Functionalist Perspective

Functionalists argue that society provides us with norms or guidelines on drug use. Cross-cultural studies reveal that there is variation in the way people expect to behave when they drink. For example, violent behavior is associated with alcohol consumption in the United States, Great Britain, and Australia; yet drinking behavior is described as “peaceful and harmonious” in Mediterranean and South African countries (Social Issues Research Center 1998).

A set of social norms identifies the appropriate use of drugs and alcohol. The use of prescription drugs, as directed by a physician, is considered acceptable behavior. Prescription drugs alleviate pain, reduce fevers, and curb infections. Alcohol in moderation may be routinely consumed with meals, for celebration, or for health benefits. One glass of red wine a day has been shown to reduce one’s risk of heart disease.

Yet society also provides norms regarding the excessive use of drugs. For example, college students share the perception that excessive college drinking is a cultural norm (Butler 1993); this perception is enforced by the media and advertisers (Lederman et al. 2003). Aaron Brower (2002) argues that binge drinking is determined by and is a product of the college environment. For example, because of particular organization norms that support binge drinking, members of Greek social organizations have higher rates of binge drinking when compared to other college students (Chauvin 2012). According to Brower (2002), unlike alcoholics, college students are able to turn their willingness to binge drink on and off depending on their circumstances (e.g., whether they have to study for an exam).

To explain drug abuse, functionalists identify a culture or the social structure as the cause. In examining substance abuse among adolescents, researchers contend that peers may be the most influential (Allen et al. 2003). Howard Kaplan, Steven Martin, and Cynthia Robbins (1984) write, “The use of illicit drugs persists as part of ongoing peer subculture(s) which may endorse, if not require, use of illicit drugs” (p. 271). Peer influence may be direct or indirect: peers provide social opportunities to engage in substance abuse, and peers shape attitudes toward substance abuse (Leventhal and Cleary 1980; Prinstein and Wang 2005).

Émile Durkheim believed that under conditions of rapid cultural change, there would be an absence of common social norms and controls, a state he called anomie. If people lack norms to control their behavior, they are likely to pursue self-destructive behaviors such as alcohol abuse (Caetano, Clark, and Tam 1998). During periods when individuals are socially isolated (such as moving to a new neighborhood, experiencing a divorce, or starting a new school year), they may experience high levels of stress or anxiety, which may lead to deviant behaviors, including drug abuse. Society can also be the source of role strain—when an individual has insufficient resources to deal with demanding social situations or circumstances. The strain occurs when the demands of one’s role exceed one’s ability and resources to fulfill that role (Wheaton 1990). Illicit drug use or self-medication can be perceived as an adaptive coping response to stress—people turn to drug use to reduce their level of stress (Crutchfield and Gove 1984). For example, Shelly McGrath, Catherine Marcum, and Heith Copes (2012) documented how drug use was used as a coping strategy among adult prisoners experiencing a sense of danger or stress during their incarceration.

Conflict Perspective

Although many drugs can be abused, conflict theorists argue that intentional decisions have been made over which drugs are illegal and which ones are not. Powerful political and business interest groups are able to manipulate our images of drugs and their users.

Economist Arthur Benavie (2009) explains how the War on Drugs in this country is defined by subjective social, religious, and political positions. For example, drugs are classified by five schedules, categories that define their susceptibility to abuse and medical application. Criminal penalties are applied to the drugs in Schedules I and II, dangerous drugs with a high potential for abuse. Benavie highlights how the classification of these drugs is determined by the U.S. Drug Enforcement Administration (DEA) of the U.S. Department of Justice (DOJ) rather than the Food and Drug Administration (FDA) or the Surgeon General.

During the late 1800s and early 1900s cocaine was promoted as a medicinal ingredient to treat pain or coughing. Heroin and opium were also used in over the counter treatments.

Encyclopædia Dramatica

Our history of drug laws, concludes Benavie (2009), has little to do with objective information about the effects or dangers of illicit drugs. Drug policy has been fueled by racial, ethnic, and economic antagonisms. For example, heroin, opium, and marijuana were considered legal substances in the late 18th and early 19th centuries, but public opinion and law changed when their use was linked to ethnic minorities and crime. Opium smoking, most associated with Chinese immigrants brought here to work on the railroads, became the subject of intense antidrug efforts after completion of the railroad system. At the same time, the oral consumption of opium, more widespread among Whites, was never considered problematic (Reinarman and Levine 1997).

According to Benavie (2009), the War on Drugs is a crusade, fueled by a fear of social disorder and disease, a perceived threat to our capitalistic economic structure, and a religious crusade against sin and vice.

Why Fight Drugs?

Feminist Perspective

Theorists and practitioners in the field of alcohol and drug abuse have ignored the experiences unique to women, ethnic groups, gay and lesbian populations, and other marginalized groups. Women face unique social stigmatization as a result of their drug use and may also experience discrimination as they attempt to receive treatment (Drug Policy Alliance 2003).

