Encyclopedia of sociology by Edgar F. Borgatta, Rhonda J. V. Montgomery (z-lib.org)

DRUG ABUSE

crops and related programs have been encour- drug use are disproportionately concentrated in
aged in Peru and Columbia. specific geographic areas and population sub-
groups. In state prisons, blacks make up some 60
Since 1930, the U.S. Treasury Department has percent of the drug-law violators although they
had responsibility for drug regulation in the Unit- represent 12 percent of the country’s population
ed States. In 1973, the Drug Enforcement Admin- and 15 percent of regular drug users. Selective
istration of the Justice Department assumed the enforcement of the laws might reasonably be con-
police and control function under federal law. sidered a possible contributor to such statistics.
Each state has laws that generally parallel the
federal laws on possession and distribution of American attitudes toward drug use have his-
controlled substances and all states have a single torically reflected ethnic and class-related preju-
state agency that coordinates other programs re- dices. Thus, earlier in the twentieth century, nega-
lated to drug abuse. tive attitudes toward cocaine were associated with
the hostility that Southern blacks, among whom
Regular or frequent drug users, without out- cocaine use was thought to be widespread, were
side income, are likely to engage in a range of believed to harbor toward whites. The public’s
criminal activities in order to buy controlled sub- suspicion of Chinese immigrants was a reflection
stances. They typically engage in six times more of their use of opium. A number of stereotypes
criminal activity when using than when they are about marijuana reflected beliefs about its use by
not using drugs. Urine testing of arrestees, under Mexican immigrants and some occupations that
the federal Arrestees Drug Abuse Monitoring pro- had low status at the time, such as jazz musicians.
gram, indicates that some two-thirds of those ar-
rested in urban communities had used an illicit For members of both majority and minority
substance prior to arrest. It is, thus, not surprising groups sentenced to prison, recidivism rates are
that the rates of street crimes tend to be positively high and represent one reason that the United
correlated with the number of illegal drug users in States has higher rates of incarceration (approach-
a community. ing two million) than any industrialized nation.
Although treatment of former drug users in pris-
During the last fifteen years, both state and on settings has produced some promising results,
federal prison populations have experienced a treatment opportunities in prison are scarce and
massive increase due to the number of people have not kept pace with the growth in the popula-
convicted and jailed for selling or using drugs. tion of incarcerated former users. Approximately
Other developments contributing to the surge in one in eight state inmates and one in ten federal
the prison population include aggressive enforce- inmates have taken part in treatment since their
ment, longer sentences, the decline of parole, and admission to prison. On a limited basis, treatment
mandatory sentencing procedures that provide is being offered in an effort to keep offenders
less latitude for judges. Thus, for example, federal from returning to prison.
penalties for possession of crack, a rock-like form
of cocaine that became popular in the 1980s and TREATMENT
sells for a low price on the street, are 100 times
greater than for powdered cocaine. Sellers targeting The treatment of substance abuse has consistently
crack to urban minorities represent one of several been a lower priority than efforts to control drug
factors that have led to a disproportionate number abuse through interdiction and criminal sanctions,
of young blacks in federal and state prisons, for although cost-benefit studies have demonstrated
violation of possession laws. Ninety percent of that every dollar invested in treatment saves seven
prisoners in federal prisons for crack violations dollars in other costs. The federal government has
are black, although twice as many whites as usually spent more than two-thirds of its substance
blacks use it. abuse budget (which now totals nearly $20 billion)
on such supply-reduction and criminal justice sys-
Survey and other data consistently report that tem strategies. Only a small minority of drug
the use of mood-modifying drugs is distributed abusers have access to treatment, since health
among all the socioeconomic and ethnic groups in
the United States; nevertheless, arrests, convic-
tions, deaths, and other negative outcomes of

