Drug abuse

Mechanisms of addiction

Drug abuse is an increasing problem in our affluent societies and carries great social and economic costs through its impacts on crime and health. Official policy in the Western world for the past 50 years has been to treat addicts as criminals and to punish them, but this has manifestly failed to prevent the increase in drug abuse. Nor have campaigns to educate people about the dangers of drugs, tobacco, and alcohol had anything other than relatively minor effects. From the neuroscientist's point of view addiction is increasingly seen as an organic disorder of brain function; if this could be better understood we might be able to offer more effective treatments to addicts.

The definition of addiction has changed in recent years. The term was previously applied only to such ‘hard’ drugs as heroin, where there are obvious signs of tolerance and physical dependence in regular users, and a painful or even life-threatening physical withdrawal syndrome when drug use is stopped. Psychiatrists now use the term ‘substance dependence’ to include both psychological dependence (where there may be no obvious withdrawal syndrome or tolerance) and physical dependence. The cigarette smoker who cannot stop smoking or the cannabis smoker whose drug habit has come to dominate their life is no less addicted than the chronic heroin user, even though they may suffer only mild withdrawal signs when drug use is stopped.

Great progress has been made in understanding the mechanisms by which the various classes of addictive substances act in the brain. These include the ‘psychostimulants’ — a large group of drugs encompassing cocaine and various amphetamines. These drugs all act in the brain to stimulate receptors that recognize the chemical messenger substance dopamine. Cocaine works by blocking the inactivation of dopamine after its release from nerve terminals in the brain — a process that involves recapture of the released chemical into the nerve endings. Blocking this process makes more dopamine available to stimulate brain receptors. The amphetamines work by displacing dopamine from nerve terminals. The ‘rave dance’ drug, ecstasy, is an amphetamine derivative that combines psychostimulant (dopamine) properties with a mild hallucinogenic effect — thought to be due to stimulation of receptors for another brain chemical messenger, serotonin. The opiates (for example heroin), cannabis, and nicotine all act on specific receptors that are present in the brain and which recognize these different drugs. When the drug binds to the receptor it triggers activity in nerve cells. One might wonder why the brain should contain such receptors, since the drugs themselves are plant products that do not exist naturally in the brain. The answer is that in each case there are naturally-occurring brain chemicals which activate these receptors, and the drug molecules hijack these normal brain mechanisms. Precisely how alcohol works remains unclear, but it is increasingly thought to act by modifying the responsiveness of the brain to the principal ‘on’ and ‘off’ chemical signals, glutamic acid and GABA — thus lowering neuronal excitability.

Knowing how these drugs act, however, does not explain why they are addictive. Furthermore, there seem to be a bewildering number of different brain mechanisms activated by the different classes of drugs. Consequently, great excitement has been generated in recent years by the first glimmers of some common themes of understanding in this area. One important series of research findings points to a common brain mechanism that is triggered by all known drugs of addiction — namely, the activation of dopamine mechanisms in a region of the forebrain known as the nucleus accumbens. This is a small dopamine-rich brain region underlying the larger dopamine-rich movement control centres, the caudate nucleus and putamen. The nucleus accumbens is part of the limbic forebrain, a brain region known to be important in emotional behaviour and in pain and pleasure. By direct measurements of dopamine release from animal brains, using tiny probes inserted into the nucleus accumbens, it has been found that cocaine, amphetamines, alcohol, nicotine, and cannabis all share the ability to cause increased levels of dopamine. When low doses of the drugs are used, the nucleus accumbens is the only brain region that shows such increased levels of dopamine. Furthermore, rats in which the dopamine-containing nerve terminals in the nucleus accumbens are selectively destroyed (by means of the selective chemical neurotoxin, 6-hydroxydopamine) no longer self-administer amphetamines or cocaine. Could it be that dopamine release in the nucleus accumbens is the common mechanism underlying the pleasurable actions of these drugs? According to this view the drugs simply subvert a normal brain mechanism in which pleasurable or ‘reinforcing’ stimuli assist the animal in learning to repeat a behaviour. Addiction can be viewed as an ‘aberrant form of learning’ — the drugs recruit brain mechanisms that have a normal place in cognitive and emotional behaviour and cause these to malfunction, so the addict ‘learns’ to continue using the drug.

