Encyclopedia of drugs, alcohol & addictive behavior

470 Pages·2001·5.69 MB·English

by  Rosalyn Carson-Dewitt

EDA&AB-ttlpgs+ 10/27.qx4 11/3/00 1:30 PM Page 1
A B
DDICTIVE EHAVIOR
E of
NCYCLOPEDIA
D , A &
RUGS LCOHOL
A B
DDICTIVE EHAVIOR
Editorial Board
EDITOR IN CHIEF
Rosalyn Carson-DeWitt, M.D.
Durham, North Carolina
EDITORS
Kathleen M. Carroll, Ph.D.
Associate Professor of Psychiatry
Yale University School of Medicine
Jeffrey Fagan, Ph.D.
Professor of Public Health
Joseph L. Mailman School of Public Health, Columbia University
Henry R. Kranzler, M.D.
Professor of Psychiatry
University of Connecticut School of Medicine
Michael J. Kuhar, Ph.D.
Georgia Research Alliance Eminent Scholar and Candler Professor
Yerkes Regional Primate Center
EDA&AB-ttlpgs+ 10/27.qx4 11/3/00 1:32 PM Page 1
A B
DDICTIVE EHAVIOR
E of
NCYCLOPEDIA
D , A &
RUGS LCOHOL
A B
DDICTIVE EHAVIOR
SECOND EDITION
VOLUME 2
E – Q
ROSALYN CARSON-DEWITT, M.D.
Editor in Chief
Durham, North Carolina
Copyright © 2001 by Macmillan Reference USA, an imprint of the Gale Group
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or by any information storage and retrieval
system, without permission in writing from the Publisher.
Macmillan Reference USA Macmillan Reference USA
An imprint of the Gale Group An imprint of the Gale Group
1633 Broadway 27500 Drake Rd.
New York, NY 10019 Farmington Hills, MI 48331-3535
Printed in the United States of America
printing number
1 2 3 4 5 6 7 8 9 10
Library of Congress Cataloging-in-Publication Data
Encyclopedia of drugs, alcohol, and addictive behavior / Rosalyn Carson-DeWitt,
editor-in-chief.–Rev. ed.
p. cm.
Rev. ed. of: Encyclopedia of drugs and alcohol. c1995.
Includes bibliographical references and index.
ISBN 0-02-865541-9 (set)
ISBN 0-02-865542-7 (Vol. 1)
ISBN 0-02-865543-5 (Vol. 2)
ISBN 0-02-865544-3 (Vol. 3)
ISBN 0-02-865545-1 (Vol. 4)
1. Drug abuse–Encyclopedias. 2. Substance abuse–Encyclopedias. 3.
Alcoholism–Encyclopedias. 4. Drinking of alcoholic beverages–Encyclopedias. I.
Carson-DeWitt, Rosalyn II. Encyclopedia of drugs and alcohol.
HV5804 .E53 2000
362.29'03–dc21 00-046068
CIP
This paper meets the requirements of ANSI-NISO Z39.48-1992 (Permanence of Paper) (cid:1)oo™
E
ECONOMIC COSTS OF ALCOHOL 1992 were very similar to cost estimatesproduced
ABUSE AND ALCOHOL DEPENDENCE over the past 20 years. The 1992 estimates were
Alcoholabuseandalcoholdependencecontinueto significantlygreaterthanthe1985estimateforal-
bemajorhealthproblemsintheUnitedStates.The cohol:42percenthigherforalcoholoverandabove
terms alcohol abuse and alcohol dependence are increases due to population growth and inflation.
based on the diagnostic criteria as stated in the Between 1985 and 1992, inflation accounted for
American Psychiatric Association’s DIAGNOSTIC about 37.5 percent and population growth for 7.1
AND STATISTICAL MANUAL of Mental Disorders, percent increases. Over 80 percent of the increase
Third Edition, Revised (1987). As such, they cost in estimated costs of alcohol abuse was attributed
the nation billions of dollars in health-care costs to changes in data and methodology employed in
and reduced or lost productivity each year. Since the new study. This suggests that the previous
themid-1980s,researchershaveissuedstudiesthat study significantly underestimated the costs of al-
estimatetheeconomiccostsassociatedwithalcohol cohol abuse.
