Besides accepted
medical use, instrumental use of other legal drugs: Nicotine==> Stay
awake while studying.
OTC (Over-The Counter)
Prescription
- Ethical/Legend
(establish in 1938)
- Advertised
only to doctors until 1997 when congress approved direct to consumer
advertising.
- 2009:
FDA and Congress cutting back on drug advertising
- "In
a recent IMS survey on direct-to-consumer advertising, 29% of
physicians said they received specific requests from patients
for Claritin, making it by far the most frequently requested brand-name
product," noted Paul Allen, Vice President, Product Management
at IMS. "Overall, Schering spent $18.5 million in the first
half of 1997 alone on TV ads. However, they were outspent by Merck,
Novartis, Glaxo Wellcome, and Pfizer. Now that companies can communicate
brand and indication in the same TV ad, we expect the industry's
investment in this type of marketing to double."
(Pharmacy Times, 1999)
"Advertisements
on TV or in magazines have made some people aware of conditions
they didn’t realize they had, or of new treatments for conditions
that they were aware of. In certain cases, DTC ads have made
patients aware that they are not alone in suffering from various
conditions, and that help is available." (Pharmacy Times,
2001)
- Shopping
for Drugs: http://www.ncpa.org/pub/st/st262/
- Prescription
Status set by Pharmaceutical Industry until 1951.
- Legitimate
for medical purposes
- Prescribed
by licensed Physician (300,000)
- Sold
by licensed Pharmacy (150,000 pharmacists; 60,000 pharmacies)
- MAJOR
SOURCE OF
- Over
$145,092,763,000 per year in sales
(2000); $124,835,595,000 (1999)
(Pharmacy Times) (around $95 Billion in 1997)
- 1,563,974,000
New Prescriptions in 2000.
- 2.98
billion total prescriptions in 2000, 2.8 billion in 1999, 2.5 billion
in 1997, 2.4 billion in 1996, 1.5 billion in 1990 (Pharmacy Times,
1999 and Pharmacy
Times, 2001)
- 1
in 7 are psychoactive
(approximately).
- 2007:
Spending
on Psychotherapeutic Drugs Soars
- Sales
top $300
billion in 2010 (local
copy)

