Encyclopedia of SociologyVol._1

crops and related programs have been encouraged in Peru and Columbia.

Since 1930, the U.S. Treasury Department has had responsibility for drug regulation in the United States. In 1973, the Drug Enforcement Administration of the Justice Department assumed the police and control function under federal law. Each state has laws that generally parallel the federal laws on possession and distribution of controlled substances and all states have a single state agency that coordinates other programs related to drug abuse.

Regular or frequent drug users, without outside income, are likely to engage in a range of criminal activities in order to buy controlled substances. They typically engage in six times more criminal activity when using than when they are not using drugs. Urine testing of arrestees, under the federal Arrestees Drug Abuse Monitoring program, indicates that some two-thirds of those arrested in urban communities had used an illicit substance prior to arrest. It is, thus, not surprising that the rates of street crimes tend to be positively correlated with the number of illegal drug users in a community.

During the last fifteen years, both state and federal prison populations have experienced a massive increase due to the number of people convicted and jailed for selling or using drugs.

Other developments contributing to the surge in the prison population include aggressive enforcement, longer sentences, the decline of parole, and mandatory sentencing procedures that provide less latitude for judges. Thus, for example, federal penalties for possession of crack, a rock-like form of cocaine that became popular in the 1980s and sells for a low price on the street, are 100 times greater than for powdered cocaine. Sellers targeting crack to urban minorities represent one of several factors that have led to a disproportionate number of young blacks in federal and state prisons, for violation of possession laws. Ninety percent of prisoners in federal prisons for crack violations are black, although twice as many whites as blacks use it.

Survey and other data consistently report that the use of mood-modifying drugs is distributed among all the socioeconomic and ethnic groups in the United States; nevertheless, arrests, convictions, deaths, and other negative outcomes of

drug use are disproportionately concentrated in specific geographic areas and population subgroups. In state prisons, blacks make up some 60 percent of the drug-law violators although they represent 12 percent of the country’s population and 15 percent of regular drug users. Selective enforcement of the laws might reasonably be considered a possible contributor to such statistics.

American attitudes toward drug use have historically reflected ethnic and class-related prejudices. Thus, earlier in the twentieth century, negative attitudes toward cocaine were associated with the hostility that Southern blacks, among whom cocaine use was thought to be widespread, were believed to harbor toward whites. The public’s suspicion of Chinese immigrants was a reflection of their use of opium. A number of stereotypes about marijuana reflected beliefs about its use by

Mexican immigrants and some occupations that had low status at the time, such as jazz musicians.

For members of both majority and minority groups sentenced to prison, recidivism rates are high and represent one reason that the United

States has higher rates of incarceration (approaching two million) than any industrialized nation.

Although treatment of former drug users in prison settings has produced some promising results, treatment opportunities in prison are scarce and have not kept pace with the growth in the population of incarcerated former users. Approximately one in eight state inmates and one in ten federal inmates have taken part in treatment since their admission to prison. On a limited basis, treatment is being offered in an effort to keep offenders from returning to prison.

TREATMENT

The treatment of substance abuse has consistently been a lower priority than efforts to control drug abuse through interdiction and criminal sanctions, although cost-benefit studies have demonstrated that every dollar invested in treatment saves seven dollars in other costs. The federal government has usually spent more than two-thirds of its substance abuse budget (which now totals nearly $20 billion) on such supply-reduction and criminal justice system strategies. Only a small minority of drug abusers have access to treatment, since health

insurers tend to discriminate against persons with substance abuse problems and there are inadequate treatment resources.

