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Understanding reasons for drug use amongst young people: a functional perspective

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Annabel Boys, John Marsden, John Strang, Understanding reasons for drug use amongst young people: a functional perspective, Health Education Research , Volume 16, Issue 4, August 2001, Pages 457–469, https://doi.org/10.1093/her/16.4.457

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This study uses a functional perspective to examine the reasons young people cite for using psychoactive substances. The study sample comprised 364 young poly-drug users recruited using snowball-sampling methods. Data on lifetime and recent frequency and intensity of use for alcohol, cannabis, amphetamines, ecstasy, LSD and cocaine are presented. A majority of the participants had used at least one of these six drugs to fulfil 11 of 18 measured substance use functions. The most popular functions for use were using to: relax (96.7%), become intoxicated (96.4%), keep awake at night while socializing (95.9%), enhance an activity (88.5%) and alleviate depressed mood (86.8%). Substance use functions were found to differ by age and gender. Recognition of the functions fulfilled by substance use should help health educators and prevention strategists to make health messages about drugs more relevant and appropriate to general and specific audiences. Targeting substances that are perceived to fulfil similar functions and addressing issues concerning the substitution of one substance for another may also strengthen education and prevention efforts.

The use of illicit psychoactive substances is not a minority activity amongst young people in the UK. Results from the most recent British Crime Survey show that some 50% of young people between the ages of 16 and 24 years have used an illicit drug on at least one occasion in their lives (lifetime prevalence) ( Ramsay and Partridge, 1999 ). Amongst 16–19 and 20–24 year olds the most prevalent drug is cannabis (used by 40% of 16–19 year olds and 47% of 20–24 year olds), followed by amphetamine sulphate (18 and 24% of the two age groups respectively), LSD (10 and 13%) and ecstasy (8 and 12%). The lifetime prevalence for cocaine hydrochloride (powder cocaine) use amongst the two age groups is 3 and 9%, respectively. Collectively, these estimates are generally comparable with other European countries ( European Monitoring Centre for Drugs and Drug Addiction, 1998 ) and the US ( Johnston et al ., 1997 , 2000 ).

The widespread concern about the use of illicit drugs is reflected by its high status on health, educational and political agendas in many countries. The UK Government's 10-year national strategy on drug misuse identifies young people as a critical priority group for prevention and treatment interventions ( Tackling Drugs to Build a Better Britain 1998 ). If strategies to reduce the use of drugs and associated harms amongst the younger population are to be developed, particularly within the health education arena, it is vital that we improve our understanding of the roles that both licit and illicit substances play in the lives of young people. The tendency for educators, practitioners and policy makers to address licit drugs (such as alcohol) separately from illegal drugs may be unhelpful. This is partly because young illicit drug users frequently drink alcohol, and may have little regard for the illicit and licit distinction established by the law. To understand the roles that drug and alcohol use play in contemporary youth culture, it is necessary to examine the most frequently used psychoactive substances as a set.

It is commonplace for young drug users to use several different psychoactive substances. The terms `poly-drug' or `multiple drug' use have been used to describe this behaviour although their exact definitions vary. The term `poly-drug use' is often used to describe the use of two or more drugs during a particular time period (e.g. over the last month or year). This is the definition used within the current paper. However, poly-drug use could also characterize the use of two or more psychoactive substances so that their effects are experienced simultaneously. We have used the term `concurrent drug use' to denote this pattern of potentially more risky and harmful drug use ( Boys et al. 2000a ). Previous studies have reported that users often use drugs concurrently to improve the effects of another drug or to help manage its negative effects [e.g. ( Power et al ., 1996 ; Boys et al. 2000a ; Wibberley and Price, 2000 )].

The most recent British Crime Survey found that 5% of 16–29 year olds had used more than one drug in the last month ( Ramsay and Partridge, 1999 ). Given that 16% of this age band reported drug use in the month prior to interview, this suggests that just under a third of these individuals had used more than one illicit substance during this time period. With alcohol included, the prevalence of poly-drug use is likely to be much higher.

There is a substantial body of literature on the reasons or motivations that people cite for using alcohol, particularly amongst adult populations. For example, research on heavy drinkers suggested that alcohol use is related to multiple functions for use ( Edwards et al ., 1972 ; Sadava, 1975 ). Similarly, research with a focus on young people has sought to identify motives for illicit drug use. There is evidence that for many young people, the decision to use a drug is based on a rational appraisal process, rather than a passive reaction to the context in which a substance is available ( Boys et al. 2000a ; Wibberley and Price, 2000 ). Reported reasons vary from quite broad statements (e.g. to feel better) to more specific functions for use (e.g. to increase self-confidence). However, much of this literature focuses on `drugs' as a generic concept and makes little distinction between different types of illicit substances [e.g. ( Carman, 1979 ; Butler et al ., 1981 ; Newcomb et al ., 1988 ; Cato, 1992 ; McKay et al ., 1992 )]. Given the diverse effects that different drugs have on the user, it might be proposed that reasons for use will closely mirror these differences. Thus stimulant drugs (such as amphetamines, ecstasy or cocaine) will be used for reasons relating to increased nervous system arousal and drugs with sedative effects (such as alcohol or cannabis), with nervous system depression. The present study therefore selected a range of drugs commonly used by young people with stimulant, sedative or hallucinogenic effects to examine this issue further.

The phrase `instrumental drug use' has been used to denote drug use for reasons specifically linked to a drug's effects ( WHO, 1997 ). Examples of the instrumental use of amphetamine-type stimulants include vehicle drivers who report using to improve concentration and relieve tiredness, and people who want to lose weight (particularly young women), using these drugs to curb their appetite. However, the term `instrumental substance use' seems to be used when specific physical effects of a drug are exploited and does not encompass use for more subtle social or psychological purposes which may also be cited by users. In recent reports we have described a `drug use functions' model to help understand poly-substance use phenomenology amongst young people and how decisions are made about patterns of consumption ( Boys et al ., 1999a , b , 2000a ). The term `function' is intended to characterize the primary or multiple reasons for, or purpose served by, the use of a particular substance in terms of the actual gains that the user perceives that they will attain. In the early, 1970s Sadava suggested that functions were a useful means of understanding how personality and environmental variables impacted on patterns of drug use ( Sadava, 1975 ). This work was confined to functions for cannabis and `psychedelic drugs' amongst a sample of college students. To date there has been little research that has examined the different functions associated with the range of psychoactive substances commonly used by young poly-drug users. It is unclear if all drugs with similar physical effects are used for similar purposes, or if other more subtle social or psychological dimensions to use are influential. Work in this area will help to increase understanding of the different roles played by psychoactive substances in the lives of young people, and thus facilitate health, educational and policy responses to this issue.

Previous work has suggested that the perceived functions served by the use of a drug predict the likelihood of future consumption ( Boys et al ., 1999a ). The present study aims to develop this work further by examining the functional profiles of six substances commonly used by young people in the UK.

Patterns of cannabis, amphetamine, ecstasy, LSD, cocaine hydrochloride and alcohol use were examined amongst a sample of young poly-drug users. Tobacco use was not addressed in the present research.

Sampling and recruitment

A snowball-sampling approach was employed for recruitment of participants. Snowball sampling is an effective way of generating a large sample from a hidden population where no formal sampling frame is available ( Van Meter, 1990 ). A team of peer interviewers was trained to recruit and interview participants for the study. We have described this procedure in detail elsewhere and only essential features are described here ( Boys et al. 2000b ). Using current or ex-drug users to gather data from hidden populations of drug using adults has been found to be successful ( Griffiths et al ., 1993 ; Power, 1995 ).

Study participants

Study participants were current poly-substance users with no history of treatment for substance-related disorders. We excluded people with a treatment history on the assumption that young people who have had substance-related problems requiring treatment represent a different group from the general population of young drug users. Inclusion criteria were: aged 16–22 years and having used two or more illegal substances during the past 90 days. During data collection, the age, gender and current occupation of participants were recorded and monitored to ensure that sufficient individuals were recruited to the groups to permit subgroup analyses. If an imbalance was observed in one of these variables, the interviewers were instructed to target participants with specific characteristics (e.g. females under the age of 18) to redress this imbalance.

Study measures

Data were collected using a structured interviewer-administered questionnaire developed specifically for the study. In addition to recording lifetime substance use, questions profiled consumption patterns of six substances in detail. Data were collected between August and November 1998. Interviews were audiotaped with the interviewee's consent. This enabled research staff to verify that answers had been accurately recorded on the questionnaire and that the interview had been conducted in accordance with the research protocol. Research staff also checked for consistency across different question items (e.g. the total number of days of drug use in the past 90 days should equal or exceed the number of days of cannabis use during the same time period). On the few occasions where inconsistencies were identified that could not be corrected from the tape, the interviewer was asked to re-contact the interviewee to verify the data.

Measures of lifetime use, consumption in the past year and past 90 days were based on procedures developed by Marsden et al . ( Marsden et al ., 1998 ). Estimated intensity of consumption (amount used on a typical using day) was recorded verbatim and then translated into standardized units at the data entry stage.

Functions for substance use scale

The questionnaire included a 17-item scale designed to measure perceived functions for substance use. This scale consisted of items developed in previous work ( Boys et al ., 1999a ) in addition to functions derived from qualitative interviews ( Boys et al ., 1999b ), new literature and informal discussions with young drug users. Items were drawn from five domains (Table I ).

Participants were asked if they had ever used a particular drug in order to fulfil each specific function. Those who endorsed the item were then invited to rate how frequently they had used it for this purpose over the past year, using a five-point Likert-type scale (`never' to `always'; coded 0–4). One item differed between the function scales used for the stimulant drugs and for alcohol and cannabis. For the stimulant drugs (amphetamines, cocaine and ecstasy) the item `have you ever used [named drug] to help you to lose weight' was used, for cannabis and alcohol this item was replaced with `have you ever used [drug] to help you to sleep?'. (The items written in full as they appeared in the questionnaire are shown in Table III , together with abbreviations used in this paper.)

