployed were drug dependent. Where one lives matters less and less; drug dependence is evenly spread throughout the nation. According to the 2006 survey, among persons over age 12 the rate of substance dependence or abuse was 9.4 percent for those in large metropolitan areas, 9.0 percent for those in small metropolitan areas, 8.9 percent for those in nonmetropolitan areas. In the country overall, the rate of substance dependence or abuse also varies: it is 7.9 percent in the Midwest, 9.5 percent in the West, 7.4 percent in the South, and 8.9 percent in the Northeast. Society

A society is an enduring group of human beings distinguished from other groups by mutual interests, shared institutions (such as government education, media), and a common culture or way of life. The society in which one lives is an environmental factor that may influence drug abuse. Is society a cause of drug abuse? Does it lead its members to use and abuse drugs? Society in itself—especially a society as diverse as that of

50 The Truth About Drugs

the United States—is too large to be studied as a whole, or to be blamed for its members’ drug abuse. Yet clearly drug abuse is a problem in American society (and in other societies throughout the world). Drugs are prevalent in American society, and so drug abuse presents a viable option to many Americans, especially teenagers. If one can obtain drugs easily, he or she can use them and abuse them. Drugs— legal and illegal drugs, prescribed and over-the-counter drugs—are all prevalent in American popular culture. See also: Depression and Drugs; Families, Communities, and Drug Abuse; Over-the-Counter Drugs; Risk Factors and Risk Taking; School Performance and Drug Abuse further reading

Aue, Pamela. Teen Drug Abuse. Detroit: Greenhaven Press, 2006. Maisto, Stephen A., M. Galizio, and G. J. Connors. Drug Use and Abuse. Belmont, Calif.: Wadsworth Publishing, 2007. Muisener, Philip. Understanding and Treating Adolescent Substance Abuse. Thousand Oaks, Calif.: Sage Publications, Inc., 1994. Walters, Glenn D. Escaping the Journey to Nowhere: The Psychology of Alcohol and Other Drug Abuse. Bristol, Pa.: Taylor & Francis, 1994.

■ Drug Counseling

See: Depression and Drugs; Rehabilitation and Treatment

■ Drug Laws

See: Law on Drugs, The

■ Drugs and Criminal Activity

Illegal acts such as theft, assault, homicide, or drug use. When people think of drugs and criminal activity, they often picture gang-related crime associated with dealing drugs. However, while youth gangs are a significant threat to public safety, gang violence represents only a

Drugs and Criminal Activity 51

small portion of the criminal activity tied to drug use. Drugs are also related to crime through the effects they have on the user’s behavior and by generating violence and other illegal activity in conjunction with drug sales. Therefore, domestic violence and school violence are often linked to drug and alcohol use. Often the victims are bystanders who happened to be in the wrong place at the wrong time. However, those who abuse drugs may also frequently fall victim to violence from drug and alcohol abuse. Since the 1980s, drug-related crime has become a major problem for law enforcement officials. Drug Abusers as Perpetrators of Crime

The physical and psychological effects of drugs and alcohol contribute in a variety of ways to the likelihood of criminal activity. Some drugs, such as alcohol, cocaine (a highly addictive stimulant), and amphetamines (a group of drugs that stimulate the central nervous system) have been shown to increase aggressive tendencies. These and a wide range of other drugs—including marijuana (a drug made from hemp that is smoked for its euphoric effect), heroin (a powerful painkiller that is highly addictive), and various prescription drugs—can also impair the user’s judgment and reduce inhibitions. Under the influence of drugs or alcohol, a person may be much more likely to engage in risk-taking behaviors (such as criminal activity)—behaviors that he or she would probably avoid when sober. In addition, someone who is dependent on a drug or addicted to it may steal to support his or her drug habit. Type and incidence of drug-related crimes

The U.S. criminal justice system classifies crimes into two broad categories: property crimes and violent crimes against individuals. Property crimes include larceny, shoplifting, and burglary; crimes against individuals include homicide, domestic violence, and sexual assault. A 2005 report from the Bureau of Justice Statistics (BJS) points out that 27 percent of violent crimes were committed under the influence of alcohol, drugs, or a combination of the two. By definition, using illegal drugs is a criminal activity. Statistics from the BJS highlight the connection between drug use and other crimes. According to the BJS, 79 percent of inmates in state prisons, and 60 percent of those in federal prisons used at least one illegal drug at some time in their lives. The most frequently used illegal drugs among state inmates were marijuana (78 percent of inmates reported

52 The Truth About Drugs

using it), cocaine and crack (44 percent), stimulants (23 percent), and opiates (23 percent). Law enforcement officials report that a majority of all crimes are committed under the influence of drugs or alcohol. The BJS found that 55 percent of jail inmates in 2005 reported using illegal drugs in the month before their arrest. The most commonly used illegal drugs by inmates were marijuana (used by 37 percent of inmates), cocaine and crack (a combined 21 percent), and stimulants (11 percent). Some drug-related crimes are committed to acquire money to purchase drugs. According to the BJS, in 2005, 25 percent of property crimes were motivated by a need to purchase drugs. In contrast, only about 14 percent of property crime offenses in 1989 were perpetrated to acquire drug money. The BJS also reported that 18 percent of all inmates in state prisons and 16 percent of those in federal prison said they committed their current offenses to obtain money for drugs. More worrisome is the number of violent crimes committed by drug users. According to the BJS 14,860 drug-related homicides occurred in 2005, a significant decline from the peak year of 1993, when over 23,000 drug-related homicides occurred. In 2005, drug-related homicides represented 4 percent of all homicides, the second-lowest proportion since the BJS started reporting in 1987. Homicide often involves teens. The Centers for Disease Control and Prevention (CDC) reports that homicide is the second-leading cause of death among 14- to 24-year-olds. According to the CDC, in 2005 there were 5,156 homicide deaths within that age group, with male teens murdered at four times the rate of females. Teens are not only victims of homicide but also perpetrators. In 2005, 1,612 teens under the age of 18 were arrested for homicide, accounting for roughly 8 percent of all murders in the United States. One of the principal factors contributing to teen homicide is the number of teens carrying handguns or other weapons. The CDC reported in the June 2008 Morbidity and Mortality Weekly Report that more than 5 percent of teens in grades nine to 12 said they had carried a gun during the previous month. When all weapons were considered, approximately 18 percent of teens in the same grades reported carrying a gun, knife, or club to school during the previous month. The presence of so many firearms or other weapons increases the potential for violent behavior among teens. The CDC also reported that 35.5 percent of students said they were involved in a fight the previous year.

Drugs and Criminal Activity 53

teens speak I’m Worried about Kids Carrying Weapons to School My name is Robert, and I’m scared for my safety because some kids at school are in gangs or dealing drugs. Just last week a guy got caught bringing a gun to school. He said that a gang member selling marijuana in the parking lot threatened him. The gang member flashed a knife at him and told him he better shut up or he’d be sorry. The next day he brought the gun. Nothing happened this time, but next time someone might get hurt or killed—even someone who just happened to be in the wrong place at the wrong time. I’ve even thought about bringing a weapon to school myself. I’m not big and sometimes I get hassled by gang members or guys who just want to show how tough they are. I think that maybe if I had a knife or a gun they wouldn’t mess with me. Then I realize how stupid it would be to take a weapon to school. I could end up killing someone or getting killed myself. Even if I never used it, if I got caught with it I’d get expelled like that guy last week. It’s not worth the trouble or the risk.

Domestic violence and gang activity

Although no studies have found evidence that alcohol or drug use is directly responsible for domestic violence, many have shown some relationship between the two. In 1997, the National Center of Addiction and Substance Abuse at Columbia University interviewed over 900 child-welfare professionals about their experiences with drugs, alcohol, and domestic violence. Eighty percent of those surveyed said that substance abuse plays a role in most cases of child abuse, and 40 percent said that drugs and alcohol are involved in over 75 percent of child abuse cases. Alcohol is the drug most often associated with domestic violence. In a 2004 study of U.S. soldiers, researchers found that heavy drinkers—those who consumed more than three drinks per day—were 66 percent more likely to abuse their

54 The Truth About Drugs

spouses than those who did not drink. The report indicated that heavy drinkers were more likely to abuse their partners, even when they were not drinking. One form of teen criminal behavior that has grown substantially since the 1980s has been gang activity. An epidemic of crack cocaine use led to an increase in the number of teens recruited by gangs to sell the drug. In their 1997 National Youth Gang Survey, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) reported that approximately 33 percent of all teen gangs in the United States are involved in drug trafficking—buying and selling illegal substances. The OJJDP also reported that 42 percent of teen gangs are involved in the smaller-scale street sale of drugs. In a 2002 study of gangs in Canada, every self-reported gang member interviewed reported at least some involvement in drug trafficking. The profits to be made from selling drugs can entice teens into the gang lifestyle. However, the possible negative consequences of gang activity—violence, the likelihood of going to prison, or death—far outweigh possible benefits of the money generated by drug dealing. Drug Abusers as Victims of Violence

Abusers of drugs and alcohol are more likely to perpetrate criminal activities. They are also more likely to be victims as well. Statistics on the number of assaults committed against individuals who were under the influence of drugs or alcohol are unavailable, simply because someone high on drugs is unlikely to go to the authorities with complaints of theft or assault. However, studies do suggest that some groups of drug users are at increased risk of being victimized. In 2004, the Centers for Disease Control reported that drug users have homicide and suicide rates 15 to 25 times higher than those of the general population. Female substance abusers also seem to be at greater risk for domestic violence, according to a 1989 study in the Journal of Studies on Alcohol titled “Spousal Violence among Alcoholic Women as Compared to a Random Household Sample.” The study discovered that women who abuse substances and are the victims of domestic violence are more likely to live with men who are also substance abusers. Those women are also more likely to use physical violence to retaliate for being battered, increasing their risk of suffering serious injury during a battering episode.

Drugs and Criminal Activity 55 The Illegal Drug Trade and Its Victims

One need not steal, commit assault, or kill to commit a drug-related crime. Possessing and selling drugs are crimes in their own right, crimes that claim a significant number of victims. In 2006, more than 1.9 million Americans were arrested on drug violations, of which 108,000 were juveniles.

Q & A Question: What percentage of all drug arrests involve juvenile offenders? Answer: According to the Bureau of Justice Statistics, 108,000 juveniles were arrested for drug violations in 2006. This represents a significant decrease since 1997, when over 122,000 juveniles were arrested for drug-related offenses.

The number of drug arrests as a percentage of all arrests has risen dramatically since the early-to-mid-1960s. At that time, drug violations accounted for only about one percent of all arrests in the United States. By 2006, that number increased by 13 times. By contrast, the percentage of arrests for violent crimes remained almost unchanged over the same period. The percentage of alcohol-related arrests declined from more than 40 percent in the early 1960s to just over 18 percent in 2006. According to the Drug Enforcement Agency (DEA), the market for illegal drugs in the United States is one of the most profitable in the world. As a result, it attracts the most ruthless, sophisticated, and aggressive drug traffickers in the world. Some of the most violent of these criminal groups operate out of South America; specifically, out of Columbia. Their primary drugs are cocaine and heroin, and their primary target is the affluent United States. Israeli, Russian, and Western European traffickers are heavily involved in distributing the drug ecstasy in the United States. Domestic drug traffickers also cultivate, produce, manufacture, and distribute illegal drugs. These larger groups involved in the drug trade are known as drug cartels. Cartels are groups that control the production and distribution of drugs. They supply the individuals and street gangs involved in trafficking drugs. The cartels sell to gang leaders, who in turn recruit gang

56 The Truth About Drugs

members to sell the drugs on the street. Thus, most of the gang crime associated with drug dealing ultimately can be traced back to drug cartels. Of course, in some sense, cartels play some part in most drugrelated crime—both violent and property crime. Their activities fuel the flow of drugs that are related to such crimes in the United States.

Fact Or Fiction? The three leading causes of death for teens are declining.

The Facts: The rates for teen homicide, suicide, and fatal motor vehicle crashes have all declined over the past few years. Nonfatal firearm injuries from crime also declined. These reductions can be attributed to a number of factors, but an emphasis on prevention appears to have paid off. Regardless of these reductions, according to the Federal Bureau of Investigation, teens in 2006 still accounted for 16 percent of all violent crime arrests, including 13 percent of aggravated assault arrests, 15 percent of forcible rape arrests, and 23.5 percent of weapons arrests. See also: Families, Communities, and Drug Abuse; Gangs and Drugs; Homicide; Illegal Drugs, Common; Law on Drugs, The further reading

Bean, Philip. Drugs and Crime. Devon, England: William Publishing, 2005. Benson, Bruce L., and David W. Rasmussen. Illegal Drugs and Crime. Oakland, Calif.: Liberty Tree Network, 1996. Benson, Michael. Drug Crime. London: Chelsea House, 2008. Hammersley, Richard. Drugs and Crime. Cambridge, England: Polity, 2008.

■ Drugs and Development

All drugs produce short-term effects that can be harmful to the physical, emotional, and mental well-being of the user. For example, marijuana has been shown to impair the user’s ability to concentrate and perform simple tasks using large and small muscle groups. Most drugs also have serious long-term effects on the user’s behavior, physical

Drugs and Development 57

health, and mental development. The destructive effects of substance abuse can begin even before birth if a woman uses drugs during pregnancy. Individuals who use drugs during childhood and adolescence are at substantial risk of stunted physical, emotional, or mental development. Many factors other than drug use (poverty, for example) can contribute to unhealthy development in an individual. However, drug abuse frequently compounds the negative effects of other unhealthy developmental influences in an individual’s environment. Pregnancy and Drugs

Because pregnant women share blood and other vital nutrients with their unborn children, any substance consumed by the mother is passed along to the child. Mothers who eat a healthful diet during pregnancy typically bear stronger, healthier children than those who do not. Similarly, if a mother abuses drugs during pregnancy, her unborn child will receive the drug and suffer from the effects of that drug. Medical studies have demonstrated that drug use during pregnancy can have serious negative effects on the development of the exposed child. In fact, the vast majority of all studies of drugs on child development have focused on the prenatal (before birth) use of drugs by pregnant women. Cocaine and Crack Cocaine

In recent years cocaine and crack cocaine have been among the drugs subjected to the most scientific research regarding their effects on development. The dramatic increase in the use of crack since the 1980s has prompted much of the interest in the developmental effects of cocaine use. One by-product of the so-called crack epidemic was an intense interest in developmental difficulties exhibited by infants whose mothers used crack during pregnancy. In the 1990s, both the popular and scientific press ran a variety of stories about the problem of “crack babies.” While later research called into question some of the initial conclusions about the health effects of prenatal exposure to crack, it is clear that both crack and powder cocaine have profound negative effects on development. Cognitive development

In 2002, researchers from Case Western Reserve University School of Medicine, MetroHealth Medical Center, and University Hospitals of Cleveland published an extensive study in the Journal of the

58 The Truth About Drugs

American Medical Association titled “Cognitive and Motor Outcomes of Cocaine-Exposed Infants.” The researchers compared the cognitive (mental) and motor development (the use of large and small muscle groups) of 415 infants who were exposed to cocaine before birth to nonexposed infants. The study, which followed the infants from birth until age two, found that prenatal cocaine exposure affects a child’s cognitive development but not motor development. According to the study, cocaine-exposed infants were more likely to be born prematurely, weigh less at birth, and have smaller heads and bodies than nonexposed infants. The researchers also found that at age two cocaine-exposed infants had nearly five times the rate of mental retardation as the general population. In addition, 37.6 percent of the cocaine-exposed children showed “mild” developmental retardation that required some type of educational intervention, as compared with 20.9 percent in the nonexposed group. The study suggests that these children are likely to have learning problems well into childhood and will probably need special educational services once they enter school. According to a 1999 study that appeared in the journal Clinics in Perinatology titled “Prenatal Drug Exposure and Child Outcomes,” researchers have found other evidence of negative cognitive effects caused by cocaine exposure. The study reported that cocaine affects the development of brain regions that regulate attention, arousal, and reaction to stress. Cocaine-exposed children scored lower than nonexposed children on tests measuring alertness, attention, and intelligence. Although the effects were not dramatic, the researchers found that they last through early childhood. As a result of the study, they suggest that cocaine-exposed children will have more trouble focusing their attention, remaining alert, and processing information than nonexposed children. Other research has confirmed that cocaine negatively impacts attention and alertness into childhood. A 1998 study from the Annals of the New York Academy of Sciences titled “Regulation of Arousal and Attention in Preschool Children Exposed to Cocaine Prenatally” suggests that cocaine affects a child’s ability to pay attention, which can seriously impact learning and memory. The article noted that cocaine-exposed children appear to require more stimulation to increase their levels of arousal and attention. At the same time, however, they are emotionally less able to control higher states of arousal than nonexposed children.

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In 2000, an article in the journal Pediatrics titled “Adverse Effects of Fetal Cocaine Exposure on Neonatal Auditory Information Processing” found that infants exposed to cocaine perform much more poorly than nonexposed infants on a test that identifies children at risk of delayed cognitive development. Infants who fare poorly on the test may be at greater risk for impaired attention and language abilities in later childhood. In a 2007 study at Vanderbilt University Medical Center (“Prenatal Cocaine’s Lasting Cellular Effects”), researchers found that prenatal exposure to cocaine causes changes in certain brain cells. Animals exposed to cocaine showed attention difficulty and decreased sensitivity to stimulants such as amphetamines. This suggests that cocaine alters the development of specific nerve pathways in the brain. Motor and physical development

Cocaine exposure can affect not only a child’s cognitive development but also his or her motor development. Research conducted at Case Western Reserve University in Cleveland has shown links between prenatal cocaine exposure and decreased motor development in children at age two. According to the 1999 study “Motor Development of Cocaine-Exposed Children at Age Two Years,” exposed children performed significantly poorer than nonexposed children on tests of both fine and gross motor development. The study concluded that “the lag in development extends beyond the neonatal period (the period immediately following birth) in exposed children.” Researchers had previously found that cocaine-exposed children who had problems in motor development at the age of four months continued to lag behind other children as late as the age of two years. Studies of the same children at age four suggest that cocaine-related problems with fine motor development last into early childhood. As the study noted, it is difficult for a child to control a pencil without properly developed motor skills. Such difficulties can negatively impact early school performance. Researchers are tracing cocaine to problems with specific organs. In a 2005 study reported in the Journal of Physiology, researchers found that prenatal exposure to cocaine increased the risk of heart disease and hypertension in male rats. Interestingly, the researchers found no similar problems in female rats exposed to cocaine.

60 The Truth About Drugs

Q & A Question: What is fetal alcohol syndrome? Answer: Fetal alcohol syndrome (FAS) is a developmental condition caused by prenatal exposure to alcohol. It is marked by physical, mental, and behavioral problems that are apparent immediately after birth. Babies with FAS show physical symptoms such as small heads, narrow eye slits, a flat and long upper lip, flattened nose, and underdeveloped and central face area. FAS babies usually have a low birth weight and are small for their age. Other physical problems linked to FAS include problems with blood circulation, heart murmurs, kidney trouble, respiratory difficulty, hernias, and shortened fingers. These infants also show delayed motor development that, in many cases, never becomes normal. A significant number of FAS children also suffer from impaired vision and/or hearing that can affect learning ability. These children also suffer cognitive impairments, including difficulty comprehending language and processing and storing information. Children with FAS typically have IQ scores ranging from normal to severely mentally retarded, with a mean score of 65 (100 is considered average). These scores do not appear to improve over time. Clearly, FAS is a serious disorder that should caution all women against drinking during pregnancy.

Heroin and Other Opiates

Heroin, which is produced from the Asian poppy plant, is part of a class of drugs known as opiates. Opiates, which also include opium and morphine, are among the most powerful illicit drugs. They produce profound physical and mental effects, including extreme drowsiness and a sense of euphoria. Prenatal exposure to opiates can have negative consequences for mental and physical development. Cognitive development

According to researcher Karol Kaltenbach of the National Institute on Drug Abuse (NIDA), most of the research into the effects of opiates on infants comes from several long-range studies conducted in the 1970s and 1980s. A number of these studies compared cognitive development in opiate-exposed children with nonexposed children

Drugs and Development 61

and found that opiate-exposed children did not perform as well on several tests of cognitive development: the acquisition of skills necessary to think, reason, and solve problems. A 1988 article in the Annals of the New York Academy of Sciences titled “Drug-Addicted Mothers, Their Infants, and SIDS” reported that opiate-exposed infants had lower scores on the Bayley Mental Development Index at 12 and 18 months of age than nonexposed infants. According to a 1979 study in the journal Pediatrics titled “The Development of Preschool Children of Heroin-Addicted Mothers,” heroin-exposed children also performed more poorly than nonexposed children on the General Cognitive Index. A more recent (1999) study supported some of these findings. In “Prenatal Heroin Exposure: Effects on Development, Acoustic Startle Response, and Locomotion in Weanling Rats,” researchers concluded that “prenatal heroin exposure could result in a marked retardation of postnatal development and learning.” Despite these findings, a number of other studies have found little or no differences in cognitive development among opiate-exposed children. According to Kaltenbach, later researchers found that environmental factors such as poverty or continued drug use by the mother contributed significantly to the cognitive delays experienced by heroin-exposed children. Motor and physical development

A larger body of evidence suggests that heroin and other opiates negatively impact motor development. A 1976 study in the journal Pediatrics titled “Behavioral Concomitants of Prenatal Addiction to Narcotics” found that scores of opiate-exposed children on the Motor Development Index declined as the children grew older. According to the 1982 study “Children of Methadone-Maintained Mothers: Follow-up to 18 Months of Age,” heroin-exposed infants performed about the same as nonexposed infants on the Motor Development Index (MDI) at six months of age but substantially worse at 12 and 18 months. A 1989 study titled “Developmental Consequences to Prenatal Exposure to Methadone” found that heroin-exposed infants scored lower on the MDI and had poorer motor coordination than nonexposed infants. Researchers have also noted a pattern of behavior among heroinexposed infants known as neonatal abstinence. This condition is marked by irritability, intestinal distress, respiratory problems, and

62 The Truth About Drugs

other symptoms such as sneezing, discoloration of the skin, and fever. Such infants may suck frantically on their hands or thumbs and may have trouble breast-feeding because of an uncoordinated sucking reflex. Infants undergoing neonatal abstinence can develop tremors and become extremely irritable. Neonatal abstinence is a form of withdrawal experienced by infants who have been exposed to heroin. If the condition is treated immediately it typically has no long-term negative effects. Marijuana

Although the physical and cognitive effects of marijuana are less intense than those of cocaine or heroin, marijuana still presents a number of developmental risks. Because marijuana is one of the drugs most widely used by adolescents, researchers have more data about the effects of marijuana on development in later childhood and adolescence than they do about many other drugs. Cognitive development

Long-term studies have revealed subtle cognitive deficits in the children of mothers who smoked marijuana during pregnancy. A 1991 study in the journal Clinical Perinatology titled “Animal Models of Opiate, Cocaine, and Cannabis Use” suggested that marijuanaexposed infants were more likely to experience learning and memory impairment but did not find these effects to be lasting. A report in the December 15, 2004, issue of the journal Behavioral Psychiatry found that prenatal exposure to cannabis may impair systems that regulate emotional behavior. In 2001, the American Academy of Pediatrics (AAP) put marijuana on its list of drugs that adversely affect infants during breast-feeding. According to the AAP, the active ingredient in marijuana, THC, can be stored in a mother’s tissues for several weeks or months and accumulates with continued use. Thomas Hale, author of the book Medications and Mother’s Milk, reports that breast milk produced by chronic, heavy marijuana users shows extremely high concentrations of THC. Marijuana taken into the body through breast-feeding can cause sleepiness in the baby, which may lead to slow weight gain and possibly slow overall development. The study also found that babies whose mothers smoke marijuana regularly have a higher risk of dying from Sudden Infant Death Syndrome, or SIDS.

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Much research has been devoted to the cognitive and behavioral effects of marijuana on adolescents and adults. Many of the effects described earlier involved the performance of a complex combination of cognitive and motor skills. A 1995 study by the Australian government titled “The Health and Psychological Consequences of Cannabis Use” found that heavy marijuana use may produce subtle cognitive impairment. Marijuana appears to have its greatest effect on short-term memory. According to a 1993 article titled “Chronic Marihuana Smoking and Short-term Memory Impairment,” marijuana use in adolescents may also result in long-term memory impairment. Evidence from a 1996 study in the Journal of the American Medical Association titled “The Residual Cognitive Effects of Heavy Marijuana Use in College Students” suggests that chronic marijuana use over many years may cause subtle reductions in attention as well as in the ability to organize and make sense of complex information. According to a 1995 article titled “The Health and Psychological Consequences of Cannabis Use,” part of the National Drug Strategy Monograph Series, there may be a modest relationship between marijuana use in adolescence and poor academic performance. Motor and physical development

Aside from its cognitive effects, marijuana has been linked to some impairment of motor functions and a range of long-term health problems. A 1990 study published in the journal Neurotoxicology and Teratology titled “Maternal Marijuana Use During Lactation and Infant Development at One Year” found that infants exposed to marijuana through their mother’s milk during the first month of life showed decreased motor development at one year of age. Several studies have detailed the risk of developing cancer as a result of smoking marijuana. According to a 1999 article in the journal Cancer Epidemiology titled “Marijuana Use and Increased Risk of Squamous Cell Carcinoma of the Head and Neck,” smoking marijuana increases the likelihood of developing cancer of the head or neck. The study, which compared 173 cancer patients and 176 healthy individuals, suggested that marijuana smoking doubled the risk of developing these cancers. The same study reported that marijuana use may also promote cancer of the lungs and other parts of the respiratory tract. A 1981 report from the Annals of the New York Academy of Sciences titled “Adverse Effects of Marijuana: Selected Issues” found that marijuana may also accelerate the changes in cells that produce cancer.

64 The Truth About Drugs

Some evidence suggests that smoking marijuana may result in long-term impairment of the immune system, which is responsible for fighting infections. A 1997 study from the Center for Substance Abuse Prevention titled “Effects of Marijuana on the Lung and Its Immune Defenses” reported that marijuana may suppress the activity of a variety of immune cells that fight disease. The article cited studies that found that the lungs of habitual marijuana smokers showed a reduced ability to kill fungal and bacterial organisms as well as tumor cells. These findings suggest that marijuana can have significant negative effects on the body’s natural defenses, which could have potentially serious health consequences for users with other immune system problems arising from AIDS, cancer, or an organ transplant. Somewhat surprisingly, no conclusive evidence links marijuana with long-term developmental problems with lung function and respiratory health. For example, a 1987 article in the British Medical Journal titled “Respiratory Effects of Non-Tobacco Cigarettes” reported that smoking an average of one marijuana cigarette per day was linked to significant impairment in small airways in the lungs. The authors of the study concluded that regular marijuana smoking was a risk factor for the development of chronic obstructive pulmonary disease (COPD), which is marked by a disabling shortness of breath. In contrast, a 1987 study published in the American Journal of Respiratory and Critical Care Medicine titled “Heavy Habitual Marijuana Smoking Does Not Cause an Accelerated Decline in FEV1 with Age: A Longitudinal Study” found no impairment in the function of small airways in association with regular use of marijuana (three cigarettes per day). These mixed findings leave open the question as to whether regular smoking of marijuana alone can lead to COPD.

teens speak I used to think that doing drugs was just a personal choice and that the person using them was the only one who could get hurt. I found out differently, though, when my sister’s baby was born. My sister Katie experimented with drugs when she was younger. When she got married, she stopped doing some

Drugs and Development 65 of the drugs she had tried in college. The one drug she still did, however, was methamphetamine. Katy worked long hours at her job, and she was often in her office until past midnight. Sometimes she’d work until six o’clock or so, then come home for dinner and head right back to the office. A lot of the time she had trouble staying alert and concentrating, so she took methamphetamine to give her energy and fight sleepiness. I was really worried about her using the drug, but she said she could handle it and that it wasn’t a problem for her. I began to worry even more after she got pregnant. I had heard in health class that almost any drug can cause problems for an unborn child, but that cocaine and methamphetamine were supposed to be really dangerous. I tried to get her to stop because of what she might do to her baby. For three months I got nowhere with her, but finally after her husband and some friends put pressure on her, she agreed to stop. Because of the pregnancy she wasn’t working full-time, so she didn’t need to stay up so late anymore. I thought we stopped her in time, but when her baby was born it was five weeks early and very small and weak. The baby trembled, twitched, and cried, and it looked very sickly. For weeks I was afraid the baby would die. Luckily my sister was in a hospital where the doctors and nurses were able to take care of her child. The baby is now six months old, and although he is still smaller and weaker than other babies, he is alive and getting healthier. It just goes to show that drugs can hurt other people even more than the person who uses them, especially when the other person is a baby.

Methamphetamine

Although cocaine, opiates, and marijuana have been the drugs most extensively studied for effects on development, research has also shed light on the negative developmental impact of methamphetamine. The drug has been found to impair infant development as well as cognitive and emotional development in later life.

66 The Truth About Drugs Prenatal effects

Studies of methamphetamine use by pregnant women have revealed several areas of physical and mental impairment in methamphetamine-­exposed infants. According to a 2003 study published in the Journal of Developmental and Behavioral Pediatrics titled “Effects of Prenatal Methamphetamine Exposure on Fetal Growth and Drug Withdrawal Symptoms in Infants Born at Term,” methamphetamine use during pregnancy was associated with delayed growth during early infancy. In addition, the group of methamphetamine-exposed infants observed in the study contained a significantly higher percentage of small-for-age infants than the nonexposed group. These findings suggest that methamphetamine use can lead to reduced growth during infancy. In 2005, researchers at the University of Toronto found that a single exposure to methamphetamine can cause pregnant mice to bear offspring with long-term developmental problems. Michael Sherman, chief of neonatology at the University of California–Davis Medical Center has found evidence of other negative effects from prenatal methamphetamine use. These include damage to the brain and spinal cord, malformation of the kidneys, problems with the development of the intestines, and skeletal abnormalities. Sherman also describes a condition called gastroschesis, in which the infant develops a hole in the abdominal wall and its intestines are outside the body. According to Sherman, this birth defect is common in mothers who abuse methamphetamine during pregnancy. Other problems noted in methamphetamine-exposed infants include cerebral palsy, seizures, paralysis, irritability, attention problems, hyperactivity, and delayed development. Effects on later development

Adolescents who use methamphetamine expose themselves to the risk of developing severe behavioral and physical problems into adulthood. According to NIDA, chronic methamphetamine use can lead to violent behavior, anxiety, confusion, insomnia, paranoia, hallucinations, delusions, and mood disturbances. Paranoia caused by chronic methamphetamine use can result in homicidal and suicidal thoughts. Long-term use can cause increased blood pressure and significantly increase the chances of suffering a stroke. Other long-term physical effects include respiratory problems, irregular heartbeat, and extreme anorexia.

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NIDA also reports several severe long-term effects on brain development in adulthood. For example, methamphetamine appears to damage brain cells in a way that can result in symptoms similar to those of Parkinson’s disease, a disorder marked by extreme, uncontrollable trembling of the limbs. According to NIDA, high doses of methamphetamine can also damage nerve cell endings, and the ability of these cells to recover appears to be limited.

Fact Or Fiction? Prenatal exposure to ecstasy causes developmental problems in infants.

The Facts: The evidence for developmental problems due to use of ecstasy during pregnancy is mixed. A long-term study of infants born to mothers in Great Britain who used methylenedioxymethamphetamine (ecstasy) during pregnancy found some increased risk of birth defects. Patricia R. McElhatton and colleagues of the National Teratology Information Service in Newcastle upon Tyne, United Kingdom, studied 136 pregnancies that occurred between 1989 and 1998. Among the women studied, 74 had taken ecstasy alone, and the other 62 took a combination of ecstasy and another drug. The study found that 15.4 percent of the infants had birth defects, compared with an expected rate of 2 to 3 percent. McElhatton said that it is unclear whether the birth defects resulted from the combined effects of mixing drugs or whether they were caused by ecstasy alone. Although she cautioned that the results do not prove a direct link between ecstasy and birth defects, they suggested that either ecstasy or amphetamines played some role. The Impact of Drug Use

There can be no question that many illegal drugs have a profoundly negative impact on both early and later development. Pregnant mothers who abuse drugs should be aware that they are sharing these substances with their unborn children, who are far less prepared to suffer the effects. Substance abuse that occurs during pregnancy can be the start of lifelong developmental problems for an exposed child, and continued abuse as an adolescent can seriously impair the quality of later life.

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See also: Crack Cocaine; Dependence and Addiction; Drugs and Criminal Activity; Illegal Drugs, Common; Law on Drugs, The; Morbidity and Mortality further reading

Brown, Waln K. Drugs and Pregnancy. Talahassee, Fla.: William Gladden Press, 2008. Inciardi, James A., Hilary L. Surratt, and Christine A. Saum. CocaineExposed Infants: Social, Legal, and Public Health Issues. Thousand Oaks, Calif.: Sage Publications, 1997. Thomas, Janey Y. Educating Drug-Exposed Children: The Aftermath of the Crack-Baby Crisis. London: Fallmer Press, 2004.

■ Drugs and Disease

A condition that impairs normal physical or psychological functioning. One of the least-appreciated drawbacks to using drugs is the possibility of developing mental disorders or contracting a serious disease such as hepatitis (an infectious disease that can cause serious liver damage) or HIV/AIDS. HIV is a virus that attacks the body’s immune system and causes AIDS, a medical condition in which the body’s immune system is so weakened that even mild infections can cause serious illness or death. Knowing about the health risks associated with drugs can help you realize just how dangerous drug use can be. Drug Psychosis

Psychosis is a severe mental disorder marked by a loss of contact with reality. Taking drugs can produce a condition called drug psychosis that generates symptoms similar to those found in other forms of psychosis. Common symptoms include hallucinations (seeing, hearing, and smelling things that are not there) and delusions (false beliefs held even in the face of contrary evidence). Druginduced psychosis can occur during the drug experience, while coming down off the drug, or when withdrawing from the drug. Since different drugs exit the body at varying times during the withdrawal period, an episode of drug-induced psychosis may start weeks after last taking a drug.

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Typically, drugs do not trigger (set off) a psychotic episode unless a mental illness is present. Although a family or personal history of psychotic illness increases the risk of drug psychosis, it is not necessary to trigger a drug-induced psychotic episode. Stress or drugs like amphetamines (synthetically produced stimulants that improve alertness and elevate mood), LSD (a synthetic hallucinogen), ecstasy (a synthetically produced substance that produce a wide range of drug effects) and marijuana (an illicit drug derived from hemp that alters mood and distorts the senses) have been known to trigger an episode in an otherwise healthy person. Using multiple drugs all at once can also increase the chances of drug psychosis. The onset and length of an episode can vary depending on the drug. A single dose of cocaine may produce a psychotic episode in a matter of minutes, while other substances may take longer. Marijuana may produce drug psychosis for a few days, but with amphetamines or cocaine (an addictive drug, derived from the coca plant, that increases energy and alertness), the drug induced psychosis can last for weeks, even after quitting the drug. Most people recover from drug-induced psychosis with treatment and by quitting the drugs. In some cases, however, tranquilizers (depressants that relieve anxiety) may be needed to reduce the likelihood of suicidal or aggressive behavior. Depression

Depression is a mental disorder caused by a chemical imbalance in the brain, characterized by feelings of profound sadness, hopeless, and worthlessness. Depression and drug use have a unique relationship. Some people may begin using illegal drugs or alcohol or increase their use of these substances in response to depression. In turn, the use of alcohol and drugs can deepen the depression. That cycle, in which drug use and depression reinforce one another, is dangerous. Illegal drugs and alcohol are especially dangerous when taken in addition to antidepressant medication. Antidepressants work by subtly altering the brain’s chemistry to maintain normal mental functioning. Alcohol and illegal drugs can interfere with this process, making the antidepressant less effective. In addition, drugs and alcohol can increase the side effects associated with many antidepressants, such as sleep disruption, headaches, nausea, agitation, and anxiety. As with any depression, suicide is always a concern, especially when drugs and alcohol are being abused.

70 The Truth About Drugs HIV/AIDS

The Centers for Disease Control and Prevention (CDC) reports that HIV/ AIDS was the seventh leading cause of death for Americans between the ages of 20 and 24 in 2004, the sixth leading cause among those aged 25–34, and fifth among those aged 35–44. HIV—the virus that causes AIDS, a serious and often fatal disease of the immune system transmitted through blood products—has a long incubation period during which the virus is present but dormant with no outward symptoms. As a result, many of those in the 25–44 age group were infected in their teens. Philip Rosenberg and Robert J. Biggar of the National Cancer Institute estimate that at least one-half of all new HIV infections in the United States are among people under the age of 25. From 2001 to 2004, over 5,300 people under age 20 were diagnosed with AIDS, bringing the total number of recorded cases of AIDS in this age group to more than 15,000 since the CDC began keeping records in the 1980s. Almost 23 percent of all AIDS cases reported from 2001–2004 were injection drug users and 30 percent were infected heterosexually. Injection drugs are drugs that are injected into the veins or muscles of the user with a needle. Males are still infected at higher rates than females, but the proportion of AIDS cases reported by women rose from 15 percent from 1981 to 1995 to 27 percent between 2001 and 2004.

Fact Or Fiction? The greatest risk for teens of acquiring HIV/ AIDS is through injection drug use.

The Facts: Fifty percent of all HIV/AIDS diagnoses in teenagers are acquired through sexual transmission, making unprotected sexual behavior the greatest HIV/AIDS risk for teens. Many teens report using alcohol or drugs when they have sex, which can negatively impact the use of protection. Data from the CDC suggests that drug injection led to at least six percent of HIV diagnoses reported among those between the ages of 13 and 24 in 2000. Although injection drug use among teens is low, other drug and alcohol use can diminish sexual inhibitions and cloud one’s judgment thus creating the potential for unprotected intercourse. Unprotected sexual intercourse provides the greatest risk of HIV infection for teens, to say nothing of the increased risk of sexually transmitted viruses.

