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Chapter 3:
Alcohol and Other Drugs
“Substance abuse, the nation’s number
one preventable health problem, places
an enormous burden on American
society, harming health, family life, the
economy, and public safety, and
threatening many other aspects of life.”
– The Robert Wood Johnson
Foundation, Institute for Health Policy,
Brandeis University
Chapter Outline
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The Global Context: Drug Use and Abuse
Sociological Theories of Drug Use and Abuse
Frequently Used Legal Drugs
Frequently Used Illegal Drugs
Societal Consequences of Drug Use and Abuse
Treatment Alternatives
Strategies for Action: America Responds
Understanding Alcohol and Other Drug Use
The Global Context: Drug Use and Abuse
What is a Drug?
• The term drug refers to any chemical
substance that:
– has a direct effect on the user’s physical,
psychological, and/or intellectual functioning
– has the potential to be abused
– has adverse consequences for the individual
and/or society.
The Global Context: Drug Use and Abuse
Drug Use and Abuse Around the World
• Globally, 4% to 6% of the world’s population
between the ages of 15 and 64 (over 200 million
people) reported using at least one illicit drug in
the previous year (2010).
The Global Context: Drug Use and Abuse
Drug Use and Abuse Around the World
3. Cocaine
2. Amphetamines
1. Cannabis
(Marijuana/Hashish)
4. Opiates
According to the most recent report, these
are the most widely used illegal drugs:
The Global Context: Drug Use and Abuse
Drug Use and Abuse Around the World
• Illicit drug use varies by location. For example,
an estimated 6.8% of adult Europeans have
used cannabis in the previous year, 2.2% in
Central America, and 1.2% in Asia.
• Drug use varies over time. In 1974, 38% of high
school seniors reported “bingeing” in the 30
days prior to the survey; by 1992, that number
had dropped to a low of 28%.
• Today, about 21% of 12th graders reported
smoking in the previous month.
The Global Context: Drug Use and Abuse
The Netherlands
• U.S. citizens visiting the
Netherlands may be
surprised to find people
smoking marijuana and
hashish openly in public.
• Pictured here is a tourist
using a water pipe to smoke
marijuana in a coffee shop.
• The Netherlands treats the
use of marijuana as a public
health issue rather than a
criminal justice issue.
What Do You Think?
Sociological Theories of Drug Use and Abuse
• Drug abuse occurs when acceptable social
standards of drug use are violated, resulting in
adverse physiological, psychological, and/or social
consequences.
• Chemical dependency refers to a condition
where drug abuse is compulsive; users are unable
to stop.
• Various theories provide explanations for why
some people use and abuse drugs. Theories of
drug use explain how structural and cultural forces
as well as biological and psychological factors
influence drug use and society's responses to it.
Sociological Theories of Drug Use and Abuse
Structural-Functionalist Perspective
• Drug abuse is a response to weakening of
societal norms (anomie).
• Drug use is a response to the absence of a
perceived bond between the individual and
society.
• Consistent with this perspective, in a national
poll of Americans 18 years or older, peer
pressure and lack of parental supervision
were the two most common responses given
for why teenagers take drugs.
Sociological Theories of Drug Use and Abuse
Structural-Functionalist Perspective
• The importance of family in
deterring the use is
highlighted in the national
youth media campaign –
“Parents, The Anti-Drug”
• This poster from the Office
of National Drug Control
Policy’s National Youth AntiDrug Media Campaign
emphasizes the importance
of a close relationship
between parent and child in
the fight against drug use
by youths.
Sociological Theories of Drug Use and Abuse
Conflict Perspective
• Drug use is a response to political, social
and power inequality.
• Drug use is an escape from alienation
from work, friends and family and
frustration caused by inequality.
• Most powerful members of society
influence the legal definition of drug use.
Sociological Theories of Drug Use and Abuse
Symbolic Interactionist Perspective
• If the label “drug user” is internalized drug
use will continue or even escalate.