The scientific literature did not address women’s addiction until the 1970s. Specifically, there has been a lack of sensitivity to the range of drug abuse experiences beyond the male or White perspective. Early prevention and treatment models treated female abusers no differently than men were treated, failing to provide comprehensive services for women such as prenatal and gynecologic care, contraceptive counseling, job training, and abuse counseling (Roberts 1991). However, there is increasing recognition of the importance of gender-specific and gender-sensitive treatment models, including the development of separate women’s treatment programs. Female users have a variety of different treatment and psychosocial needs, influenced by their backgrounds, experiences, and drug problems. Most outpatient clinics do not provide child care, and many residential programs do not admit children (Roberts 1991). And single, career-oriented women without children will have different treatment needs and priorities than will single mothers or married mothers (National Clearinghouse for Alcohol and Drug Information [NCADI] 2003a).

Data suggest that the dramatic increase in women’s imprisonment (refer to Chapter 13) is due primarily to the prosecution of drug offenses, leading some researchers to characterize the War on Drugs as the war on women (Bush-Baskette 1998). Katherine Beckett (1995) and Dorothy Roberts (1991) describe how women of color were unfairly targeted in the War on Drugs in the 1980s. As crack cocaine use spread throughout the inner cities, prosecutors shifted their attention to drug use among pregnant women, making drug and alcohol abuse during pregnancy a crime. The approach treated pregnant drug users as criminals and was “aimed at punishing rather than empowering women who use drugs during their pregnancy” (Beckett 1995:589). As Beckett (1995) explains, “Prosecutions of women for prenatal conduct thus create a gender specific system of punishment and obscure the fact that male behavior, socio-economic conditions, and environmental pollutants may also affect fetal health” (p. 588). Roberts (1991) argues that poor Black women are the primary targets for prosecutors. Research indicates that African American women are about 10 times more likely than are other women to be reported to civil authorities for drug use.

In the 1990s, federal drug legislation shifted to methamphetamine offenses, making some of the penalties similar to crack cocaine offenses. Though methamphetamine convictions were last among the five types of drugs women were convicted for in 1996 (10.3%), Stephanie Bush-Baskette and Vivian Smith (2012) report that by 2006, the number of methamphetamine convictions had doubled (23%). There was a 300% increase in the number of women convicted and sentenced for methamphetamine offenses between 1996 and 2006. White women represented the largest percentages of women incarcerated for methamphetamine. The majority of those women had little or no prior criminal record.

Interactionist Perspective

Sociologists Edwin Sutherland and Howard Becker argue that deviant behavior, such as drug abuse, is learned through others. Sutherland (1939) proposed the theory of differential association to explain how we learn specific behaviors and norms from the groups we have contact with. Deviance, explained Sutherland, is learned from people who engage in deviant behavior. In his classic study “Becoming a Marijuana User,” Becker (1963) demonstrated how a novice user is introduced to smoking marijuana by more experienced users. Learning is the key in his study:

No one becomes a user without (1) learning to smoke the drug in a way which will produce real effects; (2) learning to recognize the effects and connect them with drug use . . . ; and (3) learning to enjoy the sensations he perceives. (Becker 1963:58)

This perspective also addresses how individuals or groups are labeled abusers and how society responds to them. For example, consider alcohol abuse among the Native American population. Alcohol abuse and alcoholism are leading causes of mortality among Native Americans, and there are disproportionately higher rates of alcohol-related crimes among Native Americans. Yet Malcolm Holmes and Judith Antell (2001) argue that alcohol abuse and its related problems are not entirely objective phenomena; they also involve interpretation and stigmatization of deviant behavior. One persistent societal myth maintains that as a group, Native Americans have problems handling alcohol. However, research indicates that factors such as demography (a young population) and geography (rural Western environment) may explain high rates of alcohol-related problems in Native American populations.

The authors highlight the considerable variation in drinking patterns within and between tribal communities; there is a large segment of the Native population that do not drink or are non-problem drinkers (Hawkins and La Marr 2012). The social construction of the “drunken Indian” stereotype links alcohol abuse to the perceived “weaker” cultural and individual characteristics of Native Americans. Holmes and Antell (2001) explain, “The persistence of such myths in the symbolic-moral universe of the dominant White culture, despite evidence to the contrary, suggests that alcohol use by Native Americans still documents allegations of weak will and moral degeneracy” (p. 154).

For a summary of these four sociological perspectives, see Table 12.1.