Current treatment for drug abuse, in addition to withdrawal, ranges from psychotherapeutic interventions (provided in both inpatient and outpatient settings), pharmacology agents, and various forms of milieu therapy. It frequently includes information on relapse prevention. Psychotherapy is often used in combination with other forms of treatment, and is provided both on an individual and group basis by therapists trained in medicine, psychology, social work, nursing and education. Pharmacological treatments include approaches, that substitute or block the effect of an abused substance, such as methadone maintenance for heroin (Ball and Ross 1991). Milieu therapies include a variety of residential programs where drug abusers can learn or relearn how to live substance free. Although some relatively short-term hospitalbased programs exist (particularly for those with independent resources to pay for such services), the most common milieu consists of longer-term therapeutic communities such as Phoenix House, where drug users live in a setting in which they are closely monitored. The residents’ progress through the several levels of the program’s hierarchical social structure depends on their ability to implement the program’s rules for ‘‘right living’’ (De

Leon 1997).

Although often not considered a treatment, various fellowship groups deriving from the Alcoholics Anonymous model are widely used by drug abusers. Thus, for example, groups such as Narcotics Anonymous, Cocaine Anonymous, and parallel groups for spouses and parents of drug users exist in almost every community. Such groups, which have no professional staff and rely on the reinforcement of abstinence, support drug abusers in maintaining drug-free lives and help family members aid their drug-abusing relatives. Many treatment programs encourage their patients or clients to participate in such a twelve-step fellowship simultaneously with the treatment period or after treatment is completed.

Although substantial resources have been devoted to treatment outcome research, our knowledge of who does best in what treatment is limited.

Particularly for cocaine, the use of which can lead to dependence in a short period of time, effective

pharmacological treatments are not available. A combination of strategies is often most effective especially if it recognizes that drug abuse is a chronic relapsing disorder that is likely to include multiple treatment failures on the way to an ultimately favorable outcome. Of the treatment approaches to drug abuse, milieu treatments have been among the most intensely studied. For those able to participate in such programs, they can have extremely high rates of relatively enduring positive outcomes. Whatever the treatment modality, it must include job readiness, habilitation and vocational rehabilitation, and other dimensions that will enable the former user to function effectively in the modern information-oriented community and economy.

PREVENTION

In the late 1980s, the social problems associated with drug abuse, particularly in terms of the possession and sale of cocaine in urban areas, were perceived to have reached crisis dimensions and there was a marked increase in criminal justice efforts to control substance use. Another positive response was a renewed emphasis on the prevention of drug abuse and the collateral development of broad-based community strategies designed to reduce demand for illicit drugs. Currently, such demand-reduction efforts are undergoing systematic study in several long-term longitudinal public and private programs.

There has been a transformation in views of substance abuse as we have moved from a focus on individual pathology to programs that engage community institutions. Such efforts aim to change norms about substance use through the involvement of community members and the integration of the substance-abuse programs pursued by public and private agencies. The 1990s saw the expansion of community-based programs to include a broad range of institutions, including the police and courts, the voluntary sector, as well as the media (Falco 1994). Fostered by the government’s Center for Substance Abuse Prevention (part of the Substance Abuse and Mental Health Administration) and efforts of the Robert Wood Johnson Foundation, the country’s largest health foundation, hundreds of communities are engaged in broad-based efforts to change the culture within

which substance abuse takes place (Saxe, Reber, HalFors, et al. 1997).

The belief that substance abuse is sustained by community norms represents an ecological approach. Environmental conditions, whether they reflect physical conditions in the community, poverty, or available health care, are thus seen as risk factors for drug use and abuse. Supporters of this view believe that what is needed are coordinated, community-wide efforts to address drug abuse at multiple levels of social organization and the collaboration of many groups. The idea that multicomponent community-action efforts can prevent drug abuse derives from earlier studies of programs designed to cope with cardiovascular disease. It is consistent with efforts to promote a variety of other health issues, but substance abuse is now a primary focus of these efforts.

The largest of these comprehensive efforts is the federal government’s Community Partnership Program, which has supported over 250 partnerships. The Community Partnership Program was initiated in 1990 after the Robert Wood Johnson Foundation had begun to develop a model and sponsor broad-based community efforts. Called ‘‘Fighting Back’’ programs, they now provide longterm support to more than a dozen communities to develop comprehensive demand-reduction interventions. The foundation has also provided support and technical assistance to hundreds of additional communities through groups such as Join Together.