Statistical procedures

The internal reliability of the substance use functions scales for each of the six substances was judged using Chronbach's α coefficient. Chronbach's α is a statistic that reflects the extent to which each item in a measurement scale is associated with other items. Technically it is the average of correlations between all possible comparisons of the scale items that are divided into two halves. An α coefficient for a scale can range from 0 (no internal reliability) to 1 (complete reliability). Analyses of categorical variables were performed using χ 2 statistic. Differences in scale means were assessed using t -tests.

The sample consisted of 364 young poly-substance users (205 males; 56.3%) with a mean age of 19.3 years; 69.8% described their ethnic group as White-European, 12.6% as Black and 10.1% were Asian. Just over a quarter (27.5%) were unemployed at the time of interview; a third were in education, 28.8% were in full-time work and the remainder had part-time employment. Estimates of monthly disposable income (any money that was spare after paying for rent, bills and food) ranged from 0 to over £1000 (median = £250).

Substance use history

The drug with the highest lifetime prevalence was cannabis (96.2%). This was followed by amphetamine sulphate (51.6%), cocaine hydrochloride (50.5%) (referred to as cocaine hereafter) and ecstasy (48.6%). Twenty-five percent of the sample had used LSD and this was more common amongst male participants (χ 2 [1] = 9.68, P < 0.01). Other drugs used included crack cocaine (25.5%), heroin (12.6%), tranquillizers (21.7%) and hallucinogenic mushrooms (8.0%). On average, participants had used a total of 5.2 different psychoactive substances in their lives (out of a possible 14) (median = 4.0, mode = 3.0, range 2–14). There was no gender difference in the number of different drugs ever used.

Table II profiles use of the six target drugs over the past year, and the frequency and intensity of use in the 90 days prior to interview.

There were no gender differences in drug use over the past year or in the past 90 days with the exception of amphetamines. For this substance, females who had ever used this drug were more likely to have done so during the past 90 days than males (χ 2 [1] = 4.14, P < 0.05). The mean number of target drugs used over the past 90 days was 3.2 (median = 3.0, mode = 3.0, range 2–6). No gender differences were observed. Few differences were also observed in the frequency and intensity of use. Males reported drinking alcohol more frequently during the three months prior to interview ( t [307] = 2.48, P < 0.05) and using cannabis more intensively on a `typical using day' ( t [337] = 3.56, P < 0.001).

Perceived functions for substance use

There were few differences between the functions endorsed for use of each drug `ever' and those endorsed for use during `the year prior to interview'. This section therefore concentrates on data for the year prior to interview. We considered that in order to use a drug for a specific function, the user must have first hand knowledge of the drug's effects before making this decision. Consequently, functions reported by individuals who had only used a particular substance on one occasion in their lives (i.e. with no prior experience of the drug at the time they made the decision to take it) were excluded from the analyses. Table III summarizes the proportion of the sample who endorsed each of the functions for drugs used in the past year. Roman numerals have been used to indicate the functions with the top five average scores. Table III also shows means for the total number of different items endorsed by individual users and the internal reliability of the function scales for each substance using Chronbach's α coefficients. There were no significant gender differences in the total number of functions endorsed for any of the six substances.

The following sections summarize the top five most popular functions drug-by-drug together with any age or gender differences observed in the items endorsed.

Cannabis use ( n = 345)

Overall the most popular functions for cannabis use were to `RELAX' (endorsed by 96.8% of people who had used the drug in the last year), to become `INTOXICATED' (90.7%) and to `ENHANCE ACTIVITY' (72.8%). Cannabis was also commonly used to `DECREASE BOREDOM' (70.1%) and to `SLEEP' (69.6%) [this item was closely followed by using to help `FEEL BETTER' (69.0%)]. Nine of the 17 function items were endorsed by over half of those who had used cannabis on more than one occasion in the past year. There were no significant gender differences observed, with the exception of using to `KEEP GOING', where male participants were significantly more likely to say that they had used cannabis to fulfil this function in the past year (χ 2 [1] = 6.10, P < 0.05).

There were statistically significant age differences on four of the function variables: cannabis users who reported using this drug in the past year to help feel `ELATED/EUPHORIC' or to help `SLEEP' were significantly older than those who had not used cannabis for these purposes (19.6 versus 19.0; t [343] = 3.32, P < 0.001; 19.4 versus 19.0; t [343] = 2.01, P < 0.05). In contrast, those who had used cannabis to `INCREASE CONFIDENCE' and to `STOP WORRYING' tended to be younger than those who did not (19.0 versus 19.4; t [343] = –2.26, P < 0.05; 19.1 versus 19.5; t [343] = –1.99, P < 0.05).

Amphetamines ( n = 160)

Common functions for amphetamine use were to `KEEP GOING' (95.6%), to `STAY AWAKE' (91.3%) or to `ENHANCE ACTIVITY' (66.2%). Using to help feel `ELATED/EUPHORIC' (60.6%) and to `ENJOY COMPANY' (58.1%) were also frequently mentioned. Seven of the 17 function items were endorsed by over half of participants who had used amphetamines in the past year. As with cannabis, gender differences were uncommon: females were more likely to use amphetamines to help `LOSE WEIGHT' than male participants (χ 2 [1] = 21.67, P < 0.001).

Significant age differences were found on four function variables. Individuals who reported using amphetamines in the past year to feel `ELATED/EUPHORIC' were significantly older than those who did not (19.9 versus 19.0; t [158] = 2.87, P < 0.01). In contrast, participants who used amphetamines to `STOP WORRYING' (18.8 versus 19.8; t [158] = –2.77, P < 0.01), to `DECREASE BOREDOM' (19.2 versus 19.9; t [158] = –2.39, P < 0.05) or to `ENHANCE ACTIVITY' (19.3 versus 20.1; t [158] = –2.88, P < 0.01) were younger than those who had not.

Ecstasy ( n = 157)

The most popular five functions for using ecstasy were similar to those for amphetamines. The drug was used to `KEEP GOING' (91.1%), to `ENHANCE ACTIVITY' (79.6%), to feel `ELATED/EUPHORIC' (77.7%), to `STAY AWAKE' (72.0%) and to get `INTOXICATED' (68.2%). Seven of the 17 function items were endorsed by over half of those who had used ecstasy in the past year. Female users were more likely to use ecstasy to help `LOSE WEIGHT' than male participants (Fishers exact test, P < 0.001).

As with the other drugs discussed above, participants who reported using ecstasy to feel `ELATED/EUPHORIC' were significantly older than those who did not (19.8 versus 18.9; t [155] = 2.61, P < 0.01). In contrast, those who had used ecstasy to `FEEL BETTER' (19.3 versus 20.0; t [155] = –2.29, P < 0.05), to `INCREASE CONFIDENCE' (19.2 versus 19.9; t [155] = –2.22, P < 0.05) and to `STOP WORRYING' (19.0 versus 19.9; t [155] = –2.96, P < 0.01) tended to be younger.

LSD ( n = 58)

Of the six target substances examined in this study, LSD was associated with the least diverse range of functions for use. All but two of the function statements were endorsed by at least some users, but only five were reported by more than 50%. The most common purpose for consuming LSD was to get `INTOXICATED' (77.6%). Other popular functions included to feel `ELATED/EUPHORIC' and to `ENHANCE ACTIVITY' (both endorsed by 72.4%), and to `KEEP GOING' and to `ENJOY COMPANY' (both endorsed by 58.6%). Unlike the other substances examined, no gender or age differences were observed.

Cocaine ( n = 168)

In common with ecstasy and amphetamines, the most widely endorsed functions for cocaine use were to help `KEEP GOING' (84.5%) and to help `STAY AWAKE' (69.0%). Consuming cocaine to `INCREASE CONFIDENCE' and to get `INTOXICATED' (both endorsed by 66.1%) were also popular. However, unlike the other stimulant drugs, 61.9% of the cocaine users reported using to `FEEL BETTER'. Ten of the 17 function items were endorsed by over half of those who had used cocaine in the past year.

Gender differences were more common amongst functions for cocaine use than the other substances surveyed. More males reported using cocaine to `IMPROVE EFFECTS' of other drugs (χ 2 [1] = 4.00, P < 0.05); more females used the drug to help `STAY AWAKE' (χ 2 [1] = 12.21, P < 0.001), to `LOSE INHIBITIONS' (χ 2 [1] = 9.01, P < 0.01), to `STOP WORRYING' (χ 2 [1] = 8.11, P < 0.01) or to `ENJOY COMPANY' of friends (χ 2 [1] = 4.34, P < 0.05). All participants who endorsed using cocaine to help `LOSE WEIGHT' were female.

Those who had used cocaine to `FEEL BETTER' (18.9 versus 19.8; t [166] = –3.06, P < 0.01), to `STOP WORRYING' (18.6 versus 19.7; t [166] = –3.86, P < 0.001) or to `DECREASE BOREDOM' (18.9 versus 19.6; t [166] = –2.52, P < 0.05) were significantly younger than those who did not endorse these functions. Similar to the other drugs, participants who had used cocaine to feel `ELATED/EUPHORIC' in the past year tended to be older than those who had not (19.6 versus 18.7; t [166] = 3.16, P < 0.01).

Alcohol ( n = 312)

The functions for alcohol use were the most diverse of the six substances examined. Like LSD, the most commonly endorsed purpose for drinking was to get `INTOXICATED' (89.1%). Many used alcohol to `RELAX' (82.7%), to `ENJOY COMPANY' (74.0%), to `INCREASE CONFIDENCE' (70.2%) and to `FEEL BETTER' (69.9%). Overall, 11 of the 17 function items were endorsed by over 50% of those who had drunk alcohol in the past year. Male participants were more likely to report using alcohol in combination with other drugs either to `IMPROVE EFFECTS' of other drugs (χ 2 [1] = 4.56, P < 0.05) or to ease the `AFTER EFFECTS' of other substances (χ 2 [1] = 7.07, P < 0.01). More females than males reported that they used alcohol to `DECREASE BOREDOM' (χ 2 [1] = 4.42, P < 0.05).

T -tests revealed significant age differences on four of the function variables: those who drank to feel `ELATED/EUPHORIC' were significantly older (19.7 versus 19.0; t [310] = 3.67, P < 0.001) as were individuals who drank to help them to `LOSE INHIBITIONS' (19.6 versus 19.0; t [310] = 2.36, P < 0.05). In contrast, participants who reported using alcohol just to get `INTOXICATED' (19.2 versus 20.3; t [310] = –3.31, P < 0.001) or to `DECREASE BOREDOM' (19.2 versus 19.6; t [310] = –2.25, P < 0.05) were significantly younger than those who did not.

