Chapter01 - SECTION ONE Drug Use in Modern Society The...

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Unformatted text preview: SECTION ONE Drug Use in Modern Society The interaction between drugs and behavior can be approached from two general perspectives. Certain drugs, the ones we call psychoactive, have profound effects on behavior. Part of what a book on this topic should do is describe the effects of these drugs on behavior, and later chapters do that in some detail. Another perspective, however, views drug taking as behavior. The psychologist sees drug-taking behaviors as interesting examples of human behavior that are influenced by many psychological, social, and cultural variables. In the first section of this text, we focus on drug taking as behavior that can be studied in the same way that other behaviors, such as aggression, learning, and human sexuality, can be studied. 3 1 2 Drug Use: An Overview Which drugs are being used and why? Drug Use as a Social Problem Why does our society want to regulate drug use? Drug Products and Their Regulations What are the regulations, and what is their effect? 1 "The Drug Problem" Talking about Drug Use Drug Use: An Overview Objectives When you have finished this chapter, you should be able to: Develop an analytical framework for understanding any specific drug-use issue. Apply four general principles of psychoactive drug use to any specific drug-use issue. Explain the differences between misuse, abuse, and dependence. Describe the general trends of increases and decreases in drug use in the U.S. since 1975. Remember several correlates and antecedents of adolescent drug use. Describe correlates and antecedents of drug use in the terminology of risk factors and protective factors. "Drug use on the rise" is a headline that has been seen quite Discuss motives that people may have for illicit and/or regularly over the years. It gets dangerous drug-using behavior. our attention. At any given time the unwanted use of some kind of drug can be found to be increasing, Journalism students are told that an informaat least in some group of people. How big a tive news story must answer the questions who, problem does the current headline represent? what, when, where, why, and how. Let's see how Before you can meaningfully evaluate the answering the same questions plus one more extent of such a problem or propose possible question--how much--can help us analyze solutions, it helps to define what you're talkproblem drug use. ing about. In other words, it helps to be more Who is taking the drug? We are more conspecific about just what the problem is. Most cerned about a 15-year-old girl drinking a of us don't really view the problem as drug beer than we are about a 21-year-old woman use, if that includes your Aunt Margie's takdoing the same thing. We worry more about a ing two aspirins when she has a headache. 10-year-old boy chewing tobacco than we do What we really mean is that some drugs being about a 40-year-old man chewing it (unless we used by some people or in some situations happen to be riding right behind him when constitute problems with which our society he spits out the window). And, although we must deal. 2 Chapter 1 Drug Use: An Overview 3 Online Learning Center Resources Visit our Online Learning Center (OLC) for access to these study aids and additional resources. Learning objectives Glossary flashcards Web activities and links Self-scoring chapter quiz Audio chapter summaries Video clips example is the drinking of alcohol; if it is confined to appropriate times and places, most people accept drinking as normal behavior. When an individual begins to drink on the job, at school, or in the morning, that behavior may be evidence of a drinking problem. Even subcultures that accept the use of illegal drugs might distinguish between acceptable and unacceptable situations; some college-age groups might accept marijuana smoking at a party but not just before going to a calculus class! Why a person takes a drug or does anything else is a tough question to answer. Nevertheless, it is important in some cases. If a person takes Vicodin because her doctor prescribed it for the knee injury she got while skiing, most of us would not be concerned. If, on the other hand, she takes that drug on her own, just because she likes the way it makes her feel, then we should begin to worry about possible abuse of the drug. The motives for drug use, as with motives for other behaviors, can be complex. Even the person taking the drug might not be aware of all the motives involved. One way a psychologist can try to answer why questions is to look for consistency in the situations in which the behavior occurs (when and where). If a person drinks only with other people who don't like anyone taking heroin, we undoubtedly get more upset when we hear about the girl next door becoming a user. What drug are they taking? This question should be obvious, but often it is overlooked. A simple claim that a high percentage of students are "drug users" doesn't tell us if there has been an epidemic of methamphetamine use or if the drug referred to is alcohol (more likely). If someone begins to talk about a serious "drug problem" at the local high school, the first question should be "what drug or drugs?" When and where is the drug being used? The situation in which the drug use occurs often makes all the difference. The clearest Our concern about the use of a substance often depends on who is using it, how much is being used, and when, where, and why it is being used. 4 Section One Drug Use in Modern Society Drugs in the Media Reporting on the "Drug du Jour" At the beginning of this millennium, newspaper and television stories about drugs are dominated by the so-called club drugs, such as Ecstasy and GHB. Before that there was a wave of media reports about crystal meth and other forms of methamphetamine. In the mid-1980s, it was crack cocaine. Of course these waves of media focus are associated with waves of drug use, but the news media all seem to jump on the latest "drug du jour" (drug of the day) at the same time. One question that doesn't get asked much is this: What role does such media attention play in popularizing the current drug fad, perhaps making it spread farther and faster than would happen without the publicity? About 40 years ago, in a chapter titled "How to Create a Nationwide Drug Epidemic," journalist E. M. Brecher described a sequence of news stories that he believed were the key factor in spreading the practice of sniffing the glues sold to kids for assembling plastic models of cars and airplanes (see volatile solvents in Chapter 7). He argued that, without the well-meant attempts to warn people of the dangers of this practice, it would probably have remained isolated to a small group of youngsters in Pueblo, Colorado. Instead, sales of model glue skyrocketed across America, leading to widespread restrictions on sales to minors. Thinking about the kinds of things such articles often say about the latest drug problem, are there components of those articles that you would include if you were writing an advertisement to promote use of the drug? Do you think such articles actually do more harm than good, as Brecher suggested? If so, does the important principle of a free press mean there is no way to reduce the impact of such journalism? are drinking, we may suspect social motives; if a person often drinks alone, we may suspect that the person is trying to deal with personal problems by drinking. How the drug is taken can often be critical. South American Indians who chew coca leaves absorb cocaine slowly over a long period. The same total amount of cocaine "snorted" into the nose produces a more rapid, more intense effect of shorter duration and probably leads to much stronger dependence. Smoking cocaine in the form of "crack" produces an even more rapid, intense, and brief effect, and dependence occurs very quickly. How much of the drug is being used? This isn't one of the standard journalism questions, but it is important when describing drug use. Often the difference between what one considers normal use and what one considers abuse of, for example, alcohol or a prescription drug comes down to how much a person takes. Four Principles of Psychoactive Drugs Now that we've seen how helpful it can be to be specific when talking about drug use, let's look for some organizing principles. Are there any general statements that can be made about psychoactive drugs--those compounds that alter consciousness and affect mood? Four basic principles seem to apply to all of these drugs. 