What is a drug? For social science purposes, a drug must be defined in context. In the medical context, a drug is a chemical substance used to heal the body and mind, one that is physician approved in medical therapy. In this sense, Lipitor, a cholesterol-fighting agent, Zoloft, an anti-depressant, and Celebrex, an anti-arthritis agent, are drugs. Within a legal context, a drug is an illicit or controlled substance, one whose possession and sale are subject to legal penalties; this makes marijuana, LSD, and heroin drugs. In a psychopharmacological sense, a drug is a chemical substance that is psychoactive, that significantly influences the workings of the brain and hence the mind; it has an impact on mood, emotion, and cognitive processes. By this definition, alcohol, methamphetamine, and cocaine are drugs. Even tobacco induces a psychic state, while not an intoxication or “high” per se, that causes pleasurable sensations in the user that entices him or her to continue consumption.
To the analyst of social problems, the third of these definitions is most relevant. The psychoactive property of drugs induces a substantial number of people to use them for recreational purposes, that is, to achieve a particular state of intoxication, which often produces harmful medical and psychological effects and dangerous behavior that generate concern in the public, negative attention from the media, and calls by legislators for controlling such use. In addition, the medical administration of drugs generates social problems when their overuse or misuse causes harm, leading to still other calls for corrective remedies.
Social problems can be measured objectively and subjectively. Objectively measured, concrete indicators such as death, disease, monetary cost, and an incapacity to work or attend an educational institution define a social problem. Subjectively measured, defining a social problem is its social construction, that is, how the members of a society—including the general population, the media, lawmakers and law enforcement, social movement activists, and the medical and psychiatric professions—define and react to a given condition or supposed condition. Also referred to as the “social construction” of a social problem, this subjective definition often finds expression through emotions such as fear and dread, which may or may not be related to a condition’s objective harm.
Measuring the Drug Problem Objectively
The Drug Abuse Warning Network (DAWN) collects data from emergency departments on untoward non-lethal drug effects that cause users to seek medical care. This program also collects data from medical examiners on drug-related lethal overdoses. DAWN’s data only cover sudden, direct, or acute untoward drug episodes, or “overdoses,” such as unconciousness, convulsions, and psychotic episodes. DAWN does not tally chronic or long-term harmful effects, such as cirrhosis of the liver, AIDS, and hepatitis. In addition, DAWN’s program, especially its data collection effort on lethal overdoses, does not cover the entire population, and so its statistics are incomplete. Still, untoward effects remain one of several objective measures of drug use as a social problem.
In 2005, DAWN tallied 816,696 nonlethal drug abuse-related emergency department episodes in U.S. metropolitan areas. A total of31 percent involved illicit drugs only; 27 percent involved pharmaceutical drugs only; 14 percent involved alcohol plus one or more illicit drugs; 10 percent involved alcohol with pharmaceuticals; 8 percent involved illicit drugs with pharmaceuticals; 4 percent involved a three-way combination of alcohol, pharmaceuticals, and illicit drugs; and 7 percent were in a separate category: alcohol-only patients under the age of 21.
DAWN also collects drug-related mortality data from medical examiners in 35 metropolitan areas; as of this writing, 2003 statistics are the latest available. Of the roughly 7,000 deaths by overdose on which DAWN collected information, 70 percent involved one or more opiate or narcotic drugs, including heroin; 43 percent involved cocaine; 30 percent involved alcohol; 17 percent involved benzodiazepines, a category of tranquilizers; and 17 percent involved anti-depressants. (These percentages do not add up to 100 percent because these deaths involved more than one drug.) Clearly, with respect to death by overdose, these drugs or drug types represent a social problem.
More than 100 epidemiologists and biostatisticians from the World Health Organization surveyed the available data and isolated roughly 20 leading risk factors for premature death in countries around the world. The risk factors were somewhat different for developing countries as compared with developed countries. In such developing countries as Nigeria, Indonesia, and Bolivia, factors such as malnutrition and poor sanitation were the leading causes of premature death. But in the developed or industrialized countries such as France, the United States, and Japan, tobacco consumption accounted for 12.2 percent of the years of life lost to all the risk factors, and excessive alcohol consumption accounted for 9.2 percent. Tobacco and alcohol were the number one and number three factors in this respect. In contrast, illicit drugs only accounted for 1.8 percent of years of life lost. In other words, in the industrialized world, the legal drugs, taken together, contribute more than 5 times as much to premature death as do the illegal drugs.
