discussion

Chapter 12
Alcohol, Tobacco, and Other Drugs: A Community Concern

Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Identify personal and community consequences of alcohol and other drug abuse.
Describe the trends of alcohol and other drug use by high school students.
Define drug use, misuse, and abuse.
Define drug dependence.
List and discuss the risk factors for the abuse of alcohol and other drugs.
Explain why alcohol is considered the number one drug abuse problem in America.
Describe the health risks of cigarette smoking.
Define the terms over-the-counter and prescription drugs and explain the purposes of these drugs and how they are regulated.
Define the terms controlled substances and illicit (illegal) drugs and provide examples.

Chapter Objectives (2 of 2)
Characterize recent trends in the prevalence of drug use among American high school seniors.
List and explain four elements of drug abuse prevention and control.
Give an example of primary, secondary, and tertiary prevention activities in drug abuse prevention and control programs.
Summarize the federal government’ s drug abuse control efforts.
List and describe an effective community and an effective school drug abuse prevention program.
List the five facets of a typical workplace substance abuse prevention program.
Name some voluntary health agencies and self-help support groups involved in the prevention, control, and treatment of alcohol, tobacco, and other drug abuse.

Introduction
Use, misuse, and abuse of mind-altering substances predates recorded history
Chronic alcohol and other drug abuse or dependence is regarded as destructive behavior in most cultures
Affects individuals and the surrounding community

Scope of the Current Drug Problem (1 of 3)
More deaths, illnesses, and disabilities can be attributed to substance abuse than any other preventable health condition
Economic costs include direct costs (health care, premature death, impaired productivity) and indirect costs (crime and law enforcement, courts, jails, social work)
Those abusing are threats to themselves, their families, and their communities

Sources: Horgan, C., K. C. Skwara, and G. Strickler (2001). Substance Abuse: The Nation’s Number One Health Problem. Princeton, NJ: Robert Wood Johnson Foundation; Centers for Disease Control and Prevention (2008). “Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004.” Morbidity and Mortality Weekly Report, 57(45): 1226–1228; Centers for Disease Control and Prevention (2016). Data on Drug-Poisoning Deaths. National Center for Health . Available at http://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.htm; Centers for Disease Control and Prevention (2013). Alcohol-Related Disease Impact (ARDI) application. Available at www.cdc.gov/ARDI; Sacks, J. J., K. R. Gonzales, E. E. Bouchery, L. E. Tomedi, and R. D. Brewer (2015). “2010 National and State Costs of Excessive Alcohol Consumption.” American Journal of Preventive Medicine, 49(5): e73–e79.; Xu, X., E. E. Bishop, S. M. Kennedy, S. A. Simpson, and T. F. Pechacek (2014). “Annual Healthcare Spending Attributable to Cigarette Smoking: An Update.” American Journal of Preventive Medicine, 48(3): 326–33; National Institute on Drug Abuse (2014). Trends and . Available at https://www.drugabuse.gov/related-topics/trends-statistics#costs; and U.S. Department of Health and Human Services (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm.
Scope of the Current Drug Problem (2 of 3)

Data from: Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. Available at http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf.

Scope of the Current Drug Problem (3 of 3)

Definitions
Drug
Psychoactive drugs
Drug use
Drug misuse
Drug abuse
Drug (chemical) dependence
Psychological dependence

Factors that Contribute to Alcohol, Tobacco, and Other Drug Abuse
Risk factors – factors that increase the probability of drug use
Protective factors – factors that lower the probability of drug use
Both can be genetic or environmental

Inherited Risk Factors
Most research related to drug dependence and inherited risk is on alcoholism
Research has shown genetic and biological markers may predispose someone to increased susceptibility to develop alcohol-related problems

Environmental Risk Factors
Personal factors
Home and family life
School and peer groups
Sociocultural environment

Types of Drugs Abused and Resulting Problems
Legal drugs
Alcohol, nicotine, nonprescription (over-the-counter) drugs, prescription drugs
Controlled substances and illegal (illicit) drugs
Marijuana, narcotics, cocaine and crack cocaine, hallucinogens, stimulants, depressants, club drugs and designer drugs, anabolic drugs, inhalants

Legal Drugs
Can be legally bought and sold in the marketplace
Includes drugs that can be closely regulated, likely regulated, and not regulated at all

Alcohol
Number one drug problem in the United States
Binge drinking
Underage drinking
Problem drinkers
Alcoholism
Blood alcohol concentration (BAC)
Fetal Alcohol Spectrum Disorders
Fetal Alcohol Syndrome

Nicotine
Psychoactive and addictive drug present in tobacco products
Environmental tobacco smoke (ETS) or secondhand smoke
Synar Amendment
Tobacco use is single most preventable cause of disease, disability, and death in the U.S.
Community efforts: tax increases on cigarettes

Over-the-Counter Drugs (OTCs)
Legal drugs other than alcohol and tobacco that can be purchased without a physician’s prescription
Carefully regulated by the Food and Drug Administration (FDA)
Most only provide symptomatic relief, not a cure
Subject to misuse and abuse

Prescription Drugs
Can be purchased only with a physician’s prescription because they have serious side effects for some people
Regulated by the FDA
Subject to misuse and abuse; opioid pain relievers
Risk of dependence and unintentional overdose
Development of drug-resistant strains of pathogens

