Module 2: Lecture

Chapter 2: Alcohol and Other Drugs

Alcohol

A portion of American ambivalence toward drugs and alcohol is rooted in the distinctions among use, abuse, and addiction.  The focus of this chapter is abuse, including addiction.

• The use and abuse of alcohol is America's most serious health problem. 
• About 62 percent of Americans identify themselves as drinkers, 23 percent say they sometimes drink more than they should, and 30 percent say that drinking has been a source of trouble in their families. 
• American Indians probably have the highest rates of use and abuse of alcohol; whites drink more than African Americans or Hispanics; men drink more than women (in fact, alcohol abuse and alcoholism are primarily male problems); alcohol abuse is more common among the young than the old. 
• The skid row image of the alcohol abuser is false.
• The quality of life in the group of heavy drinkers is lower than the national average. 
• Heavy drinkers have a relatively low life expectancy, run a higher risk of coronary heart disease, and are more likely to have a heart attack. 
• Long-term effects of heavy drinking involve impairment of the major organs of the body, including cirrhosis of the liver and premature aging of the brain. 
• Alcohol also plays a role in various kinds of physical trauma such as spouse abuse and automobile accidents. 
• Heavy use by pregnant women can result in children with Fetal Alcohol Syndrome. 
• Psychological and interpersonal problems, including stress in the family of the drinker, are also higher among alcohol abusers than the general population. 
• The economic costs of alcoholism to the nation are high because of the monies expended in the arrest, trial and imprisonment of those who are drunk.
• Contributing factors to the problem of alcoholism include both social structural and social psychological conditions. 
• Adolescents whose peers abuse alcohol run a higher risk of the problem. 
• Role conflict and the experience of a major loss increase the probability of abuse. 
• Three family experiences are associated with the problem:

1. Having a parent who was an alcoholic,
2. Coming from a broken home, and disturbed family relationships. 
3. Stress and a sense of powerlessness also contribute to alcoholism. 

• The way drinking is portrayed on television contributes to a different set of attitudes toward alcohol than toward other drugs.
• The ideology that transforms the issue into a personal problem from a truly social problem inhibits efforts to shape public policy to deal with alcoholism as a social problem.
• There is growing recognition that instead of asking what can be done for an alcoholic, we need to first ask what kind of alcoholic we are dealing with. 
• Whatever the special needs they may have, alcoholics are likely to need one or more of the following types of therapy:

1. individual,
2. drug,
3. behavior, or
4. group therapy. 

• The problem of alcoholism has also been attacked through various other programs and facilities: community-care programs, halfway houses, and programs involving enforcement, prevention, and education. 
• Finally, both informal and formal measures can be taken to help those victimized by alcohol-impaired driving and to ameliorate or prevent further victimization.

Other Drugs

• Drugs may be classified into seven main types:

1. Cannabinoids, depressants, hallucinogens, opioids and morphine derivatives, stimulants, and anabolic steroids and inhalants. 
2. In addition, various designer drugs continue to appear and to be problematic.

• The physiological and psychological effects vary not only from drug to drug but also in significant ways for individuals and social situations. 
• Howard Becker's marijuana research bears on this point, as does much of our knowledge concerning alcohol use.     
• It is difficult to know the number of drug users in the United States; not all users are addicts, and not all addicts are known to the authorities. 
• There is wide variation in use, but in general use is higher among males than females, the young rather than the elderly, and the lower rather than the middle or upper social classes. 
• Alcohol is the most widely used drug, followed by tobacco and marijuana. 
• Non-narcotic drugs such as marijuana, hallucinogens, stimulants, and depressants are more widely used than narcotics. 
• Drug use rose rapidly after 1960 and reached a peak in 1979; after 1980, the upward trends stopped and even reversed for most drugs. 
• Use fluctuated during the 1990s, and increased again in 2001. 
• Increasing attention is also being paid to the abuse of prescription drugs.
•  Both older people who are self-medicating, and teenagers looking to get highly at risk for abuse of pain relievers and other similar prescription drugs. 
• One frequently raised question concerns multiple-drug usage. 
• A number of studies support the conclusion of a "tendency" toward multiple use—the majority of people who consume illicit drugs use, or have used, more than one kind of drug and also consume alcoholic beverages. 
• The stereotype of the drug user as a ghetto or skid row resident is a misconception; the problem encompasses people from many walks of life, including elementary-school children, college students, and physicians.
•  As a generalization, it can be asserted that the bulk of drug users are young, male, and poor.
• The abuse of drugs involves a number of contradictions defined as incompatible with the desired quality of life. 