Alcohol

Alcohol is the most abused drug in the United States. Although the consumption of alcohol by itself is not a social problem, the continuous and excessive use of alcohol can become problematic. Four symptoms are associated with alcohol dependence or alcoholism: craving (a strong need to drink), loss of control (not being able to stop drinking once drinking begins), physical dependence (experiencing withdrawal symptoms), and tolerance (the need to drink greater amounts of alcohol to get “high”) (NIAAA 2003b). Alcohol use is related to a wide range of adverse health and social consequences, both acute (traffic deaths or other injuries) and chronic (stroke, alcohol dependence, liver damage) (NIAAA 2005).

National surveys reveal the differences in alcohol consumption by individual attributes, cultural factors, and structural factors. For example, in 2013, current drinking (12 or more drinks in the past year) among adults was highest for Whites and persons reporting two or more races. Heavy alcohol use (five drinks on a single day at least once a month for adults) was highest among Native Hawaiians or other Pacific Islanders and Whites. Overall, alcohol consumption was lowest among Asian, Hispanic, and Black adults and Asian and Black college students (SAMHSA 2014).

Studies suggest that ethnic/racial groups have different sets of norms and values regulating drinking. While some groups exhibit low rates of problem drinking because their culture associates the use of alcohol primarily with eating, social occasions, or rituals (Herd and Grube 1996), other ethnic/racial groups may consider drinking as an activity separate from eating or ritual celebrations, leading to higher rates of problem drinking. In an examination between first- and second-generation Asian American adults, second-generation adults are at higher risk for alcohol use or abuse. Some researchers attribute this higher risk to the process of acculturation—when individuals from different cultures come together, practices and behaviors that are different from one’s own group may be adopted or learned. Due to acculturation, second-generation Asian Americans begin to develop drinking behaviors similar to their non-Asian peers (Iwamoto, Takamatsu, and Castellanos 2012).

Although social class, occupational and social roles, and family history of alcohol use all play a role in determining the drinking patterns of people in general, specific factors put women particularly at risk (Collins and McNair 2003). Research indicates that a woman’s risk for drinking increases with the experience of negative affective states, such as depression (Hesselbrock and Hesselbrock 1997) or loneliness, and negative life events, such as physical or sexual abuse during childhood or adulthood (Wilsnack et al. 1997). Other factors decrease women’s chances of developing alcohol problems. Traditionally, women are socialized to abstain from alcohol use or to drink less than men (Filmore et al. 1997). Women who do not participate in the labor force may have less access to alcohol than men do (Wilsnack and Wilsnack 1992), and women’s roles as wife and mother may also discourage alcohol intake (Leonard and Rothbard 1999).

World Health Organization: Alcohol Abuse

Tobacco and Nicotine

Tobacco is the world’s number-one problem drug, killing more people than all other drugs combined (Goode 2004). According to the World Health Organization (2014), if current smoking patterns continued, by 2030 8 million people per year worldwide would die of diseases caused by cigarette smoking. Cigarette smoking is the most prevalent form of nicotine addiction, and tobacco is the most frequently used addictive drug in the United States (NCADI 2003b). Nicotine is both a stimulant and a sedative to the central nervous system. An average cigarette contains about 10 milligrams of nicotine. Through inhaling the cigarette smoke, the smoker takes in 1 to 2 milligrams of nicotine per cigarette. In 2013, 66.9 million Americans (or 26%) reported current use of a tobacco product (SAMHSA 2014).

In the United States, the prevalence of smoking is highest among Native Americans and Alaska Natives (40.1%), followed by persons who reported two or more races (31.2%), Whites (29.5%), Blacks (27.3%), and Hispanics (21.9%) (SAMHSA 2014). Thirty-seven percent of young adults aged 18 to 25 years were current smokers (SAMHSA 2014).

Cigarette smoking is the most important preventable cause of cancer in the United States. It has been linked to most cases of lung cancer in Europe and in the United States (Crispo et al. 2004). Smoking has also been linked to other lung diseases, such as chronic bronchitis and emphysema, and to cancers of the mouth, stomach, kidney, bladder, cervix, pancreas, and larynx. The overall death rates from cancer are twice as high among smokers as nonsmokers (NIDA 1998). It is estimated that more than 400,000 annual deaths are attributable to cigarette smoking in the United States (American Lung Association 2006).

Passive or secondhand smoke is a major source of indoor air contaminants. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25% to 30% and lung cancer by 20% to 30% (NIDA 2006). Secondhand smoke is estimated to cause about 3,000 lung cancer deaths per year and may contribute to as many as 34,000 deaths related to cardiovascular disease in the United States (Centers for Disease Control and Prevention [CDC] 2014a; NIDA 1998). More than 79,000 adults die each year as a result of passive smoking in the European Union countries (European Lung Association 2006).

Despite the persistent public health message that smoking is bad for your health, smoking among teenagers has been on the rise since 1991 (Lewinsohn et al. 2000). In a study comparing adolescent smokers with nonsmokers, adolescent smokers were found to have more stressful environments, more academic problems, and poorer coping skills than nonsmokers have. Adolescent smoking has also been associated with a number of environmental factors, such as disruptive home environment, parental and peer smoking, low social support from family and friends, conflict with parents, and stressful life events (Lewinsohn et al. 2000). About three out of four teen smokers will become adult smokers (CDC 2014b).