Use
and Distribution of Prescription Drugs
- Main
Point: Following the Dramatic Decline in psychoactive drugs being prescribed through the late
1980s, there has been a notable increase in prescriptions (including
psychoactive drugs) during the past decade.
- Prozac
may be
the drug that ignited this turn-around?
-
Top 200 Drugs by prescriptions dispensed (scroll to bottom of
list for previous years' data) (see also: Mosby
for 2002)
- Top
200 Drugs by sales
Researching, Developing,
Testing, and Marketing a new drug
Valium
- Mid
1960's==> #1: $250 million/year
- 1975
was its best year==> 61.3 million prescriptions
- 1980
only 33.6, yet still best seller
- Patent
expired 1980, falls to #3, then #4 in 1983
- 1984
three companies market generic diazepam
- 1986--
Valium is #11; 1990 #47
- Now,
sales of generic versions of diazepam no longer in top 200, and
even Alprazolam (Xanax) appears to be slipping.
As of
1990 sales of all generics account for one-third of the market
We're talking BIG BUCKS here!
- The
role of advertising in the health industry has been critiqued by a
number of commentators
- $1000's
are spent per physician, millions more on direct-to-consumer ads today:
"As DTC ads become more and more common, we may see future increases
in prescriptions for products for depression, allergies, arthritis,
and gastrointestinal problems. (Pharmacy Times, 2001)
- Concern
is that the drive for profits by pharmaceutical companies, leads to
the over prescribing of psychoactive medicine as doctors are inundated
with information on the "wonders" of these drugs (and demands
for certain drugs by their patients).
Interestingly,
from the early 1970's through the mid 1980's, prescriptions for:
- Barbiturates
dropped by 90%
- Amphetamines
dropped by 60%
- Methaqualone
(which skyrocketed from 1976-1986) fell to NO
prescriptions
What's Going on
Here??
"Pharmacological
Revolutions"
(Oakley Ray, Erich
Goode, and Keel)
- Vaccines:
Polio, Smallpox==> Medicines as powerful and beneficial
- Antibiotics
(1940's)==> Faith in drugs as cures
- Anti-psychotics==>
Acceptance of drug's impact on the mind
- Oral
Contraceptives==> Use drugs on healthy body in order to
gain control
- Decline
in the use of psychoactive drugs, overall, by a factor of 50%==>
"We can get along without them." (Goode)
One
notable exception to overall trend in Psycho-Pharmaceuticals during
the 1980s: Prozac. (And, perhaps, the herald of a "new age")
- Hit
the market in 1987
- Quickly
takes #1 spot: 1 million prescriptions/month
- 1988-89
prescribing up X3
- 1989-1990
up another 60%
- Now???
Horror Stories, but major legal struggle by Eli Lilly to defend
the drug. Current status: warnings but no official action.
- Currently
(2001) 23rd drug in sales (beat by both Zoloft and Paxil) and
SSRIs rank 3rd for number of prescriptions written, and 2nd for
sales.
- And,
over the last two decades: Ambien, Lunestra, Strattera, Viagra....SO:
This (#5) appears
to have been a short-lived revolution. Now maybe beginning of #6- "Better
Living Through Chemistry: Part 2"
"Although
only one antidepressant (Zoloft) made it to the top 10 of total prescriptions,
on the money side, manufacturers of such medications had nothing to be
depressed about. Two of the top grossing drugs in 2000 were antidepressants—Lilly’s
Prozac and Pfizer’s Zoloft. Also among the top 10 earners was the antipsychotic
drug Zyprexa. And coming in at number eleven was the antianxiety agent,
Paxil. The SSRI category ranked third in the top 20 categories ranked
by total prescriptions dispensed, third in new prescriptions dispensed,
and second in total dollar sales. Dollar sales for the SSRI/SNRI category
rose 19% from 1999 to reach a huge $8.33 billion."
(Pharmacy Times, 2001) (BTW:
These revolutions are significantly related to illicit use, too.)
Problem:
As we enforce tighter controls on one drug, others, sometimes older
and more problematic drugs, other times new "replacements"
drugs, increase in use and problems increase. 1989 NY law on benzodiazepines
(which were created to replace the more problematic barbiturates) and
other similar "minor" depressants, led to significant increases
in the use of more problematic depressants, including barbiturates.
And, Prozac, created to (at least partially) replace the benzodiazepines,
seems to have its own problems.
:
If a drug is psychoactive, it rarely remains purely instrumental
- Heroin,
Cocaine all original used medically, even OTC
- Heroin:
Pain==> Britain
- Amphetamines:
Inhalers
- Marijuana:
Glaucoma, AIDS, Chemotherapy
- U.S.
stopped marijuana use for medical purposes: 1985 (Marinol), supported
by DEA in 1992
- Cited immune
system problems
- AIDS patient:
"Decision made by a bunch of Bozos"
- Now:
Legal for medicinal use in 16
states 10/2011.
Federal: illegal--Schedule I.
- U.S.
view==> if we allow these drugs to be used legitimately, there
would be more abuse
- Physicians
often hesitate to use even strong doses of morphine to relieve the
pain of terminally ill cancer patients: "Problem of addiction"
:
Definition of legal/illegal; instrumental/recreational SHIFTS (Relativity)

- $1.23
billion in sales to children
- $52
million in Federal taxes
- Office
of Smoking and Health Budget: $3.5 million
- Children
cultivated as lifelong/permanent market
- But:
Now Federal Government is debating defining nicotine as addictive
and is seeking to regulate advertising,
promotions, and sales.
- 2006
Update on tobacco sales to youth
- Not
identical to illegal recreational, but close
- Pleasure
is not an either/or proposition, but a continuum
- Cigarette smoking and health events, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. "Achievements in Public Health, 1900-1999: Tobacco Use -- United States, 1900-1999." 1999.
Tobacco:
$80.3
Billion in sales for 2002, Globally: http://www.princeton.edu/~ina/infographics/smoking.html
1994:
Smoking: Stable. 1995=>1999 significant increases for Teenagers. 2002-2007,
overall decline led by decline in teen use.
| Americans
12 and up |
1991 |
2001 |
2002 |
| Smoke
tobacco (past month) |
27% |
29.5% |
30.4 |
| Smokeless
tobacco |
3.4% |
3.2% |
3.3% |
| Cigars |
|
5.4%
(6.9% 1998) |
5.4% |
Past
Month Tobacco Use among Persons Aged 12 or Older: 2002-2010 (Latest
NSDUH)(2011 NSDUH; tables)