Historical perspective

There have been remarkable changes in attitudes to psychoactive drugs in Western society over the years. What was considered safe and beneficial in one era often comes to be seen as an evil scourge to a later generation. Nowhere is this more obvious than in the place that opium has played in British history. Imported as an important trade commodity from Turkey and India, opium was widely used in all strata of British society in the eighteenth and nineteenth centuries. The poor sought solace from the miseries of their daily lives, working mothers used opium-containing ‘cordials’ to calm their children while they went out to work, middle-class housewives took laudanum (an alcoholic extract of opium) to calm their nerves, and artists sought inspiration from it. The literary movement in Europe known as the Romantic Revival relied extensively on opium to free the users to flights of fantasy and imagination, and included such figures as Schlegel, Madame de Staël, and Pushkin, in continental Europe, and Coleridge, Wordsworth, Scott, Shelley, Keats, and Byron in Britain. Thomas de Quincey's famous autobiographical Confessions of an Opium Eater (1821), was the first literary account of the powerful addiction that opium can cause.

In mid-nineteenth-century France, cannabis was introduced from Egypt, following the Napoleonic campaign, and became fashionable among many in the literary world who frequented the ‘Club des Hashischins’ in Paris. The work of Alexander Dumas, Gerard de Nerval, and Victor Hugo was much influenced by the drug, and Charles Baudelaire wrote a classic description of the cannabis (hashish) experience in Les Paradis Artificiels published in Paris in 1860. It was not until the latter half of the nineteenth century that restrictions were placed on the use of opium in Britain. Even as late as 1895, the Royal Commission appointed to report on the use of opium in India concluded that the drug had no harmful effects on the local population. A similar conclusion had been reached a year earlier by the Indian Hemp Products Commission, which reviewed the widespread use of cannabis in India.

In much the same way, when cocaine was first discovered a century ago as the active component in coca leaves, many experts extolled its virtues, and it rapidly gained a short-lived medical acceptance for a multitude of uses. Ironically, one of its popular uses was in the treatment of opium addiction! Sigmund Freud experimented with this and other uses of cocaine and took the drug himself for many years. By the turn of the century, however, the party was over; it had become clear that cocaine was a dangerous drug of addiction.

A more recent example of changing attitudes is the way we view tobacco smoking. Cigarette smoking grew rapidly in the Western world in the first part of the twentieth century. In the US by 1945 half of all adult men were smokers — consuming an average of 20 cigarettes per day. Smoking was glamourized by Hollywood movies and even advertised as having medical benefits. Things began to change, though, after the discovery of the link between cigarette smoking and lung cancer, and the growing recognition that nicotine is a drug of addiction. Today cigarette smokers have become pariahs, no longer permitted to indulge their habit in many public places or on aeroplanes, and tobacco companies are seen as ‘evil empires’.

The historical perspective perhaps teaches us that during the late twentieth century we may have moved towards over-emphasizing the damaging effects that psychoactive drug consumption has on society. While the regulation of such dangerous drugs as heroin and cocaine may be necessary to protect citizens from them, the use of the criminal law to prohibit the use of drugs such as cannabis and ecstasy, which are less likely to cause damage, is less rational. It may have to do with our demonization of drug use as almost a modern equivalent of heresy in the Middle Ages — a crime to be punished by penalties that are more severe than the crime itself.

The way forward

Despite the importance of scientific research in this area for improving future treatment strategies, there is lamentably little effort or resource devoted to it at the moment. In thinking of treatments that might help to wean addicts from their drug habit we need to think of a range of different goals aiming to reduce craving for the drug, assist in overcoming the withdrawal signs ‘both psychological and physical’, and help the reformed addict not to relapse. We are not very close to achieving any of these at the moment. The most effective strategy we have currently is to treat addicts with a safer form of the drug itself — the heroin addict with methadone, the cigarette smoker with nicotine patches or gum. We must learn approaches that are both more sophisticated and more effective if we are to make any real impact on the problem.

— Lesley L. Iversen

Bibliography

• Berridge, V. (1999). Opium and the people. Opiate use and drug control policy in nineteenth century and early twentieth century England. Free Association Press, London.
• Musto, D. F. (1999). The American disease. Origins of narcotic control. Oxford University Press, New York.
• Robbins, T. W. and Everitt, B. J. (1999). Drug addiction: bad habits add up. Nature, 398, 567-70

See also addiction; drugs; membrane receptors; opiates and opioid drugs.

An excessive or improper use of drugs, especially through self-administration for non-medical purposes. This term has increased significance because of the enactment of the Comprehensive Drug Abuse Prevention and Control Act of 1970, which replaces the Harrison Narcotic Act.

