The Epidemiology of Multiple Drug Use

How much multiple drug use is there? What proportion of the population at any one point in time is using/abusing multiple substances? Has use of multiple substances become more normative in the recent past as opposed to exclusive use of a favorite drug? What are the principal consequences of multiple drug use? Do these consequences differ according to pharmacological parameters for interactive potential or are there other parameters of almost equal predictive value? To what extent are the consequences attributed to single drugs (traffic accidents labeled as alcohol related) really the result of impaired judgment and performance from ingestion of multiple substances? These are just a few of the questions that need to be addressed within the scientific and public policy communities. In the following section some epidemiological data pertinent to understanding the “extent” of multiple drug use are presented. Monitoring-the-Future Studies Each year since 1975, researchers at the Institute for Social Research at the University of Michigan have administered questionnaires to about 17,000 high school seniors attending schools randomly chosen to be representative of all high schools in the continental United States. These Read more […]

Measuring the Developmental Nature of Multiple Drug Use

There have been a number of studies in which attempts have been made to measure or assess multiple drug use. Some of these are from general populations while others are focused on specific subpopulations of users. The studies are grouped more on the basis of the approach taken to assessing multiple drug use than on the patterns uncovered. There are at least four different groupings of studies and some studies fit into more than one grouping. Developmental Patterns of Onset of Use One of the most influential attempts to describe patterns of multiple drug use is the “stages of drug use” model developed by Kandel. Kandel posited that persons proceed from licit to illicit drugs and from use of less to more serious drugs. The stages of drug use involvement that she identified were: (1) no use of any drugs; (2) use of beer or wine; (3) use of cigarettes and/or hard liquor; (4) use of marijuana; and (5) use of illicit drugs other than marijuana. Although it is not made explicit by Kandel, there is an implication that the drugs from the earlier stages of development are “carried forward” into the later stages of drug involvement. Thus, a marijuana user is likely to continue his or her use of cigarettes/hard liquor and beer Read more […]

Alternatives to Drug Abuse: Some Are and Some Are Not

The purpose of this paper is to discuss the current state of the art of alternatives to substance abuse as one of several approaches to prevention. This paper defines four different approaches to prevention that have been proposed and reviews the literature related to each approach. Two recent studies of alternative programs and activities will be presented and the paper will conclude with recommendations for further research. The concept of alternatives to substance abuse was one of the first responses to the problem (). The early advocates of this strategy recommended substituting positive experiences for the experiences reported to be associated with substance abuse. Some early workers in the field were aware that not all alternatives would automatically provide an acceptable substitute for some of the pleasures sought and perceived by drug-using and-abusing individuals. For example, Swisher and Horman () discovered, upon completion of a program for college student leaders, that one individual had been very impressed by the emphasis on alternatives; and even though he was only an experimenter with some drugs, he decided to pursue a viable alternative–skydiving, which may have been a greater health risk. Four Read more […]

The Mexican Experience: Fight Against Consumption

Epidemiology But Mexico is not only a drug-exporting country. A number of complexly interrelated factors have accounted for an alarming increase in domestic consumption. Estimates show that the problem is essentially an urban one. In rural areas, although one can find certain towns where drugs still are employed in religious rituals or simply as an element in the subculture of the group, drug abuse as such is not considered a problem that affects public health. The majority of urban drug abusers range in age from 12 to 21 years. The younger set uses inhalants and solvents, while the older group usually uses marihuana. It seems certain that the use of barbiturates and amphetamines is on the increase. Barbiturates and tranquilizers are preferred by young adults. At present there is a problem of hard drugs such as opium and its derivatives among a group along the northern border of the country, where an increase has been observed in the number of Mexicans taking heroin (). The highest percentage of drug experimentation and use appears to be among preadolescent and adolescent males and young adult females. In general, however, lower-class youths tend to use industrial-type solvents, which are cheap and easily Read more […]

A Review of Drug Abuse Data Bases

This chapter will identify and describe briefly data sources which may be used to project nonmedical drug use among young adults in future years. A wide variety of sources have potential utility in this regard. They range from individual studies conducted by local school districts or States to major national surveys involving thousands of respondents. Because of the proliferation of research on drug use in recent years, it was necessary to place some limitations on the data to be presented here. First, it was decided that since a complete review was conducted in 1974 (), it was unnecessary to duplicate those efforts. () The studies reviewed here are more recent and, with the exception of the earliest National Surveys, were not covered in the 1974 review. Second, this review is limited to those data bases which are national in scope. State and local surveys have severe limitations for purposes of making national projections of nonmedical drug use. For example: 1. The definitions used for nonmedical use often vary from one local or State survey to another. 2. Various local and State surveys are conducted in different time periods, so that it is often difficult to piece together a national profile. 3. The Read more […]

