7.2 Drugs and Drug Use Today

Depressants

Depressants slow down the activity of the central nervous system. Depending on the specific drug, they help induce drowsiness and relaxation, and they can reduce anxiety and pain. Several types of depressants exist. Analgesics reduce pain and include over-the-counter products such as aspirin, acetaminophen (the major ingredient in Tylenol), and ibuprofen (the major ingredient in Advil and Motrin), and many prescription medicines that contain acetaminophen. Sedatives help people relax and include alcohol, barbiturates, and sleep medicines such as Sominex and Tylenol PM (both over-the-counter) and Ambien and Valium (both prescription). Large doses of depressants may lead to physical dependence and sometimes death.

Hallucinogens

Hallucinogens are mind-altering drugs that cause delusions or hallucinations. Their ranks include ecstasy, LSD, mescaline, and PCP. Many people who use a hallucinogen report that the mind-altering effects of the drug provide them a truly wonderful experience, but many also find the effects to be troubling at best and horrible and terrifying at worst. Long-term effects include hallucinations that occur without any drug use preceding them.

Marijuana

Marijuana is by far the most popular illegal drug in the United States.

Modern Scribe Photography – Maryjane 4-20-2010 (420) – CC BY-ND 2.0.

Because marijuana’s effects do not fit neatly into any other category of drug, marijuana (along with its close cousin, hashish) is often considered to be its own category. As we will see later, it is by far the most popular illegal drug in the United States. Its effects include distortion of time and space, euphoria, hunger, increased sensory perception, and relaxation.

Narcotics

Narcotics are sometimes classified under depressants because they slow down the central nervous system, but they are often still considered as their own category. They are highly effective at relieving pain and are a common substance in prescription medicines for severe pain. By definition, all narcotics are derived from opium, either in its natural form or in a synthesized form. Examples of narcotics include codeine, heroin, methadone, and morphine. In addition to relieving pain, narcotics may induce drowsiness, euphoria, and relaxation. Although narcotics do not damage bodily organs, they are very physically addictive, and high doses can be fatal.

Stimulants

Stimulants have the opposite effect of depressants by speeding up the central nervous system. They increase alertness and energy and can produce euphoria or anxiety. Some are legal and some are illegal, and many very different drugs are all considered stimulants: caffeine, cocaine, methamphetamine and other amphetamines, nicotine (tobacco), and Ritalin. Stimulants can be very physically addictive, and nicotine is thought to be more addictive than heroin. While caffeine is very safe as long as someone does not have too many cups of coffee daily, many other stimulants may have dangerous short-term or long-term side effects on the cardiovascular system.

Not all drugs can be discussed in one chapter. In choosing which drugs to discuss in a book on social problems, it makes sense to discuss the drugs that probably concern Americans the most. We thus focus in the remainder of this section mostly on alcohol, tobacco, marijuana, cocaine, and heroin.

Alcohol

Moderate alcohol use (more than one drink per day for an adult female and two drinks per day for an adult male) is relatively safe for most people and may even have health benefits (Harvard School of Public Health, 2012). The problem is that many people drink much more than moderately. As the Harvard School of Public Health (2012) explains, “If all drinkers limited themselves to a single drink a day, we probably wouldn’t need as many cardiologists, liver specialists, mental health professionals, and substance abuse counselors. But not everyone who likes to drink alcohol stops at just one. While most people drink in moderation, some don’t.”

SAMHSA survey data show the extent of such problem drinking, as its survey measures both binge drinking (five or more drinks on the same occasion—within two hours of each other—on at least one day in the past month) and heavy drinking (binge drinking on at least five days in the past month). Table 7.2 “Prevalence of Binge and Heavy Alcohol Use, 2010*” presents the relevant data for people 12 and older and also for those aged 18–20, the customary age for people in their first two years of college.

As Table 7.2 “Prevalence of Binge and Heavy Alcohol Use, 2010*” indicates, almost one-fourth of all people 12 and older and one-third of those aged 18–20 engage in binge drinking, while almost 7 percent and about 11 percent, respectively, engage in heavy drinking. The figures for those 12 and older translate to almost 59 million binge drinkers and 17 million heavy drinkers. These numbers show that tens of millions of people abuse alcohol annually and underscore the problem of dealing with problem drinking.

The amount of alcohol consumed annually by occasional, moderate, and heavy drinkers is staggering. The relevant data appear in Table 7.3 “Alcohol Consumption in the United States, 2010”. Americans drink 7.6 billion gallons of alcohol annually, equivalent to 126 billion standard drinks. This number of drinks works out to 496 drinks per person annually for the 12 and older population and 748 drinks per person for the 12 and older population that drinks at all. Keep in mind that this is just an average. The heavy drinkers identified in Table 7.2 “Prevalence of Binge and Heavy Alcohol Use, 2010*” have many more than 748 drinks every year, while light drinkers have only a relative handful of drinks.