A significant element of many such prevention programs is the presence of a strong media component. The Partnership for a Drug-Free America, for example, develops and places hundreds of millions of dollars of advertising each year, and communities are encouraged to leverage local media to present anti-drug messages directed at youth. Although there is limited direct evidence of the effectiveness of media campaigns, it is likely that they reinforce education and prevention messages being delivered to youth through other means.

Schools play a central role in prevention programs, under the assumption that drug abuse will be more easily prevented if programs are started early. The goal of these programs is to provide youth with the skills to become successful adults and to teach them the community’s norms and

values. There is substantial evidence that positive school experiences are linked to lower levels of drug use and conversely, that drug use is related to delinquency and problems in school.

The role of school environments in affecting adolescent substance use has been validated by specific school-based trials. In both the Midwestern Prevention Project and Project Northland, significant reductions in the prevalence of substance use by adolescents were reported (Pentz, Dwyer, MacKinnon, et al. 1989; Perry, William, Veblen-Martenson 1996). Designed for students in grades six through eight, the programs include academic curricula, along with parental and community involvement. Often, a significant mass media component is part of the effort, with a focus on correcting misperceptions about the consequences of drug use and providing alternative positive behavior. The D.A.R.E. program (Drug Abuse Resistance Education) also has been a widely used school-based prevention strategy.

Schools are not the only public institution that affect youths’ likelihood to abuse drugs. The police and justice agencies, as well as the network of health and social service agencies that serve a community, have a crucial influence and prevention activities typically involve such agencies. The ability of health and social service professionals to attend to drug use is clearly important, but their role is often reactive, providing treatment rather than prevention.

One of the most important programs that has contributed to attempts by law enforcement agencies to deal with drug abuse is community policing. It represents a shift from reactive policing where the goal is to arrest offenders, to an active strategy designed to identify crime problems and work with citizens—including offenders—to avoid further difficulties. The heart of the approach is that officers get to know citizens and help them deal with minor transgressions and, in so doing, avoid serious crime. A collateral approach, widely used in the 1990s (‘‘fixing broken windows’’) is designed to improve morale and confidence and stem the physical and social deterioration of communities by prompt attention to small visible manifestations of community dysfunction or decay. There is evidence that such approaches are, at least partly, responsible for declines in violent

crime, which is closely related to substance-abuse problems.

A community’s resources and social institutions have a critical impact on drug use, but the attitudes and behavior of peers and family may have an even more direct influence. The affluence of a community and the quality of its schools have a substantial effect on the initiation of drug use, but their impact is mediated by adolescents’ peer relationships and their interactions with significant adults in their lives. Thus, peers and parents are perhaps the most vital elements of the community context—directing or guiding youngsters’ needs and desires through the obstacles in their environment. Some of the most important programs designed to address community substance abuse focus on changing peer culture and addressing family attitudes and behavior.

Parents (or other adult ‘‘guides’’) arguably have the greatest potential effect on how the youngster learns to negotiate the environment as it exists (good or bad), and they can also affect the influence that the youngsters’ peers exert. The use of drugs by parents significantly increases the likelihood that their youngsters will also use drugs. Although this might seem to be a clear example of youngsters modeling the behavior of their parents, the influence of parents’ own use of drugs is probably more complicated. Some research suggests that it is not merely that youngsters mimic parents’ behavior, but instead such modeling interacts with what they see in their peers. If both peers and parents engage in substance use, there is far greater likelihood that young people will become regular users.