• Drug users learn motivations and
techniques of drug use through interaction
with others.
• Symbols may be used for political and
economic agendas (e.g. the D.A.R.E.
campaign against drugs).
Sociological Theories of Drug Use and Abuse
Biological and Psychological Theories
• Biological Theories
– Genetics may predispose an individual
to alcoholism.
– Some individuals are physiologically
“wired” to get more pleasure from drugs
than others.
Sociological Theories of Drug Use and Abuse
Biological and Psychological Theories
• Psychological Theories
– Some personality types are more
susceptible to drug use.
– Positive reinforcement: drug use results
in pleasurable experience.
– Negative reinforcement: drug use
reduces pain, anxiety, loneliness and
boredom.
What Do You Think?
• Are alcoholism and other drug addictions a consequence
of nature or nurture?
• If nurture, what environmental factors contribute to such
problems, and what would you recommend in terms of
prevention strategies?
• If nature, do you think that drug addiction is a
consequence of biological factors alone?
• If you consume alcohol, what are some of your
motivations for drinking?
Frequently Used Legal Drugs
Alcohol: The Drug of Choice
• Between 2002 and 2009, the rate of heavy
alcohol use in the past month among 18 to 22
year olds decreased about 2%.
• Still, alcohol remains the most widely used and
abused drug in America.
• The National Survey on Drug Use and Health,
reported that 130.6 million Americans age 12
and older consumed alcohol at least once in the
month preceding the survey.
Frequently Used Legal Drugs
Alcohol: The Drug of Choice
• The U.S. Department of Health and Human
Services defines:
• Heavy Drinking as five or more drinks on the
same occasion on each of five or more days
in the past 30 days prior to the National
Survey on Drug Use and Health.
• Binge Drinking as drinking five or more
drinks on the same occasion on at least 1
day in the past 30 days prior to the National
Survey on Drug Use and Health.
Frequently Used Drugs
Alcohol: The Drug of Choice
• Additional results from the National Survey on Drug Use
and Health (2010):
– The highest levels of binge drinking are among 18- to
25- year-olds; people 65 or older had the lowest rates
of binge drinking.
– Rates of alcohol use are higher among the full-time
employed; however, rates of heavy or binge drinking
are higher among the unemployed.
– Past month binge drinking rates for full-time college
students increased between 2008 and 2009;
however, heavy drinking among those not enrolled
full-time in college decreased between 2008 and
2009.
Frequently Used Legal Drugs
Alcohol: The Drug of Choice
• For many students,
tailgating at football
games is an essential
part of college life. But
tailgating, going
“downtown,” the fraternity
or sorority party, happy
hour, Greek initiation
rituals, and all other
events deemed suitable
for drinking alcohol, have
led to high frequency and
consumption rates for
college students.
Survey The Class
• I believe that underage drinking is an
important social problem in our society.
A.
B.
C.
D.
E.
Strongly agree
Agree somewhat
Unsure
Disagree somewhat
Strongly disagree
Frequently Used Legal Drugs
The Tobacco Epidemic
• Globally, over 80% of the 1.1 billion smokers in
the world live in low or middle-income countries.
• Tobacco is one of the most widely used drugs in
the United States. According to the U.S.
Department of Health and Human Services
survey, 69.7 million Americans – 23.3% of those
12 and older – are current tobacco users.
Frequently Used Legal Drugs
The Tobacco Epidemic
• Use of all tobacco products, including smokeless tobacco
(8.6 million users), cigars (13.3 million users), pipe tobacco
(2.1 million users), and cigarettes (58.7 million users), is
higher for high school graduates than for college graduates,
males, and American Indians and Alaska Natives.
• In 2009, 11.6% of the 12 to 17 year old population reported
use of a tobacco product in the past month.
• Research evidence suggests that youth develop attitudes
and beliefs about tobacco products at an early age.
