1. Executive Summary
Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for decision making for substance abuse prevention. This report reveals the importance of supporting effective prevention programs as part of a comprehensive substance abuse prevention strategy. The following patterns of use, their attendant costs, and the potential cost savings are analyzed:
• Extent of substance abuse among youth;
• Costs of substance abuse to the Nation and to States;
• Cost savings that could be gained if effective prevention policies, programs, and services were implemented nationwide;
• Programs and policies that are most cost beneficial.

1.1. Costs of Substance Abuse
Studies have shown the annual cost of substance abuse to the Nation to be $510.8 billion in 1999 (Harwood, 2000). More specifically,
• Alcohol abuse cost the Nation $191.6 billion;
• Tobacco use cost the Nation $167.8 billion;
• Drug abuse cost the Nation $151.4 billion.

Substance abuse clearly is among the most costly health problems in the United States. Among national estimates of the costs of illness for 33 diseases and conditions, alcohol ranked second, tobacco ranked sixth, and drug disorders ranked seventh (National Institutes of Health [NIH], 2000). This report shows that programs designed to prevent substance abuse can reduce these costs.

1.2. Savings From Effective School-Based Substance Abuse Prevention
If effective prevention programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average. It has been well established that a delay in onset reduces subsequent problems later in life (Grant & Dawson, 1997; Lynskey et al., 2003). In 2003, an estimated:

• 5.6 percent fewer youth ages 13–15 would have engaged in drinking;
• 10.2 percent fewer youth would have used marijuana;
• 30.2 percent fewer youth would have used cocaine;
• 8.0 percent fewer youth would have smoked regularly.

The average effective school-based program in 2002 costs $220 per pupil including materials and teacher training, and these programs could save an estimated $18 per $1 invested if implemented nationwide. Nationwide, full implementation of school-based effective programming in 2002 would have had the following fiscal impact

• Saved State and local governments $1.3 billion, including $1.05 billion in educational costs within 2 years;

• Reduced social costs of substance-abuse-related medical care, other resources, and lost productivity over a lifetime by an estimated $33.7 billion;
• Preserved the quality of life over a lifetime valued at $65 billion.

Although 80 percent of American youth reported participation in school-based prevention in 2005 (SAMHSA, 2004), only 20 percent were exposed to effective prevention programs (Flewelling et al., 2005). Given this level of participation, it is possible that some expected benefits already exist for these students, and the estimates in this paper are adjusted for these probable benefits.
These cost-benefit estimates show that effective school-based programs could save $18 for every $1 spent on these programs.

In a program targeting families with low income, intensive home visitation coupled with preschool enrichment reduced infant/toddler abuse (Aos et al., 1999; Karoly et al., 1998). As these toddlers reach adolescence and adulthood, visitation programs also can reduce a range of problems including substance abuse and violence.

Among indicated programs (targeted to individuals who have detectable symptoms), cost estimates that primarily focused on substance abuse were not available. However, estimates indicating good returns on the investment were available for several violence prevention interventions that address the roots of multi-risk behavior. Moral reconation therapy for adult and youth offenders, and multi-systemic therapy and functional family therapy for youth offenders returned more than $30 per dollar invested.

1.3. Conclusion
The cost of substance abuse could be offset by a nationwide implementation of effective prevention policies and programs. SAMHSA’s Strategic Prevention Framework should include a planning step that considers cost-benefit ratios. Communities should consider a comprehensive prevention strategy based on their unique needs and characteristics and use cost-benefit ratios to help guide their decisions. Model programs should include data on costs and estimated cost-benefit ratios to help guide prevention planning.

Source:
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis
Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP)

UN-commissioned guidance from international experts on how to mount prevention programmes based on family skills training involving parents and children in a joint effort to improve family dynamics and child development. Engaging parents seems the major barrier.

