ROTARY AGAINST DRUGS (RAD)
HIGH SCHOOL SPEECH CONTEST
RESOURCE
MATERIALS
FOR MULTI-DISTRICT USE
revised December 21, 2007
Prepared by: Dr. Donald Hayman, PDG Rotary District 7710, Chapel Hill, N.C.
To download this booklet, go to www.Rotary7710.org/rad/
TABLE OF CONTENTS
Page
Preface to Eighth Edition
Rotary Announcement of 2003 RAD HS Speech Contest
Schedule for 2003 Rotary Against Drugs (RAD) Contest
Rotary HS Speech Contest Scoring sheet & Rules
What Rotarians, Students, Teachers Say
Results of RAD Contest 2002
1-00. What is drug abuse?
1-01. Overview of some psychoactive substances
1-02. Drug abuse prevention
1-03. Physical dependence
1-04. Addiction
1-05. Who becomes addicted?
1-06. Alcoholism
2-00.
2-01.
2-02.
2-03.
2-04.
2-05.
2-06.
Drug and alcohol abuse is a world problem
U. S. residents are largest consumers of illegal drugs
Children don’t know how many children use drugs
Drug abuse among U. S. adolescents
Drug use by N. C. middle and high school students
Drug use by high school seniors in 2000.
What is sold like candy and will kill and
disable one out of two regular users?
2-07. Alcohol
2-08. Alcohol abuse among college students
2-09. Marijuana
2-10. Tobacco use among adults --abroad and in the U.S.
2-10.1. Cigarette smoking by adults in North Carolina
2-11. Cocaine and Heroin
2-12. Cocaine addiction rates
2-13. Hallucinogens including LSD
2-14. Barbiturate/Sedatives.
2-15. Smokeless tobacco—snuff and chewing tobacco
2-16.
Inhalants
2-17.
Ecstacy
2-18.
Gender
2-19.
Substance abuse by adult women
2-20. Prescription drugs
2-21. Drug use and higher education
3-00.
3-00.1.
3-00.2.
3-00.3.
3-00.4.
3-01.
3-02.
3-03.
3-04.
3-05.
3-05.1.
3-06.
3-07.
3-08.
i
ii
iii
iv
v-vi
vii
1
1
1
5
5
5
6
7
8
9
9
11
12
13
13
14
15
17
18
18
19
19
19
19
20
20
21
21
22
23
What do drugs do physiologically, psychologically
and to careers and communities?
24
Physiological consequences—nutrition
24
Physiological consequences---health
24
Physiological consequences—deaths in 1998
25
Second hand smoke
27
How do drugs affect users behavior?
27
Psychiatric consequences
29
Educational consequences
30
Employment
30
Marriage, family, and divorce
31
Dependence—induced neglect of job and others
31
Drug use, crime, and the community
32
The intoxicated are more likely to attacks others
33
Crime and delinquency
33
4-00.
Why do children, students, and adults use
drugs and alcohol?
4-01. What are the most frequent reasons students
give for using drugs?
4-02. Peer pressure
4-03. Environment and heredity
4-04. Physiological and psychological
4-05. Schools
4-06. Work
4-07. Availability increases consumption
4-08. Is there a gateway drug?
4-09. Is tobacco the gateway drug?
4-09.1. Is alcohol the gateway drug?
4-10. Lowering legal drinking age increased accidents
4-11. Advertising alcoholic beverages
4-12. Advertising tobacco products/lying and deceit
4-13. N.C. has been less aggressive restricting tobacco
35
35
36
37
38
38
39
39
40
40
40
41
41
43
44
Page
4-14.
4-15.
4-16.
4-17.
Preoccupation with drugs
Drug abuse among health professionals
Why do people stop taking drugs?
Who is less likely and more likely to abuse drugs
5-00.
What are the economic and social costs of drug
and alcohol abuse?
Economic costs of drukg and alcohol abuse
The premature loss of children and workers
reduces the standard of living of all
Costs of drugs in the work kplace
Drug related accidents affect the user and others
Cost of crime, law enforcement, prosecution,
confinement, and supervision
U. S. Government expenditures to control the use
of illicit drugs
Arrests
Prosecutions
Prison population
Drug abusers in city ;and county jails
Convicted drug abusers under criminal justice
supervision
Health costs
Next generation health costs
Treatment
Drug abuse health costs in North Carolina
Cost of drugs in school
Total cost of drug abuse
Who bears the costs of alcohol and drug abuse?
5-01.
5-01.1
5-01.2
5-02.
5-03.
5-03.1.
5-03.2.
5-03.3.
5-03.4.
5-03.5.
5-03.6.
5-04.
5-04.1.
5-04.2.
5-05.
5-06.
5-07.
5-08.
6-00.
6-01.
6-02.
6-02.1.
6-02.2.
6-03.
6-04.
6-05.
6-06.
6-07.
6-08.
6-09.
6-10.
6-11.
6-12.
6-13.
6-14.
6-15.
6-15.1.
6-15.2.
6-15.3.
6-15.4.
6-16.
6-17.
6-18.
6-19.
6-20.
6-21.
6-22.
6-23.
6-24.
6-25.
6-26.
6-26.1.
6-27.
45
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46
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48
48
48
51
51
51
52
52
53
53
53
54
55
55
57
57
57
59
Strategies for redukcing drug and alcohol abuse 60
Reduce demand
60
Reducing demand through education
61
D.A.R.E.
61
Evaluation--drug education in the future?
62
Parent education programs
63
Reducing demand—the 46 State/Big Tobacco
settlement
64
The illegal sales to children gets them hooked
66
Three tobacco companies charged with
continuing to target children
67
U. S. Government stops subsidizing cigarettes
for military
69
Minimum ages for drinking and smoking
70
Restrictions on alcohol on N.C. colleges campuses 70
Changes in N.C. alcohol laws
71
Limits and amounts spent on advertising
72
Affect of environmental tobacco smoke (ETS)
on non-smokers
72
Excise taxes
72
N. C. taxes on cigarettes are third lowest in the U.S 74
Drug and alcohol abuse treatment in N. C.
75
Treatment for nicotine addiction
75
Treatment of addicts and psychologically ill addicts 76
Alcoholics Anonymous
76
Additional treatment programs
77
Drug courts
79
States are reconsidering long mandatory sentences 80
Punitive measures
80
N. C. Medical Association’s recommendations
80
“Just Say No.”
81
Changes suggested to reduce demand
81
Reducing supply
82
Destruction of drugs at source
83
Interdiction and enforcing laws against raising or
manufacturing outlawed drugs
84
Decriminalization
85
Legalization
90
Medical use of marijuana
91
Summary of arguments for drug prohibition,
decriminalization, and legalization
92
TABLE OF CONTENT (continued)
Page
7-00.
7-01.
7-02.
7-03.
7-04.
7-05.
8-01.
7-06.
7-07.
7-08.
7-09.
7-10.
8-00.
8-01.
8-02.
8-03
8-04
8-05
8-06
8-07
8-08
8-09
8-10
8-11
8-12
8-13
8-14
Page
What are community groups doing to promote
drug and alcohol abuse prevention?
93
What is drug and alcohol abuse prevention?
93
What do we know about the drug and alcohol
abuse problem in 2001?
93
Research suggests some drug education programs
are more successful—“Kids Listen to Kids”
93
Student Tobacco Alcohol Resource Team (START) 97
What drug abuse prevention program are
active in your community?
97
What are colleges and universities doing to
Parents are usually the most powerful role-models106
prevent drug and alcohol abuse?
97
What are civic clubs doing to prevent drug and
alcohol abuse?
98
What are Rotary clubs doing to reduce alcohol
and drug abuse?
100
D-FY-IT, (Drug Free Youth In Town)
102
Community Coalition
103
Goals for preventing drug and alcohol abuse
Minimize use and harm
Targeting Children
Parents as Role Models
Drug education and drug counseling in the schools
Treatment
Treatment on demand—more facilities needed
Supervised probation
Technological advances in use detection
Voluntary drug testing
Mandatory testing of parolees and probationers
Do judges need greater discretion in sentencing ?
Mass media
Make money laundering more difficult
Social host liability
9-00. Conclusions.
9-01. Editor’s thoughts
9-02. The Office of Technology Assessment’s Report for
the U. S. Congress on Adolescent Health,
9-03. Dr Avram Ggoldstein and Harold Kalant.
9-04. Dr Joy Dryfoos, Cornell University
9-05. Charlottesville, VA Task Force on Drug Abuse
Prevention
9-06. Dr. Peter M. Bentler
9-07. Dr. Murray E. Jarvik
9-08. Board of Trustees, American Medical Association
9-09. American Society of Addiction Medicine
9-10. Dr. Dean Nywall
FIVE COMMON MYTHS ABOUT QUITTING SMOKING
DRUG & ALCOHOL ABUSE PREVENTION ARTICLES
105
106
106
106
107
107
107
108
108
109
110
110
110
110
111
EXHIBITS AND TABLES
EXHIBIT
Page
1. Overview of Alcohol/Other Psychoactive Substances
2. Many costs to society of illegal drug use
3. Five Common Myths About Quitting Smoking
4. WWW Sources of information Re: Drug and Alcohol Abuse
TABLE
1. Drug Use Among 211 Million Persons Over 12 in U.S.
2. Drug, Alcohol, Cigarette Use 6-12 Grade Students in 1999
3. Drug Availability and Use by High School Seniors in 2000
4. BAC Tests of Student Drinking, UNC-Chapel Hill
5. Binge Drinking Among U.S. College Students—1999
6. Estimated Deaths from Drug Use in U.S. in 1998
7. Arrests by States for Alcohol Related Offenses, 1998
8. Inmates Reporting Drug Use in 30 Days or Under Influence
9. Percent of Alcohol Users Using Drugs in U.S. in 1999
10. Alcohol Related Auto Fatalities & Estimated Costs—1999
11. Defendant Sentenced for Violation of Drug Laws in
U. S. District Courts in 1999
12. Economic Costs of Alcohol & Drug Abuse in U.S.—1992-2001
13. Who Bears the Cost of Alcohol and Drug Abuse?
14. Tobacco Tax in Five Selected States, 1997 & 2000
2
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126
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10
12
13
14
26
34
34
41
50
52
58
59
78
112
112
113
114
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119
119
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122
123
PREFACE TO EIGHTH EDITION
This Rotary Against Drugs (RAD) project is the result of R. I. President Clifford
Dochterman‘s 1992 challenge to members of his Task Force to start district-wide and multidistrict drug and alcohol abuse prevention projects.
The pain and suffering and financial costs of drug abuse are ignored by most Americans. The
$358 billion annual cost of drug abuse in the U.S. and the 650,000 persons who die prematurely every
year are more than we can comprehend. The big murderers are not cocaine or heroin. Over 500,000 or
77% of all drug deaths are caused by inhaling cigarette smoke or the consumption of excessive
quantities of alcohol for 20, 30, or 40 years. These numbers are so large, we feel helpless.
How do kids start down the road to such a death? Surveys report each day 6,000 persons, most
of them kids, start smoking and the same day 3,000 other smokers become daily smokers. The 1999
N.C. Youth Tobacco Survey found the average N. C. students started smoking at 12.2 years, and
18.4% of N.C. middle school students and 38.3% of high school students are current tobacco users.
Those percentages are double the national average of 9.3% for middle school and a third more
than the national average 28.5% for high school students. Teens who smoke are three times more
likely than non-smokers to use alcohol, eight times more likely to use marijuana, and twenty-two
times more likely to use cocaine.
If children and youth would merely obey existing laws--not to smoke until 18, not drink alcohol
beverages until 21, deaths from drug use as they grew older would decline sharply.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Most authorities—medical, social, law enforcement—agree on these points:
The drug and alcohol abuse problem is a complex neighborhood, community, state, national, and
international problem.
It is easier to prevent drug use than repair the physical, psychological, social, and economic
damage resulting from drug dependency.
The earlier an adolescent initiates use of alcohol, tobacco, marijuana, or other illicit drugs, the
more likely he or she will not graduate from school and be divorced.
If experimental drug use can be postponed until after the body matures, the possibility of
permanent physiological and psychological damage and future addiction is reduced.
Parents are the first line of defense in drug abuse prevention. With broken homes, single
working parents, parent(s) abusing drugs, schools assumed greater responsibility.
Diverse strategies must be implemented: Reduce the promotion and availability of tobacco and
alcohol, prosecute persons providing tobacco and alcohol to children, provide age-appropriate
information, skill development, self-esteem enhancing courses, appropriate medical treatment,
occupational training and treatment for all including the thousands of young incarcerated drug
dealers.
The cooperative efforts of the community—parent, schools, churches, justice system, social service
agencies, health care providers, business community, service clubs (including Rotary)—are
needed if we are to reduce alcohol and drug abuse.
Research has confirmed peers are more effective than parents, doctors, ministers, police, or
teachers in discouraging children and young people from starting to experiment with
drugs and stopping drug use. “Kids listen to Kids.”
[See pages 93-97]
Special thanks to over 1.000 wonderful, gifted students from 96 high schools in four states who
gave speeches in their schools and before Rotary clubs, and to 200 who advanced to multi-district
competition. Many are known to have returned home to share their ideas and concerns with elementary,
middle school students, and peers. They are talking with students who are deciding which road to take.
They are now trying to reduce drug abuse in the colleges they
attend.
- i -
ROTARY AGAINST DRUGS HIGH SCHOOL SPEECH CONTEST
ROTARY DISTRICTS: 7570, 7690, 7710, 7720, and 7730
TOPIC: "What Must Be Done to Prevent Drug and Alcohol Abuse in the U.S.?"
TIME:
Maximum of six (6) minutes.
STATEMENT OF PROBLEM:
In U.S. today: More than 10 million persons (12 to 20 illegally drink alcohol.
More than 25% have tried a drug other than marijuana.
Average first alcohol use is 12.2 years and first marijuana use is 13.
In N.C. today: 18.4% of middle school and 38.3% of high school students use tobacco.
38% of high school students drink alcohol.
21% “ “
“
seniors used marijuana in past month.
35% “ “
“
“ smoke. Children buy 4.4 million packs annually.
RESEARCH CONFIRMS:
(1) Students who drink alcohol regularly before 15 are 48% more likely to become alcoholics.
(2) Students using illicit drugs are more likely--school dropouts, divorced and have job problems.
(3) Children delaying drug use by two years greatly reduce the likelihood of addiction.
(4) It is easier to prevent drug use than repair physical, psychological, social, economic damage.
(5) Changing student attitudes re: drug use requires altering norms of community & school.
(6) “Kids Listen To Kids. Peer programs are dramatically more effective in preventing drug use
and convincing kids to discontinuing drug use than all other interventions.”
HIGH SCHOOL SPEECH CONTEST:
These facts suggested more should be done to inform middle and high school students about
the dangers of drug abuse. Since 1993, 1.000+ N.C., Tenn., VA., and WI. students, attending 96
schools, sponsored by 83 Rotary clubs in 6 Rotary districts, have spoken out against drug abuse.
The contest encourages students to (1) consider the extent and seriousness of the use of moodmodifying drugs including alcohol; (2) learn of current efforts to reduce and prevent drug abuse;
(3) increase concern for fellow students; (4) prepare to inform peers of this dangerous problem; and
(5) listen and speak out against drugs and in doing so gain self confidence & increase self esteem.
Rotary Resource Materials maybe found at www.Rotary7710.org/rad/ . Student should
assume they are talking to other students. NO props please. Students &/or teachers select up to 4
students to represent H.S. at a Club meeting. Notes permitted. SPEECH SHOULD NOT BE READ.
ROTARY CLUB: Clubs may sponsor student from each high school in membership area.
SPEECHES: Presented to Rotary Club at ___________ o'clock, March __________
JUDGES:
Members of the Rotary Club serve as judges.
AWARDS:
All speakers receive certificate. Clubs set their own cash awards to participants.
FINALIST: Districts send their top finishers to multi-district competition (fee is $100 per student).
ELIGIBLE: All High School Students.
DISTRICT 7710
FINALS:
1:00 p.m., Sun. Mar. 16, 2008, Chapel Hill Town Hall.
AWARDS: 1st: $200; 2nd: $100; 3rd: $50;
MULTI-DISTRICT FINALS:
1:00 p.m., Sun., Mar. 16, 2008, Chapel Hill Town Hall.
AWARDS: 1st: $300; 2nd: $250; 3rd: $200; 4th: $150; 5th: $100; 6th and over $50.
For additional information contact:
D7570: RID-E Eric E. Adamson, Box 325, Front Royal, VA 22630,
(540) 635-7166; eadamson@servicetitle.com;
D7690: PP
Jim Armstrong, 1034 Cantering Rd., High Point, NC 27262 (336) 883-2928; jimarmstrong@northstate.net;
D7710: P
Mack Parker, P.O. Box 17653, Raleigh, NC 27619
(919) 255-3353; mparker130@nc.rr.com
PDG Donald Hayman, 1038 Highland Wds, Chapel Hill, NC 27517,
(919) 967-3381, haymanrota@aol.com;
D7720: PDG Brenda Tinkham, 153 Tom Browne Rd, Murfreesboro, NC 27855, (252) 398-3210; tinkhamb@hertford.k12.nc.us;
D7730: PDG Phil Crawford, 1503 Sutton Drive, Kinston NC 28503,
(252) 527-3139, philcuz@eastlink.net
- ii SCHEDULE FOR MULTI-DISTRICT--7570, 7690, 7710, 7720, 7730
ROTARY AGAINST DRUGS (RAD) HIGH SCHOOL SPEECH CONTEST
JULY:
1. District Governor announced Rotary Against (RAD) Drug High School Speech topic—
“What Must Be Done to Prevent Drug and Alcohol Abuse in the U. S. ?”
2. District Governor urges Assistant Governors and Club Presidents to:
a. Adopt the drug and alcohol abuse speech contest as a club project;
b. Appoint a committee or chair to arrange the local (and district contest); and
c. Decide the number and amounts of awards.
SEPTEMBER: (Some teachers like to be contacted early so topic can be included in lesson plans)
3. Project Chair in each club contacts High School Principal(s) and seeks permission to
contact appropriate teacher(s): (Interact sponsor, English, speech, biology, counselors or
teachers desiring to assist students) participate in the speech contest.
a. Explains objective, schedule, dates, and award given.
b. Gives teachers contest notices to post on school bulletin boards and contest scoring
sheets to inform students of the criteria used to determine finalists.
c. Gives teachers compact disc, Internet address www.Rotary7710.org/rad/
or Resources Materials booklet to help students research and prepare their speech.
d. Recommend the first round competition be held in an assembly at the school if more
than four students desire to represent the high school.
e. Inform teachers of the date of the meeting when students representing the school will
speak to the Rotary Club(s). (If two or more clubs sponsor a contest,
each club may sponsor a student from each school in the multi-district contest.)
JANUARY:
4. Project chair contacts teacher to verify school participation and answer question.
FEBRUARY - MARCH:
5. Schools holds contest and informs club of students representing the school.
6. Project chair:
a. Invites local media to attend club meeting.
b. Duplicates the Speech Scoring sheet for members to rate finalists.
c. Designates a Rotarian as Timer (6 minute time limit)
d. Presides at contest and President awards certificates and cash awards.
e. Provides names of students speaking at district conference to district chair.
f. Project Chair transports student(s) to D7710 competition at the Chapel Hill Town
Hall by 12:40 p.m., Sunday, March 9, 2008.
7. Project Chair, parent or teacher transports student (maximum 3) to multi-district
competition at Chapel Hill Town Hall by 12:40 p.m. Sunday, March 16, 2008.
(Bed/breakfast provided students and sponsors from outside D7710 on request).
For additional information contact:
D7570: RID-E Eric E. Adamson, Box 325, Front Royal, VA 22630,
(540) 635-7166; eadamson@servicetitle.com;
D7690: PP
Jim Armstrong, 1034 Cantering Rd., High Point, NC 27262 (336) 883-2928; jimarmstrong@northstate.net;
D7710: P
Mack Parker, P.O. Box 17653, Raleigh, NC 27619
(919) 255-3353; mparker130@nc.rr.com
PDG Donald Hayman, 1038 Highland Wds, Chapel Hill, NC 27517,
(919) 967-3381, haymanrota@aol.com;
D7720: PDG Brenda Tinkham, 153 Tom Browne Rd, Murfreesboro, NC 27855, (252) 398-3210; tinkhamb@hertford.k12.nc.us;
D7730: PDG Phil Crawford, 1503 Sutton Drive, Kinston NC 28503,
(252) 527-3139, philcuz@eastlink.net
- iii -
ROTARY MULTI-DISTRICT
DRUG & ALCOHOL ABUSE PREVENTION SPEECH CONTEST
Rules Governing Contest and Scoring Sheets
"What Must Be Done to Prevent Drug and Alcohol Abuse in the U.S.?”
Maximum of six (6) minutes.
Students are asked to assume they are speaking to other students.
May use notes. Speech should not be read, and NO props allowed or other digital assistance (PowerPoint,
Topic:
Rimw:
Focus:
Delivery:
music)
Objective of the Contest? Get the maximum number of kids to
(1) Consider the nature and seriousness of drug and alcohol abuse;
(2) Learn of current efforts to reduce drug and alcohol abuse;
(3) Discover what might be done in their communities to reduce drug abuse;
(4) Volunteer to serve as mentors and role models to middle and elementary students;
(5) Listen and practice expressing their ideas in an appropriate and convincing manner to peers;
(6) Increase their concern for fellow students and gain self confidence and increase self esteem.
===========================================================================================
Criteria
Scale
1
2
3
4
5
6
7
8
9
10
1. DELIVERY
a. Enunciation
&
1 - 10
________pronunciation___________________________________________________________________________________
b. Expression/poise
1 - 10
________________________________________________________________________________________________________
c.
Sincerity & tone
1 - 10
===========================================================================================
2. ORIGINALITY
a. Imaginative approach
1 - 10
_____________________________________________________________________________________________________________________
b.
Positive approach
1 - 10
3. CONTENT
a.
___b.
___c.
d.
Knowledge of subject 1 - 20
Logical development 1 - 10_______________________________________________________________________________
Clarity of ideas
1 - 10_______________________________________________________________________________
Persuasive to peers 1 - 10
TOTAL MAX SCORE 100
NOTES:
Judge’s initials:
Date:
-iv-
D RUG & ALCOHOL ABUSE PREVENTION SPEECH CONTEST-WHAT ROTARIANS, TEACHERS, PARENTS, & STUDENTS SAY
"A great way to get young people involved in recognizing the drug problem."
"No organization I am aware of sponsors a drug prevention speech contest."
"As the students say, we need to stop having commercials on TV and ads in magazines
and other print media glamorizing beer, liquor, and cigarettes.” Parent, 1996.
"This has been wonderful. Much of our time is spent reacting to problems.
Today our students have been doing something positive." E. Wake Teacher, 1995.
"Excellent. Glad to be a part of a Rotary project and campaign against drug and
alcohol abuse. Glad I wasn't a judge today. All excellent presentations." Pres. Michael
Thacker, Warrenton Club, 1993.
"The two speeches given by our finalists at a District Conference were the highlight of
the day. They received a standing ovations, and I know this project can have a beneficial
effect." "Fifteen clubs participated in both 1998 and 1999 and more this year. I want you to
know what a wonderful program this is...I hope every club will participate next year. PDG
Eric Adamson, D7570 (TN & VA) May, 1998; and Oct. 2000.
“Rotary President Carlo Ravizza and his wife Rossana attended the D7750 conference
(Dec. 1998) in Homestead, VA. After hearing four students give their drug abuse prevention
speeches, Rossana said,” “The student speeches on drug abuse prevention were the best talks of the
entire conference." PDG Eric Adamson, 1998, D7570.
“I was RI President Carlo Ravizza’s representative to the D6259 (Wisconsin) district
conference in 1999. The students gave their speeches on Sunday morning. It was a moving
experience. Their talks were tremendous; parents and Rotarians cried.” PDG Bob Squatriglia of
Conway, S.C. (D7770) Oct. 1999.
"In our 1998 contest students from five clubs spoke at our district conference. It was
the best session of the day. The judges of the 1999 contest couldn’t decide which student
should receive the $1,000 scholarship. They hurriedly met with the district governor,
announced a tie, and awarded two rather than one $1,000 scholarships. Two $1,000
scholarships were awarded in 2000.”( and 2001) PDG Don B. Mayo, D6250 (Wis.) 4-2000.
DGN Michael Donovan (D6930 in Florida) was impressed with Valencia Butler's
speech to the Zone Institute in Raleigh in Oct. 1998. He invited Valencia to speak to the
D6930 RYLA in Florida. (Valencia placed first in Chapel Hill in 1998) Michael reports RYLA
students rated Valencia's talk the "best" of the conference. Not surprisingly, Valencia’s
talk was rated best by D7710 RYLA students in both 1999 and 2000. D6930 is making
plans for sponsoring a Rotary Against Drugs Contest. October, 2001.
- v -
"It was gratifying to see such a beautiful array of young people...I hope their
communities will embrace them and give them a chance to give their speeches at churches,
schools and to other civic organizations. They have a powerful message which America needs
to hear." Parent of a 1996 student finalist.
I'm proud to be a member of an organization that has seen fit to encourage our young
people to participate in the contest." PDG Brenda Tinkham, D7720.
Many members of our community are ignorant of how drug use affects them.
Too many adults and kids fall through cracks because people believe its someone else's
problem. It is in the long-term interests of our community to help everyone through hard
times. Parent. 1995.
"When the first place finalist spoke to our District Conference, she received a
standing ovation. She said a lot in her six minute speech. Thanks for her imput, we had an
outstanding Conference. DG John L. Eller, DG7730, 95-96.
"The members of our new Interact club were eager to participate in the high school
drug and alcohol abuse prevention speech contest. I read every word of the Resource
Materials Booklet before I passed the copies on to the high school teachers. It is not preachy.
Facts are reproduced from government research publications and from medical and scientific
journals. Our Interact club members are looking forward to participating." President Jim
Jenkins, Clayton Rotary Club, 3-1995.
“The kids who participate in the contest may have a lot of influence on those that are
or who may get involved with drug abuse. My attending the contest in Chapel Hill last year
was a real highlight in my Rotary year. Many of the participants go back to their churches,
schools, and clubs and give their speech again. These messages coming from teenagers to
many other teenagers may do a lot of good. I think it is a very worthwhile program. Some of
the speakers in last year’s contest were from homes that had abuse because the parents were
involved in drugs.” Pres. Grady Beck, Wilmington East. 2-99.
“The contest provided a way for kids who see alcohol and drugs as problems to society
to speak out. It is very important for kids who have been touched by the effects of drug and
alcohol abuse, to have a way to speak out so they do not follow the pattern. My students have
enjoyed entering and competing. E. Wake Teacher, 1995.
"I am very impressed with your Resource Materials. I am proud that D7690 went
from one club participating in 1999 to seven in 2000”…(and eleven in 2001). We will
continue to support this excellent project.” Bert Wood, President, STEP ONE, Chair, D7690
Drug/Alcohol Abuse Committee, April, 2000.
“In preparing my speech I learned what a terrible problem drug and alcohol abuse is in the
U.S. and at Grimsley High (Greensboro). I had to do something so I agreed to serve as cochair, of START, (Student Tobacco & Alcohol Resource Team). This year I think we have
made a difference.” Megan Sullivan, placed first in March, 2000 contest.
For the next four years Megan will be a Jefferson Scholar at the University of Virginia.
- vi -
ROTARY AGAINST DRUGS (RAD) MULTI-DISTRICT SPEECH CONTEST
More than 150 high school students gave speeches in the 11th annual Multi-district Rotary
Against Drugs (RAD) High School Speech Contest. Since 1993 more than 1,000 North
Carolina, Tennessee, Virginia and Wisconsin students attending 96 different high schools and
sponsored by 83 Rotary clubs in 6 Rotary districts have participated.
The contest is part of Rotary International’s worldwide efforts to prevent drug and alcohol
abuse. The top finalist speaking in Chapel Hill with their high schools and Rotary club sponsor
were: Amy Kabaria (Russell County, VA) & Gate City Rotary; Chris Walter, (E. Chapel Hill High)
and E. Chapel Hill/Chapel Hill; Autumn Perry, (Cape Fear) Fayetteville Lafayette; Inn-Inn Chen,
(Blacksburg) Blacksburg, VA.; and Albert Blackmon, Jr., (North Surry) Mt. Airy.
The other winners included: Leigh Anne Beard (Hertford) Murfreesboro; Joshua Bowers
(Western Christian Academy) Triad; Holly Causey, (Arendall Parrott Academy) Kinston; Benjamin
Davis (Carteret Academy) Morehead City; Carolyn Green (Montgomery County) Troy; Andrea
Griffin, (Bethel Christian Academy) Kinston; Shauna Guyton (Apex) Apex; Brandi Johnson
(South Granville) South Granville; Joshua Monroe (Pinehurst) Pinehurst; Daniel Nead (Croatan
High) Newport; and Josh Sommer (Western Guilford)
Student spoke up to six minutes on the topic, “What Must Be Done to Prevent Drug and
Alcohol Abuse in the U.S.?” Preliminary contests were held at the school if more than four
students entered. Students spoke to Rotary clubs, and Rotarians selected one student from each
high school. Some principals asked students to speak to classes in the school.
Each student received a cash award ranging from $50 to $300. All speakers were well
prepared. They documented the extent of drug and alcohol abuse, the resulting economic health,
and social costs and human suffering. Several discussed the growing problem of binge drinking
among high school and college students. They evaluated current programs and offered suggestions
for students, parents, schools, churches, governments and industry.
The contest was started after a 1988 research study of 143 adolescent drug prevention
programs reported “Peer programs are dramatically more effective in preventing drug use and in
kids to stop using drugs than all other interventions.” “Kids listen to kids.” The contest encourages
high school students to (1) consider the nature and seriousness of drug and alcohol use, (2) learn of
current efforts to prevent drug abuse, (3) discover what is and might be done in their communities
to prevent drug abuse, (4) listen and speak to peers, and (5) serve as mentors to middle and
elementary school students.
- vii -
ROTARY AGAINST DRUGS (RAD) HIGH SCHOOL SPEECH CONTEST
1-00. What is drug abuse?
The National Institute of Drug Abuse defines drug abuse as "the non-medical use of
a substance for psychic effect, dependence, or suicide attempt. Non-medical use includes
 use of prescription drugs in a manner inconsistent with accepted medical practice;
 use of over-the counter drugs contrary to approved labeling;
 use of any other substance (heroin, marijuana, peyote, glue, aerosols, etc.) for psychic
effect, dependence or suicide.
The U. S. Department of Health and Human Services is of the view that the nonmedical use of any drug by those under 21 is abuse and to be prevented. [15, c. 12. p.503]
Some substances associated with abuse or dependence—notably beverage alcohol and
tobacco--are legally available in this country, but only to individuals over a certain age.
The minimum age for the legal sale/purchase of beverage alcohol is 21 and of cigarettes is
18 in all States and the District of Columbia.
Inhalants such as airplane glue, paint thinner, typing correction fluid, and gasoline
are legally available for purchase to individuals of all ages, but not for the purpose of
inducing intoxication. Some States and municipalities have enacted restrictions on the
provision of these substances to minors below statutory defined ages. [15, c. 12, p.II-504]
1-01. Overview of some psychoactive substances.
Box 12-A lists some of the pharmacological actions of major classes of psychoactive
substances. This information appeared in 1990 in Chapter 12 of Volume II. Background
and the Effectiveness of Selected Prevention and Treatment Services, published by the
Office of Technology Assessment, Adolescent Health, of the Congress of the United States.
1-02. Drug abuse prevention is any action or activity by a person or group that
 attempts to help keep a student in school;
 helps a person to increase self-esteem and feeling of self-worth;
 helps a person to learn how mood and mind altering drugs can effect their bodies, their
thinking, and their actions; and
 helps reduce the temptation and opportunity for a person to experiment or use mindaltering drugs.
__________
Note: Most of the information in this publication is a reprint or summary of articles
and reports. The bracket following a paragraph contains the source or a number in the
"Drug and Alcohol Abuse Prevention Articles" beginning on page 123 of this booklet.
Some www.addresses.com are included as references. The number following the letter "p"
is the page in the reference where the data or opinions may be found.
- Page 2 EXHIBIT 1. Provides an overview of psychoactive substances or mood modifying drugs
usually associated with drug abuse. It appeared in Chapter 12,Volume II of Background
and the Effectiveness of Selected Prevention and Treatment Services, published by the
Office of Technology Assessment, Adolescent Health, U.S. Congress, 1990.
OVERVIEW OF ALCOHOL AND SOME OTHER PSYCHOATIVE SUBSTANCES
______________________________________________________________________________
Class of psychoactive substance
ALCHOL (ethyl alcohol)
Description (a)
Alcohol, one of the most widely used of all drugs, is a central
Nervous system depressant with effects similar to those of
Sedative-hypnotic compounds. At low doses, alcohol may be
Associated with behavioral excitation thought to be due to the
Depression of inhibitory neurons in the brain. Alcohol differs
From sedatives hypnotic compounds in that it is used primarily
For recreational or social rather than medical purposes.
Examples
1. Beer
2. Wine
3. “Hard” liquor
(e.g., whiskey, gin).
SEDATIVE, HYPNOTICS, Sedative-hynotics are drugs of diverese chemical structure that 1. Barbiturates (“downers” or
Or ANXIOLYTICS
exerts a nonselective general depressant action on the central
“barbs”); pentobarbital
Nervous system. In addition, they reduce metabolism in a variety
sodium (Nembutal) seconal)
of tissues in the body, depressing any system that uses energy.
amobarbital (Amytal)
Depending on the dose, any sedative-hypnotic compound may be
taken orally.
classified as a sedative (an agent that allays excitement), a tran2. Non-barbiturate hypnotics;
quilizer (an anti-anxiety agent), a hypnotic (a sleep-inducing
Quaaludes)—taken orally.
agent), or an anesthetic (an agent that eliminates pain). Sedative
3. Tranqualizers: diazepam
hypnotics are used medically as sedatives, anxiolytics (anti-anxiety
(Valium), chlordliazagents), hypnotics, anti-epileptics, muscle relaxants, and general
epoxide hydrochloride
anesthetics.
(Librium) –taken orally.
CANNABIS (THC)
NICOTINE
(active ingredient)
THC (tetrahydrocannabinol), the active agent in marijuana, alters
perceptions, concentration, emotions, and behavior, though the
mechanisms of action are not entirely clear. Researchers have
found, however, that THC changes the way in which sensory
Information is processed by the brain. It can be used medically
to relieve nausea and side effects of chemotherapy in cancer
patients; It is very rarely used to treat glaucoma.
Nicotine, obtained naturally from tobacco, is a central nervous
system stimulant. It exerts its action secondary to stimulation
of certain cholinergic (excitatory) synapses both within the
brain and in the peripheral nervous system.
1. Marijuana (“pot ” or
“grass”) smoked or eaten.
2. Hashish (“hash”)-smoked or eaten.
3. Hashish oil (“Hash oil”)
smoked (mixed with tobacco)
4. Tetrahydrocannabinol
(THC) taken orally in capsules.
1. Cigarettes
2. Smokeless tobacco (i.e.
snuff or chewing tobacco)
_____________________________________________________________________________________________________________________
(a)
(b)
The potential physiological, psychological, and behavioral effects of using these psychoactive substances depend in part on the
specific drug used, the dosage level and mode of administration.
Central nerous system stimulants are drugs that can elevate mood, increase alertness, reduce fatigue, provide a sense of increased
energy, decrease appetite, and improve task performance. They can also produce anxiety, insomnia, and irritability. The drugs
differ widely in their molecular structure and mechanism of action.
- Page 3 -
OVERVIEW OF ALCOHOL AND SOME OTHER PSYCHOATIVE SUBSTANCES
______________________________________________________________________________
Class of psychoactive substance
COCAINE
Description
Cocaine, obtained naturally from coca leaves, is a potent
central nervous system stimulant. © It stimulates the
sympathetic nervous system, which regulates the activity
of cardiac muscles, smooth muscles, and glands. It also
produces bronchodilation in the lungs. It is used medically
as a topical anesthetic for surgical procedures.
Examples
1. Cocaine hydrochloride powder
(“coke” or “street cocaine”)-usually snorted or injected
intravenously. ( c)
AMPHETAMINES & RELATED
STIMULANTS
1. AMPHETAMINES
Amphetamines are a group of three closely related compounds, all of which are potent central nervous system
and behavioral stimulants. Some amphetamines are used
medically to treat attention deficit disorders or minimal
brain dysfunction in children, narcolepsy (recurrent,
uncontrollable, brief episodes of sleep) (rarely) depression.
2. NONAMPHETAMINE
Like amphetamines, nonamphetamine stimulants are
stimulants
central nervous system and behavioral stimulants. Some
nonamphetamine stimulants (e.g., Preludin) are used for
weight contro, an some (e.g. Ritalin and Cylert) are used
medically to treat hyperactivity, minimal brain dysfunction
narcolepsy, or (rarely) depression.
HALLUCINOGENS
Hallucinogens, or psychedelics, are heterogenerous group
Of compounds that affect a person’s perceptions,
sensations, thinking, self-awareness, and emotions. (d)
1. Amphetamine (“speed” “uppers”
(Benzedrine)—taken orally,
injected, or snorted.
2. Methamphetamine (“speed” or
“crytal meth” or “ice” taken
orally, or injected.
1. Pheumetrazine hydrochloride
(Preludin) taken orally or
injection.
2. Methylphenidate Hydrochloride
Ritalin taken orally or injected.
1. LSD (lysergicacid dlethylamide)
or acid, taken orally, put in eyes.
2 . Mescaline (trimethyloxphenylethyl or “mesc,” and peyote-disks chewed, swallowed. or smoked;
tablets taken orally.
3. Pallocybin (“magic mushrooms”)
chewed and swallowed
4. MDMA (methylene dioxymethamphetamine—taken orally.
( c) According to the American Psychiatric Association, the route of administration of a psychoactive substance is an important variable
in determining whether use will lead to dependence or abuse. In general, routes of administration that produce more efficient absorption
of the substance in the blood stream (e.g., intravenous injection) tend to increase the likelihood of an escalating pattern of substance uses
that lead to dependence. Routes that quickly deliver psychoactive substances to the brain (e. g., smoking or intravenous injection) are
associated with higher levels of consumption and with an increased likelihood of toxic effects. Use of contaminated needles for
intravenous administration of amphetamines, cocaine, and opiates can cause hepatitis, HIV infection and other illnesses.
(d) Most of the agents included in this class of drugs can induce hallucinations if the dose is high enough. But the term hallucinogen
does not adequately describe the range of pharmacological actions of the diverse group of substances usually included in the class. The
term psychedelic was proposed by Osmond in 1957 to imply that these agents all have the ability to alter sensory perception and thus
may be considered “mind expanding.” The effects of hallucinogens are unpredictable and depend on the amount taken, the user’s
personality, mood and expectations, and the surroundings in which the drug is used.
- Page 4 OVERVIEW OF ALCOHOL AND SOME OTHER PSYCHOATIVE SUBSTANCES
______________________________________________________________________________
Class of psychoactive substance
INHALANTS
OPIATES (NARCOTICS) AND
RELATED ANALGESICS
PCP(PHENCYCLIDINE) AND
SIMILAR ACTING
SYMPHATHOMIMETICS
Description
Examples
Inhalants are chemicals that produce psychoactive 1. Solvents (model airplane glue, polish
vapors. Although different in makeup, nearly all
remover, lighter & cleaning fluids, and
of the abused produce effects similar to those of anesthetics,
gasoline) vapors inhaled.
which act t o slow down the body’s functions or produce
2. Aerosols (e.g.., paints, hairspray) vapors
feelings of dizziness. At low doses, users may feel slightly
inhaled
stimulated. Amyl nitrite is used for heart patients because
3. Some
it anesthetics (e.g., nitrous oxide)
dilates the blood vessels and increases blood supply to the
vapors inhaled.
heart. There are no medical indications for most of the
4. Amyl nitrite ("Snappers" or "poppers")
inhalants.
and butyl nitrite ("rush") vapors inhaled.
Opiates are natural or synthetic drugs that, like
1. Heroin (“smack” or horse”) injected,
morphine, a substance derived from the
smoked, or inhaled.
opium poppy, have anagesic (pain-relieving)
2. Codeine (codeine sulfate)-taken
properties. Heroin is not approved for
orally or injected.
medical uses in the U.S. The major medical
3. Morphine (morphine hydrochloride)
use of other opiates is for the relief of
injected, smoked, or inhaled.
pain (i.e., as analgesics); some narcotics are
4. Synthetic opiates (e.g., methadone
used to relieve coughing (i.e., as antitussives)
[Dolophine]}; hydromorphone hydroor to treat diarrhea. Methadone is used in
chloride [Demerol], oxycodone and
the treatment of narcotic abstinence syndro(percodan) taken orally or injected.
mes and as an analgesic in terminal illness.
Phencycyclidine, commonly referred to as
PCP, alters the functions of the neocortex
and has been called a dissociative anesthetic.
It was developed in the 1950s as an anesthetic, but was subsequently taken off the
market in 1967 when it was discovered that
the drug caused hallucinations in some
people) PCP is now used legally only in
veterinary medicine as an immobilizing
agent.
PCP (“angel dust” or “lovely”) –
taken orally, or smoked (sprayed on
joints or cigarettes.)
_____________________________________________________________________________________________________________________
- Page 5 1-03. Physical dependence occurs:
 when an individual has taken a drug over a period of time and has to take larger doses
to realize the effect realized with smaller doses in the past; and
 when that individual would be subject to physical symptoms of withdrawal if he/she were
suddenly no longer administering the drug regularly as in the past.
1-04. Addiction is defined as a relationship with a drug or drugs that is characterized by:
 a compulsion to use the drug;
 loss of control over frequency and the quantity of the drug used during each episode;
 continued use of the drug despite negative consequences (health, family, job, school,
legal, financial, etc.) caused by the use of the drug;
 drug-seeking behavior, and
 denial of a problem or need for treatment.
The development of addiction begins with the initial contact and then moves through
the experimentation, integrated use, and periodic excessive use phases before reaching
addiction. Some individuals stop using at one of the preliminary phases before reaching
addiction and some remain at the integrated phase and don't move on to addiction. No one
is addicted to a drug before his/her initial contact with the drug. ("Crack" babies do suffer
withdrawal symptoms immediately after birth).
1-05. Who becomes addicted?
Drug addiction is today seen by physicians as a disease that can never be cured, only
managed with the help of long-term treatment and lifelong support systems. [45, p.609]
The person with the addiction-prone personality, with deep-rooted personality disorders,
is considered most likely to turn to drugs.
Many people are able to use addictive drugs in moderation. There are coffee drinkers
who take only a cup or two a day, occasional smokers who use only a few cigarettes a day,
social drinkers who consume no more than a couple of drinks a day, and marijuana user
who smoke a "joint" once in a while. Some people (at least for a period of time) can
restrict their use of heroin to weekends, or of cocaine to an occasional party. Others, in
contrast, are vulnerable to becoming compulsive heavy users, then stopping only with great
difficulty if at all, and relapsing readily. There is no sharp separation between so-called
social users and addicted users, but rather a continuum of increasing levels of use and
increasing levels of risk. [26, p.1514]
The compulsive quality of drug addiction presents a special danger because for most
drugs there is no way to predict who is at greatest risk. People who become
addicted usually believe, at the outset, that they will be able to maintain control. After the
compulsion takes control, addicts persist in using high doses, often by dangerous routes of
- Page 6 administration. As the heavy users constitute the heart of the drug problem, there is an
urgent need for more research to explain why they doggedly persist in a self-destructive
activity despite full knowledge of it consequences. [26, p. 1514]
1-06 Alcoholism.
Alcoholism is defined as a primary, chronic disease with genetic, psychosocial, and
environmental factors influencing its development and manifestations. The disease is often
progressive and fatal. It is characterized by impaired control over drinking, preoccupation
with the drug alcohol, use of alcohol despite adverse consequences, and distortions in
thinking, most notably denial. Symptoms may be continuous or periodic. [Morse, Robert M.,
Daniel K. Flavin. “The Definition of Alcoholism.” Jo. Am. Med. Assn. v. 268, n.8 (8-26-62) p. 1012-14]
- 7 2-00. Drug and alcohol abuse is a world wide problem.
In 1991 the United Nations recognized drug abuse as a serious international
problem. The U. N. now directs an effort to reduce demand for drugs, sponsors research
on prevention treatment, and sponsors training of professional staffs. Committees work
for greater cooperation in enforcement, interdiction, and treatment upon demand. The
U. N. continues to oppose the legalization of non-medical use of mood-altering drugs.
The U. N. reported, “The illicit drug trade touches millions of lives in both
developed and developing countries. Its most negative impact is concentrated amongst the
most vulnerable of our societies. The UN estimated 180 million people worldwide--4.2%
of people aged 15 years and above—were consuming drugs in the late 1990s. This figure
includes 144 million consuming cannabis, 229 million consuming amphetamine type
stimulants, 14 million taking cocaine and 13 million people abusing opiates (9 million of
whom were addicted to heroin).” The UN also reported 33 million people have AIDS and
estimated 5% of HIV infections are due to infected needles. Four million children have
died because their mother had AIDS. [93. World Drug Report June, 2001]
Economic reliance on the drug trade and drug addiction leaves many individuals
open to exploitation by criminals and criminal organizations. This threatens the health of
men, women and children, the rule of law, and ultimately the vitality and strength of all
our communities.
The U. N. reports for the first time in recent history global production of drugs
such as heroin and cocaine shows signs of decline. Global cocaine manufacture continued
to fall and was 20 per cent lower than in 1992/93. Illicit opium production, the raw
material for the manufacture of morphine and heroin, declined in 2000 and was some 15
per cent lower than in 1994. Production of opium poppy and coca leaf is concentrated in
an ever smaller number of countries. Progress is reported in the demand side, where there
are signs of a decline in some of the main markets. These concerted efforts increase the
possibility of achieving at least in part the goal of a substantial reduction in the worldwide demand for and supply of drugs set by the UN for 2008. [www.who.int/whosis]
Perhaps an even greater tragedy than the death of the four million children of HIV/AIDS
in Africa is developing in China. China with 1.27 billion people is home of 20% of the
world’s population and consumes 30% of the world’s cigarettes. 1/3 of all young men in
China are predicted to die in the next few decades unless smoking habits there change. A
British Medical Journal tracked the rising death toll from smoking in Hong Kong in 1998
where approximately 66% of all men started smoking twenty years ago. The study
revealed that 37% of the deaths of Chinese men between 35 and 69 years of age in Hong
Kong in 1998 was caused by smoking. The study confirms that cigarettes are just as
harmful to Chinese as they are to people in the West. The World Health Organization
reports cigarette smoking world wide accounted for 3,000,000 deaths in 1998 and by 2020
will cause 10,000,000 deaths. The trend mirrors what occurred in the West years ago. [63.
News & Observer. (Raleigh, N. C.) 8-16-2001, p. 13A]
- 8 2-01. U. S. residents are largest consumers of illegal drugs.
Drug abuse is widely viewed as a major problems in the United States today. U.S.
residents are 5% of the world population but consume 60% of illegal drugs produced in
the world. Adults may legally use three drugs—alcohol, caffeine, and tobacco.
The abuse of tobacco before 18 and alcohol before 21 by children and young
people, and the illegal use of the drugs listed below are the problem. An estimated 14.8
million Americans used an illicit drug at least once during the past 30 days. While drug
use among teenagers is lower than in the 70’s, professionals say today’s drug culture is a
minefield. Today’s illicit drugs are more varied, more powerful, more available, more
likely to involve violent people , and more expensive. [57. 1999 National Household Survey on
Drug Abuse, Substance Abuse & Mental Health Administration; 63. N. & O., 11-14-96.]
TABLE 1. DRUG USE AMONG 211 MILLION PERSONS OVER 12 IN U.S.
_______________________(Estimates from self reports)__________________________
Frequency of drug use past month
% population
Drug
1990
1999(a)
12 & over
Caffeine
178,000,000 (b) 198,000,000
90.0%
Alcohol
106,000,000
105,000,000
47.3
Binge drinkers (5 drinks in a row)
29,540,000
45,000,000
20.2
Heavy drinkers (binge 5 X a month)
12,000,000
5.5
Youth 12-20 (29.4% of age group)
10,400,000
4.7
Youth 12-20 (binge drinkers)
6,800,000
3.1
Youth 12-20 ( heavy drinkers binge 5 X a month)
2,100,000 (c)
1.0
Tobacco (nicotine)
57,000,000
66,800,000
30.2
Cigarettes
57,000,000 (d)
25.8
Cigars
12,100,000
5.5
Pipes
2,400,000
1.1
Smokeless
7,100,000
7,600,000 (d)
3.4
Adult used illicit drug in last 30 days
25,000,000 (e)
14,800,000
6.7
Used an illicit drug other than marijuana
6,400,000
2.9
Marijuana
12,000,000
11,100,000
4.5
Non-medical use psychotherapeutic drug 3,400,000
4,000,000 (e)
1.8
Cocaine
2,900,000
1,453,000
0.7
Crack
500,000
413,000
0.2
Inhalants
1,200,000
896,000
0.4
Hallucinogens
800,000
900,000
0.4
Heroin
1,900,000
208,000
0.1
(a) National Household Survey. 1999. www.samhsa.gov/hhsurvey/content/highlights.htm
(b) Caffeinated beverages are not considered harmful if used in moderation. .
(c) Included in immediately preceding total. 14.9% of youth 12 to 17 smoked cigarettes.
They were 7 X more likely to use illicit drugs than their peers. Youth of 17 to 21 who
smoked were 4 times more likely to use illicit drugs than peers.
(d) Over 3 million adolescents are current smokers and over 750,000 use smokeless tobacco.
(e) Pain relievers (2.6 million users); tranquilizers (1.1 million); stimulants (0.9) sedatives (0.2 million)
- 9 2-02. Children don’t know how many children use drugs.
Children believe that “drug use is epidemic” and some take drugs because
“everyone else is doing it.” For example, the average six through eight graders believe
50% of fellow students are smokers when in fact only 15% of N. C. children are compared
to 9.2% nationwide. Students also have a poor grasp of the dangers inherent in tobacco use
because tobacco ads counter health warnings. If that belief is challenged and students are
shown surveys that prove otherwise, they will be less likely to become users.
2-03. Drug abuse among U. S. adolescents.
A recent national survey conducted at Columbia University asked adolescents if
they were likely to use illegal drugs in the future. Adolescents who were not using alcohol
or tobacco were more likely to say they would never use drugs in the future. Significantly
more adolescents who smoked but did not drink alcohol said they would probably use
illegal drugs than adolescents who drank but did not smoke. The study may help
understand adolescents’ thinking about experimentation with illegal substances and the
gateway theory of drug sequencing. [40. Johnson, Boles, and Kleber, National Center on Addiction
and Substance Abuse at Columbia U., J. of Addictive Diseases, 19(2) 75-81. 2000]
“The statistics of high school students’ use of cigarettes, alcohol, and illicit drugs
are alarming. Rate of initiation of use among 12-17 year old youth increased from 100.9
to 159.2 per 1000 between 1990 and 1997. Nearly two-thirds (63%) have tried cigarettes by
12th grade, and 31% of 12th graders are current smokers. Even as early as 8th grade, four
in every ten students (41%) have tried cigarettes, and 15% already are current smokers.”
Each day in 1998 an estimated 4,266 persons under 18 used marijuana for the first time
and 430 smoked, sniffed or snorted heroin for the first time. [57. 1999 Household Survey]
Surveys for approximately ten years have reported that every day (a) more than
6,000 persons in the U.S. under 18 smoke for the first time; (b) more than U.S. 3,000
persons under 18 become daily smokers, and (c) 1,000 of those who became daily
smokers will die from a disease caused by smoking because of a decision made as a child.
Slightly more than one-third of US high school students were cigarette smokers in 1997.
[83. Report of Surgeon-General, 2001.]
“Cigarette use reached its recent peak in 1996 at grades 8 and 10, capping a rapid
climb of some 50% from 1991. Since 1996, smoking in these grades has declined. Increases
in perceived risk and disapproval of smoking may be contributing to this downturn.”
[59. National Institute on Drug Abuse, Publication No. 01-4923, 2001, p. 5]
Children who start smoking at a younger age smoke more cigarettes per day than
children who start smoking at an older age. [Everett, S.A. Preventive Medicine 29(5):327-33, 1999
Nov.] Another study found that the likelihood of lifetime drug abuse and dependence was
reduced by 4% and 5% with each year drug use onset was delayed. [30. Grant, B.F. J. of
Substance Abuse 10(2):163-73, 1998.]
- 10 TABLE 2. DRUG, ALCOHOL, CIGARETTE USE 6-12 GRADE STUDENTS IN 1999
( Percent reporting engaging in this behavior)
Total
Mrijuana use, lifetime
Marijuana use, current
Cocaine use, lifetime
Cocaine use, current
47.2%
26.7
Sex_
Male Female
51.0%
30.8
43.4%
22.6
6-8th
9.3%
5.2
Grade level
9th
10th
34.8% 49.1%
21.7
27.8
11th
12th
49.7% 48.4%
26.7
31.5
9.5
4.0
10.7
5.2
8.4
2.9
2.2
1.3
15.3
3.4
9.9
3.7
9.9
4.5
13.7
4.8
Alcohol use, lifetime
Alcohol use, current
Episodic heavy drinking
81.0
50.0
31.5
80.4
52.3
34.9
81.7
47.7
28.1
39.5
12.1
--
73.4
40.6
21.1
83.2
49.7
32.2
80.8
50.9
34.0
88.3
61.7
41.6
Cigarette use, lifetime
Cigarette use, current
Cigarette use, frequent
70.4
34.8
16.8
70.5
34.7
17.9
70.2
34.9
15.6
-17.5a
--
61.8
27.6
11.2
73.9
34.7
15.2
69.9
36.0
16.7
78.0
42.8(b)
23.1
Before age 13
…smoked whole cigarette 24.7
…drank alcohol
32.2
…tried marijuana
11.3
27.3
37.4
14.5
22.1
26.8
8.0
----
27.0
40.4
12.7
28.5
35.6
12.6
21.1
26.2
9.5
20.7
24.3
9.5
14.8
6.1
10.1
13.2
3.6
4.4
----
11.8
4.4
6.6
14.9
5.0
7.6
14.3
4.7
7.0
14.9
5.0
7.3
34.7
25.7
--
27.6
32.1
31.1
30.5
On school property
…cigarette use
14.0
…alcohol use
4.9
…marijuana use
7.2
…offered, sold or given
an illegal drug
30.2
a -- 8th grade. Sourcebook of Criminal Justice Statistics, 1999 p. 232. www.ojp.usdoj.gov/bjs.
b -- Over 3 million adolescents are current smokers and over 750,000 use smokeless tobacco.
School based surveys suffer several inherent problems. Many studies are based on self-reported
data and might be suspect for that reason. In addition to faking and unintended biases in reporting due to
respondents' needs to provide socially desirable answers, many students drop out before graduation. In
North Carolina nearly 1/4 of 8th graders drop out before graduation. Many of these individuals are at
highest risk for chemical use. Also excluded from school surveys are children in juvenile detention, court,
detoxification and treatment centers, and children at home sick or truant from school on the day of the test.
However, the one study which tested 7th and 8th grade students four times over a 15 month period
reports that 95 percent of the students accurately reported recent cigarette use. This finding was verified by
saliva tests. Self reporting on alcohol and marijuana may be similarly valid. [58, p. vi.]
A study of steel worker on the west coast collected information by self report interviews, group
questionnaires at work place, telephone interview and interviews off work site, urine specimens, and hair
analysis. They found drug use was 50% higher than employees had reported. [14. Cook, Bernstein &
Andrews, NIDA Monograph. 167:247-72. 1997]
- 11 “Alcohol use (also) remains extremely widespread among today’s teenagers. A 1999
study confirmed drinking increased from, 3.9% among youths age 12 to a peak of 66.6%
for persons 21 years old. Binge drinking rates of alcohol in 1999 were 1.7% for 12 olds,
3.7% for 13 year olds, and 7.3% for 14 year olds. The use of alcohol drops slightly for
persons in their 30s and 40s.
Four out of every five students (80%) have consumed alcohol (more than just a few
sips) by the end of high school, and about half (52%) have done so by 8 th grade. In fact,
62% of the 12th graders and 25% of the 8th graders in 2000 report having been drunk at
least once in their life. Alcohol trends have paralleled the trend in illicit drug use. Binge
drinking (5 or more drinks in a row at least once in the past two weeks for boys and 4 for
girls) increased in the early part of the ‘90s, but a smaller increase than was seen for
most of the illicit drugs. Fortunately, binge drinking rates leveled off two years ago when
illicit drugs began to decline.” Heavy drinking is defined as five or more drinks on the
same occasion at least five different days in the past 30 days. [59. National Institute on Drug
Abuse, Publication No. 01-4923, 2001, p. 5]
2-04. Drug use by North Carolina middle and high school students.
Fifteen percent of N. C. children in 6, 7, and 8 grades in 1998 reported smoking
cigarettes. The national average was 9.3%. Nearly a third (31.6%) of North Carolina
high school students smoked while the national average was 28.5%.
The N. C. Research Triangle Institute on three occasions between 1985 and 1990
asked 4,199 students in an eastern NC county as to their use of legal and illegal drugs.
The results might have been more dramatic if 25% of the students including many heavy
users of cigarettes, alcohol and marijuana and other illicit drugs had not dropped out of
school or were absent. An analysis of the student’s responses revealed the following:







Adolescents are more likely to initiate and use substances as they progress through
middle school and into high school.
Students who increased the frequency of their cigarette use between age 12.3 and 13.7
were unlikely to decrease the frequency of their use of alcohol by 15.7.
Students who increased the frequency of alcohol use between 12.3 and 13.7 were more
likely to initiate marijuana and other illicit drug use.
The transition to heavy use of alcohol and cigarettes is a turning point in an
adolescent’s substance use career.
When alcohol and cigarettes were used heavily by adolescents, they were most often
used in combination with illicit substances.
The increase in the frequency of alcohol and cigarettes use may be the best predictor of
later multi-drug use.
The earlier the use of psychoactive drugs, the more likely it will result in problem use
and the longer substance use continues, the more serious it is likely to be.
- 12 The 1999 N.C. Youth Tobacco Survey found 18.4% of N.C. middle school students
and 38.3% of high school students are current tobacco users. Those percentages are
double the national average of 9.3% for middle school and a third more than the 28.5%
for high school students. More than 45% of all 12th graders report regular tobacco use.
Since 1991, smoking among N. C. high school students has increased more than 40%.
[67. N.C. Youth Tobacco Survey, 1999] The average age students start smoking is 12.2.
[11. Centers for Disease Control, 1997]
Next Step reports 38 % of N. C. high school students drink alcohol. (Nearly one
fourth of them are binge drinkers.) High school students in N.C. abusing alcohol and other
drugs are twice as likely to have a sexually transmitted disease. N. C.’s sexually
transmitted diseases rate among teens is three times the national average. National
statistics indicate only 16 percent of the youth needing substance abuse treatment receive
that treatment. North Carolina data indicates only three percent of the 50,000 public high
school students needing treatment received it in 1995. [ Next Step, Vol. 14, Ed.3 2001, p. 4.]
Teens who smoke are three times more likely than non-smokers to use alcohol, eight
times more likely to use marijuana, and twenty-two times more likely to use cocaine.
Smoking is also associated with a host of other risk behaviors such as fighting and engaging
in unprotected sex. [83. Surgeon General’s Report, 1994] Most teen smokers, like adults, report
that they would like to quit smoking, but feel that they are unable to do so. They
experience relapse rates and withdrawal symptoms similar to those of adults.
2-05. Drug use by high school seniors in 2000.
Reported use of marijuana by high school seniors during the previous month
peaked in 1978 at 37% and declined to its lowest level in 1992 at 12% before rising to 21.6
in 2000. Cocaine use in the past month by high school seniors peaked in 1985 at 6.7%, up
from 1.9% in 1975. Cocaine use by seniors in the past month declined to a low of 1.3% in
1992 and 1993, but had risen to 2.1% by 2000.
TABLE 3. DRUG AVAILABILITY & USE BY HIGH SCHOOL SENIORS IN 2000**
Used within the last:
Used within the last
Drugs
month
12 months* Drugs
month
12 months*
Stimulants
Hallucinogens
Other opiates
Sedatives
*
**
***
5.0 %
2.6
2.9
3.1
10.5 %
8.1
7.0
6.3
Inhalants
Tranquilizers
Steroids
Heroin
Cigarettes
2.2 %
2.6
0.8
0.7
42.8***
University of Michigan, Drug Use from the Monitoring Study, December 2000.
U. S. Department of Education, Indicators of School Crime and Safety, 2000.
Surgeon Generals Report, 2001. 23.1% report daily smoking .
5.9 %
5.7
-1.5
- 13 2-06.
What is sold like candy and will kill and disable one out of three regular users?
Dr. M. P. Eriksen of the U.S. Department of Health and Human Services noted
every day 3,000 new users, primarily teenagers, begin smoking, over 400,000 U.S. smokers
die annually and 2 million in developing countries. [109] After examining the social,
cultural, economic, and public policy forces that have contributed to maintaining the
tobacco problem in U.S. as it is today. He wrote
“The continued widespread use of tobacco is one of the greatest paradoxes of the
20th century. The cigarette was introduced to society early in this century, received broad
public acceptance in response to massive marketing and distribution efforts, and
survives—or more accurately, thrives in a complex and controversial social, medical, and
legal environment. Today, over 50 million Americans continue to use tobacco regularly,
despite the fact that it is almost universally known that use of the product as intended is
likely to result in ultimate death and disability for one out of two regular users. The latest
statistics tell us that over 400,000 Americans die each year, accounting for over 5 million
years of lost life, $50 billion in medical expenditures, and another $50 billion in indirect
costs. We estimate that 10 million Americans have died from smoking since the first
Surgeon General’s Report in 1964; another 25 million Americans alive today will
ultimately die, including 5 million children, as a result of a fundamentally adolescent
decision. Clearly, a unique mix of social and political forces have combined to result in a
deadly and addicting product being sold and marketed like candy, resulting in 90% of
users acknowledging the addictive nature of the product, 70% of whom would like to quit
and wish they had never started. But despite near-universal knowledge of the harm and
addictive nature of the product and widespread public support for changes in the status
quo, the status quo has not changed. Despite a consistent belief that tobacco should be
treated commensurate with the harm that it causes, changes in public policy have been
surprisingly recalcitrant.” [78. Social Forces, “Nicotine & Tobacco Research,” 9-1999]
2-07. Alcohol.
In a self reporting survey 47.3% of Americans ages 12 and older (105 million)
indicated they were current drinkers of alcohol in the 1999. Approximately one-fifth
(20.2%) of persons 12 years of age and older (45 million people) reported they binge drank
at least once in the 30 days prior to survey. [57. National Household Survey, 1999] “The level of
alcohol use has long been associated with illicit drug use.” Of the 12.4 million heavy
drinkers, 30.5% (3.8 million) are current illicit drug users. [See p. 36]
There are 125,000 deaths each year in the U.S. due to the consumption of alcohol.
It is the 3rd leading cause of death in the U.S. and the major cause of cirrhosis of the liver.
Alcohol was involved in an estimated 1,049,900 vehicle crashes in the U.S. in 1998. These
crashes killed 15,935 and injured an estimated 821,000 people. Of the 41,611 fatalities in
auto accidents in the U.S. in 1999, 38% (15,786) involved either a drinking driver or
pedestrian. 12,321 or 30% died in a crash where either the driver or a pedestrian had a
- 14 BAC (blood alcohol concentration) of over .10. 2,236 youth died in alcohol-related crashes
in 1999. The five top ages of persons dying in crashes were 17, 18, 19, 20, and 21.
[56. National Highway Traffic Safety Administration. 9-2001. www.nhtsa.dot.gov]
In North Carolina in 1999 alcohol was a factor in 27% of auto accidents (34,600)
involving alcohol. These crashes killed 513 and injured an estimated 22,000 people. The
alcohol-related crashes in N.C. cost the public more than $3 billion in 1998. People other
than the drinking drivers paid $1.3 billion of the alcohol-related crash bill. [[In 1997 drivers or
pedestrians who had been drinking were involved in accidents in the following states: South Carolina: 4,760 crashes, 273 killed, 7,300
people injured; Tennessee: 28,900 crashes, 496 killed and 11,700 people injured; Wisconsin: 25,700 crashes, 329 killed, and 15,500
people injured; Virginia: 30,700 crashes, 343 killed, 17,700 people injured. [U.S. Department of Transportation, www.nhtsa.dot.gov]
In 1999 the N.C. drivers between 15 and 20 years of age constituted 7% of all
drivers, but were drivers in 15% of fatal crashes, and 13% of the drivers involved with
alcohol. Alcohol-related crashes accounted for an estimated 14% of North Carolina’s
auto insurance payments. Reducing alcohol-related crashes by 10% would save the
citizens of North Carolina 70 million in claims payments and loss adjustment expenses.
While the present loss of life and money due to drinking and driving is both
shocking and demanding that we do more, between 1982 and 1999 (1) the number of youth
decreased 2.9%: (2) the motor vehicle fatalities decreased by more than 25%, and (3) the
alcohol-related fatalities decreased by 58%. The new laws and better enforcement
responsible for this reduction are discussed in Sections 6 and 8.
2-08. Alcohol abuse among college students.
Two surveys in 1997 and 1999 at the University of N. C. at Chapel Hill using
breathalyzer tests found fewer students binge drinking than reported by the Harvard self
reporting nationwide survey obtained by mail. The Carolina survey was carefully
designed and controlled for class, gender, sex, fraternity/sorority, days of the week, and
hours of testing. Students were given a breathalyzer test to determine their BAC (blood
alcohol concentration) as they returned to their dorm or fraternity/sorority between the
hours of 10:00 p.m. and 3:00 a.m. on six nights of the week (every night but Tuesday).
TABLE 4. BAC TESTS OF STUDENT DRINKING, UNC-CHAPEL HILL--1997/1999
Breathalyzer Test .00
Breathalyzer Test > 8%
65% in 1997
13% in 1997
71% in 1999
9% in 1998
[Governor’s Highway Safety Committee, UNC-CH. 1999]
In the 1997 Harvard School of Public Health College Alcohol Study conducted a
random mail survey of students attending 140 colleges. They found that 2 of 5 students
were binge drinkers (42%); 1 in five (19%) was an abstainer, and 1 in 5 a frequent
binge drinker (20.7%). They found 4 of 5 residents of fraternities or sororities were binge
drinkers (81.1%). They found students involved in college athletics engaged in binge
drinking and tobacco more often than students not involved in athletics, but were less
- 15 likely to be cigarette smokers or marijuana users. The strongest predictors of binge
drinking among students involved in athletics were residence in a fraternity or sorority, a
party lifestyle, engagement in other risky behaviors, and previous binging in high school.
[92. Weshsler, Dowdall, Maenner, Hoyt.., J. of Am. College Health. 45(5):195-200, 1997; 47(2): 57-68, 1998.]
TABLE 5. BINGE DRINKING AMONG U. S. COLLEGE STUDENTS---1999
Drinking in the past 2 weeks
Problem
Nonbinge (a) Occasional (b) Frequent (c)
N=5,063
(N=2,962)
(N=3,135)
Miss a class
8.8%
Get behind in school work
9.8
Do something you regret
18.0
Forget where you were or what you did
10.0
Argue with friends
9.7
Engage in unplanned sexual activities
7.8
Not use protection when you had sex
3.7
Damage property
2.3
Get into trouble with campus or local police
1.4
Get hurt or injured
3.9
Require medical treatment for alcohol overdose 0.3
Drove after drinking alcohol
18.6
30.9%
26.0
39.6
27.2
23.0
22.3
9.8
8.9
5.2
10.9
0.8
39.7
62.5%
46.3
62.0
54.0
42.6
41.5
20.4
22.7
12.7
26.6
0.9
56.7
Henry Wechsler et al. “College Binge Drinking in the 1990s. A Continuing Problem.” J. of American
College Health, v. 48 (Mar. 2000) p. 207. Note: Table includes only students drinking alcohol in past year.
(a) Students who consumed alcohol in the past year but did not binge in the previous two week period.
(b) Students who binged one or two times in the previous 2-week period.
(c) Students who binged three or more times in the previous 2-week period.
2-09. Marijuana.
“Marijuana is the most commonly used illicit drug used by 75% of current illicit
drug users. Approximately 57% of illicit drug users consume only marijuana. 18% of
users also use another drug. The remaining 25% of drug users use one or more other
drugs but not marijuana. In 1999 marijuana was used by 0.6% of 12 year olds and by
5.9% of all 14 year olds. However, 9.2% of 14 year olds were also were using other illicit
drugs. [57. National Household Survey on Drugs, 1999]
“Teen smoking of marijuana increased more rapidly in the 1990’s than of
cigarettes. Annual use rates peaked in 1996 at 8th grade and in 1997 at 10th and 12 grades.
An estimated 2.3 million Americans used marijuana for the first time in 1998. The
number increased from 1.4 million in 1990 to 2.6 million in 1996. The rising use during
the 1990s seem to have been fueled primarily by the increasing rate of new use among
youth from age 12 to 17 years (from 45.6 per 1,000 potential new users in 1991 to 90.8 per
1,000 potential new users in 1997). Perceived risk of using marijuana declined 17% among
8th, 10th and 12th graders between 1992 and 1997.” As expected, marijuana use increased.
- 16 Southern Illinois U. surveyed students at 1,400 colleges over a three year period
and reports marijuana use in the previous month by college students rose from 14.1% in
1991 to 20.7 % in 1999. Use in the previous year rose from 26.5% in 1991 to 35.2% in
1999. Researchers believed the data is representative of 14 million college students.
The question of whether marijuana is a dangerous menace or …”a kind of benign
and unfairly persecuted folk medicine” was the focus of an article in the Dec. 9, 1996 issue
of Time. The article noted voters in Arizona and California in November had passed
propositions legalizing the use of marijuana for medicinal purposes. However, federal
laws prohibit prescribing marijuana. Physicians must have the authorization of the U.S.
Drug Enforcement Administration to prescribe controlled substances, including common
pain killers. Dr. Alan Leshner of the National Institute of Health said, “There is not a
body of scientific evidence that supports these initiatives or the medical use of smoked
marijuana.” The U.S. DEA is most concerned that teenagers are led to believe that
marijuana is harmless. The American Glaucoma Society reports no form of marijuana is
suitable for treatment of glaucoma. [1. American Glaucoma Society, Drug Abuse Update. Fall. 1996]
Time in 1996 reported, “in the past decade, media stories registering disapproval of
marijuana have tapered off…It is true that the new generation of weed is stronger than
marijuana of the 60’s…the potency of THC, tetrhydrocannabinol, the active agent in
marijuana which changes the way in which sensory information is processed by the brain
has nearly doubled in the past nine years. Potency means it takes fewer puffs to get high,
thus cutting down on damage to the respiratory system”… “Stronger pot and higher kids
often lead to more reckless driving and accidents…Apologies and rationales for
marijuana are often ingenious, sometimes fervent, and in their essence, when applied to
adolescents, dangerously wrong. The state of development through which a child passes
from age 12 to 18 is critical…It is a painful, indispensable process. Adolescence quite
precisely requires the pain and difficulty of learning in order to come out well. Among the
lessons, of course, are how to love and support others and how to be responsible.”
“When people are stoned on marijuana, they tend to focus on one thing at a time:
the food, the music, the dog. Conversation deteriorates.” More important, says Steve
Sussman, a drug-abuse researcher and associate professor at U.S.C., “you don’t learn how
to cope with real life. You don’t learn how to experience life in real terms, to feel bad
normally. Let’s say you smoked marijuana heavily from age 16 to 26, then stopped. The
way you process life events emotionally after that may be more like a 16-year old.” It is in
the realm of emotional development that marijuana does its damage.[85.Time,12-9-1996. p. 28]
Time quoted Joseph A. Califano, president, The National Center on Addiction and
Substance Abuse at Columbia University. We know marijuana “can savage short-term
memory and that it adversely affects motor skills and inhibits social and emotional
development-—just at the time such skills and development are most critical, when kids
are in school. We can tell them that smoking pot as a young teen is decidedly more
dangerous than beginning at twenty something. Our research shows that the earlier
- 17 someone smokes marijuana, the likelier that youngster is to move on to other drugs.
Children who smoke pot before age 12 are 42 times likelier to use drugs like cocaine and
heroin than those who first smoked after age 16.” [85. Time, 12-9-1996, p.28]
Donna Shalala, Secretary of the Department of Health and Human Services
wrote, “Our children need to hear a clear and consistent no-use message about
marijuana—that it is illegal, dangerous and wrong. Research tells us it limits learning,
memory, perception, judgment and motor skills, and it damages the brain, heart, lungs
and immune system. Marijuana is not a ‘soft’ drug.”
An article reported the response of marijuana users to a questionnaire as to
physical and mental health consequences of the use of the drug cannabis. A 25 item
questionnaire was mailed to 1000 persons aged 18 to 25. Of those who responded, 199
admitted to life-time cannabis use. The average age was 27, and 102 were male and 97
were female. One hundred and four subjects stated they had been daily users and smoked
an average of 3.5 cannabis cigarettes. Of the 199 users 44, (22%) had experienced acute
anxiety or panic attacks, 30 (15%) reported psychosis symptoms following cannabis use.
Thirty-eight (19%) reported memory loss or ‘blackouts’ for periods when they were
intoxicated. Twenty three (12%) stated their physical health had been harmed by
cannabis use. [16. Drug and Alcohol Dependence, Fall, 1996]
Specific physical health problems attributed to cannabis use were frequent nausea
and/or vomiting (17 subjects, 8.5%) headaches (16 subject. 8%) and persistent coughing
(12 subjects, 6%) Eighty-three subjects (42%) reported they voluntarily tried to restrict
the amount of cannabis they used. Seventy subjects (35%) reported they were unable to
stop when they wanted to and continued use despite problems attributed to the drug.
Forty-seven subjects (24%) felt unable to control consumption (26 subjects, 13%).
Thirty eight subjects (19%) reported they were unable to carry out responsibilities
because of cannabis use. A quarter of those surveyed (50) had at some time been in the
habit of taking cannabis first thing in the morning and (39) reported restlessness or
irritability if they were unable to use cannabis. Fourteen percent of subjects (14%)
reported neglect of other activities which were previously considered important or
enjoyable due to cannabis use. [16]
2-10. Tobacco use among adults--abroad and in the U.S.
The World Health Organization estimates that of the 5.7 billion people aged 15
years and over in the world one-third or 1.9 billion smoke tobacco. Of these, 800 million
are in developing countries. World wide, approximately 47% of men and 12% of women
smoke. In developing countries, 48% of men and 7% of women smoke, while in developed
countries, 42% of men smoke as do 24% of women. By mid 2020s, the transfer of the
tobacco epidemic from rich to poor countries will be well advanced, with only about 15%
of the world’s smokers living in rich countries. Health care facilities in poorer countries
will be hopelessly inadequate to cope with this epidemic. [www.who.int/whosis]
- 18 In the U.S. in 1998, an estimated 47.2 million adults (24.1%) smoked cigarettes
and an estimated 420,000 died as a result of using tobacco. Total cigarette consumption in
the U.S. was 2.5 billion in 1900, peaked at 640 billion in 1981, and is estimated at 420
billion for 2000. Per capita annual consumption peaked in 1963 and with few exceptions
has steadily declined. Since 1963 per capita consumption has declined 40 percent and is
now down to the level smoked in 1940.
Cigar consumption in 2000 is estimated at 3.7 billion cigars, 75 million less than
1999 consumption. However cigar smoking rates have increased markedly in the 1990’s.
According to the California Adult Tobacco Use Survey, cigar use among California men
almost doubled between 1990 and 1996, from 4.8% to 8.8%. Cigar use among California
women increased five-fold from .2% to l.1% Nationwide, it is estimated that 21.9% of the
adult population are current cigar smokers. In 1998, 6.8% of the population used pipes,
23% chewed tobacco and 36.3% used snuff. This is the first drop in six years. Snuff
consumption in 2000 was estimated at 70,400,000 pieces. [83. Surgeon, General Report, 2001]
The increasing spread of restrictions on where persons can smoke and the
awareness of health consequences have probably contributed to a decline in the average
number of cigarettes smoked per day. For example, between 1974 and 1998, the
percentage of adults who smoked <15 cigarettes per day increased by 33 %. Over this
same period, the percentage of heavy smokers (i. e., smoked > 24 cigarettes per day)
decreased 26.5%.
The prevalence of smoking declines with increasing years of education. In 1998,
the prevalence of cigarette smoking ranged from 10.9% among college graduates to 34.4
percent among those with less than a high school education.
2-10.1. Cigarette smoking by adults in North Carolina.
Smoking is the leading preventable cause of death in N.C.--it kills 12,000 persons
annually. A higher percent of N. C. adults smoke cigarettes than in the average state.
North Carolina tied for 9th among the 50 states in percent of adults smoking cigarettes. In
1999, 25.2% of North Carolinians smoked cigarettes. The national average was 22.7%.
2-11. Cocaine and Heroin.
The 1999 National Household Survey estimated there were 4,324,000 persons in the
U.S. who weekly used cocaine, crack cocaine, or heroin. Cocaine which is reported to be
used each week by 1,453,000 persons in the U.S. is said to be the most addictive drug
available today. Persons using cocaine at least once a week are considered "hard-core
cocaine addicts. Unlike most drugs, cocaine isn't physically addictive, so the physical
withdrawal symptoms are absent. Instead, psychological symptoms appear--depression,
anxiety, and uncontrollable drowsiness. Twice as many persons, 2,900,000 Americans
were believed to have been using cocaine in 1990.
- 19 “Crack cocaine, a crude form of cocaine free base, had a rapid growth following
its introduction in 1986. At least 413,000 persons were believed using it in the United
States in 1998. This is slightly fewer than the 500,000 persons thought to be using it in
1990. Its rapid growth has been attributed to the lower price of crack than cocaine salt
preparations, as well as the easier and more effective method of administration by
smoking. An estimated 4% of high school students are using crack once a month.”
“Heroin was believed used regularly by 205,000 persons in the U.S. in 1998.
NHSDA estimated that 149,000 persons tried heroin for the first time in 1998. One
quarter (125,000) of the persons who used heroin for the first time during 1996 and 1998
were under age 18, and another 47% were 18 to 25. Use among youths age 12-17 increased
from 5.1 in 1992 to 13.1 per thousand in 1996.” [57. NHSDA, Estimates of Substance Use, 1998]
2-12. Cocaine addiction rates.
Authorities estimate that from 4 to 20 percent of the persons trying cocaine
become addicted. Tests of cocaine addicts reveal most are using at least one other drug.
The Associated Press reported that New York City in 1993 had the highest concentration
of frequent cocaine users, one out of 40. North Carolina was reported to have 6.3 frequent
cocaine users per 1,000 residents.
2-13. Hallucinogens including LSD.
Hallucinogens or psychedelics, are a heterogeneous group of compounds that affect
a person’s perceptions, sensations, thinking, self-awareness, and emotions that were used
by an estimated 900,000 persons in 1999. (See page 3) The effects are unpredictable and
depend on the amount taken, the user’s personality, mood and expectations, and the
surroundings in which the drug is used. LSD is the most widely used hallucinogen. As
concern about “bad trips” grew in the 1970, use declined. Disapproval of LSD and its
perceived risk fell among 8th and 10th graders and high school seniors between 1993 and
1998. Since then there has been a slight increase in disapproval among high school seniors
and leveling of use among 10th graders and a further decline of use among 8th graders.
2-14. Barbiturate/Sedatives.
Barbiturate use by adolescents has increased gradually in the past several years, but few
adolescents use sedatives regularly.
Instead
short-acting barbiturates such as
pentobarbital and secobarbital are used most often to treat unpleasant effects of illicit
stimulants, to reduce anxiety, and get “high.” Barbiturates are dangerous drugs, with a
narrow therapeutic index between the dose required for sedation and the dose that will
cause coma and death. They are physiologically addicting if taken in high doses over one
month or more, and the abstinence syndrome can be life-threatening. The 1995 survey of
United States high school seniors revealed that many young people are not aware of the
significant danger and toxicity of this class of drugs.[70.Pediatrics in Review 18(8):260-4 (1997
Aug)]
20 2-15. Smokeless tobacco—snuff and chewing tobacco.
Smokeless tobacco--snuff or chewing tobacco--was reported used by 2.3% of youth
ages 12 to 17 and a total of 7,600,000 U. S. residents in 1998. (Table 1). Snuff dipping had
little future until 1981 when U.S. Tobacco (now called UST, Inc.) the dominant
manufacturer of snuff began spending millions on Olympic games ads to increase sales.
Smokeless tobacco sales increased to 48 million lbs. in 1991. Teenage snuff dipping has
increased 24 percent since 1986 while cigarette smoking declines. Dipping the moist oral
snuff allows nicotine and other drugs to seep continuously into highly absorptive tissues.
The Federal Drug Administration has established a limit of 10 parts per billion of
nitrosamine—a chemical believed to be associated with cancer— in bacon. Copenhagen
snuff, exempt from FDA regulation, contains 1,000 parts per billion.
2-16. Inhalants.
Inhalants provide many children their first experience with drugs. They include
model airplane glue, nail polish remover, lighter and cleaning fluids, gasoline, and aerosols
such as hairsprays. Although different in makeup, nearly all abused inhalants produce
effects similar to those of anesthetics, which act to slow down the body’s functions or
produce feelings of dizziness. At low doses users may feel slightly stimulated.
There were an estimated million children using inhalants in 1998 and 991,000 new
inhalant users. An increase in use by young adults has been noted. For example, first use
among young adults age 18-25 rose between 1990 and 1998 from 4.6 to 11.2 per 1,000
potential new users. [15. NHSDA, National Estimates of Substance Use, 1999]
2-17. Ecstasy.
The number of high school seniors who said they had used Ecstasy in the previous
year doubled between 1998 (3.5%) and 2000 (8%). Among 10th graders use had risen
from 3% in 1998 to 5% in 2000. Ecstasy is produced in Netherlands or Belgium and
smuggled into New York, Los Angeles, and Miami by Israeli and Russian organized gangs.
Ecstasy is reported not to cause the same dangerous changes in mood and
judgment as crack does. It induces a high for up to six hours, enhancing feelings of
empathy and closeness. Drug experts say the drug known scientifically as MDMA, is both
a stimulant and a hallucinogen. It can be disruptive and expose users to violence.
Dr. Alan Leshner, director of the National Institute of Drug Abuse in Bethesda,
Md. said, “It is a neurotoxin with serious side effects. People die from overdoses. The bad
short-term effects are quick increase in blood pressure, heart rates and body
temperature, leading to dehydration and hypothermia…There is now evidence repeated
use can damage the brain cells that produce serotonin, the neurochemical that is critical
- 21 for preventing depression and sleep disorders. People who have used Ecstasy frequently
experience memory loss and depression when the drug wears off.”
The federal government and half the states, including N.Y., N. J., and Florida have
raised the penalty for selling the drug recently. Under new federal sentencing guidelines
that took effect in May 2000. A person selling 800 pills can now receive a sentence of five
years. An Illinois bill recently passed provides 6 to 30 years for selling as few as 15 pills.
The lucrative profits on a pill which wholesales for $1 and retails for $8 to $25 has result
in gang warfare and a number of homicides. [64. N.Y.T. 6-24, 2001, p.1]
2-18. Gender.
Cigarettes were smoked by 34.9% of female high school students and 34.7% of male
high school students in 1999. 51.0% male and 57.9% female students reported they
wanted to quit; 53.4% of male and 57.9% female students said they have tried to quit in
the last 12 months; only 8.7% of male and 8.9% of female students have used cessation
programs to quit. [83. Surgeon General, Trends in Tobacco Use, 2-2001]
Tobacco use was higher among college men than college women (37.9% vs 29.7%
despite nearly identical current cigarette smoking rates between the sexes (28.5% for
women vs. 28.4% for men) because of greater use of cigars (15.7 vs 3.9%) and smokeless
tobacco 8.7% vs. 0.4% among men. [43. JAMA, 284 (6) p. 699 7-2000]
Among youth age 12-17, the rate of current illicit drug use was slightly higher for
boys (11.3%) than for girls (10.5%. While boys age 12-17 had a slightly higher rate of
marijuana use than girls (8.4% compared to 7.1$), girls were somewhat more likely to use
psychotherapeutics non-medically than boys (3.2% compared to 2.6%).
Males were more likely to be dependent on illicit drugs than females. In 1999,
2.0% of males (age 12 and older) were dependent on illicit drugs compared to 1.3% of
females. Males were also more likely to be dependent on alcohol (4.9% compared to
2.6%) and more likely to be dependent on illicit drugs (6.0% compared to 3.4%). Male
drivers dying in vehicle crashes are twice as likely as female drivers to be legally drunk.
2-19. Substance abuse by adult women.
Women's substance abuse is a problem of serious social dimensions whose impact
potentially falls heaviest on poor and minority women. Although there are indications that
illicit drug use of all kinds is declining, the number of women of childbearing age who
abuse legal and illegal drugs remains high. Five million women of childbearing age (15 to
44) currently use illicit drugs, including over three million who use marijuana. In addition,
approximately six million American women are alcoholics or alcohol abusers. [39, p. 599]
Over 2 million women were addicted to prescription drugs, 500,000 were heroin addicts,
and the female lung cancer rate now matched that of males. [25, p. 1516] Smoking during
pregnancy has been linked to low birth weight, retardation, behavioral problems in child-
- 22 ren, and even criminal behavior in adulthood. Smoking among pregnant teenagers
climbed to 20% in 1999. Without support and treatment, women substance abusers who
become pregnant pose serious threats to fetal well-being. One estimate is that 375,000
babies born per year have been exposed to illicit substances of all kinds in utero, including
cocaine. Abuse of drugs has potentially severe repercussion for fetal development.
A 1999 survey reports 3.4% of pregnant women age 15-44 were using illicit drugs
when interviewed in 1999. This was significantly lower than the 8.1% rate among nonpregnant women. Among pregnant women age 15-17 years and 18-25 years, the age groups
with generally higher levels of use, the rates were 7.5 and 6.5 respectively. [76. SAMSA, 1999]
A female drug user’s lifestyle also puts her fetus at risk of HIV infection. In 80
percent of these reported cases of pediatric acquired immune deficiency syndrome in
children under age 13, AIDS was attributed to maternal transmission of the virus. Of these
cases of maternal transmission 90 percent of the babies' mothers either used intravenous
drugs or had heterosexual partners who were intravenous drug users. [46, p. 600]
Over 22,000 babies were deserted in 851 U. S. hospitals in 1991. Following delivery,
their crack addicted mothers left the hospital providing phone addresses and home
numbers to slip back to cocaine habits and homelessness. Three quarter of the infants
tested positive for drugs at birth. The maintenance cost of caring for one premature baby
is up to $1,500 a day. [85. Time, p. 58, 1-24-94]
2-20. Perscription drugs.
In 1998 the National Household Survey on Drug Abuse found 9.3 million
Americans were abusing prescription drugs. This was more than any illicit drug other
than marijuana. More than 1.6 million were new users, three times the half million new
recreational users in 1980. Many prescription drug abusers start with a real physical
reason and are looking for a quick fix.
Of the 61,159 DWI arrests in North Carolina last year, officials estimate 4 percent
involved drugs other than alcohol. 10% of the 3,799 DWI arrests in Wake county were for
abuse of prescription drugs. The profile of a prescription drug abuser is typically a white,
middle-class female between the ages of 20 and 45. Police described the arrest of a 44 year
old Cary resident in March, 2001 as a small case. She was charged with getting more than
1,000 hydrocodone pills, sold under the brand names of Vicodin and Lortab, in the
previous six months from nine doctors and 15 pharmacies. Police report an increasing
number of people are forging prescriptions and feigning ailments to get narcotics. Fueling
demand is the growing recreational use of a new narcotic called oxycodone.
Forgery is a popular way to get narcotics. Some women pretend to be a nurse and
call in prescriptions while others alter prescriptions for higher amounts or different drugs.
Sometimes people steal prescription pads and write their own by copying what was on a
legitimate prescription. In Raleigh 49 prescriptions were known to be forged in 1998 and
- 23 94 were discovered in 1999. Traditionally, hydrocodone, a narcotic painkiller used to
alleviate moderate to severe pain such as a sore back or toothache, has been the drug of
choice for prescription drug addicts. Benzodiazepines, such as Valium or Xanax, also are
frequently abused. Oxycodone, commonly sold under the brand name OxyContin, is a
more potent narcotic than hydrocodone and was the object of three-quarters of the
forgery cases in Durham last spring. [63. N.& O., 3-27-2001. P. 1B-5B.]
2-21. Drug use and higher education.
Past month alcohol use was reported by 63.2% of full time college students
compared to 52.1% of their counterparts who were not students. Among full time
male college students 18 to 22 years of age, 53.2% reported binge drinking and
26.6% reported heavy drinking. For males not full time college students, 45.1%
reported binge drinking and 17.6% reported heavy alcohol use. More than a third
(34.2%) of female full time college students were binge drinkers and 10.7% reported
heavy alcohol use. Among females not full time college students, 26.3% reported
binge drinking and 6% reported heavy alcohol use.
College students enrolled full time in college were less likely than their peers
not enrolled full time (including part time college student and persons not enrolled
in college, to report current cigarette use. Past month cigarette use was reported by
33.8% of full time college students compared to 44.1% of their not enrolled peers.
Illicit drug use was 4.8% among college graduates and 7.1% among adults who had
not completed high school. One third (33.8%) of fulltime college students smoked
ciger- ettes in 1999. Only 10.9% of college graduates smoked cigarettes while
34.4% of those with less than a high school education did. [83. Surgeon General, Trends
in Tobacco Use. 2001] The rate of illicit drug use was the same for undergraduate
college students and non students.
- 24 3-00. What do drugs do physiologically, psychologically and to careers and communities?
The following are tangible, direct, important ways in which drug use can affect the
drug user and the well-being of others in the society. Insofar as these are accepted as
important harms to others that can be linked directly to drug use, they establish part of the
justification for criminalizing drug use. The economic and social costs will be discussed in
Chapter 4.
3-00.1. Physiological consequences--nutrition.
Drug use and abuse adversely impacts many body systems and functions, including
the digestion and metabolism of nutrients. Marijuana use is frequently accompanied by an
increase in the quantity of food consumed, but a reduction in nutritional quality, leading to
nutrient deficiencies. Heroin abuse can lead to muscle breakdown and kidney failure,
altered insulin responses, abnormal glucose tolerance, and alterations in potassium levels.
Use of cocaine has resulted in nutritional deprivation because of dramatic changes in eating
habits. Nicotine use by heavy smokers results in a lower intake of sugars and high calorie
carbohydrate foods, as well as reduced water intake. Many women believe they will eat
less if they smoke. Withdrawal can lead to substantial changes in food intake which may
cause weight gain or loss. [51. Mary Mohs, “Nutritional effects of marijuana, heroin, cocaine and
nicotine. “ [J. of Am. Dietetic Association, p. 1261]
3-00.2. Physiological consequences--health.
Most tobacco users are aware that tobacco contributes to lung cancer, heart
disease, cancer of mouth and throat and large medical and hospital expenses. [See 5-05]
Few smokers or non-smokers, policy makers or leaders know that