714

DRUG ABUSE

insurers tend to discriminate against persons with pharmacological treatments are not available. A
substance abuse problems and there are inade- combination of strategies is often most effective
quate treatment resources. especially if it recognizes that drug abuse is a
chronic relapsing disorder that is likely to include
Current treatment for drug abuse, in addition multiple treatment failures on the way to an ulti-
to withdrawal, ranges from psychotherapeutic in- mately favorable outcome. Of the treatment ap-
terventions (provided in both inpatient and outpa- proaches to drug abuse, milieu treatments have
tient settings), pharmacology agents, and various been among the most intensely studied. For those
forms of milieu therapy. It frequently includes able to participate in such programs, they can have
information on relapse prevention. Psychothera- extremely high rates of relatively enduring posi-
py is often used in combination with other forms tive outcomes. Whatever the treatment modality,
of treatment, and is provided both on an individu- it must include job readiness, habilitation and
al and group basis by therapists trained in medi- vocational rehabilitation, and other dimensions
cine, psychology, social work, nursing and educa- that will enable the former user to function effec-
tion. Pharmacological treatments include approaches, tively in the modern information-oriented com-
that substitute or block the effect of an abused munity and economy.
substance, such as methadone maintenance for
heroin (Ball and Ross 1991). Milieu therapies in- PREVENTION
clude a variety of residential programs where drug
abusers can learn or relearn how to live substance In the late 1980s, the social problems associated
free. Although some relatively short-term hospital- with drug abuse, particularly in terms of the pos-
based programs exist (particularly for those with session and sale of cocaine in urban areas, were
independent resources to pay for such services), perceived to have reached crisis dimensions and
the most common milieu consists of longer-term there was a marked increase in criminal justice
therapeutic communities such as Phoenix House, efforts to control substance use. Another positive
where drug users live in a setting in which they are response was a renewed emphasis on the preven-
closely monitored. The residents’ progress through tion of drug abuse and the collateral development
the several levels of the program’s hierarchical of broad-based community strategies designed to
social structure depends on their ability to imple- reduce demand for illicit drugs. Currently, such
ment the program’s rules for ‘‘right living’’ (De demand-reduction efforts are undergoing system-
Leon 1997). atic study in several long-term longitudinal public
and private programs.
Although often not considered a treatment,
various fellowship groups deriving from the Alco- There has been a transformation in views of
holics Anonymous model are widely used by drug substance abuse as we have moved from a focus on
abusers. Thus, for example, groups such as Nar- individual pathology to programs that engage com-
cotics Anonymous, Cocaine Anonymous, and par- munity institutions. Such efforts aim to change
allel groups for spouses and parents of drug users norms about substance use through the involve-
exist in almost every community. Such groups, ment of community members and the integration
which have no professional staff and rely on the of the substance-abuse programs pursued by pub-
reinforcement of abstinence, support drug abus- lic and private agencies. The 1990s saw the expan-
ers in maintaining drug-free lives and help family sion of community-based programs to include a
members aid their drug-abusing relatives. Many broad range of institutions, including the police
treatment programs encourage their patients or and courts, the voluntary sector, as well as the
clients to participate in such a twelve-step fellow- media (Falco 1994). Fostered by the government’s
ship simultaneously with the treatment period or Center for Substance Abuse Prevention (part of
after treatment is completed. the Substance Abuse and Mental Health Adminis-
tration) and efforts of the Robert Wood Johnson
Although substantial resources have been de- Foundation, the country’s largest health founda-
voted to treatment outcome research, our knowl- tion, hundreds of communities are engaged in
edge of who does best in what treatment is limited. broad-based efforts to change the culture within
Particularly for cocaine, the use of which can lead
to dependence in a short period of time, effective