E-cigarettes arrived on the U.S. market in 2007. The cigarettes are battery operated, turning nicotine and other chemicals into a vapor. Smoking the cigarettes is also referred to as vaping. As of November 2014, the U.S. Food and Drug Administration had not reviewed clinical studies about the safety of e-cigarettes. The FDA had not approved any e-cigarette product for therapeutic uses or as a cessation aid. Concerns have been raised about the appeal of the e-cigarettes to the teen market. In 2014, the National Institute on Drug Abuse report found that e-cigarette use surpassed traditional cigarette use among 8th-, 10th-, and 12th-grade teens (Tavernise 2014). According to the CDC (2014b), more than 260,000 youth who had never smoked a cigarette used an e-cigarette in 2013, representing a three-fold increase from 79,000 teen e-cigarette users in 2011.

Antidrug organizations have heightened their concern regarding the risks and health consequences associated with MDMA use. Ecstasy is the pill form of the drug, while Molly is the powder or crystal form of MDMA. Even when they are not fatal, Ecstasy or Molly are not harmless. MDMA produces an intense release of serotonin in a user’s brain, which can cause irreparable damage to the brain and memory functions. Research indicates that long-term brain damage, especially to the parts of the brain critical to thought and memory, may result from its use. Users may also experience psychological difficulties (such as confusion, depression, and sleeping problems) while using the drug and sometimes for weeks after. As a result of using the drug, individuals can also experience increases in heart rate and blood pressure and physical symptoms such as nausea, blurred vision, or faintness (NIDA 2003a). When users overdose, they can experience rapid heartbeat, high blood pressure, faintness, panic attacks, and even loss of consciousness (Vaughn 2002).

Though advertised as drug free zones, raves continue to be a venue for the distribution and use of club drugs like MDMA and GHB.

© milos-kreckovic/iStock

In a study of undergraduates at a large midwestern university, Carol Boyd, Sean E. McCabe, and Hannah d’Arcy (2003) found that men and women were equally likely to have used Ecstasy, and that several factors predicted its use. White students were more likely to report lifetime Ecstasy use than were African American or Asian students. According to the researchers, sexual orientation was also related to Ecstasy use: those who identified themselves as gay, lesbian, or bisexual were more likely to report lifetime, annual, or past-month Ecstasy use than were heterosexual students. Students with a grade point average (GPA) of 3.5 or higher were consistently less likely to have used Ecstasy in the past year or their lifetime than were students with GPAs below 2.5. Students who reported binge drinking within the past two weeks were also more likely to report past-month Ecstasy use. In a separate study, Kira Levy et al. (2005) confirmed the role of social pressure in the experimentation with and use of Ecstasy among college students. When sober and surrounded by Ecstasy-using friends, students described the urge to experience the drug’s effect with others.

Though deaths associated with the drug remain rare, overdoses and emergency room visits have increased in recent years. In 2013, two rave concertgoers died from Molly overdoses. Ecstasy-related emergency room visits increased from 10,200 in 2004 to 17,865 visits in 2008, an increase of 75% (ONDCP 2014). Canada is the primary source of MDMA smuggled into the United States.

Electronic Music and Ecstasy

Colorado Drug Legislation

The Legalization of Marijuana in Colorado: The Impact

Taking a World View

The Marijuana Legalization Movement

The 2012 legalization of marijuana in Colorado and Washington has been credited with encouraging legalization efforts in other states and in other countries. The small South American country of Uruguay was the first in the world to legally regulate the production, sale, and consumption of marijuana for adults. Beginning in 2014, Uruguayans over the age of 18 have had legal access to marijuana through home cultivation of up to 6 plants per household, membership clubs where 15 to 45 members can collectively grow up to 99 plants, or sales of up to 10 grams per week through licensed pharmacies. The system is regulated through the Institute for Regulation and Control of Cannabis (IRCCA) and includes educational and health programming for residents (Hetzer 2014).

As reported by the United Nations Office of Drug and Crime (2014), between 125 million and 227 million people (or between 2.7% and 4.9%) between the ages of 15 to 64 years were estimated to have used marijuana in 2012. Globally, countries with the highest rate of use are Western and Central Europe and North America.

Marijuana is grown in almost every country in the world, ranging from personal home cultivation to large-scale farm and warehouse operations. In 2012, more than 5 tons of cannabis were seized. The largest quantity was seized in the United States, which accounts for over 60% of the seizures worldwide. The area with the second highest amount of seizers was Central and South America and the Caribbean (UNODC 2014).