Tobacco and tobacco smoke contains hydrogen cyanide (used in gas chambers), arsenic
(a poison), formaldehyde (an embalming fluid, phenol (a disinfectant), lead, and more
than 45 carcinogenic compounds, like enzopyreme and benzopyreme;
the carcinogenic potency of benzopyreme is 50,000 times greater than saccharin;
an average cigarette delivers 1 mg of nicotine (acute ingestion of 60 mg. is lethal);
that spitting tobacco has nitrosamine levels hundreds of times higher than those
permitted in bacon or beer;
that nicotine rapidly crosses the placenta to the fetus, usually circulating at higher levels
in the fetus than in the mother. [Dunnington, J.S.]
Like many drugs that affect the nervous system, nicotine at once stimulates and
relaxes the body. Because it is inhaled, it takes only seven to ten seconds to reach the
brain—twice as fast as intravenous drugs and three times faster than alcohol. Once there
it mimics some of the actions of adrenaline, a hormone, and acetylcholine, a powerful
neurotransmitter that touches off the brain’s alarm system. After a few puffs, the level of
nicotine in the blood skyrockets, the heart beats faster and blood pressure increases. The
result is the smoker becomes more alert and may actually even think faster. In addition,
- 25 nicotine may produce a calming effect by triggering the release of natural opiates called
beta-endorphins. Thus a smoker commands two states of mind--alertness and relaxation.”
“Nicotine constricts blood vessels, casts a pallor over the face and diminishes
circulation in the extremities, often causing chilliness in the arms and legs. It relaxes the
muscles and suppresses the appetite for carbohydrates. Not long after taking up the habit,
smokers become tolerant of nicotine’s effects; as with heroin and cocaine, dependence
quickly follows. Tobacco only seems safer because it is not immediately dangerous.
Nicotine is not likely, for example, to fatally over stimulate a healthy heart, cause
hallucinations or pack anywhere near the same euphoric punch as many other drugs.
“People die with crack immediately, with cigarettes the problems occur twenty years down
the line. Nobody lights up their first cigarette and dies.” [83. Surgeon General, 1988 Report]
A description of some of behavioral and physical changes resulting from alcohol
use appear on page 2. For example, “Alcohol, one of the most widely used of all drugs, is a
central nervous system depressant with effects similar to those of sedative-hypnotic
compounds. At low doses, alcohol may be associated with behavioral excitation thought to
be due to the depression of inhibitory neurons in the brain. Alcohol differs from sedativehypnotic compounds in that it is used primarily for recreational or social rather than
medical purposes.”
Some studies have suggested moderate consumption of wine or some other alcoholic
beverages will reduce heart disease. A study by the National Institute on Alcohol Abuse
and Alcoholism found that rather than reduce heart disease black men and both black and
white women are more likely to experience heart disease if they consume more than two
drinks of an alcoholic beverage a day. [34. Hanna, Chou, and Grant, Alcoholism: Clinical &
Experimental Research. 21 (1):11108, 1997 Feb.]
“Marijuana alters perceptions, concentration, emotions, and behavior, although the
mechanisms of action are not entirely clear. Researchers have found, however, that THC
changes the way in which sensory information is processed by the brain. It can be used
medically to relieve nausea and side effects of chemotherapy in cancer patients; it is very
rarely used to treat glaucoma. Drug use can be determined by urinalysis (of use over
previous two days), saliva, and assay of hair (of use for several months and depending on
length of hair). Drug abuse can sometimes be diagnosed through examination of the eyes.
Cocaine, marijuana, alcohol, and barbiturates produce physical manifestations.
Marijuana reddens the eyes, dilates pupils, and if inhaled irritates the nose. [15, p.138-49.]
3-00.3. Physiological consequences—Deaths caused by drugs in the U. S. in 1998.
The U.S. Surgeon General’s 2001 Report stated 1 million persons, mainly children,
start smoking every year and 400,000 Americans die annually from diseases related to
smoking. Smoking is responsible for one in five U.S. deaths and cost the economy at least
100 billion dollars in health care costs and lost productivity each year. Since World War
II women have been increasing their smoking of cigarettes and now cancer of the lung
- 26 TABLE 6. ESTIMATED DEATHS FROM DRUG USE IN U. S. IN 1998
430,700 persons
125,000
“
53,000
“
6,000
“
1,889
“
15,938
“
13,426 (a) “
645,953
die annually of lung cancer/heart disease caused by smoking tobacco.
“
“
due to diseases attributable to alcohol.
“
“
from second hand smoke.
“
“
from overdoses of heroin and cocaine.
“
“
“
inhalent use.
“
“
killed by drunk drivers (35% of 41,471 fatalities)
“
“ ¼ of 46,247 AIDS deaths in ’98 due to needle sharing.
(a) The Center for Disease Control reports that an estimated 25% of the persons contracting AIDS in
the U.S. became infected by sharing needles while doing drugs. An estimated 40,000 new infections
occur in the U.S. annually, but that number has declined since 1995.
rates of American women have passed the rates of men. Studies estimate that at least one
third of all regular cigarette smokers
will die of smoking-related diseases.
[www.cde.gov/tob…/sgr_2000_tobacco_facts]
The Surgeon General warned in 1964 that smoking caused cancer. Tobacco companies testified before Congress as late as 1996 denying that smoking caused cancer even
though their files now reveal they have known that it did for 50 years. The Oct. 1996 issue
of Science reported a team of researchers had found cell biology linking smoking to lung
cancer. The scientists say a chemical found in cigarette smoke has been found to cause
genetic damage in lung cells that is identical to the damage seen in many malignant lung
tumors. They demonstrated how a chemical in cigarette smoking can damage a gene that
suppresses the haywire cell growth of cancer. [64. New York Times,10-18-96, p. 1, 9A]
A research study in Norway found that women who smoked 20 or more cigarettes a
day were six times more likely to suffer heart attacks than women who never smoked. For
men, heavy smokers’ risk was only 2.8 times higher. Why do women take the harder hit?
According to the report from the American Heart Association, the smoke targets two of
women’s “natural protectors” from cardiac threats—estrogen and high amounts of higherdensity lipoprotein (HDL), the ‘good” cholesterol. [75. Salina Journal (Kansas), 3-7-96,p.1.]
“Each year in the U.S. there are over 120 million episodes of impaired driving
among adults. About 1.4 million arrests are made annually for driving under the influence
of alcohol or narcotics (1 in every 123 licensed drivers). In 1997, 14% of drivers aged 16-20
years and 26% of drivers aged 21-24 years who were involved in fatal crashes were legally
drunk. Of the 41,967 traffic fatalities in U. S. in 1997,there were 28,983 persons who had
been drinking alcohol. [56. NHTSA, Fatality Analysis Reporting System, 1998] Young men aged 1820 (too young to legally buy alcohol) report driving while impaired almost as frequently as
men aged 21-34 years. At all levels of blood alcohol concentration, the risk of being
involved in a crash is greater for young people than it is for older people. Drugs other
than alcohol (e.g., marijuana and cocaine) have been identified as factors in 18% of deaths
among motor vehicle drivers. Other drugs are usually used in combination with alcohol.”
- 27 “In 1996, 21% of the 2,7651 traffic fatalities among children aged 0-14 years
involved alcohol. Of the child passenger deaths that involve a driver with a blood alcohol
level of .10, 60% of the time it is the driver of the child’s car who is impaired .” [53. National
Center for Injury Prevention and Control, Fact Sheet, 6-13-2001]
3-00.4. Second hand smoke.
In 1986 the Surgeon General reported that passive smoke now referred to as ETS
(environmental tobacco smoke) or second hand smoke was a serious health problem.
Studies have since confirmed that second hand smoke is the third leading cause of
premature death in the U.S. each year. At least 53,000 persons who do not smoke die
prematurely each year in the U.S.—37,000 from heart disease, 12,000 from other than
lung cancer, and 3,700 from lung cancer. Children of parents who smoke have increased
frequency of asthma and respiratory illnesses. 16% of spouses of smokers suffer serious
health problems from the inhalation of second hand smoke. The lungs of 87% of non
smokers most of whom are unaware they inhale significant quantities show some
respiratory damaged believed caused by second hand smoke. The courts have recognized
Awarded damages in many cases where employees claim second hand smoke has caused
medical problems.
3-01. How do drugs affect the behavior of users?
Drug use intoxicates people. When intoxicated people drive cars, or work with
moving equipment, or direct aircraft landings, they pose immediate hazards, and
sometimes inflict real harm on themselves and others.
Alcohol induces more violent, aggressive behavior in some people than any other
drug. Each year in the US there are over 120 million episodes of impaired driving among
adults. About 1.4 million arrests are made annually for driving under the influence of
alcohol or narcotics (1 of every 123 licensed drivers) [20. F.B.I, 1997 Uniform Crime Reports.]
Each year over 40,000 people die as a result of motor vehicle accidents on U.S.
highways and 300,000 to 500,000 more suffer serious injuries. A third of these fatal
accidents involved an intoxicated driver or pedestrian with a blood alcohol concentration of
at least .10 percent. Drugs other than alcohol (e.g., marijuana and cocaine) have been
identified as factors in 18% of deaths among motor vehicle drivers. Other drugs are
generally used in combination with alcohol. [56. Nat. Highway Traffic Safety Adm., Economic
Cost of Motor Vehicle Crashes]
The link between alcohol and crime is undeniable. According to one study, alcohol is
the great facilitator of the majority of crime. Alcohol causes 20 to 25 times as many deaths
annually in the U.S. as all illegal drugs combined. Drunk drivers kill more innocent
bystanders than all illegal drugs combined. [79. Tripp Spring, Our Children Are Drowning in
Drugs. Alcohol is the leading cause of death of persons in the U.S. between the ages of 16
and 24. [83] In 1996, 4 of every 10 offenders in a fatal vehicle accident self reported they
- 28 were using alcohol at the time of the accident. [www.illegal drugs.cruisin-gold.com/links p.2.html].
Alcohol is the leading cause of death of persons in the U.S. between the ages of 16 and 24.
[83, p. 5] In 1996, 4 of every 10 offenders in a fatal motor vehicle accident reported using
alcohol at the time of the accident.
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Alcohol was a major factor in all urban riots of the past century.
Alcohol is involved in two-thirds of all violent crime.
30 percent of all suicides are alcohol related.
30 percent of all accidental deaths are alcohol related.
50 percent of all murders in America each year are alcohol related.
95 percent of all domestic violence is alcohol related.
700,000 Americans are treated for alcohol.
Alcohol was involved in these recent headlines



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
Texas A & M bonfire disaster.
Murder of a gay man in Wyoming;
The dragging death of a black man in Texas;
Princess Di was killed by a drunk driver
Jeffrey Dahmer was an alcohol abuser from the age of 14.
A sample of the 166 million persons age 16 and older who drove automobiles in the
previous year found that 45 million people, or 27% of drivers, drove within two hours
after alcohol use. About 7,000,000 or 4% of drivers drove after both alcohol and drug use
(not necessarily concurrently). Four per cent reported driving after marijuana use. The
majority of those who drove after marijuana use were age 16-20.
In 1996, 21% of the 2,761 traffic fatalities among children aged 0-14 involved
alcohol. In 60% of these fatal accidents it was the driver of the child’s car who was
impaired. [11. CDC,MMWR 1997;46:1130-3.] A study of alcohol-related motor vehicle
deaths in N. C. found that 70 % of children in these crashes were passengers in cars in
which drivers had been drinking, many of whom were presumed to be the victim’s parents.
Adolescents are at higher risk than adults of becoming involved in a motor vehicle
accident if they have been drinking. The highest percent of drivers driving after heavy
alcohol were drivers age 16-20. Even though the legal blood alcohol limit is currently .08.
research suggest that there can be significant impairment in driving-related skills at blood
alcohol levels as low as .02. [57. 1996 Nat. Household Survey on Drug Abuse. Alcohol is also
involved in nearly 40 percent of adolescent drownings. It takes less alcohol to precipitate
accidents among young people than among older adults. [15, p. 5 (1-12-1994); 14, p. II-530.]
Both the U.S. and N.C. are making progress toward reducing alcohol-related traffic
fatalities. The 16,189 alcohol-related traffic fatalities in the U.S. 1997 represent a 32%
reduction from the 23,641 alcohol-related fatalities in 1987. From 1985 to 1995 for persons
- 29 ages 15-34, the alcohol-related traffic fatality rate declined 32% while the non-alcohol
traffic fatality rate declined 13%.
3-02. Psychiatric consequences.
Cocaine is said to be the most addictive drug available today—surpassing even
heroin. Unlike most drugs, cocaine isn’t physically addictive, so the physical withdrawal
symptoms are absent. Instead, psychological symptoms appear—depression, anxiety, and
uncontrollable drowsiness. When cocaine hits the blood stream, it produces an intense,
immediate “high,” accompanied by feelings of sexual arousal, clear thinking, and
boundless energy. Just as quickly, the euphoria passes. Depression follows, along with
apathy and cravings for more cocaine. To fight the “crash,” an addict may continuously
snort, inject, or freebase the drug until his supply runs out. Soon, he’ll need it to feel
“normal.” He’ll want the drug even when he can no longer feel its effects. [91, p. 72-73]
Repeated use of amphetamines or cocaine can result in a paranoid psychosis
sometimes accompanied by violence.
In classic experiments administration of
amphetamine or cocaine to normal human volunteers on a regular dosage schedule
produced paranoid psychotic behavior.
Such studies showed that no previous
psychopathology was required and that paranoid reactions to drugs of this class by addicts
cannot be attributed to fear of law enforcement but are due to direct drug effects on the
brain. [31. J. D. Grifith et al., Arch. General. Psychiatry, v. 26, p. 97 (1972) cited in 24, p. 1513]
Cocaine does not turn itself off. For most natural rewards (for example, food,
water, sex, temperature) there is an upper boundary of self-administration. Ordinarily,
satisfaction will be a protective influence. Cocaine seems to stimulate the brain and bypass
the defense mechanism. [39, p. 388] Laboratory experiments reveal monkeys with unrestricted access in a laboratory will actually kill themselves with cocaine by cardiovascular
collapse, starvation, dehydration, or skin infections due to self-mutilation. [25, p. 1515]
General use of all drugs as a teenager increased psychoticism and reduced reasoned
and thoughtful behavior. Individual reaction to marijuana differs, but psychological
stress is enhanced by the drug. Teenagers reported the use of alcohol reduced their
feelings of loneliness and increased social support. However, frequent users of many drugs
developed disorganized thinking, bizarre thoughts, and unusual beliefs that may ultimately
interfere with their problem solving abilities and emotional functioning. Most disturbing
was that use of hard drugs as a teenager, and in particular hypnotics, stimulants, inhalants,
and narcotics, generated thoughts of suicide. Teenage hard drug use reduced social
support and increased loneliness in young adulthood. Thus, use of hard drugs as an
adolescent may increase the probability of social isolation and deprivation, as well as
generate thoughts of futility and self-destruction. [5, p. 53-54]
- 30 3-03. Educational consequences.
A 1984 study of 12,000 persons was followed-up in 1988 when the persons were 19 to
27. The study found that prior use of cigarettes, marijuana, or other illicit drugs increased
the propensity of both sexes to drop out of school. The earlier an adolescent was initiated
into use (of alcohol, marijuana, or other illicit drugs for males, or cigarettes and marijuana
for females) the more likely it was that he or she would not have graduated from school.
The survey was controlled for other factors—parental education, family intactness, and
self-esteem that could influence both drug use and dropping out of school—leading to the
conclusion that dropping out is a partial function of drug use itself. [15, p. 530]
3-04. Employment.
Most drug users are employed. In 1999, 9.4 million (77%) of the 12.3 million adult
illicit drug users were employed either full time or part time. An estimated 16.5% of
unemployed adults (age 18 and older) were current illicit drug users compared with 6.5%
of full-time employed adults and 8.6% part-time employed adults. [76. SAMHA,1999]
A study of 1,325 young adults aged 24 and 25 found that those interviewed who
were ever illicit drug users in adolescence tended to have greater difficulty in obtaining and
holding a job. These young adults also had a higher rate of unemployment and had
experienced greater turnover than their cohorts who had not used drugs in the 10 th and
11th grades. However, the researcher warns that pre-existing problems may have
contributed to some individuals starting to use drugs and the employment problems may
be attributable to the underlying variables rather than to the drugs themselves. [15, p. II-531]
Heavy drug use as a teenager interferes with the mastery of critical developmental
tasks, such as gaining interpersonal and educational skills, and learning to take on family
and work role responsibilities. It also fosters precocious development, i. e. it accelerates
development by leading to premature adoption of adult roles of jobs and family, without
the necessary growth and development typically needed to ensure success with these roles.
Thus drug users may develop a pseudo-maturity that does not adequately prepare
them for the real difficulties of adult life. Adult problems can be predicted to deteriorate
even further if drug use is continued or even increased from adolescence into young
adulthood. However, the deficits acquired as a result of teenage drug use may be corrected
to some extent when drug use is decreased or stopped, permitting the skills and tasks
needed to be learned for success at adulthood to be achieved at a slightly later time.
Another study found that teenage drug use (hashish, inhalants, stimulants, and
marijuana) reduced job stability into young adulthood. It also appears to generate a life
pattern plagued by an inability to maintain gainful employment with all the potential long
range additional consequences such as low self-esteem that this brings. [5, p. 53-57]
- 31 3-05. Marriage, family, and divorce.
The N.C. Department of Social Services estimates that approximately 80 per cent of
foster care cases can be attributed to some aspect of parental substance abuse.
Contemporary concern about parental competence grows out of legitimate distress
about the conditions in which children live and the physical and emotional problems they
may suffer as a result of parental inadequacies. There is an added fear that the state will
have to bear the costs of rearing children whose parents are unable, for economic or other
reasons, to carry out their responsibilities. [45,p. 611]
It has been estimated that 7 million U.S. children live with an alcoholic parent, and
18.2 % of U.S. adults report having lived with an alcoholic or problem drinker when they
were children. ]7, p. 3166] A more recent study concluded that 1 in 4 children younger than
18 years in the U.S. today is exposed to alcohol abuse or alcohol dependence in their family.
[30. Grant, B.F., Am. J. of Public Health, 90(1) 112-5, 2000]
Statistics reveal that 48.9 % of married women categorized as problem drinkers were
married to men rated as moderate or heavy drinkers, while only 13.0 % of men who were
problem drinkers rated their wives as moderate or heavy drinkers. [6, p. 3168]
Young adults aged 24 to 25 who used drugs as 10th and 11th graders were found, in
two studies, to be more likely than non-users to be separated or divorced from their
spouses. “Childhood and adolescence are critical periods for the development of both
personal and interpersonal competence, coping skills, and responsible decision-making.
Drug use is a manner of coping that can interfere with or preclude the necessary
development of these other critical skills if it is engaged in regularly at a young age. Thus
teenage drug use may interfere with essential development that occurs during adolescence.
[15, p. II-531]
Children who live with substance-abusing parents are also at risk of physical and
emotional harm. Although addicted parents do not necessarily abuse their children, many
substance-abusing parents have impaired parenting skills because of their troubled
childhood and their drug seeking lifestyles. [45, p. 601]
3-05.1. Dependence--induced neglect of job and others.
Some drugs also produce dependence; they motivate use long beyond prudential
limits of finances and reasonable psychological commitment. Often, the dependence
interferes with the ability of the drug user to discharge his responsibilities to employers,
spouses, or children. As a consequence, these individuals are injured: the employer loses
money, the spouse becomes impoverished and dispirited, the children lose the guidance
and assistance they need to develop into responsible and resourceful citizens. [52, p. 537]
- 32 Studies have varied as to whether there is a relationship between the use of illicit
drugs and premarital pregnancy. Several studies found that male and female adolescents
who used marijuana and other drugs were about twice as likely as nonusers to become
parents during adolescence. Poor pregnancy outcomes have been associated with smoking
and other drug use in several studies of adult mothers. Mothers who smoke risk preterm
delivery, premature detachment of the placenta with adverse consequences for the mother,
placenta previa, bleeding during pregnancy, and prolonged premature rupture of
membranes, as well as exposing their infants to low birth weight and impaired physical and
intellectual development. The use of alcohol and crack cocaine by pregnant women can
have serious consequences for their infants. Studies have found a relationship between
drug use and the presence of a sexually transmitted disease. [15, p. 531]
3-06. Drug use, crime, and the community.
“The use of drugs for non-medical purposes carries risks not only for the user, but
for society as well. A compassionate society ultimately pays the costs, not only of injury to
non-users, but even of self-inflicted injuries to users themselves. Society pays the costs
through loss of productivity and by subsidizing medical care, providing welfare assistance
to users’ families and dealing with the special educational needs of children whose brains
were damaged in utero. Drug abuse is rarely a victimless crime. Society has a right to take
the costs into account in formulating its drug policies." [24, p. 1513]
Perhaps the most obvious harm caused by drug use is crime. Critics of current drug
policy state drug users commit crimes as crime is the only way they can obtain enough
money to pay for the drugs whose cost has been increased by making their sale illegal.
These facts do not prove drugs cause crime. Perhaps those who commit crime like to use
illegal drugs. Some experiments indicate that the direct pharmacological effects of some
illicit drugs (including heroin and marijuana) is to make users pacific rather than
aggressive—at least while they are under the influence of the drug. [52, p. 535]
There is physiological evidence indicating that some drugs do encourage aggression
in humans and animals, and some crimes do seem to have been committed under the
influence of drug-induced changes in perception or other physiological states. In addition,
some drugs that make users pacific at one state of metabolism, change their character at a
later stage. As alcohol is metabolized, for example, it eventually releases compounds that
tend to make people irritable and angry; when drug-dependent opiate users are deprived
of opiates they too become irritable. The drug most consistently linked to violence in the
home and assaults among strangers in public locations is alcohol—a drug that is freely
available. [52, p. 535]
Although the current observed correlation between drug use and crime cannot
prove that drugs cause crime, it cannot be assumed that all of the observed relationship is
accounted for solely by the personality of the users or the perverse effects of making drugs
illegal. If all drugs were made as freely available as alcohol, the relationship between drug
- 33 use and crime might well change. Perhaps a smaller proportion of those using drugs would
commit crimes, and more of the drug-related crimes would be associated with periods of
intoxication and temporary irritability than with sustained economic need. The point is,
that the relationship between drugs and crime would not disappear. Indeed, if the overall
level of drug use increased as a result of the more ready availability and diminished moral
stigma associated with use, the net effect of drug legalization on crime could be to increase
the level of drug-related violence. This could be true even as the proportion of drug users
involved in crime diminished. [52, p. 535]
The Drug Enforcement Administration recommended in 1996 that Rohypnol, an
illegal sedative nicknamed the “date rape” drug, should be declared a Schedule I drug.
Rohypnol, first marketed as a sleeping pill in 1975, is 10 times more powerful than Valium
and up to that time had been connected to more than 2,400 criminal investigations
nationwide. Declaring Rohypnol a Schedule I drug establishes a minimum 10-year prison
term for simple smuggling offenses and allows prosecutors to see the same sentences apply
as to the sale and possession of heroin, cocaine, and LSD. [63. N&O. 6-12-96]
3-07. The intoxicated are more likely to attack others.
Being intoxicated makes people careless and negligent as well as clumsy. In such a
state, ordinarily compelling internal inhibitions and external rules can be undermined. As
our experience with alcohol teaches us, an assault against a spouse, a friend, or a child is
far more likely when one is drunk than when one is sober. The same could turn out to be
true for psychoactive drugs if they were more commonly used than they are now. [52. p. 537]
3-08. Crime and delinquency.
The link between drug use and other forms of adolescent delinquent behavior is well
established, although not all drug-using adolescent engages in other forms of delinquent
behavior. However, a 1970 study found that men who were marijuana users in adolescence
were more likely as young adults to be violent, have police records, and to fail to graduate
from high school. Another study found delinquent activities preceded experimentation
with illicit drugs in half of the subjects involved with both substance use and delinquency.
A 1986 study found that there was a predictive association between adolescent
involvement with illicit drugs and subsequent engagement in theft among both males and
females. Another study found that any marijuana use in the period from adolescence to
early adulthood predicts interpersonal aggression (for women) and use of other illicit drugs
predicts participation in theft. Other studies suggest that infrequent, intermittent, or
occasional use of drugs by a basically healthy teenager probably has few short term and no
longer-term negative or adverse consequences. [15, p. II-532-533]
Of the 106,536 prisoners housed in Federal Bureau of Prisons facilities in 1998,
56,291 or 58.9% were sentenced for drug offenses. In 1999, 22,443 persons were convicted
in the U.S. District Courts of violating Federal drug laws and sentenced to prison.
- 34 U.S. Department of Justice reported in 1997 over 570,000 of the nation’s prisoners
(51%) of all federal, state prisons, and local jails reported that they had used alcohol or
drugs while committing their offense. The prisoners included 73% of Federal inmates and
83% of State inmates. An estimated 61,000, 33% of state prisoners, and 22% of federal
prisoners said they had committed their current offense while under the influence of drugs.
[60. Nation’s Drugs and Crime Facts, 1998], reported that “An estimated 138,000 convicted jail
inmates (36%) were under the influence of drugs at the time of the offense. 25% of
convicted jail inmates said they had committed their offense to get money for drugs.
[http://www.ojp.usdoj.gov/bjs/dcf/duc.htm]
TABLE 7. ARRESTS BY STATES FOR ALCOHOL RELATED OFFENSES, 1998
(in thousands)
All states
North Carolina
South Carolina
Tennessee
Virginia
Driving
under
influence
All
Arrests
Total
Alcohol
%
11,297
2,667
24
996
502
31
196
352
90
13
48
83
18
43
25
24
63
4
17
27
Liquor
Laws
Drunkeness
580
514
11
7
5
14
-0.2
19
34
[Sourcebook of Criminal Justice Statistics, 1999. p. 378]
Of the 106,536 prisoners housed in Federal Bureau of Prisons facilities in 1998,
56,291 or 58.9% were sentenced for drug offenses. In 1999, 22,443 persons were convicted
in U.S. District Courts of violating Federal drug laws and sentenced to prison.
TABLE 8. INMATES REPORTING DRUG USE IN 30 DAYS OR UNDER INFLUENCE
1997
Previous
Use
Federal
73%
State
83
City/County jails
“
alcohol
75
“ alcohol & drugs
Used in last
30 days
63%
--55
30
Under influence Committed offense
at time of offense
to get drugs
22%
51
36
57
[Source Book of Criminal Justice Statistics, 1999, http://www.ojp.usdoj.gov/bjs/def/duc]
25%
45
- 35 4-00. Why do children , students, and adults use drugs and alcohol?
The early explanation for casualties due to the use of drugs is that those who
succumb to addiction are seen as having a physiological idiosyncrasy or "foolish trait."
Personal disaster is thus viewed as an exception to the rule. Despite the acknowledged
importance of peer group pressure, fads, personal and social stress, we know (1) 1 in 4
children younger than 18 years in the U.S. is exposed to alcohol abuse or alcohol
dependence in their family, (2) some drugs provide for at least a limited period of time a
feeling or experience which users seek, and (3) some people turn to drugs when normal
situations fail to reinforce their illusions. [35. Grant, B.F., Am. J. of Public Health, 90(1) 112-5, 2000]
4-01. What are the most frequent reasons students give for using drugs?

To be accepted by peers.

To feel important and good at something.

To satisfy a need for relaxation.

To respond to the pressure from friends.

To escape from boredom.

To be less inhibited.

To counteract depression.

To experience the high feeling.

To achieve the excitement of "risks" and "kicks".