The repeated or uncontrolled use of controlled substances. While possession or use of controlled substances may be a crime, addiction to drugs is a disease which cannot be made a crime under the due process clause of the Constitution. 370 U.S. 660. Drug abuse or addiction is a ground for divorce in some states.

by Art Linkletter, 1971

The narcotics problem came into public consciousness in the late 1960s as the "drug culture," an aspect of the youth movement, or the "counter-culture," as it was frequently called. The use of the hallucinatory drug LSD, promoted by Harvard University psychologist Timothy Leary, and other narcotics soon was widely practiced in so-called hippie communities, notably in the Haight-Ashbury neighborhood of San Francisco. By the end of the decade drug abuse was described by government officials as an epidemic, and the smoking of marijuana spread far beyond the youth culture. The use of LSD fell off rapidly by 1970, but other "hard" drugs such as "speed" and heroin persisted, education campaigns and stricter laws notwithstanding. One byproduct of growing drug use was an increase in crime, particularly in urban areas. Drug abuse by soldiers in Vietnam was also reported to be very extensive, and many veterans returned home as addicts. In October 1970 Congress passed the toughest drug control law in history, but no great hope was entertained that laws alone could stem the situation. One of the best known spokesmen in the campaign against drugs was television entertainer Art Linkletter, whose daughter had died after using LSD. On September 14, 1971, he spoke to a special United Nations audience in New York on effective ways to deal with the drug menace.

Until two years ago my life was occupied principally in television and radio in the United States. My specialty was having fun with people. In fact, my best known NBC show for twenty years was called "People Are Funny." My ability to talk with young children was featured on the CBS network five times a week, for twenty-five years.

My professional life as an entertainer kept me on the sunny side of the street, with happy detours to every part of the world visiting my "adopted" children. Over the last thirty years, Mrs. Linkletter and I, acting as "foster parents," have taken care of underprivileged and orphan children in France, Italy, Germany, Greece, China, Japan, The Phillipines, Vietnam, and Peru. Our own five children learned to love their overseas brothers and sisters through visits, letters, and the exchange of presents.

Then, part of my life died in October 1969, when our beautiful daughter Diane was lost in the aftermath of LSD use. She would have been 21 years old that month. She was a victim of the reckless urge to experiment with hallucinogenic chemicals that became the fashionable thing to do among the young people of the world in the mid-sixties. In Hollywood this insane desire to take pills, marijuana and LSD swept through the film colony, and many, many beautiful young sons and daughters of my friends have been ruined because of their teenage yearning to be "part of the crowd."

That is why I am here today.

I am here to tell you something of what I have learned during these past two years.

Most of my generation had fixed ideas about drug addicts and dope that have been radically altered through research and knowledge based on fact-not myth. Until recently, we thought that marijuana was addictive and invariably led to narcotics. We thought all "pushers" were evil criminals sent to school yards to entice small children into becoming dope addicts. We thought that people who took any drugs for excitement and fun, or to forget their problems, were criminals and should be put in jail.

Today, we have learned that excessive users of psychotropic or narcotic drugs are sick people and only incidentally criminals. We have learned that pushers are often our own children searching for status or thrills or extra money. We have found out that you cannot stop drug abuse by making stricter laws, bigger jails, or by hiring more policemen. We have learned that drug abuse is a complex, perplexing subject that can never be simply, miraculously solved by some new drug or by some push-button method. And we have learned that it is not a passing fad that will go away with acid rock music or mod clothes. Drug abuse is on the doorstep of the world to stay. It is no new problem. ...

Drug abuse is as complex and contradictory as it is damaging. It has been easy in the past to pose a simple cause-effect-solution syndrome. For example, we say, "The person took drugs. The person met with tragedy. Eliminate the drugs, and you have eliminated the possibility of tragedy."

I can report to you from my own tragic experience that such a simplistic model is invalid. There are too many factors at work, too much uncertainty about human behavior and human interaction, to dismiss the drug abuse problem by talking only about the drugs.

The phenomenon of drug abuse touches our hearts, our minds, our courage and our imagination. A simple answer simply will not do. ...

The American people have been forced to acknowledge the bitter irony of our times. We walk on the moon, yet at least 250,000 of us are heroin addicts. We probe the secrets of the living cell, yet our hospitals are crowded with men and women who cannot throw off alcohol or other drugs. We say that our future is in our young people, yet every year sees increases in the misuse of drugs among the young.