Controlled Substances and Illicit Drugs
Those regulated by the Controlled Substances Act of 1970
Cannot be cultivated, manufactured, bought, sold, or used within the confines of the law
Schedule I – high potential for abuse; no accepted medical uses
Schedules II-V – have medical uses; scheduled based on potential for risk of dependence or abuse
Drug Enforcement Agency (DEA) responsible for enforcing Controlled Substances Act

Marijuana
Products derived from hemp plant
Most abused illicit drug in the U.S.
Often used in conjunction with other drugs – polydrug use
Acute effects – reduced concentration, slowed reaction time, impaired short-term memory, impaired judgment
Chronic effects – damage to the respiratory system (if smoked), amotivational syndrome

Synthetic Marijuana
Emerging cause for concern
Chemically produced with properties similar to THC
Pose serious threat to communities – potential for abuse and other adverse health effects, long-term effects unknown
In 2011, five chemicals used to produce synthetic marijuana were added to Schedule I of the CSA
States have banned synthetic marijuana

Narcotics
Opium and its derivatives, morphine and heroin, come from an oriental poppy plant
Narcotics numb the senses and reduce pain
High potential for abuse
Opium poppies do not grow in U.S.; drug trafficking problems
Heroin addiction leads to significant community health problems

Cocaine and Crack Cocaine
Cocaine is the psychoactive ingredient in the leaves of the coca plant
Powerful and addictive euphoriant/stimulant
Purified forms – salt (white powder), dried paste (crack)
In 2015, annual prevalence of cocaine use among high school seniors at lowest reported level of 2.5%

Hallucinogens
Produce illusions, hallucinations, changes in perceptions
Synesthesia – mixing of the senses
Both naturally derived and synthetic
LSD, mescaline, peyote, mushrooms

Stimulants
Drugs that increase the activity of the central nervous system
Amphetamines
Schedule II prescription drugs; widely abused
Methamphetamines often made in clandestine labs

El Paso Intelligence Center (EPIC/National Secure System NSS)
Total of all clandestine laboratory incidents involving methamphetamine

Depressants
Slow down the central nervous system
May lower anxiety and inhibitions
Tolerance develops
Strong physical dependence
Alcohol, barbiturates, benzodiazepines

Club Drugs and Designer Drugs
Illicit drugs, primarily synthetic, most commonly encountered at nightclubs and raves
MDMA (ecstasy) most popular club drug
Rohypnol – “date rape” drug
Designer drugs – synthesized by amateur chemists in secret labs
Constantly change design to stay ahead of law enforcement

Anabolic Drugs
Protein-building drugs
Anabolic/androgenic steroids, testosterone, human growth hormone
Have some legitimate medical uses
Sometimes abused by athletes and body builders
Acute and chronic side effects

Inhalants
Collection of psychoactive breathable chemicals
Paint solvents, motor fuels, cleaners, glues, aerosol sprays
Easy availability
Low cost
Often drug choice of young
Acute and chronic effects

Prevention and Control of Drug Abuse
Requires knowledge of:
Causes of drug-taking behavior
Sources of illicit drugs
Drug laws
Treatment programs
Community organizing skills
Persistence, and the cooperation of various individuals and agencies

Levels of Prevention
Primary prevention aimed at those who have never used drugs
Secondary prevention aimed at those who have used, but are not chronic abusers
Tertiary prevention aimed at drug abuse treatment and aftercare, including relapse prevention

Elements of Prevention
Education
Treatment
Public policy
enforcement
Education and treatment goals same:
Reduce demand for drugs
Public policy and law enforcement goals same:
Reduce supply and availability of drugs

Governmental Drug Prevention and Control Agencies and Programs (1 of 2)
Include a multitude of federal, state, and local agencies
Aim to reduce either the supply of or the demand for drugs

Office of the National Drug Control Policy, The White House (2013). National Drug Control Budget FY 2014 Funding Highlights. Washington, DC: The White House. Available at http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/fy_2014_drug_control_budget_highlights_3.pdf. Accessed June 25, 2013.

Federal drug control spending by function, fiscal years 2012-2014.

Governmental Drug Prevention and Control Agencies and Programs (2 of 2)

Federal Agencies and Programs
Office of National Drug Control Policy
Department of Health and Human Services
Substance Abuse and Mental Health Services Administration (SAMSHA)
National Institute on Drug Abuse
Department of Justice
Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF)
Department of Homeland Security

State and Local Agencies and Programs
State departments of health, education, mental health, justice, and law enforcement all address drug abuse prevention and control issues
Some states have passed laws that conflict with federal laws
Local communities have individuals, task forces, or agencies to prioritize problems and decide approaches for solving them

Nongovernmental Drug Prevention and Control Agencies and Programs
Community-based drug education programs
School-based drug education programs
DARE, student assistance programs, peer counseling programs
Workplace-based drug education programs
Employee assistance programs
Voluntary health agencies

Discussion Questions
How can risk factors for drug abuse be utilized to aid in drug abuse prevention?
How should federal, state, and local funds be used to successfully deal with drug abuse problems?