In its 2014 report, the UNODC expresses concern regarding cannabis legalization in Washington and Colorado. The organization warns, “While it is not yet clear how the market will change, the commercialization of cannabis may also significantly affect drug-use behaviors. Commercialization implies motivated selling, which can lead to directed advertisements that promote and encourage consumption” (p. 43).

Jamaica, Mexico, Morocco, and other countries have expressed interest in changing their marijuana laws, moving to some form of legalization. Economics is often cited as the motivation for legalization.

Do you agree with the UNODC’s concern about the commercialization of marijuana? Why or why not?

Drug Use in the Workplace

Employers have always been concerned about the impact of substance abuse on their workers and their businesses because drug use may undermine employee productivity, safety, and health (Frone 2004). It is estimated that 14 million U.S. workers meet the diagnostic criteria for substance dependence (Jacobson and Sacco 2012). Drug abuse cost American businesses $120 billion in lost productivity, due mainly to labor participation costs, participation in drug abuse treatment, incarceration, and premature death (ONDCP 2014).

In their examination of occupational risk factors for drug abuse, Scott MacDonald, Samantha Wells, and T. Cameron Wild (1999) found that problem drinking or drug use was linked to the quality and organization of work, drinking subcultures at work, and the safety of the workplace. Respondents reporting alcohol problems were more likely to have jobs involving repetitive tasks and dangerous working conditions. Respondents with alcohol problems were also more likely to drink with coworkers and experience some social pressure to drink. The same pattern was true for workers with drug problems: They considered their jobs “boring” or repetitive, they identified their job as dangerous, they experienced stress at work, or they were likely to be part of a drinking subculture at work. Among all factors they identified, the presence of a drinking subculture at work was the strongest risk factor for alcohol and drug abuse.

By occupation, the highest rates of current illicit drug use and heavy drinking were reported by construction workers (15%), sales personnel (11.4%), and food preparation, wait staff, and bartenders (11.2%) (U.S. Department of Labor 2014). Among employed adults, White, non-Hispanic males between the ages of 18 and 25 who have less than a high school education are likely to report the highest rates of heavy drinking and illicit drug use (U.S. Department of Labor 2003).

Problem Drinking Among Teens and Young Adults

For 2013, the National Survey on Drug Use and Health (NSDUH) reported that the highest prevalence of binge drinking (drinking five or more drinks within a few hours or within one sitting) was for young adults aged 21 to 25 (43.3%), followed by 26- to 29-year-olds (40%). Heavy drinking (five or more drinks on the same occasion on at least five different days in the past 30 days) was reported by 13.1% of those 21 to 25 years of age (SAMHSA 2014). See Figure 12.3 for a summary of heavy alcohol use among persons ages 12 and older for 2013.

An international comparative study on drinking trends among 15- and 16-year-olds revealed that teens in the United Kingdom were among those most likely to drink heavily and to experience intoxication. In 2003, 52% of boys and 56% of girls reported binge drinking in the past 30 days (Plant, Miller, and Plant 2005). From 1995 to 2003, although there was no significant increase in the proportion of boys engaging in binge drinking, researchers observed a sharp increase in the proportion of girls binge drinking since 1999. The rise in binge drinking among girls is consistent with recent reports documenting the increase in heavy episodic or binge drinking among young women in Britain. The majority of surveyed teens, 75%, reported that they had at some time “been drunk” in 2003. Researchers concluded that U.K. teenagers drink in ways that are potentially harmful and that binge drinking among U.K. teens is a matter of real concern (Plant et al. 2005).

Figure 12.3 Current, binge, and heavy alcohol use among persons aged 12 and older, by age, 2014

SOURCE: Substance Abuse and Mental Health Services Administration 2014.

By the time they reach the eighth grade, nearly 50% of U.S. adolescents report having had at least one drink, and more than 20% report having been drunk (NIAAA 2003b). Underage drinkers account for nearly 20% of the alcohol consumed in the United States (Tanner 2003). In 2013, 16- to 17-year-olds had the highest rate of currently alcohol use (23%), followed by persons aged 14 or 15 (10%) and persons aged 12 or 13 (2%) (SAMHSA 2014).

Binge drinking among college students has been called a major U.S. public health concern (Clapp, Shillington, and Segars 2000). (Refer to Figure 12.4 for a comparison of heavy drinking among those enrolled full-time in college and those who are not. Drinking rates are consistently higher for those enrolled full-time.) Henry Wechsler (1996) reported results from the 1996 Harvard School of Public Health College Alcohol Study, highlighting how binge drinking had become widespread among college students. In the Wechsler study, binge drinking was defined as five or more drinks in a row one or more times during a two-week period for men and four or more drinks in a row one or more times during a two-week period for women. The author explains that men, students younger than 24, fraternity and sorority residents, Whites, students in athletics, and students who socialize more are most likely to binge drink. On average, students who engaged in high-risk behaviors such as illicit drug use, unsafe sexual activity, and cigarette smoking were more likely to be binge drinkers. In contrast, students who were involved in community service, the arts, or studying were less likely to be binge drinkers (Wechsler 1996).