1. Drugs, per se, are not good or bad. There are no "bad drugs." When drug abuse, drug dependence, and deviant drug use are talked about, it is the behavior, the way the drug is being used, that is being referred to. This statement sounds controversial and has angered some prominent political figures and drug educators. It therefore requires some defense. For a pharmacologist, it is difficult to view the drug, the chemical substance itself, as somehow possessing evil intent. It sits there in its bottle and does nothing until we put it into a living system. From the perspective of Chapter 1 Drug Use: An Overview 5 2. 3. 4. a psychologist who treats drug users, it is difficult to imagine what good there might be in heroin or cocaine. However, heroin is a perfectly good painkiller, at least as effective as morphine, and it is used medically in many countries. Cocaine is a good local anesthetic and is still used for medical procedures, even in the United States. Each of these drugs can also produce bad effects when people abuse them. In the cases of heroin and cocaine, our society has weighed its perception of the risks of bad consequences against the potential benefits and decided that we should severely restrict the availability of these substances. It is wrong, though, to place all of the blame for these bad consequences on the drugs themselves and to conclude that they are simply "bad" drugs. Many people tend to view some of these substances as possessing an almost magical power to produce evil. When we blame the substance itself, our efforts to correct drug-related problems tend to focus exclusively on eliminating the substance, perhaps ignoring all of the factors that led to the abuse of the drug. Every drug has multiple effects. Although a user might focus on a single aspect of a drug's effect, we do not yet have compounds that alter only one aspect of consciousness. All psychoactive drugs act on more than one place in the brain, so we might expect them to produce complex psychological effects. Also, virtually every drug that acts in the brain also has effects on the rest of the body, influencing blood pressure, intestinal activity, or other functions. Both the size and the quality of a drug's effect depend on the amount the individual has taken. The relationship between dose and effect works in two ways. By increasing the dose, there is usually an increase in the same effects noticed at lower drug levels. Also, at different dose levels there is often a change in the kind of effect, an alteration in the character of the experience. The effect of any psychoactive drug depends on the individual's history and expectations. The effects of drugs are influenced by the setting and the expectations of the user. Because these drugs alter consciousness and thought processes, the effect they have on an individual depends on what was there initially. An individual's attitude can have a major effect on his or her perception of the drug experience. The fact that relatively inexperienced users can experience a high when smoking oregano and dry oak tree leaves-- thinking it's good marijuana--should come as no surprise to anyone who has arrived late at a party and felt a "buzz" after one drink rather than the usual two or three. It is not possible, then, to talk about many of the effects of these drugs independent of the user's history and attitude and the setting. How Did We Get Here? Have Things Really Changed? Drug use is not new. Humans have been using alcohol and plant-derived drugs for thousands of years--as far as we know, since Homo sapiens first appeared on the planet. A truly "drug-free society" has probably never existed, and might never exist. Psychoactive drugs were used in rituals that we could today classify as religious psychoactive: having effects on thoughts, emotions, or behavior. marijuana (mare i wan ah): also spelled "marihuana." Dried leaves of the Cannabis plant. 6 Section One Drug Use in Modern Society Drugs in Depth Important Definitions--and a Caution! Some terms that are commonly used in discussing drugs and drug use are difficult to define with precision, partly because they are so widely used for many different purposes. Therefore, any definition we offer should be viewed with caution because each represents a compromise between leaving out something important versus including so much that the defined term is watered down. The word drug will be defined as "any substance, natural or artificial, other than food, that by its chemical nature alters structure or function in the living organism." One obvious difficulty is that we haven't defined food, and how we draw that line can sometimes be arbitrary. Alcoholic beverages, such as wine and beer, may be seen as drug, food, or both. Are we discussing how much sherry wine to include in beef Stroganoff, or are we discussing how many ounces of wine can be consumed before becoming intoxicated? Since this is not a cookbook but, rather, a book on the use of psychoactive chemicals, we will view all alcoholic beverages as drugs. Illicit drug is a term used to refer to a drug that is unlawful to possess or use. Many of these drugs are available by prescription, but when they are manufactured or sold illegally they are illicit. Traditionally, alcohol and tobacco have not been considered illicit substances even when used by minors, probably because of their widespread legal availability to adults. Common household chemicals, such as glues and paints, take on some characteristics of illicit substances when people inhale them to get "high." Deviant drug use is drug use that is not common within a social group and that is disapproved of by the majority, causing members of the group to take corrective action when it occurs. The corrective action may be informal (making fun of the behavior, criticizing the behavior) or formal (incarceration, treatment). Some examples of drug use might be deviant in the society at large but accepted or even expected in particular subcultures. We still consider this behavior to be deviant, since it makes more sense to apply the perspective of the larger society. Drug misuse generally refers to the use of prescribed drugs in greater amounts than, or for purposes other than, those prescribed by a physician or dentist. For nonprescription drugs or chemicals such as paints, glues, or solvents, misuse might mean any use other than the use intended by the manufacturer. Abuse consists of the use of a substance in a manner, amounts, or situations such that the drug use causes problems or greatly increases the chances of problems occurring. The problems may be social (including legal), occupational, psychological, or physical. Once again, this definition gives us a good idea of what we're talking about, but it isn't precise. For example, some would consider any use of an illicit drug to be abuse because of the possibility of legal problems, but many people who have tried marijuana would argue that they had no problems and therefore didn't abuse it. Also, the use of almost any drug, even under the orders of a physician, has at least some potential for causing problems. The question might come down to how great the risk is and whether the user is recklessly disregarding the risk. How does cigarette smoking fit this definition? Should all cigarette smoking be considered drug abuse? For someone to receive a diagnosis of having a substance-use disorder (see DSM-IV-TR feature in Chapter 2), the use must be recurrent, and the problems must lead to significant impairment or distress. Addiction is a controversial and complex term that has different meanings for different people. Because the term is so widely used in everyday conversation, it is risky for us to try to give it a precise, scientific definition, and then have our readers use their own long-held perspectives whenever we use the term. Therefore, we have avoided using this term where possible, instead relying on more precisely defined terms such as dependence. Drug dependence refers to a state in which the individual uses the drug so frequently and consistently that it appears that it would be difficult for the person to get along without using the drug. For some drugs and some users, there are clear withdrawal signs when the drug is not taken, implying a physiological dependence. Dependence can take other forms, as shown in the DSM-IV-TR feature in Chapter 2. If a great deal of the individual's time and effort is devoted to getting and using the drug, if the person often winds up taking more of the substance than he