and alcohol abuse in the United States. In 1985, In1992,therewereanestimated107,400alco-
alcohol abuse and dependence cost an estimated hol-relateddeathsintheUnitedStates.Manyofthe
70.3billiondollarsandin1988anestimated85.8 alcohol-related deaths were among persons be-
billion dollars (Rice et al., 1990, 1991). In 1998, tween ages twenty and forty, because the major
the National Institute on Drug Abuse (NIDA) and causesofdeath,suchasmotorvehiclecrashesand
the National Institute on Alcohol Abuse (NIAAA), other causes of traumatic death are concentrated
whicharepartsoftheNationalInstitutesofHealth among younger-aged people. However, alcohol is
(NIH), released a study on these costs based on also involved in numerous premature deaths
1992surveydata.Thisreport,whichalsoanalyzed among the older population because of long-term,
drug abuse, forms the basis of this article. excessive alcohol consumption. Total costs attrib-
uted to alcohol-related motor vehicle crashes were
estimatedtobe$24.7billion.Thisincluded$11.1
EXTENT OF THE PROBLEM
billionfromprematuremortalityand$13.6billion
The economic cost to society from alcohol and from automobile and other property destruction.
drug abuse was $246 billion in 1992. Alcohol In1992,totalestimatedspendingforhealthcare
abuse and alcoholism cost an estimated $148 bil- serviceswas$18.8billionforalcoholproblemsand
lion, while drug abuse and dependence cost an the medical consequences of alcoholconsumption.
estimated $98 billion. When adjusted for inflation Specialized services for the treatment of alcohol
and population growth, the alcohol estimates for problems cost $5.6 billion. This included special-
475
476 ECONOMIC COSTS OF ALCOHOL ABUSE AND ALCOHOL DEPENDENCE
ized detoxification and rehabilitation services as CONCLUSION
wellasprevention,training,andresearchexpendi-
Alcoholabuseandalcoholdependencearecostly
tures. Costs of treatment for health problems at-
totheUnited States inresourcesusedforcareand
tributedtoalcoholwereestimatedat$13.2billion.
treatmentofpersonssufferingfromthesedisorders,
Anestimated$67.7billioninlostpotentialpro-
lives lost prematurely, and reduced productivity.
ductivity was attributed to alcohol abuse in 1992.
Data show clearly that the measurable economic
This accrued in the form of work not performed,
costs of alcohol abuse continue to be high.
including household tasks, and was measured in
terms of lostearningsandhousehold productivity.
(SEE ALSO: Accidents and Injuries from Alcohol;
These costs were primarily borne by the alcohol
Alcohol and AIDS; Cancer, Drugs, and Alcohol;
abusersandbythosewithwhomtheylived.About
Complications; Crime and Drugs; Drug Interac-
$1billionwasforvictimsoffetalalcoholsyndrome
tionsandAlcohol;SocialCostsofAlcoholandDrug
who had survived to adulthood and experienced Abuse)
mentalimpairment.Thisstudydidnotestimatethe
burdenofdrugandalcoholproblemsonworksites
BIBLIOGRAPHY
or employers.
The costs of crime attributed to alcohol abuse AMERICANPSYCHIATRICASSOCIATION.(1987).Diagnostic
wereestimatedat$19.7billion.Thesecostsinclude andStatisticalManualofMentalDisorders-3rdedi-
reduced earnings due to incarceration, crime ca- tion-revised. Washington, DC: Author.
reers, and criminal victimization; and the costs of PARKER,D.A.,&HARFORD,T.C.(1992).Theepidemi-
criminal justice and drug interdiction. Alcohol ologyofalcoholconsumptionanddependenceacross
abuseis estimatedtohave contributed to25to30 occupations in the United States. Alcohol Health &
Research World, 16(2), 97–105.
percent of violent crime.
The study estimated that 3.3 percent of social RICE, D.P., KELMAN, S., & MILLER, L.S. (1991). The
economiccostofalcoholabuse.AlcoholHealth&Re-
welfare beneficiaries in 1992 received benefits be-
search World, 15(4), 307–316.
causeofanadministrativedeterminationofdrug-
oralcohol-relatedimpairment.While1996federal RICE,D.P.,ETAL.(1990).Theeconomiccostsofalcohol
anddrugabuseandmentalillness:1985.Reportsub-
welfare reform legislation has largely terminated
mittedtotheOfficeofFinancingandCoveragePolicy
alcoholordrugdependenceasaprimarycausefor
of the Alcohol, Drug Abuse, and Mental Health Ad-
benefit eligibility, these impairments resulted in
ministration,U.S.DepartmentofHealthandHuman
transfersof$10.4billionin1992,withadministra-
Services.DHHSPub.No.(ADM)90-1694.SanFran-
tiveandotherdirectserviceexpensesof$683mil-
cisco:InstituteforHealth&Aging,UniversityofCali-
lion for those with alcohol problems.
fornia.