Binge drinking among college students has been called a major U.S. public health concern. According to the 2013 National Institute for Drug Use and Health, 43.3% of 21-25-year-olds reported binge drinking during the year (SAMSHA 2014).

REUTERS/Gerardo Garcia

Although the demographic and social correlates of college drinking have been consistently identified in many studies, attempts to explain the behavior through various sociological perspectives have been limited. Most prevalent in the literature are theories that identify drinking as part of the social learning process: addressing the role of peer groups, students’ attitudes, and perceptions as well as the social construction of drinking norms related to alcohol consumption. Similar social learning theories have also been linked to substance abuse (Durkin, Wolfe, and Clark 2005).

Access to alcohol is also related to problem drinking. Weitzman et al. (2003) reported a positive relationship between alcohol outlet density (number of bars and liquor stores near campus) and frequent drinking (drinking on 10 or more occasions in the past 30 days), heavy drinking (five or more drinks at an off-campus party), and drinking problems (self-reported).

The Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism (2010) concluded that 1,825 college students between the ages of 18 and 24 die each year from alcohol-related unintentional injuries, including motor vehicle crashes. About half a million students between the ages of 18 and 24 are unintentionally injured while under the influence of alcohol, and more than 600,000 students are assaulted by another student who has been drinking. In addition, the task force reports that 25% of college students report academic consequences (poor grades, poor performance, missing classes) as a result of their drinking, and more than 150,000 develop an alcohol-related health problem. Based on self-reports about their drinking, 31% of college students meet the criteria for alcohol abuse, and 6% meet the criteria for alcohol dependence (Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism 2010).

Brower (2002) explains that there is no evidence that drinking in college leads to later-life alcoholism or long-term alcohol abuse. He writes, “Real life is a strong disincentive for the kind of binge drinking that college students do” (Brower 2002:255). He suggests using the term episodic high-risk drinking to describe more accurately how college students drink: infrequently drinking a large quantity of alcohol in a short period. Brower and other researchers describe a “maturing out” of college drinking, shifting to moderate alcohol consumption with no associated alcohol use problems. The maturing-out process usually coincides with life changes such as employment, marriage, or a general shift to a conventional life style.

Figure 12.4 Heavy alcohol use among adults aged 18 to 22, by college enrollment: 2002 to 2013

SOURCE: Substance Abuse and Mental Health Services Administration 2014.

Teen Substance Abuse

Punishment or Treatment?

Stricter federal policies have increased the number of men and women serving jail or prison time for drug-related offenses. As conflict and symbolic interaction theories suggest, drug laws are not enforced equally, with certain groups being singled out. Although most illicit drug users are White, Blacks constitute about 80% to 90% of all people sent to prison on drug charges (Fellner 2000). Nationwide, Black men are sent to state prison on drug charges at 13 times the rate of White men (Fellner 2000). Most women in prison are untreated substance abusers incarcerated for nonviolent offenses (Alleyne 2007). Drug enforcement usually targets urban and poor neighborhoods while ignoring drug use among middle- or upper-class people. Whereas our society treats middle- or upper-class drug use as a personal crisis, lower-class drug use is defined as criminal. Consider, for example, how the media reported the drug treatment of celebrities Lindsay Lohan and Britney Spears—was either referred to as a criminal?

Sasha Abramsky (2003) explains that with tougher drug laws, the U.S. drug war was taken away from public health and medical officials and placed into the hands of law enforcement and the courts. The notion that drug abuse is a disease was replaced with the idea that drug abuse is a crime. A punishment model has also been adopted in China, where its rehabilitation centers serve as forced labor camps punishing, not treating, addicts (Jacobs 2010). In contrast, the Netherlands defines drug abuse as a public health issue and has implemented harm reduction strategies, placing the priority on drug education and treatment rather than on punishment.

However, as overall crime rates began to decline, public support for the get-tough-on-drugs policy began to wane. Research conducted by the Pew Research Center revealed how 63% of Americans favored rolling back mandatory minimum sentences for nonviolent drug offenders and 67% believed drug use should be treated as a disease rather than as a crime (Desilver 2014).

Abramsky (2003) identified key legislative changes in several states. Arizona and California passed legislation that diverted thousands of drug offenders into treatment programs instead of prisons. In 1998, Michigan repealed its mandatory life sentence law for those caught in the possession of more than 650 grams of certain narcotics. In 2002, Michigan governor John Engler signed legislation that rolled back the state’s tough mandatory-minimum drug sentences. The Kansas Sentencing Commission proposed reforms of the state’s mandatory sentencing codes, along with expansion of treatment programs. The reforms were accepted in March 2003. Though California’s 2010 ballot initiative to legalize marijuana did not pass, that same year Governor Arnold Schwarzenegger signed into law a bill that reduced the penalty for marijuana possession from a misdemeanor to a nonarrestable infraction (e.g., a traffic ticket).

