The nation's drug problem is commercial recreational pharmacology

Overdose deaths, overprescribing of opioids, illicit production of fentanyl, a resurgence of methamphetamine and cocaine, and an epidemic of vaping‐related illnesses and substance use disorders cover the nation's headlines today, as they have for years. These problems are manifestations of commercial recreational pharmacology, the personally controlled use of psychoactive drugs that super‐stimulate brain reward for pleasure. While substance use and addiction have been known throughout history, the recent increasingly greater acceptance of commercial recreational pharmacology in the United States is exacting a toll on the public health of the nation. The most dramatic example is a decline in U.S. life expectancy, which fell three years in a row from 2016–2018 as a result of overdose deaths.     

Examining links between cocaine use and street‐based sex work in New South Wales,Australia

We examined potential links between cocaine use and street‐based sex work in New South Wales, Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analyzed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested a greater number of primary heroin users were engaging in street‐based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.     

EFFECTS OF WELFARE REFORM ON ILLICIT DRUG USE OF ADULT WOMEN

Exploiting changes in welfare policy across states and over time and comparing relevant population subgroups within an econometric difference‐in‐differences framework, we estimate the effects of welfare reform on adult women's illicit drug use from 1992 to 2002, the period during which welfare reform unfolded in the United States. The analyses are based on all available and appropriate national data sets, each offering unique strengths and measuring a different drug‐related outcome. We investigate self‐reported illicit drug use (from the National Household Surveys on Drug Abuse and National Surveys on Drug Use and Health), drug‐related prison admissions (from the National Corrections Reporting Program), drug‐related arrests (from Federal Bureau of Investigation Uniform Crime Reports), and drug‐related emergency department episodes (from the Drug Abuse Warning Network). We find robust evidence that welfare reform led to a 10%–21% decline in illicit drug use among women at risk of relying on welfare, as well as associated declines in drug‐related arrests (6%–7%), drug‐related hospital emergency department episodes (7%–11%), and possibly drug‐related prison admissions (11%–19%). The findings indicate that an appropriately designed welfare system with sufficient job opportunities for those who are able to work can result in both increases in employment and decreases in drug use. (JEL I38, K42, J21)     

2021: Making COVID-caused changes permanent,for better or worse

What started in 2020 — COVID-19 — continued with a vengeance in 2021, but last year, some of the changes put into place due to the virus became permanent, at least for now. These included relaxations of the rules regarding buprenorphine and methadone, far greater use of telemedicine and other less sanguine changes, such as to-go alcohol. In the meantime, opioid overdoses continued to go up, this time with the addition of methamphetamine and cocaine.     

Examining links between cocaine use and street-based sex work in New South Wales, Australia

We examined potential links between cocaine use and street-based sex work in New South Wales (NSW), Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analysed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested that a greater number of primary heroin users were engaging in street-based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.     

Methamphetamine use: hazards and social influences

Use of methamphetamine, a potent central nervous system stimulant, increased in the early- to mid-1990s in the United States, concentrated in the west, midwest, and south. The use and trade of methamphetamine was facilitated by a fairly simple production process and the involvement of numerous small entrepreneurs as well as drug-trafficking syndicates. National data from the 1994 Drug Abuse Warning network revealed that for the period from 1991 to 1994 methamphetamine use among short-stay hospital patients more than tripled, and methamphetamine-related deaths reported by medical examiner offices nearly tripled. In addition, the Treatment Episode Data Set revealed a 43 percent increase in treatment-program admissions in which clients identified methamphetamine as the primary drug of abuse. Nonetheless, methamphetamine use did not become widespread in the U.S. population. Low-income and unemployed young white men continue to be the group most likely to use methamphetamine, but by the mid-1990s the drug had increased in popularity in more diverse populations and regions. Economic and social pressures experienced by a broad array of Americans may partially explain expanded methamphetamine use; for example, depressed economic conditions in rural and semi-rural areas have contributed to methamphetamine's appeal as a source of income. A "war against drugs" approach has characterized the policy response, with increased criminal justice penalties. A public health approach is recommended, including prevention campaigns, harm-reduction outreach and treatment approaches, and pharmacologic and abstinence-based drug treatment approaches.     