Combined functional drug use

The substances used by the greatest proportion of participants to `IMPROVE EFFECTS' from other drugs were cannabis (44.3%), alcohol (41.0%) and amphetamines (37.5%). It was also common to use cannabis (64.6%) and to a lesser extent alcohol (35.9%) in combination with other drugs in order to help manage `AFTER EFFECTS'. Amphetamines, ecstasy, LSD and cocaine were also used for these purposes, although to a lesser extent. Participants who endorsed the combination drug use items were asked to list the three main drugs with which they had combined the target substance for these purposes. Table IV summarizes these responses.

Overall functions for drug use

In order to examine which functions were most popular overall, a dichotomous variable was created for each different item to indicate if one or more of the six target substances had been used to fulfil this purpose during the year prior to interview. For example, if an individual reported that they had used cannabis to relax, but their use of ecstasy, amphetamines and alcohol had not fulfilled this function, then the variable for `RELAX' was scored `1'. Similarly if they had used all four of these substances to help them to relax in the past year, the variable would again be scored as `1'. A score of `0' indicates that none of the target substances had been used to fulfil a particular function. Table V summarizes the data from these new variables.

Over three-quarters of the sample had used at least one target substance in the past year for 11 out of the 18 functions listed. The five most common functions for substance use overall were to `RELAX' (96.7%); `INTOXICATED' (96.4%); `KEEP GOING' (95.9%); `ENHANCE ACTIVITY' (88.5%) and `FEEL BETTER' (86.8%). Despite the fact that `SLEEP' was only relevant to two substances (alcohol and cannabis), it was still endorsed by over 70% of the total sample. Using to `LOSE WEIGHT' was only relevant to the stimulant drugs (amphetamines, ecstasy and cocaine), yet was endorsed by 17.3% of the total sample (almost a third of all female participants). Overall, this was the least popular function for recent substance use, followed by `WORK' (32.1%). All other items were endorsed by over 60% of all participants.

Gender differences were identified in six items. Females were significantly more likely to have endorsed the following: using to `INCREASE CONFIDENCE' (χ 2 [1] = 4.41, P < 0.05); `STAY AWAKE' (χ 2 [1] = 5.36, P < 0.05), `LOSE INHIBITIONS' (χ 2 [1] = 4.48, P < 0.05), `ENHANCE SEX' (χ 2 [1] = 5.17, P < 0.05) and `LOSE WEIGHT' (χ 2 [1] = 29.6, P < 0.001). In contrast, males were more likely to use a substance to `IMPROVE EFFECTS' of another drug (χ 2 [1] = 11.18, P < 0.001).

Statistically significant age differences were identified in three of the items. Those who had used at least one of the six target substances in the last year to feel `ELATED/EUPHORIC' (19.5 versus 18.6; t [362] = 4.07, P < 0.001) or to `SLEEP' (19.4 versus 18.9; t [362] = 2.19, P < 0.05) were significantly older than those who had not used for this function. In contrast, participants who had used in order to `STOP WORRYING' tended to be younger (19.1 versus 19.7; t [362] = –2.88, P < 0.01).

This paper has examined psychoactive substance use amongst a sample of young people and focused on the perceived functions for use using a 17-item scale. In terms of the characteristics of the sample, the reported lifetime and recent substance use was directly comparable with other samples of poly-drug users recruited in the UK [e.g. ( Release, 1997 )].

Previous studies which have asked users to give reasons for their `drug use' overall instead of breaking it down by drug type [e.g. ( Carman, 1979 ; Butler et al ., 1981 ; Newcomb et al ., 1988 ; Cato, 1992 ; McKay et al ., 1992 )] may have overlooked the dynamic nature of drug-related decision making. A key finding from the study is that that with the exception of two of the functions for use scale items (using to help sleep or lose weight), all of the six drugs had been used to fulfil all of the functions measured, despite differences in their pharmacological effects. The total number of functions endorsed by individuals for use of a particular drug varied from 0 to 15 for LSD, and up to 17 for cannabis, alcohol and cocaine. The average number ranged from 5.9 (for LSD) to 9.0 (for cannabis). This indicates that substance use served multiple purposes for this sample, but that the functional profiles differed between the six target drugs.

We have previously reported ( Boys et al. 2000b ) that high scores on a cocaine functions scale are strongly predictive of high scores on a cocaine-related problems scale. The current findings support the use of similar function scales for cannabis, amphetamines, LSD and ecstasy. It remains to be seen whether similar associations with problem scores exist. Future developmental work in this area should ensure that respondents are given the opportunity to cite additional functions to those included here so that the scales can be further extended and refined.

Recent campaigns that have targeted young people have tended to assume that hallucinogen and stimulant use is primarily associated with dance events, and so motives for use will relate to this context. Our results support assumptions that these drugs are used to enhance social interactions, but other functions are also evident. For example, about a third of female interviewees had used a stimulant drug to help them to lose weight. Future education and prevention efforts should take this diversity into account when planning interventions for different target groups.

The finding that the same functions are fulfilled by use of different drugs suggests that at least some could be interchangeable. Evidence for substituting alternative drugs to fulfil a function when a preferred drug is unavailable has been found in other studies [e.g. ( Boys et al. 2000a )]. Prevention efforts should perhaps focus on the general motivations behind use rather than trying to discourage use of specific drug types in isolation. For example, it is possible that the focus over the last decade on ecstasy prevention may have contributed inadvertently to the rise in cocaine use amongst young people in the UK ( Boys et al ., 1999c ). It is important that health educators do not overlook this possibility when developing education and prevention initiatives. Considering functions that substance use can fulfil for young people could help us to understand which drugs are likely to be interchangeable. If prevention programmes were designed to target a range of substances that commonly fulfil similar functions, then perhaps this could address the likelihood that some young people will substitute other drugs if deterred from their preferred substance.

There has been considerable concern about the perceived increase in the number of young people who are using cocaine in the UK ( Tackling Drugs to Build a Better Britain 1998 ; Ramsay and Partridge, 1999 ; Boys et al. 2000b ). It has been suggested that, for a number of reasons, cocaine may be replacing ecstasy and amphetamines as the stimulant of choice for some young people ( Boys et al ., 1999c ). The results from this study suggest that motives for cocaine use are indeed similar to those for ecstasy and amphetamine use, e.g. using to `keep going' on a night out with friends, to `enhance an activity', `to help to feel elated or euphoric' or to help `stay awake'. However, in addition to these functions which were shared by all three stimulants, over 60% of cocaine users reported that they had used this drug to `help to feel more confident' in a social situation and to `feel better when down or depressed'. Another finding that sets cocaine aside from ecstasy and amphetamines was the relatively common existence of gender differences in the function items endorsed. Female cocaine users were more likely to use to help `stay awake', `lose inhibitions', `stop worrying', `enjoy company of friends' or to help `lose weight'. This could indicate that women are more inclined to admit to certain functions than their male counterparts. However, the fact that similar gender differences were not observed in the same items for the other five substances, suggests this interpretation is unlikely. Similarly, the lack of gender differences in patterns of cocaine use (both frequency and intensity) suggests that these differences are not due to heavier cocaine use amongst females. If these findings are subsequently confirmed, this could point towards an inclination for young women to use cocaine as a social support, particularly to help feel less inhibited in social situations. If so, young female cocaine users may be more vulnerable to longer-term cocaine-related problems.

Many respondents reported using alcohol or cannabis to help manage effects experienced from another drug. This has implications for the choice of health messages communicated to young people regarding the use of two or more different substances concurrently. Much of the literature aimed at young people warns them to avoid mixing drugs because the interactive effects may be dangerous [e.g. ( HIT, 1996 )]. This `Just say No' type of approach does not take into consideration the motives behind mixing drugs. In most areas, drug education and prevention work has moved on from this form of communication. A more sophisticated approach is required, which considers the functions that concurrent drug use is likely to have for young people and tries to amend messages to make them more relevant and acceptable to this population. Further research is needed to explore the motivations for mixing different combinations of drugs together.

Over three-quarters of the sample reported using at least one of the six target substances to fulfil 11 out of the 18 functions. These findings provide strong evidence that young people use psychoactive drugs for a range of distinct purposes, not purely dependent on the drug's specific effects. Overall, the top five functions were to `help relax', `get intoxicated', `keep going', `enhance activity' and `feel better'. Each of these was endorsed by over 85% of the sample. Whilst all six substances were associated to a greater or lesser degree with each of these items, there were certain drugs that were more commonly associated with each. For example, cannabis and alcohol were popular choices for relaxation or to get intoxicated. In contrast, over 90% of the amphetamine and ecstasy users reported using these drugs within the last year to `keep going'. Using to enhance an activity was a common function amongst users of all six substances, endorsed by over 70% of ecstasy, cannabis and LSD users. Finally, it was mainly alcohol and cannabis (and to a lesser extent cocaine) that were used to `feel better'.

Several gender differences were observed in the combined functions for recent substance use. These findings indicate that young females use other drugs as well as cocaine as social supports. Using for specific physical effects (weight loss, sex or wakefulness) was also more common amongst young women. In contrast, male users were significantly more likely to report using at least one of the target substances to try to improve the effects of another substance. This indicates a greater tendency for young males in this sample to mix drugs than their female counterparts. Age differences were also observed on several function items: participants who had used a drug to `feel elated or euphoric' or to `help sleep' tended to be older and those who used to `stop worrying about a problem' were younger. If future studies confirm these differences, education programmes and interventions might benefit from tailoring their strategies for specific age groups and genders. For example, a focus on stress management strategies and coping skills with a younger target audience might be appropriate.

Some limitations of the study need to be acknowledged. The sample for this study was recruited using a snowball-sampling methodology. Although it does not yield a random sample of research participants, this method has been successfully used to access hidden samples of drug users [e.g. ( Biernacki, 1986 ; Lenton et al ., 1997 )]. Amongst the distinct advantages of this approach are that it allows theories and models to be tested quantitatively on sizeable numbers of subjects who have engaged in a relatively rare behaviour.