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Drug use can be particularly dangerous for sexually active youth because it can diminish sexual inhibitions and cloud one’s judgment. These conditions create the potential for unprotected sexual intercourse, which provides the greatest risk of not only HIV infection but also sexually transmitted diseases such as syphilis and gonorrhea. Hepatitis

Hepatitis is an inflammation of the liver caused by an infection, drugs, toxins, or parasites. The disease is characterized by an enlarged liver, jaundice, diminished appetite, nausea, and abdominal pain. There are several different forms of the disease. The most common is hepatitis A virus (HAV). Although all forms attack the liver to some extent, hepatitis B and C, which can cause liver cancer, are of special concern because they are the most deadly varieties. HAV is usually spread from person to person by contaminated food or water and personal contact. HAV has no long-term effects, but about 15 percent of people infected have prolonged or recurring symptoms over a six- to nine-month period. The greatest risk of acquiring HAV is through contact with infected persons. The best protection against hepatitis is a vaccine.

Q & A Question: What kinds of activities increase the chances of acquiring an infectious disease? Answer: The following behaviors increase the risk of contracting an infectious disease: ■ Injecting

drugs with dirty or used needles

■ Sharing

needles or other paraphernalia associated with injection drugs

■ Sharing

razors, toothbrushes, or other personal grooming items with an injection drug user

■ Having

unprotected sex

■ Getting

tattoos or body piercings with unsterilized equipment

Hepatitis B (HVB) may be transmitted through sexual intercourse and through contaminated blood or needles. HVB has declined in recent years, primarily because of the widespread availability of a

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vaccine. The infection rate has dropped from 12 per 100,000 in 1995 to 1.8 per 100,000 in 2005. Although the highest rate of disease occurs among 20- to 49-year-olds, the most significant reduction has been among children and teens. The symptoms are very similar to those associated with HAV with the exception of joint pain. However, roughly 30 percent of those infected with HVB have no symptoms at all. Children are less likely to show symptoms than adults. If HVB is not treated, the liver can develop chronic infection. Death from chronic liver disease occurs in about 15–25 percent of those infected. HVB transmission occurs when blood or other body fluids from an infected person enters the body of someone who is not immune. There are three primary modes of transmission: having sex with an infected person without using protection; using or being stuck with an infected needle; and being born to an infected mother. HVB can be prevented if these rules are followed: ■ Don’t

use injection drugs. ■ Always use protection if engaging in sex. ■ Never share needles. Hepatitis C (HVC) is spread primarily by injection drug use. The number of new infections per year declined 11 percent from 1992 to 2005. Roughly 3.2 million Americans are chronically infected with HCV. Chronic infection occurs in 75–85 percent of those infected. The rate of chronic infection is so high because over 75 percent of those infected have no symptoms. Approximately 70 percent of those infected will acquire chronic liver disease, and a small proportion of them will suffer liver damage so severe they will require a liver transplant. The CDC estimates that illicit injection drug use causes 60 percent of all new cases of HCV and is also a primary factor in HVB infection. Transmission of HCV is very similar to HVB and occurs when blood or body fluids from an infected person enters the body of a person who is not infected. To prevent infection follow rules similar to those outlined for avoiding HBV. The major difference between HBV and HCV is that no vaccine exists to prevent HCV, although treatment can eliminate the virus in 50 percent of those infected. Hepatitis D and E are less common and less dangerous viruses than the A, B, and C strains. Hepatitis D is a virus that is found in the blood of persons infected with HVB, and it needs that virus to exist.

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Hepatitis E, a virus transmitted in much the same way as HAV, does not often occur in the United States. Avoiding risky behaviors such as drug use and unprotected sex is the only effective way to prevent the spread of diseases such as HIV/AIDS and hepatitis. The effects of injection drugs such as heroin are dangerous enough, but the possibility of contracting a serious disease from a contaminated needle makes them particularly lethal. Don’t be fooled into believing that drugs other than injection drugs are somehow safe. Any drug can impair judgment and increase the chances of taking a deadly risk that no one would even consider when sober. See also: Depression and Drugs; Drugs and Drinking; Injection Drugs; Sexual Behavior and Drug Abuse further reading

Evans, C. Illicit Drug Use and HIV Infection. Washington, D.C.: American Public Health Association, 1989. Hagan, Elizabeth, and Joan Gormley. HIV/AIDS and the Drug Culture: Shattered Lives. Binghamton, N.Y.: The Haworth Press, 1998. Johanson, Paula. HIV and AIDS. New York: Rosen Publishing, 2007. Palfreeman, Adrian, Michael Youle, and Charles F. Farthing. Drugs in HIV and AIDS. 2nd ed. Hoboken, N.J.: John Wiley and Sons, 1998. Pates, Richard, Andrew McBride, and Karin Arnold. Injecting Illicit Drugs. Malden, Mass.: Wiley-Blackwell Publishing, 2005. Turkington, Carol. Hepatitis C: The Silent Epidemic. Chicago: Contemporary Books, 1998.

■ Drugs and Drinking

Alcohol is by far the most commonly used drug among teens. According to the National Institute on Drug Abuse, in 2007 38.9 percent of all eighth graders, 61.7 percent of 10th graders, and 72.2 percent of 12th graders had used alcohol. These figures are particularly troubling, because alcohol has been identified as a gateway drug—a substance whose use may lead to the abuse of other drugs. Although the relationship between teen alcohol use and illegal drugs is unclear, there seems to be a link between the two.

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Fact Or Fiction? Teenage alcohol use continues to rise.

The Facts: Alcohol use among teens is declining. According to the National Institute on Drug Abuse, the rates for teen alcohol use between 2005 and 2007 dropped significantly in the categories of past-year and past-month use. For example, the percentage of 12th grade students who reported having at least one drink of alcohol within the previous 30 days dropped from 47 percent in 2005 to 44.4 percent in 2007. In the same time period, fewer eighth and 10th graders reported ever having ever been drunk or having been drunk in the last year. Alcohol and drug use are also linked closely to a number of mental and physical problems, including depression. Alcohol and drugs can trigger depression, and the sadness and despair associated with depression can in turn trigger alcohol and drug use. Depression, alcohol, and drugs don’t mix. The qualities of alcohol and barbiturates—drugs that slow down the functions of the central nervous system—are of special concern because these drugs can intensify the feelings of sadness or worthlessness that accompany depression. Depending on the severity of the depression, the use of alcohol and drugs may create a situation that could lead to a suicide attempt. Because suicide is one of the leading killers of teens, this relationship should not be taken too lightly.

Q & A Question: How likely is a teen to ride with someone who has been drinking? Answer: Research from the Centers for Disease Control and Prevention (Youth Risk Behavior Surveillance System, 2007) has shown that 29.9 percent of teenagers reported riding with someone who had been drinking within the last 30 days. Compounding that risk is another statistic: Approximately 11 percent of teens reported rarely or never wearing a seat belt.

The role of alcohol and drugs in crime is one of the most welldocumented relationships in criminal justice. In 2006 the Bureau

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of Justice Statistics reported that 27 percent of victims of violent crime said their attacker was under the influence of drugs or alcohol. According to a 1994 report by the National Institute of Justice titled “Psychoactive Substances and Violence,” the consumption of alcohol increases aggression, as does the consumption of cocaine, amphetamines, and hallucinogens. They all can produce violent behaviors. The report suggested that other illicit drugs such as heroin and marijuana are more closely aligned with crimes related to the sales and marketing of drugs, including disputes among drug dealers and burglary and other property crimes committed to raise money for drugs. Gang violence, drugs, and alcohol are also a dangerous combination. The use of drugs and alcohol among teens in gangs can lead to a variety of criminal activities. Drug trafficking, turf wars, and drug deals gone bad all are situations where tensions are high. The addition of drug and alcohol in an already tense situation is a recipe for violence. Homicide among teens is one of the three leading causes of death for this group. The effects of any illicit drug can be negatively affected by the addition of alcohol. Sometimes combining illicit drugs and alcohol will intensify the reaction caused by the drugs; at other times the mixture will produce a completely different reaction from what you expect. It is clear that mixing drugs and alcohol is very dangerous. The questionable formulas of drugs produced in clandestine basement laboratories make mixing them with alcohol especially dangerous. Methamphetamines, designer drugs, and club drugs often contain impurities and ingredients whose reaction with alcohol can be dangerously unpredictable. The so-called date rape drugs can also be very dangerous when used with alcohol. These drugs are powerful sedatives and their use with alcohol can cause life functions to be slowed so extensively that coma and death occur. Sexual activity among teens is closely associated with alcohol and drug use. Of the roughly 35 percent of teens who engage in sexual intercourse, 22.5 percent reported using drugs and/or alcohol the last time they had intercourse. The use of alcohol and drugs by sexually active teens may also lead to risky behaviors such as having unprotected sex, which increases the risk of sexually transmitted diseases (STDs). Many risks are associated with alcohol and drug use. It is important for teens to think before they use these substances, because drugs and alcohol impair one’s ability to make reasoned decisions after he or she takes them. And when facing the possibility of adverse drug effects, automobile accidents, or STDs, the best protection is clear thinking and good judgment.

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teens speak I Didn’t Think Drinking Was Such a Big Deal My name is Derek, and along with my buddies on the football team, I drink beer on the weekends. We party a lot, but we figured, “Hey, at least we’re not doing drugs.” What we didn’t realize was that alcohol is a drug that can be just as dangerous as marijuana or other illegal drugs. Sure, we’d heard that alcohol was a gateway drug that could lead to other kinds of drug use, but we thought that was just something the teachers say to scare you. I started to question how smart drinking was when my friend Robby got stopped for a DUI (driving under the influence of alcohol). He’d only had a few beers, but he was weaving enough that a police officer pulled him over. Robby lost his license for six months, but he’s lucky he wasn’t in an accident. Then last Friday, Craig, another buddy from the team, told me he had some marijuana and asked me if I wanted to smoke with him. I told him no, but I was really shocked that he would use drugs. Later I thought about alcohol being a gateway drug. I guess it isn’t as ridiculous as it sounds. I’m glad I turned Craig down, but I think maybe I should talk to him about marijuana and alcohol. Both of them can lead to big trouble.

See also: Club and Designer Drugs; Depression and Drugs; Drugs and Criminal Activity; Gangs and Drugs; Homicide; Sexual Behavior and Drug Abuse

■ Drugs and Smoking

This section focuses on the dangers of tobacco, particularly of smoking cigarettes, and the connection between smoking and the use of other drugs. According to the Centers for Disease Control

Drugs and Smoking 77

and Prevention (CDC), more than 45 million people in the United States—almost 21 percent of all adults—smoked cigarettes in 2007. Also, people ages 18 to 25 made up almost 24 percent of those smokers—the largest proportion of any age group measured by the CDC. These numbers do not include another 4 million smokers who are under the age of 17. Researchers have concluded that the act of smoking itself represents a potential health threat. The CDC estimates that nearly half a million Americans die from smoking-related causes each year. That risk, however, is compounded by the increased likelihood of smokers who use other drugs. EFFECTS AND RISKS OF SMOKING

People smoke cigarettes primarily as a way to obtain nicotine, a drug that stimulates the central nervous system, enhancing the user’s energy, alertness, and concentration. Smoking rapidly introduces the drug into the bloodstream, where it is carried to the brain almost immediately. As a result, many people find that smoking cigarettes gives them a quick energy boost during the day. Unfortunately, nicotine is also highly addictive; the user needs to continue smoking to maintain the same level of nicotine in the blood. A person who smokes cigarettes regularly may come to depend on them for normal functioning. Many people report that addiction to cigarettes is one of the hardest drug dependencies to overcome. In addition to acting as a stimulant, nicotine also releases a variety of brain chemicals, or neurotransmitters. Some of these, including dopamine and beta-endorphin, play a role in experiencing pleasure and blocking pain. Thus, cigarette smoking not only can stimulate the user, it also can act as a mild sedative and antianxiety agent. Nicotine thus appears to change functions from a stimulant at low doses to a painkiller and sedative at higher doses. Besides the danger of nicotine addiction, cigarette use poses a wide range of threats to the user’s health. The main health dangers include increased risk of heart attack, respiratory diseases such as emphysema and lung cancer, cancer of the mouth and throat, and pancreatic cancer. About one in six men who continue to smoke tobacco will develop lung cancer compared to one in 75 nonsmokers. Male smokers are also 85 percent more likely to suffer from impotence than nonsmokers are. Other diseases linked to smoking include various forms of cancer, stroke, cardiovascular disease, bronchitis, cataracts,

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and an increased risk of Alzheimer’s disease. Smoking has also been linked to birth defects in newborns. PREVALENCE OF CIGARETTE SMOKING

The percentage of Americans who smoke cigarettes has declined steadily since the government first began compiling statistics on smoking in the mid-1960s. In 1965, nearly 45 percent of all adult Americans—and more than half of all adult men—smoked cigarettes. At that time, antismoking advocates began to voice the first public concerns about the health risks of smoking. The media and tobacco industry, however, portrayed smoking as glamorous, sexy, and sophisticated. Many of the biggest Hollywood stars smoked, and the rugged Marlboro man was one of the best-known cigarette advertising icons. As researchers began to publish more and more reports about the health dangers of smoking, increasing numbers of smokers gave up the habit. By 1980, about 35 percent of American adults were smokers, a reduction of more than 20 percent in 15 years. Ten years later, the figure was down to 25 percent. Since that time, the rate of decrease has slowed somewhat, and use among males has actually risen since 2003. According to the 2007 study from the National Institute on Drug Abuse (NIDA), “Monitoring the Future,” the number of teens who have ever smoked cigarettes is dropping as well. In 2007, 22.1 percent of eighth graders, 34.6 percent of 10th graders, and 46.2 percent of 12th graders reported having smoked a cigarette at least once in their lives. These figures represented a decline for all grades compared to 2006. Researchers for NIDA noted that the 2.4 percent decline among eighth graders was statistically significant. Interestingly, trends in young people’s smoking ran against the national antismoking tide that began in the late 1960s and picked up momentum in the 1970s and 1980s. After dropping in the 1970s, teen smoking rates remained relatively unchanged during the 1980s and then began to increase sharply in the 1990s. The number of eighth and 10th graders who reported smoking in the 30 days prior to the “Monitoring the Future” survey shot up 50 percent between 1991 and 1996. Cigarette use in the previous month among 12th graders climbed 30 percent between 1991 and 1997. Since that time, rates of smoking have declined dramatically among all grade levels.

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The figures for daily cigarette use, however, show a different trend. Decreases in the percentage of students who reported smoking daily were considerably smaller than those for lifetime or monthly use. In fact, a slightly larger percentage of 12th graders (12.3 percent in 2007 to 12.2 percent in 2006) reported smoking cigarettes daily. In addition, smokeless tobacco use has remained virtually unchanged since 1999, and, in 2007, it increased slightly among both eighth and 12th graders. SMOKING AND OTHER DRUG USE

Teen smoking is a red flag for additional substance abuse. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), smokers ages 12 to 17 are more than 11 times as likely to use illicit drugs and 16 times as likely to drink heavily as young people who do not smoke. Reports show that some 65 percent of youths who used marijuana by the 12th grade had smoked cigarettes first. Almost all (98 percent) of those who had used both cocaine and cigarettes had smoked cigarettes first. The Center on Addiction and Substance Abuse (CASA) found that those who take up smoking in childhood are three times more likely to use marijuana and four times more likely to use cocaine than those who did not smoke as children. More than half of youths who start smoking before age 15 use illicit drugs at least once, compared to only onefourth of those who do not start smoking until they are 17 or older.

Fact Or Fiction? My friend smokes menthol cigarettes because he claims that they are not as bad for you as regular cigarettes. Is that true?

The Facts: Contrary to what many people believe, menthol cigarettes are just as bad for your health as regular cigarettes. According to a 2005 article in the Journal Archives of Internal Medicine, researchers found that menthol cigarettes “seem to be equally harmful per cigarette smoked in terms of atherosclerosis and pulmonary function decline.” What’s more, the study suggested that the added flavor might actually make menthol cigarettes more difficult to quit than regular cigarettes. Menthol, far from being better, can be actually worse than regular cigarettes!

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According to CASA, people who start smoking as children are almost four times as likely to become regular drug users and three times more likely to use cocaine regularly than those who do not smoke as children. Teens who smoke a pack a day are 13 times more likely to use heroin than smokers who smoke less heavily. The Department of Health and Human Services (HHS) estimates that 12to 17-year-olds who smoke daily are approximately 100 times more likely to have used marijuana at least 10 times and 32 times more likely to have used cocaine at least 10 times than nonsmokers. The links between smoking and drug use indicate the importance of early prevention of risky behavior such as smoking. Teens who have the right information are more likely to make smart decisions about smoking and drug use. See also: Drug Abuse, Causes of; Drugs and Drinking; Risk Factors and Risk Taking. further reading

Garman, J. Frederick. Using Tobacco During Youth. Tallahassee, Fla.: William Gladden Press, 2008. Gold, Mark S. Smoking and Illicit Drug Use. London: Routledge Mental Health, 1998.

■ Drug Testing

Drug testing is used to determine whether an individual has ingested a substance in a way that violates the law or workplace rules or regulations. Most drug testing is performed to detect forensic drug use, workplace drug use—for example, determining whether an individual is operating a vehicle under the influence of drugs or alcohol—and compliance with mandatory drug treatment. The Testing Process

The complexity of the drug-testing process depends upon the type of substance for which the tester is searching. For example, a police officer can measure the level of alcohol in a driver’s blood easily using a common, portable breath analyzer. Most modern drug testing, however, involves a two-step process: screening and confirmation. The subject first undergoes a simple and inexpensive screening test to detect the general presence of illicit drugs. This is

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followed by a more specific confirmation test that specifies which drug (or drugs) are present and, in some cases, in what quantity or concentration. The most common form of drug testing involves the collection and analysis of urine samples. A urine test can detect the presence of some drugs for a limited time after use. However, the analytical techniques used for drug detection depend on the chemical and physical properties of each substance or its breakdown products. As a result, no single test can detect the presence of all drugs, so it is necessary to employ a range of different tests for different drugs. Modern tests often use substances other than urine, including blood, saliva, sweat, and hair, depending upon the reasons for the test. A number of factors influence how long a drug may be detected in a user’s body. For example, drugs that are fat soluble, such as THC (the active ingredient in marijuana), tend to accumulate in the body’s fat. The body may subsequently release such drugs into the bloodstream over a period of days or weeks. By contrast, the body can eliminate drugs that are water soluble, such as cocaine, within a few hours. Other factors that determine how long a drug remains detectable include the user’s health and age, the amount of drug ingested, the properties of the drug, how it is distributed within the body, and the sensitivity (or reliability) of the test. Color and Microcrystalline Tests

Many drugs produce characteristic colors when they react with certain chemicals. For instance, in the Marquis test, a certain chemical mixture will turn purple in the presence of heroin or other opioids but orange-brown in the presence of amphetamines and methamphetamines. Color tests are useful only for screening; a positive result is not considered definitive evidence of the presence of drugs. Microcrystalline tests are considerably more specific than color tests for identifying drugs. In this type of test, a drop of a chemical mixture is added to a small quantity of a suspect substance on a microscope slide. This causes a chemical reaction that produces a crystalline residue. The size and shape of the crystals reveal what drug, if any, is present in the sample. Analysts have developed hundreds of crystal tests to characterize the most commonly abused drugs. Chromatography

Two very sensitive and widely used methods of drug testing are thin-layer and gas chromatography. Both of these techniques use the

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movement of matter in a specific medium to isolate and identify illicit drugs in a suspect substance. Thin-Layer Chromatography (TLC)

In TLC, the tester dissolves a suspect sample on a glass plate that is covered with a thin film of a gritty material, usually silica gel or aluminum oxide. This gritty material is held in place on the plate with a binding agent such as plaster of Paris. The plate is placed upright in a chamber containing a liquid, making sure that the liquid does not touch the sample. An electric current is then passed through the plate, causing the liquid to rise slowly up the plate. As the liquid moves past the sample, different substances in the sample separate from one another and move up the plate at differing rates. When the liquid has moved about four inches (10 cm), the plate is removed from the chamber and dried. The tester then compares the test plate to a standard plate produced using a specific drug, such as heroin. If the suspect sample travels the same distance as the sample on the standard plate, the tester can be relatively confident that the two substances are identical. Gas Chromatography (GC)

Gas chromatography (GC) is similar to TLC, except instead of using a stationary solid phase and a moving liquid phase, it has a stationary liquid phase and a moving gas phase. In GC, gas flows through a glass or stainless steel column, inside of which is a thin glass tube filled with liquid. As a column of gas is being passed through the liquid-filled tube, the tester injects the suspect mixture into the column. As with TLC, some components of the mixture travel through the column more quickly than others, and the components eventually separate from one another. The time it takes a component of the mixture to emerge from the column—known as retention time—to identify which illicit substances are in the mixture. One drawback of GC is that some substances have similar retention times under similar conditions. As a result, any results obtained by GC should be confirmed using other tests. Spectrophotometer and Mass Spectrometry

Some of the newest techniques used in drug testing examine basic properties of matter, such as atomic mass or absorption of light, to test for the presence of drugs. Spectrophotometry involves analysis of the patterns produced when a substance is exposed to various types

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of radiation. Mass spectrometry, by contrast, identifies substances by weighing the molecules of the sample being analyzed. Spectrophotometry

In spectrophotometry, a tester subjects a sample substance to one of two forms of electromagnetic radiation: ultraviolet (UV) waves or infrared (IR) waves. The molecules that make up every substance absorb certain wavelengths of radiation and reflect others. For example, the molecules that make up grass absorb all wavelengths of the radiation we call visible light except for the green wavelengths, which they reflect; that is why grass appears green. Similarly, when certain illicit drugs are subjected to UV and IR radiation, they absorb some wavelengths and reflect others. When viewed under UV or IR light using a device called a spectrophotometer, every substance produces a unique pattern of bands that resembles a bar code. Testers subject samples to either UV or IR radiation and compare the resulting patterns to standard patterns made by known illicit drugs. The main difference between the two processes is that IR produces a much more detailed band pattern. While UV spectrophotometry can narrow down the possible number of drugs present in a sample, IR provides a unique fingerprint for every substance. Mass Spectrometry

In mass spectrometry, the tester first separates the components of a suspect mixture using gas chromatography. The resulting components flow into a device called a mass spectrometer, where they are bombarded with high-energy electrons and acquire a magnetic charge. The resulting particles almost immediately decompose into smaller fragments that are then separated by mass. The relative masses of the components form a specific pattern that allows the tester to identify virtually any substance. PREVALENCE AND EFFECTIVENESS OF DRUG TESTING

According to a 2006 report by the Society for Human Resource Management, 84 percent of private employers conduct pre-employment drug testing, 39 percent conduct random testing of employees, 73 percent conduct testing for cause, and 58 percent require drug tests after on-the-job accidents. Many state and federal jobs also require drug testing.

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There is good cause for caution on the part of employers. In the 2005 National Survey on Drug Use and Health (NSDUH), researchers found that individuals whose employers do not have a drug-testing program reported a nearly 50 percent higher incidence of illicit drug use compared to those with drug-testing programs.

Fact Or Fiction? Is it true that eating poppy seeds or food cooked with wine can cause a person to test positive for drugs or alcohol?

The Facts: While eating foods cooked with wine will not cause you to test positive for alcohol use, if you eat a large enough amount of poppy seeds, you indeed may test positive for opium, morphine, or codeine. All of these drugs are derived from the seed pods of the poppy plant. Eating poppy seeds will not, however, cause intoxication. Opium is concentrated mostly in the sap contained by the pods rather than in the seeds themselves. Observers are divided on the effectiveness of drug testing. On one hand, supporters of drug testing point to a significant decline in workplace drug use over the past 20 years, which many credit to testing. The testing firm Quest Diagnostics found that only 3.8 percent of employees tested positive for drugs in 2007, the lowest figure since Quest began keeping records in 1988. Critics, however, contend that the low rate of positive results suggests that the tests are far too expensive for their value in identifying substance abusers. They also point out that most tests screen for marijuana but not for more dangerous drugs such as cocaine or amphetamines, which pass out of the body much more quickly. Despite the controversy, societal concern about drug use likely will convince most employers to continue their testing programs. See also: Workplace Drug Abuse further reading

Mur, Cindy, ed. Drug Testing. Chicago: Greenhaven Press, 2006. Sawvel, Patty Jo. Student Drug Testing. Chicago: Greenhaven Press, 2006.

Drug Use, History of 85

■ Drug Tests

See: Workplace Drug Abuse

■ Drug Victims

See: Homicide; Morbidity and Mortality

■ Drug Use, History of The medical and recreational use and abuse of drugs is not a new phenomenon. Naturally occurring drugs such as opium and marijuana have been used almost since the beginning of recorded history. With the advance of science and medical technology, humans have also invented synthetic drugs such as amphetamines and ecstasy. Additionally, some of today’s best-known drugs, including cocaine and heroin, were created by using modern scientific processes to chemically alter natural substances that have been known for centuries. Marijuana

According to the National Institute on Drug Abuse, marijuana is the most widely used illicit drug in the United States. Marijuana was not always illegal. It has been widely used for recreational, medical, and commercial purposes. Interestingly, in some places where marijuana was used commercially and medically, it never gained popularity as an intoxicating drug. In other places, intoxication was its principal use. In 1972, the National Commission on Marihuana and Drug Abuse presented a report to Congress titled “Marihuana, A Signal of Misunderstanding,” which traced a detailed history of marijuana from ancient times to the early 1970s. According to the report, some of the earliest references to marijuana appear in a Chinese medical text dated 2737 b.c. The Chinese emperor Shen-Nung recommended it as a treatment for the nutritional disease beriberi, constipation, “female weakness,” gout, malaria, rheumatism, and “absentmindedness.” However, the Chinese appear not to have used marijuana as an intoxicant. From China, marijuana seems to have spread south and west to India, where it became a major part of Hindu culture by 1000 b.c. In India, marijuana was called the “Giver of Life.” Hindus who were in the highest social caste, or class, were not permitted to use alcohol but

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could freely use marijuana. Thus, high-caste Hindus included the drug (which they called bhang) in religious ceremonies as well as at marriage celebrations and family festivals. The working classes in India came to regard marijuana in much the same way people in Europe and the United States viewed beer. They smoked bhang and drank it in a liquid form at the end of the day to relieve stress and fatigue. According to one source cited in the report, Indians used marijuana “to obtain a sense of well-being, to stimulate appetite, and to enable them to bear more cheerfully the strain and monotony of daily routines” India was not the only part of central Asia where marijuana gained popularity at this time. Clay tablet inscriptions found in present-day Iran show that the drug was used there around 700–600 b.c. Records from the Mesopotamian empire of Assyria indicate its use at the time of King Ashurbanipal’s reign (669–626 b.c.). From central Asia and the Middle East, the drug spread to Greece. In his epic story the Odyssey, the great Greek author Homer describes a drug called nepenthe, which many scholars believe was a liquid brew in which the most active ingredient was marijuana. The ancient Romans also employed marijuana as an intoxicant, according to the Roman author and physician Galen. In the second century a.d. Galen recorded that Romans would often serve marijuana to guests at banquets “to promote hilarity and happiness.” Marijuana was also popular in the early Muslim world. Like upper-caste Hindus, devout Muslims were not allowed to drink alcohol. Long before a.d. 1000 the drug not only appeared in the Muslim world but also became a part of Muslim culture. Records indicate that marijuana was used medically in Africa long before it became popular as an intoxicant. Texts from Egypt dating to the 1900s b.c. show that it was used to treat sore eyes. Marijuana was used in other parts of Africa as an antiseptic and to restore appetite and relieve hemorrhoidal pain. Other medical uses for marijuana included the treatment of tetanus, rabies, convulsion in infants, nervous disorders, cholera, rheumatism, hay fever, asthma, skin diseases, and difficult labor during childbirth. Aside from its use in ancient Greece and Rome, most Europeans had never heard of marijuana until the 1800s. Muslims apparently brought the drug to Spain in the a.d. 900s, but its use did not spread beyond the Muslim community. Some scholars believe that the Italian explorer Marco Polo may have known about marijuana before his famous trip to China in the 1200s. They are convinced that he encountered a

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powerful and concentrated form of marijuana called hashish when he journeyed through the Middle East during his travels. Marijuana seems to have first gained some popularity in Europe as a result of French emperor Napoleon Bonaparte’s invasion of Egypt in the early 1800s. Two scientific reports prepared later in the century further increased European interest in marijuana. In 1839, the British physician W. B. O’Shaughnessy recommended the medical use of marijuana for a variety of illnesses and as a mild intoxicant. A later report by Russell Reynolds, the private physician to England’s Queen Victoria, made many of the same recommendations. Members of Europe’s medical profession during the mid-1800s spoke highly of the drug, which was easily obtained without a prescription. Many popular writers of the day, including Charles Baudelaire, Arthur Rimbaud, and Pierre Gautier, wrote enthusiastically about the effects of hashish. Gautier and Baudelaire were even members of the Club des Hachischins, in which writers and intellectuals gathered and experimented with hashish. Although intrigued by the writers’ descriptions of their experiences with the drug, the public at large looked upon marijuana with a mix of fear and repugnance. As a result, hashish remained a drug whose use was largely confined to a few European artists and intellectuals. Historians disagree as to when marijuana first arrived in the United States. Some suggest that the Spanish brought the plant with them during their exploration of the Americas in the 1500s. Others claim that the drug was brought over on slave ships. Yet hemp plant from which the drug is derived has been grown in what is now the United States for centuries, apparently without widespread knowledge of its intoxicating effects. Early Americans used hemp for clothing, rope, and twine, and the first pioneers used hemp cloth to cover their wagons. During the 1800s, marijuana was often used as a medicine in the United States. Although available without a prescription, it was also widely prescribed by physicians for a variety of ailments. In 1857, the Boston physician John Bell reported using marijuana to control mental and emotional disorders in the mentally ill. Three years later, the Ohio State Medical Society’s Committee on Cannabis Indica claimed that its members had used marijuana to successfully treat pain, hemorrhage, hysteria, mania, whooping cough, infantile convulsions, asthma, gonorrhea, nervous rheumatism, chronic bronchitis, muscular spasms, tetanus, and epilepsy. It was also used to stimulate appetite.

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The first recorded use of marijuana as an intoxicant in the United States dates to the early 1900s. American soldiers stationed in Puerto Rico and the Panama Canal Zone were using it by 1916. American soldiers fighting the Mexican bandit Pancho Villa also began to smoke marijuana around this time. Marijuana use in the United States grew during the 1910s and 1920s as large numbers of Mexican laborers came north for work and brought the drug with them. During the 1920s and 1930s, marijuana grew in popularity in the United States, especially among musicians and other entertainers. It was at this time that the federal government began to express concern about the spread of the drug. The first federal antimarijuana laws were passed in the 1930s, in what is considered the beginning of the nation’s “war on drugs.” One campaign by the Federal Bureau of Narcotics portrayed marijuana as a powerful, addicting substance that would lead users into narcotics addiction. This idea of marijuana as a “gateway” drug is still supported by some authorities. These efforts, however, failed to curb a growing interest in the drug. During the 1950s, it became popular among the so-called beat generation of poets, writers, and musicians. In the 1960s, its use spread to college campuses where it became a symbol of rebellion against authority. In 1970, the federal government classified marijuana as a Schedule I drug—a drug that has the highest potential for abuse and no accepted medical use. In effect, the government proclaimed marijuana to be as dangerous as heroin or LSD. By the 1980s, the government had adopted a “zero-tolerance” program that resulted in the passage of mandatory prison sentences for possession of marijuana. This period saw a decline in the use of marijuana, a trend which began to reverse itself in the early 1990s. However, by 2000, use of the drug had once again declined below previous levels. According to the 2007 “Monitoring the Future” study, about 42 percent of 12th graders report having tried marijuana, while about 32 percent had used it in the previous year. Cocaine

According to Arthur Gibson, a University of California–Los Angeles expert on the history of commercial uses of plants, evidence of coca use dates back to 3000 b.c. At that time, the Valdiva people of coastal Ecuador produced figurines and ceramic pots showing individuals chewing coca leaves. Other ceramics showing the use of the stimulant have been found in Peru dating from 1900 to 1750 b.c. In the Nazca region of Peru, 2,000-year-old mummies were found with bags of coca leaves (chuspas) around their necks.

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However, the Incan civilization of Peru, which arose around a.d. 1300, provides the earliest useful information about early coca use. For the Incas, coca was a symbol of royalty. Only male royalty, priests, and shamans were allowed to use the drug. Reports also suggest that coca was used to treat the sick and soothe pain from ailments such as toothache and malaria. Court orators used the drug so they could recount Incan history at a single sitting. It was also used during initiation rites for young men. Thus, coca use in Incan society was typically for medical or ceremonial purposes rather than as an intoxicant. By the time of the Spanish invasion of Peru in a.d. 1533, the power of the ruling class had weakened greatly and coca was no longer a symbol of political or social status. The conquest of the Incas brought Spanish culture and the Roman Catholic Church to South America. Priests who wanted to convert the Indians to Catholicism opposed coca because they associated it with Incan culture and religion. In 1551, the bishop of Cuzco banned its use and called it “an evil agent of the Devil.” Anyone using or possessing coca could be burned at the stake. As coca plantations were cut down, the coca leaf business went underground. For many South American Indians, using coca became a way of defying Spanish authority. In time, the Spanish found that coca was indispensable to their mining operations in the Americas. Under great pressure to increase production of gold and silver, Spain’s King Phillip II decreed in 1569 that coca was not evil. Spanish overseers now supplied the Indians with coca leaves to increase their energy and productivity. Even priests who once called the drug evil now said that it was aiding “God’s work.” At this time, a merchant named Nicolas Monardes tried to import coca leaves to Spain, but they decayed during the long voyage. It was not until the late 1800s that coca enjoyed a revival of interest in Europe. In 1814, some wealthy Londoners wanted to use coca to replace food for the poor so they could increase the productivity of child labor. However, coca leaves were still unavailable in Europe at this time. In 1860, an Italian physician named Paolo Mantegazza was the first to isolate the active ingredient in coca leaves and produce the drug now called cocaine. About the same time, the chemist Angelo Mariani extracted cocaine from coca leaves and put it into cough drops and wine. His creation, called Mariani’s Coca Wine, or Dr. Mariani’s French Tonic, became extremely popular in Europe and then found fans in the United States. A host of famous and influential people endorsed its use. Pope Leo XIII even gave Mariani a gold

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medal for inventing a potion that relieved fatigue, lifted the spirits, and gave people a sense of well-being. Cocaine began to appear in popular literature at this time. The famous fictional detective Sherlock Holmes injected cocaine to relieve boredom when he was not working on a case, and Robert Louis Stevenson supposedly wrote the novel Dr. Jekyll and Mr. Hyde while under the influence of cocaine. One of the most enthusiastic supporters of cocaine use was the psychiatrist Sigmund Freud. While searching for a cure for nervous exhaustion and morphine addiction, Freud found that cocaine relieved his own depression, and he wrote a series of papers about the drug, praising it as a “magical drug” superior to morphine. In 1884, Freud recommended the use of cocaine to a Vienna ophthalmologist named Karl Koller as a local anesthetic for eye operations. Koller discovered that cocaine was also useful as an anesthetic for surgery of the ear, nose, and throat. During the late 1800s and early 1900s, cocaine appeared in many tonics, elixirs, and popular medicines. In 1886, John S. Pemberton invented Coca-Cola by combining caramel, phosphoric acid, an extract of the kola nut that contained caffeine, and cocaine. He added sugar to the formula to disguise the bitterness of the cocaine. Cocaine-based medications were extremely popular in the United States throughout the early 1900s. However, as with marijuana, federal government officials became concerned about the use of the drug. Congress passed laws banning the sale and distribution of cocaine during the 1930s, and like marijuana use, cocaine use went underground. The use of cocaine as an illegal intoxicant increased during the 1950s and 1960s, but its relatively high price made it less popular than other illicit drugs. By the 1970s, it had become the drug of choice among many wealthy and middle-class drug users. Cocaine retained an image as a more “refined” drug until the 1980s, when a powerful version called crack appeared in the United States. Crack was not only more potent but also considerably cheaper than powder cocaine. An epidemic of crack use in the 1980s, accompanied by gang violence associated with crack dealing, led to stiff penalties for possession and sale of crack. In recent years cocaine and crack use has been on the decline, especially among teens. According to the 2007 “Monitoring the Future” study, about 8 percent of 12th graders had tried cocaine at least once, down from 8.5 percent the previous year. About 3.2 percent of 12th graders in 2007 reported using crack at some time in their lives, and 1.9 percent had smoked crack in the previous year.