or she intended, and if the person has tried several times without success to cut down or control the use, then the person meets the criteria for dependence. Chapter 1 Drug Use: An Overview 7 Taking Sides Can We Predict or Control Trends in Drug Use? Looking at the overall trends in drug use, it is clear that significant changes have occurred in the number of people using marijuana, cocaine, alcohol, and tobacco. However, while it's easy to describe the changes once they have happened, it's much tougher to predict what will come next. Maybe even harder than predicting trends in drug use is knowing what social policies are effective in controlling these trends. The two main kinds of activities that we usually look to as methods to prevent or reduce drug use are legal controls and education (including advertising campaigns). How effective do you think laws have been in helping prevent or reduce drug use? Be sure to consider laws regulating sales of alcohol and tobacco to minors in your analysis. What about the public advertising campaigns you are familiar with? How about school-based prevention programs? As you go through the remainder of this book, these questions will come up again, along with more information about specific laws, drugs, and prevention programs. For now, choose which side you would rather take in a debate on the following proposition: broad changes in drug use reflect shifts in society and are not greatly influenced by drug-control laws, antidrug advertising, or drugprevention programs in schools. in nature, and Chapter 14 provides several examples of hallucinogenic drugs reported to enhance spiritual experiences. A common belief in many early cultures was that illness results from invasion by evil spirits, so in that context it makes sense that psychoactive drugs were often used as part of a purification ritual to rid the body of those spirits. In these early cultures the use of drugs to treat illness likely was intertwined with spiritual use so that the roles of the "priest" and that of the "shaman" (medicine man) often were not separate. In fact, the earliest uses of many of the drugs that we now consider to be primarily recreational drugs or drugs of abuse (nicotine, caffeine, alcohol, and marijuana) were as treatments for various illnesses. Psychoactive drugs have also played significant roles in the economies of societies in the past. Chapter 10 describes the importance of tobacco in the early days of European exploration and trade around the globe as well as its importance in the establishment of English colonies in America; Chapter 6 discusses the significance of the coca plant (from which cocaine is derived) in the foundation of the Mayan empire in South America; and Chapter 13 points out the importance of the opium trade in opening China's doors to trade with the West in the 1800s. One area in which enormous change has occurred over the past 100-plus years is in the development and marketing of legal pharmaceuticals. The introduction of vaccines to eliminate smallpox, polio, and other communicable diseases, followed by the development of antibiotics that are capable of curing some types of otherwise deadly illnesses, laid the foundation for our current acceptance of medicines as the cornerstone of our health care system. Some of the scientific and medical discoveries, problems, and laws associated with these changes are outlined in Chapter 3. The many kinds of legal pharmaceuticals designed to influence mental and behavioral functioning are discussed in Chapter 8. Another significant development in the past 100 years has been government efforts to limit access to certain kinds of drugs that are deemed too dangerous or too likely to produce dependence to allow them to be used in an unregulated fashion. The enormous growth, both in expenditures and in the breadth of substances now controlled, has led many to refer to this development as a "war on drugs." These laws are also outlined in Chapter 3, but we will trace their effect throughout the chapters on different drug classes, and the chapters on prevention and treatment of drug abuse and dependence. With both of these developments, the proportion of our economy devoted to psychoactive 8 Section One Drug Use in Modern Society drugs, both legal and illegal, and to their regulation, has also expanded considerably. So drug use would be an important topic for us to understand if only for that fact. In addition, drug use and its regulation are reflective of changes in our society and in how we as individuals interact with that society. Also, drug problems and our attempts to solve them have in turn had major influences on us as individuals and on our perceptions of appropriate roles for government, education, and health care. Therefore, the topic of psychoactive drugs provides a window through which we can study our own current psychology, sociology, and politics. Drugs and Drug Use Today Extent of Drug Use In trying to get an overall picture of drug use in today's society, we quickly discover that it's not easy to get accurate information. It's not possible to measure with great accuracy the use of, let's say, cocaine in the United States. We don't really know how much is imported and sold, because most of it is illegal. We don't really know how many cocaine users there are in the country, because we have no good way of counting them. For some things, such as prescription drugs, tobacco, and alcohol, we have a wealth of sales information and can make much better estimates of rates of use. Even there, however, our information might not be complete (home-brewed beer would not be counted, for example, and prescription drugs might be bought and then left unused in the medicine cabinet). Let us look at some of the kinds of information we do have. A large number of survey questionnaire studies have been conducted in junior highs, high schools, and colleges, partly because this is one of the easiest ways to get a lot of information with a minimum of fuss. Researchers have always been most interested in drug use by adolescents and young adults, because this age is when drug use usually begins and reaches its highest levels. This type of research has a couple of drawbacks. The first is that we can use this technique only on the students who are in classrooms. We can't get this information from high school dropouts. That causes a bias, because those who skip school or have dropped out are more likely to use drugs. A second limitation is that we must assume that most of the self-reports are done honestly. In most cases, we have no way of checking to see if Johnny really did smoke marijuana last week, as he claimed on the questionnaire. Nevertheless, if every effort is made to encourage honesty (including assurances of anonymity), we expect that this factor is minimized. To the extent that tendencies to overreport or underreport drug use are relatively constant from one year to the next, we can use such results to reflect trends in drug use over time and to compare relative reported use of various drugs. Drugs in Depth Methamphetamine Use in Your Community Assume that you have just been appointed to a community-based committee that is looking into drug problems. A high school student on the committee has just returned from a residential treatment program and reports that methamphetamine use has become "very common" in local high schools. Some members of the committee want to call in some experts immediately to give schoolwide assemblies describing the dangers of methamphetamine. You have asked for a little time to check out the student's story to find out what you can about the actual extent of use in the community and report back to the group in a month. Make a list of potential information sources and the type of information each might provide. How close do you think you could come to making an estimate of how many current methamphetamine users there are in your community? Do you think it would be above or below the national average? Chapter 1 Drug Use: An Overview 9 Table 1.1 Percentage of College Students One to Four Years beyond High School Reporting Use of Seven Types of Drugs (2006) Used in Used Daily Ever Past for Past Used 30 Days 30 Days 85 NA 47 7 11 11 8 2.3 65 19 17 0.4 2.5 0.9 1.8 0.0 4.8 9.2 4.3 0.0 0.4 0.0 0.1 0.0 daily use of any of these drugs other than cigarettes can be considered rare. Trends in Drug Use The Monitoring the Future study, which has now been conducted annually for more than 30 years, allows us to see changes over time in the rates of drug use. Figure 1.1 displays data on marijuana