Technologies for Understanding and Preventing Substance Abuse and Addiction

254 Pages·1995·3.27 MB·English

Technologies for Understanding and
Preventing Substance Abuse and Addiction
September 1994
OTA-EHR-597
NTIS order #PB95-109625
GPO stock #052-003-01388-6
Recommended Citation: U.S. Congress, Office of Technology Assessment, Technologies
for Understanding and Preventing Substance Abuse and Addiction, OTA-EHR-597
(Washington, DC: U.S. Government Printing Office, September 1994).
For sale by the (U. S. Government Printing Office
Supcrintendent of Documents, MaiI Stop: SSOP.. Washington, DC 20402- 9328
ISBN 0-16 -045198-1
F
oreword
s
ubstance abuse and addiction are major problems in the United States,
resulting in lost human potential, increased health costs, violent behav-
ior, crime, lost productivity, and premature deaths. Substance abuse and
addiction are not confined to one, or even a few, subpopulations. The
complex interactions of biochemical, physiological, psychological, and socio-
logical factors leading to substance abuse and addiction are incompletely un-
derstood, and reports of success in reducing illegal drug abuse and addiction
are often contradicted by reports of failure.
This report has four parts. The first part, Necessary Preconditions, focuses
on several factors that are necessary for substance abuse and addiction to oc-
cur, including an examination of the biological research regarding the phe-
nomenon of addiction to a variety of substances. The second part, Individual
Factors, describes individual risk and protective factors that contribute to the
abuse of, and addiction to, alcohol and drugs. The third part, Community Con-
texts, looks at how risk and protective factors play out in subcultures and in
major activity settings (home, school, workplace, and recreation), and assesses
the effectiveness of various substance abuse prevention initiatives. The fourth
section, Policy Options, addresses a range of legislative issues and options for
Congress arising from an understanding of the factors leading to substance
abuse and addiction.
The request for this report came from the House Committee on Government
Operations, the Senate Committee on Labor and Human Resources, and the
Senate Committee on Governmental Affairs. Numerous individuals, including
an advisory panel chaired by Patricia Evans, assisted the Office of Technology
Assessment (OTA) in the development of this report. OTA gratefully acknowl-
edges the contribution of each of these individuals. OTA also acknowledges
and thanks the Strong Museum in Rochester, New York, for providing OTA
with access and reproduction rights to graphics from their exhibit entitled Al-
tered States: Alcohol and Other Drugs in America. As with all OTA reports, the
final responsibility for the content of the report rests with OTA.
ROGER C. HERDMAN
Director
A
dvisory Panel
Patricia E. Evans Sheppard Kellam Roger Meyer
Chair School of Hygiene and Public George Washington University
Bayview–Hunter’s Point Health Medical School
Foundation The Johns Hopkins University Washington, DC
San Francisco, CA Baltimore, MD
David F. Musto
Marilyn Aguirre-Molina Herbert Kleber Child Studies Center
Robert Wood Johnson Medical College of Physicians and Yale University
School Surgeons New Haven, CT
Piscataway, NJ Columbia University
New York, NY Ruben Ortega
Jeffrey G. Becker Police Chief
The Beer Institute George F. Koob Salt Lake City, UT
Washington, DC Department of
Neuropharmacology Sue Rusche
Lawrence S. Brown, Jr. The Scripps Research Institute National Families in Action
Harlem Hospital/College of La Jolla, CA Atlanta, GA
Physicians and Surgeons
Columbia University Mary Jeanne Kreek Lawrence Wallack
New York, NY Department of Biology and School of Public Health
Addictive Diseases
University of California, Berkeley
Mary Edwards The Rockefeller University Berkeley, CA
New York, NY
Camden House
Detroit, MI
Kenneth E. Warner
John Lucas
School of Public Health
Bernard Ellis, Jr. John Lucas Enterprises University of Michigan
Houston, TX
Consultant Ann Arbor, MI
Santa Fe, TN
Spero Manson
Roger Wilkins
Robbie M. Jackman National Center for American George Mason University
Indian and Alaska Native Mental
State of Tennessee Fairfax, VA
Health Research
Department of Public Health
University Health Science Center
Nashville, TN
Denver, CO
Note: OTA appreciates and is grateful for the valuable assistance and thoughtful critiques provided by the advisory panel members.
The panel does not, however, necessarily approve, disapprove, or endorse this report. OTA assumes full responsibility for the report
and the accuracy of its contents.
iv
——
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roject Staff
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‘Since July 1994.