Further research is now required to determine whether our observations may be generalized to other populations (such as dependent drug users) and drug types (such as heroin, tranquillizers or tobacco) or if additional function items need to be developed. Future studies should also examine if functions can be categorized into primary and subsidiary reasons and how these relate to changes in patterns of use and drug dependence. Recognition of the functions fulfilled by substance use could help inform education and prevention strategies and make them more relevant and acceptable to the target audiences.

Structure of functions scales

Profile of substance use over the past year and past 90 days ( n = 364)

Proportion (%) of those who have used [substance] more than once, who endorsed each functional statement for their use in the past year

Combined functional substance use reported by the sample over the past year

Percentage of participants who reported having used at least one of the target substances to fulfil each of the different functions over the past year ( n = 364)

We gratefully acknowledge research support from the Health Education Authority (HEA). The views expressed in this paper are those of the authors and do not necessarily reflect those of the HEA. We would also like to thank the anonymous referees for helpful comments and suggestions on an earlier draft of this paper.

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Understanding the Demand for Illegal Drugs (2010)

Chapter: 1 introduction, 1 introduction.

A merica’s problem with illegal drugs seems to be declining, and it is certainly less in the news than it was 20 years ago. Surveys have shown a decline in the number of users dependent on expensive drugs (Office of National Drug Control Policy, 2001), an aging of the population in treatment (Trunzo and Henderson, 2007), and a decline in the violence related to drug markets (Pollack et al., 2010). Still, research indicates that illegal drugs remain a concern for the majority of Americans (Caulkins and Mennefee, 2009; Gallup Poll, 2009).

There is virtually no disagreement that the trafficking in and use of cocaine, heroin, and methamphetamine continue to cause great harm to the nation, particularly to vulnerable minority communities in the major cities. In contrast, there is disagreement about marijuana use, which remains a part of adolescent development for about half of the nation’s youth. The disagreement concerns the amount, source, and nature of the harms from marijuana. Some note, for example, that most of those who use marijuana use it only occasionally and neither incur nor cause harms and that marijuana dependence is a much less serious problem than dependence on alcohol or cocaine. Others emphasize the evidence of a potential for triggering psychosis (Arseneault et al., 2004) and the strengthening evidence for a gateway effect (i.e., an opening to the use of other drugs) (Fergusson et al., 2006). The uncertainty of the causal mechanism is reflected in the fact that the gateway studies cannot disentangle the effect of the drug itself from its status as an illegal good (Babor et al., 2010).

The federal government probably spends $20 billion per year on a wide array of interventions to try to reduce drug consumption in the United States, from crop eradication in Colombia to mass media prevention programs aimed at preteens and their parents. 1 State and local governments spend comparable amounts, mostly for law enforcement aimed at suppressing drug markets. 2 Yet the available evidence, reviewed in detail in this report, shows that drugs are just as cheap and available as they have ever been.

Though fewer young people are starting to use drugs than in some previous years, for each successive birth cohort that turns 21, approximately half have experimented with illegal drugs. The number of people who are dependent on cocaine, heroin, and methamphetamine is probably declining modestly, 3 and drug-related violence has appears to have declined sharply. 4 At the same time, injecting drug use is still a major vector for HIV transmission, and drug markets blight parts of many U.S. cities.

The declines in drug use that have occurred in recent years are probably mostly the natural working out of old epidemics. Policy measures— whether they involve prevention, treatment, or enforcement—have met with little success at the population level (see Chapter 4 ). Moreover, research on prevention has produced little evidence of any targeted interventions that make a substantial difference in initiation to drugs when implemented on a large scale. For treatment programs, there is a large body of evidence of effectiveness and cost-effectiveness (reviewed in Babor et al., 2010), but the supply of treatment facilities is inadequate and,

perversely, not enough of those who need treatment are persuaded to seek it (see Chapter 4 ). Efforts to raise the price of drugs through interdiction and other enforcement programs have not had the intended effects: the prices of cocaine and heroin have declined for more than 25 years, with only occasional upward blips that rarely last more than 9 months (Walsh, 2009).

STUDY PROJECT AND GOALS

Given the persistence of drug demand in the face of lengthy and expensive efforts to control the markets, the National Institute of Justice asked the National Research Council (NRC) to undertake a study of current research on the demand for drugs in order to help better focus national efforts to reduce that demand. In response to that request, the NRC formed the Committee on Understanding and Controlling the Demand for Illegal Drugs. The committee convened a workshop of leading researchers in October 2007 and held two follow-up meetings to prepare this report. The statement of task for this project is as follows:

An ad hoc committee will conduct a workshop-based study that will identify and describe what is known about the nature and scope of markets for illegal drugs and the characteristics of drug users. The study will include exploration of research issues associated with drug demand and what is needed to learn more about what drives demand in the United States. The committee will specifically address the following issues:

What is known about the nature and scope of illegal drug markets and differences in various markets for popular drugs?

What is known about the characteristics of consumers in different markets and why the market remains robust despite the risks associated with buying and selling?

What issues can be identified for future research? Possibilities include the respective roles of dependence, heavy use, and recreational use in fueling the market; responses that could be developed to address different types of users; the dynamics associated with the apparent failure of policy interventions to delay or inhibit the onset of illegal drug use for a large proportion of the population; and the effects of enforcement on demand reduction.

Drawing on commissioned papers and presentations and discussions at a public workshop that it will plan and hold, the committee will prepare a report on the nature and operations of the illegal drug market in the United States and the research issues identified as having potential for informing policies to reduce the demand for illegal drugs.

The committee drew on economic models and their supporting data, as well as other research, as one part of the evidentiary base for this

report. However, the context for and content of this report were informed as well by the general discussion and the presentations in the workshop. The committee was not able to fully address task 2 because research in that area is not strong enough to give an accurate description of consumers across different markets nor to address the questions about why markets remain robust despite the risks associated with buying and selling. The discussion at the workshop underscored the point that neither the available ethnographic research nor the limited longitudinal research on drug-seeking behavior is strong enough to inform these questions related to task 2. With regard to task 3, the committee benefitted considerably from the paper by Jody Sindelar that was presented at the workshop and its discussion by workshop participants.

This study was intended to complement Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us (National Research Council, 2001) by giving more attention to the sources of demand and assessing the potential of demand-side interventions to make a substantial difference to the nation’s drug problems. This report therefore refers to supply-side considerations only to the extent necessary to understand demand.

The charge to the committee was extremely broad. It could have included reviewing the literature on such topics as characteristics of substance users, etiology of initiation of use, etiology of dependence, drug use prevention programs, and drug treatments. Two considerations led to narrowing the focus of our work. The first was substantive. Each of the topics just noted involves a very large field of well-developed research, and each has been reviewed elsewhere. Moreover, each of these areas of inquiry is currently expanding as a result of new research initiatives 5 and new technologies (e.g., neuroimaging, genetics). The second consideration was practical: given the available resources, we could not undertake a complete review of the entire field.

Thus, we decided to focus our work and this report tightly on demand models in the field of economics and to evaluate the data needs for advancing this relatively undeveloped area of investigation. That is, this area has a relatively shorter history of accumulated findings than the more clinical, biological, and epidemiological areas of drug research. Yet it is arguably better situated to inform government policy at the national level. A report on economic models and supporting data seemed to us more timely than a report on drug consumers and drug interventions.

The rest of this chapter briefly lays out some concepts that provide a basis for understanding the committee’s work and the rest of the report.

Chapter 2 presents the economic framework that seems most useful for studying the phenomenon of drug demand. It emphasizes the importance of understanding the responsiveness of demand and supply to price, which is the intermediate variable targeted by the principal government programs in the United States, namely, drug law enforcement. Chapter 3 then examines changes in the consumption of drugs and assesses the various indicators that are available to measure that consumption. Chapter 4 turns to the program type that most focuses specifically on reducing drug demand, the treatment of dependent users. It considers how well these programs work and how the treatment system might be expanded to further reduce consumption. Finally, Chapter 5 presents our recommendations for how the data and research base might be built to improve understanding of the demand for drugs and policies to reduce it.

PROGRAM CONCEPTS

A standard approach to considering drug policy is to divide programs into supply side and demand side. This approach accepts that drugs, as commodities, albeit illegal ones, are sold in markets. Supply-side programs aim to reduce drug consumption by making it more expensive to purchase drugs through increasing costs to producers and distributors. Demand-side programs try to lower consumption by reducing the number of people who, at a given price, seek to buy drugs; the amount that the average user wishes to consume; or the nonmonetary costs of obtaining the drugs. This approach has value, but it also raises questions.

The value of this framework is that it allows systematic evaluation of programs. A successful supply-side program will raise the price of drugs, as well as reduce the quantity available, while a demand-side program will lower both the number of users and the quantity consumed, as well as eventually reducing the price. As noted above, this report is primarily focused on improving understanding of the sources of demand.

There are two basic objections to this approach. First, some programs have both demand- and supply-side effects. Since many dealers are themselves heavy users, drug treatment will reduce supply, just as incarceration of drug dealers lowers demand. Second, there is a collection of programs that do not attempt to reduce demand or supply; rather, their goal is to reduce the damage that drug use and drug markets cause society, which are generally referred to as “harm-reduction” programs (Iversen, 2005; National Institute on Drug Abuse, 2010). 6 Nonetheless, the classifi-

cation of interventions into demand reduction and supply reduction is a very helpful heuristic for policy purposes, as well as being written into the legislation under which the Office of National Drug Control Policy operates.

What determines the demand for drugs? Clearly, many different factors play a role: cultural, economic, and social influences are all important. At the individual level, a rich set of correlates have been explored, either in large-scale cross-sectional surveys (such as the National Survey on Drug Use and Health and the National Household Survey on Drug Abuse) or in small-scale longitudinal studies (see, e.g., Wills et al., 2005). Below we briefly summarize the complex findings of those studies.

Less has been done at the population level. It is known that rich western countries differ substantially in the extent of drug use, in ways that do not seem to reflect policy differences. For example, despite the relatively easy access to marijuana in the Netherlands, that nation has a prevalence rate that is in the middle of the pack for Europe, while Britain, despite what may be characterized as a pragmatic and relatively evidence-oriented drug policy, has Europe’s highest rates of cocaine and heroin addiction (European Monitoring Center for Drugs and Drug Addiction, 2007). There is only minimal empirical research that has attempted to explain those differences. Similarly, there is very little known about why epidemics of drug use occur at specific times. In the United States, for example, there is no known reason for the sudden spread of methamphetamine from its long-term West Coast concentration to the Midwest that began in the early 1990s. There are only the most speculative conjectures as to the proximate causes.