Patterns and economic effects of drug overdose mortality in Texas: 1980-1986

Drug overdose mortality and its economic consequences are explored for ten different drug categories in this article. Data on drug overdose mortality in Texas for the years 1980-1986 are examined and a cost of mortality analysis is presented using the human capital methodology. In addition, mortality rates per 100,000 population are presented for each drug category. The results indicate that the cost of drug overdose mortality has more than doubled over the six-year period. The greatest growth in mortality cost has been for narcotics and cocaine, with commonly prescribed psychoactive drugs remaining fairly constant. The results suggest that men are at far greater risk of drug overdose than women with respect to illicit drugs. Women, however, appear to be at greater risk for overdose from commonly prescribed drugs.     

Good news in NSDUH: New heroin use down

New users of heroin were down in 2017 from the previous year, according to the National Survey on Drug Use and Health (NSDUH) released Sept. 14. The decline is dramatic: from 170,000 new heroin users in 2016, to 81,000 in 2017. But there are concerns about increasing cocaine and methamphetamine use, a continuing increase in widespread use of marijuana, and increased substance use in the “transitional‐age” (18–25‐year‐olds) population and pregnant women.     

Anomie Among European Adolescents: Conceptual and Empirical Clarification of a Multilevel Sociological Concept1

Anomie is a complex, dynamic concept that refers simultaneously to a social state and an individual state of mind. Generations of sociologists have attempted to clarify, extend, and measure the concept at various levels of analysis. This article summarizes these developments around the twin concepts of exteriority and constraint. Exteriority refers to experiencing the social world as an objective, predictable reality, while constraint refers to the extent to which one experiences a personal commitment to the demands and expectations of society. The Anomie Scale of Exteriority and Constraint (ASEC) is presented and tested across various psychological and social outcomes among adolescents in 18 European countries. Exteriority is found to be primarily associated with more depression and less self‐esteem, while constraint is associated with a lower probability of daily smoking, illicit drug use, truancy, and suicide attempts. Societal anomie is higher in eastern European countries and it has a strong negative correlation with GDP per capita and a marginally positive correlation with GDP growth. Societal anomie is also associated with higher baseline levels of depression, self‐esteem, and illicit drug use. These results lend strong support to the theoretical construct of anomie as exteriority and constraint.     

Young Adult Substance Use and Depression as a Consequence of Delinquency Trajectories During Middle Adolescence

This longitudinal study extended work from Wiesner and Windle (2004) by examining young adult outcomes (i.e., alcohol and illicit drug use, depression) of middle‐adolescent trajectories of delinquent behavior for a community sample of 724 young women and men (at average ages 23.8 years). Each domain of young adult adjustment problems was assessed with three indicators (i.e., lifetime rates of psychiatric disorders, annual rates of psychiatric disorders, elevated levels of problem behaviors). Findings indicated specificity in trajectory‐outcome associations, with all active offender pathway groups consistently showing poorer adjustment in the domains of young adult alcohol and illicit drug use (but not depression) relative to the rare offenders. However, there was almost no evidence of differential outcomes among the four most active offender trajectory groups. Overall, this study offered limited support for the contention that differing developmental courses and experiences during middle adolescence are linked to differential outcomes in early adulthood.     

Abstracts of the Scientific Programs of the American College Health Association Fifty-Ninth Annual Meeting April 21–24, 1981, Boston,Massachusetts

Abstract

The authors examined changes in college students' illicit drug use, patterns of polydrug use, and the relationship between students' ages of initiation of substance use and later use of marijuana and other illicit drugs between 1993 and 2001. Data from 119 US colleges and universities in the Harvard School of Public Health College Alcohol Study were used in the study. They found significant increases in percentages of students' use of marijuana in the past 30 days (from 13% to 17%), past year (from 23% to 30%), and lifetime (from 41% to 47%) between 1993 and 2001, with most of the increase occurring between 1993 and 1997. Past 30-day use of other illicit drugs increased from 4% to 7% and past year use increased from 11% to 14%. More than 98% of marijuana and other illicit drug users used another substance. They also either smoked, were binge drinkers, and/or were users of another illicit drug. Drug prevention programs should emphasize heavy alcohol use and smoking and should start when students are in high school or earlier.     