To resolve poor family communication/environment/relationships.
Five factors related to higher levels of drinking:

poor intra-family communications;

peer approval of alcohol use;

parental approval of alcohol use;

poor social skills; and

positive expectancies for alcohol use. [14, p. 527]
A second study found consistent associations of smoking with three variables:

parental smoking;

peer smoking; and

sibling smoking.
Research studies associate the following factors with heavy use of alcohol and drugs:

substance-abusing parents;

dysfunctional families;

placing a low value on academic achievement;

having low academic competence;

early problem behaviors;

being shy;

having non-drug-related mental health problems, ; and

association with drug-using peers. 15, (Aug. 91) p. 1]
- 36 A 2001 report of the U.S. Department of Health combined all factors into five risk
and protective factors for adolescent drug use: community; family, peer/individual, school,
and general. Community factors include availability—had anyone offered marijuana to a
youth free or for a price; close friends' attitudes toward monthly marijuana use, friends'
marijuana use, and perceptions of no risk or moderate risk of marijuana. Youths
approached and offered to be given or sold marijuana in the past year were 7 times more
likely to have used marijuana than youths who had no such offer.
Family factor include parental disciplinary approach, family conflict, parental views
of substance use, and parental communication about drugs and alcohol. Peer/individual
factors included perceptions of risk of substance use, delinquent behavior, and friends’
substance use and attitudes as to substance use. School factors include grades achieved,
and formal anti-drug education, social support, participation in activities, exposure to antidrug media and intensity of religious beliefs and observance. A combination of two
factors—peer pressure and the individual perceived risk—were described as more
important in determining whether a youth will use marijuana and alcohol than using
cigarettes. A child who perceived no risk or slight risk in occasionally using marijuana was
twelve time more likely to have used marijuana in the last year than a child who perceived
some risk. [81. Substance Abuse and Mental Health Services Administration, Drug Abuse Stat., 9-17-01]
4-02. Peer pressure--to use drugs and not to use drugs.
Four of the reasons why students use drugs listed in Section 4-02 are (1) to be
accepted, (2) peer approval of alcohol use, (3) peer smoking, and (4) dysfunctional families
which increase the influence of peers.
Is it any wonder children don’t remember health warning about alcohol and
tobacco, when
(a) they don’t know how many children use drugs,
(b) believe “drug use is epidemic” “everyone else is doing it;”
(c) the warnings of the dangers of drinking are drowned out by thousands of TV
beer commercials they see and hear and; cigarette ads are in magazines they see;
(d) the Surgeon General’s “harmful to your health warning” in a small box in the
corner of a full page ad is dwarfed by a beautiful coed and handsome college
athlete lying on a beach, climbing a mountain, or dancing at a big party?
Social pressure seems to be a major factor in children initiating the use of gateway
drugs: first cigarettes, wine or beer, and marijuana, then hard liquor, and in the later
teens or twenties, cocaine and heroin. [33, p. 388] A study at the University of N. C. in
Chapel Hill suggests that (1) living in a single-parent family, and (2) peers were by far the
strongest predictor of adolescent drinking and smoking. [68. Norton, EC Health Economics
7(5):439-53, 1998 Aug.] Another study found that adolescents with depressive symptoms were
more likely than other adolescents to start smoking. [Addiction 93(3), p. 433-40, Mar. 1998]
- 37 A national survey asked 12 to 17 year old youth , “Do you have (1) any friends, (2) a
few friends, (3) most friends or (4) all friends using marijuana?
(1)
(2)
(3)
(4)
Only .07% of those who had no friends using marijuana had used marijuana.
8.6% of those who had a few friends using marijuana reported they had used it.
37.0% of those who had most of their friends using marijuana used it.
58.2% who reported that all of their friends used marijuana reported using it.
56.5% of youth reporting that obtaining marijuana; 12.9% were using it.
1.5% reported current use among those who said marijuana was difficult to obtain.
[www.samhsa.gov/oas/NHSDA/1999/Chapter2.htm]
One of the few encouraging developments in drug abuse prevention efforts is the
discovery that peers are a valuable resource to each other and can be positive role models as
well as negative role models. The WHOA (to drugs programs) in Charlotte and WinstonSalem, the START program in Greensboro (both described in Section 4) tell of high school
students developing skills to mentor to their peers and their success in serving as mentors to
high school and middle school students in their school and community.
4-03. Environment and heredity.
Vulnerability to drug-use is a function of both heredity and environment. The
National Association for Children of Alcoholics states that children whose parents use illicit
drugs or abuse alcohol are up to four times more likely to develop substance-abuse
problems than children whose parents do not. The 1999 National Youth Tobacco Survey
reports that 69.5% of middle school students and 61.5 high school students live in a home
in which tobacco is used by one or more parents. More than 11 million children are
affected by parental addiction. [39, p. 388]
Children of substance-abusing parents are more likely than other children to use
drugs. Some studies of twins and adoptees tends to support this conclusion. A review of 39
studies of alcoholic families over a 10-year period showed alcoholics were much more likely
than non-alcoholics to have had a parent or relative with the same affliction. Twenty-five
percent of identified alcoholics had alcoholic fathers. [8, p. 2103]
Families where parents are unskilled in parenting are at greater risk of having
children who abuse alcohol and other drugs. Parental behaviors associated with such abuse
include abuse of alcohol and other drugs by parents; increased family conflict or stress
attributable to job, marital, health or financial difficulties; positive attitudes toward drug
use; and poor parent-child relations, characterized by lack of closeness, absence of parental
involvement in children's activities, inconsistency in parental discipline, and devaluation of
children's educational achievement. Over involvement or strictness by one parent and
distance or permissiveness by another also elevates risk. [8, p. 2103]
- 38 Studies indicate that alcoholics and illicit drug users are characterized by low selfesteem, poor family relationships, low socioeconomic and educational status, poor
academic performance, the presence of psychiatric disturbances, and a high index of
novelty- or sensation-seeking behavior; dependence is furthered by high peer pressure and
the ready availability of drugs. [39, p. 388]
4-04. Physiological and Psychological.
Drug use is a form of risk-taking that peaks during the teen years. Adolescence is
also the time when the level of androgenic hormones rises. A variety of antisocial behaviors
including illicit drug-taking have been correlated with high testosterone levels, which may
account in part for the higher crime rate for men versus women. [39 p. 388]
A factor minimizing the sense of risk is our belief in our invulnerability— general
warnings do not include us. Such faith reigns in the years of greatest exposure to drug
use, ages 15 to 25. No adolescent believes he or she will get hooked when he/she first starts
using drugs. "It won't happen to me." Unfortunately, from 3 up to 20 percent of some
kids in some environments who start on threshold drugs, move on to harder drugs, and in
the 1990s were getting hooked by crack cocaine.
A study at the Centers for Disease Control and Prevention in Atlanta published in
1993 reports that adolescents with depressive symptoms were more likely to start smoking
earlier than other adolescents and their depressive symptoms increased as their smoking
increased. [Escobedo and Reddy, Addiction 93(3):433-40, 1998 Mar] A second study found that
children who externalized behavioral problems and became aggressive and delinquency
were more strongly associated with marijuana use than were those who internalized
problems and became anxious and depressed. [76. SAMHSA, Substance Abuse Statistics, 9-2001]
4-05. School.
Children who fail in school in their middle to late elementary school years are more
apt to engage in use of alcohol and other drugs than are those who do not fail; children who
fail in school for whatever reason--for example, boredom, lack of ability--tend to initiate
drug use earlier and to become regular users more frequently than those who do not fail;
adolescents who are not interested in school or academic achievement more frequently
experiment with alcohol and other drugs than do those who show interest in education.
Schools exert both direct and indirect influences on patterns of drug and alcohol
use. Schools influence the self-concept an adolescent develops. Schools influence whom
adolescents come into contact with and help structure the activities of the adolescent over
the course of the week. School transitions from elementary to middle school and from
middle to high school take the student from a more to a less personal and protected school
environment. School environments differ in exposure to and acceptability of drugs and
alcohol. Adolescents who have had academic difficulties, prior personal problems, or who
lose many friends in moving to another school are at increased risk. [15, p.526]
- 39 4-06. Work.
Adolescents' access to many jobs have been reduced by federal and state laws.
Some substance abuse has been seen as a reaction to frustration. One might expect working
to decrease substance abuse by adolescents because it helps them feel more adult-like. The
research evidence suggests that paid work may increase substance abuse. Teenagers who
work long hours are more likely to use and abuse cigarettes, alcohol, and illicit drugs than
their peers who do not work or who work shorter hours. Less adult supervision, increased
exposure to older adolescents, income to spend on alcohol and drugs, and stress of a heavy
load of school and work and family problems may influence the greater use of drugs.
Working in excess of 15 hours weekly for high school freshmen and sophomores, and
in excess of 20 hours weekly for juniors and seniors, placed adolescents at greatest risk
for work-related problems such as drug abuse. [15, p. 527]
4-07. Availability affects consumption.
Three out of four teens say its easy to get alcohol, more than half the high school
students surveyed obtain alcohol from a friend or relative who is over 21. One out of three
teens knew of a store in their community where someone underage could buy alcohol; only
one in 10 parents knew of such a location.
The ease of obtaining a drug affects its consumption. Contrary to the prevalent
view that prohibition failed, there is substantial evidence that it reduced alcohol
consumption substantially, albeit at the price of bootlegging, gangsterism, violence, and
disrespect for the law among some segments of society. De facto prohibition was introduced
in the U.S. around 1916 and continued as a wartime restriction. Consumption of alcohol
declined 50 percent. A prompt fall occurred in the death rate from liver cirrhosis, which is
a good index of the prevalence of alcoholism in the population. The decrease in cirrhosis
deaths from about 12 per 100,000 in 1916 to less than 7 in 1920 corresponds to the 50% fall
in alcohol use.
A rise in price is tantamount to decreased availability and vice verse. Thus, price
affects drug use. The mean per capita consumption of alcohol in Ontario between 1928 and
1974 varied inversely with the unit price of alcohol in constant dollars. (Consumption went
down in the proportion that the price went up). A similar relationship has been shown for
several European countries.
The sudden large increase in the use of cocaine in U. S. cities following the
introduction of crack, a crude form of cocaine free base, has been attributed to the lower
price of crack and the easier and more effective method of administration by smoking.
Data suggest that anything making drugs less expensive, such as legal sale or sale at lower
prices increases availability and results in substantial increases in use and in the harmful
consequences of heavy use.
- 40 A study of the Dutch reduction in criminal penalties and subsequent de facto
legalization of cannabis since 1976 has resulted in a growth in the drug-using population
and the use of cannabis. [49. MacCoun, R. Science 278 (5335):47-52, 1997, Oct 3.]
4-08. Is there a gateway drug?
Medical research literature has recorded the attempt to determine if there is a
“gateway drug.” Teens who smoke are three times more likely than non-smokers to use
alcohol, eight times more likely to use marijuana, and twenty-two times more likely to use
cocaine. Smoking is also associated with a host of other risk behaviors such as fighting and
engaging in unprotected sex. [83. Surgeon General’s Report, 1994]
4-09. Is tobacco the gateway drug?
A 1999 study reports that among youth using cigarettes 41.1% used illicit drugs.
Among youth who were non smokers only 5.6% used illicit drugs. [57. NHSDA, 1999] A
study of drug-involvement among 1,160 persons from ages 15 to 35 found that youth who
had used cigarettes the previous month had followed a progression from either alcohol or
cigarettes to marijuana, and then to other illegal drugs.
A recent national survey
conducted at Columbia University asked adolescents if they were likely to use illegal drugs
in the future. Adolescents who were not using alcohol or tobacco were more likely to say
they would never use drugs in the future. Significantly more adolescents who smoked but
did not drink alcohol said they would probably use illegal drugs than adolescents who
drank but did not smoke. The study may help understand adolescents’ thinking about
experimentation with illegal substances and the gateway theory of drug sequencing. [40.
Johnson, Boles, and Kleber, National Center on Addiction and Substance Abuse, Columbia U., Journal of
Addictive Diseases, 19(2) 75-81. 2000]
A 1999 study by the National Institute on Alcohol Abuse and Alcoholism also
reported smoking may play a more insidious role than drinking in the development of
dependence on illicit substances. [34. Hanna, E.Z. Alcoholism: Clinical & Experimental Research,
23(3):513-22, 1999 Mar.]
4-09.1. Is alcohol the gateway drug?
The rate of illicit drug use has also been closely associated with the level of alcohol
use. Among youth who were heavy drinkers in 1999, 66.7 were using illicit drugs. Among
nondrinkers, only 5.5% were currently illicit drugs users.
A 1999 report documents the relationship between occasional drinking, binge
drinkers, and heavy drinkers. The data includes all persons over 12 years of age. Current
users of marijuana are quick to deny vehemently that marijuana is a gateway to hard
drugs. This may be true for most recreational users of marijuana. However, “Studies have
shown that children and young adults generally begin to use the two drugs that are illegal
drugs for them to at their age—cigarettes (illegal until 18)and alcohol (illegal until 21).
- 41 TABLE 9. PERCENT OF ALCOHOL USERS USING DRUGS IN U.S. IN 1999
Drinkers
Drug Users
12.4 million heavy drinkers
include
32.4
“ binge
“
“
60.8
“ drinkers (past month)
“
Total 105.6
118.5
“
“
“ (not drink in past month) “
224.1 million drink alcoholic beverages “
3.8 million illicit drug users (30.5%)
4.8
“
“
“
“
(14.8%)
3.1
“
“
“
“ ( 5.1%)
11.7
“
3.2
“
“
“
“
“
“
“
( 2.7%)
14.9 million illicit drug users (53.1%)
National Household Survey of Drug and Alcohol Abuse. 1999. [www.samhsa.gov/oas.1999/Ch.2.htm.
before they begin to use marijuana, and marijuana is used before other illicit and/or
prescription type drugs. Frequency of intake and age of onset of drug abuse can be used as
reliable predictor of future progression. [45 ]
4-10. Lowering legal drinking age increased accidents.
Following the lowering of the age to vote from 21 to 18, 29 states lowered the
minimum legal age to consume alcoholic beverages to 18, 19, or 20. Immediately the
number of vehicle crashes and teenage deaths increased. Although drinking by those
under 21 had, no doubt, gone on previously, it increased sharply when the law
permitted it. Between 1976 and 1983, 16 states increased the minimum age for the sale of
alcoholic beverages to 21. Congress in 1984 enacted the Uniform Driving Age Act
mandating reduced federal transportation funds to states not having 21 as the minimum
age for purchasing alcohol. One thousand fewer youth have been killed in alcohol
related auto accidents every year since. Research suggest when the minimum driving age
is 21, people under age 21 drink less and continue to do so through their early twenties.
The National Transportation Safety Board has called for a national teenage
drunken-driving policy that would consider teenagers legally impaired after the first
drink, no matter what the actual alcohol level of their blood. Florida is reported to have
reduced teenage highway deaths by taking the driving license on persons under 21 who
consume alcohol.
4-11. Advertising alcoholic beverages.
By the age of 18, the average child will have seen 100,000 beer commercials. [95. p. 5]
The alcoholic beverage industry spends about $2 billion each year on advertising and
promotion--with over $800 million spent on television advertising alone.
- 42 Alcohol advertising, with its strong pro-drinking messages, is the leading source of
alcohol education for Americans, including the nation's children. More money is spent by
the alcohol industry each year promoting alcohol as the key to economic and sexual success
and general well-being than is spent by the federal government on all alcohol and other
drug prevention and education efforts. To a large degree, the companies that make their
profits selling alcohol control the message about alcohol. Because of the dependence of
media outlets on alcohol advertising revenues—especially television, radio and magazines-alcohol companies also have control of the messenger. Offending corporate sponsors by
reporting on negative health and social effects of their product or documenting industry
influence over politicians and public policy is not viewed as a good business practice.
Manufacturers of distilled spirits, vodka, Scotch, whisky, gin and tequila, have
voluntarily refrained from advertising their products on radio since 1936 and television
since 1948. In 1996 Seagrams, the nations’ second-largest seller of distilled spirits, began
defying the ban by running commercials in scattered markets around the country.
Seagrams argued, “There is no basis for letting two forms of alcohol advertising—beer
and wine—on television and radio and discriminating against another form.”
The four major national broadcast television networks have their own policies
against accepting advertising for distilled spirits, but Seagrams now places ads with
local television and radio stations and regional cable-television systems. The Distilled
Spirits Council of the U.S. ended the voluntary ban on November 7th, 1996. The Center for
Science in the Public Interest urged the 105th Congress to enact a legislative ban. The
Federal Trade Commission which has primary jurisdiction in regulating advertising has no
regulations prohibiting liquor commercials. [63. N. & O. Nov. 8, 1996, p. 1A, 10A]
In short, the prevalence of alcohol advertising in media creates and perpetuates
distorted, one-sided "feel good" messages about alcohol. It simultaneously serves as a
censor of media information about the health and social consequences of alcohol use in our
culture. [109, p. 1.] It is ironic that at the same time adolescents are exposed to public service
announcements deploring drug use, they are also exposed to advertisements and other
media presentations that glorify the use of alcohol and other drugs. It is difficult indeed for
program developers to persuade adolescents that using drugs and alcohol is undesirable
when these same young people are bombarded daily with messages designed to persuade
them that they are mood-and image-enhancing. [15, p. 527]
Researchers at the University of California at Berkeley report there is a relationship
between exposure and attention to beer advertising and expectations to drink. The
expectation to drink as an adult by children 11 and 12 years of age is related to exposure to
commercials and beliefs about the social and ritual or lifestyle uses of beer. Boys, who
watch more TV sports programs, are more significantly impacted than girls. [83]
Strategies need to be developed, say the researchers, to control or regulate beer
advertising as part of a comprehensive alcohol control policy.
- 43 Alcoholic beverage makers saturated the African-American community with potent
advertising campaigns which promote drinking and undermine prevention efforts among a
group which already experiences a high level of alcohol-related problems. African
Americans drink less alcohol per capita than White, but they suffer from related problems
at a higher rate, largely because of inadequate medical care. African-Americans are twice
as likely as Whites to die of chronic liver disease or cirrhosis. African Americans are 12%
the U.S. population but account for 18 percent of clients in alcohol treatment programs.
Malt liquor, which contains 20 to 1000 percent more alcohol than regular beer, has
been marketed primarily to African Americans and Hispanic Americans. Billboards
promoting alcohol and cigarettes are widely used, especially in inner cities. In Detroit, 56%
percent of billboards in low-income neighborhoods featured alcohol and cigarettes. In
middle and upper-income areas only 38% of the billboards advertised these products.
4-12. Advertising tobacco products—lying and deceit.
The four leading U.S. cigarette manufacturers must recruit 6,000 new smokers a
day to maintain the present level of sales. To achieve that goal, the four American
cigarette companies spend more on advertising and promotion than any other industry in
America—$6.74 billion in 1998. The makers of chewing tobacco spent $170.2 million in
1999. [21. Federal Trade Commission Report to Congress, 1999] Three of the leading cigarette
companies are continuing to advertise in magazines read by children..
The Food and Drug Administration of the U. S. Department of Health and Human
Services issued rules governing tobacco advertising in August 1996. The rules provided:
(1) all tobacco advertising in magazines read by a significant number of teens are to be
black-and-white, text-only; (2) tobacco billboards are to be black and white, text only; (3)
tobacco billboards are banned within 1,000 feet of schools or playgrounds; (4) cigarette
brand-name sponsorship of sporting events teams and race cars are banned; (5) brand
names on products like hats and T-shirts are banned; (6) single-cigarette sales, “kiddie
packs” and other marketing strategies are banned; (7) it is a federal offense to sell tobacco
products to children; (8) photo identification with proof of age required for every sale; (9)
children must be educated about the dangers of smoking by requiring tobacco companies
to fund annual anti-smoking media campaigns. [3. Am. Med. News, 9-9-1996] The tobacco
companies appealed and on March 21, 2000 the U. S. Supreme Court ruled that FDA
lacked jurisdiction to regulate tobacco products and to enforce rules to reduce the access
and appeal of tobacco products for children and adolescents. The developments since
March 2000 are included in Sec. 6. The loss of the FDA’s education and enforcement
program eliminated vital federal support for state tobacco control programs.
The Department’s 2010 national health objectives call for reducing the percentage
of retailers willing to sell tobacco products to minors to 5% or less through enforcement of
existing laws. As of April, 2001, no state had not met this objective.
- 44 Tobacco companies say, “We don’t want children to use tobacco, but it is O.K. for
adults.” Tobacco marketing documents subpoenaed by the Federal Trade Commission
advise (1) present cigarettes as one of the few initiations into the adult world, (2) present
cigarettes as part of the illicit pleasure category of products and activities, and (3) in ads
create a situation taken from the day-to-day life of the young smoker, but in an elegant
manner have this situation touch on the basic symbols of growing-up, maturity process.”
The message “we don’t want kids to smoke” reinforces the message “if you want to look
and act like an adult, do it.” [2. Am. Jo. of Public Health, 1-1996, p. 156]
A study of 571 seventh graders in San Jose, CA revealed 88% of these 13-year-olds
had seen tobacco ads in magazines, on billboards, and at stores and events. 1 in 4 owned
cigarette promotional items. Likelihood of experimenting with smoking was 2.2 times
greater among those owning promotional items and 2.8 times greater among those who had
received mail from a tobacco company. Seeing advertisements in magazines increased this
likelihood by 21%, and seeing tobacco marketing in stores increased it by 38%.
The Canadian government launched a similar broad anti-smoking offensive in 1996,
which raised cigarette taxes, bans all outdoor advertising and all radio and TV ads, bans
tobacco company logos on youth-oriented merchandise, and bans cigarette vending
machines. Only ads in publications aimed primarily at adults would be allowed.
Why do children, students, and adults use drugs? Unfortunately, and sadly, false
advertising, targeting children, lying, deceit and huge political contributions are a partial
answer to the above question. Farmers whose family have raised tobacco in North
Carolina since the Civil War did not know of all the harmful ingredients of tobacco or of
the long term consequences of smoking tobacco. They were trying to earn a little better
living for their families when everyone was poor. The founders of the big tobacco
companies could not have anticipated all of the harmful ingredients of tobacco smoke.
Many of them have been generous contributors to their communities and good citizens.
However, executives of the big tobacco companies as recent as 1996 swore under oath that
tobacco was not addictive, and approved false advertising, and made large political
contributions to defeat Senator McCain’s bill to reduce teenage smoking and reform
tobacco advertising.
The major tobacco companies have long held that smoking was just a statistical
“risk factor” for disease—not a direct cause. In 1994 Brown & Williamson Tobacco
documents filed in court show that thirty years earlier in the 1960’s the officials spoke of
the hazards of cigarettes and stated plainly that nicotine is addictive. Addison Yeaman,
general counsel, suggested in July 1963 that the company "accept its responsibility" and
disclose the hazards of cigarette directly to the surgeon general. His proposal was turned
down and the research report remained secret for 30 years and work on the safer cigarette
stopped. [63. N & O., 5-8-94, p. 7]
- 45 4-12.2. Once children start to smoke why do they continue?
Answer: “They become addicted.” The following is from a May 24, 1972 memo by
Al Udow, a Philip Morris scientist. “A widely held theory holds that most people smoke for
the narcotic effect [relaxing, sedative] that comes from the nicotine. Although more people
talk about ‘taste’, it is likely that greater numbers smoke for the narcotic value that comes
from the nicotine.” Udow wrote that “king-sized Kool had the highest nicotine ‘delivery ‘ of
all king-sized cigarettes available at the time.” He wrote this might explain Kool’s success
and suggested a “route for us to follow to capture some of Kool’s business. This ties in with
the information we have from focus group sessions and other sources that suggest that Kool
is considered to be good for ‘after marijuana’ to maintain the ‘high,’ or for mixing with
marijuana, instead.”
For those desiring to scan this and other documents (350,000 pages plus 27 million
pages of exhibits filed in State of Minnesota v. Philip Morris et al. should go to following
web site-- . Other related information can be viewed at the web site of the Center for
Disease Control and Prevention of the U.S. Department of Health and Human Services.
http://www.cdc.gov/tob…/sgr/sgr.
4-13. N. C. has been less aggressive in restricting use of tobacco products.
North Carolina, the largest tobacco-producing and cigarette manufacturing state in
the nation, has been less aggressive in dealings with the cigarette industry. A 1993 state
law requires that smoking be permitted in at least 20 percent of state buildings. Many
states ban smoking in public buildings. The N.C. law forbids local governments from
passing more restrictive rules than the state guideline. The tobacco industry sought the law
after localities started passing indoor smoking restrictions. N.C.’s excise tax on cigarettes
is 5 cents a pack. The national average of 33 cents. Only Kentucky and Virginia have lower
excise rates. Studies show higher costs cut demand for cigarettes among young people.
North Carolina has no restrictions on location of cigarette vending machines or
advertising tobacco products. NC law forbids “knowingly” selling tobacco products to a
minor, language some believe provides a loophole. A seller is required to ask for proof of
age only if the seller has reason to think the buyer is younger than 18.
4-14.
Preoccupation with drugs.
The single-minded preoccupation of many cocaine, heroin, nicotine, and alcohol
addicts with obtaining and using their respective drug can be understood by observing
experiments with rats and monkeys. A feeder is placed in a cage by which the rats or
monkeys can obtain an injection of an addicting drug by pressing a lever. The animal will
establish a rhythm of lever-pressing if (and only if) pushing the lever provides the addicting
drug. As long as the drug can be gained, normal activities of eating, drinking, exploratory
behavior, grooming or sex are abandoned. Research is progressing to reveal where the
- 46 addicting drugs act in the brain to produce the artificial state of reward. [24, p. 1515]
4-15. Drug abuse among health professionals.
Disturbing examples that education is not enough to prevent drug abuse are the
cases of medical professionals. Despite knowledge of how alcohol affects the body and the
risk of heavy sanctions—loss of professional license, possible criminal prosecution—
members of the medical profession--physicians , dentist and nurses--have a higher per
capita addiction to opiates and other illegal drugs than a matched control group of the
general population. Many medical professionals have easy (although illegal) personal
access to psychoactive drugs that are forbidden to the general public.
4-16. Why do people stop taking drugs?
Unfortunately, the most frequent answer to the above question is, “We die.”
Risk is viewed differently as one begins to reject drugs. One can perceive a
hypothetical 3% risk from taking cocaine as an assurance of 97 percent safety. Or one can
react as if told that 3% of all flights coming into an airport crash. Exposure to drug
problems at work, in one’s neighborhood, and within one’s family shifts one’s
perception and gradually shakes one’s sense of invulnerability. Cocaine has caused the
most dramatic change in estimating risk. [64, p. 47] Resistance to a drug that makes a user
feel confident and exuberant takes many years to permeate a society. [4, p. 47]
4-17. Who is less likely and who is more likely to abuse drugs?
Some adolescents can move on with their lives. One study of problem drinkers in
1972 to 1981 found 51% continued to be problem drinkers in 1981, but 49% were nonproblem drinkers. For females, the decline was more pronounced—only 16% of the
problem drinkers in 1972 were problem drinkers in 1981. Much of what is known about
risk factors for adolescents’ abuse of alcohol and other drugs and the implications for the
prevention of such abuse is described by Steinberg—“...the young person who approaches
adulthood with confidence and purpose and with well-developed social and instrumental
competencies; who associates with peers who value achievement and responsible behavior
and who devalue drug and alcohol use; and who spends time in settings which are
adequately supervised by adults is at relatively low risk for substance abuse.” [15, p. II-533]
“In contrast, the young person who has few present skills and little hope for the future;
who associates with peers who embrace an antisocial or a pro-drug lifestyle; and who
spends a large part of his or her day isolated from adults runs the risk of developing drug
and alcohol problems." [14, Steinberg, L. Ádolescence. Knopf, 1989. p. 528.]
- 47 5-00. What are the economic and social costs of drug and alcohol abuse?
The cost of drug and alcohol use includes the costs of
(1) federal and state expenditures for law enforcement—intelligence, interdiction,
investigations,
prosecution, prisons and correctional institutions, international
assistance and regulatory compliance;
(2) treatment and support of persons with alcohol and drug abuse disorders;
(3) tobacco, alcohol, and drug use;
(4) crime, motor vehicles crashes, social welfare program administrative costs, and costs
associated with the destruction of property;
(5) productivity losses for reduced productivity on the job, victims of crime, incarceration,
crime careers, and time spent to care for family members because of their illness . [15, p.
534]
(6) the human suffering of addicts, abusers and their families and friends are incalculable.
The chart below lists some of the costs of illicit drug use which cannot be estimated.
It was published by the U. S. Department of Justice in 1992. It does not include the costs
of illegal use of alcohol and tobacco products by minors or legal use by adults.
EXHIBIT 2.
See introductory pages
- 48 5-01. Economic costs of drug and alcohol abuse.
A study by the Lewin Group updating their 1992 study for the National Institutes
for Drug Abuse and Alcohol Abuse and Alcoholism estimated the costs for alcohol and
drug abuse in 1995 to be $276 billion 12.5 percent over their 1992 estimate for the
National Institutes of Health. Since 1995, the federal drug control budget has increased
40% from $11.3 billion to $18.5 billion and health costs have increased faster than the cost
of living. If the increase for the six years since 1995 were at the same rate as from 1992 to
1995, the cost of alcohol and drug abuse in the United States would be at least $338
billion in 2001. If $338 billion is divided by 281 million (pop. in 2000) = $1,200 per man,
woman and child. See Appendix A and [www.nida.nih.gov/economiccosts]
5-01.1. The premature loss of children and workers reduces the standard of living of all.
The principal resource of a national economy is the work force—the people. The
premature loss of people in the prime of life and of children with promising potential
decreases the goods and services produced, the future wealth of the nation, and the
standard of living of all for more than a generation.
Table 5 on page 23 documents the sad and alarming fact that drug abuse killed
either directly or indirectly an estimated 645,953 persons in the U. S. in 1998. Alcohol and
drug use is fostered by our culture. Why are we permitting this to happen? Does every
responsible citizen share the responsibility for, and the burden of, a generation of young
people at risk? Is this a serious character weakness in our society which is generally
overlooked except at funerals? It is a loss not included in Section 5-0l above.
To put it in perspective, more people died in 1998 from illegal drug abuse than died
in all the wars in which the U.S. has been involved in the past century. They were of all
races, all backgrounds and most had families and friends. Some were children walking to
school hit by a drunk driver running a red light. Some were parents taking children on a
vacation when a driver on drugs crossed the center line. Some were high schools seniors
celebrating their graduation. Some were students binge drinking Some went to work
under the influence of drugs or took drugs while on the job. Some spent their short lives
on the fringes of the work force or in jail or prison when they weren’t dealing drugs.
5-01.2. Cost of drugs in the work place.
Join Together reports drugs costs the nation at least 14 billion annually due to
absenteeism, unemployment, impairment, and premature death. The National Household
Survey of Drug Abuse reported in 1999 there were 14.8 million current illicit drug users,
(used drugs in prior month) or 6.7% of the population over 11. 70% of the 9 million or
6.3 were employed full time. Contrary to popular belief, drug abusers are not necessarily
the uneducated, the unskilled, and the unemployed. They have jobs in manufacturing,
services industries and most professions.
- 49 They contributed to the gross national product. They make some of the things we
buy and provided services for their communities. Some were admired for their skill, or
ability to make a deal or practice their profession. Most are proud of their work
although at times their work may not meet the standard they have set for themselves in
the past or their employer expects or thinks they are doing One-fourth are heavy illicit
drug users—doing drugs every week or binge drinking 5 times a month. 15% of the
population are spouses or dependents of these drug users. Fortunately, illicit drug use
among fulltime employees declined from 17.5% in 1985 to 7.4% in 1997.
The Drug-Free Workplace Act of 1988 was enacted because drug abuse in the
work place became one of the greatest concerns of the American business owner. Amid
the challenges of running a business in today's competitive market place, employers
discovered that drug users in their work force were robbing them blind—1 out of 4 workers
or family members have substance abuse problems; 1 out of every 5 workers ages 18-25 use
drugs on the job; 1 out of every 8 workers ages 26-34 use drugs on the job. The National
Institute of Drug Abuse conducted an extensive study which found that a typical drug using
worker compared to non-abuse colleague is or has:








Only 66% as productive at work
Late 3 times more often
3.6 times more on-the-job accidents
5 times more non-job accidents
3 times more sick leave
5 times more likely to file a worker's compensation claim
7 times more wage garnishments
3 times higher medical costs
Roger Smith, former Chairman of the Board of General Motors, stated in 1993 that
drug use cost GM more than $1 billion each year through decreased productivity,
increased health care costs, absenteeism, accidents on the job, and employee theft. Other
surveys find lost productivity, absenteeism, and medical expenses related to drug and
alcohol abuse cost employers an average of 3% of total payroll.
Between 1983 and 1991 employers got "religion" on the subject of drugs in the
work place. In 1983, only 3 percent of the Fortune 200 companies had a drug testing
program in place; by 1991, the figure has risen to 47 percent.
In 1997 illicit drug use among full time employees of small establishments (1-24
employees) was 9%; in mid-size establishments (25-499), 8% ; in large establishments (500
or more) 5.8%. The overall rate of current illicit drug use among full-time employees has
fallen from 17.5% in 1985 to a low point 7.4 in 1992. This percentage has remained steady
through 1997 at 7.7%. [89. Bureau of Justice Statistics. Drug and Crime Facts. www. 5-18-01]
- 50 TABLE 10. ALCOHOL RELATED AUTO FATALITIES & ESTIMATED COSTS--1999
State
Total
Fatalities
High Alcohol
BAC > 0. 10
No.
%
430
40
406
190
1,351
Rank
in
Pop.
12
50
15
27
1
23
49
20
33
1
25
36
46
51
3
4
29
49
50
4
353
32
328
140
1, 009
Colorado
Connecticut
Delaware
District of Columbia
Florida
626
301
100
41
2 , 918
171
101
34
16
829
Georgia
Hawaii
Idaho
Illinois
Indiana
1, 508
98
278
1, 456
1, 013
368
31
76
504
265
24
32
28
35
26
506
43
102
637
265
24
44
37
44
26
3. 0
0. 2
0. 2
2. 5
1. 7
6
47
39
85
16
10
41
39
5
14
490
537
814
924
181
119
143
229
326
51
24
27
28
35
28
160
186
281
427
59
33
27
35
46
32
1. 0
0. 8
1. 6
2. 0
1. 3
30
29
19
18
42
30
32
25
22
40
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
590
414
1, 382
625
927
137
140
442
162
300
23
34
32
26
32
179
203
547
201
362
30
49
40
32
39
1. 4
1. 3
3. 7
1. 5
2. 4
28
31
10
26
17
19
13
8
21
31
Missouri
Montana
Nebraska
Nevada
New Hampshire
1, 094
220
295
350
141
325
87
87
105
42
30
40
30
30
30
441
103
125
156
66
40
47
42
45
47
2. 6
0. 6
0. 6
1. 1
0. 3
13
40
38
36
44
17
44
35
38
41
291
206
344
536
56
40
45
22
36
47
1. 9
1. 1
3. 1
3. 0
0. 3
23
32
5
7
45
9
36
3
11
47
9
22
33
4
49
7
27
28
6
43
220
134
40
22
1, 043
$ 2.0
0.2
2.6
0.9
11 . 0
Rank
in
Fatalities
1, 138
76
1, 024
604
3, 559
27
34
34
39
280
31
53
40
31
38
Cost in
Billions
of $
Alabama
Alaska
Arizona
Arkansas
California
Iowa
Kansas
Kentucky
Louisiana
Maine
31
45
32
23
62
Any Alcohol
BAC > 0.01
No. __%
35
45
40
53
36
1.1
0. 9
0. 3
1.6
2. 3
New Jersey
New Mexico
New York
North Carolina
North Dakota
727
460
1, 548
1, 505
119
211
169
252
413
45
29
37
16
27
38
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
1, 430
739
414
1, 549
88
380
196
141
494
23
27
27
34
32
27
458
245
170
605
36
32
33
41
39
41
3. 5
1. 4
0. 9
4.0
2 .4
South Carolina
South Dakota
Tennessee
Texas
Utah
1, 065
150
1, 285
3, 518
360
283
56
382
1, 341
56
27
37
30
38
15
333
65
489
1,734
74
31
43
38
49
21
1. 6
0. 3
2. 2
1 0. 5
0. 4
14
43
11
2
35
26
46
16
2
34
Vermont
90
25
28
34
38
0.17
48
48
Virginia
877
246
28
320
36
2.5
20
12
Washington
634
225
35
265
42
3. 4
24
15
West Virginia
395
119
30
145
37
0. 9
34
37
Wisconsin
745
256
34
309
41
2.2
21
18
Wyoming
189
56
29
70
37
0. 3
41
50
U. S. Total
41, 611
12, 231
30
15,786
38
$ 99.8 billion
Note: If rank in fatalities is lower than rank in population, the state has more than average alcohol related fatalities .
- 51 5-02. Drug related accidents affect the user and others.
Drug use intoxicates people. When intoxicated people drive cars, or moving
equipment, work on an assembly line or around airplanes, etc., they pose immediate
hazards, and sometimes afflict real harm on others. Researchers in New York and
Philadelphia discovered that when traffic fatalities were tested for cocaine as well as
alcohol use, cocaine shows up in a large number of cases.
As has been reported in Section 2-09 on page 17, alcohol was involved in an
estimated 1,049,900 vehicle crashes, 35% of all crashes in the U.S. in 1999. These crashes
killed 15,935 and injured an estimated 821,000 people. In the crashes that killed 12,530
and injured 719,000, the drivers’ BAC (blood alcohol concentration) was .10 or above.
Drivers with a BAC of between .08-.09 were involved in an estimated 17,200 crashes that
killed 993 and injured 32,000. Drivers with a BAC below .08 were involved in an
estimated 33,7000 crashes that killed 2,412 and injured 70,000. See Table 8, page 49 and
note that southern states had the highest rates of fatalities in vehicle crashes.
Alcohol-related crashes in the U.S. cost the public more than $110 billion in 1998,
including more than $40 billion in monetary costs and almost $70 billion in quality of life
losses. Alcohol-related crashes are deadlier and more serious than other crashes. People
other than the drinking driver paid $51 billion of the alcohol-related crash bill. [National
Highway Traffic Safety Administration, 9-2001. www.nhtsa.dot.gov/people/injury/alcohol/US.htm] North
Carolina has an average of 1,227 alcohol-related automobile accidents involving underage
drinkers every year---which cost $500 million in 1998. Alcohol-related violence involving
underage drinkers cost nearly as much annually. [Next Step, v, 14, 3, 2001]
5-03. Cost of crime, law enforcement, prosecution, confinement, and supervision.
The most obvious harm caused by drug use is crime. Drug related crime is estimated
to have cost the nation 57 billion in 1999. Many who support criminal laws against drug
use do so because they believe drug use prompts otherwise law-abiding citizens to commit
crimes. As evidence, they point to the fact that many of those arrested for murder,
robbery, and burglary used drugs. [See Table 8 on page 34]. As reported in Section 2, a
1997 survey found 33% state and 22% federal prisoners said they were under the
influence of drugs when they committed their crime. 16% federal inmates said they
committed crime to get drug money. [89. Bureau of Justice Statistics. 1-1999]
5-03.1. U. S. government expenditures to control the use of illicit drugs in the U.S.
Of the $ 18.5 billion Federal budget for drug control in 2000, $ 5.9 billion (32%) was
for demand reduction, $9.0 billion (49%) for domestic law enforcement, $1.54 billion ( 8%)
for international support (including $954.4 million for U.S. support of “Plan Colombia, a
counter narcotics effort in the Adrean region, primarily in Colombia), $1.9 billion (10%)
interdiction, border control, etc.; 20% for treatment.
- 52 In 1997 Federal, State, and local governments spent $126 billion for criminal
justice. The Federal spent $18 billion, states $42 billion, counties $31 billion, and
municipalities $35 billion. 80% of state operating expenses ($22 billion) were for adult
prisons and 20% for juvenile justice activities, probation, parole services, and
community-based corrections. A national average of $20,142 was spent on each prison
inmate and $23,500 for each Federal inmate. N. C. in 1998 spent $25,303, Tenn. $22,904,
Virginia $16,306, and Wisconsin $27,771 per inmates . [89. Bureau of Justice Statistics, 2001]
5-03.2. Arrests.
Enforcement of drug abuse laws is a challenging responsibity. Arrests for drug
law violations in the U.S. in 1998 totaled 4,302,610 and was a part of the duties of
thousands of law enforcement officers. Drug abuse arrests totaled 1,559,100; driving
under the influence 1,402,800; liquor laws 630,400; drunkenness 710,310. This was 534
arrests per 100,000 in 1998 or 4.8 times the 112 arrests per 100,000 people in 1968.
These arrests constituted 20.7% of all state arrests and 62.6% of all federal arrests. [89.
Sourcebook of Criminal Justice. 1999. p. 247] .
5-03.3. Prosecution.
Prosecution of narcotics cases in the Federal courts rose 229% during the 1980’s
with drug cases 40 to 65% of all criminal trials. The result is that courts could not manage
the drug caseload. This resulted in delays in the prosecution of other criminal offenses.
Convicted drug offenders may be




placed on probation and supervised in the community,
incarcerated in Federal, state prisons or local jails,
(juveniles) may be held in public or private institutions,
paroled on conditional release in the community.
Of the 4.3 million adults under the care or custody of a correctional agency in 1990