Drug Use, History of  91 Opium and Heroin

Opium is one of the oldest drugs known to humans. According to the book Opium: A History, by Martin Bloom, opium poppies were grown by the Sumerians of lower Mesopotamia as early as 3400 b.c. They referred to it as the “joy plant.” The Sumerians passed the plant along to the Assyrians, who transferred their knowledge of it to the Babylonians, who in turn introduced opium to Egypt. The opium trade flourished during the 1300s and 1200s b.c. Merchants from Phoenicia and Minoa shipped opium to Egypt, Carthage, and Europe. In the 400s b.c., the Greek physician Hippocrates, known as “the father of medicine,” acknowledged that opium was useful as a narcotic as well as for treating internal diseases, diseases of women, and epidemics. Some 100 years later, Alexander the Great brought opium for his armies on their conquest of Persia and India, introducing the drug to parts of the Middle East. By a.d. 400, Arab traders brought the drug to China. Despite its early introduction to Europe, opium use virtually disappeared in Europe until the a.d. 1500s. At that time, Portuguese traders sailing the East China Sea discovered the intoxicating effects of smoking the drug. Although the Portuguese first encountered opium in China, the Chinese themselves considered the practice of smoking the drug barbaric. By 1527, the drug had once again come to the attention of Europeans through medical literature. The Renaissance physician Paracelsus reported on the existence of black pills called laudanum, which were made of opium, citrus juice, and gold extract. Known as “Stones of Immortality,” the pills were prescribed as painkillers. Opium use became widespread in Europe during the 1600s and 1700s. England’s Queen Elizabeth I ordered English merchants to bring high-quality opium from India to England, and in 1680 English chemist Thomas Sydenham introduced Sydenham’s Laudanum, a compound of opium, sherry wine, and herbs. These and other potions containing opium became popular remedies for numerous ailments. In 1803, a German chemist named Friedrich Sertuerner discovered the active ingredient of opium. By dissolving opium in acid then neutralizing it with ammonia, he produced morphine, the first synthetic opium-based drug. Many physicians who were wary of using opium because it was so powerful believed that opium had finally been “tamed.” Morphine was called “God’s own medicine” for its safety, reliability, and long-lasting effects. In 1843, Dr. Alexander Wood of Scotland became the first to inject morphine with a syringe. He

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found that the effects were almost instantaneous and several times more potent than opium or morphine taken orally. In 1895, German chemist Heinrich Dreser produced a morphine-based drug that did not have many of the common side effects of morphine. The drug, called heroin, was first marketed commercially three years later. By 1900, opium and morphine use had spread throughout Europe, Asia, and the United States. Their use generated concern, because many users became addicted to the drugs. In the early 1900s, the Saint James Society in the United States began to supply free samples of heroin through the mail to morphine addicts who were trying to give up their habits. However, within a few years, the rate of heroin addiction in the United States had grown alarmingly. In 1905, the U.S. Congress banned the use of opium, and by 1925 all opium-based narcotics were declared illegal in the United States. The ban, however, did not stop the use of heroin or other opiumbased drugs—it merely drove them underground. A thriving black market for the drugs developed, and heroin remained readily available through street dealers in large cities such as New York. In the midto-late 1900s, cultivation of opium poppies became a major source of revenue for many rebel groups in Thailand, Burma, Vietnam, and other Asian nations. Profits from opium and heroin cultivation also financed terrorist groups operating out of Afghanistan. The recreational use of heroin in the United States peaked during the 1960s and 1970s before beginning a gradual decline in the 1980s. Heroin use rose again during the 1990s, and since that time, use by teens has gradually increased. According to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, the percentage of people age 12 or older who used heroin fell from 1.6 to 1.5 percent. In 2006, 560,000 Americans age 12 and older reported using heroin during the past year, and 3.8 million reported using it at least once in their lives.

Fact Or Fiction? Great Britain and China fought wars over opium smuggling.

The Facts: Between 1839 and 1856, Great Britain and China engaged in two “opium wars” over the British importation of opium into China. In the late 1700s, the British East India Company discovered a huge market for

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opium in China, where the drug was illegal except for medicinal purposes. The company made huge profits by smuggling it into China. Angered by the British trade, the Chinese emperor banned all sale and importation of opium in 1799. In 1839, Chinese authorities ordered foreigners to turn over their stores of opium to the government. Unwilling to give up the profitable trade, the British declared war on China. After two years of fighting, the victorious British claimed the Chinese island of Hong Kong as a colony and resumed the opium trade. The Chinese refused to accept this state of affairs, and hostilities erupted into a second opium war in 1856. This time, the French, who now had colonies in the opium-producing areas of southeast Asia, joined the British. Once again, the Chinese were defeated, and they were forced to lift the ban on importation of opium into China. Synthetic Drugs

Most of today’s other widely abused drugs are synthetically produced substances that have had a much briefer history of use. For example, the drug LSD was first created in Switzerland in the 1950s and soon gained a reputation for producing powerful hallucinations and other out-of-body experiences. It became popular among college students during the 1960s, largely as a result of the writings and speeches of author Timothy Leary, who encouraged American youths to experiment with the drug under the slogan “turn on, tune in, and drop out.” Amphetamine, another widely used synthetic drug, was first synthesized in Germany in 1887. However, it was not used until the late 1920s, when it was investigated as a cure for a variety of illnesses, including epilepsy, schizophrenia, alcoholism, opiate addiction, migraine, head injuries, and radiation sickness. In 1932, amphetamine was marketed as an over-the-counter inhaler to treat nasal congestion. Five years later it was found to have a positive effect on some children with attention deficit hyperactivity disorder (ADHD). In 1919, scientists in Japan discovered methamphetamine, which was more potent and easier to make than amphetamine. During World War II, the U.S. Army used amphetamines to keep soldiers alert and reduce fatigue. After the war, supplies of methamphetamine once used for military purposes were made available to the Japanese. The result was an epidemic of intravenous methamphetamine abuse. At the same time, tablets of legally manufactured amphetamine and methamphetamine became readily available in the

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United States and were used recreationally by college students, truck drivers, and athletes. Abuse of the drugs spread widely and continues to be a major problem today. Some of the newest synthetic drugs are the so-called club drugs, or designer drugs. Many of these drugs were originally created in the 1970s as treatments for medical conditions. For example, the drug GHB was originally sold as an over-the-counter substance used for weight reduction and to build muscle mass. Users soon became aware of its sedative effects and its ability to produce euphoria, leading to widespread abuse. The federal government banned sale of GHB in 1992. The club drug ketamine was first developed as an anesthetic for veterinary medicine, which is still its main medical use. However, ketamine also became a drug of abuse because of its ability to produce euphoria. The history of drug use and abuse shows that humans have long been fascinated with the medical and recreational uses of drugs. While many drugs have been used primarily as intoxicants, few have gained popularity on that basis alone. Drugs such as heroin, cocaine, and amphetamines were first prized for their curative abilities before they were abused for their intoxicating effects. As shown by the rise in popularity of new substances such as club drugs, humans’ fascination with drugs continues today. See also: Club and Designer Drugs; Crack Cocaine; Drugs and Criminal Activity; Gangs and Drugs; Illegal Drugs, Common; Injection Drugs further reading

Booth, Martin. Opium: A History. London: Simon and Schuster, Ltd., 1996. Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse. Ogden, Utah: Sagebrush Press, 2003. Knowles, Cynthia R. Up All Night: A Closer Look at Club Drugs and Rave Culture. Thousand Oaks, Calif.: Red House Press, 2001. Musto, David. Drugs in America: A Documentary History. New York: New York University Press, 2002. Swarts, Katherine. The History of Drugs: Club Drugs. Detroit: Greenhaven Press, 2005. Tracy, Sarah, and Caroline Jean Acker. Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800–2000. Amherst: University of Massachusetts Press, 2004.

Drug Use, International  95

■ Drug Use, International This entry discusses the worldwide scope of the production, distribution, and use of illicit drugs. Although the United States is the world’s leading consumer of illicit drugs, the problems of drug trafficking and drug abuse are hardly limited to a single country or even a single continent. Illicit drugs are cultivated and produced in virtually every corner of the globe, and the demand for them is also worldwide. The international shipment and sale of drugs is a hugely profitable business. According to a 2007 article in the journal The Global titled “Globalization and the Corrupt States,” illegal drug trafficking accounts for 5 to 6 percent of total world trade or slightly more than the combined global trade in agricultural products and automobiles. UN estimates of the size of the drug trade are even higher: 8 percent of all international trade, or about $400 billion each year. Advances in transportation and telecommunications since the mid-20th century have transformed drug trafficking from a local and regional endeavor to an international one. Many countries that once produced no drugs, or only a small amount to satisfy a local market, are today net drug exporters. For example, although marijuana is native mostly to mountainous regions in the tropics, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) estimated in 2006 that the plant is now cultivated in some 172 countries. In fact, Canada, a country as far from the tropics as one can find in the Western Hemisphere, is a major source of the marijuana that is consumed in the United States.

Q & A Question: Why do some national governments tolerate or even encourage drug trafficking? Answer: Some governments, especially in poorer countries, may see drugs as an important source of revenue. In Afghanistan, for example, from 1996 to 2000, the ruling Taliban derived much of its income from taxes collected from those who grew poppy plants. In Colombia as well, since the 1990s, many of that country’s leaders have supported right-wing militias that use drug sales to finance a war against antigovernment rebels.

96 The Truth About Drugs INTERNATIONAL DRUG PRODUCTION

In most cases, the world’s leading drug-producing nations are not the largest consumers of drugs. Most of the major drug-producing countries are developing nations, such as Afghanistan and Colombia, that consume only a fraction of their own output. Industrialized nations, such as the United States, Canada, and the countries of Western Europe, are the main destinations for most international drug traffickers. In recent years, several industrialized nations have themselves grown into major centers of drug production. Marijuana

According to the EMCDDA, about 42,000 tons of marijuana were grown worldwide in 2005. Almost half of this total was grown in the Americas (North, Central, and South America and the Caribbean). North America—the United States and Canada—accounted for 23.2 percent of the world’s marijuana crop; 21.9 percent of the total came from South America. Among all the continents, only Africa (24.8 percent of the total) cultivated more marijuana than North America in 2005. It is difficult to determine exact export figures, but the EMCDDA and the U.S. Central Intelligence Agency (CIA) have identified the major exporting nations in each region. Mexico, Canada, Jamaica, and Colombia meet most of the international demand supplied from the Americas. According to estimates by the U.S. Department of Justice, the United States may have produced as much as one-fourth of the marijuana grown in the Americas in 2005. However, most of that production went to satisfy domestic demand, and relatively little was exported. Other major marijuana exporters around the world include Nigeria, South Africa, Kazakhstan, Kyrgyzstan, India, Cambodia, Thailand, and the Philippines. Opium

The poppy plant is the source of opium, a powerful drug in its own right that is also the basic ingredient in heroin. Unlike marijuana, which can adapt easily to a variety of climates, poppies are more difficult to cultivate. As a result, a relative handful of countries are major opium producers. According to the CIA, in 2005 Afghanistan was the world’s largest producer of opium, supplying more than 90 percent of world demand. Although the total area under poppy cultivation in Afghanistan

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dropped by almost 50 percent in 2005, total production declined by only about 10 percent. The CIA attributed this to good weather and lack of crop diseases in the poppy fields. The world’s second largest opium producer, Myanmar (formerly Burma), produced only one-twelfth as much as Afghanistan (380 metric tons compared to Afghanistan’s 4,475 metric tons). Other major opium exporting counties include Colombia and Pakistan. Cocaine

In 2005, the CIA reported that Colombia was the world’s leading supplier of cocaine. That distinction belonged to Peru until 1996. Since that time, Colombia has rapidly grown to dominate the world market. Today, Colombia produces two-thirds of the world’s supply of cocaine; Peru lags far behind in second place. In recent years, Bolivian growers have been exporting larger quantities of cocaine, and that country is now in third place. Transshipment and Financing

Selling and transporting drugs internationally is a complex and sophisticated undertaking. Local drug producers would not be able to sell and ship drugs internationally without financial and logistical assistance. Logistics refers to the process of planning and managing the flow of goods from the point of production to the point of sale or use. Because of this, drug traffickers rely on a network of financiers and distributors to arrange the details of delivery and payment and to ensure the smooth and uninterrupted flow of trade. Transshipment

Because transporting small quantities of drugs over long distances is inefficient, dealers typically make use of transshipment points—places where local and regional producers bring drugs for international shipment. The shipper charges producers a fee for transporting the goods to markets that the producers themselves do not have the money or resources to reach on their own. Dozens of countries have emerged as centers of transshipment for drugs. These include countries as small as Albania, Aruba, Malta, and Santa Lucia and as large as Germany and Russia. Major transshipment countries in the Western Hemisphere include Guatemala (cocaine and heroin), Brazil (cocaine), and Mexico (cocaine and heroin).

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Providing money to finance big drug-selling operations is another major element of international drug trafficking. Payments of millions of dollars regularly change hands during major drug transactions. Because these transactions frequently occur across international borders, drug dealers often arrange elaborate schemes to finance their operations and to disguise their business from law enforcement authorities. One of the most widespread illegal financial activities associated with the international drug trade is money laundering. This refers to a situation where money earned through drug sales is invested in legitimate business enterprises. Drug lords will often reinvest their drug income into ventures such as construction or real estate development and then claim these legal businesses as the sources of their income. Many countries in Europe are significant centers for money laundering, including Switzerland, Germany, the Netherlands, Italy, and the Czech Republic. The weakness of the rule of law in many nations that were once part of the Soviet Union also makes many of them potential trouble spots for money laundering activity. In the Western Hemisphere, the Cayman Islands is a major center for money laundering activity related to drug sales in the United States. INTERNATIONAL Drug consumption

UN tracking of international drug use shows that the United States is the world’s largest market for marijuana and cocaine and among the leaders in many other illicit drugs as well. A number of other countries, however, have rates of use that are higher than those in the United States. Those nations’ smaller populations, however, mean that they still consume less than the United States and other more populous nations. Marijuana

As mentioned above, the United States is the world’s largest market for marijuana. According to the UN 2008 World Drug Report, 12.2 percent of Americans ages 15 to 64 abuse marijuana—almost 30 million people. However, the United States ranks only 10th in the percentage of adults who use marijuana. The Pacific island nation of Papua New Guinea has the greatest annual prevalence of marijuana use—almost 30 percent of the population between ages 15 and 64 use

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marijuana. Other nations with greater prevalence of marijuana use than the United States include Micronesia, Ghana, Canada, Zambia, Haiti, Sierra Leone, Nigeria, and Australia. Another measure of the extent of drug use in a country is the amount of the drug seized by law enforcement. In 2005, 63 percent of all seizures of marijuana occurred in North America, primarily the United States; Africa accounted for 18 percent of seizures. While only about 2 percent of all marijuana seizures occurred in Europe, that continent was the site of about 70 percent of all seizures of hashish and hashish oil—potent drugs derived from the sticky resin of the marijuana plant. Opiates

Unlike marijuana use, opiate use is much more concentrated in Europe and Asia than in North America. About 0.6 percent of the U.S. population age 15 to 64 uses opiates. Eight countries in both Europe and Asia show higher rates of use among the adult population. The nations with the greatest prevalence of use include Iran (2.8 percent), Mauritius (2.0 percent), the Russian Federation (1.6 percent), Estonia (1.5 percent), and Afghanistan (1.1 percent). Although only 0.3 percent of adult Chinese use opiates, because of the country’s enormous population it claims the world’s largest number of opiate users. The Russian Federation has the second-largest opiate-using population; India ranks third. Cocaine

As with marijuana, the United States is also the leading consumer of cocaine. There are an estimated 14 million cocaine users worldwide, with more than 40 percent residing in the United States. About onefourth of global cocaine users are found in Europe, particularly in Spain and the United Kingdom. The Netherlands, Belgium, Ireland, Italy, and Switzerland also contain a significant percentage of cocaine users. While only about 0.3 percent of people worldwide use cocaine, 2.3 percent of North Americans, 1 percent of West and Central Europeans, and about 0.8 percent of South Americans use the drug. Worldwide Consumption Trends

When one takes into consideration all illicit drugs, North America and western Europe are clearly the largest consumer markets. Those nations have rates of use of most types of illicit drugs that are above

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the international average. Other parts of the world seem to show a more selective pattern of consumption. In Africa, for example, marijuana use is relatively common: nine nations have adult usage rates of more than 7 percent, with rates exceeding 15 percent in several countries. By contrast, rates of other types of drug use in Africa are very low by world standards. Worldwide, eastern and southeastern Asia have the lowest overall rate of drug use. According to the United Nations 2008 World Drug Report, almost no countries in eastern and southeastern Asia reported usage rates of more than 1 percent for any drug except marijuana. Macao reported an opiate use rate of 1.1 percent, and the Philippines showed an amphetamine abuse rate of a staggering 6 percent—twice as high as any other nation. Marijuana usage rates in the region were also considerably lower than in other regions. The Philippines’ rate of 4.2 percent, the region’s highest, was tied for 55th place worldwide. The world’s worst market for drugs is undoubtedly the island nation of Singapore. With extremely tough drug laws and a society in which people are under constant surveillance in public, Singapore has virtually eliminated the problem of drug abuse. Rates of marijuana use (0.0005 percent), cocaine (0.0002 percent), opiates (0.005 percent), and amphetamines (0.005 percent) are less than one one-thousandth the rates in the United States. However, few Americans would be willing to give up the civil freedoms Singaporeans have sacrificed for their relatively drug-free society. See also: Drugs and Criminal Activity; Drug Use, History of; Law on Drugs, The further reading

Aggleton, Peter, Andrew Ball, and Purina Mane, eds. Sex, Drugs and Young People: International Perspectives. London: Routledge, 2006. Ahn-Redding, Heather. Illicit Drug Policies, Trafficking, and Use the World Over. Lanham, Md.: Lexington Books, 2007. Arnold, Guy. The International Drug Trade. London: Routledge, 2005. Isralowitz, Richard. Drug Use: A Reference Handbook. Santa Barbara, Calif.: ABC-CLIO, 2004.

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■ Families, Communities, and Drug Abuse

Drug abuse is the nonmedical use of a substance taken to affect one’s mental processes, satisfy a dependence (the compulsive use of a drug despite harmful psychological, physical, or social consequences), or attempt suicide. Families affect drug use by the kind of messages they send about its acceptability as well as by how they react to drug abuse by family members. The surrounding community also plays a role. It may either reinforce the messages communicated within the family, or challenge and question those messages. Dealing with neighborhood influences that may lead teens to use drugs or alcohol is one of the most important challenges faced by parents today. Drug Abuse and Families

Drug abuse is often a family affair. Family attitudes, actions, and interactions have a profound influence on a teen’s behavior. That influence may be positive or negative, and it can start even before birth. A 2005 study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that nearly 4 percent of pregnant women had used at least one illegal drug. According to NIDA, marijuana and cocaine were the drugs most often used during pregnancy. In following up the study, researchers learned that children who had been exposed to drugs while in the womb were at greater risk for various behavior problems, including difficulty delaying gratification, handling frustration, and dealing with stress. A 1998 study by Linda Mayes of the Yale University Child Study Center found that the negative effects of cocaine use during pregnancy still affected children years later. At two years of age, children exposed to prenatal cocaine use showed more impulsive behavior and suffered more from delays in acquiring language skills than nonexposed children. Such children were also more likely to be held back a grade in school and to require special education classes. Drugs and family violence

Physical damage to children exposed to drugs prenatally is but one of many negative effects that drugs can have on family life. Studies have also shown a strong connection between drugs, alcohol, and family violence. According to a survey of 915 child-welfare

102 The Truth About Drugs

professionals sponsored by the National Center of Addiction and Substance Abuse at Columbia University, most expressed a belief that parental substance abuse produced “chaos, collapse, and calamity, leaving behind a wreckage of millions of children.” In the opinion of 80 percent of the respondents, substance abuse directly causes or plays a role in most cases of child abuse. Forty percent said that drugs and alcohol were involved in over 75 percent of the child abuse cases they handle. The respondents reported that the number of cases of child abuse more than doubled between 1986 and 1997. Seventy percent of these professionals named substance abuse as one of the three leading causes for the increase. Alcohol is the drug most often associated with domestic violence. A 1995 study of domestic violence in Memphis, Tennessee, showed how close the connection is between alcohol and domestic violence. The authors studied 62 cases of domestic violence and found that 92 percent of assailants used drugs, alcohol, or both on the day of the assault. In a 1999 study in the New England Journal of Medicine, researchers reported that 52 percent of abusive spouses used alcohol before a physical assault. Research has shown that children of abusive parents are at greater risk of becoming child and spouse abusers themselves. In the article “Men Who Batter: Some Personality Characteristics,” the Journal of Nervous and Mental Disease reported in 1983 that boys who are raised by an abusive parent are more likely to abuse their spouses as adults. Drugs and family breakup

Drug and alcohol abuse can also lead to divorce or severe family disruption. According to Psychiatric Disorders in America: The Epi­demi­ o­logic Catchment Area Study, in 1991, alcoholics represented 24.2 percent of all Americans who had been divorced or separated more than once. By contrast, only 8.9 percent of those in intact marriages were alcoholics. In 2006, the U.S. Conference of Mayors reported that families with children made up about 30 percent of the homeless, and that requests for emergency shelter by families increased by 5 percent between 2005 and 2006. Other studies suggest substance abuse played a significant role in these increases. In their 1991 article “Homeless and Dual Diagnosis,” Robert Drake and his colleagues reported that 30–40 percent of the nation’s homeless have a substance abuse problem. In addition, the U.S. Conference of Mayors found that domestic violence was a primary cause of homelessness.

Families, Communities, and Drug Abuse 103 Parental attitudes and concerns

In a 2000 Gallup opinion poll, 22 percent of Americans said that drug abuse had been a cause of trouble in their families. A Pew Foundation poll in 2001 found that 44 percent of Americans were “very concerned” about the possibility of a family member becoming involved with drugs. Another 13 percent were “somewhat concerned.” Only 25 percent said they were “not at all concerned.”

Q & A Question: What do parents think influences teen drug use? Answer: In a Pew Foundation survey in 2002, parents named peer pressure as the most important factor in determining whether or not a teen tries illegal drugs. Other factors of concern to parents included a lack of parental supervision and whether the teen’s parents smoke or drank.

Parents are also aware of the influence that they have on teen drug and alcohol use. In the 2001 Pew Foundation survey, 79 percent of Americans said that lack of parental supervision is a major factor affecting a teen’s decision to use illegal drugs. Over one-half (52 percent) said that whether the teen’s parents smoke or drink also affects the likelihood of teen substance abuse. While most parents express concern about the possibility of a child becoming involved with drugs, low-income parents (parents in families earning less than $25,000 per year) seem to have greater fears than high-income parents (parents earning more than $75,000 per year). According to a 2002 survey by Public Agenda, 73 percent of low-income parents said they worried “a lot” about protecting their children from drugs and alcohol, compared to 46 percent of highincome parents. However, over one-half (54 percent) of high-income parents named protecting their children from negative societal influences as the biggest challenge they faced in raising their family. Only 42 percent of low-income parents expressed similar views. Codependence

Despite parental concerns, some teens do take drugs and their use of drugs affects the entire family. How family members react to drug

104 The Truth About Drugs

abuse can play a major role in determining the course of abuse. Some family members may become codependent. They may behave in ways that actually support the drug abuse. Codependence is a set of compulsive behaviors that develop between a family member and a person within the family who is addicted to drugs. Codependence harms both the person abusing substances and the codependent family member. Codependency may lead to other psychological problems. Drug Abuse and the Community

Families clearly exert a significant influence on teen drug and alcohol use, but families don’t exist in a vacuum. The family is set in a community that includes not only its immediate surroundings but also the larger rural or urban area in which the neighborhood is located. While the city and countryside differ in some respects, both experience the problem of drug and alcohol abuse. Drugs and community decay

Newspapers and newscasts across the nation reveal the negative effects illegal drug use have on a community. For example, the use of crack (a potent form of cocaine produced by removing cutting agents and other chemicals) struck many cities and towns in the 1980s and 1990s and led to an increase in poverty, crime, and physical decay. Several studies from the 1980s and 1990s documented the relationship between drug sales in a community and neighborhood decay. A 1990 report, “Drug Marketing, Property Crime, and Neighborhood Viability: Organized Crime Connections,” found a relationship between property crimes and drug sales. The study also found that drug sales increased crime and violence in the community and that many people were afraid to use public spaces. Those who could afford to move out did so, leaving behind the poorer residents to face the growing problems. As the number of abandoned houses grows, property values fall and buildings fall into disrepair. In a 1982 article in Atlantic Monthly titled “Breaking Windows,” political scientist James Q. Wilson argued that these run-down neighborhoods send the message that they are unsafe places. The climate of fear surrounding such neighborhoods fosters continued crime, violence, and drug use. According to the 2005 National Crime Victimization Survey, 27 percent of victims of violent crime reported that the offender was

Families, Communities, and Drug Abuse 105

using drugs or alcohol at the time of the crime. In 1998 the Bureau of Justice Statistics (BJS) estimated that 17 pecent of current jail inmates had committed their crimes to obtain money for drugs. The BJS also reported that 10 percent of all violent criminals had committed their crimes to get drug money. Violent crime and property crime related to drug use contributes to the decay of neighborhoods and communities. Urban and suburban drug use

Some people believe that drug use is a problem largely confined to urban areas. To some extent, they are correct. Large cities do experience more problems related to drug abuse. For example, the 1997 National Youth Gang Survey reported that youth gangs were more active in drug sales in larger cities than in small cites or rural areas. Youth gangs were involved in about 49 percent of drug sales in large cities, as compared to 31 percent in small cities and 35 percent in rural areas. These numbers clearly show that suburbs and small towns are not free of drug-related crime. The survey also showed that youth gangs were involved in 43 percent of drug sales in suburban areas. And a 2003 study based on did you know ?

Perceived Availability of Drugs Among 12th Graders Percent Reporting Easy to Obtain

100 80

85.6 84.9 83.9

60 44.7 46.5 47.1

40

28.6 29.0 28.7

27.3 27.4

29.7

20 0

Marijuana

Cocaine 2005

Heroin

LSD 2006

Source: National Institute on Drug Abuse, April 2008.

2007

106 The Truth About Drugs

national school questionnaires found that suburban teens were just as likely to drink and use illegal drugs as teens living in urban areas. Community action

Sociologists and law enforcement professionals have studied ways that communities can work to prevent or decrease local drug use and sales. Studies have shown that enforcing social norms, increasing social interaction, and developing a stronger sense of community can reduce crimes like drug selling. The use of local block watches or neighborhood patrols can reduce drug sales by increasing the seller’s risk of getting caught. For example, people in Seattle organized a watch program in which residents volunteered to ride through the neighborhood, observing and photographing drug sellers and their customers. Although the citizens involved in the program received threats from the drug sellers, they were never actually assaulted. When the volunteers continued to photograph drug deals despite the threats, the sellers left the neighborhood. Other citizen watch programs have had similar successes in reducing drug sales. These efforts show that by working together citizens can help reduce drug sales and drug-related crime in their communities. Prevention efforts

Communities can also help stop drug abuse before it starts, through programs designed to encourage teens to avoid drugs. Sponsored by schools, churches, and community groups such as the Young Men’s Christian Association, these prevention programs aim to reduce or eliminate known risk factors for drug abuse and enhance factors that diminish the potential for drug use. Included in the list of these factors might be: ■ A

strong positive family environment ■ Parental monitoring that is supportive and not overbearing ■ Clear rules of conduct that are evenly and consistently enforced ■ Parental involvement in their children’s lives ■ Academic success ■ Active membership in quality school and religious groups ■ Valuing drug-free beliefs and behaviors

Families, Communities, and Drug Abuse 107

Risk factors for drug use include: ■ A

chaotic home situation with parents abusing drugs or dealing with mental illness ■ Parents with poor parenting skills ■ Inappropriately shy or aggressive behavior in school ■ Poor academic performance ■ Poor social skills ■ Peers who use drugs ■ An acceptance of drug use by family, coworkers, teachers, peers, and others in the community

Fact Or Fiction? Fear messages stop teens from using drugs.

The Facts: Fear messages—actions or communications intended to scare teens away from risky behaviors—have an impact on a teen’s behavior. The problem is that after a couple of weeks, the impact of the message wears off. Reinforcement of the message through other means such as classroom discussions, the media, or other activities may extend its impact. The NIDA suggests that school-based prevention programs include general life skills training and training in resistance skills to strengthen personal attitudes and improve communication skills, peer relationships, self-efficacy, and assertiveness. Programs designed specifically for teens should include ­ ageappropriate activities including peer discussion groups, group problem solving, and decision making. The institute believes prevention programs should also teach parents or caregivers sound parenting strategies, how to reinforce what their children learn about drugs and their harmful effects, and utilize opportunities for family discussions about drugs and family policies about their use. The institute recommends that prevention programs should continue throughout a child’s school years, with practice sessions yearly to reinforce the original goals.

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Research on the effectiveness of various prevention programs is very sparse and largely inconclusive. The guidelines above are provided to allow an assessment of various programs and do not imply an endorsement of any specific program. The best program is one that addresses the needs of teens in the local community and that will encourage participation by engaging the concerns and interest of teens and their parents.

teens speak My Friends and I Are Tired of Hearing the Same Old Drug Stories My name is Julia. The stories we heard at school were all the same. They claimed that someone died from doing this drug or how another drug turned a kid into a vegetable. The stories seemed so bogus. That all changed the night Pat died. Pat was one of the coolest people at school. He was smart and a great athlete. He was one of those truly rare people who could fit in equally well with the nerds, jocks, and druggies. To say Pat was popular would be an understatement. Pat ­didn’t believe that drugs were dangerous. One night he had a few beers at a buddy’s house and then went on to a party where he took some kind of tablet. He got depressed and then went into a coma and died later that night at the hospital. None of us could figure out what happened. Pat had used the same drug before with no problems and certainly the few beers couldn’t have caused such a disaster. At our next health class, the teacher we all thought was straight-laced and uninformed explained what happened to Pat that night. The drug Pat took was one made in an underground laboratory. These labs are notorious for having no quality control. As a result, the effects of taking even one tablet can be different from the impact of another tablet of the same drug. Pat took a dose that was much stronger than the drug normally would be. When it reacted with the alcohol in his body, the reaction was strong enough to cause respiratory failure. Without emergency help, Pat

Gangs and Drugs 109 slipped into a coma and died. The circumstances had to be right for this to happen, but with underground drugs you never really know exactly what you’re getting. I came away from the story of Pat’s death with some new feelings. First, any illegal drug can have unknown consequences, especially when mixed with alcohol. And second, maybe those health teachers aren’t so uninformed after all.

See also: Dependence and Addiction; Drugs and Criminal Activity; Risk Factors and Risk Taking further reading

Barnard, Marina, and Ferga Keane. Drug Addiction and Families. London: Jessica Kingsley Publishers, 2006. Biggers, Jeff. Chemical Dependency and the Dysfunctional Family. New York: Rosen Publishing Group, 1998. Davis, Robert C., Arthur J. Lurigio, and Dennis P. Rosenbaum (ed.). Drugs and the Community: Involving Community Residents in Combating the Sale of Illegal Drugs. Springfield, Ill.: Charles C. Thomas Publishers, Ltd., 1993. Marlow, Alan. Young People, Drugs, and Community Safety. Lyme Regis, UK: Russell House Publishing, Ltd., 1999. Singer, Merrill. Something Dangerous—Emergent and Changing Illicit Drug Use and Community Health. Long Grove, Ill.: Waveland Press, 2008. Stimmel, Barry. The Facts about Drug Use: Coping with Drugs and Alcohol in Your Family, at Work, in Your Community. Binghamton, N.Y.: The Haworth Press, 1993.

■ Gangs and Drugs

Criminal organizations whose members associate for mutual protection and profit from illegal activities. Gangs have been involved in the illicit drug trade for years, but their presence has grown significantly over the past several decades. The reasons for this dramatic increase in gang activity are not completely clear, though many observers point to economic causes. A massive downturn in the economy during the 1980s caused many inner-city blue-collar workers to lose their

110 The Truth About Drugs

jobs with little hope for future employment. It is thought that many of these displaced workers found opportunities in gangs. Crack is a very pure form of cocaine produced by removing cutting agents and other chemicals. The highly addictive drug was sold at a relatively low cost in virtually every city. Crack quickly became the drug of choice because of its rapid effects, low cost, and easy accessibility. The quick rise in use was accompanied by a massive increase in supply by Columbian drug dealers and other producers. As the drug became more popular, gangs that dealt in drugs needed more sales people and tighter controls on their territories. Many gangs became local distributors who controlled millions of dollars in sales. Trafficking in Drugs

According to the Office of Juvenile Justice and Delinquency Prevention (OJJDP), in 1997 approximately 33 percent of the teen gangs in the United States were involved in drug trafficking. About 57 percent of these gangs were in the larger cities. The National Youth Gang Survey defines trafficking as “the purchase or transfer of large quantities of drugs which are divided into smaller quantities to be sold on the street.” Street sales refer to the distribution of small quantities of drugs to individual users. The OJJDP also reported that 42 percent of teen gangs were involved in the street sale of drugs. Statistics from across the country suggest that roughly 33 percent of crack cocaine sales, 32 percent of marijuana sales, 16 percent of powder cocaine sales, 12 percent of methamphetamine sales, and 9 percent of heroin sales were through gangs. Gangs generated incredible profits through the sale of drugs and used those profits to entice teens to become gang members. Not only have teen gangs played a huge role in the sale of drugs, but research also suggests that their role in trafficking may be substantial as well. Trafficking through the movement of gangs to new communities is a major concern of law enforcement. According to the National Youth Gang Survey, 18 percent of all youth gang members had moved to their current residence from another area. Migration beyond the territory or region of the gang can establish new markets and expand sales, thus increasing drug purchases and profits. Many gangs have migrated into small cities and rural towns. The trade in illegal drugs is much like legitimate businesses in that both want to increase market share and profits, protect their sales territory, and keep employees motivated. The obvious difference is that

Gangs and Drugs 111

did you know ?

Percentage of Youth Gangs Involved in Street Drug Sales, by Region

Drug Gangs

Region Midwest Northeast South West Overall

Total Gangs

Number

Percent

  2,749    768   4,242   5,484 13,243

1,253   463 1,753   999 4,468

46% 60 41 18 34

Source: National Youth Gang Survey, Office of Juvenile Justice and Delinquency Prevention, 1998.

gangs sell an illegal product and use fear, violence, and murder to accomplish their goals.

Fact Or Fiction? Youth gangs in larger cities are more involved in drug sales than gangs in smaller towns.

The Facts: According to the 1997 National Youth Gang Survey, almost one-half (49 percent) of the youth gangs in cities with more than 100,000 people were involved in drug sales. Only 29 percent of youth gangs were involved in drug sales in towns with fewer than 10,000 residents. Drug Abuse Among Gang Members

Recent studies have provided insights into the inner workings of gangs, including drug use by gang members. It seems to vary widely from gang to gang. In a 1998 paper titled “Addressing Community Gang Problems: A Practical Guide,” the Department of Justice reported that different gangs have different attitudes toward drug use by members. Some gangs prohibit drug use by members. In other cases, it is not specifically forbidden but is frowned on. For example, Dr. Pamela

112 The Truth About Drugs

LaBorde of the University of Washington Harborview Medical Center reported that while many Vietnamese gangs sell heroin, few gang members use drugs. They consider heroin users weak. Each gang seems to have unwritten guidelines related to drug use. Gang-Related Homicide

Violence and drugs have been intricately linked, and the violence often results in homicide. A 2001 survey by the OJJDP estimated that youth gang members were involved in some 20 percent of homicides in cities with populations over 100,000. In 1997, the OJJDP reported that gangs were involved in 28 percent of all aggravated assaults and larceny/theft crimes, 27 percent of motor vehicle thefts, 26 percent of burglaries, and 13 percent of all robberies. The number of gang homicides is closely tied to territorial disputes and the ever-present threat of losing ground to a rival gang, which would mean a drop in drug sales and profits. Because virtually every gang wants to generate more profits, each tries to not only protect its own territory but also to expand into the territories of rival gangs. Law enforcement may inadvertently increase the tension. For example, if the police set out to drive drug dealers from First Street, they may force the dealers to move to Second Street. However, if Second Street is in another gang’s territory, a drug war is likely to begin. Another important issue regarding homicide and gangs is the availability of handguns. In its 2001 Juvenile Justice Bulletin the OJJDP reported that gang members are twice as likely as other teens to carry a weapon. Whether to defend themselves from rivals, ensure a smooth drug transaction, or simply defend their honor against someone who disrespected them, gang members use guns frequently. See also: Drugs and Criminal Activity; Homicide

■ Homicide

Homicide, or murder, is the intentional taking of another person’s life. Homicide is the second-leading cause of death among teens between the ages of 15 and 19. According to the Office of Juvenile Justice and Delinquency Prevention (OJJDP), homicide claimed the lives of more than 2,000 teens in the United States in 2005. That number represents a steady rise from previous years. Homicide among older teens increased by 11 percent between 2000 and 2005. The rate of

Homicide 113

teen homicide in the United States is still significantly higher than in any other Western nation. Crimes Committed Under the Influence

According to “Violence and Drug Abuse,” a 1995 publication by the National Institute on Drug Abuse (NIDA), approximately 50 percent of violent crimes can be attributed to alcohol abuse. Some 30 percent of these violent crimes are homicides. Alcohol increases aggressiveness and decreases inhibitions, an explosive combination that can lead to violence. Cocaine and methamphetamines also have the reputation of generating feelings of aggression and hostility. Statistics from the Federal Bureau of Investigation’s Uniform Crime Reports show that less than 5 percent of all homicides are related to drugs other than alcohol. A major issue in teen homicide is the accessibility of firearms. According to the Centers for Disease Control and Prevention firearms were the instrument of death in over 80 percent of teen homicides in 2004. “The Future of Children,” a publication of the Woodrow Wilson School of Public Affairs at Princeton University, reports that roughly one in four teen deaths results from firearm injuries, while only one in 760 teen deaths results from non-firearm injuries. With access to firearms, a teen’s momentary anger or carelessness can end in tragedy. Under the influence of alcohol or illicit drugs, the chances of this happening increase. According to the Bureau of Justice Statistics, in 2005 juveniles committed 10.9 percent of all homicides, but accounted for 11.9 percent of gun homicides.

Fact Or Fiction? Homicide rates are about the same for most ethnic groups.