use among 12th-graders. Look first at the line labeled "Use." In 1975, just under 30 percent of high school seniors reported that they had used marijuana in the past 30 days (an indication of "current use"). This proportion rose each year until 1978, when 37 percent of 12th-graders reported current marijuana use. Over the next 13 years, from 1979 to 1992, marijuana use declined steadily so that by 1992 only 12 percent of 12th-graders reported current use (about one-third as many as in 1978). Then the trend reversed, with rates of current use climbing back to 24 percent of 12th-graders by 1997, followed by a slow decline over the past 10 years to just under 20 percent in 2007. Because marijuana is by far the most commonly used illicit drug, we can use this graph to make a broader statement: Illicit drug use among high school seniors has been slowly declining over the past 10 years. Currently, marijuana use is about half as common among 12th-graders as it was in 1978, but it is more common than it was at its lowest point 15 years ago. This is important because there always seem to be people trying to say that drug use is increasing among young people, or that people are starting to use drugs at younger and younger ages, but the best data we have provide no support for such statements (e.g., data from 8th-graders show the same trends as for 12th-graders). How can we explain these very large changes in rates of marijuana use over time? Maybe marijuana was easier to obtain in 1978, less available in 1992, etc.? Each year the same students were asked their opinion about how easy they thought it would be to get marijuana if they wanted to do so. Looking at the "Availability" line, and using the scale on the right-hand side of Figure 1.1, Drug Alcohol Cigarettes Marijuana/hashish Inhalants Amphetamines Hallucinogens Cocaine (all) Crack Source: Monitoring the Future Project, University of Michigan Let's look first at the drugs most commonly reported by young college students in a recent nationwide sample. Table 1.1 presents data from one of the best and most complete research programs of this type, the Monitoring the Future Project at the University of Michigan. Data are collected each year from more than 15,000 high school seniors in schools across the United States, so that nationwide trends can be assessed. Data are also gathered from 8th- and 10th-graders and from college students. Three numbers are presented for each drug: the percentage of college students (one to four years beyond high school) who have ever used the drug, the smaller percentage who report having used it within the past 30 days, and the still smaller percentage who report daily use for the past 30 days.1 Note that most of these college students have tried alcohol at some time in their lives. Half have tried marijuana, and most students report never having tried the rest of the drugs listed. Also note that 10 Section One 50 Drug Use in Modern Society 100 Availability 90 80 40 Risk Risk and Availability 70 60 50 30 Use 20 Use 40 30 10 20 10 0 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 Use: % using once or more in past 30 days (on left-hand scale) Risk: % saying great risk of harm in regular use (on right-hand scale) Availability: % saying fairly easy or very easy to get (on right-hand scale) 0 Figure 1.1 Marijuana: Trends in Perceived Availability, Perceived Risk of Regular Use, and Prevalence of Use in the Past 30 Days for 12th-Graders SOURCE: L. D. Johnston, P. M. O'Malley, J. G. Bachman, and J. E. Schulenberg, "Overall, Illicit Drug Use by American Teens Continues Gradual Decline in 2007." Ann Arbor, MI: University of Michigan News Service [online], available at; accessed December 11, 2007. we can see that back in 1975 about 90 percent of the seniors said that it would be fairly easy or very easy for them to get marijuana. The interesting thing is that this perception has not changed much, remaining close to 90 percent for over 30 years. Thus, the perceived availability does NOT appear to explain differences in rates of use over time. This is important because it implies that we can have large changes in rates of drug use even when the supply of the drug does not appear to change much. There is another line on Figure 1.1, labeled "Risk" (and also tied to the right-hand scale). In 1975, about 40 percent of 12th-graders rated the risk of harm from regular marijuana use as "great risk of harm." The proportion of students reporting great risk declined over the same time that use was increasing (up to 1978). Then, as use dropped from 1979 to 1992, perceived risk increased. Perceived risk declined during the 1990s when use was again increasing, and in re- cent years perceived risk is slowly rising while rates of use are slowly declining. You should be able to see from Figure 1.1 that as time goes by, the line describing changes in perception of risk from using marijuana is essentially a mirror image of the line describing changes in rates of using marijuana. This is important because it seems to say that the best way to achieve low rates of marijuana use is by convincing students that it is risky to use marijuana, whereas efforts to control the availability of marijuana ("supply reduction") might have less of an influence. However, we must keep in mind that a cause and effect relationship has not been proven. Changes in both rates of use and perceptions of risk could be caused by something else that we are not directly measuring. In addition to the surveys of students, broad-based self-report information is also gathered through house-to-house surveys. With proper sampling techniques, these studies can 40 35 Percentage Using in Past Month Chapter 1 Drug Use: An Overview 11 30 25 20 15 10 5 0 1970 Ages 1217 Ages 1825 1975 1980 1985 1990 Year 1995 2000 2005 Figure 1.2 Marijuana Use among Persons Ages 1225, by Age Group: 19712006 Source: Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health (Rockville, MD: Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293, 2007). estimate the drug use in most of the population, not just among students. This technique is much more time-consuming and expensive, it has a greater rate of refusal to participate, and we must suspect that individuals engaged in illegal drug use would be reluctant to reveal that Marijuana is the most commonly used illicit drug, and major surveys including the Monitoring the Future Project and the National Survey on Drug Use and Health track trends in its usage. fact to a stranger on their doorstep. The National Survey on Drug Use and Health is a face-to-face, computer-assisted interview done with more than 68,000 individuals in carefully sampled households across the United States. Figure 1.2 displays the trends in reported past month use of marijuana for two different age groups. This study shows the same pattern as the Monitoring the Future study of 12th-graders: Marijuana use apparently grew throughout the 1970s, reaching a peak in about 1980, and then declining until the early 1990s, when it increased again. Again, the past few years have seen a slight decline in rates of marijuana use in both age groups, similar to the declines seen in the Monitoring the Future studies. We have seen fairly dramatic trends over time in marijuana use, but what about other substances? Figure 1.3 shows rates of current use of alcohol and cocaine alongside marijuana use for Americans between 18 and 25 years of age. Many more people are current users of alcohol (about two-thirds of adults), and many 12 80 Section One Drug Use in Modern Society Alcohol 70 Marijuana Cocaine 60 Percentage Reporting Use 50 40 30 20 10 0 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 Year Figure 1.3 Trends in Reported Drug Use within the Past 30 Days for Young Adults Ages 18 to 25 SOURCE: Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health (Rockville, MD: Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293, 2007). fewer use cocaine in any given year. But overall, the trends over time are generally similar, with the peak year for all three substances around 1980, lower rates of use in the early 1990s, and less dramatic changes after that. Finding such a similar pattern in two different studies using different sampling techniques gives us additional confidence that these trends have been real and probably reflect broad changes in American society over this time. Political observers will be quick to note that Ronald Reagan was president during most of the 1980s, when use of marijuana and other drugs was declining, while Bill Clinton was in office during