61% were on probation,
12% were on parole,
9% were in jail, and
17% were in prison.
TABLE 11. DEFENDENTS SENTENCED FOR VIOLATION OF DRUG LAWS
IN U. S. DISTRICT COURTS IN 1999
Total
Probation
Fined
Imprisonment
22,443
1,719
85
Sourcebook of Criminal Justice Statistics 1999, p. 446.
21,513
- 53 5-03.4. Prison population.
In 1996 for the first time over a million persons were convicted of a felony. 990,000
were convicted in state courts and 43,839 in federal courts. 38% went to state prisons, 31%
to local jails, and 31% were placed on probation. The average length of time given to drug
offenders in state courts were prison—51 months; local jails 6 months; probation 42
months. In 1999 there were 12,658 drug related homicides.
A survey of the 1,118,000 inmates in state and federal correctional facilities in 1997
revealed over 570,000 or 51 percent reported the use of alcohol or drugs while committing
their offense. Seventy three percent of Federal inmates reported past use of drugs and
63% reported drug use in the month before the offense of which they were convicted.
Among Federal prisoners, 49% reported prior use of cocaine-based drugs, 77% reported
prior use of marijuana, and 16% said they committed their current offense to obtain
money for drugs. [89. Drugs and Crime Facts: Bureau of Justice Statistics. 5-2001] The FBI reported
that in 1999 4.5% of the 12,658 homicides in which circumstances were known were
narcotics related (during trafficking or manufacture of drugs).
The cost of operating correctional departments in the following states was: N.C.,
$902 millions; Virginia, $618 million; Wisconsin $487 million; and Tenn. $390 million.
5-03.5. Drug abusers in city and county jails.
In 1998 an estimated 138,000 drug users were arrested, tried and sentenced by
county or municipal courts of being under the offense of alcohol or other drug. Of the
convicted jail inmates, nearly a half said they had committed their offense to get money for
drugs. [89. Bureau of Justice Statistics. 1996]
5-3.6. Convicted drug abusers under criminal justice supervision.
On Jan. 1, 2000 there were 6.3 million people under the jurisdiction or supervision
of the correctional system, or 3.1% of the adult population. 4.6 million adult men and
women were on probation or parole. A 1995 study found that 70% of the inmates reported
past drug use, and 32% said they were using illegal drugs in the month before their offense
[89. Bureau of Justice Statistics, 2001. www.ojp.usdoj.gov/bjs/dcf/htm]
In some poor, urban communities, 1 out of every 10 black males is under criminal
justice supervision, the majority of whom are either drug law violators or drug abusers.
In 1997 the U.S. Department of Justice reported that a survey of over 570,000 of the
nation’s prisoners (51%) of all federal, state prison, and local jail inmates admitted using
alcohol or drugs while committing their offense.
Since the U.S. Sentencing Commission started setting guidelines for prison terms in
1987, the length of drug sentences have more than tripled and federal prisons have swelled
- 54 with inmates. The average drug sentence increased from 2 years in 1987 to 7 years in
1991. 15,788 of 83,000 federal inmates have drug sentences of 10 years or longer.
Similarly, after a two-decade boom in prison construction to house the quadrupled
number of inmates, the states now spend a total of $30 billion a year to operate their
prisons. Since Louisiana imposed mandatory sentences six years ago, its prison population
increased 50%, from 25,260 to 38,000 and state expenditures for prisons increased 70%.
In 2000 the state spent $600 million on corrections and faced a budget deficit.
States are reconsidering long mandatory sentences for drug offenses. Reversing a 30year trend of ever-tougher criminal laws for drug offenders, a number of states have rolled
back some of their most stringent anticrime measures including mandatory minimum
sentences and forbidding early parole for drug crimes. In 2001 Connecticut, Indiana,
Louisiana, and North Dakota repealed sentencing laws requiring long terms without
possibility of parole and the number of inmates started to decline for the first time since
1972. West Virginia which had one of the fastest growing prison systems, enacted a law to
reduce number of inmates by giving money to counties to develop alternatives to prison,
like electronic monitoring of people on probation and centers where probationers would
report each day. [64. N.Y.T. 9-2-2001. p. 1,16] Last year California adopted a voter initiative
that provides for treatment rather than prison for many drug offenders. The change in
policy may be a result of falling crime rates, rising prison costs, and a poor economy. For
example, inmates in Louisiana prisons have increased from 25,200 to 38,000 in six years
and expenditures for prisons have soared 70%. [64. N.Y.T., Sept 2, 2001. p. 1,16]
5-04. Health costs.
In 1985 the estimated annual costs directly related to the treatment and support of
persons under 44 years of age with alcohol and drug abuse problems (other than smoking
or tobacco use) was 58.1 billion. That may have doubled by 2000. The findings of Kaiser
Family Foundation study were:





abusing Medicaid patients admitted to the hospital for other reasons generally stay
twice as long as others with the same primary diagnosis but no substance abuse
problem;
Intravenous drug use by parents causes half of pediatric AIDS cases. (Some other
studies suggest 25%);
87% of lung cancer is attributable to smoking;
72 percent of chronic pancreatis is due to alcohol;
65 percent of strokes among younger Americans is related to cigarettes or cocaine.
Joseph A. Califano, president of the center making the study said, "Substance
abuse is public-health-enemy No. 1 in America. The scourge of drug abuse is color-blind,
gender-neutral and oblivious to class status. It is devastating our health care system."
- 55 Of the $21.6 billion Medicaid paid for hospital care in 1990, $4.2 billion or 19.4%
was attributable to substance abuse. If the same ratio applies to Medicaid expenditures in
2001 ($38.1 billion) then nation’s drug abuse is costing 7.4 billion of what Medicaid pays
hospital for substance abusers.
5-04.1 . Next generation health costs.
Cigarette smoke can effect a future generation by causing poor pregnancy
outcomes. Smoking cigarettes accounts for 20% of low birth weight deliveries, 8% of
preterm birth, and 5% of all perinatal deaths. Maternal smoking during pregnancy
contributes to sudden infant death syndrome and may cause important changes in fetal
brain and nervous system development. The direct medical costs of a complicated birth for
a smoker are 66% higher than for non-smokers—reflecting the greater severity of
complications and the more intensive care required. After pregnancy, in addition to
adversely affecting women’s health, smoking exposes infants and young children to
environmental tobacco smoke. This exposure is linked to SIDS, respiratory illnesses,
middle ear infections, and decreased lung function. Currently 27% of US children aged 6
years and under are exposed to tobacco smoke at home. The annual direct medical costs of
parental smoking estimated at $4.6 billion and loss of life costs estimated at $8.2 billion.
Recent national survey data indicate that the goal of reducing smoking among
pregnant women from 25% in 1985 to 10% by 2000 was not met. While some reduction
was achieved, about 20% of US women currently smoke during pregnancy based on
SAMSHA national surveys. Rates are highest among unmarried women and for women
with less than a high school education. With the smoking rate for low income Medicaid
enrollees estimated at approximately 35%, this translates to one in five U.S.
births/pregnancies, or 800,000 births per year.
The goal adopted for the year 2010 is to reduce cigarette smoking among pregnant
women to a prevalence of no more than 2%. This will be an ambitious goal given that rates
of smoking among teenage girls have risen substantially over the past decade. The 1999
Monitoring the Future Survey found over a third of 12th grade girls (17-18 years of age)
report smoking in the past 30 days.
Pregnancy and the period preceding and following it provide a unique teachable
moment to help women stop smoking. Women are highly motivated to stop smoking during
this time, when they are concerned not only about their own health, but about the health of
their infants. They also are likely to experience higher levels of social and family support
for quitting. Approximately 25% of women smokers quit smoking either as they prepare
to become pregnant or as soon as they learn they are. Unfortunately two-thirds
of women who do quit smoking during pregnancy return to cigarettes within six months
following delivery. [41. Robert Wood Johnson Foundation, E. Princeton, NJ. www.tobaccocontrol.com]
- 56 5-04.2. Treatment.
Approximately 20 million Americans have alcohol or other drug addiction. In 1999
an estimated 2.8 million people (1.3% of the population age 12 and older) received some
kind of drug or alcohol treatment in the 12 months prior to being interviewed. Of this
group 1.6 million (0.7%) received treatment for illicit drugs and 2.3 million (1.0%) for
alcohol. 1.3% of youths age 12-17 years and 2.0% of young adults age 18-25 years received
treatment in the past 12 months. The rate of treatment for substance abuse was higher for
males (1.7%) than females (0.9%). [76. www/samhsa/gov/oas/NHSDA/1999/Chapter2]
Jails and prisons have been criticized as technical institutes for training prisoners in
the latest criminal techniques.
Young offenders get advanced information from
experienced addicts when they go to jail. More than half state prisoners who had ever
used a major drug (Heroin, methadone, cocaine, PCP, or LSD) reported they had not done
so until after their first arrest. Nearly 60% of those who had used a major drug regularly
said such use began after their first arrest; half of the regular users began more than a year
after their first arrest.
The N.C. Department of Corrections reported 73% of male felons admitted in 2000
were chemically dependent. Criminal justice clients are "hard cases," but even a modest
rate of success yields substantial social benefits. The reduction in arrests produces benefits
that can only be fully understood in reference to expert opinion that, for every arrest,
criminally inclined individuals have generally committed hundreds of crimes. [ 65]
The N.C. Division of Mental Health in 1992 estimated from 6 to 8 percent of the
adult population of the state needed treatment for their alcohol or drug addiction. In 1993
an estimated 35,000 residents and in 1999 45,672 residents of the state received treatment
for drug abuse in 41 mental health centers and three residential centers. 3,816 persons
received treatment in one of the three State residential treatment centers.
The N. C. Department of Correction operates two programs. The SARGE (State
Alliance for Recovery and General Education) program at two cites for juveniles and
seventeen (DART) Drug Alcohol Recovery Treatment Programs in independent residential
facilities. [65. NC Dept. Corrections, 2001. www.doc.state.nc.us/substance/docdart.htm]
The SARGE program provides yearlong treatment for youthful offenders. The
program provides the (a) mandatory five-hour school day for 134 youthful offenders plus
four hours of intensive chemical dependency treatment for six months (b) immediately
followed by (c) three months of continued 12-step care (preparation for community living)
for two hours a day five days per week or until release. The staff is now developing with
the help of a grant a three month post release community transition after-care program.
The DART program is based on the Minnesota Model of chemical dependency and
treatment. It provides intensive treatment for alcohol and drug addiction in independent
- 57 residential facilities. A total of 932 prisoners can participate at each of the five week term
programs at 17 sites. The program is offered in a medium security prison or area of the
prison, so residential and program space is separate from the prisons’ other programs or
inmate housing. The treatment programs make extensive use of up to 111 inmates working
in the role of ancillary staff, peer counselors, role models or group leaders.
The Presidential Commission on the HIV Epidemic recommended that persons
sentenced to Federal and state prisons for violation of drug laws should participate in drug
abuse prevention programs. Prisons are expensive to build and operate. The annual cost of
keeping a person in prison is $24,500 or more. Only $3,000 is needed for drug treatment.
The cost of treatment compares favorably with the estimated $50,000 lifetime cost of
treating a person with AIDS.
5-05. Drug abuse health cost in North Carolina.
Statistics show that over a quarter of a million North Carolinians are addicted to
alcohol or some other drug and that addiction and abuse costs the state at least $5 billion
dollars per year. [95, p. 2 (Feb. 1992)] North Carolina spends $44 million a year to treat
35,000 alcoholics and drug addicts in a system that many say is crowded and slow to
respond to individual needs. When an addict comes for help, it may take three to six weeks
to get him/her admitted. With addicted people, they interpret that as no help available.
Bill Carroll, Chief of Alcohol and Drug Service, said one estimate is that from 6 to 8
percent of the adult population of North Carolina, 312,000 to 416,000 people, need
treatment. [12. CH Newspaper, 7-28-1992]
5-06. Cost of drugs in schools.
A six year study of substance use in U.S. schools by Columbia University involving
students, teachers, parents and school administrators in public, private and parochial
schools across the country estimates that substance abuse and addiction will add at least
$41 billion—10 percent—to the costs of elementary and secondary education this year.
The added costs are due to class disruption and violence, special education and tutoring,
teacher turnover, truancy, children left behind, student assistance programs, property
damage, injury and counseling. [National Center on Addiction and Substance Abuse at Columbia,
Malignant Neglect: Substance Abuse and America’s Schools, 9-01] Currently, 27% of US children
aged 6 years and under are exposed to tobacco smoke at home with the annual direct
medical costs of parental smoking estimated at $4.6 billion and loss of life costs estimated
at $8.2 billion.
5-07. Total cost of drug abuse?
No current dollar estimate is available of the cost of crimes committed by persons
while under the influence of mood modifying drugs. The heaviest burden of substance
abuse and addiction falls on the states and city and county government. Of the two million
- 58 prisoners in the U.S., more that 1.8 million are in state penitentiaries and local jails.
States run the Medicaid programs where smoking and alcohol abuse impose heavy burdens
in cancer, heart disease and chronic and debilitating respiratory ailments and where drug
use is the largest cause of new AIDS cases. States fund and operate child welfare systems—
social services, family courts, foster care and adoption agencies. At least 70 percent of the
cases of abuse and neglect stem from alcohol- and drug-abusing parents. The states are
responsible for welfare systems that are overburdened with drug- and alcohol-abusing
mothers and their children. State courts handle the lion’s share of drunk driving and drug
sale and possession cases. States pour billions of dollars into elementary and secondary
public school systems that are more expensive to operate because of drug-and alcoholabusing parents and teenagers.
TABLE 12. ECONOMIC COSTS OF ALCOHOL & DRUG ABUSE IN US-1992 & 2001
(millions of dollars)
Economic costs
Alcohol
Drugs
Total
Health Care Expenditures
Alcohol and drug abuse services
$ 5,573
$ 4,400
$ 9,973
Medical consequences
13,247
5,531
18,778
Total Health Care Expenditures
$ 18,820
$ 9,931
$ 28,751
Productivity Effects (Lost Earnings)
Premature death
Impaired productivity
Institutionalized populations
Incarceration
Crime careers
Victims of crime
Total Productivity Effects
Other Effects on Society
Crime
Social welfare program
Motor vehicle crashes
Fire destruction
Total Other Effects on Society
TOTAL
31,327
67,696
1,513
5,449
-1,012
106,997
14,575
14,205
1,477
17,907
19,198
2,059
69,421
45,902
82,271
2,990
23,356
19,918
3,071
176,418
6,312
683
13,619
1,590
22,204
$ 148,021
17,970
337
-18,307
$ 97,659
24,282
1,020
13,619
1,590
40,511
$ 245,680
1995 ADJUSTMENTS (a)
$ 166,543
$ 109,832
$ 276,375
2001 IF ADJUSTED AT SAME RATE (b)
$ 203,587
$ 134,178
$ 337,765
(a) -- Health care/medical consequences increased 16% from 1992 to 1995; others increased 8.6 or 8.2%
(b) – If medical costs and cost of living increased at same rate from 1995 to 2001.
Source: The Lewin Group, National Institute on Drug Abuse, and Alcohol Abuse and Alcoholism, 9-2001.
[www.nida.nih.gov/economiccosts]
- 59 In 1998 the 50 states spent approximately $620 billion on drug abuse. $81.3 billion
or 13.1% went to pay for the state programs for citizens who are addicted or abusing
drugs. Of every such dollar states spent, only four cents was spent to prevent drug abuse.
This translates into the average American paying $277 per year in state taxes to deal with
the burden of substance abuse and addiction in their social programs and only $10 a year
for prevention. [54. National Center on Addiction and Substance Abuse at ColumbiaUniversity, 9-012001]
In 1997 the correction departments of the following states spent: North Carolina,
$902 million; Virginia, $618 million; Wisconsin $487 million; and Tennessee, $390 million.
5-08. Who bears the costs of alcohol and drug abuse?
Table 9 suggests that much of the economic burden of alcohol and drug problems
falls on the population that does not abuse alcohol and drugs. Costs are imposed on
society (non abusers) in a variety of ways. These include drug- and alcohol-related crimes
and trauma (e.g., motor vehicle crashes) government services provide in enforcing
highway safety, trying abusers, paying for their detention or supervision, higher insurance
premiums. The cost of staying in the household of the abusers are both psychologically
great and financially heavy for persons other than the abuser, e.g., spouses, children. [36.
Harwood, H.J. et al. Recent Developents in Alcoholism. 14:307-30, 1998]
The costs primarily to the income of the abusers include (1) lost earnings because of
impaired functioning in the labor market, (3) lost earnings when incarcerated. Both
translate into lost tax revenue to government.
TABLE 13. WHO BEARS THE COST OF ALCOHOL AND DRUG ABUSE?
Abusers and household
Government (all of us)
Private insurance
Victim Losses
Alcohol
45.0 %
38.6
10.2
6.0
Drugs
43.9 %
46.2
3.1
6.7
Source: The Lewin Group, National Institute on Drug Abuse, and Alcohol Abuse and Alcoholism. 9-2001.
[www.nida.nih.gov/economiccosts]
- 60 6-00. Strategies for reducing drug and alcohol abuse.
Is drug abuse—a crime or a disease?
When the “war on drugs” was declared
in the 60’s, supporters suggested half of all expenditures should be for interdiction and
enforcing drug laws and the other half for treatment. In spite of the efforts of the medical
community to picture drug abusers as sick people needing extensive and continuing
treatment, many Congressmen and citizens have grown to view drug abusers as rotten
delinquents to be put in prison to rot until they straighten up rather than sick people.
In 2001 more people were in federal prisons on drug charges than ever before and
until 2000 all were serving longer sentences. In 1998 state prisons held 236,800 persons
convicted on drug charges 57% more than were there in 1990. In 1998 it was estimated
that 70 to 80% of all state inmates, not just those convicted on drug charges, need
treatment. Only 13% received treatment. Appropriations have ballooned for incarceration
and raised only slightly for research, prevention, and treatment.
The four major strategies proposed for reducing drug and alcohol use are
(1)
(2)
(3)
(4)
reduce demand;
reduce supply;
decriminalization; and
legalization.
6-01. Reduce demand.
The following actions has been proposed and many adopted to reduce demand.
(1)
Federal and state criminal penalties have been enacted for importation, manufacturing, distribution, and sale of certain non-prescription mood altering drugs.
(2) Traffickers in illegal drugs are vigorously prosecuted.
(3) Drug shipments into and within the U.S. are interdicted.
(4) Federal authorities work with foreign governments to eradicate drug yielding crops at
their source.
(5) States lower permissible legal limit of blood alcohol.
(6) Education is provided students, parents, and adults on the hazards of using addictive
drugs in order to prevent or defer initiation of involvement with alcohol and
other drugs especially to youth, discourage continued use by others, and educate
parents on how to work with drug abusing children.
(7) Legislation raised the age when alcohol and cigarettes can be purchased and used.
(8) Taxes are increased on alcohol and tobacco.
(9) TV advertising of hard liquor and cigarettes is prohibited.
(10) Treatment is provided to those identified as in the early stages of problem behaviors
associated with alcohol and other drugs. They are counseled to cease their use.
Treatment is provided to end compulsive use and seek rehabilitation.
- 61 (11) Research is conducted on drug use, effectiveness of different treatments and
education programs and identifying less harmful medical substitutes.
(12) Voluntary drug testing of students is encouraged.
[39, p. 10]
(13) States require mandatory testing of convicted users while on probation or parole.
6-02. Reducing demand through education.
Schools have been the most popular location of programs in part because they offer a
"captive' audience and convenience of administration. Family, peer, and community-based
efforts are less common. Drug education is offered in churches, mental health centers,
social clubs, hospitals, and work sites. [15, 535]
While prevention of drug use in the young is unquestionably the most important
approach to the reduction of demand; it is also the most complex, because it requires
fundamental social changes. In high risk communities, prevention implies modifying or
working within unstable or defective family structures. An intimidating degree of social
therapy is frequently needed including family-planning and job programs. [39, p. 390]
In the 1960's school programs focused on creation of anti-drug attitudes, especially to
legal drugs--alcohol, cigarettes, and even caffeine, and avoidance of contact with illicit
drugs, especially marijuana. Drug use was rampant and it was a scary time. The first
school drug education classes used information and scare tactics to try to turn students
away from drug use. We now know that approach will not work. We also know different
behavioral techniques are necessary in inner-city schools where drugs were all around and
there are more dysfunctional families than in suburban schools. [33, p. 390]




Kids need a strong, positive self-image and the skills to resist the inevitable
exposure to drugs and alcohol.
Kids need non-abusing, positive peer role models with whom they can connect.
Kids need an environment that espouses a no-use philosophy and provides alternatives.
Kids need an environment that is involving, rewarding, and reinforcing, and
supportive of a drug-free lifestyle.
6-02.1. D.A.R.E.
D.A.R.E. was a joint project of the L.A.P.D. and L.A. School District and promoted
widely by the Rotary club of L.A.. In 1993 6,000,000 student were exposed to the D.A.R.E.
program at a cost of $750 million. It became the largest of the many different drug
education programs taught in the schools. The 17-hour (Drug Abuse Resistance Education)
program was at one time taught in the 5th or 6th grade of nearly every elementary school
in North Carolina. The course was taught by specially selected and trained uniformed law
enforcement officers. It sought to provide students with skills, and the self-esteem they
need to make decisions about drugs.
- 62 D.A.R.E. students are taught to consider the consequences of their decisions to use or
not to use dangerous drugs. They gain an increased awareness of the media's portrayal of
these substances, and peer attitudes toward drug use. They were taught assertiveness skills.
They know the choice is theirs to make. D.A.R.E. students learn eight different ways of
saying "No" to anyone who would attempt to get them involved with illegal drugs or
alcohol. D.A.R.E. equipped young people to be teachers and role models for others.
Extensive surveys have found that most D.A.R.E. students will (1) know more about
the consequences of drug use, (2) will be more likely to consider law enforcement officers
their friends, and (3) may postpone or delay tobacco use. But by the time they are seniors
in high school, their drug use has not been statistically different than youth who didn’t
have D.A.R.E. [91, 327-37] We do not know if D.A.R.E. has been more effective when
supplemented by summer camps and follow-up sessions, i. e. as in California or by the
more participatory instructions in New Zealand. [See Section 7-06]
It was unreasonable to expect 15 hours of D.A.R.E instruction in the 5 th grade to
have magical powers similar to a drop of polio vaccine on a child’s tongue or to protect all
children in all environments or postpone experimentation. How could it protect children
from experimenting with drugs six years later after they have seen thousands of beer
commercials and cigarette ads. D.A.R.E. may be more like a flu shot.
Research suggests D.A.R.E. does not help (1) in the management of stress, (2)
increase self esteem or (3) increase resistance skills, and should be revised to address the
importance of (1) commitment, (2) normative beliefs, and (3) an awareness of the value of
a lifestyle without substance use. [Hansen & McNeal] Research also suggests it might be
more effective if followed by “booster” sessions at periodic intervals providing, social and
general life skills training rather than drug knowledge (Botvin et al, 1995; Ellickson et al,
1993, and peers run programs (116. Tobler, 1986), and greater parental support.
6-02.2. Evaluation--drug education in the future?
Predicting the future is difficult and can be dangerous. We can only “look through
the glass darkly.” Current comprehensive school drug programs seek to increase
knowledge and affect attitudes and behavior. Today drug abuse prevention programs are
either "no-use" or "responsible-use" programs. The "no-use" programs are those with a
consistent message that any use of drugs, alcohol, or tobacco is always wrong and harmful.
Responsible-use approaches, while not condoning the use of drugs, alcohol, or tobacco,
attempt to prevent or delay the onset of substance use by stressing informed decision
making, or may aim to reduce the riskiest forms of use (such as drinking and driving) and
encourage reduction in use for those using tobacco, alcohol, and drugs.
Most drug use prevention programs show little change in adolescents' use of
substances. This does not imply that such programs should be discontinued. Some may
enhance adolescents' general life skills, for example:
- 63 (1) improvement in their social competence, including their ability to make decisions,
refuse unwanted peer pressure, and otherwise have rational discussions with their
peers and others;
(2) improvement in their self-understanding;
(3) improvement in knowledge of psychoactive substances and possible effects;
(4) a change in how they perceive a law enforcement officer as a friend; and
(5) cause some students to postpone experimentation with both legal and illegal drugs.
We know we must have programs that reduce addiction. To face the problem of
addiction later with enforcement or treatment is not acceptable. The extent to which
substance use prevention programs achieve some or all of these goals is largely unknown
because outcomes other than reductions in use have not usually been measured. The
danger is that broad based approaches may be discontinued eventually if they do not show
marked reductions in use. [15, p. 565]
6-03. Parent education programs.
Children report their parents can be the single greatest influence in their decisions
not to smoke or use alcohol or drugs. For many children, parents are the single biggest
determinant in these decisions—stronger than that of friends, teachers and media. A
parent’s power and effectiveness can be determined by the time spent with children, the
message given to their children both verbally and by example, and the consistency of the
messages. Hopefully a parent or parents will be a good role model and model the kind of
habits they expect from their children. “More is caught than taught, and actions speak
louder than words.”
As reported in Section 3-10, it has been estimated that 7 million U.S. children live
with an alcoholic parent, and 18.2 % of U.S. adults report having lived with an alcoholic or
problem drinker when they were children. ]7, p. 3166] A more recent study concluded
that 1 in 4 children younger than 18 years in the U.S. today is exposed to alcohol abuse or
alcohol dependence in their family. [30. Grant, B.F. Am. J. of Pub. Health, 90(1) 112-5, 2000]
Parent education programs attempt to influence adolescent behavior by altering the
inter-actions that occur within a family. Parents attend seminars or courses designed to
help them encourage and support appropriate behavior in their adolescent family
member. Typically, a program will provide factual information and training in discipline,
communication, and other parenting skills. Preliminary studies show some improvement in
parenting, but limited impact on an adolescent's behavior—including substance use. An
increasing number of drug abuse prevention programs do include parent training.
In North Carolina parents are required to accompany their student athletes to
meetings coaches hold as required by the N.C. High School Athletic Association. At the
meetings parents and athletes receive information on team policies relating to chemical
awareness as well as other issues.
- 64 6-04. Reducing demand—the 46 State/Big Tobacco Settlement.
The 46 State/Big Tobacco Settlement of November 24, 1998 was reached because the
major tobacco companies wanted to avoid the McCain Bill and federal legislation. To
understand the settlement one must be aware of four events.
(1) In 1994 the top officials of Big Tobacco testifying before a Congressional Committee
under oath stated they and their companies
(a) did not believe cigarette smoke caused cancer;
(b) had not manipulated the nicotine content of cigarettes in order to hook smokers;
(c) had not targeted advertising to encourage teenagers to smoke. (2) Four states, Florida, Minnesota, Mississippi, and Texas, sued Big Tobacco (Phillip
Morris, R. J. Reynolds, Brown & Williamson, and Lorillard), for reimbursement of
Medicaid health care cost resulting from citizens smoking cigarettes.
Documents and testimony during these trials revealed tobacco companies:
(a) had suppressed research on health hazards of smoking;
(b) dismissed/reassigned scientists finding evidence cigarette smoke caused cancer;
(c) manipulated the nicotine contest to hook smokers; and
(d) targeted teenagers as replacement smokers.
The admission by one of the smallest tobacco companies, The Liggett Group, that
cigarettes are addictive and had been pointedly marketed to kids for years weakened the
Big Tobacco defense and changed public opinion about the credibility of Big Tobacco.
[85. Time, 6-30, 1997, p. 28.]
Before each of the cases went to the jury, Big Tobacco, in out-of-court settlements,
agreed to pay the four states a total $40 billion over the next 25 years. By the time of the
settlement all of the top officials who had testified before the Congressional Committee had
retired or resigned.
In April 1998, the Senate Commerce Committee passed a tobacco control bill
sponsored by Senator McCain (R-Ariz.) by a 19 to 1 margin. The McCain bill was
expected to pass the Senate. “Sensing the bill would greatly restrict their advertising and
sale of tobacco products, more than an agreement negotiated with the state attorney
generals, Big Tobacco called a Washington news conference on April 8, 1998, withdrew
their support for the McCain bill, and launched a $40 million ad campaign against the
McCain bill.” Time reported ”Massive spending by the tobacco industry helped defeat
proposed legislation to protect the public’s health. The methods used were all too familiar:
contributions to campaign funds and a huge public relations effort aimed at defeating the
bill.” On June 17, 1998, after a month of acrimonious debate, the McCain
bill failed to pass the Senate by just 3 votes.” Ralph Nader speculated the millions of
dollars of soft money the tobacco firms gave to Republican candidates in the 1998 election
had been a factor in the defeat of the bill.
- 65 Realizing their admission of lying and cover ups had weakened their public support,
a year earlier, in July 1997 the tobacco industry began serious negotiations with the state
attorneys general who had collectively sued the tobacco industry to recoup Medicaid funds
spent on treating tobacco-related diseases.
With no possibility of the passage of the McCain bill, attorneys general of 46 states
and 5 U.S. territories negotiated an agreement with Big Tobacco and on November 23,
1998 signed a $206 billion plan to settle state lawsuits filed against cigarette makers to
recover Medicaid money spent treating diseases related to smoking. The result was a
comprehensive national settlement.
The tobacco companies agreed to make significant public health concessions.
including advertising and marketing restrictions--prevent the use of human (Marlboro
Man) and cartoon forms (Joe Camel) in advertising, billboards, stadium signs, T-shirt
giveaways, and other promotional freebies,… (and) including product placement in films,
comprehensive restrictions on youth access to tobacco products, tougher health warnings, a
$500 million per year public education campaign, funding for state and local tobacco
control programs, smoking cessation assistance, regulations against environment tobacco
smoke, recognition of the authority of the Food and Drug Administration over tobacco
products, and substantial penalties if tobacco use among children did not decrease to
specified levels.
While the agreement places new limits on the marketing of cigarettes, it was less
restrictive and less comprehensive than the proposed $368 billion settlement considered in
July, 1998. The agreement did not give the tobacco industry liability protection in classaction lawsuits or other legal challenges by organizations or groups of individuals, which
was a major sticking point in the previous year’s Senate legislation.
Under the settlement plan, $206 billion will be paid over the next 25 years ($4.6
billion will be paid annually to North Carolina) The amounts paid to states varies
according to estimated Medicaid cost. Cigarette makers will take down billboards and
make some marketing changes, finance educational campaigns intended to stop young
people from starting to smoke and pay for research intended to help smokers quit. But the
agreement does not prevent cigarette makers from continuing a number of practices that
would have been restricted under the Senate bill, like advertising in stores and in
magazines. They may continue to sponsor sports events, but with restrictions.
The agreement did not require the approval of Congress and would not end all
litigation against Big Tobacco. The agreement was opposed by anti-smoking advocates,
like Dr. C. Everett Koop, the former Surgeon General who declared “the pact weak.”
Ralph Nadar criticized the agreement writing, “The 200+ billion figure is highly
misleading. Payments are tax deductible and spread out over 25 years. The settlement
will recover only about 36 cents on the dollar of the Medicaid costs resulting from smokingrelated disease. And the settling states will receive proportionally less than
- 66 Minnesota, Texas, Florida and Mississippi which previously reached individual settlements
with the tobacco companies…The marketing restrictions are laughably weak and loophole
ridden.”
R. J. Reynolds will be forbidden from using Joe Camel, a campaign it already
canceled while Philip Morris can continue to use the Marlboro Man. Big Tobacco may
continue sponsoring events, except those having significant youth appeal, if the corporate
name does not include the brand name of the tobacco product. Among the industry
pledges in the deal is an agreement not to lobby against limitations on tobacco product
advertisements in or on school facilities. It will not curtail Big Tobacco’s advertising.
The agreement bars future suits by the states against Big Tobacco for healthrelated claims. Thousands of the industry’s secret documents will remain secret (Except
those used in state lawsuits that reveal no trade secrets). The tobacco companies do not
acknowledge that smoking causes cancer or heart disease. They do not drop their
challenge to Food and Drug Administration authority to regulate tobacco ingredients such
as nicotine, and they do not withdraw their legal challenge to Environmental Protection
Agency findings that second hand smoke is a dangerous pollutant. [63. 1998, p. 23A.]
The agreement requires tobacco companies to meet with state officials to consider
funds to compensate U.S. tobacco farmers whose allotments were reduced 17% in 1998 and
18% in 1999. U.S. flue cured tobacco allotments totaled more that 1 billion pounds in 1997
and will be reduced 666 million pounds in 1999. In anticipation of payments to states and
farmers the price of a pack of cigarettes increased immediately by 50 or 75 cents. In 1996
Philip Morris sold 24 billion packs in the U.S. for $12.5 billion and $4.2 billion profit.
6-05. The illegal sales to children gets them hooked.
An article in the Journal of the American Medical Association stated that
adolescents illegally consume almost one billion packs of cigarettes and more than 25
million containers of spitting tobacco every year, producing sales topping $1.25 billion and
profits of over $220 million. Tye DiFranza, asked “Who profits from tobacco sales to
children?” [7. JAMA v, 263, 27;84-7] Most adults who are regular smokers start smoking
before the age of 18, the legal age for purchasing tobacco products. Most adolescents who
smoke buy their own cigarettes.
The Synar Amendment to the Federal Alcohol, Drug Abuse and Mental Health
Administration Reorganization Act took effect Oct. 1, 1993. It requires all states to enact
and enforce laws prohibiting the sale or distribution of tobacco products to minors in order
to receive block grant funds for the Substance Abuse and Mental Health Services
Administration. The law requires enforcement of youth access to tobacco restrictions via
unannounced, random inspections. In 1999 seven states and the D. C. failed to meet
specified reductions in the rate of illegal sales of tobacco products to minors. In 1998
23.5% of 9-12 graders purchased their cigarettes from a convenience store or gas station.
- 67 More than two-thirds of states restrict cigarette vending machines, but many of
these restrictions are weak. Only two states (Idaho and Vermont) have total bans on
vending machines. More than 290 local jurisdictions, including New York City,
successfully adopted and enforced outright bans on cigarette vending machines or
restricted them to locations such as taverns and adult clubs where minors often are denied
entry. [83. Surgeon General Report, 2000]
All 50 states have outlawed the sale of cigarettes to minors. Thirty-four made
possession by minors illegal. Until recently few states have vigorously enforced their laws
against the sale and possession. In 1997 Florida passed a law penalizing minors under 18
caught buying, smoking or possessing tobacco. Funded by money from an earlier $11.3
billion state settlement with the tobacco industry, special police patrols now scour public
parks, malls and other places where teens light up. A first offense carries a fine of $53 or
eight hours of community service. Kids caught smoking a third time lose their driver’s
license. The offenders are required to attend smoking court.
The 2010 national health objectives call for reducing the percentage of retailers
willing to sell tobacco products to minors to 5% or less through enforcement of existing
laws. To date, no state has met this objective. U.S. Dept. of Health and Human Services. [1-2000]
In 1997, 225 million packs of cigarettes were sold illegally to minors, and daily smokers
aged 12 to 17 years smoked approximately 924 million packs of cigarettes. “Two-thirds of
students (69.6%) who purchased or tried to purchase cigarettes during the past month in a
store or gas station in 1997 were not asked to show proof of age. African American male
students (19.8%) were significantly less likely to be asked to show proof of age than white
(36.6%) and Hispanic (53.5%) male students. The same study found that 72% of 8 th –
grade students and 88% of 10th grade students believe they can get cigarettes “fairly easily”
or “very easily” if they wanted to purchase them.”
Many state or local laws specify penalties only for sales clerks. However, applying
penalties to business owners who set hiring, training, supervising, and selling policies, is
considered essential to preventing the sale of tobacco to minors. [Surgeon General Report, 1999]
6-06. Three tobacco companies charged with continuing to target children.
The tobacco companies advertise to create a demand. As part of a settlement with the
states in 1998, the biggest tobacco companies said they would stop advertising in magazines
with significant numbers of young readers. The New York Times reported in an article on
August 14, 2001 that three years later that promise is largely unfilled. “Ads from three of
the four major tobacco companies continue to appear in magazines such as Rolling Stone,
People, Entertainment Weekly, Sports Illustrated and TV Guide.”
“A study reports the settlement appears to have had little effect on cigarette
advertising in magazines and on the exposure of young people to those advertisements.
Rolling Stone’s latest issue contains advertisement for Winston and Camel cigarettes. The
- 68 Winston ad is a two-page spread near the front of the magazine. Three of the four biggest
tobacco companies—R. J. Reynolds, Brown & Williamson and Lorillard—say they
continue such advertising because the limits they agreed to in 1998 were only guidelines,
not laws. By contrast, Philip Morris, the largest tobacco company, has followed the
guidelines. A year ago, it stopped advertising in 50 magazines with young readers.” [62.
New England Journal of Medicine, 8-4-2001]
“Bill Lockyer, the attorney general of California who participated in the settlement
three years ago, disputed the tobacco companies’ version. In the settlement, the tobacco
companies said they would follow guidelines agreed upon by most of the 46 attorneys
general involved in the suit: that cigarette advertisements not appear in magazines if more
than 15 percent of the readers are younger than 18, or if more than 2 million of the readers
are younger than 18.”
Lockyer said the tobacco companies were violating what they had pledged in
writing, which according to the settlement agreement was to never “take any action
directly or indirectly to target youth” in the “advertising, promotion or marketing of
tobacco products,” and he is suing R. J. Reynolds.” “R. J. Reynolds and other companies
agreed not to market to kids, and based on our surveys, they still are.”
“Lockyer said that based on his research, Americans age 12 to 17 would be exposed
to at least 50 cigarette ads in magazines each year. He added that the tobacco companies
had a compelling reason to violate the settlement. “They kill their customers every year,”
he said, “and they need to recruit new ones.”
“Mediamark Research and Simmons Market Research Bureau release data on
readers age 12 to 18…People magazine would fall under the settlement terms because it
had 2.7 million readers younger than 18, according to numbers from Simmons. The latest
issue of People carries a two-page ad for Newports, a product of Lorillard.”
“Sports Illustrated has 4.9 million readers younger than 18, according to data from
Mediamark. But the magazine still carries ads for Camel cigarettes made by R. J.
Reynolds and other brands…The magazines reaped close to $40 million in ad revenue from
tobacco ads last year, according to Competitive Media Reporting, an organization that
monitors magazine advertising…23 percent of Rolling Stone’s readers are younger than 18,
according to both the Simmons Teen Survey and the Simmons National Consumer Survey.
Rolling Stone carries ads for R. J. Reynolds brands in practically every issue. A Rolling
Stone executive expects to double the number of Reynolds ads next year. Rolling Stone also
carries Brown & Williamson ads.”
“Of the four tobacco companies, R. J. Reynolds has the broadest view of what
constitutes an adult magazine. It is so broad that in March, Lockyer, the attorney general
of California, sued the company, accusing it of having “continuously and systematically
targeted youth” by placing large numbers of cigarette ads in magazines with a substantial
- 69 teenage readership. The attorneys general of Oregon, New York, Ohio and Washington
joined the lawsuit.”
Jan Smith, a spokeswoman for R. J. Reynolds, said “It had chosen to follow a
standard different from that promoted by the attorneys general. We do not advertise in
magazines that target minors,” she said. “We only advertise in magazines that are read by
adults.” She said Reynolds also looks at the editorial content of the magazine and
considers the presence of other advertisers—for example, for cars or liquor—to gauge
whether it is truly an adult publication.
One of the most successful uses of legislation is the Graduated Driver Licensing
(GDL) plan which is a three step licensing process that gradually phases in the licensing
privilege for new drivers 15 to 18 years old. It requires drivers ages 15 to 18 to drive with
designated adults for the first 12 months, using learner’s permits. Those who keep clean
driving records (no traffic, alcohol or drugs violations) for six months and pass a road test
may receive provisional licenses and drive unsupervised between 5 a.m. and 9 p.m. After
another six months without a traffic violation, they qualify for full licenses.
Automobile crashes are the No. 1 cause of death among U.S. teenagers, with 16year-olds historically having the highest crash rate of all. To reduce the risk, 34 states and
the District of Columbia have adopted some type of graduated driver’s licenses for teens.
North Carolina’s law was among the first, taking effect Dec. 1, 1997.
The GDL requirement of education for young drivers is credited for reducing (1)
motor vehicle fatalities of 15 through 20 year olds in N.C. by more than 25%, and (2)
alcohol-related fatalities by 58%. The state’s graduated licensing law doesn’t protect only
teenagers. Before the law took effect, about a third of those injured in accidents involving
16-year-old drivers were drivers and passengers of other vehicles. Making things safer for
teen drivers benefits others on the road. Hopefully the reductions will continue if all states
adopt the GDL plan and if current laws prohibiting the sale of alcoholic beverage to
persons under 21 are strictly enforced.
6-07. U. S. Government stops subsidizing cigarettes for military.
In 1996 the Pentagon stopped spending $30 million annually to subsidize the sale of
cigarettes and chewing tobacco at commissaries to discourage tobacco consumption.
Commissaries were selling tobacco products at prices 30 to 66 percent less than civilian
grocery stores. The Inspector General of the Defense Department estimated tobacco
consumption in the military costs the Defense Department about $581 million a year in
health expenses and $346 million in lost productivity. In 1996 32% of military personnel
including 50 percent of all junior members of the service use tobacco as compared with 25
percent of the general population. Seventy percent of the tobacco products sold in
commissaries are bought by retirees. Diseases attributed to tobacco use accounted for
about 16 percent of the deaths in the military last year. All but five Navy and Marine
- 70 Corps commissaries stopped selling tobacco products years ago.
6-08. Minimum ages for drinking and smoking.
Between 1970 and 1975, 29 States lowered their drinking age to conform with a
Federal shift in the voting age from 21 to 18 in 1970. There was an immediate increase in
deaths due to automobile accidents. By 1984, 28 States had reversed their position and
increased their legal drinking age. Also in 1984, the U.S. Congress passed the Uniform
Minimum Drinking Age Act. Under this law, increasing percentages of Federal highway
funds would be withheld from States that did not make the drinking age 21. Currently, all
50 States and the District of Columbia have a drinking age of 21. The National Highway
Traffic Safety Administration estimates that the minimum drinking age laws have saved
19,121 lives since 1975. In 1999 alone these laws saved 901 lives. As of June 1998, all states
and the District of Columbia have set a BAC limit of .02 or lower for drivers under the age
of 21. The minimum age limits for possession of tobacco products is 18.
6-09. Restrictions on alcohol on N. C. colleges campuses.
The late Chancellor Michael Hooker of the University of North Carolina at Chapel
Hill in 1997 decided it was not right for the University to discourage student drinking and
profit from beer ads run during ball games. Beginning in the summer of 1997 a no-alcoholad provision was included in the contract for broadcast rights to Tar Heel games.
A 2001 survey of 52 colleges in North Carolina concerning the availability of
alcohol was conducted. Thirty-seven of the 52 colleges, 13 public and 24 private colleges
responded to the following questions.
[www.initiative.org]
(1) What is being done to create a health-promoting social, academic and residential
environment on campus?
 33 colleges provide at least some substance-free housing, including 12 that provided
only substance-free housing.
 Several colleges changed schedules to include more early morning classes and holding
exams on Fridays.
 Many colleges have an alcohol task force involved in alcohol prevention activities on
campus.
(2) What has been done to limit alcohol availability on and/or off campus?
 13 campuses prohibit alcohol use on campus for everyone (faculty, staff, and students)
regardless of age.
 15 campuses sponsor on-campus events with alcohol. Most have a responsible server
training program and say servers check for ID all the time.
- 71 (3) Are alcohol-free options available to students?
 16 campuses report that all sponsored events are substance free. 20 schools provide at
least one alcohol-free event during the year. 11 provide alcohol-free events at least once
a week.
(4) Are there campus marketing and promotion restriction of alcoholic beverages?
 29 campuses do not allow alcohol-related advertising in the main campus paper.
 30 prohibit advertising on campus bulletin boards, flyers or posters on campus.
(5) Enforcement of campus policies and local, state and/ or federal laws.
 The 3 most frequently occurring incidents for which students receive disciplinary
action for violating campus alcohol policies are underage consumption (28); alcohol
related disruption to others (21); & alcohol-related arguments, fights, or violence (16).
Top level administrators from 30 N.C. universities and colleges at a meeting in
April, 2001 discussed how campuses can work with each other and their local communities
to effect changes in high-risk behaviors associated with alcohol use. The administrators
agreed there was a critical need for administrators