The Facts: Homicide affects certain populations at a much higher rate than other groups. Statistics from 2004 show that black male teens have a much higher homicide rate (54.8 deaths per 100,000 population) than Hispanic males (25.8 per 100,000), Native Americans (14.6 per 100,000) or white males (3.3 per 100,000). Black females also have higher homicide rates than females of other races. The rate among black females was 7.8 per 100,000 compared to 4.8 for Hispanic females and 1.8 for white females. No single fact explains the higher rates of homicide among black teens, especially black males. The data does, however, show an association

114 The Truth About Drugs

between income and teen homicide. According to the U.S. Census Bureau, in 2006, African Americans had the lowest yearly median income ($31,969) among any ethnic group. Black income was significantly below the figure for white households ($50,673), and it also trails both Hispanics ($37,781) and Asian or Pacific Islanders ($64,238). Crimes Committed in Trafficking

Drug trafficking—the distribution and sale of drugs—has become a principal effort of gangs in the United States. So it should come as no surprise that violence, specifically homicide, is a part of gang membership. Gang violence has been associated with many teen murders. The Bureau of Justice Statistics (BJS) reports that between 1976 and 2005 24.2 percent of homicides among people under age 18 were gang related. During the 1980s, the sharp rise in illegal drug use—particularly the introduction of crack, a potent form of cocaine produced by removing cutting agents and other chemicals—led drug traffickers to hire more dealers. Gang leaders began to recruit teens, because they worked more cheaply than adults and because many of the adults who once sold drugs were in prison. Many teens eagerly signed on, despite the dangers involved. The growth in firearm use among teenage gang members has led to an increase in guns and other weapons in the community at large. As a result, the rise in homicide among gang members was soon matched by a similar rise among teens in general. As the epidemic of crack use subsided in the early-to-mid-1990s, the rate of teen homicide also declined, as has the number of teens involved in drug trafficking. A rise in teen employment, especially among minority youth, encouraged many teens to turn away from drug trafficking. As a result, teen homicide has declined significantly since the mid-1990s. Despite the recent declines in gang violence, gang activity still claims many teenage victims. The BJS estimated that gangs were involved in 29 percent of teen homicides and drugs were involved in over 10 percent. The BJS reports that the territories most frequently fought for are in large cities. This is probably due to the greater potential market for drug sales in larger cities. Territorial disputes and the threat of losing turf to rival gangs can represent a drop in drug sales. And in certain respects drug trafficking is not much different than any other enterprise that needs to expand and generate increased

Homicide 115

profits. Like legitimate businesses, drug traffickers are concerned about protecting their existing markets. Loss of turf to a rival gang can also lead a tarnished reputation, another significant source of gang violence. The losing gang often decides to retaliate with violence against their rivals. This may well include killing a rival gang member, an act that can fuel a desire for revenge and lead to a continued cycle of homicide. This cycle of provocation, retaliation, and revenge fuels most gang violence. did you know ?

Motives for U.S. Youth Murder, 1976-2005 10.6% 3.7%

24.4%

10.7%

14.8%

28.9%

6.9% Drug-related murders

Murders committed in the workplace

Murders committed during other felony crimes

Murders committed during arguments

Other motives Source: Bureau of Justice Statistics, 2006.

Sex related murders Gang-related murders

116 The Truth About Drugs

Gang members carry weapons for a variety of reasons, from defending themselves from a rival gang, to assuring a smooth drug transaction, to defending their reputation against anyone who disrespects them. Firearms are the weapon of choice in gang-related violence. In fact, from the mid-1980s to the mid-1990s—a period that saw a dramatic increase in teen homicide—virtually the entire increase was due to the rise in firearm violence. Gangs involved in drug trafficking committed much of that violence. Risks to Users

Drug users are more likely than nonusers to be victims of homicide, especially if they are associated with a gang. Gang involvement in drug trafficking is big business. However, street sale of drugs, not trafficking, is the primary business of most gangs. In the 2001 National Youth Gang Survey, 35 percent of law enforcement agencies said most or all youth gang members in their jurisdictions were involved in the sale of drugs. Statistics from across the country suggest that roughly 33 percent of crack cocaine sales, 32 percent of marijuana sales, 16 percent of powder cocaine sales, 12 percent of methamphetamine sales, and 9 percent of heroin sales are through gangs. Rates

According to the Child Trend Data Bank, between 1970 and 1993 the homicide rate for teens ages 15–19 more than doubled, from 7.7 to 20.5 per 100,000. Between 1993 and 2004, the rate declined dramatically. In 1993, just over 20 of every 100,000 teens in the United States was a victim of homicide. In 2004, only 9.3 of every 100,000 teens died as a result of homicide. These most recent numbers may be related to a reduction in firearm use. Recent statistics show that firearm-related deaths have similarly declined, falling to 12.0 per 100,000 in 2004 from a high of 24.5 per 100,000 in 1995. Combined with the reduction in firearm violence is a corresponding drop in the use of alcohol and illicit drugs among teens. The 2007 “Monitoring the Future” study noted a decline in the percentage of teens who had ever used alcohol or illicit drugs since 1997. Both of these trends—declining firearm violence and a drop in drug use—offer hope for a continued reduction in teen homicide. See also: Drugs and Criminal Activity; Drugs and Drinking; Gangs and Drugs

Illegal Drugs, Common 117

■ Illegal Drugs, Common

Widely used drugs whose manufacture, sale, and use are prohibited by law. Also called illicit drugs, these are the substances that most teens generally refer to as “drugs.” The illegal drugs most commonly used by teens represent a range of substances with widely varying physical and behavioral effects. Some depress the central nervous system, causing drowsiness, impaired judgment, and lack of coordination. Others stimulate the user, producing a heightened state of alertness, anxiety, and nervousness. The effects of some of these drugs last only a few minutes, while others linger for several hours. The one thing they share is that all cause changes in the body’s chemistry—changes that alter the user’s perceptions. Marijuana

Marijuana—commonly referred to as “grass,” “weed,” or “pot”—is a drug derived from the dried flowers and leaves of the plant Cannabis sativa. Marijuana is usually rolled into cigarettes (joints) and smoked. Marijuana may also be smoked in a pipe ordinarily used for tobacco or in a water pipe (“bong”). Typically, the effects of marijuana take hold within 10 to 30 minutes and last approximately three hours. Although effects differ, marijuana generally affects memory and learning, distorts perception, and results in difficulty in thinking and problem solving, a loss of coordination, and an increased heart rate. Marijuana can also alter mood and distort the way the user experiences sight, sound, and his or her other senses. Marijuana has been used for thousands of years, but it did not gain widespread popularity in the United States until the 1960s. However, today’s marijuana is much more potent than the marijuana of the 1960s. By some estimates it is two to five times as strong. These more potent strains of marijuana are produced by selective breeding of certain plants to increase the concentration of the drug’s active ingredient, delta-9 tetrahyrocannibinol, or THC. Marijuana use among teens increased throughout the 1960s and 1970s, reaching a peak in the mid-1970s. After a decline in the 1980s, the number of teens using marijuana climbed again during the 1990s, reaching a peak in 1998 and 1999. Since that time, both the number of teens who have ever smoked marijuana and those who smoke it regularly have been on the decline. Many teens believe that marijuana is a relatively safe drug with few harmful side effects. However, a number of studies show that

118 The Truth About Drugs

marijuana use can be dangerous. One study by the National Institute on Drug Abuse (NIDA) showed that marijuana impaired the ability to operate a car safely. The study indicated that marijuana was implicated in almost half of all accidents involving drivers under the age of 30. In addition, long-term marijuana smokers often experienced chronic (long-term) conditions similar to those suffered by cigarette smokers, including lung damage and suppression of the immune system.

teens speak Marijuana Is Not As It Seems I’m Manny and I often hear teens saying that marijuana should be legalized because they know a lot of teens who smoke and nothing bad has happened to them. I also hear them say that even if the cops get you, they consider the crime small because they want the big kingpins who are trafficking in heavy drugs. But I tell them they’re stupid if they use grass. I should know; my brother Ben used to use it all the time. He started when he was about 13, and I could tell right away that it was affecting his brain. Before he started smoking weed he was a good student, but afterwards he had trouble remembering things. He was also a good athlete at one time; he played on the football, basketball, and baseball teams in middle school. After Ben began to smoke weed, he lost his focus and interest and he couldn’t make any of the teams in high school. Ben started hanging out and cruising around with a bunch of other guys who smoked. One day Ben was driving home stoned and he ran a red light. The crash killed him instantly and hurt the driver of the other car. Ben never would have had that crash if he hadn’t been high; he probably would have been practicing sports instead of driving around stoned and wasting time. After Ben’s death, I never pass up an opportunity to tell other kids that marijuana is dangerous, so don’t let some uninformed big mouth tell

Illegal Drugs, Common 119 you that nothing bad happens when you do grass. They are wrong, dead wrong.

Cocaine

Cocaine is a white powder produced by chemically treating the leaves of the coca plant. Coca leaves contain a natural stimulant that is released when the leaves are chewed. South American Indians have long used raw coca as a source of quick energy. Raw coca undergoes several chemical processes before the extract of the leaves are transformed into the white powder called cocaine. Cocaine can be snorted, smoked, or injected. Cocaine has profound and contradictory effects. It stimulates the central nervous system, making the user more alert, active, and nervous. However, it also has anesthetic or pain-killing qualities. Its effects can include mood elevation, a decrease in fatigue, an increase in alertness, and greater self-confidence. However, these effects are temporary. Increased amounts of the substance produce irritability, apprehensiveness, paranoia, and violent behaviors. Physical effects of cocaine use include increased heart rate, elevated blood pressure, loss of appetite, convulsions, muscle twitching, irregular heartbeat, and, possibly, death. Snorting cocaine can damage the lining of the nose, cause sinus infection, and impact the sense of smell. Smoking or “freebasing” cocaine can cause liver and lung damage. Cocaine can also burn uncontrollably when exposed to fire, and accidents involving freebasing have resulted in serious burns. Injecting cocaine carries the negative consequences of injecting any drug, the most serious being HIV infection (a virus that attacks the body’s immune system and causes AIDS) and hepatitis (infectious disease that can cause serious liver damage). In addition, cocaine is often mixed, or “cut” with other chemicals, including other stimulants, that can have adverse effects of their own.

Q & A Question: What is “freebasing”? Answer: Freebase is the most powerful form of cocaine. It is produced by mixing powdered cocaine with volatile chemicals like ether.

120 The Truth About Drugs This process removes the hydrochloride salts used to make powder cocaine from raw coca leaves. It also removes “cutting agents”—substances such as amphetamines that are often mixed into powder cocaine before it is sold. The result is a pure form of cocaine that is usually smoked through a water pipe or heated on a piece of foil with a lighter. Users inhale the resulting smoke. The freebase rush is quick, intense, and over quickly, which makes it highly addictive and more powerful than powder cocaine or crack.

A particularly potent form of cocaine called crack is produced by removing cutting agents and other chemicals. This process creates a dense mass, or “rock,” of cocaine that is roughly 90 percent pure. When smoked, crack provides an intense high that lasts about 20 minutes and is followed immediately by depression, edginess, and a craving for more of the drug. The intense high in the limited time period keeps crack users coming back. Although crack is relatively inexpensive, the need to continually achieve the high has resulted in drug habits costing thousands of dollars per day. Statistics complied by NIDA show that the use of both cocaine and crack cocaine among teens increased steadily from 1991 to 2001. However, the trend seems to be reversing. Since 2002, the use of both powder and crack cocaine has declined steadily among younger teens but remained relatively unchanged among older teens. Heroin

Heroin is a drug produced from morphine, a chemical that occurs naturally in the seeds of the Asian poppy plant. It is part of a family of drugs called opiates, which generally cause drowsiness, relieve pain, and produce euphoria (an intense sense of well-being). Until recently, almost all users injected heroin, but the increased potency of today’s heroin enables users to snort or smoke it. Nevertheless, most users continue to inject the drug, a process referred to as “mainlining.” The short-term effects of heroin abuse appear quickly and fade in a few hours. Users typically feel a surge of euphoria, accompanied by a warm flush of the skin, dry mouth, and heaviness in the arms and legs. This is followed by an alternately wakeful and drowsy state caused by a depression of the central nervous system that clouds mental functioning.

Illegal Drugs, Common  121

Long-term effects may include collapsed veins, infection of the heart, and liver disease. By depressing breathing, heroin use can also lead to pneumonia and other problems with the pulmonary system (the system that delivers oxygen to the body). Heroin may also contain additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain. The clotting can kill cells and cause infections in vital organs. Intravenous heroin use, as with cocaine, has also been shown to increase the risk of HIV infection, hepatitis B, and hepatitis C. Heroin use increased dramatically during the 1990s. In 1997, NIDA reported that there were 81,000 new heroin users, and between 1990 and 1995 the number of heroin-related emergency room visits doubled. The increased use of heroin came at a time when supplies increased and prices fell. Heroin remains extremely addictive and treatment efforts have had limited success. However, here too, teen use is declining. The percentage of teens who have ever used heroin declined by nearly one-third between 1997 and 2007. Club and Designer Drugs

The terms club drugs and designer drugs refer to a wide range of synthetic substances from a variety of drug categories. The club drug roster includes ecstasy (MDMA), GHB (gammahydroxybutyrate), roofies (Rohypnol), and Special K (ketamine). Club and designer drugs typically are produced in underground laboratories. These labs vary greatly in the quality of the drugs they produce and in the potency of a single dose. No one knows exactly what chemicals were used and in what quantities. Ecstasy and Special K are examples of club drugs that have stimulant effects. The effects of ecstasy are similar to those of amphetamines: increased alertness and energy sometimes accompanied by euphoria and hallucinations (false or distorted perceptions). Ecstasy has gained popularity because of its reputation for heightening sexual pleasure and reducing the user’s sensitivity to pain. However, users face many of the same risks as users of other stimulants, such as increased heart rate and blood pressure, muscle tension, nausea, blurred vision, faintness, and chills or sweating. More seriously, these drugs can cause a sharp increase in body temperature (hyperthermia) leading to failure of the liver, kidney, and cardiovascular system. Psychological effects can include confusion, depression, sleep problems, and severe anxiety. The effects of Special K are similar to those of ecstasy but are not as severe, a factor that has added to its popularity.

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By contrast, GHB and Rohypnol act as depressants, causing drowsiness, confusion, and impaired judgment and motor coordination. Rohypnol—commonly known as the date rape drug—causes a sedative effect within 20 to 30 minutes. It dissolves quickly in alcohol and, when secretly slipped into someone’s drink, can quickly render a person unconscious, making him or her helpless against sexual assault. The victim may also have great difficulty remembering what happened under the influence of the drug. GHB is also a sedative that has also been used as a date rape drug. Mixing GHB with other drugs such as alcohol can result in nausea and difficulty breathing. GHB may also produce withdrawal effects, including insomnia, anxiety, and tremors. Teen use of club and designer drugs increased dramatically during the 1990s, reaching a peak around 2000. The numbers began to decline thereafter, and the percentage of teens using ecstasy in 2005 was only half as high as it was in 2000. Unfortunately, ecstasy use among 10th and 12th graders increased in both 2006 and 2007. Barbiturates

Barbiturates, such as mephobarbital (Mebaral) and pentobarbital sodium (Nembutal), are central nervous system depressants used to treat anxiety, tension, and sleep disorders. They typically are taken in pill form. When consumed in small doses, they result in a lack of responsiveness and muscular coordination. In higher doses they can cause slurred speech, decreased rate of breathing, slowed heart rate, unconsciousness, and death. If taken with alcohol even in small doses, the combination can cause respiratory functions to slow down to such an extent that death can occur. Barbiturates are extremely addictive and typically require medical intervention to overcome. Amyl Nitrate

Amyl nitrate is a drug that reduces blood pressure and causes the blood vessels to expand rapidly, which is why it is used to reduce chest pain in heart patients. It is believed to enhance sexual sensations and orgasm by increasing blood flow to the genitals. Physical effects include headache, flushing of the face, decreased blood pressure, increased pulse, dizziness, and the relaxation of certain muscles—especially the blood vessel walls and the anal sphincter (a

Illegal Drugs, Common 123

circular muscle that opens and closes the anus). Teen use is just over 1 percent, according to the 2007 “Monitoring the Future” study. Amphetamines

Amphetamines such as benzoamphetamine (Benzedrine) and dextroamphetamine (Dexedrine) are synthetically produced stimulants that have the opposite effect of barbiturates. Amphetamines go by a wide array of names, including bennies, dexies, and speed. Amphetamines in small doses improve alertness, reduce fatigue, and elevate mood. In larger quantities over extended periods of time they can cause a laundry list of problems, including hallucinations and paranoia. They are, however, a category of illegal drugs that do have medical uses. For example, methylphenidate (Ritalin) is used to treat ADHD (attention deficit hyperactive disorder) and fenfluramine hydrochloride (Pondimin) is used to treat obesity. Methamphetamines—also known as ice, meth, and crank—are a family of nervous system stimulants related to amphetamines that produce similar but much more intense effects. Methamphetamine comes in a powder form that can be snorted, smoked or taken orally or by intravenous injection. Because the drug is produced in illegal laboratories, it may include other dangerous chemicals used in processing. The effects of taking even small amounts of methamphetamine include increased wakefulness and physical activity, decreased appetite, rapid breathing, hyperthermia, and euphoria. Immediately after smoking or injection, the user experiences an intensely pleasurable sensation, or “rush,” that lasts just a few minutes. Oral or nasal use produces euphoria but not the intense rush caused by injection or snorting. Other effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hyperthermia and convulsions can result in death. Long-term use can cause increased heart rate and blood pressure and irreversible damage to blood vessels in the brain, leading to stroke. Respiratory problems, irregular heartbeat, and extreme anorexia can also occur, and continued use can result in cardiovascular collapse and death. Methamphetamines have gained popularity because of their physical effects and lengthy high, which can last from four to 14 hours. These drugs are often used by people who need to stay alert for many hours, such as long-distance truck drivers, people who work all-night shifts, and students cramming for examinations. Overall use among teens has declined steadily since the late 1990s.

124 The Truth About Drugs Hallucinogens

Hallucinogens are drugs that cause the user to experience distorted sights, sounds, and other sensations. These distorted sensations are called hallucinations. Some hallucinogens, such as lysergic acid diethalymide (LSD) are synthetic while others, such as peyote and mescaline, are derived from natural plant sources. Most hallucinogens are taken orally. For example, LSD (also called acid) comes in several forms but is primarily sold as small squares of blotter paper saturated with the drug, which are chewed or swallowed. Hallucinogens distort the user’s sense of reality, causing him or her to hear, feel, and see things that aren’t there. Flashbacks—the reexperiencing of drug effects from previous uses—have been known to occur months or years after using hallucinogens. Other effects associated with hallucinogen use include depression, muscular weakness, anxiety or paranoia, trembling, nausea, and dizziness. The impact of hallucinogens can vary dramatically from one episode to another. Because of the effects these drugs have on heart rate and blood pressure, the results of continued use can be coma, lung, and/or heart failure. Users often suffer from feelings of confusion, suspicion, and disorientation, which may cause speech problems, weird body movements, and aggressive or violent behavior. Unlike marijuana, which is more potent today than it was in the 1970s, the strength of the average dose of LSD has decreased since that time. Nevertheless, there is still a high potential for adverse effects, even with reduced dosages. Teen use of LSD increased during the mid-1990s, then experienced a steady decline until about 2005. Use among eighth graders has remained steady, while it has risen among 10th and 12th graders. PCP

Phencyclidine, or PCP, is a depressant that affects the central nervous system. It was originally used as an anesthetic to eliminate pain during medical procedures while the patient remained conscious. Its medical use was discontinued in 1965 because patients often became agitated, delusional, and irrational while recovering from its effects. Today the drug is mostly produced in illegal laboratories. Also known as angel dust, PCP is a white powder that can be taken orally or snorted, and is frequently sprinkled onto marijuana joints.

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did you know ?

Teenagers Who Have Used Illicit Drugs 46.8 46.2

12th

7.8 1.5

Grade

41.8 35.6 34.6

10th

5.3 1.5 31.0 19.0 22.1

8th

3.1 1.3 14.2

0

5

10

15

20 25 30 Percentage

Any illicit drug Heroin

35

40

Cigarettes

45

50

Cocaine

Marijuana/Hashish

Source: National Institute on Drug Abuse, 2007.

At low to moderate doses, the physical effects of PCP include a slight increase in breathing rate and a dramatic rise in blood pressure and pulse rate. Shallow breathing, flushing of the skin, and heavy sweating can also occur, accompanied by numbness in the arms and legs and loss of muscular coordination. Taking PCP with other central nervous system depressants such as alcohol or barbiturates can lead to coma or accidental overdose. At high doses, blood pressure, pulse rate, and respiration drop. Nausea, vomiting, blurred vision, drooling, loss of balance, and dizziness can also occur. High doses of PCP can also cause seizures, coma, and death (usually from accidental injury or suicide rather than as a direct effect of the drug).

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Extreme psychological effects of PCP use resemble symptoms of schizophrenia, including delusions, hallucinations, paranoia, disordered thinking, a sensation of distance from the environment, inability to move, and garbled speech. Long-term use can lead to memory loss, difficulties with speech and thinking, depression, and weight loss. These symptoms can last up to a year after stopping PCP use. Use of PCP among teens is not widespread; in 2007 about 2.1 percent of teenagers reported using the drug. No Safe Drugs

Although illegal drug use among teens has decreased across most categories of drugs, the wide variety and ready availability of such substances poses a serious health threat to teens. All of the drugs discussed in this article have adverse mental and physical effects, and prolonged use of many of these drugs can have serious negative consequences, including death. No drug is “safe,” regardless of what your friends may tell you. The short- and long-term risks of drug use are great, and the best strategy for dealing with such drugs is to avoid them altogether. See also: Crack Cocaine; Drug Abuse, Causes of; Drugs and Disease; Inhalants; Injection Drugs; Sexual Behavior and Drug Abuse further reading

Clark, Michael. Common Illegal Drugs and Their Effects: Cannabis, Ecstasy, Amphetamines, and LSD. London: The Stationery Office Books, 1996. Courtwright, David. A History of Opiate Addiction in America. Cambridge, Mass.: Harvard University Press, 2001. Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use, and Abuse. Las Vegas: Sagebrush Press, 2003. Kuhn, Cynthia, Scott Swartzwelder, and Wilkie Wilson. Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy. New York: Norton, 2008. Robson, Philip. Forbidden Drugs. Oxford: Oxford University Press, 1999. Rudgley, Richard. The Encyclopedia of Psychoactive Substances. New York: St. Martin’s Press, 1998.

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■ Inhalants

Substances that give off fumes which, when inhaled (taken into the body by breathing), can produce a drug high. The inhalants used today are inexpensive and readily available in most homes, factors that increase their potential for abuse (the nonmedical use of a substance in order to affect one’s mental processes, satisfy a dependence, or attempt suicide). They include products such as paint, nail polishes, lighter fluids, refrigerants, glues, aerosols, cleaning solutions, fuels, lighter fluids, PVC (plastic pipe) cement, hair spray, and correction (typing) fluid.

Q & A Question: If inhalants can be purchased in any store, how can they be harmful? Answer: Some teens wrongly believe that because inhalants are legal, they are not harmful. Nothing could be further from the truth. If used as intended, these products are safe. When they are inhaled, they can be extremely toxic. Types of Inhalants

The National Institute on Drug Abuse (NIDA) classifies inhalants into four basic types, or categories. ■ Volatile

solvents are liquids that turn into gases at room temperature. They include paint thinners and removers, dry-cleaning fluids, degreasers, gasoline, glues, correction fluids, and felt-tip marker fluids. ■ Aerosols are sprays containing propellants and solvents. They include spray paint, spray deodorant, hair spray, vegetable oil sprays for cooking, and fabric protector sprays. ■ Gases include medical anesthetics and commercial or household gases. Examples of medical anesthetic gases are ether, chloroform, and nitrous oxide, also called “laughing gas.” Nitrous oxide, the most abused of the gases, is also found in whipped cream dispensers. Household or commercial products containing inhalant

128 The Truth About Drugs

gases include butane lighters, propane tanks, whipped cream dispensers, and refrigerants. ■ Nitrites are a special class of inhalants. Most inhalants affect the central nervous system, but nitrites relax the muscles and dilate blood vessels to increase blood flow. While other inhalants are used to alter mood, nitrites are used primarily to enhance sexual pleasure. Nitrites include cyclohexyl nitrite, which is found in some room deodorizers. Because it increases blood flow to the heart, isoamyl (amyl) nitrite is prescribed for patients with chest pain. Doses of amyl nitrite used for recreation are called “poppers” or “snappers” on the street. Isobutyl (butyl) nitrite is a substance similar to amyl nitrite that is often packaged and sold in small bottles also referred to as “poppers.” Effects of Inhalants

Inhalants contain gases that when inhaled or “huffed” produce euphoria, dizziness, confusion, and drowsiness. The effect of using inhalants is felt quickly because the user breathes the fumes directly into the lungs. This causes the chemicals in the fumes to reach the bloodstream in seconds, where they are quickly transported to the brain. The euphoric effects from the substance typically last 15 minutes or less. Inhalants irritate the mucous membranes of the eyes, mouth, nose, throat, and lungs, as well as presenting a few unusual concerns for users. These include suffocation from huffing on a plastic bag and the possibility of explosion if the volatile fumes are exposed to a fire or open flame. Inhalants are dangerous. Abuse of inhalants over a period of time can cause a number of serious health effects. The short-term effects include amnesia, an inability to concentrate, confusion, and impaired judgment. Hallucinations are another typical effect of inhalants. Inhalants can also cause long-term health problems such as brain damage, irregular heartbeat, anemia, liver damage, kidney failure, coma, and death. Combining inhalants with alcohol can cause dangerous interactions between the drugs and lead to serious health risks, including severe liver damage and even death. Inhalants do not produce tolerance, withdrawal, or symptoms characteristic of physical dependence, and the possibility of psychological dependence is limited. A primary concern in the use of

Inhalants 129

inhalants is the inability to control the dose. Because every person’s lung capacity is different, it is impossible to control the amount of substance inhaled. If too much of a volatile aerosol is huffed, unconsciousness can occur. If breathing is restricted for any reason while in this unconscious state, death can occur within minutes.

Fact Or Fiction? There are always specific signs of inhalant use by teens.

The Facts: Although use of an inhalant is usually apparent, sometimes it is difficult to tell. If someone you know is exhibiting one or more of the following warning signs, they may be using inhalants: Slurred speech ■ Drunk, dizzy, or dazed appearance ■ Unusual breath odor ■ Chemical smell on clothing ■ Paint stains on body or face ■ Red eyes ■ Runny nose ■

Inhalant use can be dangerous, so if you suspect a friend is doing it, talk with them and seek appropriate help. The Centers for Disease Control and Prevention reports that in 2001 almost 15 percent of students nationwide had sniffed glue, breathed the contents of aerosol spray cans, or inhaled paints or sprays to get high during their lifetime. However, according to a survey by NIDA, inhalant use by teens in 2007 was at its lowest level since 1991, the first year inhalant use was studied among eighth and 10th graders. The report also stated that rates for 12th graders were the lowest in 20 years. The report had encouraging news about perceived risk (how much risk individuals feel they are taking when they use a drug). Low perceived risk means that users are less concerned about the effects of abuse, an indicator of increased use in the future. In 2007, the perceived risk from trying

130 The Truth About Drugs

inhalants among eighth graders rose for the first time in six years. Disappointingly, however, perceived risk among 10th graders fell for the sixth straight year. See also: Dependence and Addiction; Drugs and Drinking; Overdose and Drugs

■ Injection Drugs

Drugs that are taken by injection into either the veins or muscles of the user. Among the most common intravenous drugs—drugs administered by injection into a vein—are heroin (an illicit drug, derived from the poppy plant, that causes drowsiness, relieves pain, and produces euphoria), cocaine (an illicit drug, derived from the coca plant, that increases energy and alertness), and amphetamines (synthetically produced stimulants that improve alertness, reduce fatigue, and elevate mood). Until recently, all injection drugs were classified as intravenous drugs. However, that changed with the growing abuse of muscle-building drugs called anabolic steroids, which are injected into muscles. The term injection drug includes both to cover intravenous and intramuscular drugs. Intravenous drug use in the past was limited almost exclusively to heroin. Today, heroin is one of several illegal drugs that can be administered by injection. Virtually any drug can be injected if it is dissolved in a liquid solution, but heroin, cocaine, and amphetamines make up the three primary injection drugs. An intravenous injection introduces drugs instantly into the bloodstream, allowing the drug to reach the brain very quickly. As a result, injections produce effects within minutes. While intravenous use of heroin and other drugs has been of concern for many years, the use of such drugs soared to national attention when their use was found to be directly associated with HIV infection and AIDS. HIV is the virus that causes AIDS (acquired immune deficiency syndrome), a medical condition in which the body’s immune system is so weakened that even mild infections can cause death. Drug users who are infected with HIV can spread the virus by sharing needles with other users. The HIV virus that causes AIDS attacks the immune system and depletes it to such an extent that infections

Injection Drugs 131

the body typically fights off—like colds or the flu—become life threatening. For persons with AIDS, common infections can be deadly. There is no known cure for HIV or AIDS.

teens speak It’s Really Hard to Lose a Friend It’s even harder to lose a friend twice. My name is Carolyn, and I lost my friend Steve twice. The first time I lost him to heroin; the second time I lost him to HIV. Steve was really a cool guy. He was funny and smart and he kept telling everyone how he was going to be a comedian or an actor. He was always doing really wild things like dyeing his hair green for St. Patrick’s Day and wallpapering his locker at school. There wasn’t a lot Steve wouldn’t at least consider doing for kicks, and that’s how he started getting into trouble with drugs. One day I saw some marks on Steve’s arm, and I asked him what they were. When he told me he had tried shooting heroin, I freaked out. I knew how dangerous heroin was, and I was worried that he’d get addicted. I begged him to stop, but he said I worried too much. But after a while, I could tell I was right. Steve stopped being the fun guy I knew and started spending all of his time wasted. He looked terrible; every time I saw him it was like I was looking at a ghost. I really began to worry when a couple of months went by and I hadn’t seen Steve at all. None of his old friends knew where he was, and I was too afraid to talk to the stoners he used to hang out with. When I called his house, his sister told me he was in the hospital. The doctors said he had HIV and that he most likely got it from sharing an infected needle. His sister said he was sick all the time and he was avoiding all of his old friends. It’s been almost six months now since I last saw Steve, and I don’t know if he’s even still alive. In a way I suppose the Steve I knew died when he started using drugs.

132 The Truth About Drugs

did you know ?

Proportion of U.S. AIDS Cases Among Adults and Adolescents by Transmission Category and Year of Diagnosis, 1985-2006 70% 65% 60%

Percentage of cases

55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

1985

1990

1995 Years of diagnosis

2000

2005

Male-to-male sexual contact

Injection drug use (IDU)

Male-to-male sexual contact and IDU

High-risk heterosexual contact*

*Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. Note: Data have been adjusted for reporting delays and cases without risk factor information were proportionately redistributed. Source: Centers for Disease Control and Prevention, 2007.

HIV infection is not the only health risk associated with sharing needles. Other blood-borne diseases that can be transmitted by sharing injection drugs include hepatitis B and C. Hepatitis attacks the liver, causing a variety of symptoms, including fever, headache, nausea, loss of appetite, skin rashes, and the yellowing of eyes and skin referred to as jaundice. Over time, hepatitis can cause serious persistent liver infections and chronic (long-term) liver disease, which may result in liver cancer and death.

Law on Drugs, The 133

The risk of AIDS or hepatitis is not a side effect of heroin or other injection drugs. Instead it is the result of sharing infected needles. Whenever someone injects a substance into his or her body, blood is always deposited on, and possibly in, the needle. Unless the needles are cleaned thoroughly with bleach, that blood will be injected into the next person who uses the needle. The use of new needles, or the cleaning of used ones, could reduce HIV transmission and hepatitis substantially. However, injection drug users typically share drugs and needles with a close-knit group of people and are often reluctant to ask other users to clean their needles. In the United States, the role that injection drug use plays in transmitting both HIV and hepatitis is substantial. According to a June 2007 report by the Centers for Disease Control and Prevention, roughly 25 percent of AIDS cases and 50 percent of hepatitis C cases are attributable to injection drug use. These numbers are sobering, but there are some signs that the impact of AIDS on the drug injecting community has caused many to rethink their position on sharing needles. According to the CDC, injection drug use has steadily declined as a cause of AIDS transmission since the early 1990s. A conscious effort by injection drug users to use new or clean needles would significantly decrease the risk of spreading HIV and hepatitis. However, the best way to prevent contracting such diseases is to avoid injection drugs altogether. See also: Drugs and Disease; Drug Use, History of; Risk Factors and Risk Taking

■ Law on Drugs, The

Statutes that provide a wide range of penalties for those convicted of possessing or selling drugs. Cities, states, and the federal government all have laws that deal with drugs. These laws can often be confusing. The laws that apply to teens are a good example. Depending upon a person’s age and the circumstances under which he or she is charged with a drug crime, a teen may be tried either as a juvenile or as an adult. Laws and Law Enforcement

Although governments have long attempted to control the use of drugs, it wasn’t until the early 1900s that major legislation changed

134 The Truth About Drugs

the patterns of drug use in the United States. In the 1890s, opiate addiction was at its peak in the United States, spurred in no small measure by the use of opiates (drugs with both sedative and euphoric qualities) in many over-the-counter medicines. The federal government’s first attempt to control their use came in 1906 when Congress passed the Pure Food and Drug Act. The law required medicines containing opiates and other drugs such as cocaine (a drug derived from the coca plant that increases energy and alertness and elevates confidence) to be identified as such on their labels. Before this time, manufacturers were not required to disclose the contents of their medicines. However, by the early 1900s the addictive qualities of opiates were becoming apparent to health professionals and the nation at large. The Pure Drug and Food Act of 1906 was a way to check the uncontrolled use of these drugs. The law appeared to have some success in reducing drug addiction in the United States. Congress, however, was not satisfied with a modest reduction in drug use and soon introduced significant changes to the law. The Harrison Narcotic Act, passed in 1914, prohibited the production and sale of opiates. The law required that cocaine and heroin (a drug derived from the Asian poppy that causes drowsiness, relieves pain, and produces euphoria) be used only under the control of a physician, a major change at the time. Cocaine had become an integral part of everyday life; it was even used to make Coca-Cola. When the Harrison Narcotics Act banned its use, the company had to find another substance to give its drink the “kick” that the cocaine had previously provided. The substance the company substituted for cocaine was caffeine, another strong (but legal) stimulant. Although the intent of the 1914 law was sound, an unexpected backlash occurred. With narcotics now illegal, substitutes began to appear. These substitutes proved to be dangerous due to mislabeling and contamination. By criminalizing the use of drugs, the act also served to brand those addicted to drugs as criminals, rather than people with a medical problem. The Harrison Narcotic Act was followed in 1920 by a law had an even greater impact on substance abuse in the United States. The law was called the National Prohibition Act, but was more widely known as the Volstead Act, after Andrew Volstead, the congressman

Law on Drugs, The 135

who introduced the legislation. Passage of the Volstead Act ushered in a period known as Prohibition, a time when it was a crime to manufacture, distribute, possess, or consume alcohol in the United States. During Prohibition, bars, taverns, and night clubs flourished despite the law. Smuggling became a major source of revenue for organized crime. Gang violence in major cities made figures such as the lawman Elliot Ness and the gangster Al Capone celebrities. Despite their best efforts, federal law enforcement officials failed to eliminate not only smuggling but also the manufacture of alcohol. The law was unpopular and many people found many ways to get around it. As a result, a number of critics noted a general decline in respect for law and law enforcement. Another unintended result of the law was the rise of organized crime, which prospered as a result of the demand for alcoholic beverages. In 1933, Congress repealed Prohibition and the use of alcohol was once again legal. The end of Prohibition did not stop the government’s campaign against drugs. From 1914 to 1970, Congress enacted 55 laws to address the production, distribution, sale, and use of drugs. Despite this, the 1970s were a time of increasing drug use in the United States both by teens and adults. Teen use of marijuana, cocaine, and other illegal drugs reached historic levels. By the 1980s, concern about the dangerous effects of drug use was mounting in the United States. Before long, Congress passed a new statute, the AntiDrug Abuse Act of 1986. The act had a dramatic effect on sentences for drug offenses. The sentence for a first-time offender of a drug crime involving 100 plants or 100 kilograms (220 pounds) of marijuana could be five years in prison. If the amount of marijuana increased to 1,000 plants or 1,000 kilograms (2,200 pounds), the sentence jumped to 10 years. Those who sold five grams (.175 ounces) of crack cocaine (equivalent to a couple hundred dollars) could receive a five-year prison sentence with no parole. The sale of 50 grams (1.75 ounces) of cocaine might result in a 10-year sentence. For use of LSD, the penalty was enforced if a person sold a single gram (.035 ounces). Despite the nation’s concern about drugs, the law had few supporters among experts in the health field. The experts believed that the law would not have the intended effect of squeezing the major drug traffickers, but rather would place unreasonable sentences on

136 The Truth About Drugs

did you know?