Abstract
This review and guidance initiated by the UN Office on Drugs and Crime concerned the role of family skills training programmes in the prevention of substance use problems among children in families across the board (‘universal’), or families whose children are particularly at risk (‘selective’). Unless integrated with these types of interventions, the document did not include programmes aimed at individuals identified as at high risk or as already experiencing substance use problems (‘indicated’). A literature and website review identified 130 universal and selective programmes. Research articles and programme descriptions were solicited from the developers. Practitioners, managers, researchers and developers from these programmes throughout the world were invited to a technical consultation meeting. The guide was drafted on the basis of the discussions and the literature review. This account largely relies on its final chapter, which summarised the major points.
Families can act as powerful protective forces in healthy child development, in particular with regard to substance use. To bolster this process, universal and selective family skills training programmes generally aim at strengthening the protective factors in families, equipping parents with the skills to provide supportive parenting, supervision, monitoring and effective discipline, and giving entire families opportunities and skills to strengthen attachment between parents and children. These approaches are more intensive and differ from parent education, which typically limits itself to providing parents with information about substances and their effects and does not involve the children.
Such programmes have been extensively evaluated and found effective in preventing substance abuse and other risky behaviours – about three times more effective than life skills education programmes aimed only at children and young people, and with more long-lasting benefits. Conservative estimates indicate that for each pound spent, over the long term these programmes return a saving of nine pounds. They also form part of effective multi-component programmes which offer other interventions in other settings (such as schools, media and the community), and of tiered programmes which operate across several levels of prevention simultaneously according to the needs of the families (universal, selective and indicated).
Although the evidence is limited to few programmes in high-income countries, recommended principles for family skills training programmes can be identified. These include a solid theory of how the training will affect risk and protective factors based on research on factors related to substance abuse which can be addressed at the family level. Programmes should be matched to the target population, especially the age and developmental stage of the children and the level of risk or problems in the families. This makes accurate needs assessment vital. Programmes must be of sufficient intensity and duration to address the targeted outcomes. In general, universal programmes extend over four to eight sessions, selective programmes for higher risk families, 10 to 15. Sessions last about two to three hours and should be based on interactive techniques implemented in small groups of eight to 12 families. A typical and effective programme will provide parents with the skills and opportunities to strengthen positive family relationships, family supervision and monitoring, and improve the communication of family values and expectations.
Recruitment and retention of parents are significant barriers to the dissemination of such programmes. However, retention rates of over 80% can be achieved by addressing the practical (transportation, childcare) and psychological (fear of stigmatisation, feelings of hopelessness) barriers. Interventions are most effective if participants are ready for change, such as at major transition points like children starting school or a new school phase.
Often it most feasible and/or cost-effective to base a project on an evidence-based programme developed elsewhere for a similar target group, preferably one with the best prevention record. In this case, it is important to carefully and systematically adapt the programme to the cultural and socioeconomic needs of the target population. Such adaptations enhance recruitment and retention of families. However, during its initial use the programme should be implemented with only minimal local adaptations or changes. Feedback from participants and group facilitators on what worked or did not work so well can be used as the basis for further refinements. Experience with these and outcome evaluations should be used to assess whether a deeper adaptation is required.
As with other types of programmes, adequate training and ongoing support must be provided to carefully selected staff. Most evidence-based programmes require two to three days of training for 10 to 30 future group leaders. Training should give them the opportunity to practise their skills, but also discuss the theoretical foundations, evidence of effectiveness, and the values of the programme. Ongoing support by programme managers and supervisors (and, if possible and appropriate, from programme developers) is important, especially in the form of e-mail contacts and web-based networking of group facilitators across agencies. Site visits and debriefing sessions also enhance quality and fidelity of implementation, as well as the collection of monitoring data.
Programmes should include strong and systematic monitoring and evaluation components. This work contributes to the understanding of prevention strategies, indicating which programmes are effective, under which circumstances, and for which populations, and provides evidence of effectiveness which can be used to lobby policymakers and donors, potentially helping to sustain the programme.
There is no question that the family is a powerful influence on child development and on substance use and problems in particular, nor that interventions with families and parents can (see for example this demonstration from Sweden) help prevent substance use in various forms. What is questionable is whether the research, though sometimes promising, is sufficiently extensive and sound to warrant widespread implementation of these programmes. Searching for practical guidance, British reviewers found that research deficiencies mean that no clear choice could be made about what works best either for marginalised and vulnerable groups, or for families in general. The background notes focus on two of the best researched family skills interventions (the Strengthening Families Programme and the Family Check-Up) as a way of testing the adequacy of the evidence overall, and address the issue of engaging families of early adolescent children. For other relevant evidence run this search for pre-school and parenting interventions on the Findings site.
When in 2008 the US government analysed the costs and benefits of substance use prevention programmes, family skills training programmes were among those with the highest benefit to cost ratio, though they lagged behind some other school/community/family programmes, and also well behind some entirely different kinds of initiatives like enforcing laws on serving drunk customers in licensed premises. Estimates for the two relatively well researched family skills interventions focused on in the background notes rested on one or two studies, which in both cases provided a narrow and at best tentative basis for the calculations, casting doubt over the degree to which they can be relied on to guide prevention programme planning. Nevertheless, the same may be said of some of the other programmes included in the analysis. For the analysts, the major drawback of family training as a universal prevention modality was its higher cost relative to other types of initiatives, leading them to suggest that this approach be reserved for high risk schools, areas or families
A particular issue is whether by the time family skills training comes in to its own – from age six to 11, and in major studies not until the early years of secondary schooling – enough families can be involved to make these strategies a viable way of curbing youth substance use problems across the population as a whole. British experience so far suggests this is not the case, though high-risk families under pressure to attend and/or energetically and sensitively targeted can be engaged in and benefit from family skills training. As the featured review comments, one way cost and accessibility barriers are being addressed is through computerisation of such programmes so families can go though them at times convenient to them and in their own homes, a tactic trialled for example with some success among mothers and daughters in New Jersey.
Based on UK experience and the adequacy of the international evidence, family skills training programmes of the kind reviewed can be recommended for consideration for families who have come to attention because their children (age six upwards) are at risk of behavioural problems which may include risky substance use. Sensitive personal approaches from programme staff, perhaps preferably from the same communities, can recruit many to participate, stay in and benefit from the programmes. Universal application to all families seems at the moment to lack sufficient evidence (especially in the UK) to warrant the considerable investment required, a situation which may change if low-cost, accessible computer-based alternatives prove feasible, effective and capable of widespread implementation.

Source: K. Kumfer www.findings.org.uk 09 March 2010

Journalist Nick Davies has  written  about legalising Heroin before and more recently. This is a rebuttal by an Australian professor and researcher. 

Nick Davies is right about one thing; drug policy is typically surrounded by an absurd amount of disinformation and misinformation. The truth is not always easy to find.  Governments the world over are perennially advised by experts of the day and the scientific establishment. Science, like most human activities, has within it schools of different thought and is very subject to the winds of its own internal fashions.  Phrenology in the 1930’s was one glaring example and the recent man made global warming debate is another. Many of my friends in the UK and on the East coast of the US are desperate for a good dose of global warming to thaw out their cars, homes and driveways.  The dearth of quality information in this field, and in many cases its deliberate suppression implies that, to borrow another of Davies’ metaphors, the policy debate continues to impersonate a drunken man on a dark night.  The main thing I learnt from Davies’ polemic was that the political and social left dislike Margaret Thatcher – who would have guessed?

Davies dutifully recites the many alibis and mantras of the liberal drug left including principally that heroin itself is intrinsically benign, and it is the illegal status of the drug along with the high cost, the impurities with which it is mixed and injected, and the unknown purity of the drug which are responsible for its toxicity. 

Astonishingly Davies even manages to trivialize heroin overdose, and claims it is relatively rare.  Perhaps this extraordinary claim is due to the fact that his references are mainly to Wikipedia, advised by a few drug liberalization sites or other journalists.

It is well known that the rate of death amongst heroin addicts is about 16 times higher than that of non-addicts, with some estimates from Sweden placing it 55 times higher, and others 70 times higher.  Overdose is not rare amongst heroin addicts, and many studies show that it is a common feature of people who have been injecting it for several years, and more have overdosed than have not.  In some Australian studies about half overdose several times annually.  Rather than heroin being safe as suggested, the levels of opiates in the blood are often relatively low or in the therapeutic range at post-mortem.  Therefore the reason some addicts die is often not well understood, although in the overdose situation it may be mixed with other drugs.  This does not exonerate heroin as it is a depressant drug, and obviously depressant drugs can sum together, or even potentiate the effects of each other to have a super-additive effect to halt breathing.  Moreover opiate addiction, which includes methadone and heroin, likely changes the central appetite mechanism deep in the hypothalamus of the forebrain, so that the appetite for other drugs is increased.  Davies also fails to mention that many heroin programs are actually heroin and methadone programs.  Heroin works for such a short time, that the overnight doses have to be of methadone to keep patients comfortable during the night.  So heroin programs are more properly thought of as “heroin top up programs.”

Rather than heroin being benign for the brain, the scientific literature is replete with studies and claims that long term opiate use causes damage to the mood centres in the limbic system, and the extended limbic system which includes the hippocampus and hypothalamus, which it turns out are also responsible for memory formation, learning and hormone control.  There is no such thing as a drug addict with a good memory and this is not related to the legal status of the drug.  Similarly the majority of opiate addicted patients have psychological disorders with rates in various studies particularly of depression and anxiety at over 70-90%.  Similarly epilepsy is far more common in opiate dependent patients, and there are several reasons for this.  Opiates have been shown to impair the renewal of brain stem cells, particularly in the hippocampus.  As this area is in charge of memory formation and emotionality, and is frequently the site of origin of fits, disturbances in these functions are to be expected, and are in fact commonly observed.  Indeed opiates have been shown to impair the growth of all organs, likely by impairing stem cell growth and activity.  This likely accounts for the evidence of disease and dysfunction in virtually every organ system of the body in long term users.  Opiates have actually been shown to impair the ability of cells to divide by blocking the normal progression of stem cells through the cell cycle, right at the very beginning of these transitions.  This effect is exacerbated by the action of morphine and its derivates including heroin to trigger programmed cell death, which researchers refer to as “apoptosis”.  Clearly the increased cell death, and the relative inability to replace the lost cells can hardly be good either for the health of the body’s cells and organs individually, or the patient as a whole.