to check perceptions about alcohol use and the effectiveness of various interventions;
develop a comprehensive, environmentally-based approach;
eliminate mixed messages about alcohol;
target interventions;
improve data collection and its uses; and
adopt consistent alcohol-related policies and enforce them. [29. Governor’s Institute on
Alcohol and Substance Abuse, “College Leadership Convocation.” (9-24-01).
nc.org/clc.shtml. for campus survey of practices]
See www.rush-
Rutgers University in 1995 became the first university with a dormitory especially
for students who are recuperating addicts and wish to stay away from the alcohol-charged
atmosphere of regular dormitories. Strict rules and careful management have made the
Rutgers program more successful than a similar arrangement at the U. of Maryland which
folded. [13. Chronicle of Higher Education, 11-10-95]
6-10. Change in N. C. alcohol laws.
One student was killed and two more students nearly died after drinking poisoned
alcohol at a party in Hickory in 1998. The new law states that anyone convicted for the
first time of selling or providing alcohol to someone under 21-years-old would receive a
minimum $250 fine and 25 hours of community service. A person convicted of aiding and
abetting the sale or provision of alcohol to someone under 21-years-old would receive a
minimum $500 fine and 25 hours of community service. These penalties are increased for
subsequent offenses. A second law was designed to reduce the number of alcohol outlets in
the state’s economically disadvantaged urban areas. The law now requires that all alcohol
permits doing business in an urban redevelopment zone must have at least 50% of their
total annual revenues from non-alcoholic items.
- 72 6-11. Limits and amounts spent on advertising.
Recognizing that anti-drug education messages compete with advertising that makes
Alcohol use appealing to adolescents, there has been legislative interest in limiting the
advertising of alcohol and cigarettes . Cigarettes and hard liquor are not advertised on
television or radio but can be advertised in magazines and on billboards. Wine and beer
may be advertised in any medium.
Tobacco companies have not cut back their expenditures for advertising and
promotional expenditures of tobacco products. The Federal Trade Commission annually
reports these expenditures. In 1998 tobacco companies had increased their expenditures to
$6,733,200,000 and smokeless companies to $145,500,000.
6-12. Affect of environmental tobacco smoke (ETS) on non-smokers.
The Environment Protection Agency in 1992 reported that environmental tobacco
smoke (ETS) is a human carcinogen responsible for the lung cancer deaths of more than
3,000 nonsmokers each year. In 1986 a survey of North Carolinians found that 80%
wanted smoking “Banned or controlled in public places.” In 1991 the American Cancer
Society, American Heart Association, and the American Lung Association promoted the
adoption of local regulations designed to protect citizens from exposure to ETS. Raleigh
and Chapel Hill and Union, McDowell, Cumberland, and Currituck counties passed
regulations. The tobacco industry sought and in 1993 obtained “preemption” legislation in
North Carolina preventing local communities from passing regulations more stringent than
the state law. The law passed by the General Assembly, HB 957, provided (1) no
regulations adopted after Oct. 15, 1993 shall contain restrictions regulating smoking which
exceeded those established by the bill, and (2) at least 20% of space in state-controlled
buildings shall be allocated for smokers.
The General Assembly’s passage of HB 957 caused the NC Association of Health
Directors, NC Medical Association, NC League of Municipalities, and the three largest
daily newspapers in the state to urge counties to adopt smoking regulations before Oct.
15th. Before the bill passed, 16 communities had smoking regulations. By October 15 th, 50
N.C. counties, 27 Boards of Health, and 41 city councils had adopted smoking regulations.
Eleven counties require 100% smoke free space or separate ventilation by the year 2000.
The Federal Pro-Child Act of 1994 mandates that all schools receiving federal
support eliminate smoking from school grounds. The federal act nullifies the state acts
requirements that 20% of space in school buildings be open to smokers.
6-13. Excise taxes.
Economist suggest that adolescent's use of alcohol and tobacco may be more sensitive
to increases in price than adult's use of alcohol and tobacco. One way to increase
- 73 the price of alcohol and tobacco is to increase excise taxes. As of the spring 1990, Federal
excise taxes had not been raised in real terms since 1951. Since the Tobacco Settlement in
1998 the cost of a pack of cigarettes has increased. Beer, a preferred alcoholic beverage of
adolescents, is taxed at one-third the rate of liquor.
The National Institute on Alcoholism and Alcohol Abuse in a simulation found
raising excise taxes on beer to the same level as taxes on liquor would reduce motor vehicle
fatalities among 18-to 20-year olds by 21 percent. An increase in excise tax would have a
greater effect on reducing fatalities than could be expected from increases in the minimum
drinking age because the minimum drinking age can be evaded, at least in part.
Because teen marijuana use doubled between 1990 and 1996 the Center for
Economics Research at the Research Triangle Institute in N.C. explored the possibility
that increasing the price of alcohol or limiting youths’ access may have had the unintended
consequence of also increasing marijuana use. Their study using the National Household
Survey on Drug Abuse data found evidence that both higher fines for marijuana possession
and increased probability of arrest decreased the probability that a young adult will use
marijuana. They also found that higher cigarette taxes appear to decrease the 0intensity of
marijuana use and may have a modest negative effect on use among males. [22. Farrell et al.,
Journal of Health Economics. 20(1):51-68, 2001 Jan.]
Simulations of the effects of excise taxes on cigarette smoking have focused on
reductions in premature mortality as an outcome. Cigarette smoking generally does not
result in fatalities until later in life (although there are short-term health effects of smoking
for adolescents). Grossman's analysis of an increase in excise taxes on cigarettes found that
over 800,000 premature deaths in Americans 12 and over in 1984 would be averted.
Warner suggested that raising the excise tax would discourage approximately 800,000
adolescents from starting to smoke. [15, p. 543]
An article in the Am. Journal of Public Health in Feb. 1996 suggests that a better
way to reduce the marketing of tobacco to kids is to create a real economic incentive for the
tobacco industry to stop selling tobacco to kids. Rather than advocating taxes on
cigarettes—and smokers—public health advocates should advocate taxing tobacco
companies based on actual consumption of their products by children. Not only do tobacco
companies make immediate sales, they also create customers for 16 to 20 years. The
companies should be taxed at a level that keeps them from reaping these long-term
benefits. If tobacco companies were taxed at a rate equal to twice the retail value of
cigarettes of their brands smoked by kids, they would no longer benefit from addicting
kids. Such a tax would create a situation in which the industry really would want to keep
kids from smoking. The public health community should realize that the best way to keep
kids from smoking is to reduce tobacco consumption among everyone. The message should
not be “we don’t want kids to smoke; it should be “we want a smoke-free society.” As the
tobacco industry knows well, kids want to be like adults and reducing adult
smoking sends a strong message to kids about social norms. [Dr. Stanton Glant, Dept. of
Medicine, U. of Cal., San Francisco. A. J. of Public Health, 2-96, p. 214-15]
- 74 The founder of Citizens for a Smoke Free America, Patrick Reynolds, grandson of
R. J. Reynolds, founder of R. J. Reynolds Tobacco Co., in 1996 advocated raising cigarette
taxes to $2 a pack and limiting cigarette exports. He reports the World Health Organization predicts 500 million people now alive worldwide will die from smoking. This he says is
the greatest crime of the 20th century. [63. N&O., 11-24-96 p. 34A]
6-14. N. C. taxes on cigarettes are third lowest in the U.S.
As N. C. faces its worst budget crisis in at least a decade, some lawmakers have
considered raising several taxes but not the cigarette tax. North Carolina has the thirdlowest tax in the country, 5 cents per pack. Only Kentucky and Virginia have lower taxes
rates. In 2000 North Carolina collected $5.45 per capita from the tobacco tax.
Most states have increased the tax on cigarettes in the last four years.
The
following table contains the state tax on a pack of cigarettes in 1997 and 2000, and the per
capita income from a tobacco tax in 5 states---N.C., Alaska, Cal., Maine, and New Jersey.
TABLE 14. STATE TAX ON A PACK OF CIGARETTES & PER CAPITA
INCOME FROM THE TOBACCO TAX IN FIVE SELECTED STATES.
1997 AND 2000
STATES
North Carolina
Alaska
California
Maine
New Jersey
TAX PER PACK
1997
2000
$ 0. 05
. 29
.37
.32
.40
$ 0.05
1. 00
.87
.74
.80
PER CAPITA TAXES
COLLECTED
1997
2000
$ 6.28
23.69
19.91
37.41
30.80
$ 5.45
66.00
36.19
61.35
48.08
Some legislators “argue that raising the cigarette tax is an option offered by those
who don’t appreciate the state’s rich tobacco history or its economics. They say a tax
increase wouldn’t bring more money into the state and would send the wrong message to
leaf growers already hurt by sagging demand and more competition from overseas.”
“Tobacco-control groups disagree, saying tobacco tax hikes invariably fatten state
coffers and reduce cigarette consumption. Specifically, they say every 10 percent increase
in cigarette taxes reduces adult smoking rates by 4 percent and teen smoking rates by 7
percent. At the same time, tax revenue has increased when states have raised their
cigarette taxes.”
- 75 “For example, a 50 cent-per-pack increase in cigarette taxes in North Carolina
would raise an additional $377 million each year, according to the Campaign for Tobacco
Free Kids, a Washington group that fights teen smoking. It would also reduce teen
smoking rates by more than 11 percent and create $1 billion in savings in long-term
healthcare costs, the group says, as well as saving 18,500 teenagers from suffering
premature death because of smoking.”
Deborah Bryan, director of American Lung Ass. of N.C. said, “It’s crazy the No.1
preventable cause of death in this country still enjoys so much government protection. Here
are our legislators facing this horrible budget crunch refusing to consider increasing the
tax on a product that causes so many extra health costs for this state.”
“Heath leaders also say many North Carolina politicians tend to exaggerate the
importance of tobacco to the state’s economy and underestimate public support for
increasing cigarette taxes. But a majority of legislators believe the state still owes a special
debt to tobacco.” “Whatever revenues brought in by a tax hike are offset in legislator’s
minds by the negative message to tobacco farmers,” said Rep. Paul Luebke, a Durham
Democrat and co-chairman of the House Finance Committee. “They are down and out.”
[ 63. Raleigh N. & O., p. 1-16A. 8-11-2001]
6-15. Drug and alcohol abuse treatment in N. C.
SAMHSA, the Substance Abuse & Mental Health Services Administration of the
U.S. Department of Health & Human Services reports that 45,672 persons were admitted
to North Carolina hospitals for treatment in 1998. 5,428 or 11.9% were under 20 years of
age. 691 or 1.5% were under 15; 2,454 or 5.4% were 15 to 17; and 2,283 or 5% were 18 to
20. Their primary substance of abuse at the time of admission were marijuana,
amphetamines and other stimulants and hallucinogens. Among older patients half were
admitted for abuse of alcohol and a secondary drug and 26% were using cocaine, heroin
or other opiates.
6-15.1. Treatment for nicotine addiction.
The Office of the Surgeon General in May 2001 stressed the following facts:




Tobacco use is an addiction as nicotine is a very addictive drug. For some people, it
can be as addictive as heroin or cocaine.
Because smoking is an addiction quitting is often very difficult. A number of
treatments are available that can help.
Quitting is hard. Usually people make two or three tries, or more, before being able to
quit for good.
The most effective way to quit smoking is by using a combination of counseling and
nicotine replacement therapy (such as the nicotine patch, inhaler, gum, or nasal spray)
- 76 

or non-nicotine medicines (such as bupropion SR.) Health care providers or smoking
cessation clinics can provide help with quitting.
Treatments costs for quitting cost from $3 to $10 a day. A pack-a-day smoker spends
almost $1,000 per year. Some health insurance plans cover smoking cessatioon
medications and counseling for quitting smoking.
6-15.2. Treatment of addicts and psychologically ill addicts.
The Violent Crime Control and Law Enforcement Act of 1994 require the Federal
Bureau of Prisons to provide substance abuse treatment or drug education to every eligible
inmate by the end of fiscal 1997. “Drug education” programs provide information on the
physical, social, and psychological effects of drugs and alcohol. This program is generally
available for offenders who have violated laws relating to possession, distribution, or
manufacture of illegal drugs. These offenders were involved with drugs as a business
venture and motivated solely by financial gain.
The remaining three programs serve drug related offenders, those who have
violated laws as a direct result of their drug use. Participants in these programs meet the
criteria of drug dependence as defined by the American Psychological Association.
“Residential treatment” participants are housed in a separate unit for 8 to 12
months and receive a minimum of 500 hours of drug abuse treatment. “Non-residential
treatment” is available in every Federal prison and is provided by the institution’s
Psychology Service Department. These programs are available in general population units
for inmates otherwise unable to participate in the Bureau’s residential units.
6-15.3. Alcoholics Anonymous.
The oldest, largest, and best-known self-help group is AA, which was formed to help
recovering alcoholics maintain their sobriety. As of 1986, AA included approximately 1.5
million participants. About 3 percent, or 47,000 were under the age of 20. In recent years,
participation in AA by adolescents has been increasing, at least in part because of the
inclusion of AA groups in formal treatment programs to provide group therapy and/or
aftercare (peer support and counseling, crisis services, job referral, or drop-in centers).
Adolescents in their mid-to-late teens are likely to attend two or three meetings per week,
slightly fewer than adults. Adolescent alcoholics are far more likely than adult alcoholics to
consider themselves also addicted to other drugs (80 percent of AA members in their late
teens, as compared with 30 percent 40 or over). [15, p. 548]
The 12-step model popularized by AA regards substance dependence as a chronic
illness from which recovery is an ongoing, lifetime process maintained solely by total
abstinence. The program involves acceptance of the illness and one's powerlessness in
relation to it; acknowledgment of the damage done by substance abuse; and commitments
to make amends, continue the recovery effort, and help others. A strong spiritual, but
- 77 nonsectarian, component is essential in the 12-step program. Twelve-step programs for
adults have traditionally been voluntary; adolescents are often required to attend 12-step
groups. [14, p.548]
Peer support is a primary aspect of the self-help group approach. Most AA and
Narcotics Anonymous groups include a "sponsor" system. Each recovering addict is paired
with a more experienced partner (who, in the case of an adolescent, can be either a peer or
an adult) available for crisis intervention and emotional support. The meeting format
usually involves first-person accounts of drug and alcohol problems and recovery from
them. These inspirational testimonials help participants feel less alone in their
recovery struggles. [14, p. 48]
Although an increasing number of adolescent drug users are participating in
AA meetings, the results have not been evaluated. Adolescents tend to resist the idea of
powerlessness and higher power of a religious order. Many adolescents using drugs are at
the time rebelling and trying to escape parental supervision. [14, p. 48].
Both AA and Narcotics Anonymous have traditionally been resistant to
rigorous research studies, primarily as a means of protecting the confidentiality and
anonymity of their membership. AA's own survey of its membership indicate 7 percent
of its members report having been sober for more than 1 year.
6-15.4. Additional treatment programs.
Outpatient substance abuse treatment programs are oriented around
counseling rather than medical intervention. If a person needs medically managed
detoxification, that is handled in another setting prior to entry in the outpatient drug-free
program. Outpatient substance abuse treatment programs seldom use medications on their
clients.
The most intensive outpatient treatment programs are day treatment programs,
in which participants arrive early in the day and returns home only in the evening.
Parental involvement is considered "mandatory" when available, in order to provide
family support for continued participation by the adolescent. Day treatment programs
function much like inpatient programs, with structured activities, on site education, and a
variety of therapeutic programs for adolescents and their families.
Residential substance abuse treatment programs for adolescents offer 24hour supervision by trained adults and recovering peers, providing immediate confronation of substance-abusing or other self-defeating behavior. Residential programs may
have locked units, employ nursing and counseling staff very much like those in psychiatric
hospitals, and include structured daily routines. They frequently operate on the 28-day
model, with a high level of structure in the initial stages and diminishing structure as the
client earns privileges.
- 78 Ideally, the halfway house model of residential treatment offers adolescent
participants supervision coupled
with participation in public school and
extracurricular activities. Located in neighborhoods where residents can attend regular
public schools, halfway houses are often staffed by a live-in-couple who serve as "teaching
parents."
They usually include regularly scheduled group meetings focused on
interpersonal relations and individual goals.
Wilderness-Challenge progarms. A group of adolescent clients and counselors
live together in a "primitive" camp environment.
Personal challenges include
mastering unfamiliar environmental conditions and learning survival skills. Wilderness
camps often operate on the therapeutic community model. Although information regarding
the effectiveness of these models for treatment of adolescent substance abuse is quite
limited, Tobler found alternative programs to be highly successful among disadvantaged
and high risk adolescents. [14, p. 550]
Boot camp. A more recent type of residential program is the "boot camp" or
"shock incarceration" concept for young offenders (adolescent delinquents). Boot camps
vary in nature: some are entirely militaristic environments with few if any
therapeutic staff or procedures; others incorporate drug treatment elements of the more
successful prison treatment programs but lack continuing care when the offender returns
to the community.
Inpatient substance
abuse treatment.
Hospitals--general, psychiatric, and
specialized--offer treatment for substance abuse. Most inpatient facilities include locked-door units. An adolescent requiring inpatient drug abuse treatment was much more likely
to be placed in a hospital. An adolescent requiring inpatient drug abuse treatment is much
more likely to be placed in a residential treatment facility. The standard length of stay for
adults is 28 days and slightly longer for adolescents.
Medical treatment of drug addicts. Recovery from using illicit drugs is defined
as the ability to function in society, not complete abstinence. There are four approaches:




methadone maintenance, an ambulatory program for opiate-dependent individuals;
therapeutic communities; (residential)
outpatient non-methadone programs; and
chemical-dependency programs (mainly for treating alcoholism).
Methadone maintenance, with the most positive results and the most controversial
approach, is subject to charges of substituting one addiction for another.
Detoxification, by itself, rarely leads to recovery. Prison treatment programs, in general
can not combat recidivism. [26. Dean Gerstein and Lawrence Lewin, "Treating drug problems."[ New
England Journal of Medicine, v. 323, No. 12, p. 844. (9-20-1990]
- 79 Most users of illicit drugs never receive treatment; instead, they may go to jail.
For some, whose only previous crime was illegal drug use, prison is an introduction to
crime as a way of life. Incarceration or the threat of prison should deter drug use to
some extent, but it is difficult to say how much. Some object to using criminal sanctions
against addicts and suggest legalization. [39, p. 388]
Although the number of women who use an addictive substance is substantial, there
are comparatively few programs that treat women, and the available slots are severely
limited. Requiring pregnant substance abusers to go into drug treatment is appealing to
many. The woman stops harming herself, she does not continue to physically harm the
fetus, and perhaps she will be a better parent. A 1989 Minnesota act provides that a
pregnant woman who habitually and excessively uses certain controlled substance and
refuses or fails treatment can be determined chemically dependent and subject to
involuntary commitment. [39, p. 608]
The treatment programs of the N. C. Division of Mental Health and the N.C.
Department of Corrections were described in Section 5-04.1 on pages 55 and 56.
6-16. Drug courts.
The first drug courts in the United States were established in Florida. Eight North
Carolina counties--Durham, Forsyth, Mecklenburg, New Hanover, Person-Caswell, Wake,
and Warren—have established drug courts since the program was authorized by the
General Assembly. A District Court judge presides over each drug court. To participate
with the drug court, a person must not have been convicted of a violent crime or one that
involved selling drugs. To graduate addicts must have attended Alcoholics Anonymous
and Narcotics Anonymous meetings; must not violate probation; can’t miss court which is
held every other Friday; and must pay all fines and fees, including $500 for participating in
the program.
The coordinator of the N. C. program reported that about 33% of the drug court
participants graduate. Last year almost half of Wake County’s first 25 graduates had been
convicted of new crimes. It cost about $2,500 to treat a drug court participant each year
compared with $23,000 to incarcerate an addict for a year. While the concept of drug court
is noble, its long-term effect in keeping people off drugs and away from crime is still
unknown. During the past fiscal year the state of N.C. has allocated $1.4 million for the
programs. [63. N. & O. 9-8-2001]
6-17. States are reconsidering long mandatory sentences.
Reversing a 30-year trend of ever-tougher criminal laws for drug offenders, a
number of states have rolled back some of their most stringent anticrime measures
including imposing mandatory minimum sentences and forbidding early parole for drug
crimes. Connecticut, Indiana, Louisiana, and North Dakota in 2001 repealed the 1980
- 80 sentencing laws that required criminals to serve long terms without the possibility of
parole. Iowa gave judges discretion less than the mandatory five-year sentence for lowlevel drug crimes. California passed a voter initiative that provides for treatment rather
than prison for many drug offenders. Mississippi in 2001 passed a law making first-time
nonviolent offenders eligible for parole after serving only 25 percent of their sentences
instead of the 85 percent required under a 1994 act.
The change in policy may be a result of falling crime rates, rising prison cost, and a
poor economy. For example inmates in Louisiana prisons have increased from 25,200 to
38,000 in six years and expenditures for prisons have soared 70 percent. Louisiana was
facing a budget deficit spending $600 million a year on prisons. [64. N.Y.T., 9- 2-2001, p.1,16]
6-18. Punitive measures.
While the majority of interventions to prevent drug use have centered on improving
personal and social abilities, some believe punitive measures to be an appropriate
deterrent. By enforcing tough school policies against use, possession, and distribution of
illicit drugs or possession of a weapon on school property, fear and embarrassment may
become the motivating forces for restraint. Proponents of this approach further believe
that students need to realize the ramifications of drug-related behavior or involvement in
the criminal justice system. Otherwise, illicit drug use would be regarded as a harmful, not
as a wrongful act.
6-19. N. C. Medical Association’s recommendations.
The NC Medical Society suggested in 1996 a plan supporting 12 of the 14 point
anti-tobacco plan of the American Medical Association. The NC society calls for a ban on
cigarette ads at televised sporting events, ban on cigarette vending machines, free local
governments to restrict smoking in public places and require spaces set aside for smokers
to have separate ventilation systems, prohibit candidates from accepting political campaign
contributions from tobacco companies, raise cigarette excise taxes, end tobacco exports and
create smoke-free workplaces. The NC Society did not endorse state lawsuits against
cigarette makers or prohibit universities from receiving research dollars from tobacco
companies. [63. N.& O. 11-24-96]
6-20.
“Just Say No”
Nancy Reagan spearheaded a Partnership for a Drug-Free America "Just Say
No" campaign in 1987. It was the largest advertising effort ever undertaken in the U.S. It
has been reported that $2 billion of corporate support went into a mass media advertising
venture to encourage kids not to use drugs. Studies of the effectiveness of the media
campaign found the 13-17-year-olds targeted by the campaign were the age group least
likely to have been influenced by Partnership ads. However, as high school seniors
perception of risks associated with marijuana and cocaine use increased, their use of these
- 81 drugs declined. [15, p. 536] Studies have suggested responsible use education might be a
more effective alternate. Radio and television anti-smoking campaigns targeted towards
adolescents in the Southeast U.S. were not successful in reducing smoking. [15, p. 536].
6-21. Changes suggested to reduce demand for drugs.
A Pew Research Center survey in February, 2001 found that three out of four
Americans believe “we are losing the drug war,” and by a margin of 52% to 35% said drug
use “should be treated as a disease, not a crime.”
In May 2001, a bipartisan committee of six influential Senators introduced
legislation to provide an additional $900 million for research, prevention, and treatment
and to toughen criminal laws to protect kids. The financial reverberations of the attack on
the world trade center on September 11 may prevent a hearing on the bill.
In order to reduce demand:
 Children and young adults must be made aware of the dangers inherent in tobacco use.
As reported in Section 2, research reveals students in elementary grades, high schools,
and colleges dramatically underestimate the number of tobacco-related deaths This is
believed the result of the mixed message young people receive about tobacco, with
tobacco ads countering the effects of government health warnings, in contrast to the
media’s consistent emphasis on the dangers of illegal drugs and crime.

Tobacco companies must be made to stop targeting children. An article in a leading
health journal reported in June, 2001 that three of the four major tobacco companies
continue to target children and young people in their ads claiming that they do not have
to follow the guidelines they agreed to in the tobacco settlement. [71. Perkins, H.W., J. of
Am. College Health 47(6) 253-8, 1999 May.]

Children and young adults must be made aware of the greater danger to young
children if they start smoking before their body matures and the advantages of
waiting until after 21. The age of initiating smoking is significantly related to
frequency of smoking, and daily smoking. A younger age of smoking initiation was
associated with smoking more cigarettes per day than was initiating at an older age.
[17. Everett, S.A. Preventive Medicine 29(5):327-33, 1999 Nov.]

Another study found that the likelihood of lifetime drug abuse and dependence was
reduced by 4% and 5% with each year drug use onset was delayed. [30. Grant, B.F. J. of
Substance Abuse 10(2):163-73, 1998]

Selling cigarettes to children must stop. An encouraging development has occurred in
Florida. All 50 states have outlawed the sale of cigarettes to minors. Thirty-four make
possession by minors illegal. Until recently few states have vigorously enforced their
laws against the sale and possession. In 1997 Florida passed a law penalizing minors
under 18 year olds caught buying, smoking or possessing tobacco. Funded by money
- 82 from an earlier $11.3 billion state settlement with the tobacco industry, special police
patrols now scour public parks, malls and other places where teens light up. The first
offense carries a fine of $53 or eight hours of community service. Kids caught smoking
a third time lose their driver’s license and are required to attend smoking court.
Increased efforts to reduce the sale of tobacco to teens has resulted in a 48% decline in
teen smoking in Florida. Also encouraging has been that it has been accompanied by a
38 percent drop in teen marijuana smoking.

Children and young adults must stop overestimating how often the “average student”
in their school, their peers use drugs. This misconception tends to promote or reinforce
students’ actual use. [71. Perkins, H. W. Journal of Am. College Health, 5-1999]
The following additional demand reduction actions have been proposed but not
generally enacted or implemented:







Treatment upon demand by users. (Now lengthy delays)
Legislation prohibiting all media advertising of all addictive drugs.
Mandatory treatment of addicts.
Testing drivers at road blocks for alcohol on a non-discriminatory basis.
Higher taxes on cigarettes and alcohol.
Outlaw cigarette vending machines.
Legislation lowering permissible legal limit of blood alcohol to 0.06.
6-22. Reducing supply.
The ease of obtaining a drug affects its consumption. Contrary to the prevalent
view that prohibition failed, there is substantial evidence that it reduced alcohol
consumption from 60 to 70 percent even though at the price of bootlegging, gangsterism,
violence, and disrespect for the law among some segments of society. In four years deaths
from cirrhosis of the liver declined 58 percent. Deaths of cirrhosis is an accurate index of
the prevalence of alcoholism in the population and correlates with the mean per capita
consumption of alcohol. [26,p. 1515]
Conversely, lowering of the legal drinking age in a number of states and provinces
led to an immediate increase in alcohol-related driving accidents among by drivers under
21. Thus, although drinking by those under 21 had, no doubt, gone on previously, it
increased sharply when the law permitted it.
Reducing the supply of drugs available raises the price of the drug. Heroin is 60
times more expensive than legal morphine; illegal cocaine is 15 times the legal price.
Illegality probably accounts for most, if not all of the price differential. There have been
periods in our recent history supply reduction efforts have clearly succeeded in limiting
the supply—heroin from Turkey in the early 70s and from Mexico in the late 70s and a
- 83 reduction in the supply of marijuana after 1986. On the other hand the supply of cocaine
has increased and use has increased despite enormous efforts to reduce it. [52, 549]
The person who claims demand is inelastic (that persons will buy a drug regardless
of the price) ignores the fact that there are many new users whose desire for drugs might
be less than absolute. Many users "mature out" of drug use voluntarily. Price elasticity
for heroin is 0.2 which means that a doubling in the price of drugs would result in a 20
percent decrease in the level of use. Drug laws increase the price of drugs many fold.
Numerous studies have demonstrated that a rise in price of cigarettes, liquor,
and even illegal drugs reduce use. The data suggests that anything making drugs less
expensive, such as legal sale at lower prices, would result in substantial increases in
use and lead to the harmful consequences of heavy use. [24, p. 1515] This is confirmed
again by the Dutch de-penalization and subsequent de facto legalization of marijuana.
Reduction in criminal penalties have limited effects on drug use—at least for marijuana—
but that commercial access has resulted in a growth in the drug-using population. [49.
MacCoun, R., Science. 278; 47-52, 1997 Oct. 3]
It is claimed that the serious opium problem in China was ended by stern
measures, including the death penalty, after the Communists came to power. Constitutional
guarantees would pose formidable obstacles to such a drastic course.
6-23. Destruction of drugs at source.
The United Nations has adopted three international conventions on controlling
drugs. International programs are subsidizing efforts in drug producing countries to
destroy illegal drugs in the fields and processing plants and to grow other crops where
drugs are now grown. Since 1990 the U.S. has provided millions to Colombia, Bolivia,
Mexico and Peru as a part of this effort. Southwest and East Asian countries have also
receive direct drug control aid [105, p. 103]. The U.S. Federal budget contained $1.5 billion
for international drug control activities including $954.4 million for U.S. support of “Plan
Colombia,” a counter arcotics effort in the Andean region, primarily in Colombia. [89.
Sourcebook of Criminal Justice Statistics, 1999. p. 15.]
A New York Times article [May 20,2001] points out the reward and possible
consequences of United Nations and U.S. efforts to wipe out the opium-poppy cultivation
in Afghanistan under Taliban rule. The United Nations officials report and U.S. officials
confirm “that Afghanistan, which supplied about three-quarters of the world’s opium and
most of the heroin reaching Europe in 2000, had ended poppy planting in one season. ”The
sudden turnaround by the Taliban, a move that left international drug experts stunned
when reports of near-total eradication began to come in this year, opens the way for
American aid to the Afghan farmers who have stopped planting poppies. On May 17,
2001, Secretary of State Colin Powell announced a $43 million grant to Afghanistan in
additional emergency aid to cope with the effects of a prolonged drought. “We
will…provide more assistance to the Afghan …including those farmers who have felt the
- 84 impact of the ban on poppy cultivation.” However, “The end of opium poppy cultivation
in Afghanistan has come at a huge cost to farmers. The rural economy had come to rely on
the narcotics trade. The bad side of the ban is that it’s bringing certain regions of their
country to economic ruin. They are trying to replace the crop with wheat, but that is easier
said than done. Wheat needs more water and earns no money until it is sold. With the
opium trade, they used to get their money up front. The Taliban, who used to collect taxes
on the movement of opium, is also losing money. Afghanistan is under United Nations
sanctions, imposed at the insistence of the United States because the Islamic movement will
not turn over Osama bin Laden for trial in connection with attacks on two American
embassies in Africa in 1998.”
Experts say the Taliban is likely to face political problems if the effects of the opium
ban are catastrophic and many people die. Hundreds of thousands of Afghans are already
suffering and many are dying from the drought that has destroyed other crops.
The Afghans are desperate for international help, but describe their opposition to
drug cultivation purely in religious terms citing Islamic prohibitions against drugs, and this
made it hard to defy. Those who defied the edict were threatened with prison. In southern
provinces farmers said they would rather starve than return to poppy cultivation—and
some of them will experts say. In the east, where the Taliban’s hold is less, farmers will
flee to Pakistan or risk illegal crops rather than watch their families die.
“The eradication of poppies has come at a terrible cost to farming families. Experts
will not know until the fall planting season begins whether the Taliban can continue to
enforce it.” There are questions about the size of hidden opium and heroin stockpiles near
the northern border of Afghanistan. Will the reduction of the 2001 crop raise the price
and benefit the Taliban? U.N. officials can hardly believe the swift reduction in poppy
cultivation along the northern border of Afghanistan. Demand for cocaine is more inelastic
than demand for cigarettes by young smokers.
6-24. Interdiction and enforcing laws against raising or manufacture of outlawed drugs.
The 2000 U. S. federal budget appropriated $1.923 billion or 10% of the federal
drug abuse prevention budget for interdiction. In 1988, when Congress almost
unanimously passed the Anti-Drug Abuse Act prohibiting production, marketing, and
possession of harmful psychoactive drugs, there was talk of a 50-50 allocation to curtail
both supply and demand. Highly publicized seizures of successively larger quantities of
illegal drugs indicate both the immediate success and the long-term failure of interdiction.
A sizable market persists. [39, p. 387]
An exception to the articles that favor treatment rather than enforcement and
interdiction is an article reviewing the increase in violence and particularly the use of guns
by drug dealers and users. The article concludes that reducing access to drugs may be more
effective in reducing violence than treating those who are addicted. [Charles , Marwick,
- 85 "Guns, drugs threaten to raise public health problem of violence to epidemic." [J. of Am. Med. Assn. v. 267,
p.2993 (6-10-92]
The goal of law enforcement is to control drug use, control crime associated with
drug dealing and using, prevent the development of strong and stable criminal
organizations, and to protect neighborhoods. Recently, law enforcement has targeted the
profits and assets of the illegal drug business.
The Coast Guard continues to seize large quantities of marijuana and cocaine off
the Florida coast and in the Gulf of Mexico but quantities have declined in recent years.
6-25. Decriminalization.
Dramatic shifts in attitude have characterized America's relation to drugs. During
the 19th century, certain mood-altering substances, such as opiates and cocaine, were
often regarded as helpful in life. Under the U.S. Constitution the states were
responsibility for health issues. When states did not act during the 19th century, drugs
were widely available and advertising was unrestrained. At the close of the 19 th century,
as many as three million people (4% of the 76 million) in the U. S. were dependent on
opiates and cocaine. [55. p. 40-47]
Responsibility for the Philippines in 1898 added an international dimension to the
growing domestic alarm about drug abuse. In 1905 Congress mandated prohibition of
opium in the Philippines except for medical use. In 1906 after China began a campaign
against opium and U.S. imports, the U.S. convened a meeting and campaigned for
worldwide narcotics traffic control. The anti-narcotics campaign by the U.S. was said to
have had two motivations. First, to stop the Chinese boycott of American imports, and
second, the belief, strongly held by the Federal government today, that controlling crops
and traffic in producing countries could most efficiently stop non-medical consumption of
drugs in the U.S. [55, p. 43]
By the early 1900s the country viewed psychoactive drugs as dangerous, addictive
compounds that needed to be tightly controlled. The Harrison Narcotics Act requiring
strict accounting of opium and coca entering the country was enacted in 1914. In 1920 the
18th amendment to the Constitution which prohibited the sale or consumption of alcoholic
beverages was adopted. The consumption of alcoholic beverages declined 60 to 70%. The
amendment was repealed in 1933. Drug abuse declined during the war (1940s). During
the 1950s, heroin addiction reached epidemic levels in the inner cities. In the 1960s drug
abuse spread from cities to suburbia and new drugs were used widely. Legalization of
small amounts of marijuana for personal use was proposed by a Presidential Commission
in 1972 and by the Administration in 1977 and adopted in Alaska and Oregon. [55, p. 40]
However, by 1970 the psychedelic revolution had run its course, the heroin epidemic
endured, marijuana consumption continued to increase, and cocaine reentered the drug
scene after half century of limited use. [55, p. 8]
- 86 In the late 1970s, cocaine use in the United States was described as the most serious
drug problem. It started in the professional classes, where the adverse consequences of
cocaine use were shielded from public view. By the mid 1980s, the disastrous consequences
of cocaine use began to appear. The number of cocaine users showing up in the nation's
emergency rooms and jails increased dramatically. This may have been the result of (1) the
demands of frequent cocaine use had finally exhausted the resources of the relatively well
off, (2) cocaine use had migrated downward in the socioeconomic scale, and/or (3) the
appearance of "crack"--a form of cocaine that proved quick and powerful in inducing
dependence and was especially attractive to those with less money to spend on drugs.
In 1988, when Congress almost unanimously passed the Anti-Drug Abuse Act
prohibiting production, marketing, and possession of harmful psychoactive drugs, there
was talk of a 50-50 allocation to curtail both supply and demand. Highly publicized
seizures of successively larger quantities of illegal drugs indicate both the immediate
success and the long-term failure of interdiction. Thus, a sizable market persists. [39, p. 387]
Persons calling for decriminalization hold differing opinions as to how drugs should be
made available. Proposals tend to be vague as to what drugs would be legalized.