Drug Schedules The Controlled Substances Act, part of the 1970 Comprehensive Drug Abuse Prevention and Control, outlines the laws regarding drug enforcement in the United States. The act places all drugs into one of five schedules, based on its medical use and potential for abuse. SCHEDULE I A: Drug has no current accepted medical use. B: Drug has a high potential for abuse. Examples: heroin, methaqualone, LSD, peyote, Psilocybin, marijuana, hashish, hash oil, and various amphetamine variants. SCHEDULE II A: Drug has current accepted medical use. B: Drug has high potential for abuse. Examples: Dilaudid, Demerol, methadone, cocaine, PCP, morphine and certain cannabis, amphetamine, and barbiturates types. SCHEDULE III A: Drug has current accepted medical use. B: Drug has medium potential for abuse. Examples: opium, Vicodin, Tylenol w/codeine and other narcotic, amphetamine, and barbiturate types. SCHEDULE IV A: Drug has current accepted medical use. B: Drug has low potential for abuse. Examples: Darvocet, Xanax, Valium, Halcyon, Ambien, Ativan, and other barbiturate types. SCHEDULE V A: Drug has accepted medical use. B: Drug has lowest potential for abuse. Examples: Lomotil, Phenergan, and liquid suspensions. Source: U.S. Drug Enforcement Agency, 1970.

Law on Drugs, The 137

the small-time dealers selling on the street. Many felt that the law was far too harsh, imposing penalties for drug possession and sale that were often stiffer than those for violent crimes such as assault or armed robbery. Dissatisfaction led to the Anti-Drug Law of 1988. It was even harsher than the earlier law. The new law made anyone involved in any aspect of a drug operation liable for the same punishment as the dealer. As a result, the lowest person in the operation received the same prison term as the most important. Although intended to snag high-level figures involved in drug trafficking, the law imprisoned everyone involved in the drug trade. On the surface, this may seem like a reasonable way to reduce drug traffic. However, within a sixyear period, the law resulted in a 300 percent increase in the number of prisoners convicted of drug offenses and a 450 percent increase between 1986 and 1998. Enforcement Costs

Enforcing the drug laws takes an incredible amount of people and money. The number of government agencies charged with some aspect of enforcing drug laws is staggering. The Federal Drug Seizure System (FDSS) involves the Federal Bureau of Investigation (FBI), Drug Enforcement Agency (DEA), U.S. Border Patrol, U.S. Customs Service, and U.S. Coast Guard. However, many statewide and local agencies are also key players in stopping illicit drugs. ■ Between

1999 and 2004, the number of methamphetamine laboratories seized increased from 7,438 to 17,170. ■ In 2007, the U.S. Drug Enforcement Administration (DEA) made almost 28,000 domestic arrests. ■ In 2007, the DEA seized 356,000 kg of marijuana, 97,000 kg of cocaine, 1,000 kg of methamphetamine, and 5.6 million doses of hallucinogens. Enforcing drug laws is expensive to say the least, but the financial burden is offset by a practice called forfeiture. Forfeiture allows the government to seize property, cash, boats, airplanes, and virtually anything else of value that has been used in a drug crime or is purchased with the profits from drug crimes. The seized property is sold and the proceeds are divided among the law enforcement agencies that made the bust. This practice has resulted in millions of dollars being channeled back to cover agency expenses.

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Fact Or Fiction? Forfeiture laws penalize drug kingpins more than small-time users.

The Facts: Not true, according to the DEA. In 1998, the average value of a DEA seizure was about $25,000. In addition, 80 percent of all assets seized were taken from suspects who were never charged with any crime. Some critics of the system fear that overzealous agents may accuse innocent citizens of drug crimes in order to seize their assets. Media outlets including USA Today and the television program 60 Minutes have featured stories about forfeitures based on false accusations. The lack of federal oversight into the way seized assets are being used also worries some observers. The growing number of American citizens falsely accused of profiting from drugs—and having their property and cash seized—has caused concern that basic rights are being violated. Legal Costs

An unintended consequence of harsher drug laws was an increase in the time, effort, and money needed to enforce these laws. As arrests for drug crimes rose, so has the need for more law enforcement officers and demands placed on the nation’s courts and prisons. Apprehension

The FBI reports that arrests for drug abuse violations by teens 18 years of age and under rose slightly from 2005 to 2006. However, adult violations increased slightly over the same period. Overall, drug abuse violations have increased 18.2 percent from 1997 to 2006, according to the FBI. Of the 14 million arrests made by the FBI in 2006, the single largest category was for drug abuse violations. Roughly 1.9 million arrests were made nationwide for drug abuse violations, followed by approximately 1.4 million for DUI (driving under the influence of drugs). The FBI statistics also show that in 2006, heroin and cocaine were the drugs involved in the majority of arrests. For sales or manufacturing of drugs, marijuana arrests exceeded arrests for all types of drugs possession.

Law on Drugs, The 139 Prosecution

According to the Bureau of Justice Statistics, in 2004, over 37,000 suspected drug offenders were prosecuted by the U.S. Attorneys’ offices. The figures included those charged with marijuana-related offenses (31 percent), cocaine-related offenses (28 percent), cocaine powder–related offenses (15 percent), and crack cocaine–related offenses (15 percent). Of those offenders arrested for drug violations in 1999, 65 percent had prior drug arrests and 28 percent had five or more arrests. From 1999 to 2004, federal prosecutions of drug defendants increased from 20 percent of all crimes to about 27 percent. During that same time, the number of suspects prosecuted for drug offenses increased from 29,306 to 37,501. The most frequently tried cases prosecuted in U.S. district courts were those involving drug offenders. If someone is found guilty in a drug case, the judge is required to hand down the mandatory (fixed) minimum sentence with one exception. If a drug offender provides “substantial assistance” to the Department of Justice—information that assists in the prosecution of other drug offenders—the judge may provide a more lenient sentence. Through this method, the Department of Justice can acquire testimony needed to convict other drug dealers. However, the practice of using one drug dealer’s story against another drug dealer has come under fire due to the inability to confirm the credibility of the testimony. An accused drug dealer has little to lose by providing information to help convict another dealer and he has much to gain—a lighter sentence. There seems to be little that can be done to prevent a drug dealer from fabricating a story simply to reduce his sentence. Despite potential abuses of the law, the federal government still relies on the practice of substantial assistance.

Q & A Question: What is the most frequently prosecuted offense in U.S. District Court? Answer: Of all the cases prosecuted before U.S. District Court judges, the most frequently tried cases were those involving drug offenders. From 1999 to 2004, federal prosecutions of drug defendants increased from about 20 percent of all crimes to 27 percent.

140 The Truth About Drugs Incarceration

According to the Bureau of Justice Statistics in 2004, more than 87 percent of drug offenders who were convicted were sentenced to prison. By contrast, the proportion of defendants sentenced to prison for other crimes was 77 percent. These numbers show that a person’s chance of spending time in prison is much higher if he or she is convicted of a drug crime than with any other type of crime. Not only were a higher percentage of drug offenders going to prison, but they were also staying longer. The average prison sentence for a drug offense increased from 75.6 months in 2000 to 83 months in 2006. Offenders who were involved with crack cocaine, possessed a firearm, or had extensive prior records received the longest prison terms. The court system refers to people under 18 years of age as juveniles, and in most cases it applies a different set of standards for juvenile offenders than it does for adult offenders. For example, an adult convicted of a felony such as dealing large amounts of cocaine must be sentenced to time in prison. A juvenile convicted of the same offense is sent to a youth detention facility or drug rehabilitation program, and the offense typically is erased from his record at age 18. However, in exceptional cases a teen under 18 may be tried as an adult; these situations are called delinquency cases. In 2002, an estimated 1.6 million delinquency cases were processed in juvenile court. From 1985 to 2002, the number of delinquency cases increased by 41 percent; during the same period, drug law violation cases increased by 159 percent. Teens in general are often involved in drug-related cases. The statistics suggest that younger teens are becoming increasingly involved. According to the Office of Juvenile Justice and Delinquency Prevention, in 2002 teens under the age of 18 were responsible for 12 percent of drug law violation cases. Punishment

As a result of the government’s strong antidrug policies and mandatory sentencing laws, prison sentences for drug-related crimes receive harsher sentences than other crimes. Between 2002 and 2006, the average prison sentence for persons convicted of drug trafficking rose from 71 to 83 months. Over the same time period, the average sentence for firearms offenses went from 53 to 58 months, while those for theft and fraud went from 16 to 21 months. In 2004, the average

Marijuana  141

state prison sentence for possession was 51 months, of which the average time served was estimated at 22 months. Tougher drug laws have placed increasing strains on law enforcement, the courts, and prisons, and on the larger society. As police devote more resources to drug arrests, they have fewer to employ in stopping other types of crime. The nation’s courts are becoming overcrowded with drug cases, causing backlogs and delays in the justice system. Yet despite the fact that the federal government and many state governments have spent record amounts on prison construction since the 1980s, overpopulation is still a significant problem. Despite increasing numbers of drug-related arrests and a rapidly rising prison population, there is no solid evidence that tougher laws are working. Supporters of tougher laws claim that the threat of increased jail time will discourage many people who don’t use drugs from trying them in the first place. Opponents of the laws point out that stiffer sentences have not resulted in significant or consistent declines in the use of illegal drugs. They also argue that because there are so many factors that contribute to drug use, it is extremely difficult to determine the impact of any single factor, such as tougher drug laws. The debate is unlikely to be settled any time soon. See also: Families, Communities, and Drug Abuse further reading

Cohen, Julian. Understanding Drugs and the Law. London: Drug Scope, 2002. Cohen, Peter J. Drugs, Addiction, and the Law: Policy, Politics, and Public Health. Durham, N.C.: Carolina Academic Press, 2004. Grosshandler, Janet, and Ruth C. Rosen, eds. Drugs and the Law. New York: Rosen Publishing Group, 1996. Miller, Gary J. Drugs and the Law: Detection, Recognition, and Investigation. Longwood, Fla.: Gould Publications, 1997.

■ MARIJUANA

Marijuana is the popular name of Cannabis sativa, a plant that produces psychoactive effects when ingested. It is native to the mountainous areas in tropical regions such as Central and South America, the Caribbean, Africa, and Southeast Asia, but it grows wild under

142 The Truth About Drugs

most climatic conditions. As a result, it has spread throughout most of the world. Today, marijuana is the most widely used illicit drug in the United States and Europe. Active Ingredients and Effects

The active ingredient in marijuana is a chemical known as tetrahydrocannabinol, or THC. The greatest concentration of THC occurs in a sticky resin the plant produces, which is called hashish. The flowers and leaves of the plant have smaller, but still potent, amounts of THC. The stem, roots, and seeds of the plant, by contrast, contain little or no THC. The potency of the drug varies depending upon the conditions in which the plant is cultivated; some strains contain higher levels of THC than others. Law enforcement officials have claimed that the varieties of marijuana currently available are significantly more potent than previous types. Most users ingest marijuana by smoking the dried flowers and leaves or various preparations of hashish. Occasionally marijuana and hashish are taken orally, most often baked in sweets such as brownies or cookies to mask the taste of the resin. When ingested, THC binds to specific nerve receptors in the user’s brain to produce its psychoactive effects. The National Commission on Marihuana and Drug Abuse reports the following symptoms from marijuana use: ■ At

low, social doses, the user may experience an increased sense of well-being; initial restlessness and hilarity followed by a dreamy, carefree state of relaxation; alteration of sensory perceptions including expansion of space and time; a more vivid sense of touch, sight, smell, taste, and sound; a feeling of hunger, especially a craving for sweets; and subtle changes in thought formation and expression. To an unknowing observer, an individual in this state of consciousness would not appear noticeably different from his normal state. ■ At higher, moderate doses, these same reactions are intensified but the changes in the individual would still be scarcely noticeable to an observer. ■ At very high doses, psychotomimetic phenomena may be experienced. These include distortion of body image,

Marijuana 143

loss of personal identity, sensory and mental illusions, fantasies, and hallucinations. Marijuana also causes an increase in heart rate, dryness in the mucus membranes in the mouth (commonly referred to as cottonmouth), expansion of blood vessels in the eyes, and an increase in appetite. The user typically feels the effects of smoking marijuana within a few minutes, and the short-term effects of the drug generally wear off within two to three hours. When eaten, effects take 30 to 60 minutes to appear and can last up to six hours. Heavy marijuana use is associated with loss of short-term memory and muscular coordination. This may be due to the fact that THC binds to nerve receptors that are concentrated in regions of the brain associated with these functions. Although there is no evidence that users develop physical dependence on marijuana, long-term use can lead to psychological dependence. Regular marijuana smokers also face some of the same dangers as cigarette smokers, health hazards such as chronic bronchitis, more frequent colds, and respiratory infections. In addition, the amount of carbon monoxide and tar inhaled by marijuana smokers is three to five times greater than that inhaled by tobacco smokers. Current Use

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2006, more than 97 million Americans over the age of 12 reported having used marijuana at least once in their lives. This represented nearly 40 percent of the U.S. population age 12 or older. More than 25 million had used marijuana within the past year, and nearly 15 million had done so within the past month. These figures represented a slight, but not statistically significant, increase over 2005. The National Institute on Drug Abuse (NIDA) 2007 “Monitoring the Future” study showed an overall decline in marijuana use among middle and high school students. Lifetime use by eighth graders dropped by 1.5 percent from 2006 to 2007, while lifetime use by 10th and 12th graders fell 0.8 and 0.5 percent, respectively. According to NIDA, marijuana use among middle and high school students peaked in the late 1990s, when some 22 percent of eighth graders, 40 percent of 10th graders, and nearly half of all 12th graders

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reported using marijuana at least once. Since that time, marijuana use among these groups has declined steadily. In 2007, about 14 percent of eighth graders, 31 percent of 10th graders, and 42 percent of 12th graders admitted to using marijuana at least once. These figures represent declines of 16 to 35 percent in about a decade. The trend in more recent use, however, was less positive. The NIDA study found that 0.8 percent fewer eighth graders in 2007 reported using marijuana in the month prior to the survey, compared to 2006. However, prior month use by 10th graders remained unchanged from the year before, while it actually rose 0.4 percent among 12th graders. In addition, a smaller percentage of 12th graders in 2007 than 2006 considered smoking marijuana regularly to be harmful behavior. These trends suggest the possibility that marijuana use among older teens may be on the rise. Medical Marijuana

The earliest written reference to marijuana mentions not its psychoactive effects, but its use in medicine. It appears in an ancient Chinese text dated to about 3700 b.c. and lists a wide range of uses for marijuana, including the treatment of gastrointestinal disorders and female troubles. In many places where marijuana was used primarily for medical reasons it was never used widely as an intoxicant. Even physicians in the United States and Europe recognized marijuana’s potential medical uses long before it became popular for its intoxicating effects. However, with the passage of antinarcotics laws in the early 20th century, the U.S. medical community lost interest in the drug’s potential as a treatment for certain ailments. In the late 20th century, however, physicians rediscovered marijuana’s therapeutic uses. Despite federal and state laws prohibiting the possession of marijuana, many physicians recommended it to patients for a variety of conditions. Today, cannabis is most often used to treat nausea and loss of appetite in patients undergoing treatment for cancer, AIDS, and hepatitis. In a 2002 survey, physicians in California listed some 250 conditions for which they considered marijuana an effective treatment. These included controlling convulsions or spasms in people with epilepsy or multiple sclerosis, migraine headaches, arthritis, asthma, glaucoma, and constipation. Recent studies have also shown it to be effective in treating Crohn’s disease as well as some psychological disorders.

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Fact Or Fiction? Is it true that marijuana has become considerably more potent in recent years?

The Facts: Higher-grade marijuana and products derived from the plant—such as hashish and hash oil—are more potent than ever. However, widespread claims that average THC content is 200 to 1,000 percent greater than 20 years ago are exaggerated. According to the University of Mississippi Marijuana Monitoring Project, the average THC content of marijuana seized by federal officials in 2004 was 5.81 percent, which represents about a 75 percent increase over 20 years ago. Interestingly, the THC content of the cheapest grade of marijuana has remained virtually unchanged at about one-third of one percent since the government started reporting figures in 1980. The public overwhelmingly favors legalizing the medical use of marijuana. In a 1999 Gallup poll, 73 percent of Americans favored “making marijuana legally available for doctors to prescribe in order to reduce pain and suffering.” In a 2004 poll by the American Association of Retired People, researchers found that 72 percent of Americans 45 and older approved the medical use of marijuana if recommended by a doctor. As of 2008, eight states—Alaska, California, Colorado, Maine, Montana, Nevada, Oregon, and Washington—and the District of Columbia have approved ballot initiatives in favor of medical marijuana. Nevertheless, federal law remains opposed to such use. The U.S. Supreme Court ruled in 2005 that the federal government can prosecute medical marijuana patients, even in states in which such use is not a criminal offense. Many groups—including a number of professional medical associations—continue to work to overturn federal laws prohibiting the medical use of marijuana. See also: Dependence and Addiction; Drug Use, History of; Illegal Drugs, Common; Law on Drugs, The further reading

Booth, Martin. Cannabis: A History. New York: Picador, 2007. Iversen, Leslie L. The Science of Marijuana. New York: Oxford University Press, 2007.

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Mehling, Randy, and David J. Triggle. Marijuana. New York: Chelsea House, 2003. Sanna, E. J. Marijuana: Mind-Altering Weed. Broomall, Pa.: Mason Crest Publishers, 2007.

■ Media Messages and Counteradvertising Campaigns

Messages about drugs and alcohol communicated through the media— television, film, music, and print sources. Counteradvertising campaigns are messages that challenge positive media images of drugs. The media exercise a powerful influence over the attitudes and behaviors of teens. When it comes to media messages about drugs, that influence can be positive or negative. While some groups use media to warn teens of the dangers of drug use, the media often show drug use as cool or glamorous. Therefore teens need to understand how the media influences their choices about drug use. TV and Movies

To say that watching movies is a popular pastime with teens would be an understatement. A 2007 Movie Attendance Survey by the Motion Picture Association of America reported that youth ages 12 to 24 account for 38 percent of all movie admissions although they make up only 16 percent of the population.

Fact Or Fiction? Rock lyrics contain more references to drugs than movies do.

The Facts: A 1999 study by the Office of National Drug Control Policy and the Department of Health and Human Services found that 98 percent of movies showed illegal drugs, alcohol, tobacco, or ­ over-the-counter/ prescription medicines. By contrast, only about 27 percent of the songs studied contained references to drugs. What connection does going to movies have with drugs? Are movies providing negative drug messages to teens? The study by the Office of National Drug Control Policy found illegal drugs, alcohol,

Media Messages and Counteradvertising Campaigns 147

tobacco, or over-the-counter medicines were depicted in 98 percent of the films it examined. These substances were used by the major characters in the film. Five percent of the primary actors used illegal drugs, 25 percent smoked tobacco, and 65 percent consumed alcohol. A study reported in the October 2005 issue of the Journal of the Royal Society of Medicine found similar results. That study, conducted by researchers at the University of Sydney in Australia, analyzed 200 popular films released since 1983. It found that 68 percent of the films showed characters smoking, 32 percent showed people getting drunk, 8 percent depicted marijuana use, and 7 percent showed people injecting drugs. About half the references to marijuana use in these films were positive, while the remainder were neutral. When popular movie stars use drugs or alcohol as part of their movie role, they tend to trivialize, normalize, and glorify drug use. Teens are more likely to view these behaviors as acceptable. It’s difficult sometimes to remember that it’s just a movie and that the actors are simply playing roles. TV is equally popular with teens. The primary difference is that on TV the promotion of products through advertising is more recognizable. Companies promote their products in movies by having a character use the product; on TV a product is promoted primarily through commercials. For commercials to be effective, television advertisers need to promote an emotional connection between the product and viewers. That emotional connection is so important that companies pay celebrities handsomely to endorse their products. They reason that if viewers have a positive feeling about a celebrity, that positive feeling may be transferred to the product. If you like Britney Spears or Dale Earnhardt Jr., you will probably consider trying the products they endorse. Advertisers also try to make an emotional connection with viewers through the use of humor. Many beer commercials use humorous situations or characters to appeal to the viewer. What these advertisements never show, however, is the negative impact alcohol abuse has on the lives of ordinary people. The Centers for Disease Control and Prevention have pointed out that over 70 percent of all deaths among 10- to 24-year-olds resulted from just four causes: motor-vehicle crashes, other accidents, homicide, and suicide. Alcohol can be a primary contributor to all four causes, despite the glamorous image of drinking portrayed in beer commercials. To what extent are decisions about using drugs influenced by advertisements? The truth is that advertising has a greater impact

148 The Truth About Drugs

than anyone wants to admit. The American Academy of Pediatrics points out that the average adolescent spends more than 21 hours a week watching television, which means that the typical teen views some 360,000 advertisements before graduating from high school. As a matter of fact, the alcohol industry believes so strongly in the effectiveness of media promotion that it spends $2 billion a year on advertising. So to whom are alcohol companies advertising? This is the million-dollar question. They are adamant that they are not targeting teens with their advertising. Yet their ads show young people using liquor as part of a wide variety of popular activities, including sporting events and parties. Drug messages are also promoted on TV when popular programs depict the show’s stars or other likeable characters abusing alcohol. A 2000 study found that over 75 percent of the episodes of the top 20 TV shows among teens and adults included references to alcohol. Only about one in four episodes that included references to alcohol use mentioned its negative consequences. More recent studies in Europe have reached similar conclusions. A 2003 survey of British soap opera content counted an average of seven drinking scenes per hour. The characters used alcohol mainly during celebrations and romantic scenes, and the shows tended to portray potential problem drinkers in a humorous manner. In a 2006 report on Dutch television programming, researchers reported in the British Medical Journal that a link was found between soap opera viewing and teen alcohol abuse. Music and Videos

Music is an important aspect of a teen’s life. A study published in the February 2008 issue of the Archives of Pediatric and Adolescent Medicine estimates that teens are exposed to music 25 hours per day. Think about the times when you have music playing in the background, while in the car, or doing homework, and it’s easy to see where those hours come from. During that time, the average adolescent is exposed to 84 explicit references to substance abuse in popular songs. According to that same study, one-third of the songs surveyed contain references to drugs or alcohol. However, only 4 percent of the songs containing lyrics about illegal drugs include an anti-use message. The study did find that music lyrics tended to view the consequences of drug use slightly more unfavorably than favorably. However, the number and nature of references to drug use and its

Media Messages and Counteradvertising Campaigns 149

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consequences varies according to the type of music a teenager listens to. Rap music, for example, is much more likely to contain lyrics that mention drug use. Computer Games

Computer games have become a mainstay in many teenagers’ lives in recent years. According to the Nielsen Company over 41 percent of all TV households had a video game console unit in 2006, that represented an 18 percent increase in two years. Teenagers spend approximately 4.2 hours per week playing games, primarily at home. Video games are a $9.5 billion business in the United States. Critics have noted that in many video games, the main character is repeatedly shown using alcohol or illicit drugs. The effect is to legitimize those behaviors. Over time, teens are likely to forget that the game is a fantasy. They may come to see drug use as acceptable because they tend to view the behaviors exhibited by the characters in video games as normal. Internet

The Internet can be an incredible source of information on virtually any subject. So it comes as no surprise that the Internet is also a source

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for all kinds of information on illegal drugs. A 2001 study reported in the American Journal of Psychiatry found some 81 hallucinogenrelated Web sites using just one popular search engine. So how can the Internet promote drug use? Although the Internet is packed with information, not all of it is accurate and some of it is dangerous. The Internet is very similar to other sources of information with one exception—its speed. What might take hours to find in a conventional library is available within seconds on the Internet. Just as information in books can be misleading, so can information on the Internet. Remember that anyone can post something on the web, so the quality of Web information needs to be evaluated for accuracy.

Q & A Question: Where can a teen go for accurate information on drugs? Answer: If someone tells you that certain substances are “safe,” you can check credible Web sites for information, including: ■ American ■ Center

Academy of Pediatrics—www.aap.org

for Substance Abuse Prevention—www.forreal.

org ■ Centers

for Disease Control and Prevention—www.cdc.

gov ■ Clubdrugs.org—www.clubdrugs.org ■ Drug

Free America—www.drugfreeamerica.org

■ National

Institute for Drug Abuse—www.nida.nih.gov

■ Prevline—www.health.org

Information from the Internet should be read with caution and not relied on until it can be confirmed. Even if the information is accurate, it may still be dangerous. For example, the article in the American Journal of Psychiatry quoted above identified a handful of Internet sites that contain all the information needed to “cook up” illegal drugs. The information on those sites may well be accurate, but creating and using drugs based on that information is not only illegal but also very dangerous.

Media Messages and Counteradvertising Campaigns 151 Overcoming the Influence of Media

Media education can be an effective way to better understand and counter the influences of negative media images and messages. Advertisers are experienced at developing influential and effective media messages directed at teens. So what can a teen do to counter negative media and messages? The American Academy of Pediatrics (AAP) recommends that teens understand the following: ■ All

media messages are constructed; that is, they are designed to achieve a specific purpose. ■ Media messages shape our understanding of the world. ■ Each individual interprets media messages in his or her own way. ■ Mass media has powerful economic implications. The AAP also specifies that a media-educated person is one who is able to: ■ limit

use of media; ■ make positive media choices; ■ select creative alternatives to media consumption; ■ develop critical thinking and viewing skills; and ■ understand the political, social, economic, and emotional implications of all forms of media. Media education provides a way for teens to be less vulnerable to influences from the media industry. The more teens understand about how media messages are designed and produced, the better prepared they are to make educated decisions for themselves—decisions based on sound information rather than on corporate influence and pressure. See also: Drugs and Drinking further reading

Manning, Paul. Drugs and Popular Culture. Devon, England: Willan Publishing, 2007. Roberts, Donald F., and Peter G. Christenson. Here’s Looking at You, Kid: Alcohol, Drugs, and Tobacco in Entertainment Media. Menlo Park, Calif.: The Henry J. Kaiser Family Foundation, 2000.

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Roberts, Donald F., Lisa Henriksen, and Peter G. Christenson. Substance Use in Popular Movies and Music. Washington, D.C.: National Drug Control Policy and Department of Health and Human Services, 1999.

■ Morbidity and Mortality

Morbidity, the frequency of illness or injury caused by a particular substance or action, in this case a particular drug; and mortality, the death rate in a given population as the result of taking drugs. Tracking trends in teen drug abuse can be difficult because of the secrecy that often surrounds illegal drug sales. However, morbidity and mortality figures from a wide range of sources can provide a valuable tool for identifying future issues and trends that may impact drug abuse prevention efforts. Injury and Illness from Drug Abuse

Statistics on morbidity and mortality from drug abuse can be acquired indirectly by examining drug-related injuries and illnesses identified through the criminal justice and health-care systems. Many of the current statistics on drug abuse morbidity are based on drug tests of teens involved in car crashes and of those incarcerated. Criminal justice sources can also provide valuable drug–related information on a teen’s cause of death. Health-care facilities collect valuable information on drug use by teens who have been admitted to their care. Mental health providers—especially those who treat teens for substance abuse—can provide important data as well. Statistics about how the number of teens suffering from injuries and illnesses related to drug abuse can reveal trends in teen behaviors. Identifying and studying these trends can provide helpful information on future patterns of drug use. Morbidity regarding teen drug abuse is closely tied to specific behaviors. The three leading causes of death among teens—suicide, homicide, and motor vehicle crashes—all have direct ties to alcohol and drug abuse. Drug and alcohol abuse are also closely associated with violent acts such as assault and armed robbery as well as with accidents like drowning. The Drug Abuse Warning Network (DAWN)—a nationwide project of the Office of Applied Studies and the Substance Abuse and Mental

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Health Services Administration (SAMHSA)—provides data drawn from a survey of 466 hospital emergency departments in 21 metropolitan areas in the United States. DAWN reported an estimated 1.4 million drug-related emergency department episodes in 2005. The survey also indicated that between 2004 and 2005, the number of drug-related emergency episodes among youth under age 21 fell by more than 11 percent. Drug use is related not only to accidents but also to violent behavior. Teens who reported participating in one or more acts of violence during the preceding year were also more likely to use alcohol and illegal drugs. A study reported in 2007 by the Department of Health and Human Services found that 6.7 percent of teens used marijuana in the past month (illicit drug that depresses mood and distorts the way the user experiences sights, sounds, and other senses) and that 9.8 percent used some type of illegal drugs. Teens who used drugs reported higher rates for behaviors such as fighting at school or work, gang fights, and attacks on others with the intent of seriously hurting them. In 2007, the Office of National Drug Control Policy reported that youth who used illicit drugs were almost twice as likely to engage in violent behavior than those who have not used drugs. The risk of suicide is also higher for teens who reported alcohol or illicit drug use than for teens who did not use these substances. According to the 2007 “Monitoring the Future” study conducted by the National Institute on Drug Abuse (NIDA), teen drug use may be on the rise. Use of marijuana, hallucinogens, PCP, ecstasy, and heroin rose among 12th graders from 2006 to 2007. By contrast, use of all those drugs except ecstasy fell among 12th graders between 2005 and 2006. Among 10th graders, use of illicit drugs besides marijuana rose for the first time since 2001. With this information, treatment professionals and educators are able to focus their efforts on combating the use of these drugs. Data from drug surveys can also help identify increases in teen use of certain drugs or the appearance of new drugs. By identifying a trend quickly, professionals can prepare effective treatment programs and spread the word of the dangers of drug use through a variety of educational outlets. Death Rates

The number of people who died as a direct consequence of alcohol and drug problems exceeded 55,000 in 2005, with 21,600 of those deaths associated with alcohol abuse and 33,500 associated with drug abuse.

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However, death rates from drug overdose for teens are extremely low. The majority of the alcohol and drug abuse–related deaths were in the 20 to 40 age group, because the major causes of death, such as motor vehicle crashes, other causes of traumatic death, and HIV infection, are concentrated among this age group. The single largest death rate for teens is from alcohol-related motor vehicle crashes. Causes of Death

DAWN reports mortality data for major cities across the country. Its studies reveal that in 2003 drug abuse deaths are relatively rare (less than 4 percent of all deaths) for those under age 20 in over half of the cities surveyed by DAWN. However statistics for those over the age of 35 are very different. That segment of the population accounted for over half the drug-related deaths in 30 of 32 cities surveyed. DAWN also noted that in the average metropolitan area roughly 50 percent of drug abuse deaths were ruled accidental, 17 percent suicides, and 30 percent due to undetermined or other causes. Drug abuse deaths rarely occur from the use of a single drug. The use of multiple drugs was reported in the overwhelming majority of drug abuse deaths across the country. The typical case reported by DAWN involved between two and three types of drugs. For example, about 75 percent of deaths involving cocaine included another drug. Research has shown that three specific drugs are used most frequently when a combination of drugs result in death. Those three drugs are heroin, cocaine, and alcohol. All three have profound physical effects on the heart, central nervous system, and pulmonary system (the system that did you know?

Number of Deaths Attributed to Drug Abuse, 1999-2005 Data Series

1999

2000

2001

2002

2003

2004

2005

Deaths 19,128 19,120 21,705 26,040 28,723 30,711 33,541 Attributable to Drug Abuse Source: Centers for Disease Control and Prevention, 2008.

Natural Drugs 155

distributes oxygen throughout the body). When these substances are used together, their physical effects can be lethal. The DAWN study also reported on deaths from abuse of prescription and over-the-counter drugs. Two classes of prescription drugs—benzodiazepines and narcotic analgesics—were responsible for most of the deaths attributed to prescription drugs. The benzodiazepines, which include Valium and Librium, are a family of drugs prescribed to combat anxiety. Narcotic analgesics, drugs prescribed for pain relief, include methadone, codeine, hydrocodone, oxycodone, and diphenhydramine. Populations Most Affected

The population most affected by alcohol and drug abuse depends on the specific drug. Males, for example, are significantly more likely than females to be involved in motor-vehicle crashes involving alcohol or drug use. Females, on the other hand, are more likely to attempt suicide, a behavior frequently associated with drug and alcohol abuse. The use of inhalants is most likely to involve younger teens from lower socioeconomic groups. Female teens are more likely than their male peers to report that cocaine, crack, LSD, and heroin were easy to obtain. For all teens, involvement in suicide, homicide, violence, or motorvehicle crashes probably have some ties to alcohol and drug abuse, according to the 2003 DAWN survey. The message is clear: abusing alcohol or drugs increases the chances of illness, injury, or death regardless of ethnicity, place of residence, or socioeconomic background. Perhaps the single most effective thing one can do to increase the chances of leading a long, healthy life is to avoid drugs and alcohol. See also: Crack Cocaine; Depression and Drugs; Driving Under the Influence of Drugs; Drugs and Criminal Activity; Drugs and Disease; Illegal Drugs, Common; Inhalants; Media Messages and Coun­ter­ad­ver­ tis­ing Campaigns; Over-the-Counter Drugs

■ Natural Drugs

Natural drugs are substances found in or derived from wild plants and used to treat various ailments or medical conditions. Many illicit drugs, including marijuana, cocaine, and heroin are made from plants that grow naturally. However, the term natural drug, as used here,

156 The Truth About Drugs

refers to naturally derived substances that may be legally dispensed without a prescription. Humans have long been aware that certain plants can be used to provide quick energy, treat specific ailments, or improve a person’s mood. Physicians and healers in all preindustrial societies had their lists of locally available herbs and medicines, many of which have been used for centuries. With the advance of medical technology and the discovery of drugs such as amphetamines, morphine, and Valium, industrialized societies largely abandoned these natural remedies and treatments. In recent years, however, popular backlash against institutionalized or traditional medicine and an increased focus on a more organic lifestyle has led to renewed interest in natural drugs in the industrialized world. Although many physicians accept the effectiveness of natural drugs for some uses, they also warn that researchers have not studied many of these substances closely. As a result, our knowledge about the precise effects of many natural drugs is still incomplete. Of particular concern is the fact that some of these drugs have the potential for serious adverse interactions with other substances. NATURAL STIMULANTS

Two of the most commonly used natural drugs are stimulants—substances used to increase energy and alertness. The most common of these is caffeine, a chemical found in more than 60 different plants. In the wild, caffeine serves as a natural pesticide, killing or paralyzing insects that eat the leaves, berries, or fruit of the host plant. In humans, caffeine acts as a moderate stimulant, increasing short-term energy as well as mental and physical sharpness and coordination. People consume caffeine in a wide variety of food and drinks, most popularly coffee and tea. However, many soft drinks also contain caffeine, as do chocolate and cocoa. According to a 2007 article in the magazine New Scientist titled “Coffee: The Demon Drink?” some 90 percent of North Americans consume caffeine daily. Worldwide, caffeine is the most popular psychoactive substance. Ginseng is a plant native to northeastern Asia, particularly China, Korea, and Siberia. Traditional Asian healers prize the root as a stimulant and an aphrodisiac—a substance used to cause sexual arousal. It traditionally is used to treat sexual dysfunction in men and to boost the body’s resistance to stress. The results of experimental studies into these claims, however, have been mixed. Animal studies have not confirmed any increased health or longevity from ginseng use. Some

Natural Drugs 157

animal experiments do, however, seem to support claims of increased sexual arousal and performance. Ginseng is an ingredient in many popular energy drinks because of its stimulant effects. Both caffeine and ginseng can also have adverse effects. Extended heavy consumption of caffeine can lead to nervousness, anxiety, headaches, insomnia, and even heart palpitations. Ginseng can cause difficulty sleeping, as well as nausea, diarrhea, headaches, and elevated blood pressure. While extreme caffeine intoxication can lead to death, there is no known fatal dose of ginseng. NATURAL MOOD ENHANCERS

Experts estimate that more than 10 percent of adults in the United States take some form of antianxiety or antidepressant medication daily, such as Xanax, Valium, or Librium. Two naturally occurring substances that seem to have similar effects are valerian and Saint-John’s-wort. Valerian is a plant that is native to Europe and Asia. Its root contains an oil used by many people to relieve anxiety and promote sleep. The oil, extracted from the dried and crushed root, traditionally has been used as a sedative and pain reliever, as well as to treat migraine headaches and prevent convulsions. Clinical studies have confirmed its effectiveness as a sedative and antianxiety agent, but some users have experienced headaches and night terrors. Saint-John’s-wort is a plant originally native to Europe, which has spread to most parts of the Northern Hemisphere. Its name comes from St. John’s Day (June 24), when Europeans traditionally harvested the plant. The leaves of the plant contain an oil that acts as a natural antidepressant for humans. Saint-John’s-wort has been used in this manner for centuries, and physicians in some European countries often prescribe it to treat mild depression. Clinical studies show that the drug is effective in treating mild to moderate depression. Interestingly, while Saint-John’s-wort may be beneficial to humans, it is toxic to livestock. Animals that consume too much of the plant over time become uncontrollably restless and suffer from skin irritation. Individuals who take Saint-John’s-wort need to be careful about combining it with other drugs. A fairly large number of drugs, including certain antidepressants, stimulants, and illicit drugs including ecstasy, LSD, and cocaine, have the potential to cause adverse reactions if taken with Saint-John’s-wort. Together, these substances seem to affect levels of the neurotransmitter serotonin, which plays a role in regulating mood as well as metabolism and body temperature.

158 The Truth About Drugs

Saint-John’s-wort may also reduce the effectiveness of certain medications if taken at the same time. These include antianxiety drugs, antiepileptic medications, some oral contraceptives, and certain drugs used to treat immune system diseases. Interference with some of these drugs—particularly antiepileptic medications or immune system drugs—can have fatal consequences for the user. Experts recommend that anyone taking prescription medication should consult a physician before using Saint-John’s-wort to avoid the risk of potentially fatal drug interactions. See also: Addiction, Biology of further reading

Ali, E., F. Hui, and K. Vegotsky. The All-in-One Guide to Natural Remedies and Supplements. Niagara Falls, N.Y.: AGES Publications, 2001. Meletis, Chris. Interactions Between Drugs and Natural Medicines, Second Edition. Sandy, Oreg.: Eclectic Medical Publications, 2005.