1. It contradicts our value of physical well-being.  Addicts do not just suffer a large number of physical illnesses; they also tend to die at an early age, and often their deaths are associated with drug overdose.  Tobacco causes more physiological damage than any other nonalcoholic drug, and is the leading cause of preventable death in America.  Marijuana, once considered relatively harmless, is now known to have adverse acute and chronic physical consequences.  Marijuana, however, may also have more medical uses than previously thought. 
2. Drug abuse contradicts the quest for psychological well-being.  The short-range euphoria from mild drug use can be misleading and should not be considered in the same light as extended abuse, which is conducive to self-destructive behavior or psychological impairment. 
3. Americans value the ability to get along with others.  That value is contradicted by the problematic interaction that tends to result from drug abuse. 
4. The drug problem involves heavy economic costs, and also consumes funds that might otherwise enhance our quality of life.

• The factors contributing to the problem possess a twofold effect:

1. they maintain demand by encouraging use of drugs,
2. they also guarantee a supply. 
3. This effect may be viewed through examination of social structural factors, including group norms, role problems, family experiences, political processes, and the economics of the drug traffic; or it may be viewed through examination of social psychological factors such as attitudes and ideology.
4.  Positive attitudes, group norms, and ideologies about drug use reinforce one another.  When combined in favor of abuse, these factors are difficult to counter.

• Most efforts dealing with abuse have tended to focus on the individual, and on treatment rather than prevention. 
• The authors do not disparage these efforts; however, they feel that we must not only help the individual addict but also get at the social factors leading to those conditions. 
• In particular, there is a need for an emphasis on reducing demand rather than merely stopping the supply. 
• Coercion, education, correction, and the use of alternative drugs (for example, methadone) have been and are continuing to be tried. 
• Some observers believe these measures have largely failed and suggest other alternatives such as decriminalization or concentration on high-risk patterns of use, where drug involvement demonstrably and significantly increases the chance of self-harm.
• Enforcement programs by government agencies focus on the supply—preventing drugs from entering the country or from being produced within the country. 
• Treating addicts focuses on reducing the demand. 

1. Treatment methods include detoxification, methadone maintenance, brief intervention therapy, family therapy, drug-treatment centers, religious-type experiences, and peer support.  No single treatment works for everyone. 
2. Various education and prevention programs also show promise for reducing demand.
3. Some authorities advocate the decriminalization of drug use to reduce demand, but others disagree.

Learning Objectives:

• Learn the types and effects of alcohol and various other drugs.
• Identify the patterns of use in the United States.
• Explain the personal, interpersonal, and societal consequences of the use and abuse of alcohol and other drugs.
• Understand the varied social structural factors that facilitate and help perpetuate the problem.
• Describe the kinds of other drugs.

Key Terms: (refer to page numbers for additional reading)

Abuse: Improper use of Drugs or alcohol to the degree that the consequences are defined as detrimental to the user or society. 

Addiction:  Repeated use of a drug or alcohol to the point of periodic or chronic intoxication that is detrimental to the user or society.  

Detoxification:  Supervised withdrawal from dependence on a drug. 

Placebo:  Any substance having no physiological effect that is given to a subject who believes it to be a drug that does have an effect. 

Role conflict:  A person’s perception that two or more of his or her roles are contradictory, or that the same role has contradictory expectations, or that the expectations of the role are unacceptable or excessive.