Because DAWN’s data are incomplete, the Robert Wood Johnson Foundation estimates the total number of direct deaths (mainly overdoses) in the United States per year as a result of taking illicit drugs at 15,000 to 20,000. The foundation estimates the number of deaths caused by illegal drug-taking from all sources (AIDS, hepatitis, tuberculosis, homicide, injury, suicide) at 25,000 to 30,000. The number of direct deaths from alcohol consumption are estimated at 20,000 per year, and the foundation’s tally of alcohol’s total contribution from all sources is 100,000. The federal Centers for Disease Control and Prevention estimate the number of deaths caused by long-term cigarette smoking at just under 440,000. (Smoking causes virtually no sudden or acute deaths.) Of the 2.4 million deaths that occur in the United
States each year, approximately one in four is caused by alcohol, tobacco, and illicit drug use. The Robert Wood Johnson Foundation calls substance abuse the nation’s number one health problem.
The National Institute on Alcohol Abuse and Alcoholism has calculated the risk or chance of being killed in a single-vehicle crash, given a specific level of blood alcohol concentration (BAC). At the 0.08 to 0.09 BAC level, DWI (driving while intoxicated) or DUI (driving under the influence [of alcohol]) in all states, for 16- to 20-year-old males, that chance increases 52 times; for females at the same age, the chance increases 15 times. At the 0.15 BAC level or higher, for males 16 to 20 years old, this risk increases by over 15,000 times; for females, this figure is 738 times. For the older age categories, the risk is less elevated. After 1982, the number of alcohol-related fatalities in the United States declined by some 10,000 per year, but between 1999 and the early 2000s, it increased slightly each year. In contrast, teenage alcohol-related fatalities consistently declined after 1982, for under-16-year-olds, from 1,269 to 573 in 2002, and for persons 16 to 20, from 5,244 to 2,329. Nonetheless, drinking and driving remains a major social problem.
Death, effects that trigger emergency department admissions, and automobile accidents are but three of many objective measures of drugs as a social problem. Estimates place the U.S. economic cost of substance abuse at a half trillion dollars in the value of lowered on-the-job productivity due to illness and injury, health care expenditures, motor vehicle crashes, fire, and violence; 40 percent of that total is from alcohol abuse, a third from smoking, and a quarter (27 percent) from illicit drug use.
High school students who use illicit drugs and engage in binge drinking are more likely to experience impaired personal relationships and difficulties in their mental and physical health. The relationship between drug use and criminal behavior, while causally complex, is nonetheless an epidemiological fact: People who commit crime are hugely more likely to use drugs than the population at large, and it is possible that drug use may be causally implicated in the commission of criminal behavior.
Clearly, the contribution of substance abuse to death, disease, monetary cost, educational and occupational impairment, accidents, and violence is considerable. Drug use is a social problem of major proportions.
The Social Construction of the Drug Problem
A measure of independence exists between the subjective and the objective as it does for all other conditions that cause harm and damage to the society. For instance, given the nearly 600,000 deaths caused by the use of alcohol and tobacco compared with the 20,000 or 30,000 deaths caused by illicit drug use, why does the latter generate so much more concern than the former? Considering solely the objective harm caused by a given condition—using death as one measure of harm—why should the less serious problem generate more public concern and dread?
The answer to this question does not stem solely from irrational factors. Some of them seem entirely reasonable. For one thing, on a dose-for-dose basis, several of the illicit drugs (most notably, heroin, and to a lesser extent, PCP, cocaine, and methamphetamine) are more damaging and dangerous than alcohol and cigarettes. A single episode of heroin use is vastly more likely to kill the user than a single episode of alcohol consumption and, even more emphatically, a single episode of cigarette consumption. Second, heroin and cocaine tend to kill earlier in the user’s life for each death than is true of alcohol and, especially, cigarettes. Hence, with respect to number of years of life lost, to equal one crack cocaine death, it would take 10 cigarette deaths and perhaps three to five alcohol deaths. It seems entirely reasonable that the former would generate more public concern than the latter. Third, most cigarette deaths result from chronic conditions, such as lung cancer, whereas most cocaine and heroin deaths result from sudden, acute conditions, and sudden, dramatic deaths attract more attention than long-term, chronic deaths. Last, illicit drugs are implicated in maladies other than, and in addition to, direct drug-induced medical death: maladies such as drive-by and bystander shootings, robbery, burglary, holding a neighborhood hostage to drug dealers, addicted babies, and the spread of HIV/AIDS. Of course, some of these harms can be traceable to the illicit status of illegal drugs. Nonetheless, illegal drugs, especially cocaine, heroin, and methamphetamine, are implicated in other objective social problems more than the legal drugs are. And many of these conditions are what people worry most about.