715

DRUG ABUSE

which substance abuse takes place (Saxe, Reber, values. There is substantial evidence that positive
HalFors, et al. 1997). school experiences are linked to lower levels of
drug use and conversely, that drug use is related to
The belief that substance abuse is sustained by delinquency and problems in school.
community norms represents an ecological ap-
proach. Environmental conditions, whether they The role of school environments in affecting
reflect physical conditions in the community, pov- adolescent substance use has been validated by
erty, or available health care, are thus seen as risk specific school-based trials. In both the Midwest-
factors for drug use and abuse. Supporters of this ern Prevention Project and Project Northland,
view believe that what is needed are coordinated, significant reductions in the prevalence of sub-
community-wide efforts to address drug abuse stance use by adolescents were reported (Pentz,
at multiple levels of social organization and the Dwyer, MacKinnon, et al. 1989; Perry, William,
collaboration of many groups. The idea that Veblen-Martenson 1996). Designed for students in
multicomponent community-action efforts can pre- grades six through eight, the programs include
vent drug abuse derives from earlier studies of academic curricula, along with parental and com-
programs designed to cope with cardiovascular munity involvement. Often, a significant mass me-
disease. It is consistent with efforts to promote a dia component is part of the effort, with a focus on
variety of other health issues, but substance abuse correcting misperceptions about the consequences
is now a primary focus of these efforts. of drug use and providing alternative positive
behavior. The D.A.R.E. program (Drug Abuse Re-
The largest of these comprehensive efforts is sistance Education) also has been a widely used
the federal government’s Community Partnership school-based prevention strategy.
Program, which has supported over 250 partner-
ships. The Community Partnership Program was Schools are not the only public institution that
initiated in 1990 after the Robert Wood Johnson affect youths’ likelihood to abuse drugs. The po-
Foundation had begun to develop a model and lice and justice agencies, as well as the network of
sponsor broad-based community efforts. Called health and social service agencies that serve a
‘‘Fighting Back’’ programs, they now provide long- community, have a crucial influence and preven-
term support to more than a dozen communities tion activities typically involve such agencies. The
to develop comprehensive demand-reduction in- ability of health and social service professionals to
terventions. The foundation has also provided attend to drug use is clearly important, but their
support and technical assistance to hundreds of role is often reactive, providing treatment rather
additional communities through groups such as than prevention.
Join Together.
One of the most important programs that has
A significant element of many such preven- contributed to attempts by law enforcement agen-
tion programs is the presence of a strong media cies to deal with drug abuse is community policing.
component. The Partnership for a Drug-Free Ameri- It represents a shift from reactive policing where
ca, for example, develops and places hundreds of the goal is to arrest offenders, to an active strategy
millions of dollars of advertising each year, and designed to identify crime problems and work
communities are encouraged to leverage local me- with citizens—including offenders—to avoid fur-
dia to present anti-drug messages directed at youth. ther difficulties. The heart of the approach is that
Although there is limited direct evidence of the officers get to know citizens and help them deal
effectiveness of media campaigns, it is likely that with minor transgressions and, in so doing, avoid
they reinforce education and prevention messages serious crime. A collateral approach, widely used
being delivered to youth through other means. in the 1990s (‘‘fixing broken windows’’) is de-
signed to improve morale and confidence and
Schools play a central role in prevention pro- stem the physical and social deterioration of com-
grams, under the assumption that drug abuse will munities by prompt attention to small visible mani-
be more easily prevented if programs are started festations of community dysfunction or decay.
early. The goal of these programs is to provide There is evidence that such approaches are, at
youth with the skills to become successful adults least partly, responsible for declines in violent
and to teach them the community’s norms and