At the federal level, the Obama administration, through the ONDCP, has focused on addiction as a disease and has called for increases in drug prevention and treatment programs for all who need them, including drug-involved offenders. In 2010, President Obama signed the Fair Sentencing Act into law, reducing the disparity in the amounts of powder cocaine and crack cocaine required for the imposition of mandatory minimum sentences. In 2011, the U.S. Sentencing Commission voted to retroactively apply the new guidelines to individuals sentenced before the federal law was enacted. In 2014, Governor Jerry Brown signed the California Fair Sentencing Act, reducing the same sentencing disparity in crack versus powder cocaine offenses.

Federal Drug Laws and Criminal Sentencing

In Focus

Alcopops

Flavored alcoholic beverages, sugary fruit-flavored alcoholic beverages such as Mike’s Hard Lemonade and Bacardi Silver, have become popular with young drinkers. Though the alcohol content must be included in the packaging, some packaging makes these beverages appear more like nonalcoholic soft drinks or energy drinks than an alcoholic beverage containing 5% to 7% alcohol per volume. State lawmakers and parents have increasingly grown concerned about the popularity of these drinks, believing that these beverages contribute to underage drinking (Marshall 2007) and referring to them as “gateway” drugs (leading youth to more traditional alcoholic beverages).

A 2001 national poll revealed that 41% of all teens ages 14 to 18 had tried an alcopop, with twice as many 14- to 16-year-olds preferring them to beer or mixed drinks. When asked why they would choose these beverages over beer, wine, or liquor, teens reported that they liked the sweet taste of the drinks and the disguised taste of alcohol. Most surveyed teens believed the products were marketed to their age group (Alcohol Policies Project 2001).

However, there appears to be more concern about the growing consumption of these beverages among young girls. The American Medical Association released 2004 poll results that indicated that a third of all teen girls older than age 12 have tried alcopops. As part of an effort to urge then-governor Arnold Schwarzenegger to reclassify these beverages as hard liquor, Cinthya Luis, a high school senior and member of the San Diego Youth Council, explained, “Kids all over the state and the nation call these products ‘cheerleader beer’ and ‘girlie beer’ because they are so popular with underage girls—their sweet taste is designed to appeal to young drinkers.” Though Schwarzenegger vetoed the bill in 2005, the California State Board of Equalization voted to reclassify alcopops as distilled spirits (taxable at $3.30 per gallon) rather than beer (taxable at $0.20 per gallon). Prevention and youth advocates applauded the decision, hoping the higher cost would discourage underage consumption.

In addition to California, several other states, such as Arkansas, Illinois, and Nebraska, have considered reclassifying these beverages as hard liquor. Critics argue that these beverages are no different from beer, which contains 4% to 6% alcohol per volume. Maine and Utah have already reclassified these beverages as hard liquor.

Federal Programs

Throughout the first part of this chapter, I have already referred to three U.S. offices: NIDA, the ONDCP, and the NIAAA. All three programs are federally funded.

The NIAAA was established after the passage of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970. Signed into law by President Richard Nixon, the legislation acknowledged alcohol abuse and alcoholism as major public health concerns. The law instructed the NIAAA to “develop and conduct comprehensive health, education, research, and planning programs for the prevention and treatment of alcohol abuse and alcoholism and for the rehabilitation of alcohol abusers and alcoholics” (NIAAA 2003a). Since then, the NIAAA’s mission has been revised to include support and implementation of biomedical and behavioral research, policy studies, and research in a range of scientific areas to address the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems (NIAAA 2003b).

NIDA was established in 1974 as the federal office for research, treatment, prevention, training services, and data collection on the nature and extent of drug abuse. Like the NIAAA, NIDA is part of the National Institutes of Health, the federal biomedical and behavioral research agency. NIDA’s stated mission is to bring “the power of science to bear on drug abuse and addiction” (NIDA 2003b). NIDA supports more than 85% of the world’s research on the health aspects of drug abuse and addiction.

The ONDCP is the newest federal drug program, operated through the White House. Established in 1988 through the Anti-Drug Abuse Act, the ONDCP’s mission was to set national priorities, design comprehensive research-based strategies, and certify federal drug control budgets. According to the act, the purpose of the office was to prevent young people from using illegal drugs, reduce the number of drug users, and decrease the availability of drugs (ONDCP 2003). Ten years later, the ONDCP’s mission was expanded under the Reauthorization Act of 1998. Some of the legislative requirements included a commitment to a five-year national drug control program budget, the establishment of a parents’ advisory council on drug abuse, development of a long-term national drug strategy, and increased reporting to Congress on drug control activities (ONDCP 2003). The act also provided support for the High Intensity Drug Trafficking Areas (HIDTA) program, coordinating local, state, and federal law enforcement drug control efforts.