A Review of Drug Abuse Data Bases: the National Survey

The data base which appears to provide the most consistent source of drug use data on youth and young adults is the National Survey co2nducted between 1971 and 1977. There are five studies in this series. The first two surveys were conducted for the National Commission on Marihuana and Drug Abuse. The most recent three were conducted for the National Institute on Drug Abuse. The five studies are entitled: 1) 1971 study: Public Attitudes Toward Marihuana. 2) 1972 study: Drug Experience, Attitudes and Related Behavior Among Adolescents and Adults. 3) 1974 study: Public Experience with Psychoactive Substances. 4) 1976 study: Nonmedical Use of Psychoactive Substances. () 5) 1977 study: National Survey on Drug Abuse. () These surveys share several critical characteristics which contribute to their utility for estimating drug use: Data collection on the “at risk” 18-25 year age bracket; Adequate and consistent sampling methodology; Comparability of drugs investigated; Comparability of question formats; and Accessibility of detailed tabular data. Each of the five studies is discussed below to demonstrate its adequacy as a data base for projecting the number of drug users in the United States Read more […]

A Review of Drug Abuse Data Bases: Treatment-Oriented Data Systems

Six treatment-oriented data systems were studied: 1. Drug Abuse Warning Network (DAWN) Purpose. Project DAWN is a Federal program jointly funded by the Drug Enforcement Administration (DEA) and the National Institute on Drug Abuse (NIDA). DAWN has been in existence since 1972 and was established to monitor the consequences of drug abuse using two indicators, emergency room visits and deaths. Respondents and Sampling. DAWN collects its information through episode reports provided by selected hospital emergency rooms, crisis centers, and medical examiners. In order to be eligible, emergency rooms must: Be open 24 hours per day; Be located in non-Federal short-term general hospitals (specialty hospitals, hospital units of institutions, and pediatric hospitals are excluded); and Have at least 1,000 patient visits to the emergency room per year. At the end of 1978, over 900 facilities were supplying data to the program. Reporting facilities are concentrated in 24 Standard Metropolitan Statistical Areas (SMSA’S) which are not randomly selected but are chosen to account for approximately 30 percent of the population of the U.S. in geographically diverse locations. Drugs Investigated. DAWN distinguishes Read more […]

Epidemiology of Drug Use Among Adolescents

This review of the epidemiology of adolescent drug use focuses on typical stages of the drug use career and assesses the diversity of experience that my characterize special subgroups of youth. As shown by earlier longitudinal studies (), drug use during the adolescent years is a dynamic, multistage phenomenon which my best be understood by a conceptualization of progressive stages of involvement. The most recent data on dominant patterns of drug use in the 12 to 21 age group are provided by two series of nationwide surveys: the national survey of high school seniors () and the national survey of household population aged 12 and older (). Both of these surveys are cross-sectional, but because many of the data consist of retrospective drug use histories, nationwide patterns of use in 1979 can be described in terms of sequential stages of drug experience. As Kandel has noted, the study of stages of adolescent drug use does not imply “that the use of a drug causes the progression to the next level. Nor can we assume that once started adolescents will progress through the entire sequence” (). Rather, during the adolescent years, each stage of the drug use career represents a risk factor with regard to more serious stages Read more […]

Methamphetamine and the Courts: Treatment as a Sentencing Consideration

Although substance abuse in general and methamphetamine abuse in particular have given rise to sentencing enhancement rather than leading to a primary focus on recidivism prevention, the importance of intervention has not been lost in the criminal justice system. Toward that end, as was seen in the review of court cases above, recommendations for treatment as part of probation or conditional release are not uncommon. However, reaching a goal of reducing addictive behavior and the crime that is associated with it depends on having adequate treatment modalities. Treatment for chemical dependency in general and specifically for methamphetamine has not been uniform around the country. There have been a number of attempts through the National Institute on Drug Abuse (NIDA) and American Society for Addiction Medicine (ASAM) to develop standardized treatment protocols that would act as guidelines to programs that treat addiction. However, the penetration of these algorithms in the provider community has been at best sporadic and fragmented. Many providers continue to use a traditional approach to treatment that is primarily based on the disease concept and follows the Hazleton model. This approach, although effective for Read more […]

Substance-Related Disorders

The ability to recognize and treat substance use disorders (SUDs) is a core competence in psychosomatic medicine. SUDs are common in both inpatient and outpatient medical settings. Alcohol and tobacco use alone contribute to a host of medical illnesses. Illegal drug use taxes the health care system. Drug and alcohol dependence disorders are best characterized as chronic medical illnesses. Hepatitis C is an example of a potential long-term complication of even brief drug use, injection drug users being at increased risk. Emergency departments have seen a steady increase in overdoses of drugs, including “club drugs” not prevalent until recently. The long-term effects of perinatal drug abuse are becoming known. Devastating complications result from the internal concealment of illicit drugs (e.g., body packing). Core competence in addiction medicine includes the ability to make accurate diagnoses, initiate treatment, and plan and coordinate services. Some hospitals have specialized addiction consultation services, but there is a shortage of board-certified addiction psychiatry specialists. All psychiatrists working in general medical settings are on the front lines of substance abuse and must be sufficiendy knowledgeable. The Read more […]