It has also been shown that – pure – opiates both suppress and stimulate the immune system.  Whilst some may find this dual action confusing, it is reminiscent of an old car struggling to keep up with the speed limit with a dying engine.  As the car goes up the highway it blows smoke everywhere, and gets pulled over by the police for failing to keep up to the speed limit!  It is also very noisy, as its engine rev’s hard to do its best.  It is clearly working both hard and weakly at the same time.  This seems to be the picture of the opiates saturated immune system.  It parallels other clinical disorders such as rheumatoid arthritis and lupus, where patients with an overactive immune system also display evidence of generalized immunosuppression.  This immune stimulation is particularly damaging for the body, and likely takes a big toll of all organ systems.  Such immunity has been found to be important in many diseases including dementia, atherosclerosis, diabetes, obesity, osteoporosis, chronic periodontitis, cancer development and the ageing process itself.  Opiates have been shown to directly stimulate many aspects of the innate immune system, an evolutionarily ancient and very powerful arm of the immune response which acts quickly and promptly to alert the body to danger signals, and to summon other yet more powerful components of the truly matching adaptive immune response.  Moreover components of the innate immune system have now been shown to be also involved in controlling brain formation, synapse formation between nerve cells, brain stem cell generation and differentiation, and controlling neuronal and dendrite growth in the brain.  The immunosuppressive action of opiates increases the infectivity of, and damage caused by HIV in the immune system and brain, and Hepatitis C damage in the liver.

In particular one of the most sensitive tissues are actually stem cells, as these fragile baby cells, which all carry opiate receptors, are unusually sensitive to the noxious effects both of opiate agents and immunity.  This means that opiates actually pack a triple punch on cells throughout the organism:  there is the devastating effect of opiates on cell growth, and particularly stem cell growth; there is the stimulating effects of opiates on the immune system which leads to damage to the body as a whole; and then there is the compounded interactive effect of the immune effects of opiates particularly on the stem cells, which is likely more severe than the effect of either action working alone. 

Evidence of damage to the vascular system has also been published, which has been linked with stroke and heart attack.  Evidence of widespread hormonal disruption has also been shown.  The dental disease is well known, and this in its turn has been shown to be linked with higher rates of systemic pathology including hardening of the arteries and the development of dementia, probably by further stimulating the immune system.  Opiates disrupt cellular barriers both in the gut, allowing increased access of highly toxic germs to the blood stream, and in the brain where the immune system gains increased access to the nerve cells of the critical centres of the brain through a leaky blood brain barrier.  Similarly bone healing and formation is disturbed by opiates, likely by both stem cell and immune stimulatory mechanisms.  90% of an American study of opiate dependent males, with a mean age of about 40 years, had evidence of measurable and clinically significant bone loss, called osteopaenia or osteoporosis.  This is very important as it integrates the effects of addiction over significant time.  The liberalists argue that opiates are without intrinsic harm themselves, whilst conservatives argue the obvious denigration of virtually all drug users with time.  In one sense both might be true.  If the net defect suffered is only minor – say 5% annually, then over 20 years, the total deficit suffered is 64%!  Over 40 years this is 87%!  This implies that studies which demonstrate short term efficacy, typically over 6-12 months, really have essentially nothing to say about the long term toxicity of the drugs, as none of them have the necessary sensitivity to assess damage at this high degree of precision.

In fact there are very few published studies which examine the effect on physiology over the very long term.  Those which are available all paint a very bleak picture, with one major American study recently calling for geriatricians to be appointed to those addicts who survive to the age of 50 years, as their health was essentially falling apart in many body systems with evidence of widespread physical and mental disease, disability, misery and – of course – death in those who had not survived to complete the survey.

As for giving heroin out, one must be very careful.  The recent report of the Canadian heroin trial showed that it had a primary failure rate over one year of 40%.  This makes it far from the panacea depicted in its marketing blurb.  Data from the Sydney injecting groom, a room where illegal heroin can be taken under the supervision of Government employed nurses, showed that the rate of overdose was over 30 times higher than that in the general community.  In other words, in the presence of support staff clients were more than happy to “go for the magic big hit”, with near fatal overdoses on many occasions only averted by prompt action from the attending professional staff.

Davies mentions the disrupted social networks characteristic of heroin users.  It is sad that people who are dearly loved by their families die alone.  The utter chaos surrounding the heroin addicts life is legendary.  So many patients have told me that while they are using they think they are only hurting themselves; however when they get clean they realize how destructive their drug abuse is on all their family, friends and social relationships.  Most of these patients tell me that the best thing they could do is to come upon a bag of free heroin, and when they are sick many admit praying for a free hit.  However they freely and universally admit that this is also the worst thing that could happen to their own children.  When I ask them which view is correct, their view for themselves or their view for their children, they start to see that they have been badly deceived, and wickedly seduced.  It also becomes very obvious to them that they will not be truly free from their addiction in their mind until the way they think about heroin for themselves is the same as the way they think about heroin for their children.  As much is likely also true of societies.

As to heroin use being normalized in Switzerland and Zurich, that is not what the many refugees from that city who have fled all the way to Australia have told me on many occasions, nor is it the story which is in the published medical press.  Many have fled the gross social degradation which have taken over the forced closure of the Swiss “Needlepark” [ “Platzspitz”], and the criminal explosion which accompanied it.  According to published reports the top 1 meter of soil had to be bulldozed out of the park to clean it up.  Its closure only saw it move over the road to the abandoned railway station. 

Davies’ claim that the introduction of methadone was a cunning move to push up the price of black market heroin betrays his obvious agenda.  The simple fact is that a wave of heroin abuse has taken the world since the 1960’s which the various programs were designed to allay.  I found his figures for the majority of property crime in the UK being related to heroin use interesting in that they are virtually identical to those from Australia. 

The arguments of the left are seductively simple, but they are best addressed by stating the obvious from everyday life, the social, physical and psychological nightmare of active addiction.  These are the hard lessons learnt in places such as Sweden in 1968 and in Zurich where liberal policies such as those presently advocated were tried on the basis of seductive supposedly compassionate advice such as that which Davies and his ideological colleagues presently so eloquently argue.  Whilst there is a superfluity of robust evidence available in the scientific literature to refute such claims, it is also clear that much more work in this area could be done.  Nor is it relevant only to addiction medicine.