One indicator of the subjective or constructionist perspective defining a social problem is the public’s designation of drug abuse as the number one problem facing the country today. Between January 1986 and September 1989, the Gallup poll and the New York Times/cbs polls reported that the proportion of Americans naming drug abuse as the country’s most important problem catapulted from 2 to 64 percent. Clearly in the late 1980s, the crack cocaine epidemic had caught the public’s attention. In just 2 months, however, this figure had slipped to 38 percent; by July 1990, it had decreased to 18 percent and in August 1990, to only 10 percent. Throughout the 1990s and into the first 2 years of the new century, up until September 2001, the percentage of the U.S. population indicating drug abuse as the most important problem facing the country today remained in the 5 to 10 percent range. After the attack on the World Trade Center towers and the Pentagon on September 11, 2001, the public’s priorities shifted. A Gallup poll taken in November 2001 revealed that more than a third of the respondents (37 percent) named terrorism as the nation’s top problem, and from then until today, somewhere between 1 and 3 percent of Americans, depending on the specific date of the survey, list drug abuse as the country’s top social problem.
What the roller-coaster ride of drug abuse as a major social problem indicates is that conditions compete with one another for public attention and concern. In other words, a “carrying capacity,” or saturation point, of public attention means only so many issues can rank near the top and, obviously, only one can be number one. The war in Iraq and the War on Terrorism crowded out drug use as a major social problem, causing its decline on the list of the public’s major concerns.
Another way drug abuse is socially constructed as a social problem is through the criminal justice system. In 1970 the number of prisoners in state and federal penitentiaries totaled 200,000. As of 2006 the nation’s prisons housed 1.5 million inmates; its jails held nearly 800,000 detainees. This enormous increase did not come about as a result of an increase in the crime rate; in fact, the country’s crime rate declined sharply. In 1994, the violent crime victimization rate was 51.2 per 1,000; in 2005 it was 21.2. In 1977, the country’s property crime victimization rate was 544.1; in 2005, it was 154.0. Likewise, the country’s drug use has not increased since the 1970s; in fact, it has decreased. In 1979, 14.1 percent of respondents said they had used at least one illicit drug in the past month; in 2005, the
figure was 8.1 percent. The figure for cocaine in 1979 was 2.6 percent, but in 2005 was 1.0 percent. What has happened is that arrests and incarcerations for drug possession have skyrocketed. In 1970, the country’s drug arrests totaled 322,000; in 2004 they were more than 1.7 million. In 1970, 16 percent of all inmates housed in federal penitentiaries were sentenced for drug offenses; today, the figure is 55 percent. In the state prison system (whose population makes up 90 percent of all prisoners), there are more inmates incarcerated for a drug offense than a violent offense. The federal justice system spends $20 billion a year fighting the drug war; states spend roughly the same amount. Clearly, the country is waging a drug war, and that war is a measure of drug use as a social problem, an indicator of public concern about drug use.
The subjective recognition of substance abuse as a social problem does not mean that its designation is arbitrary or fanciful. Saying that drug use is a constructed problem is not to say that it is “just” a construction; not all social constructions are equal. Still, we must be alert to disjunctions between claims and evidence, and drug use represents one condition for which such discrepancies are especially striking. In general, such discrepancies are normal because claims issue from interested parties, interest groups, political activists, and ideological and moral entrepreneurs, as well as a variety of other sources, whereas objective measures of material harm issue from social, medical, and natural scientists. By any criteria, drug abuse is a major social problem, but the claims made about the degree of harm it causes do not always match up with material reality. Indeed, this is one of the more intriguing features of drug use as a social problem.
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