So I am talking today not about what should be done in the rest of the world, but what must be done in all of the world. Not your nation, not my nation, but all our brothers and sisters share the pain and need our help.

It will not be easy to map out a worldwide plan to combat drug abuse. Perhaps it is wisest to begin by taking note of some of the things we should not do, some of the pitfalls we should avoid, as we begin to attack the problem.

First, let no nation speak with arrogance or false wisdom on the subject of drug abuse. Chauvinism and political pride have no place in our deliberations. My country has made this mistake in the past, and our present crisis makes a mockery of our boasts. I am confident that the United States will learn from its own mistaken attempts to prescribe drug abuse cures for the world, and I am equally confident that other nations will exercise good judgment in this regard.

Second, let no nation be guilty of saying that "it's somebody else's responsibility." No nation in the world is free from at least some form of drug abuse and no nation should attempt to excuse itself from the world-wide effort to combat it.

Third, let us avoid secrecy and intrigue in our work. The medical, scientific, academic and law enforcement communities of the world must be allowed to cooperate freely if we are to make any headway. There is nothing to be gained by refusing to share resources and insights with each other. In fact, there is everything to lose.

Fourth, let us refrain from making wrong-headed assumptions about alleged "character flaws" on the part of one people or another. It might be popular in some circles for one country to dismiss another's drug abuse problem as the result of ethnic or cultural deficiencies. Clearly, though, it would be incorrect. If any character is being tested, it is the spirit and strength of the whole human family.

Finally, let us not fall prey to those who would use drug abuse as an excuse to divide the world. Let us resist the fear-mongers and the wall-builders. I do not think there is much chance for success in a worldwide campaign of repression, recrimination and revenge. Nor do I think the people of the world would tolerate any attempt to drive wedges between countries or hemispheres.

My fear is that we will again be deceived by the mistaken notion that we have "cures" for drug abuse, and that those "cures" need only be applied around the world with sufficient force, and then the drug abuse problem will disappear. ...

In my travels throughout the United States of America, in small towns or big cities, I have found that there is unanimous "head nodding" to my warning statements but too often no action. Until you have personally been touched by the degradation and death that follows drug abuse, the inclination is to "let the other fellow do it." The defensive statements from every segment of our society are repudiated by what I like to call "universal" guilt. All of us, in one way or another, are partly responsible for the drug abuse epidemic.

To begin with, we are living in a drug-oriented society. We find people of all ages, and from every walk of life, increasingly turning to chemicals for relief from stress.

As I see it, there are today two separate but related problems involved in heavy drug abuse. There is, first, the hard core narcotic use, and second, there is the related illegal international trade. This we may call the traditional drug problem. One is a dangerous sickness that should be treated ...the other is a death dealing trade that should be struck down. ...

Here in the U. S. we have seen in the past decade millions of middle class youngsters turning to pot, acid, uppers and downers to escape from boredom or anxiety, to have a thrilling experience they've heard about or read about, to achieve a sense of belonging, to achieve "understanding" or "insight," or to express independence and sometimes hostility.

The drug abusers cut across all economic, religious, and political lines. They are found in small and large towns. They come from liberal or conservative homes. And they have followed the example and leadership of acid rock stars until taking drugs has become almost a puberty rite in America. Now, heroin and cocaine are becoming their "in" drugs.

Most of these millions of youngsters and Thank God-are only experimenters who will try so called "soft" drugs a few times and then discard them. The next largest group become week-end, recreational smokers or drug users who use pot and pills at parties of their friends. Then we come to the 10 percent who have come to depend on drugs almost daily to get them through their problems and keep them happy. And finally, the smallest hard core group of users, those who have insured the tragedy of drug abuse with the hypodermic needle: injecting amphetamines and heroin.

At this moment in time, the people of the United States are thoroughly aroused over the problem of drug abuse. In a recent Roper poll of public opinion, drugs were voted as the number one problem over war, unemployment, and violence in the streets. ...

In the last three years, the federal government will have spent a little over a quarter of a billion dollars to develop programs to deal with drugs. Funding for the overall federal program jumped to about $135 million in 1971. Of this latter amount, the United States proposed to apply the funds as follows: $46.6 million for law enforcement and $90 million for treatment, rehabilitation, education and research and other support.

America is aroused. America is doing something about it. But trying to get people to stop taking drugs just because society decrees them illegal is trying to bail the Atlantic with a teacup. ...