■ Over-the-Counter Drugs

Legal medications that can be purchased without a prescription from a medical professional. Over-the-counter (OTC) drugs include commonly available pain medications such as aspirin, acetaminophen (Tylenol), and ibuprofen (Advil); cold and flu remedies; laxatives; and a wide range of other substances. A related class of drugs are prescription drugs, which are also legal but may only be acquired with a prescription from a doctor. Even though they are legal, misuse of prescription and OTC drugs can lead to both psychological dependence (reliance on a substance for normal functioning) and physical dependence (intense craving for a drug that is not accompanied by physical dependence). People may increase their intake of these drugs to ensure a sense of well-being while treated for unrelated illnesses or health problems. They may also engage in nonmedical use of OTC or prescription drugs. Regardless of the reason, abuse of OTC and prescription drugs is both dangerous and illegal. Commonly Abused Over-the-counter Drugs

OTC medications can be divided into several different categories: stimulants, analgesics, and cough and cold medications. This article lists a large number of common OTC drugs, but it’s important to

Over-the-Counter Drugs 159

remember that, with new drugs coming on the market all the time, no list can ever be completely accurate. In addition, virtually any medication can be abused, so just because a drug doesn’t appear in the list, doesn’t mean it can’t be abused. The OTC stimulants are divided into two types of drugs: amphetamines and caffeine. Diet pills contain amphetamines, while caffeine is found in a wide array of products including coffee, tea, many soft drinks, pain medications, and allergy and cold remedies. Both amphetamines and caffeine are used to delay the onset of mental and physical fatigue. Because they increase short-term energy, they are often abused by people who work long hours or athletes looking for a physical advantage in their sport. Consuming excessive doses of stimulants over an extended period of time may lead to anxiety, hallucinations, severe depression, or physical and psychological dependence. Teens need to be aware that stimulants are in a wide variety of everyday products. Checking labels is important. Analgesics are OTC drugs that typically are used to treat fever, pain, and arthritis. The most common analgesic is aspirin; other widely available analgesics include acetaminophen and ibuprofen. Possible side effects of taking too much aspirin include nausea, heartburn, or the development of bleeding ulcers. To reduce the possibility of these side effects, aspirin can be purchased in a coated form. Acetaminophen, which is the active ingredient in Tylenol, is also used to treat aches, pains and fevers. However, unlike aspirin, it is usually free from side effects. Large doses, however, may cause rashes, fevers, or changes in blood composition. Ibuprofen, which is sold under such brand names as Motrin, Advil, and Nuprin, is used to relieve discomfort associated with arthritis, menstrual cramping, fever, and muscle strains. Side effects such as upset stomach, dizziness, drowsiness, headache, or ringing in the ears may occur. Abuse of this OTC drug may lead to confusion, tingling in hands and feet, and vomiting.

Q & A Question: Can a teen die from an overdose of aspirin? Answer: Yes, but it is rare. Aspirin is an analgesic. As one of the three most popular analgesics, aspirin—along with acetaminophen, and ibuprofen—is widely used to treat fever, arthritis and pain. The signs and symptoms of aspirin overdose can include hyperactivity, fever,

160 The Truth About Drugs convulsions, collapse, low blood pressure, rapid heart rate, rapid breathing, and, possibly, respiratory failure. Aspirin overdose can also produce wheezing, ringing in the ears, deafness, nausea and vomiting, dry mouth, bleeding, dizziness, hallucinations, and drowsiness. The best advice in the event of aspirin overdose is to call poison control or the local hospital emergency room. The following procedures may be performed, depending on the severity of the situation: ■ Gastric

lavage (stomach pump)

■ Administration

of activated charcoal to neutralize ­salicylic acid, the active ingredient in aspirin

■ Administration

of a laxative to flush the aspirin from the

victim’s body ■ Taking

of a blood sample to determine the salicylate level in blood and arterial blood gasses

■ Administration

of fluids (milk, fruit juices or, in severe cases, IV fluids) to prevent dehydration

■ Administration

of a sponge bath to control fever

■ Administration

of medications as needed

Most cold preparations are designed to treat specific cold symptoms and provide temporary relief from discomfort. There are several categories of commonly used cold remedies. Antihistamines are typically used to relieve the itchy, watery eyes caused by allergies or cold and flu viruses. As their name suggests, decongestants are intended to reduce congestion of the sinuses, nose, and throat due to allergies, colds, and flu. Both antihistamines and decongestants can cause drowsiness or excitability. Antitussives are cough suppressants used to treat painful, persistent coughs. Expectorants are used to help clear mucous from the respiratory system. Both of these types of medications may contain alcohol and some may contain analgesic narcotics, such as codeine, to relieve pain and induce sleep. They may be addictive.

Fact Or Fiction? The most widely abused category of over-thecounter drugs is laxatives.

The Facts: Laxatives are the most widely misused and abused of all overthe-counter medications. Laxatives are primarily intended for short-term

Over-the-Counter Drugs 161

use to ease constipation; however, excessive and continual use overtime can lead to dependency. Any drug that creates dependency can affect a teen both psychologically and physically. Commonly Abused Prescription Drugs

Prescription drugs make complex surgery possible, relieve temporary pain for millions of people, and enable many individuals with chronic (long-term) medical conditions to control their symptoms and lead productive lives. Most people who take prescription medications use them responsibly. However, the nonmedical use of prescription drugs can lead to abuse and addiction, characterized by compulsive drug use. Antidepressants

Antidepressants are prescription medications used to treat depression, a disease affecting more than 19 million Americans, according to “The State of Depression in America,” 2006, from the Depression and Bipolar Support Alliance (DBSA). Some of the original antidepressants were Nardil, Tofranil and Elavil. Although not technically an antidepressant, lithium, which is used to treat bipolar disorder, is often included in this group. The side effects of prolonged and excessive use of these drugs include excessive urination or thirst, diarrhea, vomiting, drowsiness, dizziness, or muscle weakness. Some newer antidepressants are Wellbutrin, Prozac, and Zoloft. There are fewer side effects with these medications. In 2004 the U.S. Food and Drug Administration advised that antidepressants prescribed to children might initially worsen depression and increase the risk of suicide and called for warning labels and further investigation, particularly into the possibility of similar effects in adults. Sedatives and tranquilizers

Sedatives are drugs prescribed to encourage sleep, while tranquilizers are commonly used to treat anxiety. A family of drugs called benzodiazepines, which include Valium and Librium, are the most widely prescribed tranquilizers and sleep-inducing medications. Other drugs used to treat anxiety and tension are Xanax, Ativan, and Tranxene. Common sleeping medications include Dalamine, Restotril and Halcion. Possible side effects of these drugs include drowsiness, poor coordination, and light-headedness. Overuse of sedatives and tranquilizers can lead to respiratory difficulties, sleeplessness, coma, and even death. Seconal, Phenopbarbital,

162 The Truth About Drugs

and Nembutal are less commonly prescribed medications used to treat anxiety and insomnia. If improperly used, these drugs can cause an individual to feel depressed or experience respiratory difficulties. Misuse And Dependence

More than $200 billion in prescription and OTC drugs are produced each year in the United States. According to a 2005 study by the National Center on Addiction and Drug Abuse (NCADA), OTC and prescription drug abuse almost doubled between 1992 and 2003. Abuse among teens more than tripled during that same period. In 2005 the NCADA reported that more than 15 million people over the age of 12 reported using one or more psychotherapeutic drugs (stimulants, sedatives, tranquilizers, and analgesics available through prescription) for nonmedical purposes at some time in their lives. While the total U.S. population grew by 14 percent during that time, the number of adults abusing prescription and OTC drugs increased by 81 percent. The number of youths 12 to 17 abusing such drugs leaped 212 percent. The total number of prescription and OTC drug abusers exceeded the number of people using cocaine, heroin, hallucinogens, and inhalants combined. Stimulants, analgesics, and tranquilizers were the most widely used drugs that fit this category. About one-third of the 495,000 treatment admissions for primary prescription and OTC drug abuse in 2004 were for prescription narcotic drugs. Sedatives, hypnotics, and antianxiety drugs accounted for 35 percent of such admissions; antidepressants made up 13 percent; stimulants made up less than 2 percent of admissions for drug abuse. Addiction rarely occurs among people who use pain relievers, central nervous system depressants, or stimulants as prescribed. However, inappropriate use of prescription drugs can lead to addiction. In addition, the amphetamines found in many diet pills have been tied to the development of anorexia nervosa, a disease associated with extreme dieting and excessive thinness. Many medications contain alcohol or sedative drugs such as codeine, which can be addictive and life threatening. Young people may abuse these medications for the effects derived from alcohol use, as the alcohol content in some OTC preparations may be as high as 40 percent. In addition, the use of alcohol, a depressant, with some prescription and OTC drugs may inhibit or enhance the drug’s effectiveness and cause a loss of coordination. Combining OTC drugs with some prescription drugs can cause similar effects or even more harmful types of reactions. Patients, health-care professionals, and pharmacists all have roles in preventing misuse and addiction. For example, physicians and other

Over-the-Counter Drugs 163

did you know?

Treatment Admissions for Prescription and OTC Drug Abuse, by Sex 80

Male

70

Percent

60 50

53

56 47

44

Female 50

50

49

51

58

40

42

30 20 10

Pr es Na crip rc tio ot n ics Pr e St scr im ip ul tio an n ts P Tr res an cr qu ipt ili ion ze rs Pr es Se crip da tio tiv n es Co O un ve te rr D th ru egs

0

Source: Substance Abuse and Mental Health Services Administration, 2004.

health-care providers should screen patients for substance abuse during routine history-taking by asking questions about what prescriptions and OTC medicines the patient is taking and why. If a doctor prescribes a pain medication, central nervous system depressant, or stimulant, the patient should follow the directions for use carefully. He or she should also learn what effects the drug may have and the impact of interactions with other drugs by reading all information provided by the pharmacist. The pharmacist should make sure the patient understands how to use the medication and answer any questions about its use. See also: Drug Abuse, Causes of; Drugs and Drinking further reading

Brodin, Michael. The Over-the-counter Drug Book. New York: Pocket Books, 1998. Leber, Max, Max R. Leger, Anthony Scalzo, et al. The Handbook of Over-the-counter Drugs and Pharmacy Products. Berkeley, Calif.: Celestial Arts, 2000. Reader’s Digest. Prescription and Over-the-counter Drugs. Pleasantville, N.Y.: Reader’s Digest, 2001.

164 The Truth About Drugs

Tone, Andrea, and Elizabeth Watkins. Medicating Modern America: Prescription Drugs in History. New York: New York University Press, 2007.

■ Overdose and Drugs

The accidental or intentional use of a drug or medicine in an amount high enough to cause an adverse physical reaction. Virtually any substance, from over-the-counter drugs to prescription drugs to illegal drugs, can be abused and thus result in overdose. Many drugs, when combined with other substances, taken with alcohol, or taken in amounts beyond the recommended dose, can lead to an overdose. Certain groups are at a greater risk for overdose, including children and people coping with suicidal tendencies resulting from depression, a mental disorder characterized by symptoms such as hopelessness and sadness. Teens are at increased risk of an overdose, because suicide is a leading killer of adolescents. What Causes an Overdose?

Overdose can occur by accident or design. An accidental overdose occurs most frequently among children and the elderly. Young children put almost anything they find in their mouths, including drugs or chemicals. The elderly, on the other hand, typically take a whole battery of drugs on a regular schedule. Many consult a variety of specialists and receive different medications from each of them. Sometimes the combination of certain drugs will cause a reaction different from the one intended. At other times, an elderly person may unintentionally take larger doses of the drugs than prescribed, thus causing an overdose. Drug-tracking systems in pharmacies have helped reduce the problem of drug interactions caused by taking medicines prescribed by different physicians. New devices for assisting visually impaired seniors are also being used to prevent overmedicating. Accidental overdose also occurs when users of illicit drugs take a combination of drugs with unexpected and sometimes deadly results. Some dealers “cut” or mix their drugs with other substances to increase the volume of the drug so that more can be sold. These dealers will use almost any cutting agent, from crushed aspirin to baking soda. These cutting agents not only distort the effects of the drug, but also impact its potency. Since many illicit drugs are made or cut in underground laboratories, quality control is limited at best and the result is little

Overdose and Drugs 165

consistency from one dose to another. A drug that makes someone feel good one time can be disastrous the next. Combining drugs with others or alcohol also can have a deadly impact. For example, both alcohol and barbiturates work by depressing the functions of the circulatory system, which delivers oxygen and nutrients throughout the body and controls respiration. Mixing the two depressants can slow down or stop one’s breathing, leading to coma and even death. The same drug can have greatly varied effects on different people. A particular dose of a drug that may be fine for one person may result in an overdose in someone else. Just as drugs affect different people in different ways, their impact can take longer to appear in some users than in others. A person who takes a drug and does not experience its effects as quickly as expected may become impatient and take another dose before the original dose has had time to produce the desired effects. In many cases, taking the additional amount is enough to cause an overdose. Not all overdoses are accidental. When a person deliberately takes an excessive amount of drugs with the goal of overdosing, it is called an intentional overdose. Intentional overdoses are a common form of suicide, and suicide is a leading cause of death among teens. Rates

Death from overdose has increased significantly since 1990. A large number of accidental overdoses are attributed to users of injection drugs who mix drugs. However, intentional overdose is also a serious problem among other drug users. A third of all overdose deaths are intentional. Chronic (long-term) drug use can cause increasingly depressed feelings in an individual, thus making the person more likely to attempt an intentional overdose. Dangers of Overdose

The dangers of overdose depend largely upon the kind of drug a person takes. Overdoses of depressants—drugs that depress the central nervous system—can be extremely dangerous. This class of drugs includes a wide range of substances including alcohol, opiates, and prescription drugs such as barbiturates, tranquilizers, antidepressants, and narcotic analgesics. All of these drugs slow respiration (breathing) and, when taken in large enough doses, can depress breathing to dangerously low levels. Symptoms of overdose from a depressant include slow and shallow breathing, clammy skin, extremely low blood pressure, convulsions, respiratory failure, coma, and possibly death.

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Taking a combination of depressants can be particularly lethal. The combined effects of two different depressants can be more powerful than the effects of a single one. Alcohol is probably the depressant most frequently used in combination with other depressants and represents a major cause of overdose. The National Institute on Alcohol Abuse and Alcoholism reported that overdoses involving a combination of alcohol and other drugs may have played a part in up to 27 percent of all emergency room visits in 2005. Stimulants such as amphetamines and methamphetamines have the opposite effect of depressants, but an overdose of stimulants can be just as deadly. Stimulants increase heart and respiratory rates and elevate blood pressure. Increased dosages of stimulants produce symptoms including rapid or irregular heartbeat, loss of coordination, and physical collapse. Overdose of stimulants can result in blurred vision, dizziness, restlessness, anxiety, delusions (false or distorted perceptions), intense agitation, fever, hallucinations, convulsions, and possible death. Symptoms of a cocaine or crack cocaine overdose are similar to those involving a stimulant overdose. They include seizures, high blood pressure, increased heart rate, paranoia, and other changes in behavior. Both heart attack and stroke are serious risks within three days of cocaine overdose, a particular issue of concern for those who use crack. Overdoses of hallucinogens such as LSD and PCP, and designer drugs including ecstasy, can also have severe consequences. Longterm or chronic use of hallucinogens may cause depression, violent behavior, anxiety, and distorted perceptions of time. An overdose can result in convulsions, psychosis, coma, and death. Recent research has pinpointed the dangers associated with overdoses of a category of drugs known as anabolic steroids. Steroids are synthetic compounds that are used to improve athletic performance by increasing body weight and muscle strength. Steroids offer the temptation of quick results. While the use of steroids may cause quick weight and muscle gains, it can also generate mood swings and extremely aggressive behavior typically called “roid rage.” An overdose also results in severe skin rashes and impotence in males. An overdose in females may result in the development of irreversible masculine traits, such as increased facial hair and interrupted menstruation. Even over-the-counter drugs can be dangerous when used to excess. An overdose of acetaminophen (Tylenol) can cause liver damage. In the initial stages of overdose, symptoms include loss of appetite, tired-

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ness, nausea and vomiting, paleness, and sweating. By the final stage of liver failure, the person becomes jaundiced (a yellowing of the skin and whites of the eyes caused by the death of red blood cells). Aspirin, as well as some muscle and joint creams, can contain substances called salicylates that have the potential for overdose. When used in excess, these substances can produce symptoms that include irritation of the stomach and intestine, fever, and vomiting. Overdoses of salicylates may cause rapid heartbeat, fast breathing, confusion, hallucinations, tiredness, and ringing in the ears. The most serious symptoms are acute renal (kidney) failure, coma, and heart failure. Marijuana is the illegal drug most widely abused by teens. An overdose is rarely if ever fatal, except when users attempt to drive a car or operate machinery while under the influence of the drug. Symptoms of overdose can include fatigue, lack of coordination, paranoia, and drug psychosis. did you know?

Risk of Overdose in Combination with Other Factors Risks increase when the user: ■ mixes

drugs and alcohol; ■ uses opiates such as heroin while using another drug or drugs; ■ uses opiates after a period of abstinence when tolerance will be low; ■ has a history of overdose; ■ has a long history of injection drug use; ■ shares used injection equipment such as needles; ■ has a high alcohol intake; ■ has a high drug intake; ■ has suicidal thoughts; ■ has feelings of depression; and ■ has not been in a treatment program. Source: Centers for Disease Control and Prevention.

168 The Truth About Drugs Emergency Response and Treatment

Any first responder (police officer, firefighter, or paramedic) to a medical emergency looks for immediate symptoms which may be life threatening. Overdose emergencies are no different. However, the effects of the drug on the victim may make it more difficult for the first responder to do his or her job effectively. For example, if the person is conscious, he or she can provide key information such as what drugs were ingested and in what quantities. He or she will also be able to inform the first responder if alcohol is involved. However, if the victim is unconscious, the only information available will be from friends and bystanders, who may not know what drug the victim took or may provide inaccurate information. In either case, the first responder may not have all the information needed to properly treat the victim.

Q & A Question: What information do I need to contact a poison control center about an overdose? Answer: The information needed by any first responder or poison control center is the same. The information you need to have should include: ■ Whether

the person is conscious

■ Whether

the person is breathing

■ What ■ How

drug(s) were taken

much of the drug was taken

■ When

the drug was taken

■ Whether

the drug was taken with alcohol or any other drugs or chemicals

■ The

age of the person

■ The

symptoms the victim is experiencing

A drug overdose can be frightening. It’s important to keep your wits about you so that the necessary information can be given to the first responder. Your calmness may mean the difference between life or death.

Peer Pressure and Drugs 169

In case of an overdose, determining what drug was taken and how fast it will be absorbed into the system is critical. Having all of the necessary information at hand is extremely important in helping a first responder successfully treat an overdose. See also: Depression and Drugs; Drugs and Drinking; Morbidity and Mortality; Over-the-counter Drugs; Steroids, Anabolic further reading

Cohen, Jay S. Over Dose: The Case against the Drug Companies: Prescription Drugs, Side Effects, and Your Health. New York: Putnam, 2004. Graedon, Joe, and Teresa Graedon. Dangerous Drug Interactions. New York: St. Martin’s Press, 1999. Olsen, Kent R. Poisoning and Drug Overdose. Stamford, Conn.: Appleton and Lange, 2006.

■ Peer Pressure and Drugs

Influence exerted by one’s peers—people of the same age or social group—to act or behave in a certain way. Everyone wants to make friends and get along with people, and teens are especially eager to be accepted by their peers. However, when peers accept or encourage drug and alcohol use, a teen may feel pressure to do the same for fear of being rejected. Such negative peer pressure is a risk factor in teen drug and alcohol abuse. Peers can also be a positive influence on one another by avoiding alcohol and illegal drugs. Effects of Peer Pressure

In a 2001 survey by the Pew Foundation, 82 percent of Americans named peer pressure as a major factor in determining whether a teen will use illegal drugs. However, some researchers have disputed the connection between peer pressure and teen drug and alcohol use. In 1996, the journal Addiction published an article titled “On the Importance of Peer Influence for Adolescent Drug Use: Commonly Neglected Considerations.” The article suggested that factors such as family environment, socioeconomic status, and heredity may be as or more important than peer pressure in determining teen behavior.

170 The Truth About Drugs

These findings may help explain why school drug programs that focus on resisting peer pressure have not achieved better results. Other studies, however, do show a relationship between peer behavior and drug use. One conducted in 2001 by the Substance Abuse and Mental Health Services Administration (SAMHSA) suggested that teens who had a few close friends who smoked marijuana were 39 times more likely to use the drug than teens whose friends did not smoke. The same study found that teens are 16 times less likely to try marijuana if they think their friends would be “very upset” if they did not do so. Clearly, among the teens surveyed by SAMHSA, peer attitudes made a big difference. A 2005 study of over 4,200 adolescents by Brigham Young University also found that peer drug use significantly affected the chances of a young person using drugs.

teens speak Kim Seemed Like a Great Person I’m Pat, and I’ve been friends with Kim for only a short period of time because I just moved here. I didn’t meet Kim until school started, but we became close friends very quickly. She seemed like a great person, popular with the cool girls and guys alike. Kim was always concerned about how I was doing and was so considerate of my feelings, wishes, and interests. One Friday night, Kim asked me if I wanted to go to the volleyball match at the high school. It sounded like a good time, and I rarely passed up an opportunity to spend time with Kim. At halftime, Kim suggested that we leave and meet up with some other kids from school. I want to emphasize that Kim had never been anything but a super person and good friend. But when we met up with the others, Kim started to act weird, talking trash and trying to be all cool. It became apparent to me that she was trying to impress people by acting “all bad.” As I met different people at the party, one of Kim’s friends, who was obviously “wasted,” offered me a strange-looking pill and said, “Take one; it’s the bomb and everybody’s doing it.” All of a sudden I got this sick feeling in my stomach just

Peer Pressure and Drugs 171 thinking how stupid I was to have befriended this obnoxious person. Not wanting to seem like a nerd, I told Kim’s friend that I had been on strong medication to control my anger and aggression and that any other drug could cause me to become very hostile. I figured if I was going to make up something, it might as well be a good story. I had no interest in doing whatever pill they had, but to save face I provided an alternative reason why I couldn’t. Even if I was pressured, I was going to stand my ground. I would have eventually just walked away if I had been pressured at all. Actually, I had planned ahead for such a situation so I was prepared. One thing’s for sure—Kim is history.

In 2003, the University of Pennsylvania’s Annenberg Public Policy Center published a study that revealed a troubling aspect of the relationship between peer pressure and drug use. The study, “Young Americans Say Alcohol, Marijuana, Cigarettes, and Lottery Tickets are Easily Accessible,” found that people between the ages of 14 and 22 are more likely to connect behavior such as drinking, using drugs, smoking cigarettes, and gambling to popular kids rather than unpopular ones. Researchers are also discovering that peer pressure begins at a younger age than many people suspect. The National Institutes of Health in 2001 reported that peer attitudes may influence a child’s decision about smoking and drinking as early as sixth grade. The study found that elementary school children held generally negative attitudes toward smoking and drinking. By middle school, however, young people are more likely to associate with friends who smoke or drink as well as to smoke and drink themselves. Middle-school girls were more likely than boys to be swayed by peer pressure to drink. The study also showed that these behavior patterns tended to remain throughout high school.

Q & A Question: What are the steps a teen can take to make a good decision? Answer: Decision making can be difficult at any age. Professionals suggest six steps to making good decisions. They will not help you

172 The Truth About Drugs make a snap decision, but they can be helpful when you have time to go through each step carefully. The steps include: 1. Identify the problem. What decision do you have to make? 2. Consider your values. What is important to you? 3. List the options. What possible actions could you take? 4. Weigh the consequences. List the pros and cons of each option. 5. Decide and act. Describe what you will do. Explain your decision. 6. Evaluate your choice. How do you feel about the action you took? Did you make a good decision? Would you take a different action if faced with the same scenario?

Resisting Peer Pressure

You’ve probably heard the peer pressure speech from your parents a thousand times, right? The one where they ask, “If so-and-so jumped off a cliff, would you jump off too?” Well, it may seem corny, but it carries an important message about thinking for yourself. It’s not easy to resist the pressure to do something your friends are telling you is “cool,” even if you know it’s not the right thing to do.

Fact Or Fiction? A teen can fend off anyone who is pressuring him or her to use drugs by using refusal skills.

The Facts: Having a prepared refusal response makes it easier to withstand even intense peer pressure. Refusal skills are rehearsed responses to pressure from peers to use drugs. They may include invented stories, bogus instructions from parents, and even the truth. The following are ways to counter the pressure to use drugs without losing face: Say no. How would you say no to pressure? ■ Offer an alternative. What else could you do with friends? ■ Stand your ground. What would you do if friends kept pressuring you? ■

Rehabilitation and Treatment 173

Walk away. How would you get out of the situation? ■ Plan ahead. What could you do to avoid this situation? Who can help you practice refusing peer pressure? ■ Have a support system. Who will stand by you and how can you best use their support? ■

Recent studies showing a drop in teen drug use suggest that young people are getting better at resisting pressure to use alcohol and drugs. The National Institute on Drug Abuse’s 2007 “Monitoring the Future” study shows that teen use of most drugs has steadily declined since the mid-1990s. Some school officials attribute the decline to a combination of parental and neighborhood involvement, as well as positive peer pressure from students to avoid drugs. They report that fewer students today think using alcohol or drugs is “cool.” See also: Risk Factors and Risk Taking further reading

Brown, Waln K. Drugs and Peer Pressure. Talahassee, Fla.: William Gladden Press, 2008. Donatelle, R. J., and L. G. Davis. Access to Health. 5th ed. Needham Heights, Mass.: Allyn & Bacon Publishing, 1996. Myers, Arthur. Drugs and Peer Pressure. New York: Rosen Publishing Group, 1995. Slavens, Elaine, and Ben Shannon. Peer Pressure: Deal with It Without Losing Your Cool. Davidson, N.C.: Lorimer Press, 2004.

■ Prenatal Exposure to Drugs See: Drugs and Development

■ Rehabilitation and Treatment

The process of breaking the physical, mental, and spiritual bonds of addiction to drugs and alcohol and returning to normal functioning. Rehabilitation is most effective when accompanied by a comprehensive, individually designed treatment program. The individually

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designed program is important because every addiction is different. Individualized programs assist teens in dealing with the issues of greatest concern in their recovery. Comprehensiveness is important because addiction impacts not only the teen’s physical, mental, and spiritual well-being but also the lives of family and friends. Overcoming addiction is greatly enhanced by a reputable rehabilitation and treatment program. What is Involved in Rehabilitation?

There are two stages to rehabilitation from drug or alcohol abuse: detoxification and recovery. Detoxification is the process of completely removing the drug from one’s system. Only after he or she is freed of physical dependence from the drug can the process of recovery begin. Recovery involves learning about the nature of addiction in general as well as about the circumstances surrounding one’s own addiction. This knowledge is invaluable in helping one identify harmful influences or patterns of behavior that increase his or her chances of using drugs again. Both detoxification and recovery are necessary to break addiction and return to a normal life. Detoxification

Detoxification can take several different forms, depending on the type of addiction, the level of addiction, and the patient’s ability to pay. Because drug addiction withdrawal is difficult, medical support is frequently required. Although some drug users may initiate detoxification themselves (a process known as “going cold turkey”), most require assistance as withdrawal symptoms intensify. Many detoxification programs use substances called agonists and antagonists to block the action of drugs in the nervous system. As a result, even if the patient abuses a drug while in detoxification, the drugs will have no effect. The use of these substances is typically combined with some form of counseling or therapy to bring about behavior changes. In residential or inpatient detoxification programs, withdrawal from addiction takes place in a supportive and supervised environment. The use of residential detoxification should be considered if: ■ The

risk of severe withdrawal symptoms, such as epileptic seizures or extreme agitation, is high; ■ The home environment is inadequate to support the detoxification and rehabilitation process, or other drug users are present;

Rehabilitation and Treatment 175 ■ The

teen is homeless or is currently residing in a crisis shelter; or ■ Previous attempts through nonresidential or community detoxification failed. Residential or inpatient detoxification can be medically assisted or nonmedical, depending on the situation. Reasons for a medical residential detoxification would include a history of severe withdrawal symptoms, coexisting medical problems such as heart disease, multiple drug and alcohol dependencies, or a previous failures with nonmedical residential detoxification. Nonmedical residential detoxification is appropriate for those who do not have a severe addiction. In such cases, medications are unnecessary and the individual can work through the withdrawal with counseling and support. When the dependency is mild and the individual is sufficiently motivated, nonresidential or outpatient based detoxification may be the best route to take. When drug addiction results in a profound decrease in normal levels of mental and physical functioning, urgent care may be required. Before treatment can be initiated, a medical assessment is necessary to rule out other possible causes of the condition. A wide variety of detoxification programs exist. Each uses different methods to rid the body of drugs. The most widely advertised form of detoxification is known as rapid, anesthesia-assisted detoxification (RAAD), also called “rapid detoxification” or “ultrarapid detoxification.” RAAD, used in cases of opiate addiction, is typically a four-tosix hour treatment during which a patient withdraws from addiction while safely asleep under general anesthesia. In newer forms of RAAD the patient receives the drug naltrexone, which blocks the action of opiates in the nervous system. After the procedure, the patient remains hospitalized for approximately 24 hours. This procedure requires professional medical assistance by a licensed physician in a medical facility. RAAD is frequently followed up with counseling and other outpatient services as needed. With some drugs, the best approach to detoxification is to gradually reduce dosage over a period of time. For example, detoxification for a person taking 30 milligrams of Valium a day might include reducing the dose by 5 milligrams per month. However, for other drugs, such as cocaine or amphetamines, detoxification can be rapid and abrupt. Rapid detoxification usually results in a strong craving for the drug along with withdrawal symptoms such as depression, anxiety, agitation, and fatigue. These symptoms typically fade in eight to nine days,

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but in some cases the patient is given drugs such as desipramine to relieve the withdrawal symptoms. The detoxification programs described here are only a fraction of those available. Some programs encourage dietary changes, while others use holistic therapies that seek to cure addiction by changing many aspects of a person’s lifestyle and behavior. The best method is the one that works best for the individual. A call to a family physician, local mental health department, or Alcoholics Anonymous (AA) may yield a list of some local programs with successful track records. Recovery

Once detoxification has been completed, the process of recovery can begin. The first step is for the patient to gain a clearer understanding of his or her addiction. Many treatment programs view addiction as a complex disease that damages the individual not only physically but also mentally and spiritually. Because the disease impacts all three areas, recovery efforts must also go beyond the physical and address emotional and spiritual needs. Experts disagree over whether addiction is a disease or a learned behavior. Those who view it as a disease regard addiction as similar to other illnesses over which the individual has little control. Those who view addiction as a behavior regard it as a choice. To support the idea of addiction as a disease, recent research suggests there may be a genetic component to addiction. In addition, physiological changes in the brain have been identified that can result from drug use. These two research findings lend credibility to the idea that addiction is a disease and not simply a learned behavior. Types of therapy

Therapy involves the examination of one’s behaviors. It takes hard work to change behaviors associated with drug abuse by talking about them. Most therapists believe that drug abuse disorders are difficult to treat because they often require structure and a multiple treatment approach to be successful. To effectively treat addicted teens, it is important to combine therapy with knowledge of the treatment process, including an understanding of the drug itself as well as its intoxication and withdrawal effects, a working knowledge of drug culture and addictive lifestyles, and knowledge of various recovery programs.

Rehabilitation and Treatment 177

According to Alan Leshner, director of the National Institute on Drug Abuse, therapy that combines a variety of approaches is more effective than a single approach, because addiction is both a biological and a behavioral disorder. Bruce Rounsaville, the principal investigator at two major clinical research centers for the study of substance abuse and psychiatric disorders at Yale University, argues that combining treatments is more effective because different treatments address different aspects of the addiction. Medications such as naltrexone tackle the physiological aspects of addiction, while psychotherapy and counseling explore behavioral issues related to drug use. One form of psychotherapy used for treating addiction is called cognitive-behavioral therapy, or CBT. This approach focuses on teaching patients how to recognize and avoid situations in which they are likely to use drugs. In addition, CBT aims to help patients control their urge to use drugs and deal with the emotional, psychological, and practical problems caused by their addiction. Another popular form of therapy, called the 12-Step Program, was pioneered by AA and is now used by many other groups seeking to end an addiction. The 12 steps of the program reflect the basic changes that need to be made for recovery. The steps include:   1. Admitting that you are powerless over the drug and that your life has become unmanageable   2. Believing that a higher spiritual power can restore you to normal functioning   3. Making a decision to turn your will and your life over to the care of God according to your own spiritual beliefs   4. Making a moral inventory of your life   5. Admitting to God, to yourself, and to another human being the exact nature of your wrongs   6. Being ready to have God remove all these defects of character   7. Humbly asking God to remove your shortcomings   8. Making a list of all persons you have harmed, and being willing to make amends to them all   9. Making direct amends to such people wherever possible, except when to do so would injure them or others

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10. Continuing to take personal inventory and admitting when we are wrong in the future 11. Seeking through prayer and meditation to improve your contact with God, according to your beliefs, asking only for knowledge of God’s will and the power to carry it out 12. Carrying this message to other addicts and practicing these principles in all your affairs What sets 12-step programs apart from other approaches is its emphasis on the spiritual dimension of recovery. Although the element of spirituality is not specific to a particular religion, some groups choose not to include it. Spirituality also involves a belief in or sense of connection to something greater than oneself, which is consistent with some of the newer models of psychotherapy. Historically, 12-step treatment programs are linked largely to recovery from alcohol abuse and addiction. AA, the original 12-step program, has been supporting recovery since its inception in 1935. Over 1 million persons have achieved recovery through involvement in AA programs. At any one time, more than 100,000 men and women worldwide are involved in AA 12-step programs. Addiction affects not only those recovering from drug abuse but also his or her family and friends. They, too, may need counseling. A number of support groups help them deal with the issues caused by alcohol or drug use. For example, Al-Anon helps families and friends of alcoholics. Alateen offers a similar recovery program for teens. Both programs are based on the 12 steps. The only requirement for membership in either group is having a relative or friend who is an alcoholic. Issues in therapy

In treating drug abuse with psychotherapy, a number of issues complicate the process. One issue is the time and energy needed to overcome denial and get the client into treatment. In addition, the therapist must develop treatment goals early in the process and keep these goals at the forefront of treatment. Therapists must also develop a good rapport with the client and support him or her. An additional issue is that the therapist must stay abreast of the client’s compliance with the overall treatment program, which may include monitoring attendance in different parts of the recovery program, providing regular urinalysis, and reporting use of any drugs. In the event of

Rehabilitation and Treatment 179

did you know?

Other Rehabilitation Programs Although 12-step programs are very popular, there are a number of other programs that do not follow the 12-step guidelines. These include: ■ Moderation

Management, an alcohol education group for earlystage problem drinkers ■ LifeRing, a secular abstinence support group ■ Recovery, Inc., a skill-building group for dealing with emotional issues ■ Secular Organizations for Sobriety, disease- and abstinencebased support groups ■ Self-Management and Recovery Training (SMART) (formerly Rational Recovery), an alcohol, drug, and other addiction ­abstinence skills group ■ Women for Sobriety, a disease- and abstinence-based support group with emphasis on self-empowerment

substitution therapy, such as methadone maintenance, it is important to record the different aspects of the treatment. Family members can play an important role in recovery. Family and even close friends can facilitate the recovery process and help the teen create a better, more knowledgeable support network. Doing so may actually decrease the negative family behavior patterns that can slow recovery such as codependence, a set of compulsive behaviors that frequently develop between family members and a person within the family who has an addiction. Family programs can help participants improve communication and parenting skills. The National Institute on Drug Abuse claims that parents who take an active role in their children’s lives by talking with them about drugs, monitoring their activities, getting to know their friends, and understanding their problems and personal concerns are more likely to raise teens who do not abuse drugs or alcohol. The impact of peers (people of one’s own age and social group) on treatment cannot be understated. Peers can provide a support network

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that encourages for rehabilitation and treatment. However, many of the peers in a teen’s life may have actually contributed to the drug problem. Most recovery programs will work with teens in dealing appropriately with peer pressure, but often building new, more supportive peer networks will speed the recovery process. Communication is critical to recovery, whether the communication is between the therapist and patient, family/friends and patient, or even from the patient to himself or herself. Many therapists encourage an internal dialog about one’s own attitudes, actions, and behavior. Known as self-talk, this kind of communication can be important in overcoming psychological barriers to recovery. Often self-talk is negative and demeaning. Some people have a tendency to be very hard on themselves, criticizing themselves for small failings or perceived weaknesses. Negative self-talk can lead to low self-esteem, which can hinder your ability to resist drugs as well as to recover from drug addiction. Positive self-talk is an important part of recovery because positive habits need to be reinforced. People learn not to be so hard on themselves when something does not go as planned, or when a potentially embarrassing event occurs. Substituting positive self-talk for negative self-talk is a good first step toward facing and dealing with your situation realistically. Recovery can be a long-term process that often requires multiple attempts and many lifestyle changes. Several episodes of relapse (falling back into addiction) are not uncommon before achieving the long-term goal of being drug- or alcohol-free. In addition, there is little research that accurately measures success rates for different types of treatment and therapy. This means that finding the best treatment for a particular individual may be a long and difficult process. However, discovering the recovery plan that works best and sticking to it can be the first step in helping the addict once again gain control over his or her life. See also: Dependence and Addiction; Drug Abuse, Causes of; Risk Factors and Risk Taking further reading

Eisenberg, Arlene, Howard Eisenberg, and Al L. Mooney. The Recovery Book. New York: Workman Publishing Company, 1992. Hawes, Gene, and Anderson Hawes. Addiction-Free: How to Help an Alcoholic or Addict Get Started on Recovery. New York: Thomas Dunne Books, 2003.