Past Month Tobacco
Use among Youths Aged 12 to 17: 2002-2010 (Latest
NSDUH)(2011 NSDUH; tables)

- Smokers 4 times more likely to be heavy users
of ETOH and illicit drugs
- Rate
of use of alcohol and nicotine (except among the young) is
declining, except for Caffeine (most popular)
- Nicotine
alone is used by more people than all illicit drugs combined
- Nicotine
is used most frequently by those who use drug
- Current
MTF Data (MTF: Cigarettes: Trends in 30-Day Use, Risk, Disapproval, and Availability in Grades 8, 10, and 12
- Current
National Survey on Drug Use & Health (2011 NSDUH; tables)
Alcohol:
- Recent
Alcohol Industry Statistics
- Historical
Data:
| Americans
12 and up |
1991 |
2001 |
2002 |
2010 |
| Ever
tried ETOH |
85% |
81.7% |
83% |
82.5% |
| Used
ETOH past month |
52%/21%
teens |
48.3%/teen
use stable |
51% |
51.8% |
| Binge
Drinkers |
-- |
20.5%
(15.7% 1998) |
22.9% |
23.1% |
| Heavy
Drinkers (binge 5x/month) |
-- |
5.7%
(5.9% 1998) |
6.7% |
6.7% |
Current,
Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age:
2010 (Latest
NSDUH)(2011 NSDUH; tables)


Correlates
of Use of Legal Drugs
(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
drug
- "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%)
Within
and Between Group Patterns
African-Americans
- Youth--low
levels
- 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 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 student, 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.

- Socially
Approved Purpose
- User's
self-image==> NOT "drug" user; Don't seek "High,"
"technically illegal- but not criminal or deviant"
- Viewed
similar to OTC use
- Public
Opinion: Goal is OK, means--problematic, but not "as" deviant
as illegal recreational
Sources
- Diversion
of legally manufactured pharmaceuticals
- "Script"
doctors
- Illicit
manufacture
- Smuggling
- Element
of and often focal point of subculture
- Link
to roles and status and expectations from dominant culture
- Masculinity
- Perfect
Body
- Sex
appeal
- Success
- Winning
is everything