I recommend that the Economic and Social Council and its Commission on Narcotic Drugs begin at once to find answers to basic questions we must face if we are to put an end to drug abuse. These questions have to do not with methods of detection, or techniques for investigation, or codified approaches to human behavior; instead, they are questions about human life.

How do drugs become a part of daily life for millions of people? We know that some people reject drug abuse while others are caught by it. Why does this happen?

What about human goals and aspirations? Is there anything left to accomplish, or have we done everything there is to do? Is drug abuse a substitute for other risks we no longer need to take?

How do dangerous drugs get a death-grip on young people in underdeveloped nations, and in slum neighborhoods of rich nations? If an empty, agonizing life drives people to drugs, how do we change that life?

Why are there so many suicides in the world? Why do so many people arrive at a personal crisis unable to face it, resolve it, overcome it? Why is drug abuse so often a part of the tragic picture?

Is life boring? In the final analysis, do we turn to drugs because life holds so little challenge, so little meaning?

Can we talk to each other anymore? Some have said that communication is easier now than ever before, because of technology. But has technology helped us communicate, or has it merely hastened the flow of empty words over the great gulf that divides us?

These are the kinds of questions that must be answered if we are to do away with the abuse of drugs. I do not pretend that finding the answers is all that we must do, but it is certainly the first thing we must do.

The United Nations, through its agencies will serve all mankind if it begins the dialogue on these compelling questions. Working in this way, you will be going to the heart of the drug abuse crisis, and the results of your labors will enrich the understanding of the specialists in medicine, sociology, education, law enforcement and human development. The fund which has been established would be flexible enough to meet this challenge.

An independent council I head may serve as an example of this point. This national council combines the energies and skills of more than 100 diverse groups, agencies and institutions. It allows its member organizations to share information and resources, and by so doing, develops an interdisciplinary approach to our struggle with drug abuse education and treatment.

The operating philosophy of the council is that no one approach is likely to be sufficient in the face of the staggering complexity of the problem. Therefore, a multidisciplinary approach is required, one in which a sharing of insights and skills is not only necessary, but possible.

I would recommend this operating philosophy to the United Nations, because I believe it holds the most promise for our work: it is based on cooperation and interaction, and its goal is material improvement in the programs we develop to combat drug abuse.

This article is an overview of the nontherapeutic use of alcohol and drugs of abuse. For the mental health classification, see substance abuse.

Drug abuse
Classification and external resources
Comparison of the perceived harm for various psychoactive drugs from a poll among medical psychiatrists specialized in addiction treatment[1]
ICD-10	F10.-F19.
ICD-9	303-305
DiseasesDB	3961
MeSH	D019966

Drug abuse has a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opium alkaloids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.^[2] Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions.

Worldwide, the UN estimates there are more than 50 million regular users of heroin, cocaine and synthetic drugs.^[3]

Drug abuse
Drug addiction
Substance abuse
Substance abuse prevention
Substance-abuse rehabilitation
Substance abuse treatment

Contents 1 Classification 1.1 Public health definitions 1.2 Medical definitions 2 Signs and symptoms 3 Prevention 3.1 The Vienna conference in March 2009 4 History 5 Society and culture 5.1 Legal approaches 5.2 Cost 6 See also 7 Notes 8 Further reading 9 External links

Classification

Public health definitions

Source: A Public Health Approach to Drug Control in Canada, Health Officers Council of British Columbia, 2005

Public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasising the role of society, culture and availability. Rather than accepting the loaded terms alcohol or drug "abuse," many public health professionals have adopted phrases such as "substance and alcohol type problems" or "harmful/problematic use" of drugs.

The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence (see diagram to the right).

Medical definitions

In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognise 'drug abuse' as a current medical diagnosis. Instead, DSM has adopted substance abuse^[4] as a blanket term to include drug abuse and other things. ICD refrains from using either "substance abuse" or "drug abuse", instead using the term "harmful use" to cover physical or psychological harm to the user from use. Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) ). It's section Substance dependence begin with:

"Substance dependence When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders...." ^[4]

However, other definitions differ; they may entail psychological or physical dependence ^[4] , and may focus on treatment and prevention in terms of the social consequences of substance uses.