A DYNAMIC AND HETEROGENEOUS PROCESS

The committee’s starting point is that drug use is a dynamic phenomenon, both at the individual and community levels. In the United States there is a well-established progression of use of substances for individuals, starting with alcohol or cigarettes (or both) and proceeding through marijuana (at least until recently) possibly to more dangerous and expensive drugs (see, e.g., Golub and Johnson, 2001). Such a progression seems to be a common feature of drug use, although the exact sequence might not apply in other countries and may change over time. For example, cigarettes may lose their status as a gateway drug because of new restrictions on their use. 7 Recently, abuse of prescription drugs has emerged as a possible gateway, with high prevalence rates reported for youth aged 18-25;

however, because of limited economic research on this phenomenon, this report’s focus is on completely illegal drugs.

At the population level, there are epidemics, in which, like a fashion good, a new drug becomes popular rapidly in part because of its novelty and then, often just as rapidly, loses its appeal to those who have not tried it. For addictive substances (including marijuana but not hallucinogens, such as LSD), that leaves behind a cohort of users who experimented with the drug and then became habituated to it.

An important and underappreciated element of the demand for illegal drugs is its variation in many dimensions. For example, the demand for marijuana may be much more responsive to price changes than the demand for heroin because fewer of those who use marijuana are drug dependent (Iversen, 2005; National Institute on Drug Abuse, 2010). Users who are employed, married, and not poor may be more likely to desist than users of the same drug who are unemployed, not part of an intact household, and poor. There may be differences in the characteristics of demand associated with when the specific drug first became available in a particular community, that is, whether it is early or late in a national drug “epidemic.”

There are also unexplained long-term differences in the drug patterns in cities that are close to each other. In Washington, DC, in 1987 half of all those arrested for a criminal offense (not just for drugs) tested positive for phencyclidine, while in Baltimore, 35 miles away, the drug was almost unknown. Although the Washington rate had fallen to approximately 10 percent in 2009 (District of Columbia Pretrial Services Agency, 2009), it remains far higher than in other cities. More recently, the spread of methamphetamine has shown the same unevenness: in San Antonio only 2.3 percent of arrestees tested positive for methamphetamine in 2002; in Phoenix, the figure was 31.2 percent (National Institute of Justice, 2003). These differences had existed for more than 10 years.

The implication of this heterogeneity is that programs that work for a particular drug, user type, place, or period may be much less effective under other circumstances, which substantially complicates any research task. It is hard to know how general are findings on, say, the effectiveness of a prevention program aimed at methamphetamine use by adolescents in a city where the drug has no history. Will this program also be effective for trying to prevent cocaine use among young adults in cities that have long histories of that drug?

This report does not claim to provide the answers to such ambitious questions. It does intend, however, to equip policy officials and the public to understand what is known and what needs to be done to provide a more sound base for answering them.

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Despite efforts to reduce drug consumption in the United States over the past 35 years, drugs are just as cheap and available as they have ever been. Cocaine, heroin, and methamphetamines continue to cause great harm in the country, particularly in minority communities in the major cities. Marijuana use remains a part of adolescent development for about half of the country's young people, although there is controversy about the extent of its harm.

Given the persistence of drug demand in the face of lengthy and expensive efforts to control the markets, the National Institute of Justice asked the National Research Council to undertake a study of current research on the demand for drugs in order to help better focus national efforts to reduce that demand.

This study complements the 2003 book, Informing America's Policy on Illegal Drugs by giving more attention to the sources of demand and assessing the potential of demand-side interventions to make a substantial difference to the nation's drug problems. Understanding the Demand for Illegal Drugs therefore focuses tightly on demand models in the field of economics and evaluates the data needs for advancing this relatively undeveloped area of investigation.

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Research on drugs

test UNODC research on drugs generates the sound knowledge needed to support evidence-based policies and programmes. Analysis of persistent and emerging challenges across the drug supply chain, from drug cultivation to trafficking and use, aims at strengthening responses to the drug problem at global, regional and national levels.

UNODC research activities on drugs dates back to the 1990s, when the 1997 World Drug Report, first of a long series, was published. The Report has become the flagship publication of the UNODC and its preparation, including the research activities it entails, embodies the large spectrum of issues that UNODC research on drugs covers.

World drug report

For the first time since its conception, this year the World Drug Report consists of two products, a web-based element and a set of booklets. The latest global, regional and subregional estimates of and trends in drug demand and supply are presented in a user-friendly, interactive  online segment . While  Special points of interest  include key takeaways and policy implications,  booklet 1  takes the form of an executive summary based on analysis of the key findings of the online segment and the thematic  booklet 2  and the conclusions that can be drawn from them. In addition to providing an in-depth analysis of key developments and emerging trends in selected drug markets, including in countries currently experiencing conflict, booklet 2 focuses on a number of other contemporary issues related to drugs. 

RESEARCH ON DRUG CULTIVATION AND PRODUCTION

UNODC provides evidence on the general situation and trends in the production of opiates, cocaine, amphetamine-type stimulants and cannabis at the global, regional and national levels.

To enhance knowledge and support countries in the collection of and reporting on data, UNODC works with Member States to monitor drug cultivation, production and manufacture, while collaboration with regional partners, intergovernmental organizations and academic institutions enhances monitoring capacities at national, regional and international levels.

RESEARCH ON DRUG TRAFFICKING

UNODC monitors global and regional developments in drug trafficking based on regular reporting from Member States, the monitoring of open sources and first-hand information from structured interviews or similar exercises.

Research on drug trafficking provides an overall picture of the illicit markets, covering aspects such as trafficking routes and flows, latest trends and emerging patterns in trafficking and distribution, criminal actors involved and modi operandi employed.

RESEARCH ON DRUG USE

UNODC monitors global and regional developments in the demand for drugs, including the non-medical use of pharmaceutical drugs, through various channels and activities, including regular reporting from Member States, household surveys and targeted studies of vulnerable population groups. 

Information from these sources is used to produce datasets but also analysed holistically to provide an overall picture of the many challenges the world faces in terms of drug use and health consequences, covering aspects such as trends in extent and patterns of drug use, risk behaviours, drug related morbidity and mortality and coverage of drug treatment for those suffering from drug use disorders.

UNODC regularly updates global statistical series on drugs, including on drug trafficking (drug seizures, drug prices, drug purity, drug-related arrests). These data are available at dataUNODC

Following an extensive review of the current data collection instrument on drugs, the Annual Report Questionnaire, the UNODC, in consultation with experts from the Member States and international organisations, is preparing a revised Annual Report Questionnaire, which will be implemented from 2021.

28-30 August 2019 ,  Second Expert Working Group on improving drug statistics and strengthening the Annual Report Questionnaire (ARQ)

29-31 January 2018 ,  Expert Working Group on Improving Drug Statistics and Strengthening the Annual Report Questionnaire (ARQ)

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Studying the Relationship Between Drugs and Crime

Sidebar to the article Identifying New Illicit Drugs and Sounding the Alarm in Real Time , by Jim Dawson, published in NIJ Journal issue no. 281.

In 1976, Congress directed NIJ to collaborate with the National Institute on Drug Abuse to explore the relationship between drug use and crime. By 1980, a team of four NIJ-sponsored researchers had compiled and published Drugs and Crime: A Survey and Analysis of the Literature . [1] This report summarized existing research on patterns of drug use and criminal behavior and the effects of drug treatment strategies on criminality, setting the stage for NIJ to launch its Drug Use Forecasting (DUF) program in 1987. DUF measured and tracked drug use among arrestees to generate reliable and current information on drug use in relation to the criminal justice system. After a decade of collecting data, NIJ refined and expanded DUF to form the Arrestee Drug Abuse Monitoring (ADAM) program, improving the quality of its annual estimates of drug use prevalence. ADAM was in operation until 2003. [2] The data from these two NIJ efforts proved foundational for understanding the changing landscape of drug use across regions and over time.

In addition to tracking drug use trends, NIJ has also invested significant resources in original research on how to decrease drug use. NIJ-funded studies in the 1990s showed that drug treatment could be integrated into the criminal justice system to effectively reduce criminality. Building on these findings, NIJ began to evaluate an array of drug treatment modalities for persons convicted of crimes, including drug courts, residential drug treatment corrections programs, intensive probation supervision, and systemwide approaches. NIJ’s drugs and crime portfolio over the past decade has focused on crime reduction by studying prevention and intervention strategies for drug-related crimes, tactics for disrupting and dismantling drug markets, and technologies for improved drug detection and recognition.

More recently, NIJ research has focused on the policies, practices, and resources available to law enforcement to deter, investigate, and prosecute opioid use. As part of the U.S. Department of Justice’s overall response to the opioid epidemic, NIJ’s current priority is to address drug trafficking, markets, and use related to heroin and other opioids such as fentanyl and its analogues.

About This Article

This article was published as part of NIJ Journal issue number 281 , published May 2019, as a sidebar to the article Identifying New Illicit Drugs and Sounding the Alarm in Real Time , by Jim Dawson.

[note 1] Robert P. Gandossy, Jay R. Williams, Jo Cohen, and Henrick J. Harwood, Drugs and Crime: A Survey and Analysis of the Literature , Washington, DC: U.S. Department of Justice, National Institute of Justice, May 1980, NCJ 159074.

[note 2] Although NIJ ended ADAM in 2003, the Office of National Drug Control Policy operated ADAM II from 2007 to 2013. Ten of the original ADAM sites were selected for geographic diversity to address questions regarding methamphetamine trends beyond the Southwest, and instrumentation was modified to add items specific to methamphetamine.