716

DRUG ABUSE

crime, which is closely related to substance-abuse children) who live in that community, can the
problems. interactions among the multiple forms and levels
of influence begin to be understood.
A community’s resources and social institu-
tions have a critical impact on drug use, but the RESEARCH
attitudes and behavior of peers and family may
have an even more direct influence. The affluence Social science research has played a critical role in
of a community and the quality of its schools have the identification of the substance-abuse problem,
a substantial effect on the initiation of drug use, it social consequences, and strategies to arrest the
but their impact is mediated by adolescents’ peer use of illicit drugs. There is now a long-standing
relationships and their interactions with signifi- tradition of surveys to identify drug use and atti-
cant adults in their lives. Thus, peers and parents tudes toward the use of mood-modifying substances
are perhaps the most vital elements of the commu- and their consequences. Surveys, such as the Na-
nity context—directing or guiding youngsters’ tional Household Survey on Drug Abuse (which
needs and desires through the obstacles in their assesses the drug use of a random sample of U.S.
environment. Some of the most important pro- residents over twelve years old) and Monitoring
grams designed to address community substance the Future (a school-based survey of junior and
abuse focus on changing peer culture and address- senior high school students), have each been con-
ing family attitudes and behavior. ducted for more than two decades. Although there
is considerable discussion about the validity of
Parents (or other adult ‘‘guides’’) arguably these surveys and how to ensure veridical data
have the greatest potential effect on how the young- (Beveridge, Kadushin, Saxe, et al. forthcoming),
ster learns to negotiate the environment as it exists there is no question that they have influenced
(good or bad), and they can also affect the influ- social policy.
ence that the youngsters’ peers exert. The use of
drugs by parents significantly increases the likeli- More recently, much of the focus of social
hood that their youngsters will also use drugs. research has shifted to assessing strategies to pre-
Although this might seem to be a clear example of vent drug use and to evaluate treatment programs.
youngsters modeling the behavior of their par- Under the auspices of the National Institute on
ents, the influence of parents’ own use of drugs is Drug Abuse (a component of the National Insti-
probably more complicated. Some research sug- tutes of Health), a variegated research program
gests that it is not merely that youngsters mimic includes both biological and sociopsychological
parents’ behavior, but instead such modeling in- components. An emphasis of research is on assess-
teracts with what they see in their peers. If both ment of programs such as D.A.R.E., the Commu-
peers and parents engage in substance use, there is nity Partnership Program, and Fighting Back. De-
far greater likelihood that young people will be- termining whether these programs achieve their
come regular users. goals of preventing substance abuse is a particular-
ly difficult challenge. The programs are imple-
The influences of peers and parents may inter- mented differently across communities and the
act in complex ways and each community is differ- research design needs to separate the effects of
ent—its resources and institutions function differ- race, socioeconomic status, and other factors from
ently. Communities can be directed to the key program implementation (Rindskopf and Saxe 1998).
levers, but there is no simple formula available to
determine which activities will be most important It is also the case that antidrug programs
for a particular community. What is clear, howev- develop loyal followings and their proponents de-
er, is that to understand and develop strategies velop a stake in showing that their efforts are
that reduce adolescent substance abuse, it is neces- successful. Thus, for example, there has been a
sary to consider the social context in which a child major debate about the D.A.R.E. program and
lives. Only by identifying the resources available whether it is successful, with researchers claiming
within a community, the roles played by the social that the evidence suggests it is not effective. In
institutions within that community, and the behav- other cases, such as the Community Partnership
iors and values of the individuals (parents and Program and Fighting Back, the issue has been the

717

DRUG ABUSE

availability of data that can show the effects of the De Leon, G. (ed.) 1997 Community As Method: Therapeu-
program over time. tic Communities for Special Populations and Special
Settings. Westport, Conn.: Praeger.
One development that will likely allow much
better utilization of social research is the availabili- Evans, R., and I. Berent 1992 Drug Legalization: For and
ty of sophisticated methodologies. Thus, for exam- Against. La Salle, Ill.: Open Court Press.
ple, meta-analytic techniques are now available
that permit the synthesis of data across multiple Falco, M. 1994 The Making of A Drug Free America:
studies, allowing us to amalgamate multiple small- Programs That Work. New York: Times Books.
scale tests of programs. In addition, new analytic
strategies are being developed to allow construc- Gerstein, D. R., and H. J. Harwood (eds.) 1990 Treating
tion of multilevel statistical models. Such hierar- Drug Problems. Washington, D.C.: National Acade-
chical linear modeling permits one to take account my Press.
of the fact that programs are conducted in particu-
lar settings and facilitates the segregation of com- Heather, N., A. Wodak, E. Nadelmann, et al. 1998
munity effects from overall program effects. Qualita- Psychoactive Drugs and Harm Reduction. London, U.K.:
tive ethnographic techniques have been used to Whurr Publishers.
track the life cycle of substance abuse and the
structure of the illegal markets. Johnson, B. D., P. Goldstein, E. Preble, et al. 1985
Taking Care of Business: The Economics of Crime by
FUTURE Heroin Abusers. Lexington, Mass.: Lexington Books.