Signs and symptoms

Depending on the actual compound, drug misuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, mortality, physical dependence or psychological addiction.^[5] Drug abuse, including alcohol and prescription drugs can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia. Severe anxiety and depression are commonly induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate alcohol sustained use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.^[6]

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others.^[7]

Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however, drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally marketed under the name "ReVia," and now marketed in intramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of alcohol dependence. This drug has reached very few patients. This may be due to a number of factors, including resistance by Addiction Medicine specialists and lack of resources.^[8]

Prevention

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2002.

     no data      less than 40      40-80      80-120      120-160      160-200      200-240      240-280      280-320      320-360      360-400      400-440      more than 440

The Vienna conference in March 2009

The declaration from UN's Commission of Narcotic Drugs Fifty-second session in Vienna, 11-20 March 2009, with participation from 130 member countries, state that "We are determined to tackle the world drug problem and to actively promote a society free of drug abuse..." The concept drug abuse is used five times in the declaration. ^[9].

History

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol^[10]

"In the early 1900s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders referred to both alcohol and drug abuse as part of sociopathic personality disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness ^[11]. By the third edition, in the 1940s, drug abuse was grouped into 'substance abuse'."^{[citation needed]}

In 1932, the American Psychiatric Association created a definition that used legality, social acceptability, and even cultural familiarity as qualifying factors:

…as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien."

—Glasscote, R.M., Sussex, J.N., Jaffe, J.H., Ball, J., Brill, L. (1932). The Treatment of Drug Abuse for people like you...: Programs, Problems, Prospects. Washington, D.C.: Joint Information Service of the American Psychiatric Association and the National Association for Mental Health.

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision':

…'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.

Society and culture

Legal approaches

Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug prohibition

Most governments have designed legislation to criminalise certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history.

Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health.^[12][13] In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens.

Despite drug legislation (and some might argue because of it), large, organized criminal drug cartels operate world-wide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

Cost

The UK Home Office estimated that the social and economic cost of drug abuse to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year.^[14].

It does not however estimate what portion of those crimes are unintended consequences of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition ^[15].

See also

• Combined drug intoxication
• Drug addiction
• Drug overdose
• Poly drug use
• List of drug-related deaths
• List of drugs illegal in the United Kingdom

Notes

1. ^ Nutt D, King LA, Saulsbury W, Blakemore C (March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831. http://www.antiproibizionisti.it/public/docs/thelancet_20070323.pdf.  edit
2. ^ (2002). Mosby's Medical, Nursing, & Allied Health Dictionary. Sixth Edition. Drug abuse definition, p. 552. Nursing diagnoses, p. 2109. ISBN 0-323-01430-5.
3. ^ "Drug Trade". BBC News.
4. ^ ^{a b c} DSM-IV & DSM-IV-TR:Substance Dependence
5. ^ Burke PJ, O'Sullivan J, Vaughan BL (November 2005). "Adolescent substance use: brief interventions by emergency care providers". Pediatr Emerg Care 21 (11): 770–6. PMID 16280955. 
6. ^ Evans, Katie; Sullivan, Michael J. (1 March 2001). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). Guilford Press. pp. 75-76. ISBN 978-1572304468. http://books.google.co.uk/books?id=lvUzR0obihEC. 
7. ^ Jaffe, J.H. (1975). Drug addiction and drug abuse. In L.S. Goodman & A. Gilman (Eds.) The pharmacological basis of therapeutics (5th ed.). New York: MacMillan. pp. 284–324.
8. ^ Board on Behavioral, Cognitive, and Sensory Sciences and Education (BCSSE). (2004) New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions. The National Academies Press. pp. 7–8, 140–141
9. ^ Commission on Narcotic Drugs Fifty-second session, Vienna, 11-20 March 2009
10. ^ Global Status Report on Alcohol 2004
11. ^ schaeffer
12. ^ Copeman M (April 2003). "Drug supply and drug abuse". CMAJ 168 (9): 1113; author reply 1113. PMID 12719309. PMC 153673. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12719309. 
13. ^ Wood E, Tyndall MW, Spittal PM, et al. (January 2003). "Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure". CMAJ 168 (2): 165–9. PMID 12538544. PMC 140425. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12538544. 
14. ^ http://drugs.homeoffice.gov.uk/drug-strategy/drugs-in-workplace
15. ^ Thornton, Mark, The Economics of Prohibition, http://mises.org/story/2269 

Further reading

• British Medical Association (1997). The Misuse of Drugs. Routledge. ISBN 90-5702-260-5. http://books.google.ca/books?id=eWtKrL-PRUcC. Retrieved April 15, 2009. 

External links

• Drug abuse at the Open Directory Project
• Health-EU Portal Drugs in the EU

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