• There is also considerable evidence that cigarette
advertisers target minorities
Frequently Used Legal Drugs
The Tobacco Epidemic
• Tobacco Packaging: The Campaign for Tobacco-Free
Kids calls the introduction of candy-flavored cigarettes
and smokeless tobacco an “outrageous” tactic to lure
youth into using tobacco products. Note the appeal to
African-American youth and women in some of the
packaging.
Frequently Used Illegal Drugs
• More than 21.7 million people in the
United States are current illicit drug users,
representing 8.7% of the population ages
12 and older. Users of illegal drugs,
although varying by type of drug used, are
more likely to be male, to be young, and to
be a member of a minority group.
Frequently Used Illegal Drugs
Frequently Used Illegal Drugs
Marijuana Madness
• Most commonly used and trafficked illicit drug.
• Globally, there are between 129 and 191 million
marijuana users, representing 2.9% to 4.3% of
the world’s 15 to 64 year old population.
• Regionally, marijuana is the most dominant illicit
drug, particularly in North America.
Frequently Used Illegal Drugs
• The largest producers of marijuana in the world
are:
2. PARAGUAY
3. UNITED
STATES
1. MEXICO
Frequently Used Illegal Drugs
• There are more than 16.7 million current
marijuana users, representing 6.6% of the
U.S. population age 12 and older.
– According to the Monitoring the Future
(MTF) survey, daily marijuana use
increased dramatically in 8th, 10th, and
12th grades, with daily use estimated to
be 1.2%, 3.3%, and 6.1%, respectively.
What Do You Think?
Frequently Used Illegal Drugs
Frequently Used Illegal Drugs
Cocaine: From Coca-Cola to Crack
• Cocaine is classified as a stimulant and, produces
feelings of excitation, alertness, and euphoria.
• Cocaine, made from the coca plant, has been used
for thousands of years.
• According to the National Survey on Drug Use and
Health:
• Globally, cocaine use has decreased, particularly in
North America where the largest number of cocaine
users is found. Currently, 1.9 million Americans 12
years and older are current cocaine users.
Frequently Used Illegal Drugs
Cocaine: From Coca-Cola to Crack
• Crack is a crystallized product made by boiling a
mixture of baking soda, water, and cocaine.
• The result, also called rock, base, and gravel, is
relatively inexpensive and was not popular until
the mid-1980s.
• Crack dealers often give drug users their first
few “hits” free, knowing the drug’s intense high
and addictive qualities are likely to produce
returning customers.
Frequently Used Illegal Drugs
Cocaine: From Coca-Cola to Crack
 An addiction to crack can take 6–10 weeks to
fully develop
– An addition to pure cocaine can take 3–4 years.
• According to the National Survey on Drug Use and
Health, the number of people 12 and older who
used crack cocaine for the first time decreased from
337,000 to 94,000 between 2002 and 2009.
Frequently Used Illegal Drugs
• Methamphetamine (meth, speed, crank) is
a central nervous system stimulant that
can be injected, snorted, smoked, or
ingested orally and is highly addictive.
• Today, meth is relatively inexpensive and
easily obtained, with more than 36.8% of
high school seniors reporting that “crystal
meth” in its crystalline form, is “fairly easy”
or “very easy” to get.
Frequently Used Illegal Drugs
Frequently Used Illegal Drugs
• Club drugs
– A general term for illicit, often synthetic, drugs
commonly used at nightclubs or all-night dances
called “raves.”
– Examples include
• LSD
• Ecstasy
• Heroin
• “bath salts”
• prescription drugs and inhalants.
Frequently Used Illegal Drugs
• Date-rape drugs
– Drugs that are used to render victims
incapable of resisting sexual assaults.
– Examples Include:
• GHB
• Rohypnol
Frequently Used Illegal Drugs
• Heroin is a painkiller and is the most commonly
abused opiate drug.
• Highly addictive, heroin can be injected, snorted,
or smoked.
• If intravenous injection is used, the euphoric
effects are felt within 7–8 seconds; if heroin is
snorted or smoked, the effects are felt within 10–
15 minutes.