- Big
Bucks here: U.S.- consume 60% of world's output
- Internationally,
spend more on illicit drugs than any other product or service ($1/2
trillion) (accuracy?)
- U.S.
sales (DEA est.) $80 billion in 1980; $30-130 billion is the typical
range
- U.S.
News and World Report-- $100 billion
- Whatever:
HUGE DEMAND
- Statistics
are difficult, no records kept of the sales
- Drug
Use in Europe: The
European Monitoring Centre for Drugs and Drug Addiction
Newsbrief:
UN Reports Drug Use on the Rise Worldwide
http://www.stopthedrugwar.org/chronicle/243/worldofdrugs.shtml
"The United
Nations Drug Control Programme has released its annual report, showing
an increase in global drug consumption. According to the report, 185
million people now use illicit drugs. 147 million of these are cannabis
(marijuana) users, but the increase of global consumption is primarily
due to increased use of ecstasy and amphetamines.
Worldwide, cannabis
use is most popular among individuals ages 18 to 20, and other drugs
are most popular among those aged 18 to 25. Almost half of all 10th
graders in the United States have used drugs, the report says, though
the rate has fallen somewhat since last year. No other country in
the world was reported to have a rate nearly that high, despite the
massive US drug war effort."
2005 World
Drug Report (from the executive
summary):
"Some 200
million people, or 5% of the world’s population age 15-64, have used
drugs at least once in the last 12 months. This is 15 million people
higher than last year’s estimate but remains significantly lower than
the number of persons using licit psychoactive substances (about 30%
of the general adult population use tobacco and about half use alcohol).
The number of cannabis users worldwide is now close to 160 million
people or 4% of the population age 15-64. Estimates of the number
of ATS users - 26 million people using amphetamines and 8 million
using ecstasy - are slightly lower than those of last year’s World
Drug Report (WDR), reflecting declines of methamphetamine use in South-East
Asia (notably Thailand) and of ecstasy use in North America (notably
in the USA). The number of opiate users is estimated to have risen
slightly to around 16 million people (11 million of which abuse heroin),
mainly reflecting increasing levels of opiate abuse in Asia. No significant
changes were observed in most other parts of the world. The number
of cocaine users – close to 14 million people – rose slightly.
Unsurprisingly,
the main problem drugs at the global level continue to be the opiates
(notably heroin) followed by cocaine. For most of Europe and Asia,
opiates continued to be the main problem drug, accounting for 62%
of all treatment demand in 2003. In South-America, drug related treatment
demand continued to be mainly linked to the abuse of cocaine (59%
of all treatment demand). In Africa, the bulk of all treatment demand
– as in the past – is linked to cannabis (64%)."
World
Drug Report: 2008 (Transnational
Institute Response)
Major
Domestic surveys:
- NIDA
supported Institute for Social Research, "Monitoring the Future
survey of High School Students and Young Adults (since 1975)
- SAMHSA
supported "National Survey on Drug Use & Health "
(NSDUH) (Formerly called the National Household Survey) (since early
1970's) (2011 NSDUH; tables)
- DAWN
Report (since mid 1970's) (see below)
- ADAM:
Arrestee
Drug Abuse Monitoring Program. Now, ADAM II since 2007 (2010 Report)
- Pulse
Check: January
2004 (local
copy) St. Louis 2004 (local
copy) January
2002 Report (local
copy) seems to have lost funding. 2004 was last year available)
- Complete
listing of federal data sources
Other sources

MTF
(ISR) Focus:
- Use:
Lifetime, Annual, 30 day, Daily (20/30)
- Attitudes
- Follow-up:
Young Adults
- Good
on trends: How extensive, Use increasing or decreasing
SAMSHA
National Survey on Drug Use & Health (2011 NSDUH; tables)
- Pre
1990: 12-17, 18-25, over 26 years of age
- Now
26-34, and over 35 years of age
- No
figures of daily use
- No
military, prisons, or homeless

General Findings
(NSDUH 2010)
- ETOH
and Nicotine extensively used-- Legal, Available, long cultural history
- About
47% (over 100 million people) have tried illicit drugs
- 15.1%
used past year (12.6% 2001 NHS)
- 8.9%
past month (7.1% 2001)
- ~3-4%
are "frequent users (51 or more days over past year)
- Over
two-thirds of illicit use is Marijuana (used by 75% of past month
illicit users, 57% only use marijuana): 41.5% lifetime use, 11.3%
past year, 6.9% past month.
- Current
NHDUH (2011 NSDUH; tables)
- 2006
Press Release: teen use down (for third year, baby-boomer use
up)
- Cocaine,
Hallucinogens, and non-medical use of pain relievers "tie"
for the #2 spot.
- Cocaine:
14.7%, Hallucinogens: 14.4% and pain relievers: 13.3% lifetime
(cocaine up compared to 2007)
- Cocaine
- 2.1%
past year (2% occassional 1997 NHS)
- .7% past
month (.9% 1998 NHS) this is also the same as for frequent
use,
- .1% are
past month crack users (.7% 1997--ongoing decline over past
couple of years)
- Hallucinogen
use is "high" too--14.4% report lifetime use, 1.5% past
year, and .4% past month
- 4% have used
other drugs illicitly in the past year. 1% in past month
- Figures on
heroin too small for accuracy
Past Month
Use 2002-2010 for various illicit drugs.
2010 NHSDUH General
Findings: (Latest
NSDUH)(2011 NSDUH; tables)
Past
Month Use of Selected Illicit Drugs among Persons Aged 12 or Older:
2002-2010 (Latest
NSDUH)(2011 NSDUH; tables)