The Drinking Culture and the Alcohol Industry

As noted earlier, alcohol has a long history in the United States and an even longer history in much of the rest of the world. When we think about the tens of millions of Americans who drink at least occasionally, the ads for beer and wine and hard liquor that appear regularly in the popular media, and the thousands of bars and related venues across the country, it is certainly no exaggeration to say that we have a drinking culture.

Once upon a time, the federal and state governments tried to eliminate this culture. We are speaking, of course, about Prohibition. The passage of the Eighteenth Amendment to the US Constitution in January 1919 banned the manufacture, sale, and transportation of alcohol; the ban took effect a year later. For reasons we will discuss later, the ban was eventually deemed a failure, and the passage of the Twenty-First Amendment in 1933 repealed the Eighteenth Amendment. The manufacture, sale, and transportation of alcohol became legal once again.

Alcohol manufacturing and sales are a major industry worldwide today. Several alcohol companies rank among the largest corporations in the world as well as in the United States (Jernigan, 2009). US alcohol sales amount to about $160 billion annually, and they rose by 20 percent in the 2010–2011 period during the faltering economy (Smith, 2011). The amount of money the public spends on alcohol equals 12.5 percent of what it spends on food (US Department of Agriculture, 2011). The alcohol industry provides about 2 million jobs annually, more than $40 billion in wages, and more than $50 billion in taxes, and it contributes more than $160 billion to the annual national economy (Distilled Spirits Council of the United States, 2011). All these figures show that the alcohol industry plays a significant role in the US economy.

Despite this role, if the United States does indeed have a drinking culture, the alcohol industry bears a major share of the responsibility. As the American Medical Association (2004) has stated,

Like the tobacco industry, the alcohol industry produces a legal, widely consumed drug; is dominated by relatively few producers; and utilizes a powerful combination of advertising dollars, savvy marketing, political campaign contributions, and sophisticated lobbying tactics to create and maintain an environment favorable to its economic and political interests. It requires the recruitment of new, youthful drinkers to maintain and build its customer base…As a chemical that affects our bodies, alcohol is a powerful drug resulting in more premature deaths and illnesses than all illicit drugs combined. Yet the industry has shaped public opinion and forced government to treat it not as a drug but as a cultural artifact, a valued legal commodity, almost a food, even a necessity of life.

As just one example of how the alcohol industry promotes its “powerful drug,” the headline of a recent news article declared that the “alcohol companies go online to lure young drinkers” (Gardner, 2010). According to the report, alcohol companies are increasingly using Facebook and other social media to persuade young people to buy and drink their products. Not surprisingly, many of these young targets turn out to be under the legal drinking age of 21 because they are easily able to gain access to alcohol sites. This problem led a public health professor to observe, “Close to 5,000 people under the age of 21 die of alcohol overuse each year. Virtual worlds show all of the appeal and none of the consequences of alcohol use and undercut efforts to reduce the incidence of underage drinking. At this point, alcohol companies appear limited only by their imaginations and pocketbooks” (Gardner, 2010).

The alcohol industry is a major part of the US and worldwide economies and provides about 2 million jobs annually in the United States.

amateur photography by michel – Aardwolf Brewing Company – CC BY 2.0.

Tobacco and Nicotine

Nicotine, the major drug in tobacco, is another legal but very dangerous drug. As we saw earlier, its use kills four times as many people every year as those killed by alcohol use. Tobacco is a slow poison. If it were not already a legal drug used by millions, and a company had just manufactured cigarettes for the first time, the Food and Drug Administration would never approve this product. Fortunately for tobacco companies, nicotine does not distort perception the way that alcohol and many other psychoactive drugs do. Someone smoking or otherwise using tobacco can safely drive a car, operate machinery, and so forth, and someone “under the influence” of tobacco does not become violent.

Tobacco is a slow poison. If it were a new drug, it would not be approved for public consumption.

Raul Lieberwirth – cigarette – CC BY-NC-ND 2.0.

If you have ever watched any number of pre-1970s movies or television shows like “Mad Men” that portray life back then, you know that the United States used to have a tobacco culture the way it now has an alcohol culture. Many, many people smoked cigarettes, and a large number smoked cigars or pipes. This particular drug culture began to abate in the 1970s after much evidence mounted about the deaths and other serious health effects of tobacco use and especially about the dangers of second-hand smoke. Whereas college students a generation ago often sat in smoke-filled classrooms and Americans generally sat in smoke-filled restaurants and other venues, today most Americans can count on being in enclosed public spaces in which smoking is banned.