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Linton, Jeremy M. Overcoming Problematic Alcohol and Drug Use: A Guide for Beginning the Change Process. London: Routledge, 2007. Manville, Bill. Cool, Hip, and Sober: 88 Ways to Beat Booze and Drugs. New York: Forge Books, 2003. Tyler, Bob. Enough Already: Guide to Recovery from Drug and Alcohol Addiction. Denver: Outskirts Press, 2005.

■ Risk Factors and Risk Taking

Any behavior or set of circumstances that increase the chances of a person taking drugs. Having many risk factors for drug or alcohol abuse does not mean an individual will use drugs or alcohol. When all is said and done, a person still has choices. The teen years are a time of change, growth, and exploration. New relationships and increased personal freedoms are among the challenges that involve both opportunities for personal growth and substantial risks. Teens need to be aware of the kinds of behavior that can increase the risk of using drugs. Knowing the risk factors can help teens avoid situations where drug use is likely to occur. Individual and Personal Factors

Many factors tempt teens to engage in risk-taking behaviors. The desire for greater independence, individuality, and self-expression deepens as teens mature. They want greater control over their lives and their futures. While young teens (12- and 13-year-olds) depend heavily on adult supervisors, older teens (18- and 19-year-olds) are more independent and spend more time with peers (people one’s own age and social group). Growing up takes time, but most teens are eager to move as quickly as possible. The teen years are also a time of taking risks. Peers may encourage risk-taking behaviors such as speeding, skipping school, or experimenting with drugs. Peer pressure can have a strong influence on a teen’s decision to engage in such behaviors. However, every action has consequences. Teens who speed for thrills or to go along with their friends eventually find out the hard way how foolish and risky speeding is. Those who abuse drugs and alcohol learn the same hard lesson. What may have seemed a good idea the night before is regretted the day after. Understanding the

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consequences of risky behaviors in advance can be invaluable in making sound judgments and avoiding bad decisions. To reduce exposure to the risk factors associated with drug and alcohol use follow a few basic rules: ■ Don’t

hang out with people who use drugs and alcohol. ■ Avoid going places or attending events where drugs and alcohol are consumed. ■ Don’t ride with anyone who has been drinking or using drugs. ■ Before going to a party, make arrangements for a friend to act as a designated driver. By understanding the consequences of actions in advance, teens might realize that what appears on the surface to be fun, exciting, and cool in actuality may be a giant hassle in the making. Family Influences

Families play a major role in the life of teens. Families with adult role models who abuse drugs or alcohol can have a negative influence on teens. Teens often imitate, or model, the behavior of authority figures, and a parent who uses drugs sets a bad example that teens might follow. According to the American Academy of Child and Adolescent Psychiatry, children raised in families with a history of drug or alcohol abuse are themselves at greater risk of abusing those substances. Additionally, families who use intimidation, violence, and abuse as parenting tools foster teens who run a much higher risk of using alcohol and drugs as coping mechanisms. A positive family environment is one in which teens have support from adults to help them make a successful transition from childhood to adulthood. A positive family environment will also help both parents and teens weather tough times during that transition. Unfortunately, many teens do not feel supported by their family, especially when a request for advice results in ultimatums or threats. Having the support and understanding of one’s family when making tough decisions can be priceless. Establishing a situation of mutual respect within families is extremely helpful, but sometimes relationships like these are not possible. Identifying an adult outside the family circle who understands the difficulties a teen faces can be a helpful substitute when turning to family is not an option. Finding a special teacher, religious leader,

Risk Factors and Risk Taking 183

counselor, or coach to discuss tough issues with can be most helpful, especially when support and perspective is needed.

Q & A Question: Does moving around frequently increase the chances a teen will use drugs? Answer: Moving frequently does not automatically mean that a teen will have problems with drugs. However, the more often a teen’s family moves, the higher the risk of abusing substances. The reason? Teens who are uprooted frequently lack sufficient time to develop strong, trusting friendships. Sometimes teens in a new environment will unknowingly befriend teens who use drugs. Peer substance abuse is a strong indicator that a teen will also use drugs. For this reason, moving around can be a risk factor for substance abuse.

Community Influences

Where a teen lives can be supportive or detrimental. The physical and socioeconomic situations that shape some communities increase the chances that local teens will become involved with drugs or alcohol. For example, communities located in run-down sections of town where the residents have little money or resources may have a greater likelihood of drug and alcohol use. Such communities often experience greater gang activity, which not only increases drug traffic but also the potential for violence. According to the 2004 National Youth Gang Survey, rural communities are not immune from drug and gang influences, but the number of gangs dealing drugs was greatest in and around big cities. Economic factors definitely play a role in community drug and alcohol issues. According to the 1996 book When Work Disappears: The World of the New Urban Poor, when businesses move out of the inner city, residents are left with fewer legitimate opportunities to work and make a living. This, in turn, can lead to increased drug use in a community, especially in communities where unemployment is already high. Gangs typically establish or expand their drug business into lower socioeconomic areas within large metropolitan areas. The increased drug traffic and subsequent violence within these areas places a heavy burden on the teens living there. Drug use and the associated violence, elevated rates of HIV infection, and nonviolent

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crime such as prostitution are all-too-typical characteristics of living in poor areas. Affluent communities also must deal with the influence of drugs and alcohol. Teens in wealthy suburbs often have large amounts of free time and cash to spend, which can lead them to experiment with drugs. Gangs realize the potential for sales to affluent youth and may service communities with drugs through local couriers. A recent example occurred in Plano, Texas, an upscale suburb of Dallas. In the late 1990s, Plano experienced a wave of heroin abuse that led to a number of overdoses among teens. A heroin-trafficking ring that targeted wealthy teens with lots of free time and money victimized Plano, named an “All-American City” in 1994. The police eventually arrested those responsible for trafficking heroin, but the episode left the community shaken. Plano parents had believed their community was safe from a drug that they associated with innercity crime and violence. A 2007 study in California found that areas with wealthy residents near Oakland experienced higher levels of teen drug and alcohol abuse than less affluent communities. In the wealthier communities, 26 to 29 percent of 11th graders reported engaging in binge drinking. By contrast, only 14 to 17 percent of 11th graders in poorer areas reported such behavior. Wealthier communities may take the position that drugs and drug dealers only happen in the “other” communities, and thus provide little support to teens. Conversely, less well-off communities may realize the need for teen support and establish services and centers to help teens in need. Regardless of whether it is rich or poor, every community chooses to be supportive of teens or not. Any community that believes it doesn’t need to be concerned about drugs has a bigger problem than it can imagine.

Fact Or Fiction? Cultural identification with friends of the same culture might reduce risk factors for drug abuse despite the influence of peer drug users, drug availability, or a parent’s drug use.

The Facts: The 1999 National Institute on Drug Abuse (NIDA) study “Ethnic Identification and Cultural Ties May Help Prevent Drug Use” found

Risk Factors and Risk Taking 185

that cultural identification with friends of the same culture had a significant influence on teen drug use. An awareness of cultural history and tradition, identification with friends of the same culture, or participation in cultural activities can reduce the risk of drug use. Cultural influence can even be strong enough to offset the influence of peer drug users, drug availability, and a parent’s drug use.

Cultural Influences

A wide variety of cultural factors, such as sexual preference or ethnic heritage, affect whether an individual will be vulnerable to alcohol and other drug use. Cultural influences can either significantly increase or substantially decrease the risk of teen drug and alcohol use. Cultural factors can also affect a teen’s response to substance abuse treatment. In some cultures, the use of certain drugs under tightly controlled situations is part of some religious rituals. For example, members of some Native American cultures take hallucinogenic drugs such as peyote as part of their religious ceremonies. However, the use of illicit drugs in cultural celebrations, rituals, or rites is the exception rather than the rule. According to Well Connected, a health newsletter written and edited by medical faculty at Harvard University and Massachusetts General Hospital, alcoholism does vary among ethnic groups. Some, such as Irish and Native Americans, have a higher than average rate of alcoholism while others, such as Jewish and Asian Americans, have a lower risk. Some researchers feel these differences may represent cultural factors; others suggest that they reflect biological or genetic differences between different groups. In 1999, NIDA published a research study titled “Ethnic Identification and Cultural Ties May Help Prevent Drug Use.” The study found that ethnic identification may significantly influence drug use, and it identified important cultural issues that can impact drug use. For example, the study reported that Puerto Rican and African-American adolescents were less vulnerable to risk factors for drug use if they strongly identified with their communities and cultures. Members of the Asian community who responded to the study expressed the belief that drug abuse prevention programs can be more effective by including ethnic and cultural components

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into planning. For example, prevention programs should emphasize important cultural values that are at odds with or threatened by drug abuse. There is still some question about just how much impact cultural influences have in shaping antidrug behavior. However, in conjunction with family, personality, or positive peer influences, cultural factors may substantially reduce risk factors for drug abuse. See also: Drugs and Criminal Activity; Drugs and Disease; Families, Communities, and Drug Abuse; Gangs and Drugs; Peer Pressure and Drugs further reading

Faupel, Charles B., Alan M. Horowitz, and Greg Weaver. The Sociology of American Drug Use. New York: McGraw-Hill, 2003. Monaghan, Lee F. Bodybuilding, Drugs, and Risk. New York: Routledge, 2001. United Nations. Adolescent Substance Abuse: Risk and Protection. New York: United Nations Publications, 2004. Wolfe, David A., Peter G. Jaffe, and Claire Safe. Adolescent Risk Behaviors: Why Teens Experiment and Strategies to Keep Them Safe. New Haven, Conn.: Yale University Press, 2006.

■ School Performance and Drug Abuse

Relationship between academic and social performance in a school setting and drugs. Various studies have found that drug and alcohol use can have a negative impact on school attendance and performance. Drug use by peers and peer pressure are risk factors for teen drug abuse. Roughly 60 percent of high school teens report that drugs are used, kept, or sold at their schools. Students at these schools are three times more likely to smoke, drink, or use illegal drugs than students whose schools are substance-free. Attendance and Academic Performance

A wide body of scientific literature shows a strong relationship between drug abuse and academic performance. According to the National Clearinghouse for Alcohol and Drug Information, teens that take drugs have a dropout rate five times greater than other students. Teens who abuse alcohol are four times more likely than other students to cut

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did you know?

Academic Performance and Substance Use A or B Average Grade

C or Less Average Grade

Average Grades During the Last Semester or Grading Period Among Students Aged 12 to 17, by Past Month Alcohol Use, 2002 to 2004 100% 90% 80%

27.5

32.9

72.5

67.1

No Past Month Alcohol Use

Past Month Alcohol Use, but Not Binge Use

42.3

70% 60% 50% 40% 30%

57.7

20% 10% 0%

Past Month Binge Alcohol Use

Average Grades During the Last Semester or Grading Period Among Students Aged 12 to 17, by Past Month Marijuana Use, 2002 to 2004 100% 90% 80%

27.8

42.0

70%

55.1

60% 50% 40% 30%

72.2

58.0 49.9

20% 10% 0%

No Past Month Marijuana Use

Source: SAMHSA, 2003, 2004, 2005.

Past Month Marijuana Use on 1 to 4 Days

Past Month Marijuana Use on 5 or More Days

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classes or skip school, and those who use marijuana are six times more likely to do so. These statistics are especially troubling because the majority of teens who later abuse drugs typically start their drug use with tobacco, alcohol, inhalants, and marijuana. These drugs are often called gateway drugs or entry-level substances because they are often the first substances in a progression of drug abuse. For teens that stay in school, drug or alcohol use can result in academic failure. Results from the 2002–2004 National Survey on Drug Use and Health, a study sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that alcohol, tobacco, and drug use produces an array of negative effects on academic performance. For example, 27.8 percent of teens ages 12–17 who did not smoke marijuana reported a letter grade of C or below for the previous semester, compared to 42 percent of teens who had used marijuana one to four times in the previous 30 days and 55.1 percent of those who used marijuana five or more times. Similarly, 27.5 percent of students who did not drink alcohol reported a grade average of C or lower. By contrast, 32.9 percent of those who drank in the previous month had a C average or lower, as did 42.3 who binge drank in the previous month. In 2002, researchers at the University of Minnesota and the University of North Carolina at Chapel Hill conducted the National Longitudinal Study of Adolescent Health, the largest, most comprehensive survey of adolescents ever undertaken in the United States. Approximately 90,000 students in grades seven through 12 from 145 schools across the country participated. The purpose of the study was to identify factors that tend to protect teens from engaging in harmful behaviors such as alcohol and drug use. The study found that repeating a grade seemed to increase the risk of substance abuse. Some 20 percent of teens are held back yearly, according to the study. Many teens view repeating a grade as proof of academic failure, which is a risk factor for drug and alcohol abuse. By contrast, academic success tends to reduce the chances that a teen will use drugs or alcohol. Drug abuse not only takes an academic toll on students but also has a financial impact on schools. According to a recent study titled “Malignant Neglect: Substance Abuse and America’s Schools” by the National Center on Addiction and Substance Abuse at Columbia University, the costs to schools associated with drugs include the costs associated with truancy, violence, property damage, lost productiv-

School Performance and Drug Abuse 189

ity, teacher turnover, special education, school security, disciplinary programs, higher insurance costs, and legal expenses. The study estimated that these and related costs add 10 percent (approximately $41 billion) to the budgets of schools across the country, money that most schools are hard-pressed to find. The study also detected a large gap between the way students and faculty members view drugs in relation to their school. Students and faculty were asked if they thought their school grounds were drug-free. While 89 percent of principals and 65 percent of teachers responded yes, only 34 percent of students claimed their schools were drug-free. In addition, only 5 percent of principals think students drink alcohol on school grounds, compared to 33 percent of students. One-half of all high school teachers think students who use marijuana every week can still do well in school, but only 23 percent of students think a user can navigate studies as well as a non-user.

teens speak I Have Witnessed the Impact of Drugs and Alcohol I am a senior, and I have seen how many kids start out using cigarettes or alcohol thinking it’s no big deal and then find themselves using much heavier drugs and ending up addicted. A lot of them drop out of school, but the ones who try to stick with it usually end up flunking out or are suspended for some drug- or violence-related issue. For the few drug users who remain, their grades are typically bad. That is why I am really concerned that my little brother has started smoking and hanging around with a bad crowd. He is a smart kid, but he has low self-esteem. He is easily influenced by anyone who appears cool. Maybe he thinks less of himself because he is not as big and well-built as his athletic brothers, or maybe because he is the youngest in the family he feels he was treated differently. I really don’t know why he doesn’t believe in himself, all I know is that because he doesn’t, he has a tendency to connect with some shady characters.

190 The Truth About Drugs I am going to sit down and have a long talk with him about all this stuff. I am concerned though that he won’t listen to me. I have considered talking with my health teacher about the issue. Ms. Simpson has my brother in class this year. I know he respects and likes her so I think he might listen to what she has to say. She will also keep track of him and make sure he is not heading in the wrong direction. He really is a good kid, but I know if he continues down this path he will end up like the others—out of school and without a good future.

Social Activities and Drug Use

Drug and alcohol abuse also affects teen participation in extracurricular school activities such as athletics, cheerleading, academic competitions, or musical and artistic performances. SAMHSA studies have found that participation in two or more activities was highest for teens with an A average and lowest for teens with a D or less than D average. Also, teens who participated in two or more activities during the previous year were less likely than those who participated in one activity or none to have used cigarettes, alcohol, or an illicit drug. The 2002 study indicated that 16 percent of teens who took part in two or more activities during the previous year used alcohol, compared with 22 percent of those who did not participate at all or only took part in one activity. Similar results were found regarding illicit drug use and participation in teen activities. Teens who participated in one or fewer activities in the past year were twice as likely to have used an illicit drug compared with youths who participated in two or more youth activities. A 2008 study that explored the connection between extracurricular activity and drug use found similar results. The researchers found that nonathletic activities are associated with less drug use among both males and females. Athletic activities, however, seemed to increase the risk of drug use among males, but not females. However, simply participating in social or extracurricular activities does not protect a teen from exposure to drugs or alcohol. Some people believe that only certain social groups in school—often those who are shunned or considered misfits by a large percentage of students—abuse drugs and alcohol. The fact is, teen substance abuse can occur in any social group or school organization. For example,

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some school social clubs use alcohol and drugs as a part of their initiation ceremonies. Often the initiation rites that social groups perform are nothing more than hazing—physical and psychological abuse that a prospective member of the group undergoes before being admitted. Hazing is an extreme form of peer pressure, in which the abuse is typically justified as a way to show one’s loyalty to or solidarity with other members of the group. Alcohol and drugs can play a big part in hazing activities. A number of students in recent years have died as a result of alcohol poisoning or accidents caused by use of alcohol and drugs during hazing rituals. No social group is immune to hazing activities. In the past, athletic clubs were most notorious for drug and alcohol abuse, but they are no longer alone. According to a 1999 study conducted by Alfred University, members of church groups, choir groups, marching bands, and cheerleading squads all report being hazed as new members. Hazing has become a major problem in American high schools and colleges. Almost half of students who belong to student groups reported being hazed. Given the fact that 91 percent of high school students belong to at least one group, you can see that hazing is a significant problem. However, it is just one symptom of the wider problem of drug and alcohol abuse in schools. See also: Drug Abuse, Causes of; Peer Pressure and Drugs; Risk Factors and Risk Taking further reading

Brown, Waln K. Drugs and School Performance. Talahassee, Fla.: William Gladden Publishers, 2008.

■ Sexual Behavior and Drug Abuse

Intimate contact with another person including but not limited to sexual intercourse. The use of drugs and alcohol affects sexual behavior, because drugs reduce inhibitions and cloud judgment, making teens more vulnerable to faulty decision making. In its 2007 Youth Risk Behavior Surveillance System (YRBSS), the Centers for Disease Control and Prevention (CDC) reported that approximately 35 percent of U.S. teens are sexually active and roughly 7 percent had sex before

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the age of 13. About 22.5 percent of sexually active teens have used drugs and/or alcohol while engaging in sexual intercourse. Not only do alcohol and drugs cloud the decision about whether to engage in sex, but they also may affect the decision to use protection. The CDC YRBSS points out that only 61.5 percent of those teens who recently engaged in sexual intercourse reported using a condom, which means that nearly one-half of all teens are at risk of sexually transmitted diseases (STDs).

Fact Or Fiction? Drug and alcohol use is associated with increased STD transmission.

The Facts: Research has found a relationship between alcohol and other drug use and high-risk sexual behavior among heterosexuals. A teen’s high-risk sexual behavior and problem-drinking patterns were strongly predictive of self-reported sexually transmitted disease. Decisions about whether to use a condom may be influenced by drug and alcohol abuse. Teens who abuse drugs or alcohol tend to engage in more risk-taking behaviors because those substances reduce inhibitions and impair judgment and reasoning skills. The result may be a failure to consider or dismiss the importance of wearing a condom. Considering the value of condoms in preventing sexually transmitted diseases such as HIV (the virus that causes AIDS), teens cannot afford to risk a failure of judgment in such a situation.

Q & A Question: What are “beer goggles?” Answer: The phrase “beer goggles” describes the influence that alcohol and drugs have on one’s perception of another person’s appearance. Guys often use this term in a demeaning fashion. However, the term is not connected to a specific gender. Males and females equally can fall prey to the impact of drugs and alcohol on their judgment and decision-making ability. Research sponsored by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism has shown that drug and alcohol

Sexual Behavior and Drug Abuse 193 use can negatively affect a teen’s judgment about sexual (and other) behaviors, increasing the chance that users will engage in unplanned and unprotected sex. This activity can place teens at increased risk for contracting HIV and other STDs from infected sex partners. Date Rape Drugs

Recently the media has focused attention on date rape drugs, substances that are used to render a person unconscious and susceptible to rape. These drugs, which are typically slipped into a drink, leave the victim with no recollection of what happened. Date rape drugs generally fall under the heading of depressants, because they depress the functions of the central nervous system, causing symptoms such as drowsiness, dizziness, nausea, visual disturbances, and a sense of euphoria (feeling of extreme elation and well-being). Three substances are commonly identified as date rape drugs: Rohypnol, GHB (gamma-hydroxybutyrate), and ketamine. Two other less popular chemical depressants related to GHB are GBL (gamma-butyrolactone), and 1,4 butanediol, sometimes called BD. Rohypnol, which may be the most widely used date rape drug, is actually a potent tranquilizer that was developed for use as a surgical anesthetic (painkiller), muscle relaxant, or sleeping pill. It is the trade name for the drug flunitrazepam, a benzodiazepine. On the street, Rohypnol has a wide array of names, including roofies, rope, ruffies, ruffles, roche, forget-me pill, Roffies, rophies, R-2s, LaRocha, Mexican Valium, rib, roach, and roofenol. The effects of Rohypnol include muscle relaxation and a slowing of motor (muscular) response. It also decreases blood pressure, causes urinary retention, and produces an alcohol-like intoxication. The most profound effect of the drug is that it produces anterograde amnesia—the inability to remember events that take place after the drug was taken. It is this aspect of the drug that causes it to be so widely used as a date rape drug. The effects of Rohypnol kick in roughly 10–20 minutes after ingestion and last from two to eight hours. When Rohypnol is mixed with alcohol, it results in lack of inhibition along with the amnesia. The effects can last from eight to 24 hours. Rohypnol is odorless and tasteless. However, due to its unintended use as a date rape drug, the company changed the formula so a color appears when Rohypnol is dissolved in liquid. In the past, Rohypnol was undetectable in drinks. The reformulated pills now take 45 minutes to dissolve, leave a chalky film, and turn a light-colored drink

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blue. It may take some time to remove all the old formula off the streets, so teens need to be vigilant. Rohypnol is available in three different forms: as a .5-milligram oblong tablet, a 1.0-milligram tablet, and a 1.0-milligram per liter injectable solution. If someone shows signs of being drunk—dizziness, confusion, or other sudden unexplained symptoms—after drinking any beverage, chances are he or she has been drugged. If you suspect that you or someone you know has been drugged, seek medical attention immediately. Rohypnol by itself is rarely life threatening, but when mixed with alcohol it can slow certain vital functions—such as heartbeat and breathing—to dangerously low levels. Victims are at risk of coma or even death from respiratory failure. Gamma-hydroxybutyrate, or GHB, goes by a variety of street names, including liquid ecstasy, liquid X, easy lay, grievous bodily harm, saltwater, scoop, and Gamma-O. It is an odorless, colorless, liquid depressant that acts like an anesthetic. GHB acquired its reputation as a date rape drug because of the tranquility, sensuality, and loss of inhibitions it produces, particularly in women. GHB also promotes hormones that stimulate muscle growth. Bodybuilders used to take GHB, but its use has been banned since 1990 because of its side effects. At lower doses, GHB produces euphoria similar to alcohol, generating the feeling of being relaxed, happy, and sociable. At higher doses, dizziness, vomiting, and muscle spasms are possible. GHB produces symptoms of lethargy, extreme intoxication, impaired judgment, nausea, vomiting, and dizziness. It can also cause unconsciousness, depression, seizures, severe respiratory depression, and coma. Once the drug is consumed, symptoms appear within 15–20 minutes and can last two to three hours. However some effects may continue to linger for an entire day. The symptoms are more dangerous when GHB is slipped into alcohol, because both drugs depress central nervous system functioning. Symptoms such as respiratory depression and coma are a result of mixing alcohol and GHB. The combination has caused a number of deaths. One of the most dangerous aspects of GHB use is the unpredictability of dosages. Because GHB is manufactured in basements, the strength and size of a dose are inconsistent, making it unpredictable and especially dangerous. A dose that produced no serious problems one time may result in an overdose the next time. Also, a variety of factors can impact dosage including body weight and the amount of

Sexual Behavior and Drug Abuse 195

food an individual has consumed. There is no “safe” dose of GHB, and previous experience with the drug is not necessarily a reliable predictor of future experiences. Although GHB is produced primarily in liquid form, it can also be found in powder or capsule form. GHB is colorless, odorless, and has a slightly salty taste that makes it easy to mistake for a highly carbonated health drink. It dissolves easily in liquids and can be added to bottled water or hidden in other containers. The fact that it can be easily added to a drink without the victim’s knowledge increases the dangers associated with the drug. Ketamine is a relatively new date rape drug. It is a legal drug that is used as an animal tranquilizer due to its anesthetic characteristics. Ketamine has a wide array of street names, which include K, Special K, vitamin K, and Ket. Its effects have been compared to those of PCP and include hallucinations, amnesia, and dissociation—a feeling that the mind is separated from the body. Ketamine can also produce near-death experiences, depression, long-term memory and cognitive difficulties, and fatal respiratory problems. Ketamine is typically a liquid that is injected, applied to smokable material, or consumed in drinks. It can also be found as a powder or pill. HIV and Drug Abuse

In 1981 when HIV (the virus that causes AIDS) was recognized, unprotected sexual intercourse and the sharing of intravenous drug needles were identified as the two primary methods of transmission. Since those early days, much new information has been discovered about HIV. One of those discoveries identified the increased risk of infection from anabolic steroid injections. Since steroids are injected into the muscles, not the veins, the name intravenous drug use has changed to injection drug use to include steroid abuse. One fact that remains constant—sharing drug needles increases the risk of HIV/AIDs. Teen use of injection drugs nationally is minimal; less than 2 percent of teens responding to the 2007 National Institute on Drug Abuse “Monitoring the Future” study reported using heroin, the most widely abused injection drug. However, for those who do inject drugs and share needles, the risk of HIV is ever present. Sharing needles with anyone is highly risky behavior. A person can be infected with HIV and not show outward symptoms for years. In the meantime he or she transmits the virus to other people. The same scenario applies to unprotected sexual intercourse.

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Unless a blood test is performed, it’s almost impossible to know someone’s HIV status. So the rule is, always assume someone is infected and make decisions accordingly. According to the National Center on Health Statistics, AIDS killed more than 12,000 Americans in 2005. Teens need to protect themselves and the best way to do that is prevention. Sexual and Reproductive Function

Ironically, some of the drugs that increase a teen’s risk of engaging in sexual activity can also impair his or her sexual and reproductive functioning. A large number of studies have shown a link between alcohol use and sexual dysfunction. According to “Medications That May Contribute to Sexual Disorders,” a 1997 article in the Journal of Family Practice, chronic alcohol abuse can suppress normal hormonal functions such as sexual arousal. It can also reduce the size of the testes. The 2003 Health Professionals Follow-up Study reported that impotence was more common among men who drank alcohol. Drugs other than alcohol can also have a negative effect on sexual function. The 1997 article reported that cocaine use may hinder the ability to attain an erection or achieve orgasm. Like cocaine, chronic use of amphetamines also affects orgasm and erection. Barbiturates can impact sexual function as well by reducing desire and making it difficult to achieve erection or orgasm. A 1996 article, “Sexual Side Effects of Antidepressants,” that appeared in the Journal of Sex and Marital Therapy, found that antidepressant medications may also reduce sexual desire and interfere with orgasm. A 2000 study in the Journal of Clinical Psychology reported that sexual dysfunction can occur in up to half the patients treated with certain types of antidepressants. The wide range of sexual problems associated with drug use undermines the myth that using drugs enhances pleasure or is somehow “sexy.” See also: Drugs and Disease; Drugs and Drinking; Injection Drugs; Risk Factors and Risk Taking further reading

Aggleton, Peter (ed). Sex, Drugs, and Young People: International Perspectives. London: Routledge, 2006. Brown, Waln K. Drugs and Sex. Talahassee, Fla.: William Gladden Publishers, 2008.

Steroids, Anabolic 197

Plant, Moira, and Martin A. Plant. Risk Takers: Alcohol, Drugs, Sex, and Youth. New York: Routledge, 1992.

■ Steroids, Anabolic

Artificially manufactured drugs derived from the male sex hormone testosterone. Athletes have long used steroids to develop greater muscle mass and strength despite dangerous effects. In recent years, anabolic steroids have become popular among teens, especially teen athletes. What was thought to be a problem only among college and professional athletes has now become a concern in middle schools and high schools across the nation. Medical Use

Unlike many other abused drugs, steroids have medicinal value. The steroids used most frequently in medicine are cortisone and various synthetic offshoots of cortisone. These drugs are used for a variety of skin ailments, rheumatoid arthritis, asthma, allergies, and various eye diseases. Steroids can also be used to treat a malfunctioning adrenal cortex, the part of the brain that regulates the body’s response to stress. They have also been found to help treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection. (HIV is the virus that causes AIDS.) Illegal Use and Side Effects

Concern about steroid abuse grew after scientists discovered serious side effects with the drugs’ use. In 1974, this new information, along with a newly developed method of testing athletes, led the International Olympic Committee to ban the use of steroids.

teens speak I’m Built Like a Bean Pole I have never been that good in school, and my body is not what you would call developed. So I basically didn’t fit in with any group. But I recently got interested in lifting

198 The Truth About Drugs weights with a couple of my buddies. All of a sudden I feel better about myself and my confidence is the best it’s ever been. We are really committed to lifting, never missing a day. I can see the difference in my body even after only a few weeks of training. I know it will take time and effort but I am willing to pay the price. Not long after we began training, one of my lifting buddies showed up with a pill that he says will help us get bigger and stronger faster. The pill is a steroid, and he told us it is harmless and said if we really want to get really big we can “stack” steroids. I wasn’t totally sure about this, so I went to talk with Coach Smith. She told me that “stacking” is when two or more anabolic steroids are taken together. People who stack mix oral and injection steroids and sometimes add drugs like stimulants or painkillers. She said the idea behind stacking is an unproven belief that the different drugs interact to produce a greater effect on muscle size. She also said we needed to be careful because steroid use had some really nasty side effects. It can cause acne, reduce a guy’s sperm count, shrink the testicles, lead to impotence, result in difficulty or pain in urinating, baldness, and even irreversible breast enlargement. She said that the long-term effects can include cancer and possibly heart attacks and strokes. After hearing the facts and doing some soul-searching, I told my buddies they can do what they want, but I want to do this on my own—not the cheater’s way by using steroids. I may not get as big as fast but I will have done it on my own. That makes me feel good.

Despite the ban, steroid abuse continues to be a problem in international sports. Athletes are regularly accused of using performanceenhancing steroids at not only the Olympic Games but also other athletic competitions. In the 1998 Los Angeles Olympics, 100-meter dash champion Ben Johnson was disqualified after he failed a test for steroids. In 2004, the United States government launched an investigation into steroid use in major league baseball. In 2008, U.S. Olympic star Marion Jones was forced to forfeit her medal after admitting that she used steroids prior to the 2000 Olympic Games. With the enormous salaries paid to many professional athletes, some seem to think the benefits of steroid use may be worth the risk.

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It is not. While athletes who use steroids gain an unfair advantage in competitions, the advantage comes at a high price. Steroids have been shown to produce serious psychological and physiological side effects, including increased aggressive behavior and cancer of the liver. The National Institute on Drug Abuse (NIDA) points out that in male teens, anabolic steroid abuse can reduce sperm production, shrink the testicles, and cause impotence and irreversible breast enlargement. In female teens, the development of secondary masculine characteristics such as deepening of the voice and excessive body hair may occur. Anabolic steroids may also stunt bone growth and cause permanent damage to the heart, liver, and kidneys. Those who inject anabolic steroids and share the needles increase their chances of developing HIV and other blood-borne infections. The practice of shooting up steroids actually caused health officials worldwide to change the name of a key mode of transmission for HIV and AIDS. Because steroids are injected into the muscle—and not intravenously, as many illegal drugs are—the designation intravenous drug use was changed to injection drug use to include the risk of HIV from the sharing of steroid needles. The threat to teens from anabolic steroid abuse is real, and teens seem to be getting the message. NIDA has been collecting information about the use of the drug among students for 25 years. Its 2007 “Monitoring the Future” study showed a decrease in anabolic steroid use among eighth and 12th graders and no increase among 10th graders. The survey discovered that roughly 2 percent of eighth, 10th, and 12th graders had taken anabolic steroids at least once in their lives. These statistics show a significant decrease from the 2002 survey, when 4 percent of 12th graders and 3.5 percent of 10th graders reported using steroids. A comparison of the 2002 and 2007 studies also showed that about the same number of 12th graders in 1999 believed that taking steroids is risky behavior. However, the figure was down from the previous year, when 60.2 percent believed that taking steroids is risky. This is a particularly troubling development, because perceived risk indicates how seriously teens regard the threat posed by a particular substance. A decline in the perceived risk of a substance is typically followed by an increase in its use. Social Issues

American society places a high regard on body image and many teens will spend large sums of money and take drastic measures to improve

200 The Truth About Drugs

their physical appearance. This obsession has increased substantially the number of teens battling eating disorders and having plastic surgeries and breast augmentations. In 2003 the Society for Adolescent Medicine reported that the eating disorder anorexia nervosa was the third most common chronic illness in adolescent women. Victims of anorexia are dangerously thin and obsessively concerned about their weight. About 90 percent of reported cases of eating disorders are in females, but the rate for males seems to be increasing. However, males who have concerns about body image typically want to build up their muscles and are thus more likely to abuse steroids. Although some females use steroids, their use is more common among males. As the science behind muscular development and performance enhancement evolves, researchers are introducing new techniques that provide athletes with opportunities to reach optimum performance without steroids. The truth is, it takes hard work to achieve optimum performance no matter what method is used. Those who wish to do so should consider taking the following steps: ■ Decide

on a realistic goal. ■ Research nutritional plans and workout schedules to fit that goal and your time schedule. ■ Include time for mental and spiritual development. A stress management course or a mental imagery program may also be valuable. ■ Plan your time; develop a reasonable schedule, especially in the beginning, when new habits need to be developed and old ones broken. ■ Work your plan. Do not let yourself be sidetracked. The beginning is always the toughest. Sticking with any plan requires discipline and self-control. ■ Establish a fitting reward; rewards that can be earned on a weekly or monthly basis are great motivators in addition to a big reward when the overall goal is achieved. It matters little if the goal is trying to reach the Olympics or just to get in better physical shape. To accomplish each step in a plan requires dedication, self-discipline, and motivation. Many athletes find it helpful to train with a partner. Having someone to keep you on track on a day when your motivation is low is valuable. A partner also makes following the plan more fun.

Workplace Drug Abuse 201

See also: Drugs and Disease; Injection Drugs; Media Messages and Counteradvertising Campaigns

■ Suicide and Drugs

See: Depression and Drugs; Drugs and Drinking; Morbidity and Mortality

■ Synthetic Drugs

See: Club and Designer Drugs

■ Treatment Programs

See: Rehabilitation and Treatment

■ Withdrawal

See: Rehabilitation and Treatment

■ Workplace Drug Abuse

Use of illegal drugs while on the job. Drug abuse in the workplace is a real problem in the United States. For example, coworkers may have to work harder to pick up the slack for workers who are using drugs. Absenteeism may rise, requiring employers to add staff to cover for absent employees. Also, those who take drug utilize health benefits more frequently than other employees, raising insurance rates for everyone. In addition, roughly half of all workplace accidents are drugrelated. Because of higher turnover rates among drug abusers, employers find themselves having to assume the additional cost of replacing workers more often. As these costs mount, company profits decline. Teens often underplay the seriousness of using drugs or alcohol on the job. However, even a simple task like climbing a ladder can result in serious injury if someone trips because he or she is “high.” The chances of getting hurt increase substantially when attempting more dangerous tasks such as operating power equipment. Even if a workplace accident is not life threatening, it can create significant hardships. Breaking an arm or leg on the job because of an accident

202 The Truth About Drugs

caused by being high on drugs or alcohol can ruin a summer or force someone to drop out of athletics or other activities. Incidence and Cost of Workplace Substance Abuse

In 2007, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that about one in 12 full-time workers in the United States currently uses illicit drugs and about one in 11 drinks heavily. In the study, “Worker Substance Use and Workplace Policies and Programs,” researchers reported data from 2002–2004 showing that illicit drug use and heavy alcohol use are associated with higher levels of absenteeism and frequent job changes. Nearly twice as many illicit drug users skipped one or more days of work in the past month compared with workers who did not abuse drugs. Drug users were also more likely to report missing two or more work days in the past month due to illness or injury. The report found the highest rates of illicit drug use among the food service workers (17.4 percent) and construction workers (15.1 percent). The highest rates of current heavy alcohol use were found among construction, mining, excavation, and drilling workers (17.8 percent) and installation, maintenance, and repair workers (14.7 percent). Occupations with the lowest incidence of substance abuse included police and firefighters (3.4 percent) and community workers and social service providers (2.8 percent). Alcohol, marijuana (an illicit drug that alters mood and distorts the way the user experiences sight, sound, or other senses), and cocaine (an illicit drug that increases energy and alertness and elevates confidence) are the drugs most frequently abused in the workplace and therefore cause the greatest problems. SAMHSA reports that substance abusers are 33 percent less productive than sober workers. The average substance abuser costs his or her employer $7,000 in lost productivity each year. In 2002, productivity losses attributed to substance abuse reached an estimated $180 billion. Workplace accidents are far more common among drug and alcohol abusers than among other workers. Workplace drug abusers are 3.6 times more likely to suffer a work-related injury and five times more likely to file a worker’s compensation claim. Between 38 and 50 percent of all worker’s compensation claims are related to drug or alcohol abuse. Forty percent of fatal industrial accidents involve alcohol abuse.