Alargeamountoftheeconomicburdenofprob-
SHULTZ,J.M.,RICE,D.P.,&PARKER,D.L.(1990).Al-
lems falls on the population that does not abuse
cohol-related mortality and years of potential life
alcohol. Governments bore costs of $57.2 billion
lost—United States, 1987. Morbidity and Mortality
(38.6 percent) in 1992, compared with $15.1 bil-
Weekly Report, 39(11), 173–178.
lion for private insurance, $9 billion for victims,
WILLIAMS, G.D., ET AL. (1987). Demographic trends,
and$66.8billionforalcoholabusersandmembers
alcohol abuse and alcoholism, 1985–1995. Alcohol
oftheirhouseholds.Costsareimposedonsocietyin Health & Research World, II (Spring), 80–83, 91.
avarietyofways,includingalcohol-relatedcrimes HARWOOD,HENRICK,FOUNTAIN,DOUGLAS,&LIVERMORE,
and trauma (e.g., motor vehicle crashes), govern- GINA. (1998). The Economic Costs of Alcohol and
mentservices,suchascriminaljusticeandhighway DrugAbuseintheUnitedStates,1992.NationalIn-
safety, and various social insurance mechanisms, stituteonDrugAbuse&NationalInstituteonAlcohol
such as private and public health insurance, life Abuse and Alcoholism. Bethesda, Maryland.
insurance,taxpayments,pensions,andsocialwel- DOROTHYP. RICE
fare insurance. REVISEDBYFREDERICKK. GRITTNER
EDUCATION AND PREVENTION 477
ECONOMICS OF ALCOHOL AND DRUG Theconceptofpreventionhasevolvedsincethe
ABUSE SeeProductivity;SocialCostsofAlcohol 1960s to become much broader, one that has
and Drug Abuse shifted from a focus primarily on adolescents to a
life-span perspective that includes all ages from
the fetus through the elderly. Prevention services
ECSTASY See MDMA recognize all potentially addictive substances—
including alcohol, tobacco, MARIJUANA, cocaine,
OPIOIDS, INHALANTS, HALLUCINOGENS, and pre-
scription and nonprescription (OVER-THE-
ED50 The ED50 is the median effective
COUNTER, OTC) medications. Linkages have been
dose—the dose of a drug that is required to pro-
developedwithseveralservicestoincludePREVEN-
duceaspecificeffect(e.g.,relieffromheadache)in
TION, intervention, and TREATMENT. Prevention
50 percent of a given population. The ED50 can
programs now emphasize comprehensive long-
be estimated from a dose-effect curve, where the
termsystematicprogrammingforindividuals,peer
dose of the drug is plotted against the percentage
groups, FAMILIES, and/or communities. Such pro-
of a population in which the drug produces the
grams utilize prevention concepts based on the
specified effect. Therefore, if the ED50s for two
positive results of controlled experiments and
drugs in producing a specified amount of relief
quasi-experimentalstudies.Theycontainacoreof
from headache are 5 and 500 milligrams, respec-
pro-social skills central to the prevention of sub-
tively, then the first drug can be said to be 100
stance abuse as well as other social problems—
times more potent than the second for the treat-
SUICIDE, unwanted pregnancies, and VIOLENCE.
ment of headaches.
CONTEMPORARY PRINCIPLES
BIBLIOGRAPHY
OF PREVENTION
GILMAN, A.G., ET AL. (EDS.). (1990). Goodman and
Several authorities have analyzed prevention
Gilman’s the pharmacological basis of therapeutics,
programsforsubstanceabuseandhavelistedprin-
8th ed. New York: Pergamon.
ciples of effective prevention programs (Dryfoos,
NICKE. GOEDERS 1990;Falco,1992;Hawkinsetal.,1992;TheU.S.
General Accounting Office, 1992; and The Higher
EducationCenterforAlcoholandOtherDrugPre-
EDUCATIONANDPREVENTION Ameri- vention, 1999). The principles in this section
can adolescents increased their use of most illicit emerged from this literature as well as other
substancesthroughoutthe1990safterasignificant sources. This type of ‘‘lumping,’’ of necessity, ig-
drop in the previous decade, and in 1999 Drug noresmanysubtlepointsapplicabletospecificpro-
Czar Barry McCaffrey responded to the recent grams or to particular issues. Nonetheless, wide-
Monitoring the Future study by saying drug use spread agreement exists that these principles
‘‘remainsunacceptablyhigh’’(UniversityofMichi- provide a foundation for planning effective, cost-
gan Institute for Social Research, 1999). Data on effective, prevention programming.
special populations such as infants, the homeless, 1. Effective prevention programs provide for
the ELDERLY, and those with HIV/AIDS indicate comprehensive,coordinatedservicestoindividuals
increasing needs for prevention and education and their families along a continuum of care.