One group wants an end to prosecution of people who have drugs in their possession
or engage in small-scale, street trade.
A second group urge that banned drugs be available to competent adult, production
and sale would be regulated, treatment available to all who need it, and children
should be educated as to the danger of drug use.
A third group urge policemen be replaced by physicians, and punishment by
treatment.
A fourth group call for the legalization of drugs and creation of a regulated market like
now prevails for alcohol.
Any attempt to treat cocaine, heroin, marijuana, and other psychoactive
substances of abuse in the U.S. as medicine to be sold on prescriptions will
encounter the strong opposition of many responsible physicians. These physicians believe
the purposes of medical practice (1) to prevent disease or to treat persons with diseases
with the aim of providing cure, remission, or restoration of function, and (2) to respond to
the needs of the sick. Physicians desire to avoid actions that could harm patients and
refrain from creating the appearance of legitimizing recreational or pathological use of
substances of abuse.
Admittedly, legalizing and regulating drugs that are now illicit should through
quality control measures, eliminate or reduce harmful effects due to unknown and variable
potencies, adulterants, toxic byproducts of illicit manufacture, and bacterial or viral
contamination. [25, p. 1513]
- 87 Persons calling for decriminalization of drugs pointed out that prohibitionist
policies had failed to prevent the increased use of drugs. They claimed efforts to restrict
drug use had created social evils worse than the problem of drug use. Billions have been
spent on interdicting the international and domestic commerce in drugs. The courts, jails,
and prisons are filled with persons who violated drug laws or committed property crimes to
pay the inflated black-market prices for illicit drugs or committed acts of violence in the
underground economy. The streets of the urban ghettos have become wastelands
dominated by the armed sellers, buyers, and users of drugs. HIV infection has spread
among drug injectors under conditions that encourage the sharing of syringes and needles.
Lawyers for international drug smugglers claim the civil liberties of their clients are
violated by government agents prosecuting the war on drugs. [4, p. 341]
During the 1980s, persons on the right and left urged that the drug laws be
changed. Libertarians who believe what one does with one's body is his or her own
business frequently urged no restraint on production of and sale of psychoactive
drugs except to children.
Some conservatives saw drug legalization as an economic problem. Free market
economists Milton Friedman and E. van den Haag and editor William F. Buckley claimed
making drugs available and cheap would remove the profit and drastically reduce, if not
eliminate, the illicit market. Drug-related crime spurred by the enormous sums of money
to be made in drug trafficking would decline. Legalization would relieve the overburdened criminal justice system, reduce the need for prisons and allow law enforcement
to focus on other crimes. [39, p. 388]
Public opinion switched. The favorable attitudes toward marijuana that began in the
late 1970s reversed. A Gallup Poll in 1980 reported that 53 percent of Americans favored
legalization of small amounts of marijuana; by 1986 only 27 percent supported that view.
Those favoring penalties for marijuana use rose from 43% in 1980 to 67% in 1986. By
1990 65% felt legalization would increase drug use in public schools, 67% felt legalization
would increase the number of addicts, 63% felt legalization would increase the number of
drug overdoses, and 52% felt legalization would increase drug related crime. Making
marijuana possession a crime again by popular vote in Alaska in 1990 is an example of this
reversal.
Conservatives are divided. In the 1980s Milton Friedman, the Nobel Prize winning
conservative economist wrote Drug Czar William Bennett, "The path you propose of more
police, more jails, use of the military in foreign countries, harsh penalties for drug users
and repressive measures can only make a bad situation worse. The drug war cannot be
won by those tactics without undermining the human liberty and individual freedom that
you and I cherish." To which William Bennett replied, "Drug use--especially
heavy drug use--destroys human character. It destroys dignity and autonomy, burns
away the sense of responsibility, it makes a mockery of virtue...Libertarians don't like to
hear this. Drugs are a threat to the life of the mind. That's why I find the surrender to
- 88 arguments for drug legalization so odd and so scandalous." [4, p. 356]
Black leaders have been equally vehement in their reaction against the calls for
decriminalization. They have seen their communities devastated by drug use and drug
wars and fear that legalization would write them off as expendable. [5, p. 357]
The policies governing prevention of drug abuse logically must strike a balance
between the harm that is done by the drugs and the harm that results from strict legal
prohibitions and their enforcement. The current debate over drug prohibition is being
conducted in the face of uncertainty about the potential consequences of legalization.
Proponents assert that the risks have been exaggerated and the costs of not legalizing
cocaine, heroin, and "other relatively dangerous drugs" are too great.
Critics of decriminalization like James Q. Wilson, nationally recognized authority
on law enforcement, are of the opinion "legalization would produce a vast increase in drug
use with devastating impacts on the most vulnerable. We will consign millions of people,
hundred of thousands of infants, and hundreds of neighborhoods to a life of oblivion
and disease." [4, p. 358]
If all drugs were made as freely available as alcohol, crime might well
increase. Perhaps a smaller proportion of those using drugs would commit crimes, and
more of the drug-related crimes would be associated with periods of intoxication and
temporary irritability than with sustained economic need. If the overall level of drug
use increased as a result of the more ready availability and diminished moral stigma
associated with use, the net effect of drug legalization could be to increase the absolute level
of drug-related violence. [26]
Dr. Ronald Bayer of the Columbia University School of Public Health writes,
"The prospects of even minimum steps toward decriminalization are far weaker than in
1970. The significance of the debate may (1) expose the profound imbalance between
public expenditures for law enforcement designed to repress drug sales and use and
the funds available for the treatment of individuals whose drug dependency has resulted
in personal misery, and (2) compel discussion of what drugs should be licit and what
ones should be illicit. “ [39, p. 359]
Under what conditions could a society tolerate legalization of a strongly abusive
drug such as inhaleable or injectable cocaine? A sufficient majority of the population
(say 99%) would need to be immunized against the use of the drug, for example, by
fear of toxicity or by moral objection, so that they could successfully resist the
temptation to experiment. This would require a heavily indoctrinated and compliant
populace in which voluntary deviant behavior is conspicuously stigmatized (for example,
many vegetarians have never tasted meat and most orthodox Jews and Moslems have
never tasted pork). If the social pressure against cocaine use could be made as strong as
social taboos and customs, legal prohibition for this drug might be relaxed. In a commun-
- 89 ity where conformity is high and where most of the mentally ill and the poor are cared for
by the society, such as among the Mormon or the Amish communities, legalization of
cocaine could possibly succeed. Group disapproval or religious conviction may deter drugtaking more effectively than threat of prison; it may account for the lower use of legal
alcohol and cigarettes in such communities. [39, p. 389]
Would legalization of opiates and cocaine result in levels of addiction comparable
to those seen currently among the users of alcohol and tobacco? Opiates and cocaine
are certainly not less addictive than alcohol or nicotine. Although the intravenous route
might never become widely popular, smoking (especially of crack) would be the route of
choice for millions. There is no reason to doubt that the increased costs to society would
rival those now attributable to alcohol. In that case the economic savings that might be
achieved, even if it were possible to eliminate all the costs of drug law enforcement, might
well be offset by the additional costs resulting from the consequences of increased drug use.
[26, p. 1516]
If the government were to attempt to prevent large increases in consumption by
raising the prices for drugs sold through drug stores, as suggested by some proponents
of legalization, prices of illicit drugs could then be competitive, and drug traffickers
could continue in business. Government would be in the position of choosing between
raising prices to discourage excessive use, thus allowing the illicit traffic to continue, and
lowering prices to drive out the illicit trade, thus increasing consumption. [26, p. 1516]
It has been argued that legalizing and taxing drugs would provide financial
resources for treatment of those who become addicted, but in Canada in 1984 the total
social costs of alcohol were double the revenues generated from alcohol at all levels of
government. In the United States in 1983 the social costs of alcohol were ten times the
revenues collected from alcohol. [26, p. 1516]
The recent decline in drug use among high school students in the U.S. and
Canada probably reflects a gradual acceptance of medical evidence that has been part of
the justification for the continued illegal status of some drugs. A consequence of
legalization would be the risk of conveying the message that drug use is not really as
harmful as the students had come to believe and thus would weaken an important influence
tending to keep consumption levels low. [26, 1516]
The Gallup Poll documented the change in public opinion in the 1980s as those
who could not handle occasional cocaine use have succumbed to domination by drugs
and by drug-seeking behavior. These addicts became not only miserable themselves but
also frightening to their families and friends. The percentage of those who try a
substance and acquire a dependence or get into serious legal trouble from cocaine is
estimated from 3 to 20 percent, or higher.
- 90 Early in the cycle the explanation for casualties is that those who succumb to
addiction are seen as having a "foolish trait." Personal disaster is thus viewed as an
exception to the rule. Another factor minimizing the sense of risk is our belief in our own
invulnerability--that general warnings do not include us. Such faith reigns in the years of
greatest exposure to drug use, ages 15 to 25. Resistance to a drug that makes a user feel
confident and exuberant takes many years to permeate a society. [55, p. 47]
6-26. Legalization.
The legalization of psychoactive drugs has been proposed as a possible way to
reduce the high costs of enforcing existing prohibitions. Not only would the police,
courts, and prisons no longer have to deal with the huge load of drug cases with which
they are now burdened, but also the legal sale of drugs of known purity at moderate
prices would, it is argued, drive the illicit traffic out of existence. In addition, licit
businesses and government would allegedly earn huge revenues that now find their way
into drug traffickers' bank accounts. [25, p. 1516]
What would be the costs and dangers of legalization? Even the proponents of
legalization acknowledge some risk of increased drug use with its attendant problems, but
they argue that the extent of such increase would be small. However, as an editorial in The
New York Times remarked, "there is little evidence to support so stupendous a
contradiction of common sense; indeed, past experience suggest that the increase in use
would be very large.” [25, p. 1516]
This common-sense expectation is generally confirmed by historical evidence.
Alcohol and tobacco, which are now so freely available, are also the most widely abused
drugs, but alcohol consumption was much lower when the drug was less readily available.
Social custom made cigarettes effectively unavailable to women until after World War I;
then consumption increased steadily as it became more acceptable for women to smoke,
and the lung cancer rate for females eventually matched that for males. Opiates and
cocaine were legal and freely available before passage of the Harrison Act in 1914. Despite
the absence of sound nation wide surveys, there is evidence to suggest that this availability
had given rise to widespread and serious misuse. According to an epidemiological study
conducted in 1913, the percentage of adults addicted to these drugs appears to have
been not very different from the percentage addicted to alcohol in present-day North
America. [25, p. 1516]
The history of alcohol provides some basis for predicting what might be expected
from the removal of all drug prohibitions. The key question is whether legalization of
opiates and cocaine would result in levels of addiction comparable to those seen currently
among the users of alcohol and tobacco. Opiates and cocaine are certainly not less
addictive than alcohol or nicotine by any criterion. Although the intravenous route might
never become widely popular, smoking (especially of crack) would be the route of choice
for millions. There is no reason to doubt that the increased costs to society would rival
- 91 those now attributable to alcohol. In that case the economic savings achieved if it were
possible to cut costs of drug law enforcement, might well be less than the additional costs
resulting from the consequences of increased drug use. [25, 1516]
If the government were to attempt to prevent large increases in consumption by
raising the prices for drugs sold through licit outlets, as suggested by some proponents of
legalization, prices of illicit drugs could then be competitive, and drug traffickers could
continue in business. Government would be in the unhappy position of having to
choose between raising prices to discourage excessive use, thus allowing the illicit traffic to
continue, and lowering prices enough to drive out the illicit trade, thus increasing
consumption. [25, p.1516]
Legalization advocates praise Zurich, Switzerland for opening Needle Park in 1987
where drug users could congregate, find drugs, treatment and free needles. The park was
closed in February 1992. Crime near the park has since declined, but it has increased in
other parts of the city. [30, p. 2315]
6-26.1. Medical use of marijuana.
Most discussion of the legalization of drugs includes a statement “marijuana should
be legalized for all persons over 21 because it relieves painful symptoms in some cancer and
glaucoma patients and it is a victimless crime.”
The report prepared for Congress in 1991, see Box 12-A, page 2, [14, 1-500] states
tetrahydrocannabinol (THC), the active agent in marijuana, has been prescribed to relieve
nausea and side effects of chemotherapy in cancer patients and “it is very rarely used to
treat glaucoma.” Marijuana has been used medicinally since ancient Egypt. Israeli
archaeologists in 1993 discovered marijuana in a fourth century tomb. It is said to have
been commonly used to ease childbirth—promoting contractions while relieving pain.
Starting in 1976, the U. S. government allowed people suffering from certain
diseases and didn’t find relief in traditional medications to apply to the Food and Drug
Administration for permission to use the illegal drug. The FDA approved marijuana on a
case-by-case basis (1) to ease nausea and loss of appetite caused by cancer and AIDS
treatments, (2) to ease muscle spasms for people with spinal cord injuries or multiple
sclerosis and (3) to alleviate the eye pressure that blinds glaucoma sufferers. Some medical
studies have confirmed that marijuana does relieve some symptoms in such cases.
In 1992 the Bush administration banned the medical testing or use of marijuana,
saying that inhaling marijuana smoke can harm patients with weakened immune systems.
The 15 people receiving the drug were allowed to continue. Since then voters in Arizona,
Alaska, California, Colorado, Maine, Nevada, Oregon and Washington have approved
ballot initiatives allowing marijuana for medical purposes. Hawaii's governor signed
legislation in 2000 authorizing the use of marijuana for medical purposes. The Nevada
- 92 legislation in 2000 authorizing the use of marijuana for medical purposes. The Nevada
state assembly on May 23, 2001 approved legislation to authorize medical use of
marijuana and to lessen the criminal penalty for possessing the drug. The Nevada Senate
was expected to approve the bill. The Nevada bill would allow seriously ill people to have
as many as seven marijuana plants for personal use. A new state registry would list
patients whose doctors recommend that they use marijuana for medical reasons.
The U.S. Supreme Court ruled unanimously on May 14, 2001 that a federal law
classifying marijuana as illegal makes no exception for ill patients. The result of the
standoff appear to be that Nevada is saying “we will not prosecute patients on the registry
for raising and using marijuana--it is a federal crime—but don’t worry about that.” [63.
Raleigh N. & O. 5-24-2001, p 11a]
6-27. Summary of arguments for drug prohabition, decriminalization, and legalization.
Prohibitionists
Would increase number of users, addicts
Would increase safety hazards on highways,
Would increase drug-related health problems
Would increase drug-related family problems
Would increase drug-related crime
Implies endorsement, sends wrong message
Increase school/work problems
Would disrupt families
Disproportionately harms poor & minorities
Drug use is immoral
Alcohol prohibition was effective
Decriminalizers and Legalizers
Decrease drug-related crime
Eliminate illicit drug markets
Reduce burden on criminal justice system
Current laws are hypocritical
Current legal penalties are too harsh
Current laws infringe on civil rights
Social conditions are the problem
Should emphasize treatment/education
Regulate illicit drugs like prescriptions
Make drugs available for medical uses
Alcohol prohibition was ineffective.
[49, p.615-29]
- 93
-
7-00
What are community groups doing to promote drug and alcohol abuse
prevention?
7-01. What is drug and alcohol abuse prevention?
Thousands of organizations—international, national, regional, statewide,
local, private, public non-profit, civic, religious are working to prevent drug and
alcohol abuse.
In Sec. 1-02 a broad and inclusive definition of drug abuse prevention was
suggested. Any action that




attempts to help keep a student in school;
helps a person to increase self-esteem and feeling of self-worth;
helps a person to learn how mood and mind altering drugs can effect their
bodies, their thinking, and their actions; and
helps reduce the temptation and opportunity for a person to experiment or use
mind-altering drugs.
7-02. What do we know about the drug and alcohol abuse problem in 2001?
 No strategy in isolation will deter alcohol and other drug abuse.
 Rather we must implement diverse strategies. Hopefully all populations of the
community---parents, schools, churches, justice system, social service agencies,
health care providers, business community---will cooperate in a collaborative
approach to prevent and intervene in alcohol and other drug abuse.
 Changing individual student attitudes toward substance abuse requires altering
the norms of the local community and the school “environment” in particular.
 The earlier an adolescent initiates use of alcohol, marijuana, or other illicit
drugs, the more likely he/she will not graduate from school, be divorced, will
have employment and health problems. Students who start drinking alcohol
regularly before 15 are 40% more likely to become alcoholics.
 Most adults who are regular smokers started smoking before the age of 18, the
legal age for purchasing tobacco products.
 It is easier to prevent drug use than repair the physical, psychological, social,
and economic damage resulting from drug dependency. [43. J. of Am. Med. Ass. v.
263, 1990]
7-03. Research suggests some drug education programs are more successful
than others:
 Peer programs, when children and youth are partners is drug education.
“Kids listen to Kids.”
 Health “resisting temptations” program when drug abuse education is a part
of a broader program to convince kids to consider the long term
consequences of stealing, joining a gang, dropping out of school, running
away from home, premarital sex (particularly unprotected sex and teen-age
child bearing), drinking and driving, and similar endeavors.
- 94 Drug prevention has a lot in common with positive interventions designed to get people to
invest in their own well being, including health promotion, encouraging exercise, good
nutrition, good school performance, etc. Many school-based programs but even more
community-based and alternatives-based programs are trying to generate such diverse
benefits already. [10. J. Caulkins,”Drug Prevention: The Paradox of Timing,” The FAS
Drug Policy Analysis Bulletin, No. 5 (Oct. 1998) ]
A study of 143 adolescent drug prevention programs by Nancy Tobler first
published in [86. The Journal of Drug Issues, v. 16(4)], 1986 reported two types of
programs were effective in reducing high drug abuse among teens. First, peer programs
were superior to all other programs in the size of the change obtained in the knowledge,
attitudes, use, skills, and behavior of average school-based adolescent population. Second,
alternative programs were highly successful for the “at risk” adolescent such as drug
abusers, juvenile delinquents or students having school problems.
Tobler's follow-up study of 91 programs, "Drug Prevention Programs Can Work: Research
Findings" appeared in 1992 in the Journal of Addictive Diseases. Both articles described
how the peer programs work to prevent, retard, or reduce high drug use.
Tobler’s analysis divided the programs into five groups:
Group #1
Group #2
Group #3
Group #4
Group #5
programs with teachers presenting the legal, biological, and psychological
effects of drug abuse with limited group discussion and some scare tactics.
programs attempted to change student attitudes, build self-esteem, increase
self-awareness, and feelings, and clarify values.
stressed both knowledge and attitude included in 1 and 2 above.
programs involved students in community activities, youth centers,
volunteer jobs. Recreational activities were made more appealing than drug
use.
programs included the content of Group #3 but used group situations
to train students to provide peer support for not using drugs.
Tobler reports students after receiving training in group leadership can serve as
effective leaders in Group #5 programs when offered in grades six through eight. Persons
with greater experience in group process such as mental health professionals and counselors
usually provide information to students and act as guides to 10th to 12th grade students in
peer teaching, peer counseling, and peer intervention techniques with elementary and
middle school students. This information and knowledge of group process increases
student’s self esteem, self awareness, coping skills, "saying no" techniques, assertive skills,
and intervention techniques. Two identified strategies for their self esteem enhancement are
to learn something new and to do something for others. [86, p.22]
Most peer leaders were usually older high school students who volunteered and
received training in the program activities. After the peers were trained they were
frequently more effective leaders than regular classroom teachers. However, they were
supported by teachers who remained in the background to maintain classroom discipline.
- 95 Why peer programs? If a young person’s peer group approves deviant patterns of behavior
or holds pro-drug attitudes, alcohol abuse is more likely. [58. NIDA 1981,15] If the
teenager’s self-image is also highly negative, the youngster is in double jeopardy.
Tobler found positive research results if highly structured formats were used to (1)
build a repertoire of refusal skills, (2) provide a knowledge of the social pressures to use
drugs, and (3) provide the necessary practice time to acquire skills to counter these
interpersonal pressures. Specific skills “stressed” included:
(a)
(b)
(c)
(d)
factual drug information to change the perception that "everybody's doing it;"
immediate feed-back and positive reinforcement from their peers;
role plays and rehearsals by students;
modeling by older and by popular same-age peer leaders using both videotapes
and live enactments;
(e) safety intervention techniques such as how to refuse a ride with someone who
has been drinking or planning tactics ahead of time for preventing driving after
drinking.
If the following broad-spectrum skills and interpersonal skills are lacking, the
student may be more likely to become a drug abuser. Up to 20 hours are spent on these
skills and their programs are highly structured and accompanied by detailed manuals.
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
communication skills;
assertiveness skills;
problem solving and decision making skills;
techniques of cognitive-behavior therapy;
goal setting;
coping skills;
social skills; and
conversation and dating skills.
The unique aspect of the peer programs is the extent of the use of small groups to
share ideas, feelings and experiences. Discussions focus on the person, his/her feelings,
behavior, and own particular way of handling life, but the group discussions maintain an
emphasis on drugs and are not just rap sessions. Leaders encourage a non-authoritarian,
non-threatening atmosphere in order to facilitate
open communication and aim to establish warm and trusting relationships. A minimum of
10-12 regularly scheduled sessions are usually held with consistent membership and regular
attendance.
Frank Riessman believes peer tutoring and cooperative learning or learning through
teaching is an important strategy for public education. He asserts there are 20,000 such
programs, where peers mediate conflict, provide drug education and AIDS awareness in a
variety of peer-centered designs. He writes, “The peer strategy expands the resources
-
96 -
of the schools quantitatively and qualitatively by: (1) utilizing the target
population itself as a resource; (2) converting random, often negative, peer
interactions into informed, positive help; (3) building on the indigenous skills of the
target population--youth communicating with youth in their own vocabulary and
style; and (4) utilizing the helper-therapy principle, in which help givers are helped
through helping.” [72, p. 3]
The peer recipients of help can in turn become helpers. This is perhaps best
illustrated in cross-age tutoring; for example, eight graders may tutor six graders
who may in turn tutor fourth graders who tutor second graders, and so forth.
The important principle of peer tutoring and cooperative learning is the
principle of learning through teaching. The peer tutor or the member of the
cooperative learning team has the opportunity to engage in the learning process by
explaining a concept to another child. The aim is to distribute this opportunity
widely so that all children can play the tutor role whether in one-to-one tutoring or
in cooperative learning. Riessman sees this as an approach which helps to impart
democratic values in an experiential manner and is applicable to all students
including those at risk.
Many similar programs are active across the nation. The "WHOA! A Great
Way to Say No" program is reported to have been used successfully at Cook Middle
School in Winston-Salem and Independence High School in Charlotte. Peer
leaders receive six hours of instruction in teaching other students ways to resist
trouble. Student facilitators, through training, are empowered with new
knowledge and responsibility, thus increasing self-esteem. The program builds on
the strengths of the students. Students and adult leaders solve difficult situations
arising in their groups and share strategies. The program provides opportunities for
role play and positive interaction. [“The Next Step”, p. 1.]Other programs which are
said to have been effective are Reconnecting Youth, Life Skills Training, Project
ALERT, Project STAR, Alcohol Misuse Prevention, and Project Northland. The
SADD program with more than 30,000 chapters gets students involved in helping
others.
In serving as tutors and counselors the students increase their communication
skills in both articulating and listening. Youth facilitators also reinforce their own
understanding of resistance and assertiveness as they teach others. Students are
chosen as facilitators on their leadership abilities, not by academic performance or
record. Facilitators become aware that they are role models for others, thus
strengthening their personal commitment to the program and to staying out of
trouble. Students become part of the solution rather than part of the problem.
Adult advisors must be available in the classroom to provide support and
affirmation. Adults become "professional peers" to the youth facilitators,
eliminating the "you" and "them." Also encouraged is a support team of peer
facilitators and advisors within the school. [72, p. 7]
- 97 7-04. Students Tobacco Alcohol Resource Team (START):
A student who participated in the March 2000 speech contest was asked to serve as cochair of the START program when it was started at Grimsley High School in Greensboro
in the fall of 2000. She said it was what she had to do after learning that drug abuse was
such a terrible problem in the nation, in Greensboro, and in her school.
START is a joint partnership of Alcohol and Drug Services, Project ASSIST, and the
Guilford County Schools. It is funded by a three year grant from Moses Cone-Wesley Long
Community Foundation. In Guilford County juvenile arrests for drug use and possession,
DWI, drunkenness, liquor law violations, juvenile non-violent and violent crime arrests
are 40% higher than the State mean. [9, p.1-4]
In 1999 the student led project was started at Northwest High with help from the Summit
Rotary Club. In 2000/2001 three more schools in Guilford County participated---Eastern
Guilford High School, Grimsley High School, and Ragsdale High School. In each of the four
schools a group of 25 students was selected by application to become a part of a specially
trained student club responsible for planning and implementing activities which they feel
would be effective within their own campus and community.
The students have planned, conducted, and/or promoted the following: staff booths at
middle and high school during Red Ribbon Week, Great American Smokeout, Alcohol
Awareness Week, Kick Butts Day. They--made presentations to middle school health
classes; written articles for school newspapers and PTSA letters; prepared bulletin boards
and banners; hosted and conduct a parent education session, etc. As suggested by the
activities listed, students worked with peers, middle school students, parent and members of
the community confident they could make a difference.
What drug abuse prevention programs are active in your community?
Students are encouraged to investigate the range of projects and programs in their
community that are sponsored by or operated by governments, civic, religious, and/or notfor-profit community groups seeking to reduce or prevent drug and alcohol abuse in their
community. They are also encouraged to talk to school counselors and others about groups
and individuals seeking to help students and adults with drug problems or to help a family
or families with a member experiencing drug abuse problems.
7-06. What are colleges and universities doing to prevent drug and alcohol abuse?
Colleges in North Carolina are trying to reduce the use of drugs and the consumption of
alcoholic beverages, particularly “binge drinking” on campus. (See Section 6-09 on page
70). An increasing number of colleges have established living areas for students agreeing
not to drink or smoke in their rooms. Most non-drinking students at Triangle universities
say they decided not to drink long before they set foot on campus. One characteristic nondrinking students have in common is the desire to be in control of actions. Abstaining
students reject the idea they are removed from the mainstream of college social life and say
they prove wrong the notion that alcohol is the basic ingredient of a good time. [ 63. N. &
O. 12-14-96, p. 1B,6B]
- 98 President Nannerl O. Keohane of Duke University wrote the following which was included
in the January, 2001 issue of the Duke University Alumni Magazine. [47. p. 1,2]
“At eighteen, we were all immortal. Post-adolescents often assign different probabilities to
various risks than they will ten or fifteen years later...But sometimes they push those limits
beyond the pale--as is true for those who drink themselves into oblivion, for instance, every
weekend. That’s not healthy, and needs to be discouraged. Thirty thousand American
students each year are treated for acute alcohol poisoning, and some of them die. Last year
at Duke, for instance, we lost a student who died from the after effects of breathing his own
vomit while he was unconscious.”
“In 1998, 41 percent of Duke students reported binge drinking within the previous two
weeks; 37% admitted having done something they later regretted as a result of alcohol use.
Twenty eight percent reported memory blackouts, while almost 20% remembered having
driven a car while drunk and nearly 10% remembered having been taken advantage of
sexually while drunk.”
“Since Duke is a residential undergraduate campus, much of the student drinking occurs
within its boundaries. This means figuring out how to deal with uncivil behavior-- latenight noise in dorms, discourteousness, even destruction of property related to alcohol use.
We have processes in place, forums such as the honor council, ways to manage that aspect
of drinking. The lively discussions that have ensued have been healthy for the campus
community…”
“Encouraging civil disagreement in response to uncivil behavior is an excellent means of
furthering education…Our Alcohol Task Force, composed of students and administrators,
has been working for months to educate and inform students about responsible alcohol
consumption, as well as to generate creative alternatives…Student leaders clearly
understand that it’s in everybody’s best interest to change the norms, but they are
frustrated, as we all are, by a complex problem of truly national scope.”
7-07. What are civic clubs doing to prevent drug and alcohol abuse?
Civic club members share common concerns for the health and education of all children
and that each child have a safe, loving, and supportive home. They are worried by the
increase in school dropouts, drug use and abuse, and violence in our society.
All four of the largest civic clubs in the U.S. have adopted specific national or international
activities which member clubs are asked to sponsor. Individual clubs are encouraged to
develop projects which will reduce drug abuse in their communities. An example of a
nationwide project would be the Lions Clubs joining in 1986 with the Quest National
Center, the National PTA, and the American Association of School Administrators to
publish two textbooks, “Changes: Becoming the Best You Can Be” for students and “The
Supervising Years” to help parents be better parents. Both texts have chapters on alcohol
and other drugs and drug use and were provided free of charge to schools to supplement
the elementary curriculum.
- 99 The Elks Clubs in the late 1980’s started helping local drug prevention programs by
paying the cost of printing hundreds of thousands of pamphlets annually for local
schools to use in the drug abuse curriculum they adopt. Kiwanis clubs sponsor the
“Terrific Kid” program which seeks to increase adolescent student self-esteem.
A survey of the literature reveals civic clubs have started or led in starting valuable
local programs which have become community programs. For example:
Civic clubs have led in organizing citizen groups to identify the problems which
contribute to drug abuse in their community, searched for tailored and imaginative
original responses to the problems, and secured funding to start the programs;
Civic clubs have led in creating task forces of citizens who work to complete specific tasks
and in volunteering persons to individually serve in arranging and providing:
(1) school-based drug education and esteem building courses;
(2) anti-truancy programs to improve school attendance;
(3) anti-drug education programs in housing projects;
(4) information program for parents about the challenges of adolescence and the
social forces that cause young people to experiment with substances, and
roles for parents within the school, family, and community;
(5) support for community groups organizing to reclaim their neighborhoods
from the drug dealers and users;
(6) support and help to arrange education, skills training, job placement, and
mentoring for young men and women and mentoring for younger students;
(7) leadership in organizing business and government support for social service
agencies delivering assistance to people in need;
(8) support for expanded drug treatment centers for addicts who desire to shake
the habit;
(9) encouragement apartment managers to enforce lease provisions forcing
drug dealers out of the building;
(10) media support for the activities of school and parent groups, and promotion
of substance abuse prevention as a community priority;
(11) support for clean up, fix up, paint, remove debris, enhance lighting,
improve recreational areas, and establish drug-free recreational programs for
youth
(12) support for law enforcement and stiffer criminal penalties for dealers.
[Hayman, Donald. Rotary District 771 Newsletter, (9-1990) p. 3.
- 100 7-08. What are Rotary clubs doing to reduce alcohol and drug abuse?
Rotary International first urged clubs to start drug abuse prevention projects in
1982. Preventive education has been the focus of many projects. The Los Angeles
Rotary club sponsored the first D.A.R.E. classes and publicized D.A.R.E. both
nationally and internationally. Shortly after the U. N. announced an emphasis on
drug abuse prevention during the 1990-2000 decade, Rotary International
presidents asked clubs to adopt drug abuse prevention projects that might address
the problems in their communities. The following projects designed to reduce drug
abuse were active in 1993. Some of them although considered worthwhile were
discontinued as governors and presidents tried to follow new emphases and achieve
the goals of new international presidents.
D5160.
Anderson, CA club project reinforces D.A.R.E instruction by providing one week of
leadership skills training in a national park for 300 8 th and 9th graders (in groups of 50).
High school students serve as counselors and D.A.R.E. instructors provide classroom
presentation on leadership topics and recreational activities designed to strengthen
leadership techniques originally learned in D.A.R.E.
D5160.
13 Contra Costa County Rotary Clubs organized a foundation, “Rotarians Against
Substance Abuse” in 1983. The foundation raises funds to finance substance abuse
prevention and rehabilitation programs and with the local drug abuse council funds the
following programs (1) Friday Night live—in 28 schools with 30,000 teens; (2) SafeRides
program; (3) A Drug and Alcohol “Hot Line” at a local hospital; (4) Driver’s
Education/Parents Night in three school districts; (5) “sober Graduation Week,” (6) Grants
$500 to Rotary Clubs in the county that will initiate a drug or alcohol abuse program.
D5160. Walnut Creek-Sunrise, CA club organized a D.A.R.E. Walkathon and Carnival for 500 5 th
and 7th grade D.A.R.E. students from eleven elementary schools and two intermediate
schools. Students bring their completed pledge sheets and walk to a park with their
D.A.R.E. officer. Students are given T-shirts at the carnival games and food booths are
provided.
D5340. Thousand Oaks, CA club supports peer-group counseling class for high school students. The
students tutor “at risk” intermediate school students first on academic subjects and then
with the guidance of intermediate school principal and counselors on personal problems i. e.
drug involvement, abusive parents, pregnancy, truancy, etc.
D5580. In and around Duluth, Minnesota has publicized the “Operation Aware” curricula. Courses
provide students with information and skills for wise choices about their bodies and their
relationships. Students are helped to understand peer pressure and to develop problemsolving skills. Classroom lessons are designed to build self-esteem and a positive self-image.
The course at middle and high school supplements and reinforces D.A.R.E. instruction.
D5580. Duluth Harbortown, MN club provide two Rotarian facilitators to lead small groups (10 to
20) of parents in 2-hour “It’s Time to Talk” sessions. The sessions give parents training in
initiating discussions with children about the use/not use of alcohol and other drugs.
D7810. Rockwell, TX club sponsored a voluntary drug testing program for high school and middle
school students. Students testing negative for drugs are given an identification card entitling
them to discounts at many local stores.
- 101 D6760. Donelson-Heritage, TN club members from 1989 until 2000 annually served as instructors
presenting two 45-minute programs, one on the danger of drug use and a second on self
esteem. Third and fourth grade students in twelve schools attended the classes. The
students complete an assignment, use a coloring book, enter a poster contest, receive a
certificate and a Drug Free T-shirt.
D6980.
Kissimee, FL club in 1989 began donating time and services of Rotarians to finance drug
testing of all athletes and cheerleaders at Gateway High if all (100%) favored drug testing.
Offer was accepted and in 1991 the Rotary club proposed mandatory drug testing of all
athletes and cheer leaders. The proposal was supported by school administration, coaches,
team members, and parents. School service clubs are voluntarily requiring participation in
the drug testing program as a requirement for membership. School officials believe the
program has been a deterrent as no student has tested positive.
D7390. Lancaster Northeast, PA club provides financial support and adult leadership for TASK
(Together Adolescents Support Kids). High school students volunteer by making a written
pledge to be a role model for other students by abstaining from the use of alcoholic
beverages and any form of drug abuse. The students, working in small groups with an adult
committee, plan original skits on saying no to drugs. The groups perform their anti-drug
theme skits for third, fourth, and fifth grade students in four schools. After the presentation
adults are excluded and the student meet with the elementary students for questions.
D7430. Amber PA club commissioned a psychiatrist member to develop “Students at Risk” a series
of emotionally-charge realistic problem situation in the lives of teenagers. The situations are
presented by trained professionals to demonstrate how normal adolescent adjustment
difficulties become dangerous through the abuse of alcohol. Spontaneous theater and
clinical psychodrama are used to experience the situations and explore alternative behavior.
Both students and parents interact with the actors through questions, suggestions, and
playing roles in the scenes. The students present programs on community issues relating to
alcohol and drug abuse to students in lower grades. The topics covered including parenting,
communication barriers, peer relationships and pressures, effects of rejecting and prejudice,
ego, self-esteem and confidence–building, as well as substance abuse identification,
prevention, and intervention.
D7510.
Fanwood-Scotch Plains, NJ club supports “Children Are People Program” a 12-week
program in which (1) group counseling is given to children ages 5-12 who come from families
where an alcohol or alcohol and drug dependency problem exists, (2) the children in peer
groups with skilled leaders share mutual concerns, develop constructive social relationships
and enhance problem-solving skills; (3) the children in a supportive and structured group
environment learn about the effects of alcohol/drug abuse in families and share common
feelings and experiences; (4) the sessions help the children to understand the challenges in
their lives and how they can deal more effectively so that their self-esteem can remain intact;
and (5) other family members are included in the education/prevention groups when
possible.
D7510.
Red Bank, NJ club (1) funds a School-Community Coalition on Substance abuse, (2)
supports a tutorial program which brings 70 volunteers from the business and professional
community to school one night a week to provide one-on-one tutoring of third and fourth
graders in order to encourage students and to help them raise their level of aspiration and
see the value of doing well in their studies; and (3) invites a parent or parents one night a
month to the school to a spaghetti dinner served by their children. On that night parents are
coached on how to work with their children at home.
- 102 D7620. Frederick, MY Rotary club received the 1990-91 Rotary presidential Award of Honor for
Drug Abuse Prevention. The club sponsored or participated in seven projects: (1)
sponsored a drug summit for 200 high school students; (2) paid cost of training two D.A.R.E.
instructors; (3) assisted in organizing 7 groups of Parents Against Drugs in county; (4)
sponsored five students to Maryland Alcohol & Drug Abuse Prevention Conference; (5)
sponsored three students to attend the National Narcotics Anonymous Conference; (6) Cosponsored two-a-week drug free Young Adult Dances during the summer & fall of 1990; and
(7) supported a community health training program which reached 26,000 adults in two
years.
D7710. The Central Johnston, NC Rotary club gave $25,000 to the L3 (Life, Long Learning) program
of the Johnston County Educational Foundation. 9 th graders may sign a contract with the
Foundation promising to (1) attend school at least 95% of the time, (2) donate 15 hours of
pre-approved community service during each school year (some are tutoring every week),
(3) complete 20 prescribed high school courses, (4) pass all parts of the N.C. Competency
Test, (5) remain drug and alcohol free, and (6) work no more than 20 hours a week and not
after 10 p.m. during the school week unless approved in writing. The Foundation will pay
$1,500 a year, maximum of $6,000 in 5 years, for tuition and books to participating approved
higher education institution or approved apprenticeship program for each student meeting
the conditions of the contract.
D7710. Four NC Rotary districts and D6250 in Wisconsin and D7570 in Tennessee and Virginia
sponsor a Multi-district Rotary Against Drugs (RAD) High School Speech Contest. If more
than four students desire to participate from a high school, a contest is held at the school and
four student are selected to represent each high school. (In a local contest sponsored by more
than one club, each club may sponsor a student from each high school to represent it in the
Multi-district Contest. Clubs provide an award for each student who enters the contest.)
Students are encouraged to consult the Resource Materials on D7710 web site in preparing
their speeches. Students selected to represent a club or district are invited to participate in
the Multi-district Rotary Against Drugs High School Speech Contest held in Chapel Hill, N.
C. in March of each year. “There are no losers.” All students speaking in the multi-district
contest will receive a monetary award, a certificate of recognition, and will be recognized in
a news story provided their local newspaper.
D7770. Spring Valley club (Columbia), SC initiated a “FOR KIDS ONLY” program which brings 16
disadvantaged children (8 to 12 years of age) from alcoholic and/or chemically addicted
families together once a week for six weeks. Through the program and follow-up sessions
with counselors and volunteers, the kids are given love, understanding, and support, plus a
knowledge of alcoholism and drug addiction that will better equip them to deal with the
pressures to experiment as they grow older. [ 37. Hayman, Donald. “Drug and alcohol abuse
prevention: What are Rotary Clubs Doing?” -List of Selected U.S. Rotary Drug Abuse
Prevention Projects. Rotary District 771, Newsletter (9-1990), p. 3]
7-09. D-FY-IT, DRUG FREE YOUTH IN TOWN.
A student-run program called Drug-Free Youth in Town is reported to have
“grow like a Texas brush fire” with extensive support of Texas Rotary clubs.
Students who voluntarily take and pass urine tests showing they have no drugs in
their system receive a card which makes them eligible for discounts from
merchants. To keep their cards and retain club memberships, they are subjected to
random testing throughout the year.
- 103 The program, initiated by students in Kilgore, TX was adopted by a Rotary
club in Tyler and then by two Rockwall Rotary clubs in 1990. “The Rockwall
Rotary clubs got a fantastic response,” said Jack Horn, chairman of the program
for RI District 5810. “The first year 500 students took the test, the next year over
1,000 of the 1,300 students at Rockwall High School participated” and in 2,001 and
more than 1,500 are participating.
Belonging to D-FY-IT (pronounced “defy it”) is fun because the club has
numerous activities. It also confers considerable status among family and peers.
“Some girls won’t date boys unless they are members of D-FY-IT.” Horn said. The
biggest incentives are the substantial discounts students receive at 110 local
businesses such as a third off the price of a car wash and two tickets for the price of
one at a movie theater. The cards are also usable at all D-FY-IT sponsoring
businesses, wherever the program operates.
“The beauty of Drug-Free Youth in Town,” Horn said, “is that it is a
program conceived by kids and run by kids. A counselor assists, but the young
people make all the decisions. The kids made the decision that parents should be
notified if a student fails the drug test. If a student has a drug problem, the parents,
students, and counselor try to find a solution. It’s not a policing program.” The
testing has safeguards to protect the reputation of the students being tested.
“Students can fake their tests, but no more than 5 percent of them do. The kids will
know if someone cheats,” he said. Inner-city youth in Dallas are among the greatest
supporters of the D-FY-IT program. [74. R. I. Turning Point: Creative Ways to Combat
Drug and Alcohol Abuse. 1993]
7-07. Community Coalition.
When citizens of a community recognize they have a difficult drug abuse
problem and ask, “What shall we do?” The answer most often heard is “Form a
community coalition.” Over 2,000 communities in the U.S. have accepted the
challenge and formed a coalition to address local concerns about the use of alcohol,
tobacco, and other drugs.
Project Northland, a major research initiative, established a multi-year
program for youths in 24 northern Minnesota school districts. Aided by a major
grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
Project Northland was developed by the University of Minnesota and began in 1991.
Its goal was to reduce substance abuse in the class of 1998 through an ongoing
intervention program.
The project was guided by the belief that a reduction in adolescent alcohol
abuse requires participation by the broader community and by behavioral theory
that changing individual attitudes toward substance abuse requires altering the
norms of the local community and the school environment in particular. By
- 104 reducing the community’s toleration for drinking, Project Northland sought to
reduce drinking among younger adolescents. It called for improved communication
between parents and children about alcohol use and attempts to change how the
community and students regard alcohol use.
Beginning in 1991, Project Northland focused its attention on that year’s
sixth-grade class in the 24 school districts. From 1991 until 1995, the program
focused its attention on the class of 1998 as it progressed through middle school. In
addition to the curricula and programs for students, it included community and
parental involvement in each grade and creation of community forums and linkage
with public and private community organizations. At the end of the 8th grade,
monthly drinking was 20% lower in the Project Northland districts than those in a
control group and weekly drinking was 30% lower.
A second example of a school-based program extending to include the entire
community occurred in Kansas City, Kansas. The objective of the Midwestern
Prevention Project was to reduce adolescent use of tobacco, alcohol, and marijuana.
But the project took a broad-based approach spreading from the school to mass
media, parents, and community organizations.
The difficulty of reducing drug use is documented by a professionally
prepared evaluation of the Project Freedom in Wichita, Kansas.
Many
professionals worked very hard for four years and the only statistically significant
result was a modest success in reducing cigarette smoking. [19. Fawcett, S. B.
“Evaluating …Project Freedom..,” Health Education & Behavior, 12-1997. p. 812-28]
The greatest contributions of civic club members may be their leadership as
parents, church members, and leaders in other community organizations. Some
members develop and support employee assistance programs, give freely of their
time and money to local and school recreational programs, the Salvation Army,
Alcoholics Anonymous, Narcotics Anonymous, Mothers Against Drunk Driving,
Students Against Drunk Driving, Operation Aware, Project Graduation, and
hundreds of other worthwhile programs. Some help develop a formal or informal
community coalition capable of making their community a better, safer place for the
children and all residents.
- 105 8-00. Goals for preventing drug and alcohol abuse.
The war against drugs must be waged in:
(1) homes and schools and in the minds of children and their parents,
(2) offices, factories and banks,
(3) hospitals and treatment centers,
(4) the media, and
(5) prisons as well as on the streets, courts, and high seas.
Neighbors must organize and entire communities must work together if
progress is to be made. Plans and programs are needed to stem the worsening
cycles of poverty, psychiatric illness, crime, and drug abuse.
[39, p. 387]
Technological advances offer promise in treating drug abusers and in detecting
drug use and reducing confinement in correctional facilities.
Join Together, an organization of the Robert Wood Johnson Foundation
which since 1972 has given more than $2 billion in grants to improve access to basic
health, improve ways health services are organized, reduce the harm caused by
substance abuse, etc., sponsored a study of how the criminal justice system should
work within communities to reduce substance abuse. The Feb. 1996 report has the
following recommendations:
“We must stop pushing low-level nonviolent substance abusers through a
revolving door of ineffective punishment. Sanctions and sentences for low-level,
nonviolent substance abusers must focus on treatment and rehabilitation as well
as deterrence and separation. The system must serve to break the cycle of
substance abuse, not merely interrupt it.”
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Mandatory sentencing laws must be repealed.
Truth in sentencing—sentences should reveal actual time an offender will serve.
Judges and legislators must craft sanctions focusing on curbing negative
behavior.
Drug courts should be established or expanded to allow judges to divert
offenders to treatment and rehabilitation where appropriate.
Close supervision of drug offenders on probation or parole.
Disparities in sentencing based on race or class must be eliminated. Access to
prevention and treatment of substance abuse must be an integral part of the
criminal justice system. The entire system must support prevention efforts.
Appropriate treatment in a coordinated & continuous manner must be required
for every substance abuser who comes in contact with the criminal justice system
Barriers must be broken among the various entities that make up the criminal
justice system so they can cooperate—share resources, training, and insight
while respecting and observing each other’s appropriate role.
The criminal justice system must ensure public safety in the entire community.
The police must work in partnership with their communities to develop longrange strategies for reducing substance abuse. [41]
- 106 8-01. Minimize use and harm.
Psychoactive drugs have always been with us and probably always will be.
The practical aim of drug policy should be to minimize the extent of use, and thus to
minimize the harm. As behavior change comes slowly, it is important to be patient
and give improved drug policy time to work.
The goals of drug abuse programs should be to:


reduce the recruitment of new addicts by making it more difficult and more expensive
to obtain psychoactive drugs and by strengthening an anti-drug consensus through
education, and
improve the circumstances of those already addicted by regarding them as
victims of a life-threatening disease (as indeed they are) requiring compassionate
treatment.
The following countries have concluded that the use of snuff should not be
tolerated: Australia, Hong Kong, Ireland, Israel, New Zealand, Saudi Arabia,
Singapore, Tasmania, Thailand, the United Kingdom, and other European
Community nations have banned the manufacture, sale and/or import of snuff.
8-02. Targeting children.
During the trial of the State of Minnesota vs. the Big Four Tobacco
companies, secret memos were made public establishing that all four companies
had targeted children with the hope they would smoke, become hooked, and
continue to smoke as adults. They secretly hoped the children would break the law
and begin smoking at an early age.
If children and youth are not going to get hooked, greater effort must be
planned and executed to assure they do not smoke or drink illegally.
8-03. Parents are usually the most powerful role-models.
The example parents set are usually the most powerful role-models in their
child’s life. The example they set is more powerful than anything they or others can
say. If parent listen and help children learn to manage the stress of academic, social,
interpersonal, and sexual challenges, children are less likely to get involved with
drugs or alcohol.
Parents who down a drink or two (or maybe four) at the end of the day to
drive away stress can contribute to their children’s drug and alcohol use,
particularly when kids’ peers are also using these substances.
Good parental health habits—exercising, eating well, getting enough rest-show a child the importance of self-care as opposed to the self-destructiveness of
drug and alcohol use. Parents can also demonstrate how to channel stress into
productive activities such as community service, hobbies, and other endeavors.
- 107 During ordinary conversations, opportunities will arise for parents to discuss
the value of good health and rewarding pursuits. Without preaching, parents can
focus on the benefits of abstinence more than the dangers of alcohol and drug use.
Such an approach helps a young person realize that he/she is the captain of the ship
and that avoiding drugs is in their power and best interest. If the parent hasn’t
been a good role model, the parent should get help, and tell the youngster not to
follow in his/her footsteps.
8-04. Drug education and drug counseling in the schools.
Federal funds are helping with school based instruction and counseling. In
1991 it was said that more school counselors would be of great help. As a result it
was proposed that one substance abuse counselor be placed in every middle school
in the country. Federal funds were appropriated to provide counselor service in the
schools. Some richer school districts now have counselors but many poor districts
seldom do.
8-05. Treatment.
The search for a substitute drug for treatment of cocaine abuse continues.
Some researches believe nicotine and caffeine are possibilities. Pharmaceutical
companies are loathe to develop rewarding drugs unless these drugs are to be used
for life threatening or painful conditions such as terminal cancer. However,
companies will search for the same type of substances under the names ‘mood
elevator” and “performance enhancers.”
Research has demonstrated that if alcoholics stop using alcohol they
increased the possibility they can stop smoking. Smokers with active alcoholism in
the preceding year were 60% less likely to quit than were smokers with no history of
alcoholism. In contrast alcoholics who smoked who were off alcohol were at lest as
likely to quit smoking as persons with no history of alcoholism. Compared with
persistent alcoholism, those off alcohol were 3 times more likely to stop smoking. [2.
Am. J. of Public Health, 1-1996, p. 985.]
8-06. Treatment on demand--more facilities needed.
In 1988 when Congress passed, almost unanimously, the Anti-Drug Abuse
Act prohibiting production, marketing, and possession of harmful psychoactive
drugs, there was talk of a 50-50 allocation to curtail both supply and demand. But
since then 70% or more has been appropriated for apprehending traffickers and
30% or less for education and treatment. Highly publicized seizures of larger
quantities of illegal drugs indicate both the immediate success and the long-term
failure of interdiction. The medical community advocates reversing the percentages
with 70 percent for treatment.
Persons desiring to get off drugs must wait weeks and sometimes months to
be admitted to treatment. Evidence suggests that private treatment centers appear
to be underutilized, while public facilities are almost always at capacity.
- 108 Although the number of women using addictive substances is substantial,
there are comparatively few programs that treat women, and the available slots are
severely limited…Requiring pregnant substance abusers to go into drug treatment
is appealing to many…The woman stops harming herself; thus state intervention
takes the form of rehabilitation rather than punishment.
Evidence indicates that the costs associated with fetal cocaine exposure are of
sufficient magnitude to make education and treatment programs for pregnant
women cost effective. The fact that certain women continue to reproduce despite
the knowledge that their substance abuse during pregnancy places their offspring at
risk of potentially very serious deficits is a source of legitimate concern for all. A
woman’s addiction to drugs does compromise her ability to make well-thought-out
choices.
Seeing the effects of drugs on infants in a nursery and caring for addicted
babies may facilitate understanding of the consequences (of harm that drug abuse
brings to her and her children). However, the author of the journal article
recommended less drastic alternatives to accomplishing the goal of improving
children’s lives, and reducing the necessity for public support should be pursued
before giving the state the power to decide who can or cannot reproduce or the
timing of reproduction. [46 p. 595-621]
8-07. Supervised probation.
To relieve the burden on the criminal justice system, government must
either make the law enforceable—provide adequate money for more prisons and
courts, or develop intensive probation as an intermediate punishment between
parole and incarceration. It is cheaper than prison and could mandate provisions
for rehabilitation with continuous surveillance and frequent urine testing. As
pointed out in Section 5-03.5,
the skyrocketing costs of housing and supervising the increasing number of federal,
and state prisons and local jails is forcing states to consider treatment and
supervised probation.
8-08. Technological advances in drug use detection.
Modern chemical detection techniques provide important possibilities for
detecting the presence and use of drugs.
(1) in the environment,
(2) in urine,
(3) in saliva,
(4) in hair, and
(5) by telemetering transmission of the physiological effects of drug use.
- 109 Sensitive drug detectors have been developed that are invaluable in controlling
drug abuse; the inevitable development of instruments that will detect a few
airborne drug molecules like a trained dog should make drug concealment difficult.
If deployed properly, these instruments could drastically reduce abuse.
Urine testing technology is well developed. Some say the major factor in
reducing drug use should be judicious application of urine testing. Section 7-07
reports on the success of voluntary urine testing programs done on high school
students participating in the D-FY-IT program in Texas and six other states.
Saliva testing. Despite higher cost, saliva testing may be preferable to urine
testing because saliva can be collected under direct observation without
embarrassment or pain.
Hair testing for drugs has been used since 1954. The technology has two
advantages. First, the presence of drugs can be detected in hair for up to three
months after their use depending on hair length. Second, the levels or dosage of
illicit drugs can be reliably estimated. The costs are slightly higher than for urine,
but would be cost-effective as they would not need to be done as frequently as urine
tests.
The Federal Food and Drug Administration has not yet approved hair
testing for drug usage. The basic analytical process in drug-screening for hair is not
controversial. However, the processes by which illicit drugs—or other substances—
are incorporated into hair are not well understood. Hair analysis may become the
preferred drug-screening method when the effect of washing, external
contamination, and the effects of variations in hair texture and type are established .
[50, p. 135-49]
Telemetering physiological transmitter. Drug abusers could be sentenced to
wear an electronic detector that would measure tachycardia and lower skin
temperatures, or both. This transmitter would be an adaptation of the telemetered
bracelet now used in law enforcement. It would alert the officer or therapist
whenever the ex-addict succumbed to a stimulant. The constant monitoring should
discourage drug use more effectively than intermittent urine or saliva testing could.
The system would have to discriminate drug use from false positives induced by
stress, sex, or other activities.
8-09. Voluntary drug testing.
Drug detection could be used to generate anti-drug social pressure. With
voluntary participation in testing, drug use could be stigmatized and abstinence
rewarded in drug-infested communities.
Anti-drug organizations could be
established as a type of neighborhood watch. To join, one would have to agree to
random saliva tests. Participants would receive an award for each negative test and
ultimately a certificate, perhaps a button medal, or shield, and a token redeemable
for some monetary reward. Participants who tested positive would receive free
counseling and immunity from prosecution.
Since participation would be
voluntary, these organizations would not constitute an invasion of
- 110 privacy, and ostracism by the community would be the prime weapon used to
encourage abstinence in potential drug users. Mistakes or false positives could be a
problem, but appropriate duplication of test could prevent such errors.
8-10. Mandatory testing of all parolees and probationers.
In 1981 a tragic crash on the aircraft carrier Nimitz focused national
attention on drug use in the military. Nearly half of all sailors on the ship had
recently used marijuana, cocaine, or other illicit drugs. This led to a new initiative
in the military, labeled Zero Tolerance, focused on regular, random drug testing of
all service personnel. This effort led to prompt and profound reductions in drug use
in the military. Industry followed suit with drug testing in the workplace for the
two illicit gateway drugs—marijuana and cocaine. Since the 1980’s there has been a
growing recognition that drug testing should become a routine and universal
function of the criminal justice system.
Testing can be used to identify illicit drug users at the time of arrest as well
as to monitor persons released to the community before trial and after conviction.
Testing would cover all illicit drugs and take advantage of the new immunoassay
drug tests. The application of the new drug-testing technology to hair instead of
urine, would extend the window of drug use from 1 to 3 days by urine tests to 90
days provided by long hair.
Incarceration would be the swift response to continued drug use. Treatment
would be linked with incarceration as a way of helping offenders stop their drug
use. The period of incarceration need not be long, but it must be repeated as often
as the offender returns to illicit drug use. Testing offers the best hope of reducing
the need for more prisons.
8-11. Do judges need greater discretion in sentencing?
Are long mandatory sentences doing more than spending large sums of money?
Could the money be better spent? Addictive Diseases, v. 11, (3) 1992]
8-12. Mass media.
Attitudes against drug abuse can be molded by mass media presentations
designed by experts in social psychology, publicity and advertising. The antitobacco campaign, sponsored and financed by the government, is an example of a
mix of both controlled and uncontrolled programs. Since cigarette smoking has
clearly decreased coincidentally with the campaign, perhaps such a mixture is not a
problem. [39,p. 390]
8-13. Make money laundering more difficult.
A drug policy designed to dismantle the cocaine industry should provide:
(1) stiffer penalties against banks, bankers, and their boards of directors,
-
111 -
(2) the internationalization of laws against money laundering, and
(3) improved methods of detection.
Cooperative enforcement of such laws would reduce the cocaine industry
funds for production, distribution, protection, and bribery. [11, p. 20]
8-14. Social host liability.
The N.C. Supreme Court in Hart v. Ivey, 332 N.C. 299 (1992) held that hosts at a
party served alcoholic beverages to Ivey, an 18 year old, and could be sued for
negligence. The Court held the hosts knew Ivey was under the influence and he
would shortly drive an automobile. The Supreme Court did not limit its holding
only to persons who serve underage drinkers. Courts in a number of other states
are following a similar line of reasoning.
- 112 9-00. Conclusions. (Ed. Note: The following recommendations from ten sources
were edited to eliminate duplication.)
9-01. Editor’s thoughts. (after reviewing more than 2,000 journal articles)
(1) No family is immune from the problem of drug addiction.
(2) It is easier to prevent drug use than repair the physical, psychological, social and
economic damage resulting from drug dependency.
(3) Some persons can experience neglect and abuse and apparently live normal lives
without family love and support. Most of us, and especially children, need
unselfish love, family care, and positive role models to provide encouragement
and to raise their level of aspiration.
(4) Many children who do not receive the support outlined in (3) above are at-risk
children. They are more likely to play hooky from school, get behind in school
work, drop out of school, start using threshold drugs, get caught in the criminal
justice system, learn more about drugs while in detention, and develop serious
drug dependency problems. If they have learning problems or physical and
psychological disabilities, they may be at even greater risk.
(5) A small but significant percent of children from apparently loving, caring families develop deviant behavior. Unfortunately, in nearly every city and town a few
adolescents motivated by curiosity or rebellion intentionally or unintentionally
overdose a dangerous illegal drug or drugs and blow their minds.
(6) Prevention of drug use in the young is unquestionably the most important first
step in the reduction of drug abuse. Education of young people and their
parents is only a beginning and booster support is necessary.
(7) The high incidence of illegal drug dependency among medical students and
practicing physicians, dentists, and nurses suggest (a) knowledge alone is not
enough to prevent drug and alcohol dependency, and (b) easy access to drugs
increases abuse and dependency.
(8) In America and all around the world there are thousands of poor, at-risk youth
from broken homes who drop out of school, can’t find any kind of a job in the
burned out and ravaged slums or dying crossroad of the rural countryside.
Their problems have few easy solutions. Add drug addiction and hope of a
better future is bleak. Such challenges require community-wide efforts to attack
all aspects of the predicament.
(9) Many debate if there are “gateway drugs.” A recent study found that pack-aday cigarette smokers were 3 times more likely to drink alcohol, seven times
more likely to use smokeless tobacco, and from 10 to 20 times more likely to use
illicit drugs than non-smokers. Studies of prison populations have found that
most young offenders used marijuana with alcohol and cigarettes before starting
on crack and other illegal drugs. For some individuals all three may be gateway
drugs.
- 113 –
(10) Research suggests that if experimental drug use can be postponed until after the body
matures, the possibility of permanent physiological and psychological damage and
future addiction is reduced but not eliminated. Existing laws which provide that
children and young adults not smoke until 18 and not drink until 21 is supported by
current research. If children and youth would obey existing laws and not smoke until
18 and not drink alcohol beverages until 21 or if the laws were strictly enforced, deaths
from drug use would decline sharply as they grew older.
(11) Projects which provide leadership in organizing or supporting community-wide efforts
on the most difficult problems may have the greatest possibility of success.
(12) Research confirms that the “Kids Helping Kids” may offer hope if supported by
a community effort.
(13) As children, we were taught “You are your brother’s keeper.” Or as the Torah
advises, “He who saves a life saves the world.” Rotarians should remember “To
whom much is given, much is expected” and “No one stand as tall as when he
stoops to help a child.”
9-02. The Office of Technology Assessment’s report for the U.S. Congress on
Adolescent Health concluded
(1) Adolescents’ use of psychoactive substances is of great public concern.
(2) Adolescents’ use of substances legally available to adults, i.e., alcohol and
nicotine—is more prevalent than their use of illicit drugs.
(3) It is unclear that the resources applied to preventing substance abuse are
targeted appropriately.
(4) The evaluation of most substance use prevention programs show little change in
adolescents’ use of substances. This does not imply that such programs should
be discontinued. Some programs may turn out to be effective in enhancing
adolescents’ general life skills, for example:
**
improvement in their social competence, including their ability to make
decisions, refuse unwanted peer pressure, and otherwise have rational
discussions with their peers and others;
** improvement in their self-understanding; and
** improvements in their knowledge about a range of psychoactive substances.
The extent to which substance use prevention programs achieve some or all of
these goals is largely unknown, because outcomes other than reductions in use
have not usually been measured.
(5) There is no valid way to predict years in advance which adolescents need
treatment or the effectiveness of treatment provided.
(6) Patients without money may have trouble getting treatment.
(7) Treatment is unavailable in many areas and industry-provided private
insurance for drug treatment was provided by only 17 percent of medium and
large firms and not required by Medicaid in 1993. [15, p. 565]
- 114 9-03. Dr. Avram Goldstein and Harold Kalant assert there is no real hope of
eventually achieving a completely drug-free society, but a reduced demand for
drugs offers the only hope of achieving substantial less drug abuse. They offer the
following recommendations for achieving substantially less drug abuse:
(1) Psychoactive drugs are, to varying degrees, dangerous to users and to society.
(2) Drug consumption is strongly influenced by availability.
(3) Availability can be modified, not only by outright prohibition, but in many
ways short of prohibition.
(4) Although supply reduction is a desirable goal, demand reduction is the real key
to lasting amelioration of the drug problem.
(5) Rational drug policy ought to be tailored to the dangers presented by each
psychoactive drug to users and to society.
(6) Congress should delegate regulation of the non-medical use of psychoactive
drugs to the existing Alcohol, Drug Abuse, and Mental Health Administration
(ADAMHA) with its three component institutes, the National Institute of Drug
Abuse, the National Institute on Alcohol Abuse and Alcoholism and the National
Institute on Mental Health as it has delegated the regulation of therapeutic
agents to the Food and Drug Administration.
(7) Whatever degree of regulation is desirable for each drug, enforcement is
essential for credibility and as a concrete expression of social disapproval.
Enforcement raises the black-market price of illicit drugs and makes such drugs
more difficult to obtain. Drug bazaars operating in full view of the police are
intolerable in a society that claims to be ruled by law. Dealing effectively with
the drug problem has broad implications for the rule of law in a democratic
society.
(8) Enforcement should be directed primarily at the higher levels of the
distribution. Grandiose attempts to achieve a total interdiction of drug entry
from abroad are a relatively poor investment. Advances in pharmaceutical
chemistry are such that highly potent psychoactive drugs of every kind can be
synthesized readily in clandestine laboratories, so the illicit market would adjust
quickly even to a complete sealing of our borders, were that possible. A modest
level of highly visible interdiction activities should be continued. The federal
drug war budget would be more cost effective if the present ratio of supply
reduction to demand reduction—71% to 29%--were reversed.
(9) Enforcement will be most effective if coupled to community action, originating
locally but supported by adequate governmental funding and assistance.
(10) The present legal prohibitions on the importation, manufacture, distribution,
and sale of opiates, amphetamines, cocaine, marijuana, and dangerous
hallucinogens like PCP should be continued. At the same time we suggest
reducing penalties for possession of small amounts of these drugs for personal
use. We recommend that humane and constructive sentencing options be
restored in drug cases.
(11) It is sometimes argued that as marijuana seems to be the least harmful of the
psychoactive drugs (except only caffeine), it could be legalized safely. However,
the scientific evidence is still insufficient as to the potential magnitude of long-
- 115 -
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
term harm, whereas the acute disturbance of psychomotor behavior is clearly
dangerous.
High taxes should be levied on tobacco and alcohol as it is known to be an
effective means of discouraging consumption. However the increases must not
be so great as to make an illicit market profitable. Uniformity of taxation across
the country will be essential to avoid providing an incentive for interstate
smuggling.
Federal and state laws should abolish cigarette vending machines as with such
machines accessible, laws forbidding sale to minors are completely ineffective.
Routine or random drug testing is justifiable for people in sensitive jobs, whose
use of psychoactive drugs (whether licit or illicit) could endanger public safety.
As the role of alcohol and other drugs in highway accidents is well documented,
on-the-highway testing of drivers for alcohol on a nondiscriminatory basis at
road blocks is justified as a protection for the innocent, and the U.S. Supreme
Court has ruled that such tests are not unreasonable searches as specified in the
U. S. Constitution.
If the permissible legal limit for blood alcohol were lowered (currently 0.10% in
some jurisdictions) to 0.08% or 0.06%, it could have significant beneficial effect
on highway safety. (The legal limit in N.C. is now 0.08%).
U. S. and Canada should assist the Latin American countries in reducing
economic dependence on drug exports. The U.S. export of tobacco to developing
countries undercuts any principled opposition to coca or opium export by other
countries.
The ban on TV advertising of cigarettes should be strengthened to prevent its
circumvention by the prominent, supposedly incidental, display of cigarette
product names during TV coverage of sports and other public events.
International comparisons show that alcoholism can occur just as readily in
predominant beer-or-wine-drinking as in spirit-drinking countries. Although
scientific studies have failed to prove or exclude a short-term effect of alcohol
advertising on consumption, progressive restrictions on the advertising of
addictive drugs is an important and desirable first step in a long-term process of
altering the present public perception of these substances as ordinary consumer
products.
Both school and community should join in prevention efforts. The educational
message should deal broadly with the health hazards of using psychoactive
drugs.
For specific populations with exceptional severe drug problems, such as
American Indian communities, or low income African-American or Hispanic
groups in major urban centers, effective prevention must include creating
opportunities for economic advancement within a legal social framework and for
enhanced self-respect through reinforcement of traditional social and cultural
values.
-
116 –
(22) Treatment should be available to all who desire it without a long wait. Having
enough clinics to meet the demand would be expensive, but cost-effective.
(23) Funding for treatment research to test innovative approaches should be
provided.
(24) Methadone maintenance programs should be expanded and consideration
should be given to developing and testing treatment programs that incorporate
an initial phase in which the addict’s drug of choice is made available to bring
users of heroin or cocaine into contact with health personnel as a part of a
treatment program.
(25) Basic and applied research must be funded on the mechanics of drug addiction
to aid diagnosis and treatment, on genetic vulnerability to permit targeting of
prevention efforts, on novel treatments to suppress craving, and on studies on
the effectiveness of prevention education strategies. [26, p. 1513-19]
9-04. Dr. Joy Dryfoos of Cornell University lists 12 concepts for a successful drug
prevention program.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
A broad social and environmental approach which is directed at risk factors
(such as peers, parents, and schools) rather than specific behavior is necessary.
Community-wide prevention efforts must be simultaneously directed at all the
major social influences and institutions: schools, parents, children, role models,
media, police, courts, businesses, vendors of cigarettes and alcohol, and youthserving agencies.
No one intervention or program has been shown to bring down substance abuse
over a long term.
School systems have become the central agency for substance abuse prevention
programs. Early action is believed to be more effective, before the onset of the
behaviors. Middle school grades (5-7) are often mentioned as the best time,
prior to the traumatic transition to high school.
School-based substance abuse prevention requires a K-12 approach, with ageappropriate instruction and activities. This means “booster” programs in future
years. For counseling, it means availability throughout the school years.
Schools should demand research evidence of effectiveness of curriculum
offered.
School systems must provide time and resources for teacher in-service training
and supervision in order that teachers will be adequately prepared.
Social workers, counselors and health educators should be given specialized
training in order that they will work together in substance abuse prevention.
-117(9)
Social skills (coping and resistance) training appears to be promising. Research
is needed to determine if they will be effective in the long term and if they will be
as effective with high-risk children as with others.
(10) Peer-led programs appear to be more successful than teacher or counselor-led
…programs. The most effective arrangement used older students (senior high)
as teachers and role models for younger students (junior high and elementary).e
prevention programs frequently target a whole class or school. The greatest
need may be the high risk children.
(11) Experience with preventing substance abuse among high-risk children suggests
the need for individual attention and intensive counseling.
(12) Model programs are designed for “old drugs,” like cigarette smoking; there are
no models that specifically address the use of “crack.” While AIDS prevention
education is mandated in every state, there is no evidence as yet that these new
curricula have had any impact on intravenous drug use.
9-05. Charlottesville, VA Task Force on Drug Abuse Prevention recommended
(1) Total community involvement including a campaign to educate the public
concerning the seriousness of the problem.
(2) Drug counseling in public schools—including training school staff, working with
curriculum personnel, and counseling students with drug problems.
(3) A review of drug education program in the public schools and developing better
methods to involve parents and students, and starting the drug education
program in kindergarten;
(4) Establish all schools as designated “drug-free” zones with appropriate signs
citing state law that dealing drugs within 1000 feet of school is a felony (persons
possessing drugs “with no intent to profit thereby” would be Class 1
misdemeanors); and
(5) Continuation of the self-esteem program in public schools from kindergarten
through grade 12.
9-06. Dr. Peter M. Bentler concludes that most drug abuse prevention programs
used in the last 20 years have not consistently worked, but offered 17
recommendations consistent with his and other drug abuse research.
(1) Since the causes of drug abuse are multiple, prevention should be multiple, i.e.,
even the best single approach such as self-esteem improvement, skills
enhancement, or assertive- ness training, probably will not work without
attention to other risk factors.
(2) On the other hand, one should not discount the importance of creating a major
shift through prevention in even a single risk factor. One has to start
somewhere.
(3) Since risk factors are societal, environmental, social, behavioral, and personal,
many classes of variables are legitimate targets of prevention efforts.
- 118 (4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
Prevention programs aimed at minimizing drug use or abuse must inevitably aim at
lessening other problem behaviors, especially delinquency, which are highly correlated
with, and typical precursors to and consequences of, drug use.
Elimination of risk factors for drug use, or negative consequences of use, such as
dropping out of school or early family formation, are appropriate prevention targets
even without any specific concern with drugs in such a program.
Prevention efforts should span the age spectrum from pre-adolescence to young
adulthood, though with different emphases at various ages.
Preventing targeted at nonuse of adult-legal gateway drugs, such as cigarettes and
alcohol, is appropriate at younger ages, but at later ages, dealing with problem use is a
more appropriate goal. Non-problematic use for all individuals may mean “no drinking
and driving,” while for other individuals it may mean “no use ever.”
A prevention policy based on total abstinence from substances may be an appropriate
goal, but is unachievable as a society, since legal drugs such as cigarettes and alcohol are
part of our culture and youngsters inevitably copy adult actions.
Efforts aimed at stopping existing drug use, prior to development of negative
consequences, e.g. non-marital pregnancy or drug use on the job, are vitally important.
Such efforts should focus on drug misuse or abuse, and not on experimental use, and
may well need to be continued into young adulthood.
Adult and peer models (both real and imagined via television or advertising) for licit
and illicit drug use should be de-glorified. Models for nonuse and appropriate nonproblematic (responsible, legal) use should be made available.
Supply reduction strategies are a valuable means of reducing environmental and
modeling effects on drug use.
Conditions conducive to family cooperation, unity, and psychological health must be
developed (e.g. via parent-student-teacher cooperation), in a culturally sensitive way.
Poor parental relations is an especially serious risk factor for blacks.
Family integration into a caring community with some traditional values that recognize
individual worth and responsibilities (e.g., religion) is important.
Conditions conducive to youngsters’ psychological health must be developed. For all
youngster’s this means providing adequate social support in the form of good relations
with significant others. For some individuals, this will require counseling, while for
other it will require more intense psychotherapy. For still others, it may require
removing them from noxious homes or communities.
Socially acceptable alternative expressions of sensation-seeking and risk taking, which
are frequently associated with drug use, should be developed and supported.
Conditions conducive to psychological and social growth e.g., practice in adult behavior
and responsibilities, are critical in giving youngsters an alternative to drugs as a way of
striving for adult identity.
Encouragement of adult habits during childhood is unhealthy, but when ordinary
schooling fails, alternative to high school, coordinated with industry and labor, should
be provided. An illustration might be a paid apprenticeship program with guaranteed
job opportunities. [5, p. 58-59]
- 119 9-07. Dr. Murray E. Jarvik concludes
If the present drug epidemic is to be contained, restrictions against cocaine should
continue, with modifications to aid enforcement and to acknowledge financial constraints.
Developments in chemical and electronic technology should help to reduce drug use, but
appropriate privacy protections must be assured. A greater proportion of federal resources
should be devoted to reduction of demand rather than interdiction of supply. Research to
develop more effective methods of prevention and treatment is critical. Efforts should focus on
stimulating social pressure and risk awareness, especially in the poor, uneducated and
psychiatrically ill. Reducing demand in these vulnerable groups should decrease the need for
police and prisons and help sustain the American ideal of democracy and freedom. [39, p. 391]
9-08. Board of Trustees, American Medical Association recommends
(1) Continuing Federal support for community-based prevention strategies—
kindergarten up, support for prevention and treatment, and innovative programs
that train and involve parents, educators, physicians, and community leaders.
(2) Major media programming is needed to prepare more accurate and preventionoriented messages about effects of alcohol and other drug abuse.
(3) Pursue development of educational programs to produce prevention specialists
who can relate to the economically disadvantaged, ethnic, racial, and special
populations.
(4) Investigate developing a “core curriculum” in support of prevention activities.
(5) Urge government and private sector collaborative efforts to develop a national
consensus on prevention and eradication of alcohol and drug abuse. [7 p. 2107]
9-09. American Society of Addiction Medicine supports
(1)
(2)
(3)
A comprehensive and coordinated national program involving a combination of
approaches will be required to combat these serious and complex problems.
Extensive public education about the nature, causes, and prevention of
alcoholism and other drug dependencies, and about the full range of alcohol and
drug related problems, will be required to develop support for comprehensive
prevention. Physicians have an indispensable and ongoing role in this public
education.
Sound scientific research into the causes of these problems, and the careful
evaluation of prevention measures are needed to improve the fund of knowledge
upon which more effective prevention strategies may be based. The American
Society of Addiction Medicine, therefore, recommends that such research be
given high priority by government, universities, foundations, and other research
institutions.
- 120 The ASAM supports the following prevention policies and programs:
(1) Control of quality, availability, advertising and promotion of tobacco products
and alcoholic beverages. Such controls should include:
(a) Establishing a national purchase age of 21 years for all alcoholic beverages.
(b) Curbs on advertising of all alcoholic beverages and tobacco products,
including the voluntary elimination of radio and TV advertising, and
intermediate measures, such as the establishment and enforcement of
national standards for radio, TV and print advertising which eliminate use of
young people, athletes, persons engaging in risky activity, and sexual
innuendo.
(c) Eliminating sponsorship of youth-oriented concerts and all sports events by
tobacco and alcoholic beverage manufacturers.
(d) Eliminating alcohol advertising and promotion on college campuses, where a
proportion of the audience reached is under the legal drinking age.
(e) Eliminating alcohol advertising and promotion that portrays activities that
can be dangerous when combined with alcohol use.
(f) Banning special low price promotions, such as cut rate “happy hours,” “twofor the –price of one drinks,” or free drinks for female patrons.
(g) Counter advertising, through paid and public advertising, including health
warnings about alcoholism and alcohol-related problems, nicotine
dependence, and tobacco produce related health problems.
(h) Requiring that alcoholic beverage containers display all ingredients and
alcoholic content by volume, in addition to a rotating series of health
warnings on
 drinking and driving
 drinking and pregnancy
 alcohol and drug interactions

links of excessive alcohol use to health-related disorders, including
alcoholism, cirrhosis, heart disease and cancer.
(i)
Health warning posters at point of sale.
(j)
Eliminating the sale of alcoholic beverages by gasoline retailers.
(k)
Adjusting taxes on beer and wine to equate with those for distilled spirits, and
adjusting taxes on all alcoholic beverages for inflation experienced since 1951.
(l)
Devoting funds derived from increased taxes to support prevention and
research.
( 2) Control the quality, distribution, and availability of psychoactive drugs, including:
(a)
Measures to prevent the manufacture, importation and sale of illicit drugs.
(b)
Programs to prevent diversion of licit drugs for illicit sale and use.
(c)
Discourage the inclusion of alcohol as an ingredient in the formulation of
medicines, beyond the minimum required as a solvent.
- PAGE 121 (d)
Promoting safe and appropriate prescribing practices for drugs that may
produce dependency.
(e)
Warning labels on prescription and over-the-counter drugs that describe
possible adverse interaction with alcohol and other drugs. Warning
labels that indicate the potential of drugs to produce dependence.
(f) Programs to educate health professionals about identifying drug-abusing,
manipulative patients who seek psychoactive drugs for inappropriate use.
(3) Scientifically sound education for all segments of society, including:
(a) Age-appropriate education about the nature and effects of alcohol and drug use,
including alternatives to such use, throughout the school curriculum.
(b) Public education about nature and causes of alcoholism and other drug dependence,
the interaction of alcohol and other drugs, alternative techniques of managing
stress, and the effects of alcohol and other drugs on health and safety.
(c)
Adequate professional education about alcohol and other drug problems in all
programs to prepare students for careers in health, human services, teaching,
the clergy, police, public administration, and law.
(d) Avoidance by media of glamorizing tobacco, alcohol, and other drug use.
(e)
Accurate reporting in print and broadcast news of the adverse societal
consequences of alcohol and other drug use.
(f)
Accurate reporting in print and broadcast news of the adverse societal consequences
of alcohol and other drug use.
(g) Special programs aimed at populations known to be at high risk, including children of
alcoholic and drug-dependent parents, pregnant women, medical, dental,
nursing, pharmacy and veterinary students, health professionals, persons
recovering from alcohol or other drug dependence, persons undergoing
stressful life situations and others.
(h) Education, for bartenders and others who serve alcoholic beverages (including social
hosts and hostesses), about safe serving practices and preventing harm to an
alcohol-impaired person.
(i)
Including accurate information about alcohol and other drug use in all health prevention programs.
( i ) Measures to discourage or deter the manufacture, sale, and promotion of drug
paraphernalia (products designed to process, prepare and administer illegal
substances) [American Society of Addiction Medicine. “Public Policy Statement.” Journal of
Addictive Diseases, v. 11, (3) 1992]
9-10. Dr. Dean Nywall, a general practitioner in Minnesota for forty years and now retired in
Arizona has written, “God never created junk. By that I mean individuals of no worth.
People become junk by what we as individuals choose to do about our situations. It’s not
the difficulties that surround us but how we react to those difficulties. We need to create in
children self esteem and reinforce that esteem at every opportunity.” (Letter, 10-1994)
- PAGE 122 EXHIBIT 3.
FIVE COMMON MYTHS ABOUT QUITTING SMOKING
Myth 1: Smoking is just a bad habit.
Fact:
Tobacco use is an addiction. According to the U.S. Public Health
Service Clinical Practice Guidelines, Treating Tobacco Use and
Dependence, nicotine is a very addictive drug. For some people, it
can be as addictive as heroin or cocaine.
Myth 2: Quitting is just a matter of willpower.
Fact:
Because smoking is an addiction, quitting is often very difficult. A
number of treatments are available that can help.
Myth 3: If you can’t quit the first time you try, you will never be able to quit.
Fact:
Quitting is hard. Usually people make two or three tries, or more,
before being able to quit for good.
Myth 4: The best way to quit is “cold turkey.”
Fact:
The most effective way to quit smoking is by using a combination
of counseling and nicotine replacement therapy (such as the
nicotine patch, inhaler, gum, or nasal spray) or non-nicotine
medicines (such as bupropion SR). Your health care provider or
smoking cessation clinic is the best place to go to for help with
quitting.
Myth 5: Quitting is expensive.
Fact:
Treatments cost from $3 to $10 a day. A pack-a-day smoker
spends almost $1,000 per year. Check with your health insurance
plan to find out if smoking cessation medications and/or
counseling are covered.
For More Information
To get a free copy of other consumer products on quitting smoking, call any of the
following toll-free numbers
 Agency for Healthcare Research and Quality, 800-358-9295
 Centers for Disease Control and Prevention, 800-CDC-1311
 National Cancer institute, 800-4-CANCER
You may get more online information at the Surgeon General’s Web site at
www.surgeongeneral.gov/tobacco.
Public Health Service http://www.surgeongeneral.gov/tobacco/5myths.htm
- 123 DRUG AND ALCOHOL ABUSE PREVENTION ARTICLES
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- 126 EXHIBIT 4.
WWW SOURCES OF INFORMATION RE: DRUG & ALCOHOL ABUSE--2001
[Editor’s Note: The following are a few of the sources of information used in
preparing this booklet. Many other creditable government, university and
private foundation sources are available. There are also websites that are
sponsored by private groups that are pushing the legalization of marijuana
and some other drugs]
Bureau of Justice, Drug Enforcement Adm.
http://www.usdoj.gov/dea/demand/druglega
Bureau of Justice Statistics, 2001 www.ojp.usdoj.gov/bjs/dcf/htm.
Bureau of Justice Statistics, Drug and Crime Facts:
http://www.ojp.usdoj.gov/bjs/dcf/
Center for Disease Control and Prevention of the U.S. Department of Health and
Human Services.http://www.cdc.gov/tob…sgr/sgr; and
www.cde.gov/tob…/sgr2000tobacco.
Columbia University National Center on Addiction and Substance Abuse.
www.casacolumbia.org/newsletter.htm
Hazelton.research.hazelton.org
Health.org/programs/abuse/navigating/issue
Robert Wood Johnson Foundation, www.tobaccocontrol.com.
National Center for Health Statistics. Center for Disease
Control.www.cdc.gov/nchs/fastats/alcohol.htm.
National Council for Science and the Environment,
www.cnie.org/NLE/CRSreports/Agriculture/ag-72.cfm.
National Highway Traffic Safety, www.nhtsa.dot.gov/people/injury/alcohol/NC.htm.
National Household Survey, www.samhsa.gov/hhsurvey/content/highlights.html.
National Institute Drug, www.nids.nih.gov/economiccosts
N. C. Department of Corrections 2001. www.doc.state.nc.us/substance/docdart.htm
Student Tobacco Alcohol Resource Team, www.start4.org/about.html.
University of Michigan Monitoring the Future Study,
www.MonitoringTheFuture.org/pubs/Future.org/
UN Office for Drug Control and Crime Prevention,
www.undcp.org/drug_demand_reduction.
www.samhsa.gov/oas/NHSDA/1999/tobaccofacts
www.TobaccoControl.com
World health Organization: www.who.int/whosis
State of Minnesota v. Philip Morris et al.
www.nhtsa.dot.gov
nids.nih.gov/economiccosts
www.pk/vsdpk.gov/bjs
www.initiative.org.