The fact that opiate addicts notoriously suffer from exorbitant rates of atherosclerosis, dementia, psychological disorders, osteoporosis, dental disease, immune dysfunction, hormonal disturbances and disruption of their sleep-wake cycles and appetite drives, and a very high rate of some cancers, implies that if we understood more of this process we could treat these major disorders much better.  Moreover, collectively they demonstrate an acceleration of the ageing process, so we would likely begin to understand the ageing process much better, potentially developing treatments which might increase the human “healthspan”, or our number of disability free years, minimizing our risk of long term disablement and years spent in a nursing home.  And the deficit of detailed long term studies of these important issues is clearly a major gap in our understanding, which urgently needs to be addressed.  Whilst it is true that there exists enough data in the published science to effectively refute the raucous arguments for legalization of all presently proscribed drugs, it is equally true that much more could be done in the toxicological sciences to explore these issues in more detail.  That western societies allow mainstream science to continue to overlook such areas, whilst drugs pose so present and imminent a major social threat, is an international disgrace, and one which can only be overcome by the will of the people being felt by the policy makers, to properly protect the coming generations. 

For example cannabis has been shown to be linked with eight cancers, including congenital leukaemia and brain cancer, and has been shown to be mutagenic.  This may be related to its genotoxic effects mediated via AP-1 and MAP kinase pathway activation.  Opiates also stimulate these same pathways, and have also been shown to be linked with carcinogenesis.  Environment has been shown to impact gene regulation through epigenetic regulation including chromatin methylation confirming the Barker hypothesis that in utero and neonatal influences can permanently affect gene expression for decades to come.  There is no liberalization argument to address genotoxicity in this generation, and no liberalist defence of genetic mutagenicity in the next generation.  The demonstration in many studies that parental opiate use produces body and organ growth retardation, impairs brain growth, induces organ structural abnormalities, and intellectual and behavioural disabilities in affected offspring into their teenage years has no liberalist defence, and is in fact egregariously indefensible.  As developed nations we have much more to learn and much more to do

The author runs the largest heroin detox clinic in Queensland Australia, and has published many papers on heroin and drug addiction and its treatment.

Source: Stuart Reece Feb.2010

Two NIDA-funded studies identify health risks that  underscore the importance of curbing marijuana abuse.

BY PATRICK ZICKLER, NIDA Notes Contributing Writer                             

A large new epidemiological study suggests that marijuana smoke can cause the same types of respiratory damage as tobacco smoke. Significant associations between marijuana smoking and a variety of respiratory diseases also have been confirmed by an extensive review of clinical literature.

MONITORING THE EFFECTS OF TOBACCO AND MARIJUANA

Dr. Brent Moore and colleagues at Yale University, the National Cancer Institute, and the University of Vermont evaluated data from a nationally representative sample of 6,728 adults. Their analysis indicated that a history of more than 100 lifetime episodes of smoking marijuana, with at least one episode in the past month, increased an individual’s risk of chronic bronchitis, coughing on most days, wheezing, chest sounds without a cold, and increased phlegm.

“The most significant difference between tobacco smoke and marijuana smoke is their principal active ingredients—nicotine in tobacco and delta-9-tetrahydrocannabinol (THC) in marijuana. Beyond that, marijuana contains at least as much tar and half again as many carcinogens as smoke from conventional tobacco,” says Dr. Moore. “Quitting marijuana smoking may benefit respiratory health as much as quitting cigarettes, in addition to the clear and considerable health, psychological, and social benefits of no longer abusing an illicit drug.”

The information Dr. Moore and his colleagues analyzed was gathered through the third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994. Participants included 4,789 nonsmokers of either tobacco or marijuana; 1,525 smokers of tobacco but not marijuana; 320 smokers of both marijuana and tobacco; and 94 who smoked marijuana only. On average, marijuana abusers had smoked the drug on 10 of the preceding 30 days, with 16 percent reporting daily or almost daily smoking. Tobacco smokers consumed roughly the same number of cigarettes—averaging 19.2 per day—whether or not they also smoked marijuana. Survey participants answered questions about their experiences of a range of respiratory symptoms and were examined for signs of respiratory abnormalities.

The researchers concluded that tobacco smokers who also smoked marijuana had a higher prevalence of most respiratory symptoms than tobacco-only smokers. Compared with tobacco-only smokers, however, those who also smoked marijuana were less likely to have had pneumonia during the previous year or to show spirometric evidence of obstructive pulmonary disorder. Commenting on this finding, Dr. Moore says that it is important to note that the marijuana smokers in the sample were significantly younger (average age 31.2 years) than the tobacco smokers (average age 41.5 years). “The marijuana-related respiratory effects correspond to a relatively young population, and NHANES III did not ask participants older than age 59 about drug use,” he adds. “It is likely that respiratory effects will be higher in older marijuana smokers, and, because of the high prevalence of tobacco use among marijuana smokers, there appears to be an increased risk for illness due to cumulative effects of smoking both drugs.”

MARIJUANA’S LONG-TERM PULMONARY EFFECTS

Further evidence of marijuana’s respiratory toxicity emerged from a study conducted by Dr. Donald Tashkin at the University of California, Los Angeles. Dr. Tashkin conducted an extensive review of clinical and epidemiological research to determine the extent to which chronic marijuana smoking might lead to long-term pulmonary effects and diseases similar to those caused by tobacco. Unlike the NHANES III data examined by Dr. Moore, the studies evaluated by Dr. Tashkin made it possible to assess a possible association between marijuana smoking and respiratory cancers.

The results of animal and cell culture studies are mixed with respect to the carcinogenic effects of THC, some studies showing that THC promotes lung cancer growth and others showing an anti-tumoral effect on a variety of malignancies. Although the results of epidemiological studies are also mixed, a large, recently completed case-control study has failed to find a direct link between marijuana use (including heavy use) and lung, throat, or other head and neck cancers. “Nevertheless, there is evidence that suggests precarcinogenic effects in respiratory tissue,” Dr. Tashkin says. “Biopsies of bronchial tissue provide evidence that regular marijuana smoking injures airway epithelial cells, leading to dysregulation of bronchial epithelial cell growth and eventually to possible malignant changes.” Moreover, he adds, because marijuana smokers typically hold their breath four times as long as tobacco smokers after inhaling, marijuana smoking deposits significantly more tar and known carcinogens within the tar, such as polycyclic aromatic hydrocarbons, in the airways. In addition to precancerous changes, Dr. Tashkin found that marijuana smoking is associated with a range of damaging pulmonary effects, including inhibition of the tumor-killing and bactericidal activity of alveolar macrophages, the primary immune cells within the lung.

