(from Mosher and Akins, Drugs and Drug Policy: The Control of Consciousness Alteration, Sage Publications, 2007, pages 171-200.

Age

• Typically highest during late adolescence
• Drinking peaks: 21 (also binge and heavy use)
  • Alcohol used for ASC (not simple sociability)
  • Performance-enhancing drugs
  • "Pharming"
    • Rapid increase in recent years
    • Ritalin, Adderall, DXM, prescription pain pills
    • Perception of "difference" from illegal drugs, "safer,"
    • Parallels high levels of prescription use--including to adolescents

The Elderly

• Perhaps 17% of those over 60 "addicted" to alcohol and prescription psychoactives
• 2-3 times more likely to be prescribed drugs
  • Frequent dosing--added problems
  • Leads to: confusion, falls, toxicity
  • Alcohol use difficult to chart, yet rates of problem use appear high.
  • Minimization--other problems
  • Factors--similar to adolescents, and stressors associated with aging.

Gender

• Use (and problematic use) more likely among males
• Gap varies by drug and age
  • Adolescents: drinking versus binge/heavy drinking--true for adults, too
  • Performance-enhancing drug (males)
  • Diet-pills and "fat-burners" (females)
  • Cultural factors
  • Tobacco--similar use patterns, especially recently
  • Females--more likely to use/over-use prescription medication (gender norms--women/mothers not "on the streets")
  • Women more likely to seek treatment, especially for mood disorders
  • Men, self-medicate

Race/Ethnicity

• Similar to illegal drugs--misperception of overuse by minorities
• Alcohol: Whites and Native Americans--high levels of use throughout the life-course
  • White adults higher rates, NA adolescents higher.
  • NA adults high levels of binge/heavy drinking, but also abstinence
  • Tobacco: far higher among Native American youth (almost twice), also high for adults (nearly 50%)
  • Most focus on alcohol
  • Acculturation, SES stress, and minority status
  • See, illegal use patterns
• African-Americans
  • Youth--low levels (compared to whites and NA)
  • Adults--similar to whites. As age increases, problematic drinking for African-Americans increases
  • High levels of abstinence, yet consequences of drinking more severe--issues:
    • SES
    • Family disruption
    • Social isolation
    • Unemployment
    • Limited access to health care
    • Hyperavailability
    • Segregation and concentrated poverty
    • Alcohol outlets and advertising
  • Yet, parental vigilance over youth and negative attitudes towards drinking and drunkenness
• Hispanics
  • Moderate levels of use throughout the life-course
  • variation across groups
  • Disproportionate exposure (similar to blacks)--leads to higher rates of problems
  • Protective factors (compared to blacks)
    • employment
    • marriage
    • less isolation
    • Females drink less
• Mexican-Americans males binge/heavy drinking rates high
  • High rates of problems
  • "Fiesta Drinking" (high rates of abstaining, yet high binging)
• Acculturation: most recent groups (South Americans, Cubans)--more likely to drink and smoke
• Traditional norms discourage heavy use, but "machismo" may encourage binge drinking, i.e. drink less frequently, but when drinking they consume a lot.
• Native Americans
  • Display highest patterns of legal drug use
  • Genetics? (alcohol)
  • Social/economic disadvantage
  • Culture (destruction of traditional culture--issue of drunken comportment)
• Asians and Pacific Islanders
  • Lowest levels of use
  • Importance of family
  • Focus on education
  • Affluent and employed
  • Yet--diverse
  • Pacific Islanders and Native Hawaiians: similar to American Indians
  • Asians--recent immigrants--heavy use. Increased availability? Also, high rates of tobacco use

Social Class

• Rates of use of many legal drugs (especially alcohol) highest in middle to upper class
• Race/ethnic differences (SES little impact on whites, minorities more adverse effects due to poverty)
• Tobacco use higher in lower/working class youth
• Prescription pharmaceuticals--varies by type
• Alcohol use and education--varies by age--high among young students, lower among older graduates (employment?)
  • "Hyperavailability" on college campuses
  • Yet, availability of resources to mediate effects of consumption (compare to poor neighborhoods, consequences limited for college youth)
  • Hagan's "party subculture."
  • Participation results in lower educational attainment
  • Controlling for educational attainment, party subculture results in positive occupational outcomes for middle/upper class and lower outcomes for working class youth. Issue: consequences of heavy use varies by class.

Urban/Rural

• Small cities and rural areas--higher rates of binge drinking, heavy alcohol use, tobacco use, inhalants,and illicit pharmaceutical use
• Boredom and recreational opportunities
• Although legal/illegal drug use patterns are similar across other correlates, urban/rural correlate displays dissimilarity
  • Limited interest in illegal drugs (no "critical mass")
  • Negative attitudes
  • Disapproval of use of illegal drugs, yet less likely to disapprove of problematic use of legal drugs: type of drug rather than level of use as key factor.

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