most of the 1990s, when these rates rose. Were these changes in drug use the result of more conservative drug-control policies under the Reagan administration and more lib- eral policies under the Clinton administration? There are two reasons to think that is not the answer. First, the timing is not quite right. President Reagan was elected in 1980, took office in 1981, and didn't begin focusing on the "Just Say No" antidrug messages until 1983. Most of the important legislation was passed in 1986. All of this was after the downward trend in drug use had already begun. It seems more likely that the Reagan administration recognized the opportunity provided by an underlying change in attitude among the general public. The government's policies might have helped to amplify the effects of this underlying social change, but they did not create it. The same timing problem is associated with trying to link increased drug use to the Clinton presidency: The election was in 1992, and increased use was already begin- Chapter 1 Drug Use: An Overview 13 ning in 1993, during the first year of the Clinton administration. Also, the Clinton administration can hardly be accused of having liberal drug-control policies--drug-control budgets and arrests for drug violations were both higher than in any previous administration. If we can't point to government policies as causes of these substantial changes in drug use, how can we explain them? The short answer is that for now, we can't. We are left with saying that changes in rates of illicit drug use and in alcohol use probably reflect changes over time in a broad range of attitudes and behaviors among Americans--what we can refer to as "social trends." This isn't much of an explanation, and that is somewhat frustrating. After all, if we understood why these changes were taking place it might allow us to influence rates of substance use among the general population, or at least to predict what will happen next. Perhaps some of today's college students will be the ones to develop this understanding over the next few years. tics of the people who have "ever tried" alcohol, because that group usually represents more than 90 percent of the sample. Much of the research on correlates of drug use has used marijuana smoking as an indicator, partly because marijuana use has been a matter of some concern and partly because enough people have tried it so that meaningful correlations can be done. Other studies focus on early drinking or early cigarette smoking. Risk and Protective Factors Increasingly, researchers are analyzing the correlates of drug use in terms of risk factors and protective factors. Risk factors are correlated with higher rates of drug use, while protective factors are correlated with lower rates of drug use. A study based on data obtained from the National Survey on Drug Use and Health examined risk and protective factors regarding use of marijuana among adolescents (ages 1217).2 This largescale study provides some of the best information we have about the correlates of marijuana use among American adolescents. The most significant factors are reported in Table 1.2. In some ways, the results confirm what most people probably assume: the kids who live in rough neighborhoods, whose parents don't seem to care what they do, who have drugusing friends, who steal and get into fights, who aren't involved in religious activities, and who don't do well in school are the most likely to smoke marijuana. The same study analyzed cigarette smoking and alcohol use, with overall similar results. There are some surprising results, however. Those adolescents who reported that their parents frequently monitored their behavior (checking homework, limiting TV watching, and requiring chores, for example) were actually a little more likely to report using marijuana than adolescents who reported less parental correlate (core a let): a variable that is statistically related to some other variable, such as drug use. Correlates of Drug Use Once we know that a drug is used by some percentage of a group of people, the next logical step is to ask about the characteristics of those who use the drug, as compared with those who don't. Often the same questionnaires that ask each person which drugs they have used also include several questions about the persons completing the questionnaires. The researchers might then send their computers "prospecting" through the data to see if certain personal characteristics can be correlated with drug use. But these studies rarely reveal much about either very unusual or very common types or amounts of drug use. For example, if we send a computer combing through the data from 1,000 questionnaires, looking for characteristics correlated with heroin use, only one or two people in that sample might report heroin use, and you can't correlate much based on one or two people. Likewise, it would be difficult to identify the distinguishing characteris- 14 Section One Drug Use in Modern Society Table 1.2 Risk and Protective Factors Associated with Marijuana Use by Adolescents Risk Factors (in order of importance): 1. Having friends who use marijuana or other substances 2. Engaging in frequent fighting, stealing, or other antisocial activities 3. Perceiving that substance use is prevalent at your school 4. Knowing adults who use marijuana or other substances 5. Having a positive attitude toward marijuana use Protective Factors (in order of importance): 1. Perceiving that there are strong sanctions against substance use at school 2. Having parents as a source of social support 3. Being committed to school 4. Believing that religion is important and frequently attending religious services 5. Participating in two or more extracurricular activities monitoring. This finding points out the main problem with a correlational study: We don't know if excessive parental monitoring makes adolescents more likely to smoke marijuana, or if adolescents' smoking marijuana and getting in fights makes their parents more likely to monitor them (the latter seems more likely). Another example of the limitation of correlational studies is the link between marijuana Mind/Body Connection Religion and Drug Use More than three-fourths of American adolescents report that religion plays an important part in their lives. In study after study, those young people who report more involvement with religion (they attend services regularly and say their religion influences how they make decisions) are less likely to smoke cigarettes, drink alcohol, or use any type of illicit drug. Consider your own feelings about religion and about drug use. Why do you think this relationship between "religiosity" and lower rates of drug use is such a consistent finding? If you have friends from different religious backgrounds, discuss this relationship with them. Some religions have specific teachings against any alcohol use or tobacco use, but the general relationship seems to hold even for those religions that do not forbid these behaviors (at least for adults). What other factors related to religious involvement in general might serve as protective factors against the use of these substances? smoking and poor academic performance. Does smoking marijuana cause the user to get lower grades? Or is it the kids who are getting low grades anyway who are more likely to smoke marijuana? One indication comes from the analysis of risk and protective factors for cigarette smoking in this same study. The association between low academic performance and cigarette smoking was even stronger than the association between low academic performance and marijuana smoking. This leads most people to conclude that it's the kids who are getting low grades anyway who are more likely to be cigarette smokers, and the same conclusion can probably be reached about marijuana smoking. The overall picture that emerges from studies of risk and protective factors is that the same adolescents who are likely to smoke cigarettes, drink heavily, and smoke marijuana are also likely to engage in other deviant behaviors, such as vandalism, stealing, fighting, and early sexual behavior--what some researchers refer to as problem behaviors. We all can think of individual exceptions to this rule, but correlational studies over many years all come to the same conclusion: If you want to find the greatest number of young people who use illicit drugs, look among the same people who are getting in trouble in other ways. Race, Gender, and Level of Education Table 1.3 shows how some demographic variables are related to current use of some