Taken together, Dr. Tashkin’s survey of clinical and epidemiological studies and Dr. Moore’s assessment of self-reported and clinically observed effects provide an extensive catalog of respiratory and pulmonary damage associated with marijuana smoking. Smokers are subject to:

·         Coughing and phlegm production on most days;

·         Wheezing and other chest sounds;

·         Acute and chronic bronchitis;

·         Injury to airway tissue, including edema (swelling), increased vascularity, and increased mucus secretion;    

·         Impaired function of immune system components (alveolar macrophages) in the lungs.

Moore, B.A., et al. Respiratory effects of marijuana and tobacco use in a U.S. sample. Journal of General Internal Medicine 20(1):33-37, 2005. [Full Text]

Tashkin, D.P. Smoked marijuana as a cause of lung injury. Monaldi Archives for Chest Disease 63(2):93-100, 2005. [Abstract]

Hashibe, M., et al. Marijuana use and aerodigestive tract cancers: a population-based case control study. Cancer Epidemiology, Biomarkers & Prevention (In Press).

Source:NIDA Notes > Vol. 21, No. 1  Oct.2006

 

 

 

 

Fred M. Jacobs, M.D., J.D., Commissioner,
New Jersey Department of Health and Senior Services
August 2007

Dear Dr. Jacobs,

Re: Establishment of Needle and Syringe Programs

I understand that the state of New Jersey is considering a needle and syringe “exchange” program. I am also advised that New Jersey is a liberal democratic society whose members for the most part believe in freedom of the individual to pursue “life, liberty and happiness”. This of course is wonderful! And also provides a useful opportunity to note that no drug addict enjoys real freedom while their will, their lives, their relationships and their resources are largely dedicated to the service and slavery of their chemical addiction. This would make your lovely part of the world an excellent place in which to pursue those liberties which should be the birthright of every human being.

To introduce myself I am a family physician in Australia, and have pursued a special interest in the treatment of addiction especially for heroin, but also other drugs of addiction for the last ten years. Health department figures indicated last year that in the years 2001-2006 I single handedly registered 11,000 of the 14,000 registrations for opiate detoxification in the state of Queensland. I have also attained one of the three largest numbers of naltrexone based rapid opiate detoxifications in the country of Australia with over 1,800 procedures performed including 600 naltrexone implants. This was done with only two overnight hospital admissions which is a world safety record. I have also submitted evidence to several Government committees and leaders on the subject of drug policy.

As the so-called “needle “exchange” programmes” make little effort to exchange syringes, and as actual exchange makes little difference to the operation or mission of the programs, it is probably more accurate to refer to them as needle and syringe distribution programs, or NSP’s. It is important that your community appreciate this because syringe disposal is a real problem with these facilities. It has been so in this country. Our lovely and world famous Bondi beach in Sydney is now said to be one of the best places in the country to get a needle stick injury, due to the many syringes hidden in the sand. Clean up patrols have operated in King’s Cross twice daily for years to clean up the extreme public nuisance of hundreds of used syringes left dangerously in the streets and side walks, to protect the public . This is a well recognized problem with NSP’s which is generally covered up while such programs are in the planning phase.

Epidemiological Evidence

Since the NSP experts readily resort to discussion of “evidence based treatments”, and since the community decision to fully implement this program has such far reaching implications both in terms of needle disposal bins in all public toilets and for the time and direction of public health policy in the management of addiction, it is very appropriate that careful consideration be given to the quality of evidence which is typically cited in support of NSP’s. In particular the evidence based literature waxes lyrical about “levels of [reliability of] evidence.”

Self-report data is widely used in the addiction literature but it has been shown many times to be highly flawed and unreliable, and to fails to correlate with more objective and hard signs of HIV rates. As was pointed out to you by Dr. Fred Payne’s letter, and as was noted in the Institute of Medicine Report on this subject, it is well recognized that most of the literature on the subject of needle exchange is based on self report. This would clearly make it the least reliable form of evidence by their own criteria. Actually one would have to wonder if the evidence based gurus would accept such data at all.

Secondly we are aware of the “ecological” studies where they repeatedly report many cities with and without NSP’s. The work of Dr. Kirsten Kall’s group from the University of Linkoping shows clearly that in such an epidemic the rate of rise of the epidemic is related to the population at risk. Epidemics it is argued have a natural life history with a rise, fall and usually stabilization levels. Depending where in the natural history of the epidemic one takes one’s samples one will get a different picture of the efficacy of the NSP’s. It is for this reason that showing either a rise or a fall in HIV incidence or prevalence after NSP introduction is irrelevant if one is not informed of the natural history of the epidemic, and unless one can adduce by other means the likely outcome in its absence. This is a severe criticism, and one which effectively invalidates the whole of this genre of studies. I am also assured by epidemiologists familiar with such matters, that such studies are given no weight in epidemiological circles for this reason. That they have been foisted upon the rest of the world and even mentioned in major UN reports shows the degree to which such sloppy unscientific methods have been adopted within such agencies.

Indeed Dr. Alex Wodak, understood to be one of the primary authors of the relevant section of the 2006 UNAIDS report which eulogized NSP’s and the harm minimization addiction management paradigm, unequivocally stated in 1995 that formal proof of the methods of harm minimization would be impossible as it would not be possible to control in real life the many confounding factors which would be acting, and thereby prove that any particular intervention alone had been salient in controlling the target disorder .

Furthermore there is a clear conflict of interest by some of the leading proponents of NSP’s . Dr. Alex Wodak was for many years the President of the International Drug Law Reform Foundation and is the current president of the Australian Drug Reform Foundation which lobbies unceasingly for drug decriminalization. Dr. Don Jaralais in the USA is also understood to be of a similar ideology, and his advocacy for NSP’s is well known. I am of the understanding that such parallels could be made repeatedly for many of the most ardent advocates of NSP’s.

Dr. Payne’s letter mentions the very high rates of HIV in Vancouver at present despite the operation of an NSP, having risen from 1% to 35%. It was also shown long ago in Montréal that the HIV rate amongst NSP attendees was 2.5 times that amongst non-attendees (3.1 Vs. 7.9%) .

In terms of its control of other virus transmission NSP’s seem to substantially lack power. They failed to control Hepatitis B in Amsterdam , or Hepatitis C in Australia where rates of HCV carriage amongst IVDU who have been involved in the lifestyle for longer than six months exceed 80%.

Special Situations

Some situations are special and require special consideration. We are well aware that the apparent success of harm minimization techniques in this country is frequently cited overseas and in international fora as proof of principal of the efficacy of harm minimization epidemic management techniques. What is repeatedly overlooked in such discussions is our record rates of other infections such as Hepatitis B and C, and the venereally transmitted agents Herpes, Warts and Chlamydia. Indeed recently released data shows 30-100% growth in the last five years in Queensland in Gonorrhea, Hepatitis C, Chlamydia and Syphilis . Indeed it has been estimated that the Australian health care system has now to plan for over 100,000 liver transplants required for Hepatitis C alone in the next 20 years. One also notes that the outcome after transplantation for Hepatitis C is inferior to that for other infections due to the universal early graft re-infection which invariably occurs in the first few post-operative days, and the clash between anti-rejection immunosuppressive therapy and the anti-viral needs of fighting an aggressive viral infection in the context of the immuno-suppression and likely immuno-senescence induced by drug addiction, which is reversed to an unknown extent by abstinence.