Past
Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2008-2010
(Latest NSDUH)(2011 NSDUH; tables)

Past
Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2010 (Latest
NSDUH)(2011 NSDUH; tables)

Past Month Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2010 (Latest
NSDUH)(2011 NSDUH; tables)
High School
Seniors (3/4 of users of illicit drugs)
Current
MTF Data (MTF
2009 Overview)
Marijuana (8th-12th)
#1:
Vicodin
(8th-12th) #2
Stimulant (amphetamines)
(8th-12th) #3:
Tranquilizers,
Cough Syrup, and Oxycotin--#4-#6
Cocaine (8th-12th)
#7:
Relative to
other Illicit drugs, Marijuana Use is in a class by itself!

- Some
try, then stop
- Some
use infrequently
-
Others:
Loyalty
- Highest in
user loyalty: Alcohol and Cigarettes
- 60% of
those who have ever used ETOH, used in past 30 days
- 40% of
those who have ever used Nicotine, used in past 30 days
- Crack
was at about 25% of ever used, used past 30 days(1990)-- but this
ratio has fallen in recent years. Today Cocaine: 8% "loyalty
rate," and Stimulants: 9%
- 15%
of population who have ever used and 34% of HS Seniors who have
tried Marijuana, still using--Marijuana ranks highest in contnuance
of all illicit drugs.
- 2001:
53.9% of HS Seniors have used Marijuana
Drugs
most likely to be given up:
- Heroin
- LSD/Hallucinogens
Higher
rate of "user loyalty" for high school students has to do
with their age and the recency of initial use: We tend to see that
as a population ages, many "mature out" of their drug use.

- No
surveys pre- 1970
- "Retrospective
estimates" indicate Marijuana, Cocaine and Hallucinogens were
the most popular drugs.
- 1960
estimate: 6% had ever used marijuana (18-25 year olds)
- Use
rose gradually throughout the 1960's
- 1967:
15% had tried marijuana
- 1967-1972:
Dramatic increase, by 1972 (1st household survey) 48% had tried
marijuana
- Same
pattern holds for other drugs (at correspondingly lower levels)
- "Summer
of Love"-- 1967/68 largely a localized phenomenon
- Peak
of use: 1979-1982(some disagreement here based on sampling
differences of surveys and specific drug in question.
- 1980-early
1990's: Steady and dramatic decline for just about all drugs (some
exceptions and irregularities)
- Even
Alcohol and Nicotine use was down (contrary to belief that their
use would increase as illicit use declined)
- At
worse use of Alcohol has been stable, but with decline in many age
groups
- Illicit
use: Way down until 1990/91 (except for stability of "lifetime
use")
- Exception:
Interesting Stability of LSD Use, also increases
- 1998-2002:
RISE IN REPORTED USE, growth in regular, frequent use of cocaine
(peaks in 1999), perceived rise in binge drinking among young adults
(40-45% of college population)
- 1997-1998:
Stabilizing? Downward trend beginning? Or, Lull before the
storm?
- 1998-2001:
Modest increases in many drug categories
- 2001-2002:
Slight decreases in most use--especially alchol and tobacco. Even
ecstasy use is down slightly from peak in 2001 (9.2% seniors/lifetime).
Also, modest increases in stimulant use (cocaine and methamphetamine).
Also, slight increases in heroin use--yet these findings could be
insignificant year-to-year variations.
- 2002-2006:
Stabilization and or significant decrease in use--especially cigarettes.
- 2008:
Tobacco use stabilizing
- 2010:
Illicit use up, concern over prescription pain relievers, tobacco
use dropping. (Latest
NSDUH)(Latest MTF)
- 2012: Tobacco use down, especially among the young