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v
c
ontractors
Sema Aydede William B. Hansen Theodore Reich
Istanbul, Turkey Bowman Gray School of Jewish Hospital of St. Louis
Medicine
Wake Forest University, NC
Frank Baker Janice Roehl
Baltimore, MD Institute for Social Analysis
Stephanie Lin Pacific Grove, CA
Cupertino, CA
Carter Blakey
Editor The Urban Institute
Bethesda, MD David Liskowsky Washington, D.C.
Arlington, VA
Brenna H. Bry George Woody
Rutgers University, NJ Alan Lozier Philadelphia Veterans
Stanford, CA Administration Medical Center
and University of Pennsylvania
Center for Youth Development
and Policy Research William J. McBride
Washington, D.C. Indiana University School of
Medicine
Theodore J. Cicero
Washington University School of The National Center for Juvenile
Medicine Justice
Pittsburgh, PA
Stephen H. Dinwiddie
Jewish Hospital of St. Louis Mitchell S. Ratner
TIGER Research
Takoma Park, MD
Chris Hansen
Olympia, WA
vi
c
ontents
1 Executive Summary 1
Root Causes 1
Necessary Preconditions 2
Individual Factors 9
Community Contexts 15
policy Options 18
2 Introduction 23
Root Causes 25
What Are Substance Abuse and Addiction? 25
Magnitude of the Problem 34
Measuring Substance Use and Abuse 35
Organization and Scope of the Report 38
Part 1: Necessary Preconditions 41
3 Biology and Pharmacology 43
I 1
Drug Action 44
Genetic Factors 50
Role of Learning 55
Summary 55
4 Availability 57
Availability 57
Are Drugs Readily Available? 62
Marketing 63
Summary 69 I I
5 Substance Use and Transitions to Abuse
and Addiction 71
Substance Use 72
Stages in the Initiation of Use 74
Stages in the Cycle of Use, Abuse, and Addiction 76
Stages in Problem Behaviors 77
Key Aspects of Use 78
Summary 80
vii
Part II: Individual Factors 81
6 Individual Risk and Protective Factors 83
Demographics 65
Economics 105
Psychosocial/Behavioral 110
Summary 118
Part Ill: Activity Settings 119
7 Ethnographic Drug Studies 121
Ethnographic Studies of Alcohol and Other Drug
Use 121
Social Context of Drug Use 125
Poverty, Racism, and Cycle of Abuse 129
Future Research 132
Summary 133
8 Community Activity Settings 135
Homes and Families 137
Schools and Peers 145
Workplaces 153
Recreational Settings 157
Planning, Implementing, and Evaluating
Community-wide Programs 161
Summary 163
9 Policy Options 165
Federal Focus and Prevention Program Structure 166
Research Needs 170
Community Activity Settings 172
Availability 175
. . .
Vlll
APPENDICES
A Drug Control Policy in the United States:
Historical Perspectives 177
B Federal Programs: Prevention and
Causation 164
C Perspectives on Defining Substance
Abuse 194
D List of Contracts 200
E List of Workshops and Participants 202
F Acknowledgments 206
G References 210
INDEX 236
Executive
1
Summary
T
he abuse of licit and illicit drugs represents a major public
health problem in the United States. The costs to society
of such abuse include thousands of premature deaths
annually due to drug-related illnesses, accidents, and
homicides; economic costs related to health care, criminal justice,
and lost productivity; and the mental and physical pain suffered
by millions of Americans. Many ills plaguing the nation today—
including the AIDS epidemic, increased crime and violence, and
homelessness—in some cases, may be linked to individuals’
physical dependence on a variety of abusable substances. The
consequences of substance abuse and addiction have been felt by
people within every economic, social, racial, religious, and politi -
cal boundary.
What are the root causes of substance abuse and addiction?
Why and how does addiction occur? Who are the substance abus-
ers? What factors lead to addiction? What are the implications for
A
prevention and treatment?
ROOT CAUSES
The Office of Technology Assessment (OTA) was asked to identi-
fy the root causes of substance abuse and addiction. The term root .-
. . . . -.
: :.:.:..
causes has been used in political discussions and debate. To
some, root causes of substance abuse and addiction are framed in
a moral context, in which decisions related to use, abuse, and ad- p~/~,
diction are the responsibility primarily of individuals. To others,
root causes include a multitude of social and economic problems,
f
such as homelessness, poverty, and racism. Many people have
strongly held opinions as to what constitutes the general root
causes of substance abuse and addiction in populations, but no
II