Substance Abuse: Patterns, Social Factors, and Prevention

Introduction: Extent of Alcohol, Tobacco, and Drug Use

Addiction means physical dependence on a drug, with withdrawal symptoms when its use ceases. In this sense, alcohol, tobacco, marijuana, cocaine, heroin, hashish, opiates, and amphetamines are all addictive drugs. In addition, these drugs also cause psychological dependency, since they enhance a person's sense of pleasure, sociability, sexuality, and emotional satisfaction, and also mask pain, low self-esteem, and anxiety (Wilson and Kolander, 2011, p. 6). Student surveys are "likely to underreport the overall level of substance use and abuse by young people," and since Black and Hispanic students have higher dropout and absenteeism rates, this affects survey results as well (Mosher and Akins, 2007, p. 136). Hard drug users and addicts are also more likely to be homeless, which means that their true numbers are always unknown.

Prevalence Among Adolescents and Young Adults

All studies and surveys confirm that marijuana is the illegal drug that high school students are most likely to experiment with, and this has been true since 1975. Experimentation was most common in the 1970s, fell steadily until the early 1990s, and then rose slightly again. About 40–50% of high school students will try marijuana at some point, but very few are destined to become habitual or regular users, especially as they begin to take on adult responsibilities after age 25. As for other illegal drugs such as ecstasy, methamphetamine, cocaine, heroin, and hallucinogens, fewer than 10% of high school students have ever been likely to experiment with these — only about 1% in the case of heroin — and only a small number of those are likely to become addicts in the true sense (Mosher and Akins, p. 138). Only about 4% of high school students use marijuana daily, while over half have never tried it at all (Maisto et al., 2010, p. 265).

Overall tobacco, alcohol, and illegal drug use among high school students has not changed much in the last ten years, and the most at-risk youth for illicit drug use are minorities and the poor concentrated in inner-city communities. In 2007, one study showed that 9.8% of those aged 12–17 smoked cigarettes, 15.9% used alcohol, and 9.5% used illegal drugs. All of these rates were higher among 18–25-year-olds, although only 3% of those over 26 used illegal drugs. Binge drinking is also more common among young adults than among high school students, and reaches a peak around age 21. Per capita alcohol consumption among high school students has been declining since the 1980s, and only 9.7% of high school students binge drink, compared to 41.8% of 18- to 25-year-olds and 31.4% of those over age 26. In 2008, 30% of 10th graders and 45.6% of 12th graders reported having been drunk at least once in the past year, while in 2007, 15.9% of 12–17-year-olds had been drunk in the past month, compared to 61.2% of 18–25-year-olds (Wilson and Kolander, p. 33). According to most studies, "relatively few adolescents in most communities become seriously involved in illegal drugs even though a majority may experiment with some of them, typically marijuana" (Wilson and Kolander, p. 10).

In 2008, 20.4% of high school students smoked cigarettes at least occasionally, while 5.7% smoked half a pack or more per day. This latter group is most likely to go on and become heavy smokers for life, although in 1992 these numbers were 28.3% and 10.7% respectively. Children whose parents and siblings smoke are also more likely to smoke themselves, and this pattern holds for alcohol and other drugs as well (Goldberg, 2010, p. 146). About 2.7% of high school seniors used smokeless tobacco, down from 5.1% in 1987, with the rate of use highest in the South and among student athletes (Goldberg, p. 147). Few people start smoking after age twenty, and most "who become regular smokers do so by that age" (Wilson and Kolander, p. 6). Tobacco may in fact be the most important gateway drug to experimenting with illegal substances, and "adolescents who don't smoke are unlikely to use other drugs, such as marijuana and cocaine" (Wilson and Kolander, p. 26).

Socio-Cultural and Historical Dimensions of Drug Policy

Public hostility to drugs and alcohol always increases when they are associated with unpopular immigrant and minority groups or with those lower on the social and economic scale. In the United States, the first drug laws at the state and local levels during the 19th century were directed at opium smoking by Chinese immigrants. This group was widely stigmatized and hated — denied the right to vote, own land, or attend public school, and often subjected to mob violence on the Western frontier. Chinese immigrants were also the first group to be restricted by federal law, under the Chinese Exclusion Act of 1882, and were ultimately barred outright from immigrating. Most Chinese migrants were young, single males hired as contract laborers for low wages in the mines and on the railroads, and were often not permitted to bring their wives and families to the United States. The campaigns against their "opium dens" were therefore more a product of racism and moral panic directed at a despised and "alien" ethnic group than a genuine public health concern. The history of drug and alcohol policy contains numerous parallel examples.