Correlates
of Use of Illicit Recreational Drugs
(from Mosher and Akins, Drugs and Drug
Policy: The Control of Consciousness Alteration, Sage Publications,
2007, pages 147-169.
Age
- Use
increases rapidly during adolescence
- Independence
- Lack
of responsibility
- Boredom
- Peaks--18-21
- Same
issues for young adults
- Positive
functions of limited experimentation
- Peer
bonding
- Independence
- Identity
experimentation
- Young
less likely to experience serious health problems compared to older
adult users
- Resurgence
of use among older adults
- Mainly
alcohol and prescription drugs
- Retirement,
free-time, and lack of commitments
- Issue--aging
baby-boomers: 65 million
Gender
- Boys
experiment early
- Late
adolescence--similar rates
- Adulthood--males
higher rates
- Social
stigma for female users
- Women
view use as more risky and are less tolerant
- Societal
institutions reinforce norms of gender difference
- "Traditional
female role" and motherhood
- Males
use in more problematic ways
- Women
more likely to use prescription drugs: more likely to visit physicians
Race/Ethnicity
- Low
levels of use among minorities--especially African-Americans. "Asians"
lowest levels.
- Issue
of under-reporting: drop-outs and school-based surveys, yet differences
apparent at 8th grade prior to drop-outs
- Though
overall use low in comparison to Whites, problems in minority communities
are higher
- "Two
worlds," large population practicing temperance and small,
heavy using
- Hyperavailability:
legal and illegal
- Easy
to obtain
- Visible
sales
- Visible
users (drunk and high)
- Negative
and positive effects
- African-American
adolescents and parental influence (vs. peer): another deterrent
- African-American
Adults--use rates similar too Whites
- SES:
$25,000 and above--similarities; $7,500: 5 times
- Educational
levels same relationship
- "Truly
Disadvantaged"
- Inner-city
isolation
- Under-class
- Lack
of supporting institutions
- Hispanics
- Similar
to Whites, but...
- Diversity
- Residence:
exposure factor--even rural area Rio Arriba County (NM)--highest
drug mortality rates
- Puerto
Ricans versus other groups: Acculturation
- Traditional
norms--protect against illegal (even legal, re: Mexico)
- American
Indians
- Again
diversity, highest levels of use
- Extreme
social and economic disadvantage
- Unemployment
- Limited
health care access--self-medication, no rehab
- Asian
and Pacific Islanders
- Diversity
- Model
Minority Myth
- Overall,
lowest rates of use
- Acculturation
factor: Pacific Islanders--most likely to use
- Others--illiterate
and poor (South East Asia)
- Linguistic
(and social) isolation
- Traditional
value system--traditional norms of use
Social
Class
- Important,
but not "determining
- Lower
class NOT more likely to use
- Adults:
high levels of education--high levels of use
- Poverty
(poor similar to wealthy, BUT "Extreme Poverty" (200% below
poverty line)
- Relevant
for minorities versus whites
- Exposure
to numerous sources of disadvantage
Urban/Rural
- Urban:
access, exposure.
- Rural:
high levels of legal drug use (alcohol and tobacco)
- Prominent
role of family and church
- Yet,
Arriba County and Methamphetamine in midwest
- Fewer
resources
- Cultural
traditions resist seeking help

Three General
Areas of Concern
- Considered
Harmful
- Disapproval
of Use
- Availability
- Support
Criminalization
Between
1979 and 1990 the rate of disapproval on all three of these items
DOUBLED for Marijuana and Cocaine, and increased or remained stable
for other drugs. Since 1992, disapproval rankings dropped then rose slightly for cannabis, leveled off 2005-2008 and have dropped in 2009 and 2010. Disapproval of cocaine use has been rather stable throughout the past decade.
| |
Disapprove
of cannabis use (12th) |
Support
Criminalization |
1975 |
47.0% |
28% |
1979 |
34.2% |
28% |
1990 |
67.8% |
52% |
2001 |
49.1% |
? |
2010 |
51.6% |
? |
Long-term
Patterns through 2012
Generally, Throughout
the period 1979-1990:
- Opposition
towards "Hard" drugs remained strong
- Opposition
towards legal drugs remained weak, with a growing awareness of their
risks.
- Opposition
to Marijuana grew dramatically
As
of 1990 most High School Seniors disapproved of illicit drug use,
view it as harmful and feel the use of such substances should be criminalized.
BUT,
most still felt that experimentation is OK and relatively safe
1991-1996:
Strong reversal taking place
Generational Forgetting??
- No
experience
- No
subculture to inform
- Problems
of use vague: not only are the use of drugs such as marijuana increasing;
but LSD, Inhalants, and heroin use are remaining stable, perhaps
even increasing (sampling problems)
1996
Analysis: Link to Control/Social Bonding Theory
This Millenium??