Use of illegal drugs continues despite the efforts of these three lead agencies. And the War on Drugs comes with huge economic costs, with the Obama administration having requested $25.4 billion for prevention and treatment programs and law enforcement and incarceration for 2015.

Drug Legalization

The contemporary debate about the legalization of drugs emerged in 1988 during a meeting of the U.S. Conference of Mayors. Baltimore’s Kurt L. Schmoke called for a national debate on drug control policies and the potential benefits of legalizing marijuana and other illicit substances (Inciardi 1999). Proponents present several arguments for the legalization of drugs: current drug laws and law enforcement initiatives have failed to eradicate the drug problem, arresting and incarcerating individuals for drug offenses does nothing to alleviate the drug problem, drug crimes are actually victimless crimes, legalization will lead to a reduction in drug-related crimes and violence and improve the quality of life in inner cities, and legalization will also eliminate serious health risks by providing clean and high-quality substances (Cussen and Block 2000; Silbering 2001). Many supporters of legalization argue that drugs should be legalized based on the libertarian legal code (Trevino and Richard 2002), namely that the legalization of drugs would give a basic civil liberty back to citizens by granting them control over their own bodies (Cussen and Block 2000).

The term legalization is often used interchangeably with another term, decriminalization. The terms vary in the extent to which the law can regulate the distribution and consumption of drugs. In general, decriminalization means keeping criminal penalties but reducing their severity or removing some kinds of behavior from inclusion under the law (e.g., eliminating bans on the use of drug paraphernalia). Some would support regulating drugs in the same way alcohol and tobacco are regulated, whereas others would argue for no restrictions at all. Legalization suggests removing drugs from the control of the law entirely (Weisheit and Johnson 1992).

Several European countries including Portugal, the United Kingdom, and Switzerland have moved toward drug legalization or decriminalization in some form. The country most identified with liberal drug policies is the Netherlands. Since the mid-1970s, Netherlands coffee shops have been allowed to sell marijuana products. Though possession and sale of marijuana are not legal, in practice sales through these shops are not prosecuted, and buyers (18 years of age or older) are not prosecuted for possession of small (personal use) amounts.

In the United States, drug legalization is generally opposed by the medical and public health community (Trevino and Richard 2002). The American Medical Association has consistently opposed the legalization of all illegal drugs, arguing that most research shows drugs, particularly cocaine, heroin, and methamphetamines, to be harmful to an individual’s health. Opponents charge that drug use is a significant factor in the spread of sexually transmitted diseases such as HIV, and drug users are more likely to engage in risky behaviors and in criminal activity (Trevino and Richard 2002). The DEA has also been clear about its opposition to drug legalization, citing concerns about potential increases in drug use and addiction, drug-related crimes, and costs related to drug treatment and criminal justice.

In the 1990s, the drug debate began to change, with legalization proponents advocating a “harm reduction” approach. Many opposed to legalization began to accept aspects of the harm reduction approach. Harm reduction is a principle suggesting that “managing drug misuse is more appropriate than attempting to stop it all together” (Inciardi 1999:3). Proponents acknowledge that current drug policies are not working, but they are still not in favor of full decriminalization (McBride, Terry, and Inciardi 1999). The harm reduction approach emphasizes treatment, rehabilitation, and education (McBride et al. 1999), including advocacy for changes in drug policies (such as legalization), HIV/AIDS-related interventions, broader drug treatment options, counseling and clinical case management for those who want to continue using drugs, and ancillary interventions (housing, healing centers, advocacy groups) (Inciardi 1999). Refer to this chapter’s Exploring Social Problems feature for a discussion on the legalization of marijuana.

Exploring social problems

Support of the Legalization of Marijuana

Figure 12.5 Percentage who support legalization of marijuana, 2003, 2010, and 2014

SOURCE: Adapted from Saad 2014.

Figure 12.6 Percentage who support legalization of marijuana, by political views, 2010, 2012, and 2014

SOURCE: Adapted from Saad 2014.

Figure 12.7 Percentage who support legalization of marijuana by age cohort, 2014

SOURCE: Adapted from Motel 2014.

What Do You Think?

Though general support for the legalization of marijuana has shifted in recent years (refer to Figure 12.5), there is still some variation by social groups (refer to Figures 12.6 and 12.7).

Based on Figure 12.6, compare the differences in legalization support for the three groups presented. Which group’s level of support changed the most? Which group’s level of support changed the least?

How would you describe the difference in legalization support by generational group (Millennials born 1981–1998, Gen X born 1966–1980, Boomers born 1948–1964, and Silent born 1928–1945) as reported in Figure 12.7? How does age affect level of support?

From a sociological perspective, how are attitudes about marijuana legalization dependent upon social or structural factors?