Even so, we have already seen that more than one-fourth of Americans 12 and older, or some 70 million people, are still current users (past month) of tobacco. Almost one-fifth of American adults (18 and older), or 45.3 million adults, smoke cigarettes daily or occasionally (King, Dube, Kaufmann, Shaw, & Pechacek, 2011). Thanks to the greater knowledge about tobacco’s health effects, public education campaigns about these effects, heavy taxes on cigarettes, and changing attitudes about tobacco, these numbers represent a significant decline from a generation ago.

Tobacco use causes more preventable death and illness in the United States than any other cause of death; if no one used tobacco, the more than 400,000 tobacco-related deaths each year would not occur. As we think about tobacco, this startling statistic needs to be kept in mind: About half of all cigarette smokers will one day die from a premature death caused by a smoking-related illness (King et al., 2011). To repeat what was said just earlier, nicotine is a slow poison.

Tobacco kills in several ways. Smoking causes 80–90 percent of all lung cancers, and it greatly increases the risk of emphysema and other lung disease, coronary heart disease, and stroke. In addition to lung cancer, tobacco use also causes several other cancers, including bladder cancer, cervical cancer, esophageal cancer, stomach cancer, and throat cancer. Women who smoke are at greater risk for lower bone density and hip fracture when they get older.

The economics of tobacco use are also worth knowing. Americans spend about $90 billion annually on tobacco products, with most of this amount spent on cigarettes (Centers for Disease Control and Prevention, 2011). They purchase more than 300 billion cigarettes annually, with most of the cigarettes sold by three companies. Cigarette smoking is estimated to cost almost $200 billion annually in medical expenses and lost economic productivity. This works out to a national economic loss of about $10.50 for every pack of cigarettes that is sold.

One interesting and very important fact about the economics of cigarette smoking is what happens when the cost of cigarettes is increased. Most smokers begin their deadly habit during adolescence or young adulthood. Because this is a period of their lives when they do not have much money, increases in the cost of cigarettes are particularly useful in persuading some of these young people not to buy cigarettes. Government data indicate that every 10 percent increase in the price of cigarettes reduces cigarette consumption among young people by 4 percent (Centers for Disease Control and Prevention, 2011). A similar but smaller effect occurs among older smokers.

Earlier we said that the alcohol industry plays a major role in the amount of drinking that occurs in the United States. The same is true of the tobacco industry and smoking. This industry spends about $15 billion annually—or an average of $41 million daily—in advertising, sponsorship of public events, and other activities to promote its deadly product, and for many years hid or distorted data about the deadly effects of cigarette smoking (Brandt, 2009). Because of funding cutbacks during the recent faltering economy, the states have reduced their media campaigns and other efforts aimed at reducing smoking. This reduction, combined with the tobacco industry’s huge promotional spending, leads one public health professor to lament, “The tobacco companies are winning the battle” (Martin, 2011).

Marijuana

As we have seen, marijuana is easily the most widely used illegal drug in the United States. The percentages for marijuana use in Table 7.4 “Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*” translate to 106 million people who have ever used marijuana, 29 million people who used it in the past year, and 17 million people who used it in the past month (current users). As Table 7.5 “Prevalence of Illegal Drug Use, Ages 18–20, 2010*” showed, marijuana use is especially high among young people: One-third of people ages 18–20 have used marijuana in the past year, and one-fifth are current users.

Marijuana use can cause several problems (National Institute on Drug Abuse, 2010). Marijuana distorts perception, impairs coordination, and can cause short-term memory loss, and people who are high from marijuana may be unable to safely drive a motor vehicle or operate machinery. In addition, regular pot smokers are at risk for respiratory problems, though not lung cancer. Chronic marijuana use is also associated with absence from school and the workplace and with social relationship problems, although it is difficult to determine whether marijuana is causing these effects or whether the association exists because someone with personal problems begins using marijuana regularly.

Despite these problems, marijuana is almost certainly the most benign illegal drug in terms of health and social consequences, and it is also much more benign than either alcohol or tobacco (Drug Policy Alliance, 2011; Faupel et al., 2010). As noted earlier, these latter two drugs kill about 520,000 Americans annually. In contrast, marijuana has probably never killed anyone, and its use has not been associated with any cancers. Alcohol use is a risk factor for violent behavior, but marijuana use is a risk factor for mellow behavior; if everyone who now uses alcohol instead smoked marijuana, our violent crime rate would probably drop significantly! Despite some popular beliefs, marijuana is generally not physiologically addictive, it does not reduce ambition and motivation, and it does not act as a “gateway drug” that leads to the use of more dangerous drugs (Hanson, Venturelli, & Fleckenstein, 2012). A review of the evidence on marijuana summarized research findings as follows: “Studies of long-term marijuana smokers do not produce gross or major clinical, psychiatric, psychological, or social difference between users and nonusers, or between heavier and lighter users” (Goode, 2008, p. 247).