Workplace Drug Abuse 203

Less noticeable risks of drug and alcohol abuse also can have an impact on a company’s productivity and profitability. Such risks include low morale, increased absenteeism among nonabusers, and high illness rates. These conditions often arise when an employer is aware of drug or alcohol abuse by an employee but does nothing to address the problem. Employees who do not abuse drugs or alcohol begin to question whether the employer values hard work and dedication in his or her employees. The reality of the problem was brought home in a 1998 article, “New Perspectives for Worksite Alcohol Strategies: Results from a Corporate Drinking Study.” The study revealed that roughly 20 percent of American workers claimed that they needed to work harder or redo work because of work done incorrectly by a colleague who abused drugs. They also reported covering for a coworker’s poor performance due to substance abuse or being exposed to danger or injury as a result of a fellow employee’s drinking. Drug-Free Workplaces

The Drug-Free Workplace Act of 1988 requires that all businesses receiving federal funds provide a drug-free workplace. Under the law employers are required to: ■ Inform

employees in writing that making, buying, selling, possessing, or using illegal drugs is prohibited in the workplace. The statement should also state the actions that will be taken against employees who violate the policy. ■ Establish a program to make employees aware of the dangers of drug abuse in the workplace, the policy of maintaining a drug-free workplace, available drug counseling, rehabilitation, and employee assistance programs, and penalties for drug abuse violations. ■ Notify employees that they must abide by the terms of the policy statement and let their employer know within five days if they have been convicted of a drug violation in the workplace. ■ Notify the federal government that an employee has been convicted of a criminal drug violation in the workplace within 10 days of receiving notice of the violation.

204 The Truth About Drugs ■ Penalize

the employee or require him or her to participate in a drug abuse assistance or rehabilitation program. ■ Make an ongoing, good-faith effort to maintain a drugfree workplace by meeting the requirements of the act. To ensure a drug-free workplace, many employers have instituted preemployment drug testing, as well as routine spot testing for drug use among current employees. American companies spent an estimated $1 billion in 1998 on drug testing. A 2006 study by the Society for Human Resources Management found that 84 percent of private sector firms tested new hires for drug use, and 39 percent conduct random screenings of employees. Industries that tested over one-half of new hires for drug use included transportation and material moving and protective services. By contrast, workers in the legal field and the arts, design, sports, entertainment, and media were much less likely to be tested. Preemployment drug testing is not the only way companies try to lower rates of drug and alcohol abuse among their employees. Other methods include providing employees with information about the dangers of drugs and alcohol abuse, following written policies on abuse to the letter, and offering assistance to employees who have did you know?

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Workplace Drug Abuse 205

addictions. Although these actions may seem minor, they can have a considerable impact on workplace drug use. There is some evidence that these efforts are succeeding. The rate of positive drug tests among the U.S. workforce has declined steadily since the late 1980s. According to the drug testing firm Quest Diagnostics, positive drug test ratings fell from nearly 14 percent in 1988 to just over 4 percent in 2005. Marijuana was the most common illicit drug discovered during testing, comprising more than half of all positive tests. Cocaine (about 14 percent) and amphetamines (about 10 percent) were the next most often abused drugs. Drug testing laws are constantly changing. Because of changes in regulations, employers and employees alike need to continually monitor these laws. The federal laws that impact drug testing include the National Labor Relations Act, Title VII, and the Americans with Disabilities Act. Among the other laws that deal with workplace drug use are the Family and Medical Leave Act, workers’ compensation statutes, unemployment compensation statutes, and federal privacy laws. State guidelines also need to be considered. With all these laws involved, it’s easy to see why drug testing is so complicated. See also: Law on Drugs, The; Morbidity and Mortality; Risk Factors and Risk Taking

Hotlines and Help Sites Alateen URL: http://www.al-anonalateen.org Phone: 1-888-4AL-ANON (8 a.m.–6 p.m. ET, Mon.–Fri.) Affiliation: Part of Al-Anon, an organization of relatives and friends of alcoholics Mission: To help young people deal with problems of alcohol in their families or among friends Program: Provides regular meetings of young people to discuss their problems and help each other to face them Alcohol Treatment Referral Hotline Phone: 1-800-ALCOHOL (24 hours a day, 7 days a week) The CDC National AIDS Hotline Phone: 1-800-342-AIDS (24 hours/7 days); 1-800-344-SIDA (Spanish) (8 a.m.–2 p.m., 7 days); 1-800-AIDS-TTY (TDD) (10 a.m.– 10 p.m., M–F) Affiliation: Centers for Disease Control and Prevention, an agency of the federal government Program: Trained specialists offer anonymous, confidential HIV/AIDS information, answer questions about HIV/AIDS, and provide referrals to appropriate services and service agencies throughout the United States Center for Substance Abuse Treatment URL: http://csat.samhsa.gov Phone: 1-800-662-HELP (English and Spanish); 1-800-457-4889 (TDD) (24 hours a day, 7 days a week) 207

208 The Truth About Drugs

Affiliation: U.S. Department of Health and Human Services Mission: To develop and promote better treatment for substance abuse Cocaine Anonymous URL: http://www.ca-online.org Mission: To help cocaine users break their addiction through mutual help and support Program: 12-step treatment program for cocaine addiction Cocaine Hotline Phone: 1-800-COCAINE (24 hours a day, 7 days a week) Freevibe URL: http://freevibe.com Affiliation: National Youth Anti-Drug Media Campaign Mission: To provide information to young people about alcohol and drugs and help kids find alternative interests and activities Intervention Center URL: http://www.intervention.com Mission: To assist family and friends in confronting addicts and persuading them to break their addictions Program: Provides interventional resources for substance abuse, eating disorders, gambling, computer addiction, and other selfdestructive behavior Marijuana Anonymous URL: http://www.marijuana-anonymous.org Phone: 1-800-766-6779 Mission: To help marijuana users break their addiction through mutual help and support Program: 12-step program for treating marijuana addiction National Council on Alcoholism and Drug Dependence URL: http://www.ncadd.org Phone: 1-800-NCA-CALL (24 hours a day, 7 days a week) Program: Provides public education and information about alcohol and drug abuse, treatment, and recovery

Hotlines and Help Sites  209

Narcotics Anonymous World Services URL: http://www.na.org Phone: 1-818-773-9999 Program: 12-step program for treating drug addiction Sober Recovery URL: http://www.soberrecovery.com Mission: To provide resources for those seeking help from alcoholism, addiction, and mental health issues Program: Offers an online list of rehabilitation and treatment centers, sober living houses, recovery-related Web sites, and referrals and information for treatment programs for adults or adolescents

GLOSSARY abstinence   the practice of refraining from a behavior, especially risky behavior such as alcohol, tobacco, or drug use accidental overdose   a dangerously large dose of a drug taken by mistake AIDS  (acquired immune deficiency syndrome)   medical condition in which the body’s immune system is so weakened that even mild infections can cause serious illness or death amphetamines   synthetically produced stimulants that improve alertness, reduce fatigue, and elevate mood antianxiety drugs   prescription drugs used to reduce anxiety and nervousness antidepressants   prescription drugs that prevent or relieve depression barbiturates   prescription drugs that depress the central nervous system; used to treat anxiety, tension, and sleep disorders bipolar disorder   a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function; also known as manicdepressive illness central nervous system   the part of the nervous system consisting of the brain and spinal cord 211

212 The Truth About Drugs

cocaine   illicit drug, derived from the coca plant, that increases energy and alertness and elevates self-confidence codependence   condition in which a person close to a substance abuser behaves in ways that unconsciously support the user’s habit date rape drug   drug administered without the user’s consent that causes unconsciousness and makes the victim helpless against sexual assault delinquency cases   crimes in which a juvenile is treated as an adult under the law delusions   persistent beliefs that have no basis in reality depressants   drugs, including alcohol, tranquilizers, and inhalants, that slow the functioning of the central nervous system, causing relaxation, drowsiness, and loss of motor control designated driver   a person who remains sober to provide safe transportation for people who are drinking or using drugs designer drugs   synthetically produced illicit substances that produce a wide range of drug effects; also called club drugs detoxification   the process of gradually removing a drug from an addict’s system drug psychosis   a loss of touch with reality produced by an adverse drug reaction euphoria   a feeling of extreme elation and well-being felony   a serious crime, such as murder or arson, punishable by one year or more in a state or federal prison forfeiture   the seizure of assets believed to have been acquired through the trafficking or sale of drugs

Glossary  213

gateway drugs    substances whose use is believed to lead to the abuse of other drugs; alcohol, tobacco, and marijuana are considered the main gateway drugs hallucinations    false or distorted perceptions caused by the use of some drugs hallucinogenic    capable of producing false or distorted perceptions hallucinogens    illicit drugs whose main effect is to produce hallucinations hepatitis    an infectious disease that can cause serious liver damage; often spread through sharing of injection drug equipment heroin    illicit drug derived from the Asian poppy that causes drowsiness, relieves pain, and produces euphoria HIV (human immunodeficiency virus)    virus that attacks the body’s immune system and causes AIDS (acquired immune deficiency syndrome); frequently spread through sharing of injection drug equipment intentional overdose    a dangerously large dose of a drug taken deliberately, typically as a means of committing suicide intravenous drugs    drugs administered by injection into a vein juvenile    legal term for a person under the age of consent; in most states, a person under 18 years of age legally drunk    having a blood alcohol concentration of 0.10 grams of alcohol per deciliter of blood LSD (lysergic acid diethalymide)    widely used synthetic hallucinogen; also known as acid marijuana    illicit drug derived from the plant cannabis sativa that produces relaxation, alters mood, and distorts the way the user experiences sight, sound, or other senses

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mental illness   medical disorder that can cause distressful effects ranging from mild sleep problems or relationship troubles to drug addiction or suicide mescaline   a mind-altering drug in the form of a white, crystalline powder methamphetamines   family of illicit nervous system stimulants that are related to amphetamines and which have similar but much more intense effects neurons   nerve cells neurotransmitters   chemical substances that transmit impulses from one nerve cell to another opiates   family of drugs derived from the Asian poppy that includes opium, morphine, and heroin paranoia   extreme and unreasonable feelings of persecution PCP  (phencyclidine)   powerful illicit central nervous system depressant originally used as an anesthetic; also known as angel dust physical dependence   dependence on a substance for normal physical or psychological functioning prescription drug   drug whose use is legal only when prescribed by a medical professional psychoactive   having a profound or significant effect on mental processes psychological dependence   intense craving for a drug that is not accompanied by physical dependence psychosis   a mental disorder characterized by loss of touch with ­reality

Glossary  215

schizophrenia   a mental disorder that causes a separation between the thought processes and the emotions sedative   drug used to induce sleep or unconsciousness self-talk   the things one says to oneself about one’s own competence, skills, and self-image sexually active   currently participating in sexual behavior sexually transmitted diseases (STDs)   diseases transmitted widely or primarily by sexual contact social skills   ability to make friends, deal successfully with other people, and set appropriate limits on your own behavior stimulant   drug, such as caffeine, nicotine, amphetamines, or cocaine, that tends to elevate mood, and increase alertness and energy street sales   sales of small amounts of illicit drugs to individual users tolerance   the need to use larger doses of a substance to produce the desired effect trafficking   the transport and sale of large amounts of illicit drugs to drug dealers tranquilizer   drug intended to make the user calm or incapable of physical resistance trigger   the act of setting off or initiating withdrawal   a condition caused by stopping the use of a drug and marked by adverse physical reactions such as nausea, sweating, and convulsions

Index Boldface page numbers indicate extensive treatment of a topic.

A AA (Alcoholics Anonymous) 176, 177–178 AAP (American Academy of Pediatrics) 62, 148, 150–151 academics 186–191 acetaminophen 159 acquired immunodeficiency syndrome. See AIDS. See also human immunodeficiency virus (HIV) ADAM (Arrestee Drug Abuse Monitoring Program) 25 Addiction 169 addiction, biology of 11–16. See also drug abuse, causes of action of drugs 11–12 genetics 15–16 neurochemistry 12–15 addiction and dependence 31–35 codependence 34–35, 103–104 and inhalants 128 marijuana 143 types of dependence 31–33 Addison’s disease 37 AIDS 64, 144, 197 Al-Anon 178 Alateen 178, 207 alcohol. See drinking and drugs Alcoholics Anonymous (AA) 176, 177–178 Alcohol Treatment Referral Hotline 207 Alexander the Great 91 American Academy of Child and Adolescent Psychiatry 182 American Academy of Pediatrics (AAP) 62, 148, 150–151

American Association of Retired People 145 American Journal of Psychiatry 150 American Journal of Respiratory and Critical Care 64 Americans with Disabilities Act 205 amphetamines about 123 and crime 51, 75 and detoxification 175–176 drug schedules 136 effects 121 history 93–94 as intravenous drug 130 and neurochemistry 13 overdose of 166 over-the-counter 159 and psychosis 69 and sexual dysfunction 196 and workplace drug abuse 205 amyl nitrate 122–123, 128 anabolic steroids 130, 166, 197–201 analgesics 159 Annals of the New York Academy of Sciences 58, 61, 63 Annenberg Public Policy Center 171 anorexia 66, 200 antidepressants about 38–39, 161 and alcohol/drugs 69 and neurochemistry 14 overdose of 165 and sexual dysfunction 196 and St. John’s Wort 157–158 Anti-Drug Abuse Act 28, 135–136 Anti-Drug Law (1988) 137 Archives of Pediatric and Adolescent Medicine 148

217

218 The Truth About Drugs Arrestee Drug Abuse Monitoring Program (ADAM) 25 aspirin 159–160, 167 athletes 197–199 Atlantic Monthly 104 attention deficit disorder 45, 123 automobile accidents. See driving under the influence of drugs

B

barbiturates 14, 74, 122, 136, 196 Baudelaire, Charles 87 Bayley Mental Development Index 61 Behavioral Neuroscience 37 Behavioral Psychiatry 62 Bell, John 87 Benzedrine 123 benzoamphetamine 123 benzodiazepines 14, 19–20, 155, 161 beta-endorphin 77 Biggar, Robert J. 70 biology of addiction 11–16 bipolar disorder 37, 39, 161 BJS. See Bureau of Justice Statistics (BJS) Bloom, Martin 91 Bonaparte, Napoleon 87 British Medical Journal 64, 148 Bureau of Justice Statistics (BJS) crack cocaine 27–28 crime 51–52, 74–75, 105 homicide 113–115 law enforcement 139–140 butanediol 193

C

caffeine 156–157, 159 Cancer Epidemiology 63 Cannabis sativa. See marijuana Capone, Al 135 car accidents. See driving under the influence of drugs CASA 79–80 CBT (cognitive-behavioral therapy) 177 CDC. See Centers for Disease Control and Prevention (CDC) CDC National AIDS Hotline 207 Center for Substance Abuse Prevention 64, 150 Center for Substance Abuse Treatment 207–208 Center on Addiction and Substance Abuse (CASA) 79–80 Centers for Disease Control and Prevention (CDC) contact information 150 crime statistics 52, 54 driving under the influence of drugs 40–41, 42, 74

firearms 113 hepatitis 72 HIV/AIDS 70, 132, 133 inhalants 129 morbidity and mortality 147, 154 National AIDS Hotline 207 overdose, drug 167 sexual behavior and drug abuse 191–192 smoking 76–77 Central Intelligence Agency (CIA) 28, 96–97 Child Trend Data Bank 116 chromatography 81–83 chronic obstructive pulmonary disease (COPD) 64 CIA (Central Intelligence Agency) 28, 96–97 Clinical Perinatology 62 Clinics in Perinatology 58 club and designer drugs 16–22. See also individual drugs about 121–122 date rape drugs 21–22 ecstasy 17–18 GHB (gamma-hydroxybutyrate) 18–19 history 94 ketamine 20 overdose of 166 production 75 rohypnol 19–20 Clubdrugs 150 Coca-Cola 90 cocaine. See also crack cocaine about 119–120 absorption of 11 and aggression 75, 113 and cigarettes 79–80 and crime 51–52, 55 dependence on 32–33 and detoxification 175–176 and development 57–59 drug schedules 136 and ecstasy 18 gang sales of 110, 116 among high school students 105 history 88–90 and HIV/AIDS 121 international trends 97, 99 as intravenous drug 130 and law on drugs 134, 138–139 and neurochemistry 13 overdose of 166 and pregnancy 101 and psychosis 69 and sexual dysfunction 196 and suicide 39 testing for 81 and workplace drug abuse 202, 205

Index  219 Cocaine Anonymous 208 Cocaine Hotline 208 codependence 34–35, 103–104, 179 cognitive-behavioral therapy (CBT) 177 color tests 81 communities, families, and drug abuse 101–109 computer games, influence of 149 Controlled Substances Act 136 COPD (chronic obstructive pulmonary disease) 64 counteradvertising campaigns 146–152 crack cocaine 22–31. See also cocaine about 120 and crime 52 description and effects 22–24 and development 57–59 effects on communities 104 epidemic of 26–28 and gang activity 110, 114, 116 history 90 incidence of use 24–25 law enforcement responses to 28–30 and law on drugs 135, 139 overdose of 166 criminal activity and drugs 50–56. See also homicide; law on drugs about 74–75 drug abusers as perpetrators of crime 51–54 drug abusers as victims of violence 54 illegal drug trade 55–56 cultural influences 184–186 Cushing’s disease 37

D

Dark Alliance: The CIA, the Contras, and the Crack Cocaine Explosion (Webb) 28 date rape drugs 21–22, 75, 122, 193–195 DAWN (Drug Abuse Warning Network) 23, 27, 152–153, 154–155 DBSA (Depression and Bipolar Support Alliance) 161 DEA. See Drug Enforcement Administration (DEA) death rates. See morbidity and mortality delinquency cases 140 delusions 66, 68, 166 demographics 27, 49, 111, 183–186 dependence and addiction 31–35 codependence 34–35, 103–104 and inhalants 128 marijuana 143 types of dependence 31–33 depressants. See also individual drugs and club drugs 17 and depression 38 GHB (gamma-hydroxybutyrate) 122

overdose of 165–166 and psychosis 69 Rohypnol 122 depression 35–39. See also disease and drugs and alcohol 74 and drug abuse 46, 69 and stimulants 159 suicide 39 symptoms and risk factors 35–38 treating 38–39 Depression and Bipolar Support Alliance (DBSA) 161 designer drugs. See club and designer drugs desipramine 175 detoxification 174–176 development and drugs 56–68 cocaine and crack cocaine 57–59 fetal alcohol syndrome (FAS) 60 heroin and opiates 60–62 impact of drug use 67 marijuana 62–64 methamphetamine 64–67 pregnancy 57, 101 Dexedrine 123 dextroamphetamine 123 disease and drugs 68–73. See also depression drug psychosis 68–69 hepatitis 71–73 HIV/AIDS 70–71 domestic violence 53–54, 101–102 dopamine 13, 14–15, 77 Drake, Robert 102 Dreser, Heinrich 92 drinking and drugs 73–76. See also driving under the influence of drugs and crime 51, 53–54 and domestic violence 102 as gateway drug 34 and GHB 19 legally drunk 41, 42 and neurochemistry 14 overdose of alcohol 166 and suicide 39 and workplace drug abuse 202 driving under the influence of drugs 39–43. See also drinking and drugs deaths and injuries 40–41. See also morbidity and mortality legal issues 42–43, 138 legally drunk 41, 42 passengers, teenage 74 drug abuse, causes of 43–50. See also addiction, biology of and crime 54 family and peers 47–49 psychological health 45–46

220 The Truth About Drugs social skills 45 society 49–50 Drug Abuse Warning Network (DAWN) 23, 27, 152–153, 154–155 drug cartels 55–56 drug counseling. See depression; rehabilitation and treatment drug dealing. See trafficking drugs Drug Enforcement Administration (DEA) 26–28, 55, 136, 137, 138 Drug Free America 150 Drug-Free Workplace Act 203 drug laws. See law on drugs drug schedules 136 drug testing 80–84 chromatography 81–83 color and microcrystalline tests 81 prevalence and effectiveness 83–84 process 80–81 in workplaces 204–205 drug use, history of 85–94 cocaine 88–90 heroin/opium 91–93 marijuana 85–88 synthetic drugs 93–94 drug use, international 95–100 consumption 98–99 production 96–97 shipment and financing 97–98 trends 99–100 DUI. See driving under the influence of drugs

E

eating disorders 66, 200 ecstasy about 17–18, 121 and crime 55 and development 67 and neurochemistry 13 overdose of 166 and psychosis 69 Elizabeth I (queen of England) 91 EMCDDA (European Monitoring Centre for Drugs and Drug Addiction) 95–96 endogenous opioids 13, 15 epilepsy 14 euphoria 23, 120, 128, 193 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 95–96 extracurricular activities 190–191

F

fact or fiction alcohol and teenagers 74 automobile accidents 40–41

crack cocaine 28 cultural influences 184–185 depression 38 designer drugs 19 drug abuse 47 drugs and development 67 drug testing 84 fear messages 107 forfeiture 138 gang activity 111 history of drug use 92–93 HIV/AIDS 70 homicide 113–114 inhalants 129 marijuana 145 media and drugs 146 menthol cigarettes 79 mortality rates, teenage 56 over-the-counter drugs 160–161 peer pressure 172–173 sexually transmitted diseases (STDs) 192 families, communities, and drug abuse 101–109 community and drug abuse 104–108 families and drug abuse 101–104 influence of families and communities 47–49, 182–185 Family and Medical Leave Act 205 FAS (fetal alcohol syndrome) 60 FBI (Federal Bureau of Investigation) 56, 137 FDA (Food and Drug Administration) 161 FDSS (Federal Drug Seizure System) 137 Federal Bureau of Investigation (FBI) 56, 137 Federal Bureau of Narcotics 88 Federal Drug Seizure System (FDSS) 137 Federal Judicial Center 29 fenfluramine hydrochloride 123 fetal alcohol syndrome (FAS) 60 financial aspects of drug abuse. See also demographics and law on drugs 137–140 for schools 188–189 workplace drug abuse 201, 202–203 firearms 52, 112, 113, 116 flunitrazepam. See rohypnol Food and Drug Administration (FDA) 161 forfeiture 137–138 Freevibe 208 Freud, Sigmund 90

G

GABA (gamma-aminobutyric acid) 14, 15 Gallup opinion poll (2000) 103 gamma-aminobutyric acid (GABA) 14, 15

Index  221 gamma-butyrolactone (GBL) 193 gamma-hydroxybutyrate 18–19, 94, 122, 193–195 gangs and drugs 109–112. See also homicide drug abuse in 111–112 homicide 112, 114–116 trafficking drugs 54, 75, 110–111 gastroschesis 66 gateway drugs 34, 73, 88, 188 Gautier, Pierre 87 GBL (gamma-butyrolactone) 193 gender and crime 52, 54 and driving 40–41 and drug abuse 44 and HIV/AIDS 70 and morbidity/mortality rates 155 General Cognitive Index 61 genetics and addiction 15–16 GHB (gamma-hydroxybutyrate) 18–19, 94, 122, 193–195 Gibson, Arthur 88 ginseng 156–157 Global, The 95 gonorrhea 71 guns 52, 112, 113, 116

H

Hale, Thomas 62 hallucinations about 68 and ecstasy 17, 121 effect of overdose 166 and inhalants 128 and LSD 93 and methamphetamine 66 and stimulants 159 and withdrawal 31–32 hallucinogens 17, 75, 124, 166. See also individual drugs Harrison Narcotic Act 134 hashish 142 hazing 191 hepatitis 68, 71–73, 119, 121, 132–133 heroin about 120–121 among high school students 105 and crime 51, 75 dependence on 32–33 and development 60–62 drug schedules 136 gang sales of 110 history 91–93 as intravenous drug 130 and law on drugs 134, 138

and neurochemistry 13 in Plano, Texas 184 Hippocrates 91 history of drug use 85–94 HIV. See human immunodeficiency virus (HIV) Homer 86 homicide 112–116. See also criminal activity and drugs; gangs and drugs crimes committed in trafficking 114–116 crimes committed under the influence 113–114 gang-related 112 rates 116 risks to users 116 hormones 37 human immunodeficiency virus (HIV). See also acquired immunodeficiency syndrome (AIDS) about 68, 70–71, 195–196 and cocaine 119, 121 and heroin 121 and injection drugs 130–133, 199

I

ibuprofen 159 illegal drugs, common 117–126 amphetamines 123 amyl nitrate 122–123 barbiturates 122 club and designer drugs 121–122 cocaine 119–120 hallucinogens 124 heroin 120–121 marijuana 117–119 PCP 124–126 incarceration 140 inhalants 127–130, 155 injection drugs 130–133. See also specific drugs and hepatitis 71–73 and HIV/AIDS 70, 195 international drug use 95–100 International Olympic Committee 197 Internet 149–150 Intervention Center 208 intramuscular drugs 130 intravenous drugs 130–133 isobutyl nitrite 128

J

Jones, Marion 198 Journal Archives of Internal Medicine 79 Journal of Clinical Psychology 196 Journal of Developmental and Behavioral Pediatrics 66

222 The Truth About Drugs Journal of Family Practice 196 Journal of Nervous and Mental Disease 102 Journal of Neural Transmission 19 Journal of Neuroscience 19 Journal of Physiology 59 Journal of Sex and Marital Therapy 196 Journal of Studies on Alcohol 54 Journal of the American Medical Association 24, 57–58, 63 Journal of the Royal Society of Medicine 147 juvenile offenders. See law on drugs

K

Kaltenbach, Karol 60 ketamine 20, 94, 121, 193, 195 Koller, Karl 90

L

LaBorde, Pamela 111–112 Lancet 37 law on drugs 133–141. See also criminal activity and drugs; specific laws crack cocaine 28–30 and driving 42–43 enforcement costs 137–138 laws and enforcement 133–137 legal costs 138–140 punishment 140–141 laxatives 160–161 Leary, Timothy 93 legally drunk 41, 42. See also drinking and drugs Leo XIII (pope) 89–90 Leshner, Alan 177 LifeRing 179 liquid ecstasy. See GHB (gammahydroxybutyrate) Lovox 39 LSD about 124 among high school students 105 dependence on 32–33 drug schedules 136 history 93 and law on drugs 135 and neurochemistry 13 overdose of 166 and psychosis 69 lysergic acid diethylamide. See LSD

M

mainlining. See injection drugs Mantegazza, Paolo 89 MAOIs 14 Marco Polo 86

Mariani, Angelo 89 marijuana 141–146 about 117–119 active ingredients and effects 142–143 among high school students 105 and cigarettes 79–80 and crime 51–52, 75 current use 143–144 dependence on 32–33 and development 62–64 and driving 41 and ecstasy 18 gang sales of 110, 116 history 85–88 international trends 96, 98–99 and law on drugs 135, 138–139 medical uses 144–145 mentioned 153 overdose of 167 peer pressure 170 and pregnancy 101 and psychosis 69 and school performance 186–188 testing for 81 and workplace drug abuse 202, 205 Marijuana Anonymous 208 Marquis test 81 Mayes, Linda 101 McElhatton, Patricia R. 67 MDMA. See ecstasy Mebaral 122 media and drugs 146–152 computer games 149 Internet 149–150 music and videos 148–149 overcoming the influence of media 151 TV and movies 146–148 medical uses of drugs amphetamines 93 cocaine 89–90 GHB (gamma-hydroxybutyrate) 94 marijuana 85–87, 144–145 opium/heroin 91–92 steroids, anabolic 197 Medications and Mother’s Milk (Hale) 62 menthol cigarettes 79 mephobarbital 122 mescaline 13 methadone maintenance 179 methamphetamines about 123 absorption of 11 and aggression 113 and development 64–67 gang sales of 110, 116

Index  223 history 93–94 overdose of 166 production of 75 methylenedioxymethamphetamine. See ecstasy methylphenidate 123 microcrystalline tests 81 Moderation Management 179 Monardes, Nicolas 89 money laundering 98 “Monitoring the Future” study amyl nitrate 123 crack cocaine 25, 90 drug use, trends in 1, 3, 116, 153 ecstasy 18 GHB (gamma-hydroxybutyrate) 19 marijuana 88 peer pressure 173 smoking 78 steroids, anabolic 199 morbidity and mortality 152–155 causes of death 154–155 death rates 153–154 injuries and illnesses from drug abuse 152–153 and overdose 165 populations most affected 155 and suicide 39 Morbidity and Mortality Weekly Report 52 morphine about 60 drug schedules 136 history 91–92 mentioned 120 and neurochemistry 13 mortality rates. See morbidity and mortality Motion Picture Association of America 146 Motor Development Index 61 murder. See homicide music, influence of 148–149

N

NAHIC (National Adolescent Health Information Center) 39 naltrexone 175, 177 narcotics 155, 165 Narcotics Anonymous World Services 209 National Adolescent Health Information Center (NAHIC) 39 National Cancer Institute 37 National Center on Addiction and Substance Abuse 53, 101–102, 162, 188–189 National Center on Health Statistics 196 National Clearinghouse for Alcohol and Drug Information 186

National Commission on Marihuana and Drug Abuse 85, 142 National Comorbidity Survey 39 National Council on Alcoholism and Drug Dependence 208 National Crime Victimization Survey 104–105 National Drug Strategy Monograph Series 63 National Highway Traffic Safety Administration (NHTSA) 41–42 National Household Survey on Drug Abuse 27 National Institute of Justice 25, 75 National Institute on Alcohol Abuse and Alcoholism 166, 192–193 National Institute on Drug Abuse (NIDA) alcohol 73, 74 contact information 150 crack cocaine 23 cultural influences 184–186 dependence on drugs 31 driving under the influence of drugs 41 drugs and development 60–61, 66–67 drug use among high school students 105, 125, 153 ecstasy 18 GHB (gamma-hydroxybutyrate) 18 heroin 121 inhalants 129 marijuana 85, 118, 143–144 parents’ impact 179 peer pressure 173 prevention programs 107 sexually transmitted diseases (STDs) 192–193 smoking 78 steroids, anabolic 199 violent crime 113 National Institutes of Health 171 National Labor Relations Act 205 National Longitudinal Study of Adolescent Health 188 National Prohibition Act 134–135 National Survey on Drug Use and Health 18, 46, 49, 84, 188 National Teratology Information Service 67 National Youth Gang Survey 54, 105, 110–111, 116, 183 natural drugs 155–158 needles, injection 130–133, 195 Nembutal 122 Ness, Elliot 135 neurochemistry 11–15, 77, 157 Neurotoxicology and Teratology 63 New England Journal of Medicine 102 New Scientist 156 NHTSA (National Highway Traffic Safety Administration) 41–42

224 The Truth About Drugs nicotine 77 NIDA. See National Institute on Drug Abuse (NIDA) Nielsen Company 149 nitrites 122–123, 128 nitrous oxide 127

O

The Odyssey (Homer) 86 Office of Applied Studies 152 Office of Juvenile Justice and Delinquency Prevention (OJJDP) 54, 110, 112, 140 Office of National Drug Control Policy 146–147, 153 Ohio State Medical Society 87 OJJDP 54, 110, 112, 140 Olympic Games 197–198 opiates and crime 51–52 and detoxification 175 and development 60–62 international use 99 and law on drugs 134 mentioned 120 overdose of 165 opium 32–33, 60, 91–93, 96–97, 136 Opium: A History (Bloom) 91 O’Shaughnessy, W. B. 87 overdose 164–169 causes 164–165 dangers 165–167 emergency response and treatment 168–169 rates 165 over-the-counter drugs 158–163 and amphetamine 93 commonly abused over-the-counter drugs 158–160 commonly abused prescription drugs 161–162 GHB (gamma-hydroxybutyrate) 18–19 misuse and dependence 162–163 overdose of 166–167

P

Paracelsus 91 paranoia 23, 66, 119, 166 parents. See families, communities, and drug abuse PCP 124–126, 136, 166 Pediatrics 59, 61 peer influence 47–49, 179–180 peer pressure 169–173 Pemberton, John S. 90

pentobarbital sodium 122 Pew Foundation 103, 169 peyote 185 phencyclidine 124–126 Plano, Texas 184 Pondimin 123 poppy seeds 84 pregnancy and drugs. See development and drugs prescription drugs 44, 51, 155, 158, 161–162, 165 prevention programs 106–108 Prevline 150 Prohibition 134–135 Prozac 39 Psychiatric Disorders in America: The Epidemiologic Catchment Area Study 102 Psychology Information Online 36 psychosis 68–69 Public Agenda 103 Pure Food and Drug Act 134

Q

Quest Diagnostics 84, 204, 205 questions and answers addiction 32 beer goggles 192–193 crack cocaine 24 crime and drugs 55 depression 36–37 disease and drugs 71 driving under the influence of alcohol/drugs 42, 74 drug abuse 44 drug use, teenage 103 fetal alcohol syndrome 60 freebasing 119–120 information sources 150 international drug use 95 law 139 overdose, emergency treatment of 168 over-the-counter drugs 159–160 peer pressure 171–172 relocating and families 183

R

rapid anesthesia-assisted detoxification (RAAD) 175 recovery. See rehabilitation and treatment Recovery, Inc. 179 rehabilitation and treatment 173–181. See also withdrawal detoxification 174–176 elements 174

Index  225 emergency treatment of overdose 168–169 recovery 176–180 Reynolds, Russell 87 Rimbaud, Arthur 87 risk factors and risk taking 181–186 community influences 183–185 cultural influences 185–186 family influences 182–183 personal factors 181–182 Ritalin 123 Rohypnol 19–20, 122, 193–194 Rosenberg, Philip 70 Rounsaville, Bruce 177

S

Saint James Society 92 Saint-John's-wort 157–158 SAMHSA. See Substance Abuse and Mental Health Services Administration (SAMHSA) San Jose Mercury 28 schizophrenia 14, 93, 126 school performance and drug abuse 186–191 seasonal affective disorder 37–38 Secular Organizations for Sobriety 179 sedatives 161–162 Self-Management and Recovery Training (SMART) 179 self-talk 180 serotonin 13–14, 17, 157 Sertuerner, Friedrich 91 sexual behavior and drug abuse 191–197 about 191–193 date rape drugs 193–195 HIV/AIDS 195–196 sexual and reproductive function 196 sexually transmitted diseases (STDs) and alcohol 75 and drug abuse 192–193 gonorrhea 71 hepatitis 68, 71–73, 119, 121, 132–133 HIV/AIDS. See acquired immunodeficiency syndrome (AIDS); human immunodeficiency virus (HIV) syphilis 71 Sherlock Holmes 90 Sherman, Michael 66 SIDS (Sudden Infant Death Syndrome) 62 60 Minutes 138 SMART (Self-Management and Recovery Training) 179 smoking and drugs 76–80 additional substance abuse 79–80 effects and risks 77–78 prevalence 78–79

Sober Recovery 209 Society for Adolescent Medicine 200 Society for Human Resources Management 83, 204 spectophotometry 82–83 statistics acquiring and studying 152 AIDS deaths 196 alcohol 73 communities and drug abuse 104–105 crack cocaine 23–28, 90 crime and drugs 51–52, 54, 55, 74–75, 105 death rates 153–154 demographics and drug use 184 driving under the influence of drugs 40 drug dealing 110 drug testing by employers 83–84 drug use, trends in 1, 3, 18–20, 22, 122, 143–144, 153 gangs and drugs 111, 112 heroin use 121 homicide 113–116 inhalants 129 law enforcement 137, 139–140 marijuana 88, 145 over-the-counter drug abuse 162 smoking 76–80 workplace drug abuse 202 STDs. See sexually transmitted diseases (STDs) steroids, anabolic 197–201 illegal use and side effects 197–199 as injection drug 130, 199 medical use 197 overdose of 166 social issues 199–200 Stevenson, Robert Louis 90 stimulants. See also individual drugs and club drugs 17 crack cocaine 22 and crime 51–52 natural 156–157 nicotine 77 overdose of 159, 166 street sales 110, 116 Substance Abuse and Mental Health Services Administration (SAMHSA) 3 crack cocaine 24–25, 27 depression 35 drug abuse 46–47, 49, 101 ecstasy 18 heroin 92 marijuana 143 mentioned 188 morbidity and mortality 152–153

226 The Truth About Drugs over-the-counter drug abuse 163 peer pressure 170 school performance and drug abuse 190 smoking 79 workplace drug abuse 202 Sudden Infant Death Syndrome (SIDS) 62 suicide 39, 54, 69, 74, 164–165. See also depression Sydenham, Thomas 91 synthetic drugs. See amphetamines; club and designer drugs; ecstasy syphilis 71

T

teens speak addiction 33 alcohol 76 club drugs 20–21 crack cocaine 25–26 death and drug use 108–109, 131 development and drugs 64–65 drug abuse 48–49 injection drugs 131 marijuana 118–119 peer pressure 170–171 school performance and drug abuse 189–190 steroids, anabolic 197–198 violence 53 television 146–148 testing, drug 80–84 THC 41, 81, 117, 142. See also marijuana Title VII 205 tolerance 32 trafficking drugs about 55–56 and crack cocaine 26–27 and crime 114–116 in gangs 54, 110–111 international 95–100 laws on 28–29, 137 treatment. See rehabilitation and treatment tricyclics 14 12-Step Program 177–178, 179

U

USA Today 138 U.S. Border Patrol 137 U.S. Census Bureau 114

U.S. Coast Guard 137 U.S. Conference of Mayors 102 U.S. Customs Service 137 U.S. Department of Health and Human Services 24, 46, 146–147, 153 U.S. Department of Justice 111, 139 U.S. Department of Transportation 41 U.S. Sentencing Commission 29–30 U.S. Supreme Court 145

V

valerian 157 Valium 41 victims of drugs. See homicide; morbidity and mortality violence 53–54, 101–102. See also criminal activity and drugs; homicide Volstead, Andrew 134–135 Volstead Act 134–135

W

Webb, Gary 28 Well Connected 185 When Work Disappears: The World of the New Urban Poor 183 Wilson, James Q. 104 withdrawal. See also rehabilitation and treatment about 31–32 in infants 61–62 and neurochemistry 15 and psychosis 68 Women for Sobriety 179 Wood, Alexander 91–92 workplace drug abuse 201–205. See also drug testing drug-free workplaces 203–205 incidence and cost 202–203

Y

Young Men’s Christian Association (YMCA) 106 Youth Risk Behavior Surveillance System 3, 191–192

Zoloft 39

Z