In the 19th century, opiates were freely available in drugstores and patent medicines that claimed to cure all diseases, and the typical addict was a middle-aged white woman who consumed these substances at home rather than the "lower-class adolescent male" of today (Wilson and Kolander, p. 20). White women were never the targets of moral panics and legal repression, however, in contrast to Asian opium smokers or Black and Hispanic users of cocaine and marijuana.

Per capita alcohol consumption in the United States was much higher in the 18th and 19th centuries, especially of whiskey and hard liquor, although public drinking — and public drunkenness — was only socially acceptable for men. Women alcoholics certainly existed, but almost always within the confines of the home. At the state and local levels in the 19th century, the first prohibition laws emerged alongside the first great wave of Irish and German immigration in the East. The mostly white, Protestant temperance advocates genuinely feared the cultural, social, and economic influence of Catholic immigrants from Europe. Racism and discrimination against these immigrant groups remained open and blatant well into the 20th century, and actually intensified with the subsequent wave of immigration from southern and Eastern Europe (Wilson and Kolander, p. 18). It was no accident that the prohibition and immigration restriction movements grew up side by side, generally driven by the same constituencies. Not long after national Prohibition became law in 1919, these groups also succeeded in restricting immigration to "Nordic" or "Aryan" countries of origin through the National Origins Act of 1924. Without the efforts of the Ku Klux Klan and similar organizations, neither of these laws would likely have passed when they did.

Again and again in American history, moral panics and hysteria about drugs and alcohol have been directly tied to racism and fear of the "alien other." Just as Hispanic immigrants today are routinely associated with vice, crime, and drug abuse, so too was every previous immigrant group in its time, while fear and hatred toward Black Americans was frequently expressed through attempts to control drug and alcohol consumption in the South and in inner-city communities. In other words, the abuse of drugs and alcohol may not be the real issue at all, but rather a symptom of deeper fears and resentments within the larger society.

Crack cocaine was generally perceived as a "ghetto" drug used by inner-city youth, and the penalties for its possession and distribution were heavier than for powdered cocaine — a substance that was more expensive and that appealed to young whites of middle or upper-class status in the 1970s and 1980s. During the War on Drugs, the U.S. prison population became the highest in the world, and no country incarcerates a larger share of its population. In many large cities, the majority of young Black men are in jail or on probation and parole, while over 70% of the prison population consists of young Black and Hispanic males convicted of various drug offenses. A harsh and regressive drug policy has created a prison-industrial complex in the United States, complete with its own lobbyists and contractors demanding harsher sentences and more prison construction — facilities increasingly turned over to private operators. Meaningful investment in rehabilitation, education, or drug prevention among these young Black and Hispanic men has been largely absent, and many have been locked away under three-strikes laws. This is not new in American history: the double standard and dual system of justice for Black Americans has existed since the era of slavery. Black Americans have always been more likely to be arrested than white Americans, more likely to be convicted, more likely to receive harsher sentences for the same crimes, and more likely to serve longer prison terms. The current War on Drugs is simply a continuation of this pattern. As one source summarizes, "certain drugs have served as a proxy for racial and ethnic bias," and this has been true throughout American history (Wilson and Kolander, p. 8).

Conclusion: Realistic Expectations for Intervention

Very few people who experiment with drugs in their youth or in stressful situations will go on to develop a long-term dependence or addiction, and they will have the resiliency and self-control to avoid this problem on their own. Even among soldiers in Vietnam who regularly used heroin because of the stress of that wartime environment, very few continued to do so when they returned to the United States. For most people, then, no intervention will be necessary at all. A natural life cycle appears to be at work in which those in their late teens and early twenties experiment with drugs and alcohol — especially when they are first breaking free of parental and school control but have not yet established themselves in jobs, homes, and families of their own. As adult responsibilities accumulate, experimentation declines, except for the minority who become addicted to or dependent on drugs and alcohol.

In reality, much of the money spent on treatment, education, and intervention programs is wasted, except insofar as it sustains the social workers, bureaucrats, and administrators employed by these programs. Moral panics, fear, and anxiety about rebellious youth, or about Black and immigrant males, are not new in American society, and their real motivation has rarely been about the drug and alcohol problem itself.

References

Goldberg, R. (2010). Drugs across the Spectrum (6th ed.). Wadsworth Cengage Learning.

Maisto, S. A., et al. (Eds.). (2010). Drug Use and Abuse (6th ed.). Wadsworth Cengage Learning.

Mosher, C. M., and Akins, S. (2007). Drugs and Drug Policy: The Control of Consciousness Alteration. Sage Publications.

Wilson, R., and Kolander, C. A. (2011). Drug Abuse Prevention: A School and Community Partnership. Jones and Bartlett Publishers.