Participants in this course may ask themselves am I aware of the silent, pervasive addictions infiltrating the United States? Could these addictions be affecting people in my office, my community, and my home? The answers may be yes because substance abusers are masters at disguising their condition. They come from all segments of society regardless of their financial status, ethnic background, or age. The following case histories may sound familiar:
Joan, a 30-year-old divorced mother of two, owned her own business. As the stress of her job increased and the demands of raising her two children alone became more difficult, she began using alcohol to cope. It started with one drink after work a couple of nights a week, but eventually, she was consuming two and three drinks after work every night. After six months of this pattern, her performance at work was declining. A co-worker noticed the changes in Joan's behavior and suggested she get help. Joan denied her addiction to alcohol until she was charged with DUI at the scene of an accident in which she hit a child on a bicycle.
Jim, a popular high school senior, was actively involved in athletics and clubs and did not appear to have any stress in his life. Unknown to others, Jim had smoked since he was 10 years old, and during his senior year of high school had started experimenting with marijuana "just for fun." Since he enjoyed marijuana, he thought some other drugs might make him feel even better, so he tried cocaine. His experience with cocaine was different, but he felt he was still in control. However, his cocaine experience led to addiction. He lost his athletic scholarship and found himself struggling to maintain his once high grades. Meanwhile, his self-esteem and popularity plummeted. Jim's parents admitted him to a substance abuse treatment facility, and he was finally able to get his addictions under control. Although it was not in time to save his athletic scholarship, it did give him a better chance at life.
This third case did not end as well. Cindy, a bright, cheerful college student, wanted to be a Certified Public Accountant (CPA) and was well on her way to a successful life. She was fun to be around, well adjusted, articulate and focused, as her parents had taught her to enjoy life. However, her life ended abruptly when, Mark, a fellow student with whom she was riding, crashed his car into another vehicle, killing both Cindy and the driver of the other car. Unknown to Cindy, Mark was under the influence of alcohol and also had been free-basing cocaine.
Introduction
"Although
substance abuse is a major concern throughout the world, this course will
only include the use and abuse of drugs in the United States.
Attitudes of people in the United States towards drug abuse changed rapidly in the beginning of the 19th century when patented medicines containing morphine and opium were often used to treat coughs, diarrhea, dysentery, and "women's pains." These opiates were the most effective methods available to physicians to relieve the pain of virtually any ailment.1 Opiates were rarely used as recreational drugs until the Civil War, when soldiers were treated with injected morphine and experienced the same euphoric effects as dancing, smoking, and gambling. People were viewed not as drug abusers but "spiritually weak."2
By the end of the 19th century, it became easier to isolate and produce morphine, cocaine, and opium. Since there were no legislative controls over these drugs, they were readily available from pharmacists and physicians and were heavily promoted by pharmaceutical firms.3 Parke-Davis offered coca and cocaine in forms that could be smoked, sniffed and injected, and Coca-Cola even created a soft drink with it. Despite questions about cocaine's safety, most medical experts considered it a harmless stimulant. Therefore, its use spread quickly across the United States and stories of overdoses, addictions, reactions, and the antisocial behavior of users began to rise. At the same time, another opioid, morphine, was made a prescription drug, and its use declined, due largely in part to the public's awareness and apprehension about addiction and the casual-use of habit forming drugs.4
The federal government passed laws early in the 20th century to control substance abuse. The Harrison Narcotic Act of 1914 limited the sale of opium, morphine, heroin, cocaine, and other drugs to small quantities, except when prescribed by a physician. Thereafter, abuse of opiates declined, except among people of middle to higher classes.4
The popularity of cocaine also dropped, except for among Hollywood celebrities and those involved in the criminal world. In the 1920s and 1930s, marijuana was brought to the United States by Mexican immigrant workers, and its use spread to jazz musicians.4
The picture began to change following World War II. New medications, such as tranquilizers and other mind-altering prescription drugs, became the substances of choice--especially since they were used for relieving anxiety and depression. At the same time, organized crime began smuggling narcotics into the United States on a larger scale.4
Between the 1960s and 1970s, drug addiction was being discussed as a symptom of psychological problems, requiring hospitalization for treatment. Marijuana was "rediscovered" by teenagers and was widely use\ by this age group and continued through the '90s. Hallucinogenic drugs, termed the "psychedelic" or "conscious-expanding" drugs such as lysergic acid diethlamide (LSD) and mescaline also became popular, as did designer drugs such as methylene dioxymethamphetamine (MDMA--an appetite suppressant), and phencyclidine (PCP--an anesthetic). Heroin, barbiturates, amphetamines, and cocaine became readily available to athletes and the wealthy.4
The 1980s and 1990s brought extensive use of crack cocaine and a subsequent increase in crime and violence. The term designer drugs was first used to describe synthetic or laboratory-produced derivatives of prescription drugs controlled by the U.S. Food and Drug Administration (FDA). Until late in 1986, as long as such drugs were not identical to controlled drugs, their producers could not be prosecuted or fined for making them. "Designer drug" also refers to a known, abused drug that has been repackaged or redesigned for easier use or increased appeal to consumers. Crack cocaine is such an example.
In addition to these newer drugs, alcohol abuse continues to be a major health risk in the United States. A recent report to the U.S. Congress estimates that 18 million adults 18 years and older are currently having problems resulting from alcohol use, many of them are actually addicted to it.5 A National Institute of Mental Health survey of more than 20,000 U.S. adults found that 13.7% had experienced problems with alcohol dependence, and that one half of those who were alcoholics had at least one additional problem, such as abuse or addiction to another drug.5 The inefficacy of intervention programs, complicating social and cultural factors, and controversies over the causes and treatments for substance abuse make this a complex issue. Therefore, health care professionals should be able to identify substance abusers, as well as be armed with adequate information to attempt to help them.5
