Drug has been used as a device for therapeutic uses or as a form of leisure or escapism, and has been evident in many diverse cultures over the centuries. The explanation for purposes of drug is uncertain, however, it is believed that man has used plants, fungi, and natural products as a source to alter their state of mind for religious practices or rituals, healing, seeking pleasure, and escape from reality. However, drugs can cause harm to individuals and to society. This can be analyzed in terms of public health, which is a measure of the health status of the population. Public health is often highlighted as prevention rather than the cure, with emphasis on promoting good health and well-being to prevent diseases and illnesses. The public health method to drug abuse is pinpointed to the consequences of drug taking or substance misuse, rather than attempting to distinguish between drug use and drug misuse. For an individual to develop a drug-related problem, it would involve using a substance, whether illicit or a legal drug, to a point where there would be some kind of negative consequence to their physical, psychological, emotional, or social health. A significant proportion of the population in developing and developed countries today are exposed to diseases, illnesses, and health problems derived from substance misuse. The high cost to people who misuse substances and the general public can be justified by the harm that is caused and that others are indirectly affected. The harm caused by misuse of substances can range from occasional episodes of depression to chronic conditions that severely impact quality of life and shorten lifespan. The key area that substances harm, lost quality of healthy life is through addiction. Addiction is characterized by an inability to abstain and control the use of a substance and continued use despite awareness of the harm it causes. Addiction has a major effect on people’s social life today, as societies are much more multicultural and globalized than in the past. Addicts are often marginalized from mainstream society, therefore affecting the integration of minority ethnic groups and immigrants. Addicts often get caught up in violence and crime, whether it be to obtain drugs, selling drugs to fuel their addiction, and at worst cases, to other addicts. Crime can also reflect into drug policy with corruption of public servants and instability of the state.
Prevalence of Drug Abuse
The monetary costs of drug abuse are substantial and have a major impact on the economy. Estimating the total cost is difficult; however, a study from the National Institute on Drug Abuse conducted in 1992 concluded that the cost has to be between $150-$200 billion annually in the United States alone. This value partially addresses the costs related to crime and social welfare, which will be discussed further in later chapters. An increase in productivity in the workforce would lessen the impact of presenteeism and absenteeism from substance-using employees, as well as workers’ compensation and healthcare costs. The increase in productivity would come largely due to fewer health-related losses, and it is unlikely that the workforce put in a full day’s work. Preventing those with drug problems from entering the workforce and aiding the recovery of other workers will also increase the productivity of the workforce. Offering effective drug abuse prevention and treatment will be less costly compared to the immediate and extended costs of drug abuse. This has been supported by the Office of National Drug Control Policy, who stated that every dollar invested in preventing drug use saves $4-$5 in costs for the criminal justice system.
Drug abuse is widely prevalent in the United States. The Social Indicator Survey of the National Institute on Drug Abuse (1985) established that an estimated sixteen million Americans are problem drinkers and another twelve million are current users of illegal drugs. The survey detailed criteria for defining these conditions: problem drinking included consumption of five or more drinks a day at least five of the last thirty days, and users of illegal drugs were defined specifically as those who have used drugs in the past two months. The estimated numbers are a strong indicator of the widely spread use of alcohol and illegal drugs, which can be detrimental to public health. It is possible that the numbers recorded are at the smaller end of the spectrum due to bias in reporting illegal behavior; however, that in and of itself is a problem caused by the prevalence of drug abuse.
Health Consequences of Drug Abuse
Drug abuse affects the body and mind. In the short term, it “releases tension, lessens inhibition, and provides a mood change” for the user. If a person is uncomfortable in a social setting, they may consume a few drinks or snort a line of cocaine in order to change their mental state. Physical effects of the drug depend on the drug taken. For instance, the “high” from marijuana comes from its effects on the heart, increasing the heart rate by as much as 50%. Cocaine constricts blood vessels and increases temperature and the heart rate. Measures as small as taking a “hit” of ecstasy at a club can lead to serious health problems. Ecstasy increases heart rate and can rise to a dangerously high level, leading to a 23% rise in emergency room cases involving Ecstasy since 2004. Long-term drug abuse destroys health. Cannabis alone affects the immune and respiratory system, learning and social behavior, due to increased solubility in the lungs of the THC component native to this drug. Effects of cocaine range from strokes, seizures, and abdominal pain and consist of the likes of liver and kidney damage which can also be associated with alcohol abuse. It’s evident that an underlying factor to all types of drug abuse is the damage it does to a person’s mental health.
Social and Economic Implications
On a more positive note, a less punitive shift in drug policy which is now taking place in many developed countries may result in less emphasis being placed on the incarceration of low-level drug offenders and more focus on public health and safety. This will hopefully be reflected in increased funding for treatment and prevention of abuse to reduce the level of drug-related illnesses and deaths.
On the global level, the most pronounced economic effect of drug abuse is seen in the production of illicit drugs and its trade. It’s a demand for a ready supply of these drugs which far outstrips the demand for effective treatments to the many health problems related to abuse. This means that not only are there millions of people involved with the production and trafficking of drugs, but this is occurring in an environment in which there are very few employment opportunities for lower-skilled workers. Prices for illicit drugs are high and little research and development is done for more cost-effective prevention and treatment of drug abuse. This means that economic stimulation from the production and selling of drugs is minimal.
The abuse of drugs has resulted in the generation of a negative image of individuals who take drugs. This has been reflected on the societal level by the belief that drug abusers are largely at fault for their addiction, have criminal personalities, and should be able to stop taking drugs if they are willing to do so. These beliefs often act as barriers to the treatment of drug abuse on the part of the drug abuser. With the public, the image of drug addiction and abuse has been that it is a moral failing on the part of the abuser. This has led to the belief that drug addiction is an antisocial behavior, i.e., that it is something that goes against a community’s shared values, and that drug abusers should be punished in order to make an example of them.
Strategies for Prevention and Treatment
Prevention of drug abuse and addiction in the general population, and the prevention of relapse to harmful drug use in those who are in recovery, requires the availability of treatment for those who have already progressed to drug abuse or addiction. The aim of treatment should be the cessation of drug use (or return from harmful use to casual or controlled use) and prevention of relapse to drug use. This can occur through a variety of means, with the ultimate goal being the improvement of the health and functioning of the person who has been using drugs. Like prevention, treatment can and does occur in the broad array of medical and behavioral health settings.
A comprehensive prevention strategy usually involves an array of programs that occur in multiple settings, which include: Schools, families, and communities. Research has shown that prevention programs are most effective when they are interactive, well-designed, aimed at a specific population, implemented over an extended period of time, focus on an area of concern (e.g., anxiety, depression, anger), and implemented by well-trained teachers. Measures to prevent progression to drug use or progression to harmful patterns of use among those who have already used drugs are also critical.
Strategies for preventing and treating drug abuse are widely recognized as key to lowering the enormous costs and adverse public health effects of drug abuse and addiction. Policymakers, practitioners, and researchers have developed a variety of measures to address drug problems. Some are quite effective, others are of unknown effectiveness, and some are harmful. The ideal drug abuse prevention program is capable of preventing initial use and progression to addiction for all individuals. This would entail the program being effective with the entire population, with subgroups of the population (such as a low income or racial/ethnic minority group), and with the individual who may be at various stages of risk for drug abuse. Since this ideal program has yet to be realized, it is important that further efforts be made to enhance the effectiveness of prevention programs that have been shown to be effective while dropping programs that have not been effective in preventing drug abuse.