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Understanding Drug Use and Addiction DrugFacts

Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

• decision-making

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

• Biology . The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.
• Environment . A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.
• Development . Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient’s drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

• Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
• Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
• Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
• Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.
• Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.
• No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.
• Drug addiction is treatable and can be successfully managed.
• More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

For information about understanding drug use and addiction, visit:

• www.nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction

For more information about the costs of drug abuse to the United States, visit:

• www.nida.nih.gov/related-topics/trends-statistics#costs

For more information about prevention, visit:

• www.nida.nih.gov/related-topics/prevention

For more information about treatment, visit:

• www.nida.nih.gov/related-topics/treatment

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

• https://findtreatment.samhsa.gov/

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

University of Notre Dame

Notre Dame Philosophical Reviews

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The Legalization of Drugs: For & Against

Douglas Husak and Peter de Marneffe, The Legalization of Drugs: For & Against , Cambridge University Press, 2005, 204pp., $18.99 (pbk), ISBN 0521546869.

Reviewed by William Hawk, James Madison University

In the United States the production, distribution and use of marijuana, heroin, and cocaine are crimes subjecting the offender to imprisonment. The Legalization of Drugs , appearing in the series "For and Against" edited by R. G. Frey for Cambridge University Press, raises the seldom-asked philosophical question of the justification, if any, of imprisoning persons for drug offenses.

Douglas Husak questions the justification for punishing persons who use drugs such as marijuana, heroin, and cocaine. He develops a convincing argument that imprisonment is never morally justified for drug use. Put simply, incarceration is such a harsh penalty that drug use, generally harmless to others and less harmful to the user than commonly supposed, fails to justify it. Any legal scheme that punishes drug users to achieve another worthy goal, such as creating a disincentive to future drug users, violates principles of justice.

Peter de Marneffe contends that under some circumstances society is morally justified in punishing persons who produce and distribute heroin. He argues a theoretical point that anticipated rises in drug abuse and consequent effects on young people may justify keeping heroin production and distribution illegal. According to de Marneffe's analysis, however, harsh prison penalties currently imposed on drug offenders are unjustified.

The points of discord between Husak's and de Marneffe's positions are serious but not as telling as is their implicit agreement. Current legal practices and policies which lead to lengthy incarceration of those who produce, distribute and use drugs such as marijuana, heroin, and cocaine are not, and cannot be, morally justified. Both arguments, against imprisoning drug users and for keeping heroin production illegal, merit a broad and careful reading.

The United States has erected an enormous legal structure involving prosecution and incarceration designed to prohibit a highly pleasurable, sometimes medically indicated and personally satisfying activity, namely using marijuana, heroin, and cocaine. At the same time, other pleasure-producing drugs, such as tobacco, alcohol, and caffeine, though legally regulated for the purposes of consumer safety and under-age consumption, can be purchased over the counter. As a result, while the health and safety risks of cigarettes may be greater than those proven to accompany marijuana, one can buy cigarettes from a vending machine and but go to prison for smoking marijuana. A rational legal system, according to Husak, demands a convincing, but as yet not forthcoming, explanation of why one pleasurable drug subjects users to the risk of imprisonment while the other is accommodated in restaurants.

Drug prohibitionists must face the problem that any "health risk" argument used to distinguish illicit drugs and subject offenders to prison sentences runs up against the known, yet tolerated, health risks of tobacco, as well as the additional health risks associated with incarceration. "Social costs" arguments targeting heroin or cocaine runs up against the known, yet tolerated, social costs of alcohol, as well as the additional social costs of incarceration. Even if one were to accept that illicit drugs were more harmful or exacted greater social costs than tobacco and alcohol (and the empirical studies referred to in the text do not generally support this thesis), that difference proves insufficient to justify imprisoning producers, distributors or especially users of illicit drugs.

Decriminalizing Drug Use. Douglas Husak presents a very carefully argued case for decriminalizing drug use. He begins his philosophical argument by clarifying the concepts and issues involved. To advocate the legalization of drugs calls for a legal system in which the production and sale of drugs are not criminal offenses. (p. 3) Criminalization of drugs makes the use of certain drugs a criminal offense, i.e. one deserving punishment. To argue for drug decriminalization, as Husak does, is not necessarily to argue for legalization of drugs . Husak entertains, but cautiously rejects the notion of a system where production and sale of drugs is illegal while use is not a crime. De Marneffe advocates such a system.

Punishing persons by incarceration demands justification. Since the state's use of punishment is a severe tool and incarceration is by its nature "degrading, demoralizing and dangerous" (p. 29) we must be able to provide "a compelling reason … to justify the infliction of punishment… ." (p. 34) Husak finds no compelling reason for imprisoning drug users. After considering four standard justifications for punishing drug users Husak concludes that "the arguments for criminalization are not sufficiently persuasive to justify the infliction of punishment."

Reasons to Criminalize Drug Use . 1) Drug users, it is claimed, should be punished in order to protect the health and well being of citizens . No doubt states are justified in protecting the health and well being of citizens. But does putting drug users in prison contribute to this worthy goal? Certainly not for those imprisoned. For those who might be deterred from using drugs the question is whether the drugs from which they are deterred by the threat of imprisonment actually pose a health risk. For one, Husak quotes research showing that currently illicit drugs do not obviously pose a greater health threat than alcohol or tobacco. For another, he quotes a statistic showing that approximately four times as many persons die annually from using prescribed medicines than die from using illegal drugs. In addition, one-fourth of all pack-a-day smokers lose ten to fifteen years of their lives but no one would entertain the idea of incarcerating smokers to further their health interests or in order to prevent non-smokers from beginning. In sum, Husak accepts that drug use poses health risks but contends that the risks are not greater than others that are socially accepted. Even if they were greater, imprisonment does not reduce, but compounds the health risks for prisoners.

2) Punishing drug users protects children . Husak here responds to de Marneffe's essay which focuses on potential drug abuse and promotes the welfare of children as a justification for keeping drug production and sale illegal. Husak finds punishing adolescent users a peculiar way to protect them. To punish one drug-using adolescent in order to prevent a non-using adolescent from using drugs is ineffective and also violates justice. Punishing adult users so that youth do not begin using drugs and do not suffer from neglect -- which is de Marneffe's position -- is not likely to prevent adolescents from becoming drug users, and even if it did, one would have to show that the harm prevented to the youth justifies imprisoning adults. Husak contends that punishing adults or youth, far from protecting youth, puts them at greater risk.

3) Some, e.g. former New York City mayor Guiliani, argue that punishing drug use prevents crime . Husak, conceding a connection between drug use and crime, turns the argument upside-down, showing how punishment increases rather than decreases crime. For one, criminalization of drugs forces the drug industry to settle disputes extra-legally. Secondly, drug decriminalization would likely lower drug costs thereby reducing economic crimes. Thirdly, to those who contend that illicit drugs may increase violence and aggression Husak responds that: a) empirical evidence does not support marijuana or heroin as causes of violence and b) empirical evidence does support alcohol, which is decriminalized, as leading to violence. Husak concludes "if we propose to ban those drugs that are implicated in criminal behavior, no drug would be a better candidate for criminalization than alcohol." (p. 70) Finally, punishing drug users likely increases crime rates since those imprisoned for drug use are released with greater tendencies and skills for future criminal activity.

4) Drug use ought to be punished because using drugs is immoral . In addition to standard philosophical objections to legal moralism, Husak contends that there is no good reason to think that recreational drug use is immoral. Drug use violates no rights. Other recreationally used drugs such as alcohol, tobacco or caffeine are not immoral. The only accounts according to which drug use is immoral are religiously based and generally not shared in the citizenry. Husak argues that legal moralism fails, and with it the attempts to justify imprisoning drug users because of health and well-being, protecting children, or reducing crime. Husak concludes, "If I am correct, prohibitionists are more clearly guilty of immorality than their opponents. The wrongfulness of recreational drug use, if it exists at all, pales against the immorality of punishing drug users." (p. 82)

Reasons to Decriminalize Drug Use. Husak's positive case for decriminalizing drug use begins with acknowledgement that drug use is or may be highly pleasurable. In addition, some drugs aid relaxation, others increase energy and some promote spiritual enlightenment or literary and artistic creativity. The simple fun and euphoria attendant to drug use should count for permitting it.

The fact that criminalization of drug use proves to be counter-productive provides Husak a set of final substantial reasons for decriminalizing use. Criminalizing drugs proves counter-productive along several different lines: 1) criminalization is aimed and selectively enforced against minorities, 2) public health risks increase because drugs are dealt on the street, 3) foreign policy is negatively affected by corrupt governments being supported solely because they support anti-drug policies, 4) a frank and open discussion about drug policy is impossible in the United States, 5) civil liberties are eroded by drug enforcement, 6) some government corruption stems from drug payoffs and 7) criminalization costs tens of billions of dollars per year.

Douglas Husak provides the conceptual clarity needed to work one's way through the various debates surrounding drug use and the law. He establishes a high threshold that must be met in order to justify the state's incarcerating someone. Having laid this groundwork Husak demonstrates that purported justifications for drug criminalization fail and that good reasons for decriminalizing drug use prevail. For persons who worry about what drug decriminalization means for children, Husak counsels that there is more to fear from prosecution and conviction of youth for using drugs than there is to fear from the drugs themselves.

Against Legalizing Drug Production and Distribution. Peter de Marneffe offers an argument against drug legalization . The argument itself is simple. If drugs are legalized, there will be more drug abuse. If there is more drug abuse that is bad. Drug abuse is sufficiently bad to justify making drug production and distribution illegal. Therefore, drugs should not be legalized. The weight of this argument is carried by the claim that the badness of drug abuse is sufficient to justify making drug production and sale illegal.