What Do You Think?
• According to Jeffrey Reiman on the “basis of
available scientific evidence, there is every
reason to suspect that we do our bodies more
irreversible damage by smoking cigarettes and
drinking liquor than by using heroin.”
• How would a social constructionist explain the
legality of alcohol and tobacco products?
• Why do you think alcohol and tobacco products
are legal, whereas heroin continues to be a
target of the war on drugs?
Frequently Used Illegal Drugs
Societal Consequences
Family Costs of Drug Use
• It is estimated that 1 in 10 U.S. children live with
at least one parent in need of treatment for drug
or alcohol dependency.
• Children raised in such homes are more likely
to:
– Live in an environment riddled with conflict
– Have a higher probability of physical illness
including injuries or death from automobile
accidents
– Are more likely to be victims of child abuse
and neglect
Societal Consequences
Crime and Violence
• The drug behavior of individuals arrested,
incarcerated, and in drug treatment
programs also provides evidence of a link
between drugs and crime.
• For example, surveys indicate that about
27 percent of victims of violent crime
report that the offender was involved with
alcohol or drugs.
Societal Consequences
Crime and Violence
• The relationship between crime and drug use,
however, is complex. Sociologists disagrees to
whether drugs actually “cause” crime or whether,
instead, criminal activity leads to drug
involvement.
• In addition to the hypothesized crime–drug use
link, some criminal offenses are defined by use
of drugs: possession, cultivation, production, and
sale of controlled substances; public intoxication;
drunk and disorderly conduct; and driving while
intoxicated.
Societal Consequences
The High Price of Alcohol and Other Drugs
• A report by the National Center on Addiction and
Substance Abuse at Columbia University (CASA
2009) set the total annual cost of substance abuse
and addiction in the United States at $467.7 billion.
• The report contends that, for every dollar spent on
drug abuse by federal and state governments:
– 95.6 cents went to shoveling up the wreckage
and only 1.9 cents on prevention and treatment,
0.4 cents on research, 1.4 cents on taxation or
regulation and 0.7 cents on interdiction.
What Do You Think?
Societal Consequences
Physical and Mental Health Costs
• Cigarette smoking is the leading preventable cause of disease and
death in the world.
• According to the World Health Organization (2008), there are six
state initiatives which, if adopted, could potentially reverse the
worldwide tobacco crisis by:
– (1) developing policies that prevent tobacco use
– (2) protecting people from tobacco smoke by developing smokefree laws
– (3) providing help to people who want to quit using tobacco
products
– (4) publicizing the dangers of tobacco products
– (5) banning, and enforcing existing bans, which prohibit “tobacco
advertising, promotion, and sponsorship”
– (6) increasing the cost of tobacco products by raising taxes
Societal Consequences
Physical and Mental Health Costs
• Annually, alcohol abuse is responsible for over 2.5
million deaths, 4 percent of all deaths worldwide.
Alcohol kills more people than AIDS, tuberculosis, or
violence, and is annually responsible for 80,000 deaths
in the United States.
• Maternal prenatal alcohol use is associated with one of
the leading preventable causes of birth defects and
developmental disabilities in children, fetal alcohol
syndrome, a syndrome characterized by serious
physical and mental handicaps, including low birth
weight, facial deformities, mental retardation, and
hearing and vision problems.
Societal Consequences
Physical and Mental Health Costs
• Drunk Driving
– Get-tough policies and
increased domestic law
enforcement is not just
limited to illicit drug
control.
– Recent campaigns by
MADD and the National
Highway Traffic Safety
Administration (NHTSA)
have focused on “cracking
down” on drunk driving.
Societal Consequences
Physical and Mental Health Costs
Societal Consequences
The Cost of Drug Use on the Environment
• Although not something usually considered, the
production of illegal drugs has a tremendous
impact on the environment.
• Much of the impact is a consequence of the
cultivation of marijuana, cocaine, and opium.