In Australia our HIV rate amongst IVDU who do not share other risk factors is very low by international standards of the order of 1%. New cases of HIV nationally in all groups have risen from about 100 in 1991 to around 300 in 2005 . There appears to be significant variation in the estimates for the number of syringes distributed to addicts in this country with estimates varying from 20,000,000 to 200,000,000 – a level of inexactitude which in itself should give us pause. The former number was more than our total population at the time, and the latter number is substantially greater than the number of sheep here (which says a lot for a nation which for a long time was said to ride on the sheep’s back!) One important feature then facing the advocates of any NSP program is exactly how many syringes do they want to distribute? One for every man woman and child in the state?

However in the case of Australia we would do well to heed Wodak’s warnings about the inability to control for other confounders. From a modeling point of view the epidemic began in certain well known high risk groups. Its spread would then have been related to the population at risk, the activity of the various risk taking behaviours, and the intersection of these behaviors with the wider general community. Still today over half of all HIV infections in this country occur amongst men who have sex with men. It should also be added that the rate of IVDU in this group is 10-20 times higher than it is in the general community. Clearly then the spread of the disease into the wider community is related to the behaviour of this reservoir of infected people. One of the obvious confounding factors which has never been studied or quantified is what might be termed the homosexualization of the Australian culture with many laws, many bureaucracies, and schools of public health completely subsumed by the new ideology accompanying the public health impetus of the HIV epidemic. In that this likely instilled major good will in the primary target community, and is likely to have very positively influenced the relevant risk taking behaviours, it is clearly an intimate confound which confuses and likely dilutes any effects which might be attributable strictly to NSP’s.

Another important confounding factor was that Australia made treatment for HIV free to all patients who would have benefited from it from the outset of the epidemic. Assuming that the most at risk individuals were infected near the beginning of the epidemic, then those that survived their infection might reasonably be expected to have had a lower viral load for most of this time making them les infectious. This can be expected to have significantly slowed the rate of progression of the epidemic in this country.

Sweden is an important case in point which must be mentioned in any intelligent discussion of the NSP movement. Sweden has very limited methadone treatment availability, until recently no NSP activity, and no legal “shooting galleries” and a very low rate of HIV in IVDU. Hence the methods of harm minimization cannot strictly be said to be required for HIV control. Clearly HIV control can occur in a very effective manner in the absence of the model harm minimalist strategies.

The situation in prisons, or penitentiaries, is a special one and well worth at least some specific consideration. I was privileged to give evidence to the Inquiry into the Impact of Illicit Drug Use on Families before the Federal House of Representatives of the Australian Parliament on 3rd April 2007 . During that interview I stated that “my blood ran cold at the thought of 500 inmates all sharing the same syringe barrel” as was recounted to me by one of my HIV positive patients. However typical harm minimalist solutions such as methadone, syringe distribution and bleach use have been found to be impractical in the prison environment, and in this country have triggered strikes and industrial disputes by the prison warders due to the creation of unsafe workplaces. Since making those comments to the committee I have considered what might best be done about this appalling situation. One approach follows below (see “Other Treatment Modalities”).

In essence it is my belief that where the crime for which a person is committed is referable to opiate drugs, the standard of care will become naltrexone implant insertion on admission to the jail (after appropriate detoxification procedures), naltrexone implant maintenance during incarceration, and naltrexone implant prior to discharge to prevent the overdose which so often accompanies discharge (and the ritualistic “get a whack, get a woman” routine which is invariably followed). Indeed in Perth patients discharged from the prison are taken by volunteer escort from the prison gates to the clinic for implantation before the whole destructive cycle can re-commence. This seems the most sensible, responsible and compassionate management of this problem.

Other Treatment Modalities

Naltrexone was fist synthesized in the USA 1963 at Endo laboratory by Matossian acting under Blumberg’s instruction . Naltrexone implants and depot preparations have recently received a lot of attention from the international addiction management literature, and have been commercially introduced in the USA. American developed depot injections typically last 3-4 weeks. A preparation recently developed in this country lasts typically 4-6 months. The results of the first formal clinical trial conducted in Perth will soon be announced, probably in a leading medical journal such as JAMA or New England Medical Journal. They have been extensively used in this clinic where we have inserted over 600 USA (Wedgewood) and Australian (Perth “Go Medical”) implants. I was asked by the Preventative and Community Medicine Committee of the Queensland Faculty of the Royal Australian College of General Practitioners to evaluate naltrexone medicine including the Perth naltrexone program in 1998, and since 2001 I have been involved with the development in Perth of their naltrexone implant.

Unofficially the abstinence rate in terms of not returning to dependent heroin use at five months was well in excess of 50% in a study which set new standards international medical literature for patient follow-up. Only 11% of the 70- patients were lost to follow-up compared to over 90% in a similar (larger) study conducted in leading centres in the USA reported by Hollister in 1977 for NIDA at the NIH . Naltrexone is also a widely recognized and used technique for reducing problem drinking in alcoholics. It has also been used for gambling addiction, with positive results on some occasions. Moreover other results reported from the Perth clinic indicate that naltrexone is likely to have a controlling effect on other chemical addiction such as benzodiazepines, cannabis and stimulants such as amphetamines.

It is my personal view that they are excellent and will soon revolutionize the treatment of opiate addiction. Opiate dependence of course is the most addictive and refractory of all drug addictions, and the possibility of gaining control of such patients in a drug free context, as opposed to the usual medical model involving the indefinite maintenance of addiction, must be one of the most exciting opportunities ever to be offered to physicians in addiction medicine.

Another medical agent which has shown enormous promise in the control of multiple addictions is the cannabinoid antagonist rimonabant (“Accomplia”; SR141716A) which has been used with success against opiate, tobacco, alcohol, amphetamine food and cocaine addictions. This drug has attracted attention from NIDA and is undergoing further testing. I am not sure what its regulatory status is in the USA. It was available in eight European nations when I enquired with the pharmaceutical company (Sanofi-Synthelabo) about four months ago. The drug is still under patent, so this impedes its being re-formulated into an implant or depot preparation.

The combination of naltrexone and rimonabant has yet to be tested but would appear to show obvious promise, and it would be a priority in a rational testing program to investigate this further.

Future Research Directions

Many studies show increased evidence of drug use in young people.

All senior authorities in the world agree that there is far too little resources put towards investigating the toxicological effects of addictive drugs in general, and in adolescents in particular.