drugs of interest. The first thing to notice is Chapter 1 Drug Use: An Overview 15 Table 1.3 Drug Use among 18- to 25-year-olds: Percentage Reporting Use in the Past 30 Days African Female White American Hispanic 58 37 13 2 69 51 19 3 47 33 15 0.5 52 31 10 3 Native American Asian 53 56 25 3 50 26 7 0.7 High School College Graduate Graduate 57 48 17 2 80 34 12 1 Drug Alcohol (Age 21+) Tobacco (all types) Marijuana Cocaine Male 66 51 20 3 Source: Substance Abuse and Mental Health Services Administration, Results from the 2006 National Survey on Drug Use and Health (Rockville, MD: Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293, 2007). something that has been a consistent finding over many kinds of studies for many years, and that is that males are more likely to drink alcohol, use tobacco, smoke marijuana, and use cocaine than are females. This probably doesn't surprise most people too much, but it is good to see that in many cases the data do provide support for what most people would expect. Expectations regarding ethnic and racial influences on drug use are more likely to clash with the data from the National Survey on Drug Use and Health. For example, overall, whites are much more likely to drink alcohol, use tobacco, or use cocaine than are African Americans, and whites are slightly more likely to use marijuana as well. These results do not conform to many peoples' stereotypes, so let's remind ourselves that we are talking about household surveys that cut across socioeconomic and geographic lines and attempt to examine American society at large. Also, remember that we are getting data simply about recent use of these substances, which for most people means relatively low-level and infrequent use, at least for alcohol, marijuana, and cocaine. If we restricted ourselves to looking at the smaller group of people who can be classified as substance abusers, and if we compared urban neighborhoods with high minority populations to suburban white neighborhoods, we would find higher rates of drug abuse in the urban "ghetto." But within the general population, it appears that rates of use are lower among blacks than among whites. We do see from Table 1.3 that the group labeled "Native American" (American Indian and Alaskan Native groups) have somewhat higher rates of tobacco and marijuana use, and across Asian groups there is a generally lower rate of use of all these substances. Education level is powerfully related to two common behaviors: young adults with college degrees (compared to those who only completed high school) are much more likely to drink alcohol and much less likely to use tobacco. Those with more education are also somewhat less likely to use marijuana or cocaine. Personality Variables The relationships between substance use and various indicators of individual differences in personality variables have been studied extensively over the years. In general, large-scale survey studies of substance use in the general population have yielded weak or inconsistent correlations with most traditional personality traits as measured by questionnaires. So, for example, it has been difficult to find a clear relationship between measures of self-esteem and rates of using marijuana. More recently, several studies have found that various ways of measuring a factor called "impulsivity" can be correlated with rates 16 Section One Drug Use in Modern Society of substance use in the general population.3 Impulsivity is turning out to be of much interest to drug researchers, but also hard to pin down in that different laboratories have different ways of measuring it. In general, it seems to relate to a person's tendency to act quickly and without consideration of the longer-term consequences. We can expect to see more research on this concept over the next few years. Instead of looking at any level of substance use within the general population, we can look for personality differences between those who are dependent on substances and a "normal" group of people. When we do that, we find many personality differences associated with being more heavily involved in substance abuse or dependence. The association with impulsivity, for example, is much stronger in this type of study. Likewise, if we look at groups of people who are diagnosed with personality disorders, such as conduct disorder or antisocial personality disorder, we find high rates of substance use in these groups. Overall, it seems that personality factors may play a small role in whether someone decides to try alcohol or marijuana, but a larger role in whether that use develops into a serious problem. Because the main focus of this first chapter is on rates of drug use in the general population, we will put off further discussion of personality variables to the next chapter. Antecedents of Drug Use Finding characteristics that tend to be associated with drug use doesn't help us understand causal relationships very well. For example, do adolescents first become involved with a deviant peer group and then use drugs, or do they first use drugs and then begin to hang around with others who do the same? Does drug use cause them to become poor students and to fight and steal? To answer such questions, we might interview the same individuals at different times and look for antecedents, characteristics that predict later initiation of drug use. One such study conducted in Finland found that future initiation of substance use or heavy alcohol use can be predicted by several of the same risk factors we have already discussed: aggressiveness, conduct problems, poor academic performance, "attachment to bad company," and parent and community norms more supportive of drug use.5 Because these factors were measured before the increase in substance use, we are more likely to conclude that they may be causing substance use. But some other, unmeasured, variables might be causing both the antecedent risk factors and the subsequent substance use to emerge in these adolescents' lives. A few scientists have been able to follow the same group of people at annual intervals for several years in what is known as a longitudinal study. One such study has tracked more than 1,200 participants from a predominantly African American community in Chicago from ages 6 through 32.6 Males who had shown a high "readiness to learn" in first grade were less likely to be cocaine users as adults, but females with poor academic performance in first grade had lower rates of cocaine use than females with higher first-grade scores. Males who were either "shy" or "aggressive" in first grade were more likely to be adult drug users compared to the students who had been considered neither shy nor aggressive 26 years earlier. It is much more difficult to obtain this type of data, and it is somewhat surprising that any variables measured at age six could reliably predict adult drug use. Genetics There is increasing interest in genetic influences on drug use. Again, studies looking across the general population and asking simply about recent use are less likely to produce significant results than studies that focus on people diagnosed with substance-use disorders. Genetic factors probably play a small role in whether someone tries alcohol or marijuana, but a larger role in whether that use develops into a serious problem. Studies of genetic variability in impulsivity and related traits are beginning to show clear association with substance-use disorders.4 Genetic factors in dependence are discussed further in Chapter 2. Chapter 1 Drug Use: An Overview 17 Males who are aggressive in early elementary school are more likely to be drug users as adults. Gateway Substances One very important study from the 1970s pointed out a typical sequence of involvement with drugs.7 Most of the high school students in that group started their drug involvement with beer or wine. The second stage involved hard liquor, cigarettes, or both; the third stage was marijuana use; and only after going through those stages did they try other illicit substances. Not everyone followed the same pattern, but only 1 percent of the students began their substance use with marijuana or another illicit drug. It is as though they first had to go through the gateway of using alcohol and, in many cases, cigarettes. The students who had not used beer or wine at the beginning of the study were much less likely to be marijuana smokers at the end of the study than the students who had used these substances. The cigarette smokers were about twice as likely as the nonsmokers to move on to smoking marijuana. If the gateway