Chapter 2: Drug Use as a Social Problem

There are two broad categories of problems caused by psychoactive drugs.  The first category is problems directly related to taking the drug, such as the risk of overdose.  The second category is problems related to the fact that the use of certain drugs is illegal and associated with social problems such as the cost of treating drug dependence and incarcerating drug offenders.

American society has changed from being one that tolerated a wide variety of individual drug use to being one that attempts strict control over some types of drugs.  This change occurred in response to social concerns in three areas: first, drug toxicity; second, the potential for drug dependence; and third, drug-related crime and violence.

Drug toxicity can refer either to physiological poisoning or to dangerous disruption of behavior.  Toxicity can be acute, resulting from the presence of too much of a drug, or chronic, resulting from long-term exposure to a drug.

The Drug Abuse Warning System, known by its acronym DAWN, collects data on drug-related emergency room visits and drug-related deaths.  The data from DAWN should be viewed in conjunction with information on the relative danger of a drug versus its total impact.  For example, heroin and cocaine have high risks of toxicity per user, but their overall public health impact is low compared to that of tobacco and alcohol, which are much more widely used. Prescription drugs are also important contributors to overall statistics on drug toxicity.  People who inject drugs face the specific toxicity risk of HIV infection and other blood-borne diseases.

A second major area of concern is the risk that drug use will lead to dependence.  Drug dependence is linked to three basic processes.  The first is tolerance, in which repeated use of a drug leads to diminished effects as the user's body develops ways to compensate for the chemical imbalance caused by the drug.  The second is physical dependence, defined by the occurrence of withdrawal symptoms if drug use is suddenly stopped.  The third is psychological dependence, characterized by a high rate of drug use, craving for the drug, and a tendency to relapse after stopping use.

Ideas about drug dependence have changed over time.  The early medical model was based on the idea that true addiction involved physical dependence. More recently, psychological dependence has been viewed as the driving force behind repeated drug use.  The diagnostic criteria developed by the American Psychiatric Association state that substance dependence can occur with or without physical dependence.  A bio-psychosocial perspective views dependence as a complex condition related to dysfunctions of biology, personality, and social interactions.

The third major social concern about drug use is its possible links to crime. The idea that opioid drugs or marijuana can produce violent criminality in their users is an old and largely discredited one.  Opioid users seem to engage in crimes mainly to obtain money rather than because the drugs they take make them more criminal.  One drug that is widely accepted as contributing to crime and violence is alcohol.

There are more than 1.5 million arrests each year in the United States for drug-law violations.  Laws developed to control drug use have a legitimate social purpose, which is to protect society from the dangers of some types of drug use.  There is some question, however, of whether the dangers of drug use have always been viewed rationally and whether all the laws have had their intended effect.