Social Capital and Adolescent Substance Use: The Role of Family,School, and Neighborhood Contexts

This study assesses the link between social capital factors of norm‐setting social arenas including family, school, and neighborhood and adolescent substance use measured by cigarette smoking, alcohol consumption, and illicit drug use among a sample of adolescents in California. The key messages of this study are that socialization processes at different life domains, in varying degrees, are associated with adolescent substance use behavior. Compared with school and neighborhood contexts, family is the most influential setting that should be primarily targeted for youth substance use prevention. Among different aspects of within‐family social resources, parental monitoring seems to be the most protective of adolescent substance use. Study implications on family‐based interventions are discussed.     

Drug markets,violence, and the need to incorporate the role of race

While race has proven to be a critical variable in the sociological understanding of multiple social outcomes, scholars have yet to fully appreciate the nature by which it shapes drug‐related violence. Empirical responses to the 1980s urban proliferation of illicit drugs generally relied on systemic explanations of drug market violence and how participants, by virtue of social positioning, are unable to use the criminal justice system to address grievances. Contrarily, the contingent causation hypothesis suggests that drug markets engender violence in settings where socioeconomic conditions are already favorable for violence. In spite of the contributions of these two themes, we argue that both represent oversimplifications of the complex ways by which race structures drug‐related violence. To truly understand drug market violence, the dominant narrative of emerging research must contextualize the proliferation of illicit drugs within the socio‐historical context of race and institutional racism. Only if and when that happens will the field move towards realistic solutions to ameliorate this social problem.     

A Randomized Controlled Trial Assessing the Efficacy of Cognitive Behavioral Therapy for Substance‐Dependent Domestic Violence Offenders: An Integrated Substance Abuse‐Domestic Violence Treatment Approach (SADV)

The current study evaluates a therapy for substance‐dependent perpetrators of partner violence. Sixty‐three males arrested for partner violence within the past year were randomized to a cognitive behavioral substance abuse‐domestic violence (SADV; n = 29) or a drug counseling (DC; n = 34) condition. Seventy percent of offenders completed eight core sessions with no differences between SADV and DC conditions in the amount of substance or aggression at pretreatment. SADV participants had fewer cocaine‐positive toxicology screens and breathalyzer results during treatment, were less likely to engage in aggressive behavior proximal to a drinking episode, and reported fewer episodes of violence than DC participants at posttreatment follow‐up. SADV shows promise in decreasing addiction and partner violence among substance‐dependent male offenders.     

Physical victimization of rural methamphetamine and cocaine users

Substance use and physical violence often coincide, but little has been published on the correlates associated with receipt of partner versus nonpartner physical violence for rural users of methamphetamine and/or cocaine. In this study, participants' substance use, depression and past-year physical victimization were assessed. In separate logistic regression models, received partner violence in females was associated with age; alcohol, cocaine, and methamphetamine abuse/dependence; and number of drugs used in the past 6 months. In males, received nonpartner violence was associated with age, cocaine abuse/dependence, and being Caucasian. Findings suggest a relationship between stimulant use and received violence among rural substance users and a need for victimization screenings in settings where such individuals seek health care.     

Reflections Regarding Future Cannabis Use Among High‐Frequency Users in a Canadian University Student Population

Cannabis is the most widely used illicit drug worldwide, and the most commonly used illicit drug in Canada, among postsecondary student populations. This cross‐sectional study qualitatively assessed 112 high‐frequency, cannabis‐using university students in Canada: It examined their subjective expectations regarding what they anticipated their cannabis use would look like in the short‐ and mid‐term future and explored factors they saw potentially contributing to changes in their prospective drug use. Results indicated that participants believe that decisions about future cannabis use will be influenced by several contextual factors, including education and employment responsibilities, intimate relationships, and peer associations. These findings help illuminate the natural evolution of cannabis use and can guide the development of interventions for high‐frequency cannabis users in the future.