theory can explain something about later drug use, then perhaps looking at those people who followed the traditional order of substance use (alcohol/cigarettes, followed by marijuana, followed by other illicit drugs) and comparing them to people who followed different orders of use might tell us something useful about the importance of particular orders of initiation. One recent study examined 375 homeless "street" youth, ages 1321, in Seattle.8 They were asked at what age they first started using various substances, and then grouped into categories depending on whether they followed the traditional gateway order or some other order of initiation. The order of use did not predict current levels or types of drug use in this population, leading the study's authors to conclude that knowing which substances people use first might not be very important in helping to prevent future escalation of drug use. One possible interpretation of the gateway phenomenon is that young people are exposed to alcohol and tobacco and that these substances somehow make the person more likely to go on to use other drugs. Because most people who use these gateway substances do not go on to become cocaine users, we should be cautious about jumping to that conclusion. More likely is that early alcohol use and cigarette smoking are common indicators of the general deviance-prone pattern of behavior that also includes an increased likelihood of smoking marijuana or trying cocaine. Because beer and cigarettes are more widely available to a deviance-prone young person than marijuana or cocaine, it is logical that beer and cigarettes would most often be tried first. The socially conforming students are less likely to try even these relatively available substances until they are older, and they are less likely ever to try the illicit substances. Let's antecedent (ant eh see dent): a variable that occurs before some event such as the initiation of drug use. longitudinal study (lon jeh too di nul): a study done over a period of time (months or years). gateway: one of the first drugs (e.g., alcohol or tobacco) used by a typical drug user. 18 Section One Drug Use in Modern Society Targeting Prevention Preventing What? Chapter 1 provides an overview of psychoactive drug use, primarily based on data from the United States. As we look forward to the topic of prevention, it's appropriate to think about what aspects of psychoactive drug use we would most like to reduce. Following are some perspectives: We should work to prevent any use of tobacco or alcohol by those under age 21, as well as any use of drugs such as marijuana, cocaine, and LSD. These drugs are all illegal, and we know that early use of tobacco and alcohol is associated with a greatly increased risk of illicit drug use in the future. Focusing only on drug use ignores the fact that illicit drug use is usually part of a larger pattern of deviant or antisocial behavior. Therefore, our efforts would be more effective if we were to target younger people and work to prevent poor academic performance, fighting, shoplifting, and other early indicators of this lifestyle, in addition to early experimentation with tobacco and alcohol. Wait a minute! We're confusing what might be desirable with what might be possible. We can't prevent everyone from doing things we don't like. For example, as adults most people will drink alcohol at least once in a while, yet perhaps only 10 percent of drinkers have most of the problems. Trying to prevent all drug use and other undesirable behavior is just too big a job, and it violates our sense of individual freedom. We need to focus our efforts on preventing abuse and the crime that goes with it. That's a much smaller problem, and we have a better chance of success. With which of these perspectives do you most agree at this point? Are there other perspectives not represented by these three? ask the question another way: If we developed a prevention program that stopped all young people from smoking cigarettes, would that cut down on marijuana smoking? Most of us think it might, because people who don't want to suck tobacco smoke into their lungs probably won't want to inhale marijuana smoke either. Would such a program keep people from getting D averages or getting into other kinds of trouble? Probably not. In other words, we think of the use of gateway substances not as the cause of later illicit drug use but, instead, as an early indicator of the basic pattern of deviant behavior resulting from a variety of psychosocial risk factors. Motives for Drug Use To most of us, it doesn't seem necessary to find explanations for normative behavior; we don't often ask why someone takes a pain reliever when she has a headache. Our task is to try to explain the drug-taking behavior that frightens and infuriates--the deviant drug use. We should keep one fact about human conduct in mind throughout this book: Despite good, logical evidence telling us we "should" avoid certain things, we all do some of them anyway. We know that we shouldn't eat that second piece of pie or have that third drink on an empty stomach. Cool-headed logic tells us so. We would be hard pressed to find good, sensible reasons why we should smoke cigarettes, drive faster than the speed limit, go skydiving, sleep late when we have work to do, flirt with someone and risk an established relationship, or use cocaine. Whether one labels these behaviors sinful or just stupid, they don't seem to be designed to maximize our health or longevity. But humans do not live by logic alone; we are social animals who like to impress each other, and we are pleasure-seeking animals. These factors help explain why people do some of the things they shouldn't, including using drugs. The research on correlates and antecedents points to a variety of personal and social variables that influence our drug taking, and many psychological and sociological theorists have proposed Chapter 1 Drug Use: An Overview 19 People who use drugs and who identify with a deviant subculture are more likely to engage in a variety of behaviors not condoned by society. models for explaining illegal or excessive drug use. We have seen evidence for one common reason that some people begin to take certain illegal drugs: usually young, and somewhat more often male than female, they have chosen to identify with a deviant subculture. These groups frequently engage in a variety of behaviors not condoned by the larger society. Within that group, the use of a particular drug might not be deviant at all but might, in fact, be expected. Occasionally the use of a particular drug becomes such a fad among a large number of youth groups that it seems to be a nationwide problem. However, within any given community there will still be people of the same age who don't use the drug. Rebellious behavior, especially among young people, serves important functions not only for the developing individual but also for the evolving society. Adolescents often try very hard to impress other people and may find it especially difficult to impress their parents. An adolescent who is unable to gain respect from people or who is frustrated in efforts to "go his or her own way" might engage in a particularly dangerous or disgusting behavior as a way of demanding that people be impressed or at least pay attention. One source of excessive drug use may be found within the drugs themselves. Many of these drugs are capable of reinforcing the behavior that gets the drug into the system. Reinforce- ment means that, everything else being equal, each time you take the drug you increase slightly the probability that you will take it again. Thus, with many psychoactive drugs there is a constant tendency to increase the frequency or amount of use. Some drugs (such as intravenous heroin or cocaine) appear to be so reinforcing that this process occurs relatively rapidly in a large percentage of those who use them. For other drugs, such as alcohol, the process seems to be slower. In many people, social factors, other reinforcers, or other activities prevent an increase. For some, however, the drug-taking behavior does increase and consumes an increasing share of their lives. Most drug users are seeking an altered state of consciousness, a different perception of the world than is provided by normal, day-to-day activities. Many of the high school students in the nationwide surveys report that they take drugs "to see what it's like," or "to get high," or "because of boredom." In other words, they are looking for a change, for something new and different in their