If we are ever going to do more than shut the door after the horse has bolted, clearly the issue of the true toxicity of addiction must be much better investigated, and the results of such studies broadcast far and wide to our young people, to de-glamourize the dreadfully seductive marketing program to which the rock music and popular culture misleadingly subjects them. If we are ever going to contain the monster of rampant destructive drug use in our younger people, then their dangers must be better emphasized.

Given the obvious multi-system damage of long term chemical addiction which is immediately apparently to even the untrained observer, one can only conclude which a Science which espouses the relative benignity of addiction must be grossly and egregariously deficient.

I have formulated a detailed plan by which such a strategy can be put in place, based around the accumulated ageing changes evident in the skin, teeth, hair, blood vessels, bones, immune system, stem cells and brains of addicts. It invites international collaboration and multi-system multilevel cooperation and the application of state of the art techniques to classical clinical problems. That however, is another story.

CONCLUSION

In summary NSP’s incur great social cost and are clearly part of the problem rather than part of the solution. Their scientific literature is remarkable for its lack of compelling evidence and methodological rigor, not to mention the prominence of adverse findings, when properly adjudicated. Rather the global penetration of NSP’s is an indicator of the strength of the marketing strategy of the ideology they enshrine. They are in any case about to be phased out like old dinosaurs by the cutting edge technologies which are moving ever closer to being a real market alternative, particularly the revolutionary long lasting Australian naltrexone implant.

I have been advised that now methadone is worth $150/week to dispensing hospitals in Federal hospital subsidies. As some of the most famous institutions in the USA have 10,000 – 20,000 patients enrolled on it, this income source forms a major stream of hospital funding. As such it is not likely to be disrupted. What the management of the Australian HIV epidemic does teach us is that it is best to get on and treat the HIV infection as soon as medically appropriate. In addiction medicine we have up until now largely done the reverse, for there we have deliberately continued indefinitely maintenance treatment designed to not to confront the addicted physiology, but rather to postpone indefinitely the definitive redress of that medical condition. The Australian success with HIV management tends to rather emphasize the reverse approach. This is the therapeutic route suggested by naltrexone implant maintenance. In all the discussion we would appear to have forgotten that in the early 1960’s New York was in urgent need of a treatment for addicted GI’s returning home from Vietnam. Methadone as the only medical solution then available was adopted and quickly came to command tremendous official support to the point where it became in time, the established industry. We have now a far more exciting opportunity to launch naltrexone implants and other new treatments in a similar and innovative manner. In would be my sincere hope that nations can move speedily to deliver proven and safe medical treatments to vulnerable populations without incurring undue, unnecessary and officious regulatory obstruction.

This would appear to be the visionary, drug free and health enhancing approach. As these concepts are more widely understood it is hoped that regulators and administrators will cooperate to mobilize international best medical practice on behalf of those with whose care they have been entrusted. I would invite the legislators of New Jersey to work with us on these issues of major cultural importance.

Yours Sincerely,

A. Stuart Reece, MBBS (Hons.), FRCS (Ed.), FRCS (Glas.), MD, FRACGP.
Family Physician, Highgate Hill Brisbane,
Senior Lecturer, Medical School, University of Queensland,
Fellow, Drug Watch International,
Fellow, Drug Free Australia,
Member, Society for Neuroscience,
Member, International Cannabinoid Research Society,
Attendee, College of the Problems of Drug Dependence Conferences 2002-2006.
Awardee, National Institute of Drug Abuse, International, 2003, 2004, 2006.

Abstainers Are Not Maladjusted, but Lone Users Face Difficulties

Key findings:
• Although some consider experimenting with marijuana normal behavior for adolescents, those adolescents who abstain are not maladjusted as others have reported.
• Young abstainers do better than experimenters into young adulthood.
• Even strict abstainers — youth who avoid all drugs — fare well in life.
• Solitary substance use is not uncommon among youth.
• Young solitary users are an overlooked at-risk group who face a wide range of psychosocial and behavioral difficulties as teens and young adults.

A lot of adolescents experiment with marijuana — the National Institute on Drug Abuse estimates that 46% of high school seniors have tried this drug at some time. Pushing boundaries is what young people do, and some researchers believe that trying marijuana is a normal part of growing up. Does that mean that young people who do not indulge are somehow maladjusted?

Jonathan Shedler and Jack Block[1] raised this possibility in a report in 1990. They suggested that adolescents who experimented with marijuana were better adjusted emotionally and socially than their counterparts who avoided all drugs. Specifically, abstainers were observed to be anxious, emotionally constricted, and lacking in social skills compared with experimenters. Not surprisingly, these findings caused widespread comment in the drug-prevention community.

Now, RAND Corporation researchers have revisited Shedler and Block’s classic study and have uncovered evidence that challenges those initial findings. Kids who abstained from marijuana through the last year of high school were not socially or emotionally troubled. And they had better outcomes as young adults.

A second study looked at a largely ignored group of adolescents: kids who go off by themselves to use marijuana and other harmful substances. The researchers documented a wide range of psychosocial and behavioral difficulties faced by youth who use harmful substances while alone, rather than only in social settings like parties. And the troubles followed them into young adulthood.

For policymakers, these two studies help clarify the picture of youthful marijuana use: Marijuana abstainers do well, solitary users do poorly, and kids who use marijuana only in social settings are in between.

Digging for Clues About Youthful Marijuana Use
To re-examine the provocative findings of Shedler and Block, the RAND researchers, led by Joan Tucker, a social psychologist, mined a wealth of data on youthful substance use accumulated since 1985 by the RAND Adolescent/Young Adult Panel Study. This database contains survey responses from thousands of individuals who answered questions about their use of harmful substances, about their social and emotional well-being and behavior, and about school. The survey was given in grades 7, 8, 9, 10, and 12, and again at ages 23 and 29. The database was used to evaluate the effectiveness of the Project ALERT drug use prevention program that RAND developed for middle-school students. For their study, the researchers examined responses to the surveys given in 12th grade and at age 23. They divided the responders into abstainer and experimenter categories, which replicate as closely as possible those used in the 1990 Shedler and Block study:

Abstainers — those who had never tried marijuana or any other illicit drug.

Experimenters — those who had used marijuana less than 10 times in the year before being surveyed and less than three times in the preceding month, and none or only one other illicit drug in their lifetime.

A different picture emerges of youth and marijuana
From their analyses of survey responses, the RAND researchers pieced together a picture of marijuana abstainers and experimenters as teens and as young adults that contradicts that painted by earlier studies. Their key findings, some of which are shown in the figure, include

Youth who stayed away from marijuana through their senior year of high school functioned better overall than did seniors who experimented with the drug. Compared with experimenters, abstainers

• had more parental support
• devoted more time to homework
• spent more time in extracurricular school activities
• earned better grades
• got into less trouble
• were emotionally better off.

Both groups were similar in that

• on average, they rarely felt lonely
• they reported similar levels of peer support and ease in interacting with the opposite sex.