• For example, the Colombian government
estimates that during the decades of 1988 to
2008, nearly 5.4 million acres of rainforest (an
area the size of New Jersey) were destroyed
because of illegal drug production.
Treatment Alternatives
• In 2009, 4.3 million people aged 12 or older
were treated for some kind of problem
associated with the use of alcohol or illicit drugs.
• Individuals seeking treatment have several
options: family therapy, counseling, private and
state treatment facilities, community care
programs, pharmacotherapy (i.e., use of
treatment medications), behavior modification,
drug maintenance programs, and employee
assistance programs.
Treatment Alternatives
Inpatient and Outpatient Treatment
• Inpatient treatment refers to treatment of
drug dependence in a hospital and, most
importantly, includes medical supervision
of detoxification.
• The longer patients stay in treatment, the
greater the likelihood of a successful
recovery.
Treatment Alternatives
Inpatient and Outpatient Treatment
• Offenders who were the least likely to complete
treatment:
– (1) had a history of significant problems with their
mothers
– (2) had problems with their sexual partners in the 30
days prior to admission to the program,
– (3) had longer periods of incarceration
– (4) had used heroin in the 30 days prior to admission
to the program
– (5) were younger in age than those who successfully
completed the program.
Diseases Caused by Smoking
Diseases Caused by
Second-Hand Smoke
Treatment Alternatives
Peer Support Groups
• Twelve Step Programs: Both Alcoholics
Anonymous (AA) and Narcotics Anonymous
(NA) are voluntary associations whose only
membership requirement is the desire to stop
drinking or taking drugs.
• AA and NA are self-help groups in that
nonprofessionals operate them, offer “sponsors”
to each new member, and proceed along a
continuum of 12 steps to recovery.
Treatment Alternatives
Peer Support Groups
• Some have argued that AA and NA members trade their
addiction to drugs for feelings of interpersonal
connectedness by bonding with other group members.
• In a survey of recovering addicts, more than 50%
reported using a self-help program in their recovery.
• AA boasts over 115,000 groups where over 2.1 million
members meet in 150 countries.
• Women make up about 35% of AA membership.
• Symbolic interactionists emphasize that AA and NA
provide social contexts in which people develop new
meanings.
Treatment Alternatives
Peer Support Groups
Treatment Alternatives
Peer Support Groups
• Therapeutic Communities: In therapeutic
communities, which house between 35 and 500
people for up to 15 months, participants abstain
from drugs, develop marketable skills, and
receive counseling.
• Symbolic interactionists argue that behavioral
changes appear to be a consequence of revised
self-definition and the positive expectations of
others.
Treatment Alternatives
Drug Courts
• Drug courts are special courts that divert
drug offenders to treatment programs in
lieu of probation or incarceration.
• In a recent report by The Sentencing
Project, entitled Drug Courts: A Review of
the Evidence, identifies two types of drug
courts—deferred prosecution programs
and postadjudication programs.
Treatment Alternatives
Drug Courts
• In a deferred prosecution or diversion
setting, defendants who meet certain
eligibility requirements are diverted into the
drug court system prior to pleading to a
charge.
• Alternatively, in the postadjudication model,
defendants must plead guilty to their charges,
but their sentences are deferred or
suspended while they participate in the drug
court program.
Strategies for Action: America Responds
• Because society sends mixed messages
about the acceptability of drug use, many
programs, laws or initiatives may be
unrealistic. Nevertheless, numerous
social policies have been implemented or
proposed to help control drug use and its
negative consequences with various levels
of success.
Strategies for Action: America Responds
Alcohol and Tobacco
• There are a number of promising
strategies aimed at reducing alcohol and
tobacco use including the following:
– Economic Incentives
– Government Regulations
– Legal Action
– Prevention
Strategies for Action: America Responds
Illegal Drugs
• The War on Drugs: In the 1980s, the federal
government declared a “war on drugs,” which was
based on the belief that controlling drug availability
would limit drug use and, in turn, drug-related problems.