The war on drugs is far from being ‘‘won,’’ but Kleiman, M. A. R. 1992 Against Excess: Drug Policy for
drug abuse appears to have stabilized, with use Results. New York: Basic Books.
remaining nearly constant. Two trends, that could
be counterreactions, have emerged and may help Musto, D. F. 1987 The American Disease: Origins of Narcot-
to shape future use of illicit drugs. The first is the ic Control. New York: Oxford University Press.
call for legalization or decriminalization of the
possession of drugs such as marijuana. Several Office of Applied Studies 1999 National Household Sur-
national organizations have emerged to promote vey on Drug Abuse Main Findings 1997. Rockville,
this goal and to urge a harm reduction approach. Md.: Substance Abuse and Mental Health Services
The second trend is the increased licit use of Administration.
mood-altering prescription substances, such as
Prozac and Ritalin. Such powerful psychotropic Office of National Drug Control Policy 1999 The Nation-
agents are being prescribed by physicians for de- al Drug Control Strategy 1999. Washington D.C.: The
pression, difficulties in concentration, and similar White House.
problems. As the medical options increase, misuse
of prescription drugs will likely increase and it may Pentz, M. A., J. H. Dwyer, D. P. MacKinnon, et al. 1989
be more difficult to control the sale of less power- ‘‘A Multi-Community Trial for Primary Prevention of
ful nonprescription drugs. Adolescent Drug Use: Effects on Drug Use Preva-
lence.’’ Journal of the American Medical Association
(SEE ALSO: Alcohol) 261:3259–3266.

REFERENCES Perry, C. L., C. L. Williams, S. Veblen-Martenson, et al.
1996 ‘‘Project Northland: Outcome of A Community
Ball, J. C. , and A. Ross 1991 The Effectiveness of Metha- Wide Alcohol Use Prevention Program for Early
done Maintenance Treatment. New York: Springer-Verlag. Adolescence.’’ American Journal of Public Health
86:956–965.
Beveridge, A., C. Kadushin, L. Saxe, D. Rindskopf, and
D. Livert forthcoming ‘‘Survey Estimates of Drug Rindskopf, D., and L. Saxe 1998 ‘‘Zero Effects in Sub-
Use Trends in Urban Communities: General Princi- stance Abuse Programs: Avoiding False Positives and
ples and Cautionary Examples.’’ Substance Use and False Negatives in the Evaluation of Community-
Misuse. based Programs.’’ Evaluation Review 22:78–94.

Robins, L. N., J. E. Helzer, M. Hesselbrook, et al. 1980
‘‘Vietnam Veterans Three Years After Vietnam.’’ In
L. Brill and C. Winick, eds., Yearbook of Substance Use
and Abuse, vol. 2, 213–232.New York: Human Sci-
ences Press.

Saxe, L., E. Reber, D. Halfors, C. Kadushin, D. Jones, D.
Rindskopf, and A. Beveridge 1997 ‘‘Think locally, act
globally: Assessing the impact of community-based
substance abuse prevention.’’ Evaluation and Pro-
gram Planning 20:357–366.

718

DRUG ABUSE

Winick, C. 1983 ‘‘Addicts and Alcoholics as Victimizers.’’ Textbook 3rd ed. 10–16. Baltimore, Md.: Williams and
In D.E.J. Mac Namara and A. Karmen, eds., Deviants: Wilkins.
Victims or Victimizers? Beverly Hills, Calif.: Sage ———(ed.) 1974 Sociological Aspects of Drug Dependence.
Publications. Cleveland, Oh: CRC Press.

——— ‘‘Epidemiology.’’ In J.H. Lowinson, P. Ruiz, R.B. LEONARD SAXE
Millman, et al. eds., Substance Abuse: A Comprehensive CHARLES WINICK

719