Addiction and dependence

While addiction has been called a victimless crime, nothing could be further from the truth. Research consistently demonstrates that acts of violence against self and others, accidents, decreased productivity, health problems, and a number of other social ills have links to alcohol and drug abuse and addiction. Every day we read about, hear about, or know someone who is a victim of a crime caused by those who use or seek drugs. For some, it is tempting to ignore the ravages of addiction by rationalizing their lack of substance use. However, much like recent findings on secondhand smoke, researchers are identifying other deleterious secondhand effects of substance abuse and dependence. These events include dealing with noise from intoxicated partiers, assault from intoxicated persons, and encountering intoxicated drivers (Wechsler, Lee, Nelson et al.).

Few people disagree that substance abuse and dependence are destructive health behaviors, yet there seems to be a vast sea of confusion surrounding these behaviors. The facts are clear: Addiction to and dependence on tobacco, alcohol, illicit and legal drugs, and possibly biologically driven behaviors such as sex and eating, and social activities such as gambling, are widespread and very destructive.

Addiction has wide-ranging consequences. In 1998 over 500,000 full-time college students were unintentionally injured under the influence of alcohol and over 600,000 were hit or assaulted by another student who had been drinking (Hingson, et al.). Over 1,400 students died from unintentional alcohol injuries (Hingson, et al.), 42 percent of adolescents admitted to a trauma center tested positive for drugs or alcohol and 72 percent of adolescents who were victims of gunshot wounds tested positive for substance use (Madan, et al.). Young persons are not the only ones affected by drug and alcohol abuse. For example, almost half of patients over 65 years old who were treated at trauma centers tested positive for alcohol (Zautcke et al.).

As can be seen from the above data, drug and alcohol abuse puts an extreme burden on the healthcare system. Over the past eighteen years, persons admitted to level I

trauma centers testing positive for alcohol has declined by about one-third. However, during this same period, the number of patients testing positive for cocaine has increased 212 percent and for opioids, 543 percent. (Soderstrom et al.)

Drug and alcohol abuse and dependence cut across all geographic, ethnic, and social boundaries although some groups have rates higher than other ethnic groups (National Household Survey on Drug Abuse, 2000). According to the Drug Enforcement Agency (DEA), the total sales of illicit drugs in the United States in 1993 amounted to $100 billion. This makes the sale of illicit drugs as large a business as a top ten company on the Fortune 500 list.

Despite concerted efforts at education and interdiction, drug use is still commonplace in the United States. For example, National Household Survey on Drug Abuse data indicate that 14 million Americans (6.3% of the population age twelve and older) used an illicit drug in the month prior to the survey. Marijuana was the most commonly used drug (4.8%). National rates for other drugs were as follows: cocaine (0.5%), hallucinogens (0.4%), and inhalants (0.3%). Approximately 130,000 Americans (0.1%) are heroin users. MDMA (Ecstasy) use between 1999 and 2000 increased by almost 25 percent to 6.4 million persons (National Household Survey on Drug Abuse, 2000). This statistic is particularly alarming given the propensity of Ecstasy to cause permanent brain damage in its users.

The business community is so concerned about substance abuse and dependence that pre-employment drug screening of prospective employees has become commonplace. The majority of Fortune 500 companies have some sort of drug-testing program. Drug testing is the norm in the U.S. armed forces, and many court cases in the early twenty-first century are examining if and when the government has the right to test its employees. In 2002 the U.S. Supreme Court, in Board of Education of Independent School District No. 92 of Pottawatomie County et al. v. Earls et al., held that drug testing of students is a reasonable means of preventing and deterring drug use among school children and is not a violation of Fourth Amendment rights.

The death toll from health problems caused by smoking is staggering. A study published in the Journal of the American Medical Association (JAMA) in 2000, estimated that almost 400,000 Americans die each year from smoking related illnesses (Thun, et al.).

Beyond the health consequences for adults, smoking is a serious threat to young people on several levels. Despite widespread antismoking programs, 14.9 percent of teenagers smoke on a regular basis. Unfortunately, many youth perceive low risk of dangers from smoking and others start smoking tobacco cigarettes after smoking safe marijuana.

Smoking is not the only potential threat from addictive substances to young people. The National Household Survey on Drug Abuse estimates that 27.5 percent of twelve- to twenty-year- olds have used alcohol in the past month. The 2000 Household Survey found that 6.6 percent of the household population, ages twelve to seventeen, had used marijuana in the preceding month while 9.8 percent reported using some illicit drug during the same period.

Why would anyone engage in such behavior in the face of such obvious and dire consequences? What are the root causes of such behavior? Why is there any debate about drug use when the frightening consequences are known? Part of the answer comes from exploring the question of what addiction really means.

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