throughout the life span. COCAINE and HEROIN Comprehensive prevention programming in a
patients in emergency rooms have also increased community includes services for all age groups,
since1990andtheAmericanLungAssociationes- with multiple forms of programming for any age
timatesthat430,700Americansdieeachyearfrom group.Comprehensiveservicesarearrayedalonga
diseases directly related to smoking. Clearly, the continuumtoincludeeducation,prevention,inter-
use of ALCOHOL, TOBACCO, and other drugs— vention,andreferraltotreatmentwhennecessary.
whether licit or illicit—by various age groups and Further,most people inhigh-risksubstance-abuse
special populations continues to be a problem in environments need a variety of other services—
the United States. health, nutrition, prenatal care—along with sub-
478 EDUCATION AND PREVENTION
stance-abuse prevention services. All of these ser- fulexperiencesthatavarietyofprogramshavehad
vices need to be coordinated for maximum effect with participants from diverse racial and ethnic
and efficiency. In any community, pregnant orientations(e.g.,Resnick&Wojcicki,1991;Mar-
women, children, adolescents, workers and/or el- cus & Swisher, 1992). A recent novella aimed at
derly,someareinneedofinterventionratherthan Hispanic youths and their families received acco-
prevention; a comprehensive strategy provides for ladesforculturalsensitivityandscope,andreader
intensive services as required. responses suggested the work had some positive
Effective prevention programs also involve the impactonHispanicyouthattitudestowardalcohol
families of the target populations, either as the (Lalonde, Rabinowitz, Shefsky, & Washienko,
focus of the service or as a tangent to a service 1997).
array. Such programs include training in relation- Those in special circumstances (e.g., the home-
shipsandparentingskills,whilereinforcingfamily less) require different approaches in the effective
awareness of the purposes and procedures of sub- deliveryofpreventionservices.Forexample,reach-
stance-abuse prevention programs. Bry, Conboy, ing and engaging the homeless requires different
andBisgay(1986)reportedreducedsubstanceuse strategies (Federal Task Force on Homelessness
and fewer problems in programs for youth that and Severe Mental Illness, 1992) and some re-
taught their parents needed parenting skills. searchers have been successful (reduced drug use)
Student-assistance programs and EMPLOYEE- with prevention programming for the homeless
ASSISTANCEPROGRAMS(EAPs)haveemergedtofill (Botvin and Dusenbury, 1992).
animportantgapinthecarecontinuum.Suchpro- 3. Effective prevention programs use behavior
gramsidentifythosewhoseperformance(academic change technology to equip people with life skills,
or work) deteriorates, to assist them in obtaining knowledge of substance abuse, and awareness of
themostappropriatehelp.Theyareconsideredby the services available to them.
businesses to be beneficial (U.S. Department of Equipping people with life skills includes deci-
Labor,1991),andschoolsperceivethemasessen- sion making; coping; knowledge about the effects
tial to their total programming (Swisher et al., of alcohol, tobacco, and other drugs; awareness of
1993). services;andassertiveness/refusing.Thisclusterof
2. Effective prevention programs are develop- skillsalsoequipspeoplewiththeabilitytomanage
mentallyappropriate,culturallyrelevant,andsen- their immediate situations with the healthiest out-
sitive to ethnic minority members, females, and comes. Such strategies teach people to understand
persons in special circumstances (e.g. homeless that they are engaging in risky behaviors and give
persons). them the skills to resist peer pressure and other
Theymustalsobedevelopmentallyappropriate influences, such as ADVERTISING. Recent studies
andadjustedtotheemotionalandmentaldevelop- have shown that alcohol advertising may increase
mentoftheindividualorgroup.Toooftenpreven- consumption, while counter-advertising and bans
tionprogramshaveattemptedtoprovideadiluted decreasealcoholusetosomedegree(Saffer,1997).
versionofaprogramtoayoungeragegroupwith- There is somewhat dated but nonetheless rele-
outconsideringthedevelopmentalstage.Programs vant literature of prevention technologies, such as
must be adapted to an individual’s needs in the LifeSkillsTraining(e.g.,Botvin&Tortu,1988)or
varioustransitionsofourlives.Someprograms,for Normative Education (Hansen, 1990), which pro-
the oldest members of a community, must be de- videintensiveinstructioninavarietyofcompeten-
signed for their particular needs and frequent in- cies. Similarly, there are several comprehensive
volvementwithchronicillness(Garrity&Lawson, curricula offered sequentially from kindergarten
1989). through twelfth grade (Center for Health Promo-
Prevention programs are most effective when tion, 1990). Only two of these comprehensive
they are culturally relevant to the norms and as- schoolcurricula havehadpositiveoutcomesbased
sumptions of the various ethnic and minority on experimental evaluations; these are the Here’s
groups. Role models and media materials must be Looking At You editions (Comprehensive Health
culturally sensitive or they will be rejected by the Education Foundation, 1990) and Growing
audienceeitherconsciouslyorsubconsciously.Sev- Healthy (e.g., Connell, Turner, & Mason, 1985).