De Marneffe centers his argument on heroin. Heroin, he contends, is highly pleasurable but sharply depresses motivation to achieve worthwhile goals and meet responsibilities. Accordingly, children in an environment where heroin is legal will be subjected to neglect by heroin using parents and, if they themselves use heroin, they will be harmed by diminished motivation for achievement for the remainder of their lives. It is this later harm to the ambition and motivation of young people that, according to de Marneffe, justifies criminalizing heroin production and sale. As he puts it:

… the risk of lost opportunities that some individuals would bear as the result of heroin legalization justifies the risks of criminal liability and other burdens that heroin prohibition imposes on other individuals. The legalization of heroin would create a social environment -- call it the legalization environment -- in which some children would be at a substantially higher risk of irresponsible heroin abuse by their parents and in which some adolescents would be at a substantially higher risk of self-destructive heroin abuse. (p. 124)

Are the liberties of individual adult drug producers, distributors and users sacrificed? Yes, but this may be justified by de Marneffe's "burdens principle." According to the burdens principle, "the government violates a person's moral rights in adopting a policy that limits her liberty if and only if in adopting this policy the government imposes a burden on her that is substantially worse than the worst burden anyone would bear in the absence of this policy." (p. 159) According to this, de Marneffe claims that burdens on drug vendors or users may be justified by the prevention of harms to a particular individual or individuals. As he puts it:

What I claim in favor of heroin prohibition is that the reasons of at least one person to prefer her situation in a prohibition environment outweigh everyone else's reasons to prefer his or her situation in a legalization environment, assuming that the penalties are gradual and proportionate and other relevant conditions are met. (p. 161)

According to this view, the objective interest of a single adolescent in not losing ambition, motivation and drive justifies the imposition of burdens on other youth and adults who would prefer using drugs. Although Johnny might choose heroin use, his objective interest is for future motivation and ambition that is not harmed by heroin use.

De Marneffe's "burdens principle" seems to hold the whole society hostage to the objective liberty interests of one individual. Were this principle applied to drug producers or distributors who faced imprisonment it seems that imprisonment could not be justified. I suspect a concern for consistency here gives de Marneffe reason to make drug production and distribution illegal but without attaching harsh prison sentences for offenders. He advocates an environment where drugs are not legal, in order to protect youth against both abuse and their own choices that may cause them to become unmotivated, but recognizes that prison sentences are unjustified as a way to support such a system.

In The Legalization of Drugs the reader gets two interesting arguments. Douglas Husak makes a compelling case against punishing drug users. His position amounts to drug decriminalization with skepticism toward making drug production and sale illegal. On the other side, Peter de Marneffe justifies making drug production and sale illegal based upon the diminishment of future interests of young people. De Marneffe introduces a "burdens principle" which is likely much too strong a commitment to individual interests than could ever be realized in a civil society. In both instances, the reader is treated to arguments that effectively undermine current drug policy. The book provides philosophical argumentation that should stimulate a societal conversation about the justifiability of current drug laws.

Illegal Drugs Research Paper

Illegal drugs and the effects of drug dealing, drug use and drug addiction on families/communities. Drugs are substances that can be inhaled, injected, smoked, consumed, absorbed or dissolved under the tongue. Drugs can cause a temporary physiological change in the body and can often lead to drug addiction . Four common illegal drugs are 1. Cannabis (common names are: Weed, hash, skunk, marijuana) 2. Cocaine (common names are: sniff, white, powder, snow) 3. Heroin (common names are: brown, hatsy, smack, opium) 4. Ecstasy (common names are: mdma, yokes, pingers) Methods of use: • Cannabis:  Smoking- this is the most common and easiest way to take cannabis. Through smoking it gets to the lungs quicker but also is the most damaging to the lungs. …show more content…

The vaporiser heats cannabis above 100 degrees. It caused the cannabis to evaporate into a gas but does not burn any of the plant. It is more effective than smoking.  Food- cannabis can be used in foods, hash cookies are made from cannabis. Visibly there is no difference between regular bakery and those containing drugs. If cannabis bakery is consumed you will notice a fresh grassy smell indicating that cannabis is present.  Drink- cannabis can be put in drinks often alcohol to create a green dragon. It can also be made in tea.  Ingestible oils- these most often come in capsules that can be eaten along with food or drink • Cocaine:  The most common way of taking cocaine is by snorting it through the nose. It can be injected which may be deadly.  The easiest way to take cocaine is rubbing it along your gums with your finger. Rubbing on the gums helps to numb them giving the user a satisfying effect.  Powdered cocaine can be smoked by rolling it on joints. Heroin:  Injecting is the most popular way to take heroin. This only works when the heroin is mixed with water and an acid and is heated. Clothing is tightly wrapped around the arm to present the vein and users then inject the heroin into veins in the arms, it may also be injected in to the …show more content…

Almost 5 million people reported using cocaine at some point in 2015, and nearly million reported use at some point in their life. Approximately 1.75 times more men than women abused cocaine in 2015. Additionally, in 2011, the Drug Abuse Warning Network found that cocaine was the most common illicit substance involved in emergency department visits in 2011, found in more than 40% of cases’. Addiction recovery is based on how bad the addiction level is, often users are sent to rehabilitation centres to undergo

Cocaine In The 1880's

Drug enforcement agencies throughout North America spend over 40 billion tax dollars annually on their government funded war on drugs. The DEA currently classifies cocaine as an addictive and dangerous, schedule-two drug. Around the 1880’s, however, cocaine was celebrated in the United States for its “magical, medicinal purposes” (New Ulm Weekly Review). The miracle medicine of the late 19th century, cocaine, is derived from the coca plant native to South America, more specifically, the Andes Mountains. South Americans chewed the coca leaves for thousands of years to counter the nauseating effects of living in thin mountain-air environments and to stimulate their heart and breathing rates for hunting purposes.

Opioids Research Paper

Opioids come in many forms, both licit and illicit drugs. Licit drugs would be considered pharmaceuticals, since they are prescribed by doctors and usually come in pill forms. Some examples of licit opioids are: OxyContin®, Vicodin®, codeine, morphine, methadone, and fentanyl. The illicit drugs would be heroin and can come in many different forms. Both forms must be consumed with caution due to their addictive nature.

Chapter Fourteen: Social Use, Abuse, And Dependence

These substances are often taken orally, consumed, inhaled, smoked, injected, or inhaled through the nose. Many of the individuals who reside in these types of drugs often affect their whole family. These substance abusers will often try to avoid taking responsibility for their behavior because they have already developed their common defense mechanism.

Opioid Crisis Essay

The opioid crisis in the United States has been a problem since the late 1970’s. The use of cocaine started increasing by the early 80’s. In this time, many considered cocaine to be the drug for the famous. At one point, it was called “the champagne of drugs,” which made people feel like they were living like the rich and the high-line people. All celebrities and famous athletes would take cocaine, therefore, all their fans followed in their footsteps.

Opiate Addiction

Opiate addiction is much different than that of other substances that are abused and can cause addiction. Opiate addiction is a serious problem in our country and will become an even bigger problem in the years ahead. The persistent use of opiates and is thought to be a disorder of the central nervous system. Though opiate painkillers are prescribed by physicians, opiate addiction is an insidious medical disease. But since opiate addiction is far more than a behavior problem, treatment requires more than just therapy.

Opioid: The Use Of Narcotics In America

The use of narcotics in America is on a steady rise, Opioids such as Heroin being the deadliest. It’s categorized as a “Schedule 1,” meaning a high potential for abuse, along with severe psychological and physical dependence. Before the Twentieth Century, Heroin was actually widely available and marketed by Bayer, and Aspirin Company. This deadly substance can be injected, snorted, or smoked.

Cocaine Decline

History: Cocaine is the oldest and most dangerous drug. In ancient times they would chew on coca leaves to get their hearts racing and speed up their breathing. In the 1880s it became popularized and used in the medical field. They used it as a cure to depression and sexual impotence.

Cocaine Effects On Society

The substances most commonly used in this process are sugars, such as lactose and mannitol, and local anesthetics. Some other names for cocaine that people may or may not know are, coke, crack, coca, blow, and powder.

Crack Cocaine Informative Speech

Also cocaine is known as a stimulant drug and it is a schedule II narcotic. Cocaine is also known to be called C, coke, white dust and snow. Cocaine has 2 main forms that it can be used in. The forms that cocaine can be used in are, crack cocaine and cocaine hydrochloride (powder cocaine). Crack cocaine can be known as rock or crack on the streets as well.

History of Drug Abuse and its Effects on the Body

The reason people love the way cocaine feels is because of its feeling of euphoria the increase of energy levels and elevated mood of self esteem. In accordance to drugabuse.com short term side effects of using cocaine are, Paranoia, Dizziness, Muscle twitches, Dilated pupils, High body temperature, loss of sexual appetite. In addition the long term effects of cocaine include rectal functions from eating cocaine, could end up getting HIV from using the same needle again or with another person, Heart attacks, Constant nose bleeds, Strokes and even Seizures. Alternative names used among the streets are, Coke, Toot, Base, Powder, Candy, White, Flake, Basa, Rail, Snow, Bump, Yeyo and the list goes on.

Informative Essay About Marijuana

Marijuana is a drug extracted from Cannabis Sativa (hemp plant). In other words, marijuana is also called cannabis, hemp, and herb; in slang terms it is called weed, hash, joint, blunt, Mary Jane, etc. Marijuana is known to be used for medical as well as recreational purposes. It is a drug which alters the mood of a person, induces calmness and is used by certain medical institutions as a form of pain reliever. It can be consumed by smoking, vaporizing or by mixing it in food items.

How Does Drugs Affect Consciousness

Drugs are substances that trigger temporary changes in the body which may result in such a pleasurable and relaxing effect. Some of the types can slow down the nervous system’s action, while other types can have the exact opposite effect; spurring the nervous system into rapid action. Drugs are connected to cravings or addiction since a person’s body starts yearning for drugs after he or she has taken it for a while. Drugs affect consciousness significantly! They may cause people to hear or see things that aren’t real (hallucinations), experiencing mood swings, or may even distort people’s perceptions.

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Marijuana, also known as Cannabis, is derived from the Cannabis plant and is used commonly for either recreational or medical purposes. Marijuana is composed of chemicals such as tetrahydrocannabinol (HTC, and over eighty cannabinoids. Marijuana is acknowledged for providing smokers with a “high” feeling. Since the twentieth century, this illicit drug has been banned across the world. However, over the past few years studies have been conducted on marijuana and the results show that it can actually be helpful in many different areas of society.

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Marijuana, crack, and cocaine are three of the main drugs that are overused and abused in Venezuela. Three different types of cocaine are being illegally overused: powder cocaine, crack cocaine and basuco, a toxic form of unpurified cocaine. There has been a rise in the amount of youth that have been abusing drugs in the Bolivarian Republic of Venezuela. People have become more interested in drug trafficking in the Bolivarian Republic of Venezuela because Venezuela barely has any money, has terrible law enforcement, and there are many drug traffickers near Venezuela. Sadly, less than 2,000 people out of the 27 million Venezuelans have received drug addiction treatment.