lives. This aspect of drug use was particularly clear during the 1960s and 1970s, when LSD and other perception-altering drugs were popular. We don't always recognize the altered states produced by other substances, but they do exist. A man drinking alcohol might have just a bit more of a perception that he's a tough guy, that he's influential, that he's well liked. A cocaine user might get the seductive feeling that everything is great and that she's doing a great job (even if she isn't). Many drug-abuse prevention programs have focused on efforts to show young people how to feel good about themselves and how to look for excitement in their lives without using drugs. Another thing seems clear: Although societal, community, and family factors (the outer areas of Figure 1.4) play an important role in determining whether an individual will first try a reinforcement: a procedure in which a behavioral event is followed by a consequent event such that the behavior is then more likely to be repeated. The behavior of taking a drug may be reinforced by the effect of the drug. 20 Section One Drug Use in Modern Society Societal Laws and Penalties Availability and Cost Community and Family Family Political Statements Peers Antidrug Commercials Individual Personality Knowledge/Attitudes/Beliefs Personal Drug Experience Motives/Needs Biology Schools Church Alcohol and Tobacco Ads Clubs/ Organizations Local Police Portrayal in Movies/Novels Statements by Authorities/ Celebrities Gangs Portrayal in News Articles/Shows Figure 1.4 Influences on Drug Use drug, with increasing use the individual's own experiences with the drug become increasingly important. For those who become seriously dependent, the drug and its actions on that individual become central, and social influences, availability, cost, and penalties play a less important role in the continuation of drug use. Deviant drug use includes those forms of drug use not considered either normal or acceptable by the society at large. Drug misuse is using a drug in a way that was not intended by its manufacturer. Drug abuse is drug use that causes problems. (If frequent and serious, then a diagnosis of substance-use disorder is applied.) Drug dependence involves using the substance more often or in greater amounts than the user intended, and having difficulty stopping or cutting down on its use. Among American college students, about 65 percent can be considered current (within the past 30 days) users of alcohol, about 20 percent current smokers of tobacco cigarettes, less than 20 percent current marijuana users, and less than 2 percent current users of cocaine. Summary In discussing a drug-use issue, you must consider who is using the drug, what drug is being used, when and where the drug use is occurring, why the person is using the drug, how the person is taking the drug, and how much drug is being used. No drug is either entirely good or bad, and every drug has multiple effects. The size and type of effect depends on the dose of the drug and the user's history and expectations. Chapter 1 Drug Use: An Overview 21 Both alcohol and illicit drug use reached an apparent peak around 1980, then decreased until the early 1990s, with a slower increase after that. Current rates of use are lower than at the peak. Adolescents who use illicit drugs (mostly marijuana) are more likely to know adults who use drugs, less likely to believe that their parents would object to their drug use, less likely to see their parents as a source of social support, more likely to have friends who use drugs, less likely to be religious, and more likely to have academic problems. A typical progression of drug use starts with cigarettes and alcohol, then marijuana, then other drugs such as amphetamines, cocaine, or heroin. However, there is no evidence that using one of the "gateway" substances causes one to escalate to more deviant forms of drug use. People may use illicit or dangerous drugs for a variety of reasons: They may be part of a deviant subculture, they may be signaling their rebellion, they may find the effects of the drugs to be reinforcing, or they may be seeking an altered state of consciousness. The specific types of drugs and the ways they are used will be influenced by the user's social and physical environment. If dependence develops, then these environmental factors may begin to have less influence. 4. 5. 6. 7. 8. About what percentage of college students use marijuana? What do the results of the National Survey on Drug Use and Health tell us about the overall rates of marijuana and cocaine use among whites compared to African Americans in the United States? How does having a college degree influence rates of drinking alcohol? Using tobacco? Name one risk factor and one protective factor related to the family/parents. How does impulsivity relate to rates of drug use in the general population? How does impulsivity relate to substance dependence? References 1. Johnston, L. D., P. M. O'Malley, J. G. Bachman, and J. E. Schulenberg. Monitoring the Future National Survey Results on Drug Use, 19752004. Volume II: College Students and Adults Ages 1945 (NIH Publication No. 05-5728). Bethesda, MD: National Institute on Drug Abuse, 2005. Wright, D., and M. Pemberton. Risk and Protective Factors for Adolescent Drug Use: Findings from the 1999 National Household Survey on Drug Abuse (DHHS Publication No. SMA 04-3874, Analytic Series A-19). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2004. Vangsness, L., B. H. Bry, and E. W. LaBouvie. "Impulsivity, Negative Expectancies, and Marijuana Use: A Test of the Acquired Preparedness Model." Addictive Behaviors 30 (2005), pp. 107176. Kreek, M. J., D. A. Nielsen, E. R. Butelman, and K. S. LaForge. "Genetic Influences on Impulsivity, Risk Taking, Stress Responsivity and Vulnerability to Drug Abuse and Addiction." Nature Neuroscience 8 (2005), pp. 145057. Poikolainen, Kari. "Antecedents of Substance Use in Adolescence." Current Opinion in Psychiatry 15 (2002), pp. 24145. Ensminger, M. E., H. S. Juon, and K. E. Fothergill. "Childhood and Adolescent Antecedents of Substance Use in Adulthood." Addiction 97 (2002), pp. 83344. Kandel, D., and R. Faust. "Sequence and Stages in Patterns of Adolescent Drug Use." Archives of General Psychiatry 32 (1975), pp. 92332. Ginzler, J. A., and others. "Sequential Progression of Substance Use among Homeless Youth: An Empirical Investigation of the Gateway Theory." Substance Use & Misuse 38 (2003), pp. 72558. 2. 3. 4. 5. Review Questions 1. Besides asking a person the question directly, what is one way a psychologist can try to determine why a person is taking a drug? What two characteristics of a drug's effect might change when the dose is increased? In about what year did drug use in the United States peak? 6. 7. 2. 3. 8. Check Yourself Do Your Goals and Behaviors Match? One interesting thing about young people who get into trouble with drugs or other types of deviant behavior is that they often express fairly conventional long-term goals for themselves. In other words, they want or perhaps even expect to be successful in life, but then do things that interfere with that success. One way to look at this is that their long-term goals don't match up with their short-term behavior. Everyone does this sort of thing to some extent--you want to get a good grade on the first exam, but then someone talks you into going out instead of studying for the next one. Or perhaps you hope to lose five pounds but just can't pass up that extra slice of pizza. Make yourself a chart that lists your long-term goals down one side and has a space for short-term behaviors down the other side, like the one below. Name Date Write in your goal under each category as best you can. Then think about some things you do occasionally that tend to interfere with your achieving that goal and put a minus sign next to each of those behaviors. After you have gone through all the goals, write down some short-term behaviors that you could practice to assist you in achieving each goal, and put a plus sign beside each of those behaviors. How does it stack up? Are there some important goals for which you have too many minuses and not enough plusses? If study skills and habits, relationship problems, or substance abuse appear to be serious roadblocks for your success, consider visiting a counselor or therapist to get help in overcoming them. Goals (Long-Term) Educational Behaviors (Short-Term) Physical health and fitness Occupational Spiritual Personal relationships 23 ...
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