eralauthoritieshavecompiledexamplesofsuccess- GrowingHealthyisacomprehensivehealthcurric-
EDUCATION AND PREVENTION 479
ulum that includes a limited focus on alcohol, to- 2. family history of antisocial behavior or crimi-
bacco,andotherdrugs,whereasHere’sLookingat nality
You: 2000 is an alcohol, tobacco, and other drug- 3. family management problems
use-prevention curriculum. 4. early antisocial behavior and hyperactivity
The results of a groundbreaking study were re- 5. parental drug use and positive attitudes
leasedin1996,whentheU.S.DepartmentofEdu- toward use
cation published the results of a word association 6. academic failure
testcalledtheEnvironmentalAssessmentInitiative 7. little commitment to school and education
(EAI). The EAI looks at the language people use 8. alienation, rebelliousness, and lack of social
and from that determines attitudes and beliefs bonding to society
about alcohol—indeed, theEAI studyreported80 9. antisocial behavior in early adolescence
percent accuracy in noting differences between 10. friends (peers) who use drugs
users and nonusers regarding perceptions about 11. favorable attitudes toward drug use
drugsandalcohol(Katz,1996).Thestudysuggests 12. early first use of drugs
increasing the influence of students who do not
Risk factors for other age groups need to be
overindulgeinalcoholasawayofimprovingcam-
researched if prevention practitioners are to be
pus life. Possible steps include offering numerous
maximallyeffectiveinaddressingallpopulationsin
activities that do not involve alcohol, as well as
a given community. Efforts have also focused on
developing strategies and rules that shed roman-
developingresilienceinpeopleathighrisk(North-
ticized views of alcohol abuse.
east Regional Center for Drug-Free Schools and
Effective PREVENTION PROGRAMS must provide
Communities, 1992).
accurateinformationthattherearerisksassociated
5. Effective prevention programs operate in
with the use of various substances. This scientifi-
communitiesthatestablishpositivenormsthrough
callybasedinformation—highlightingtherelation-
enforcement of clear policies.
ships between an abused substance and its conse-
Communities that establish positive norms re-
quences—has been an important component in
garding alcohol, tobacco, and other drug use have
changing behavior in all age groups (Johnston,
also been successful in delaying the onset of use.
Bachman & O’Malley, 1993).
Such communities have changed their policies
4.Effectivepreventionprogramsemphasizethe
toward access to substances by children and ado-
early identification of risks and resiliency factors
lescents, including the location of advertisements
and program accordingly.
and beverage-serving establishments; they have
Effective substance abuse prevention programs
also promoted positive lifestyles. Gerbner (1990)
emphasize early identification and intervention to
has underscored the importance of communities
reach a substance abuser and his or her family as
reducing their ambivalence about communicating
earlyaspossible,eveninpreschoolprograms.Risk
about all substances, licit or illicit.
status assessment coupled with interventions have
Preventionservicesandpolicychangeshavere-
become standard in effective prevention programs
ducedtheregularuseofalcohol,tobacco,andother
(Lorion, Bussell, & Goldberg, 1991).
drugs,andtherehasbeenaconcurrentreductionin
Some communities are expanding programs
consequences—including reduced highway ACCI-
suchasDrugAbusePreventionEducation(DARE)
DENTSbecauseofalcohol;improvedgeneralhealth
from elementary classrooms into the junior high
becauseoftobaccoprevention;andreducedcrimi-
schools as well, hoping to send youths a positive
nal activity because of illicit substance abuse. A
message early and often—and at an age when
1992 report from the Office of the Inspector Gen-
manychildrenarefirst exposed todrugsandalco-
eralconfirmedanalmosttotallackofenforcement
hol.
effortsbystateagenciestocontrolcigaretteaccess,
Research by Hawkins and Lishner (1985) lists
despitenumerousprovisionsinexistingstatelaws.
riskfactorsforschool-ageyouth.Theseriskfactors
In a study of media programming targeted to spe-
are important to a total process in planning for
cificaudiencesandcombinedwithcommunityfol-
prevention services.
lowup,significantdifferencesintheuseofalcohol,
1. family history of alcoholism tobacco, and other drugs were found between ex-