This “zero-tolerance” approach advocates get-tough law
enforcement policies, and is responsible for the dramatic
increase in the jail and prison population.
• The contrasting idea to the “war on drugs” is a harm
reduction position, which focuses on minimizing the
costs of drug use for both user and society (e.g.,
distributing clean syringes to decrease the risk of HIV
infection).
Strategies for Action: America Responds
Illegal Drugs
• Effects of the “War on Drugs”
– In 1980, there were an estimated 40,000 drug
offenders in jail or prison; in 2009, there were more
than half a million.
– Required prison sentences for almost all drug
offenders – first time or repeat – and limited judicial
discretion in deciding what best served the public’s
interest.
– Is it working? Is it stopping the flow of illegal drugs
into the U.S. and lowering drug-related problems?
– There are also concerns that present policies are not
only ineffective but create collateral damage.
Survey the Class…
• A 2010 survey of 1,003 U.S. adults echoes
politicians’ concerns about the
effectiveness of the “War on Drugs.” 63%
of Democrats, 64% of Republicans, and
70% of Independents believe that the “War
on Drugs” has been an abject failure.
What do you think? Why?
What Do You Think?
Strategies for Action: America Responds
Illegal Drugs
• Deregulation or Legalization:
– Deregulation is the reduction of government
control over certain drugs.
– Legalization is making prohibited behaviors
legal; for example, legalizing drug use or
prostitution.
– Decriminalization, which entails removing state
penalties for certain drugs, promotes a medical
rather than criminal approach to drug use that
encourages users to seek treatment and adopt
preventive practices.
Strategies for Action: America Responds
Illegal Drugs
• There are many
across the United
States who support
the legalization of
marijuana.
Strategies for Action: America Responds
Illegal Drugs
Strategies for Action: America Responds
Illegal Drugs
• State Initiatives:
– Several initiatives have resulted in statewide
referendums concerning the cost
effectiveness of government policies.
– Over the past decade, voters and state
governments have enacted significant drug
policy reforms.
Understanding Alcohol and Other
Drug Use
• In summary, substance abuse—that is, drugs and their
use—is socially defined. As the structure of society
changes, the acceptability of one drug or another
changes as well.
• There are two issues that need to be addressed in
understanding drug use.
– The first is at the micro level—why does a given
individual use alcohol or other drugs? Many
individuals at high risk for drug use have been “failed
by society.”
– The second question, related to the first, asks why
drug use varies so dramatically across societies,
often independent of a country’s drug policies.
Quick Quiz
1. Which drug use is the leading
preventable cause of deaths in the United
States?
A.
B.
C.
D.
cigarette smoking
alcohol use
heroin
cocaine
Answer: A
• Cigarette smoking is the leading
preventable cause of deaths in the United
States.
Quick Quiz
2. If the government reduced its control over
various illegal drugs that would be
termed:
A.
B.
C.
D.
legalization.
deregulation.
decriminalization.
interdiction.
Answer: B
• If the government reduced its control over
various illegal drugs that would be termed
deregulation.
Quick Quiz
3. Which substance is the most widely used
and abused drug in the United States?
A.
B.
C.
D.
nicotine
cocaine
marijuana
alcohol
Answer: D
• Alcohol substance is the most widely
used and abused drug in the United
States.
Quick Quiz
4. A conflict theorist would argue that the
war on drugs:
A. all of these choices.
B. unfairly targets minorities.
C. has resulted in the changing of definitions and
labels.
D. contributes to society by providing thousands of
jobs for people.
Answer B
• A conflict theorist would argue that the
war on drugs unfairly targets
minorities.
Quick Quiz
6. The most commonly used and most
heavily trafficked illegal substance in the
world is:
A.
B.
C.
D.
cocaine.
methamphetamines.
heroin.
marijuana.
Answer: D
• The most commonly used and most
heavily trafficked illegal substance in the
world is marijuana.