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People tend to try drugs for the first time when they are offered them by someone in their peer group or someone they admire. In addition to trying drugs, people also learn methods to obtain drugs and money to buy

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• Indian J Med Res
• v.149(6); 2019 Jun

Drug misuse in India: Where do we stand & where to go from here?

Ajit avasthi.

Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Abhishek Ghosh

The first International Day against Drug Abuse and Illicit Trafficking was observed by the UN General Assembly on June 26, 1987. Since then, every year, this day marks the coherent and seamless global cooperation to achieve a drug-free society. So far, the UN has organized three international conventions in 1961, 1971 and 1988. The first one sought to eliminate the illicit production and non-medical use of opioids, cannabis and cocaine. The meeting held in 1971 extended the scope to the psychotropic medications or synthetic drugs ( e.g ., amphetamines, barbiturates and LSD). The third convention against illicit trafficking was targeted at the suppression of the illegal global market, and the restriction was also extended to the precursor chemicals 1 , 2 .

During the last five decades, the United Nations has also convened two special sessions to discuss the world drug problems, in 1998 and 2016. In the first session, the UN envisioned to reduce the illicit supply and demand for narcotics and synthetic drugs by 2008. However, the World Drug Reports rather showed an increase in the use of the illicit drugs 3 , 4 . A gross disparity in the access to narcotic drugs (especially opioid analgesics for pain conditions) among various nations across the globe also became apparent 5 . Taking note of the failure on both the fronts - curbing misuse and ensuring access for medicinal and scientific purposes - the UN convened the second special session in 2016. The report has acknowledged that the Sustainable Development Goal (SDG) 3.5 is 'complementary and mutually reinforcing' with the UN's commitment to curbing the world drug problem 6 . In addition, SDG 3.3 has also emphasized on the importance of the treatment of substance use to end the epidemics of HIV and hepatitis. The resolutions of the outcome document are likely to be reviewed this year.

India: The existing three-pronged strategies to address the drug problem

As enshrined in its constitution (Article 47) and being one of the signatories of the United Nation's International Conventions, India had the onus act to eliminate the use of illicit drugs, to develop measures to prevent drug use and to ensure availability of treatment for people with drug use disorders. India has adopted the three-pronged strategies - supply, demand and harm reduction.

Following the 1971's UN Convention on Psychotropic Substances, the Ministry of Health and Family Welfare, Government of India, established an Expert Committee to look into the issue of drug and alcohol use in India. The Committee's report was submitted in 1977, and after approval from the Planning Commission, Drug De-addiction Programme (DDAP) was rolled out in 1985-1986 7 . The primary aim of the DDAP was drug demand reduction. During the same time, India had enacted the Narcotic Drugs and Psychotropic Substances (NDPS) Act in 1985, which was amended thrice, latest in 2014 7 . The primary aim of the NDPS was 'to prevent and combat drug abuse and illicit trafficking', an apparent emphasis on the supply reduction. The consultative committee (an advisory committee formed by the NDPS Act), which was constituted in 1988, formulated a national-level policy to control drug abuse. The committee created a fund, National Fund for Control of Drug Abuse and involved a couple of other major stakeholders - the Ministry of Health (and Family Welfare) and the Ministry of Welfare (currently Social Justice and Empowerment). The Ministry of Health was entrusted with the job of prevention and treatment of drug dependence, whereas the Ministry of Welfare was assigned with the responsibility of the rehabilitation and social integration of people with drug dependence 7 . The Ministry of Health established seven treatment centres during the first phase (in 1988). The aims of these centres were treatment, drafting of educational material and training of medical and paramedical staff to generate the future workforce to deal with the problem of drug abuse. In addition to these centres, under the DDAP, one-time grant was provided to 122 De-Addiction Centres (DACs) of various psychiatry departments of government medical colleges and district hospitals. The Ministry of Welfare funded several non-governmental organizations (NGOs) across the country to establish counselling and DACs with the objectives of awareness building and treatment rehabilitation at the community level and human resource development 8 . The Ministry subsequently identified 10 Regional Resource and Training Centres (RRTCs) to mentor, train and provide technical inputs to various other NGOs 8 . RRTCs work under direct supervision of the National Institute of Social Defence (NISD).

Over the last three decades, there has been a substantial expansion of services in all dimensions. The Ministry of Social Justice and Empowerment published the draft policy of the drug demand reduction, the National Drug Demand Reduction Draft Policy in 2013 9 . To scale up the existing services, the Ministry has rolled out the 'Central Sector Scheme of Assistance for Prevention of Alcoholism and Substance Abuse and Social Defence Services 9 .' The Ministry of Social Justice has also published its five-year plan, 'National Action Plan for Drug Demand Reduction' in 2018 10 . Till date, there are more than four hundred NGOs, spread across the country and are functioning as the Integrated Rehabilitation Centre for Addicts. The DDAP has also extended its scope from the previous DACs to the newly formed Drug Treatment Centres (DTC). These are parts of general hospitals, where a dedicated service with dedicated staff delivers outpatient-based care for substance use disorders, and medications are dispensed free of cost 9 .

The harm reduction dimension was added in 2005 by the provision of low threshold, community-based opioid substitution therapy (OST). It was initially funded by the Department for International Development till 2007 when the Ministry of Health and Family Welfare took over the responsibility. The National AIDS Control Organization (NACO) continued the OST and Needle Syringe Exchange Programmes (NSEPs) under the targeted interventions. Adult HIV incidence has been brought down from 0.41 per cent in 2001 to 0.35 per cent in 2006 to 0.27 per cent in 2011 11 . However, the pace of decline of the new HIV infection was said to have levelled off, and the infection among the people with injection drug use (IDU) was implicated for the same. Under the National AIDS Control Programme-IV, special emphasis was placed on increasing the availability and accessibility of treatment of the people with IDU. The data published in 2012 suggested that there were 150 OST centres and >15,000 people with IDU, registered in those centres 12 . The National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, has built-up a new model of OST service delivery - the GO-NGO model, to scale up the services. Under this model, the psychiatry departments of the government hospitals functioned as OST centres and worked in close collaboration with the NGOs. The NGOs acted as the bridge between the patients with IDU and the OST centres 13 . The latest amendment of the NDPS Act (in 2014) has included methadone as an essential narcotic drug and permitted use of methadone for OST, by licensed users 14 . This amendment has expanded the scope of OST in India.

The Mental Health Care Act (2017) has included alcohol and drug use disorders under its ambit. This measure is likely to increase the adherence to the human rights, to ensure non-discrimination, the respect to the right to autonomy and confidentiality, to increase the availability and access to the minimum standard of care and rehabilitation for people with substance use disorders 15 . The NISD and the RRTCs have formulated a minimum standard of care to be followed by the NGOs, whereas the NDDTC, AIIMS drafted the same for the government DACs 16 , 17 .

Drug abuse in India: Current and future challenges

In the last three decades (following the inception of the NDPS), the Ministry of Social Justice and Empowerment has conducted two nation-wide drug surveys, published in 2004 and 2019 18 , 19 . The results of these surveys suggest that drug use in India continues to grow unabated. Opioid use has increased from 0.7 per cent in the previous report to a little >2 per cent in the present one - in terms of magnitude from two million to more than 22 million. More disturbingly, heroin has replaced the natural opioids (opium and poppy husk) as the most commonly abused opioids. A large scale epidemiological study from Punjab also concurred with this finding 20 . The uses of other synthetic drugs and cocaine have also increased significantly. The survey results suggest a need to strengthen our existing system, to have a more concerted effort and a need to fix the loopholes. In the years to come, the government might like to concentrate on the following:

• ( i ) The National Mental Health Survey (2015-2016) showed a treatment gap of >70 per cent for drug use disorders 21 . The recent nation-wide survey on substance use disorders has replicated the result, with nearly 75 per cent treatment gap for drug use disorders. Added to that misery, merely five per cent of people with illicit drug use disorders received inpatient care 19 . This large treatment gap indicates poor accessibility, utilization and quality of health care. To meet this unmet need, one should expand the treatment and rehabilitation facilities for substance use disorders. The DTC scheme by the Ministry of Health and Family Welfare could be the starting point, but it is not enough. At present, the scheme is implemented by the NDDTC, AIIMS. Other centres may also be involved. As drug demand reduction falls under the direct purview of both the ministries of Health as well as Social Justice, a coordinated and concerted effort is required to fill the treatment gap with a minimum standard of care. Nation-wide drug surveys are to be conducted on regular intervals to discover the undercurrents of substance use in India and to encourage the government to make informed decisions.
• ( ii ) The harm reduction arm of the three-pronged approach needs to be strengthened further. Despite the progress made by the NACO and the GO-NGO model, the coverage of the OST among the IDUs is only seven per cent 12 . It calls for the scaling up of the OST, safely and effectively 22 . The NDPS policy prohibits the NSEP, whereas it is one of the cornerstones of harm reduction, practiced by the NACO. The NDPS policy also advocates a time-limited OST, which does not have any scientific evidence base and might cause more harm (than good). Recovery-oriented OST could potentially replace this time-limited OST policy 23 . These discrepancies and loopholes in the policies need to be fixed.
• ( iii ) Current and future challenges in the supply reduction arm lie in the early detection and scheduling of the new psychoactive substances. The recently published report of the International Narcotic Control Board (INCB) revealed India's threat to mephedrone and captagon (a derivative of amphetamine and theophylline) 24 . The Report also discussed the country's potential problem with the precursor chemicals. Moreover, it has noted with caution the rapid proliferation of internet-based pharmacies and bitcoin-based transactions for the illicit drug use in India 24 . Misuse of the over-the-counter medications with definite ( e.g ., benzodiazepines, tramadol and codeine) or with possible addictive potential ( e.g ., pregabalin) is another concern, voiced by the international forum.

In summary, India has taken early and decisive steps to address drug problems. Though the government has an over-encompassing blueprint, committed workforce and several dedicated programmes and policies at its disposal, there is a need to improve the current programmes (to address the unmet needs), to have a coordinated effort between Ministries, incurring uniformity at the policy level, to make scientifically informed choices and to strengthen the supply reduction chains.

Conflicts of Interest : None.