While not entirely safe, then, marijuana is much safer, both on an individual basis and on a societal basis, than either alcohol or tobacco. Even so, it remains an illegal drug. This fact underscores our earlier observation that the legality or illegality of drugs has no logical basis. If the personal and social harm caused by a drug determined whether it is legal or not, then it would be logical for marijuana to be legal and for alcohol or tobacco to be illegal.

For better or worse, though, the millions of marijuana users have broken the law. In most states, marijuana possession is a crime punishable by a jail or prison term that depends on the amount of marijuana involved. Fourteen states (Alaska, California, Colorado, Connecticut, Maine, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, New York, North Carolina, Ohio, Oregon) have decriminalized simple possession of small amounts of marijuana: They treat possession as a minor offense similar to a traffic violation and punish it with only a small fine. Most of these states decriminalized the drug in the 1970s after a national commission with members appointed by the US Congress and by President Richard Nixon recommended taking this action. There is no evidence that marijuana use in these states increased compared to use in the states that have not decriminalized marijuana (Beckett & Herbert, 2008). In fact, marijuana use in the nation declined sharply in the 1980s, the first decade after decriminalization began, both in the states that decriminalized pot possession and in the states that did not decriminalize it.

Cocaine

Cocaine produces a high that is considered more pleasurable than that for any other drug. According to sociologist Erich Goode (2008, p. 288), “Cocaine’s principal effects are exhilaration, elation, and euphoria—voluptuous, joyous feelings accompanied by a sense of grandiosity.” As a stimulant, cocaine also increases energy, alertness, and a sense of self-confidence. It is not physiologically addictive, but it is considered psychologically addictive: The high it produces is so pleasurable that some users find they need to keep using it.

Cocaine is a particularly addictive drug because of the high degree of pleasurable feelings it causes.

Nightlife of Revelry – Cocaine – CC BY 2.0.

Cocaine is made from coca plants grown in South America. It most often appears in a powdered form that is sniffed (or, to use the more common term for this method, snorted). The high it produces takes some time to occur but may last up to thirty minutes once it does arrive. A more potent form, crack cocaine (or, more commonly, crack), is made by heating a mixture of powdered cocaine, baking soda, and water. A user then heats the mixture that remains and breathes in the vapors that result. Crack produces an immediate, intense high and is a relatively inexpensive drug. These features made crack a very popular drug when it was first introduced into US cities in the 1980s (Faupel et al. 2010). Street gangs fought each other to control its distribution and sale, much as organized crime gangs fought each other over alcohol distribution and sale during Prohibition.

Cocaine and crack use has declined since the 1970s and 1980s, but, as Table 7.5 “Prevalence of Illegal Drug Use, Ages 18–20, 2010*” showed, almost 15 percent of the public has used cocaine at least once; this number translates to some 37 million Americans. Still, past-year use is only 1.8 percent, and past-month (current) use is only 0.6 percent. Cocaine use thus must be considered rare in percentage terms. At the same time, these percentages translate to 4.5 million and 1.5 million Americans, respectively. These are not small numbers. Moreover, past-year and past-month cocaine use is higher among young people, as Table 7.5 “Prevalence of Illegal Drug Use, Ages 18–20, 2010*” showed. Further, crack use remains a problem in the nation’s urban areas.

In terms of health risks, cocaine is a much more dangerous drug than marijuana. As a stimulant, cocaine speeds up the central nervous system. Because it does so much more intensely than most other stimulants, its use poses special dangers for the cardiovascular system (National Institute on Drug Abuse, 2011). In particular, it can disrupt the heart’s normal rhythm and cause ventricular fibrillations, and it can speed up the heart and raise blood pressure. An overdose of cocaine can thus be deadly, and long-term use produces an increased risk of stroke, seizure, and heart disease. Because cocaine also constricts blood vessels in the brain, long-term use raises the risk of attention deficit, memory loss, and other cognitive problems. Long-term abuse has also caused panic attacks, paranoia, and even psychosis.