The influences of peers and parents may interact in complex ways and each community is differ- ent—its resources and institutions function differently. Communities can be directed to the key levers, but there is no simple formula available to determine which activities will be most important for a particular community. What is clear, however, is that to understand and develop strategies that reduce adolescent substance abuse, it is necessary to consider the social context in which a child lives. Only by identifying the resources available within a community, the roles played by the social institutions within that community, and the behaviors and values of the individuals (parents and

children) who live in that community, can the interactions among the multiple forms and levels of influence begin to be understood.

RESEARCH

Social science research has played a critical role in the identification of the substance-abuse problem, it social consequences, and strategies to arrest the use of illicit drugs. There is now a long-standing tradition of surveys to identify drug use and attitudes toward the use of mood-modifying substances and their consequences. Surveys, such as the National Household Survey on Drug Abuse (which assesses the drug use of a random sample of U.S. residents over twelve years old) and Monitoring the Future (a school-based survey of junior and senior high school students), have each been conducted for more than two decades. Although there is considerable discussion about the validity of these surveys and how to ensure veridical data (Beveridge, Kadushin, Saxe, et al. forthcoming), there is no question that they have influenced social policy.

More recently, much of the focus of social research has shifted to assessing strategies to prevent drug use and to evaluate treatment programs.

Under the auspices of the National Institute on

Drug Abuse (a component of the National Institutes of Health), a variegated research program includes both biological and sociopsychological components. An emphasis of research is on assessment of programs such as D.A.R.E., the Community Partnership Program, and Fighting Back. Determining whether these programs achieve their goals of preventing substance abuse is a particularly difficult challenge. The programs are implemented differently across communities and the research design needs to separate the effects of race, socioeconomic status, and other factors from program implementation (Rindskopf and Saxe 1998).

It is also the case that antidrug programs develop loyal followings and their proponents develop a stake in showing that their efforts are successful. Thus, for example, there has been a major debate about the D.A.R.E. program and whether it is successful, with researchers claiming that the evidence suggests it is not effective. In other cases, such as the Community Partnership Program and Fighting Back, the issue has been the

availability of data that can show the effects of the program over time.

One development that will likely allow much better utilization of social research is the availability of sophisticated methodologies. Thus, for example, meta-analytic techniques are now available that permit the synthesis of data across multiple studies, allowing us to amalgamate multiple smallscale tests of programs. In addition, new analytic strategies are being developed to allow construction of multilevel statistical models. Such hierarchical linear modeling permits one to take account of the fact that programs are conducted in particular settings and facilitates the segregation of community effects from overall program effects. Qualitative ethnographic techniques have been used to track the life cycle of substance abuse and the structure of the illegal markets.

FUTURE

The war on drugs is far from being ‘‘won,’’ but drug abuse appears to have stabilized, with use remaining nearly constant. Two trends, that could be counterreactions, have emerged and may help to shape future use of illicit drugs. The first is the call for legalization or decriminalization of the possession of drugs such as marijuana. Several national organizations have emerged to promote this goal and to urge a harm reduction approach. The second trend is the increased licit use of mood-altering prescription substances, such as Prozac and Ritalin. Such powerful psychotropic agents are being prescribed by physicians for depression, difficulties in concentration, and similar problems. As the medical options increase, misuse of prescription drugs will likely increase and it may be more difficult to control the sale of less powerful nonprescription drugs.

(SEE ALSO: Alcohol)

REFERENCES

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De Leon, G. (ed.) 1997 Community As Method: Therapeutic Communities for Special Populations and Special Settings. Westport, Conn.: Praeger.

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Falco, M. 1994 The Making of A Drug Free America: Programs That Work. New York: Times Books.

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Winick, C. 1983 ‘‘Addicts and Alcoholics as Victimizers.’’ In D.E.J. Mac Namara and A. Karmen, eds., Deviants: Victims or Victimizers? Beverly Hills, Calif.: Sage Publications.

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———(ed.) 1974 Sociological Aspects of Drug Dependence. Cleveland, Oh: CRC Press.

LEONARD SAXE

CHARLES WINICK