- Drug
Abuse Warning Network
- Charting
medical problems associated with drugs
- Emergency
room episodes (ER) (drug-related reactions, including OD's) (As
reported by PATIENT)
- Medical
Examiner Reports (ME) (If drugs are thought by examiner to have
been a factor in the patients death)
- Alcohol
only included when in combination with other, illegal drugs for
adults 21 years of age and older.
- Pre
1990, survey of 27 metro areas, now complex nation wide sample
- Influences
and distortions:
- changing purity:
# of users constant, but OD's increase
- variations
in availability: dosage and frequency of use
- drug mixing
and adulterants (is all that matters known to or reported by patient?)
- Route of administration
- no reporting
of Chronic complications, only Acute
- one person,
multiple admissions
- problem of
drugs as an indirect cause of death- not included
- Some drugs
show up, esp. In suicides, not because the are dangerous or unsafe,
but because they are available
- Aging user
population: older, chronic users, tend to die more, have more problems
(the Graying of the Flower Children)
- Illegality
and unstandardized doses: more problems
Laboratory
Analysis of DAWN Reports:
- Only
20% of cases were the drugs reported actually ingested
- 10%
significant differences
- 70%
incomplete listing
- Lots
of multiple drug use
Abuse
potential==> Number of problems/number of total users. Dawn is
risky, but drugs that show up frequently and consistently==> probably
a problem.
SO:
- Cocaine
is a big problem: 20-25% ER; 40% ME (slight drop in '89-'90, but
holding as 1 of top 2 illegal drugs now)
- 1995
27% of all admissions were related to cocaine (little change in
1996 report)
- Heroin/narcotics:
continuing to increase. 1 of 6 ER; 60% ME. This is significant
since less than 1% of population has ever used vs. 10% for cocaine.
- 1993:
Highest level ever for Heroin. Upswing continuing
- 1990-1995:
Mentions for Heroin doubled
- 1994-1995:
Admissions for Heroin up 19%
- Alcohol,
although only reported with other drugs: 30% ER; 33% ME. Signs of
a drop in 1990, but for 1995 still frequently mentioned.
- Decline
that Goode notes for 1989-1990 (12% drop in ER, 20% drop in ME)
appears to have been non-significant.
- 1991-2001
continual yearly increases.
- DEA
Statistics on ER admissions, http://www.usdoj.gov/dea/statistics.html#cocaine
Explanations:
- Perhaps
drug marketing wars-- purity levels of heroin going up.
- Perhaps
aging cocaine population: frequent, heavy users experiencing more
problems.
- Trend
of increased use

General
Trends and Patterns
- Cigarettes:
Use has been down, but trend flattened in early 90's and rose through
the latter 1990s, now very siginificant declines from peak in 1999.
- General
use of Alcohol fluctuated throughout the 1990s, and daily use and
"Binge" drinking (5 or more drinks in a row within the past
two weeks) increased (40% of college age youth). However, this trend
appears to have plateaued, too. Significant declines (2001-2002) for
high school students.
- LSD
use has been relatively stable. Recent (1995) surveys showing significant
increases at younger age levels. Annual and lifetime prevalence was
up, but now appears to be declining, too. Surge in MDMA use seems
to have peaked and shows decline (2003).
- Heroin
use, although difficult to chart, is apparently on the upswing (increasing
purity and availability). Also, frequent, regular use of cocaine appears
to stabilized- perhaps increasing at younger age levels
- Marijuana
use increased rather dramatically among the younger age levels (49%
HS Seniors report lifetime use, 37% past year, 22.4% past month, 5.8%
daily), stablizing in 2002-2007, but trending upward 2008-2011.


URL: http://www.umsl.edu/~keelr/180/trends.html
Owner: Robert O. Keel rok@umsl.edu
References
and Credits for this Page of Notes
Last Updated:
Tuesday, March 5, 2013 11:59 AM
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