Heroin

Heroin is derived from opium (and more immediately from morphine, an opium derivative) and is almost certainly the most notorious opiate. It was one of the popular opiate drugs that, as discussed earlier, were used so widely during the late nineteenth century. Heroin was first marketed as a painkiller and cough suppressant by the company that makes Bayer aspirin. As the United States became more concerned about opium use, Bayer Laboratories discontinued heroin marketing in 1910, and heroin, like other opiates, was banned under the 1914 Harrison Narcotic Act.

Although Table 7.4 “Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*” shows that its use is minuscule in percentage terms, these percentages translate to 600,000 people who have used heroin in the past year, and 240,000 who have used in the past month. Because these users are concentrated in the nation’s large cities, heroin, like crack, is a special problem for these areas.

Like other narcotics, heroin use produces a feeling of euphoria. After it is injected, “the user feels a flash, a rush, which has been described as an intense, voluptuous, orgasmlike sensation. Following this is the feeling of well-being, tranquility, ease, and calm, the sensation that everything in the user’s life is just fine. Tensions, worries, problems, the rough edges of life—all seem simply to melt away” (Goode, 2008, pp. 308–309).

Although heroin use is uncommon, it continues to capture the public’s concern more than perhaps any other illegal drug. As sociologist Goode (2008, pp. 307–308) has observed,

For decades, it was the most feared, the most dreaded, the “hardest” drug; heroin has virtually defined the drug problem. In spite of being somewhat overshadowed since the mid-1980s by cocaine, and specifically crack, heroin probably remains the single substance the American public is most likely to point to as an example of a dangerous drug. Until recently, disapproval of any level of heroin use was greater than for any other drug. And, until recently, heroin addicts were the most stigmatized of all drug users. Heroin is the epitome of the illicit street drug. Its association in the public mind with street crime, even today, is probably stronger than for any other drug. The stereotype of the junkie is that he or she is by nature a lowlife, an outcast, a “deviant,” a dweller in the underworld, an unsavory, untrustworthy character to be avoided at any cost.

Users typically take heroin into their body by injecting it into a vein. This mode of administration is undoubtedly a major reason for the public’s very negative image of heroin users. Indeed, the image of a heroin addict “shooting up” is one that has appeared in many movies and television shows past and present. Many heroin addicts share their needles, a practice that increases their risk of contracting HIV and hepatitis.

The public’s image and concern about heroin is partly deserved in some ways and partly undeserved in other ways. Like other opiates, heroin is extremely physiologically addictive, although not as addictive as nicotine. But also like other opiates, heroin does not damage body organs. The emaciated look we often associate with heroin users stems not from the drug itself but from the low-caliber lifestyles that heroin addicts tend to live and their decisions to spend the little money they have on heroin rather than on food and a healthier lifestyle. An overdose of heroin can certainly kill, just as overdoses of other drugs can kill. One reason heroin overdoses occur is that heroin users cannot know for sure the purity of the heroin they buy illegally and thus may inject an unsafe dose to get high.

Prescription Drug Abuse

Table 7.4 “Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*” showed that about one-fifth of Americans have used prescription drugs for nonmedical purposes. This type of use is illegal. It constitutes the most widespread illegal drug use other than marijuana use and has grown in recent years, especially among adolescents. The prescription drugs that are most often abused are those containing narcotics, tranquilizers, and stimulants; two of the most common brands that are abused are OxyContin and Vicodin. Because prescription drugs are beneficial for so many people even if they are abused, our nation faces a special difficulty in dealing with the abuse of these drugs. As the head of the National Institute on Drug Abuse explains, “The challenges we face are much more complex because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders” (Zuger, 2011, p. D1). Thus according to a news report, “These drugs must be somehow legal and illegal, encouraged yet discouraged, tightly regulated yet easily available” (Zuger, 2011, p. D1).

Many prescription drug abusers use drugs obtained from their own prescriptions or from prescriptions of friends or relatives.

sharyn morrow – the husband’s vicodin – CC BY-NC-ND 2.0.

Most prescription drug abusers have their own prescriptions or obtain their drugs from friends, acquaintances, or relatives who have their own prescriptions. Whatever the source, some of these prescriptions are obtained legitimately—for actual medical conditions—and then abused, and some are obtained after feigning a medical condition. Many experts fault physicians for overprescribing painkillers and other prescription drugs.

Prescription drug abuse is thought to be growing for two reasons (National Institute on Drug Abuse, 2005). First, physicians’ prescriptions for painkillers and other drugs continue to rise, creating a greater supply of prescription drugs that can be abused. Second, online pharmacies and pain clinics have made it easier to obtain prescription drugs, with or without an actual prescription.

The Note 7.14 “Applying Social Research” box discusses the roots of adolescent prescription drug abuse in family and school factors. The importance of these factors reinforces the sociological view that the origins of drug use often lie beyond the individual and in the social environment.