The one exception was that,

• although abstainers were socially active, they went to parties and dances significantly less frequently than did experimenters.

By the time they turned 23, those who had avoided marijuana in high school functioned better overall as young adults than those who had experimented with it in their youth. Compared with experimenters, abstainers

• were better educated
• were happier with their friends
• were less involved in deviant behavior (stealing and drug selling).

Both groups were similar in that

• they showed no differences in their satisfaction with family life and with general mental health, or with limitations due to emotional problems.

The emotional and social well-being of strict marijuana abstainers — those who had tried neither marijuana nor cigarettes and had not used alcohol in the past year — was also compared with that of experimenters, both in high school and as young adults:

• Even this more-stringent subgroup of marijuana abstainers did not show the adjustment problems suggested by earlier studies.

Why did two different pictures emerge?
The conflicting findings may be due to methodological factors. For example, the RAND team examined longitudinal data for more than 3,000 individuals who were originally recruited from 30 California and Oregon schools. These schools were chosen to represent a wide range of community types, socioeconomic status, and racial/ethnic composition. Thus, the RAND sample was considerably larger and more diverse than the 100 or so youth from the San Francisco Bay area whom Shedler and Block followed.

Young Solitary Substance Users: An Overlooked, At-Risk Group
Surprisingly little research looks at the sizable minority of teens who use marijuana and other harmful substances when alone rather than only in social settings. In a second study, researchers again used the RAND Adolescent/Young Adult Panel Study database for clues about the extent of solitary substance use, as well as about the well-being, behavior, and future risks, of this largely ignored group. For this study, these youth are referred to as “solitary users,” even though they may also use marijuana, cigarettes, or alcohol in social settings with others. This time, the researchers analyzed responses to the surveys given in 8th grade and at age 23. They found that:

Although they constitute a small percentage, solitary users are an overlooked, at-risk group:

• In 8th grade, 4% of young people said they sometimes or often used marijuana alone rather than limiting its use to parties or other social occasions. This figure was 16% for cigarettes and 17% for alcohol.

By 8th grade, solitary substance users are worse off than classmates who use only in social settings. Compared with social-only users, solitary users

• engaged in heavier and more-frequent drug use
• got into more trouble (e.g., stealing, acting out at school)
• confided less in their parents about personal problems
• performed more poorly in school (had lower grades, spent less time on homework, participated less in extracurricular school activities).

Solitary users are not social outsiders. Contrary to what might be expected, these youth are not loners. They are socially active teens who spend more time hanging out with friends, going to parties, and dating than do youth who limit substance use to social settings. Popularity with peers may help compensate solitary users for their poorer academic track records and behavioral problems in the short term.

Solitary use foreshadows problems down the road. Compared with social-only substance users, teen solitary users faced more difficulties as young adults: They made fewer educational strides, had poorer health, and experienced more substance-use problems.

Solitary users perceive drug consequences differently than do social-only users. Solitary users more strongly believed that turning to marijuana, cigarettes, or alcohol helped them get away from their problems, relax, and have more fun — an optimistic bias that could lead them to underestimate the potential for serious negative consequences.

Implications for Drug-Prevention Programs
New insight into youthful substance use emerged from the RAND studies that can help improve drug-prevention programs for adolescents and teens.

Experimentation with drugs has sometimes been viewed as developmentally appropriate and adaptive. In contrast, the RAND results indicate that youth who experiment with marijuana are worse off in many respects than those who abstain throughout their teenage years. This insight helps the drug-prevention community put into perspective the conflicting conclusions from prior studies about marijuana use and its consequences.

The research also documented the wide range of psychosocial and behavioral difficulties that lone substance users, as opposed to strictly social users, face as teens and young adults. These findings suggest that drug-prevention programs should pay closer attention to this at-risk group of young people.

Source: http://www.rand.org/pubs/research_briefs/RB9265/index1.html 2007
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[1] Shedler J, and Block J, “Adolescent Drug Use and Psychological Health: A Longitudinal Inquiry,” American Psychologist, Vol. 45, No. 5, May 1990, pp. 612–630.
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This Highlight summarizes RAND Health research reported in the following publications:
Tucker JS, Ellickson PL, Collins RL, and Klein DJ, “Are Drug Experimenters Better Adjusted Than Abstainers and Users?: A Longitudinal Study of Adolescent Marijuana Use,” Journal of Adolescent Health, Vol. 39, No. 4, 2006, pp. 488–494.

Tucker JS, Ellickson PL, Collins RL, and Klein DJ, “Does Solitary Substance Use Increase Adolescents’ Risk for Poor Psychosocial and Behavioral Outcomes? A 9-Year Longitudinal Study Comparing Solitary and Social Users,” Psychology of Addictive Behaviors, Vol. 20, No. 4, 2006, pp. 363–372.

The following extracts are taken from the NHS Statistics on Drug Misuse: England, 2009. It is quite difficult to compare many of the statistics from the body of the report – some relate to age groups 16-59, others to 16-24 year olds, others to 11-15 year olds. Some give information from l996, others mention 2001, some relate to 2007/08 and others to 2008/09. Some mention an ‘overall decrease’ but when you delve into the detail you find that this overall decrease does not apply to some groups where there is an increase. Particularly disturbing is the information that the highest levels of drug use in the last year for all age groups were in the 16-19 and 20-24 year olds.

In the age group 16-24, 22% had used drugs in the previous year, 18% used cannabis in the previous year.

The report states that between l996 and 2008 the use of Class A drugs rose as follows:

25 – 29 years of age – 3.9% – 8.4%
30 – 34 “ “ “ – 1.9% – 5.2%
35 – 44 “ “ “ – 0.5% – 1.7%

And between 2007/8 to 2008/9 the rises were:

16 – 24 years of age – 6.9% – 8.1%
25 – 29 “ “ “ – 6.4% – 8.4%
30 – 34 “ “ “ – 3.8% – 5.2%

Note the differing age groups which make total comparisons difficult.
The report then makes a statement which is impossible to understand:

‘However, Class A drug use rose from 6.9% to 8.1% between 2007/08 and 2008/09; hence Class A drug use among young people is now stable over the long term’ ??

The most notable figure, repeated in the report in several places were:
7.9% of adults used cannabis in the past year (2008/9). This figure hardly agrees with media pronouncements and ‘accepted facts’ that cannabis use is endemic throughout the population. It might be very common in the younger age groups but this report suggests that over 92% of the adult population are non-users of cannabis. Ergo restrictive drug policies work.

Main findings:

Drug misuse among adults (16 – 59 years) In England and Wales:

• In 2008/09, 10.1% of adults had used one or more illicit drug within the last year,
compared with 9.6% in 2007/08. However, over the longer term this shows an overall
decrease from 11.1% in 1996.

• In 2008/09, 3.7% of adults had used Class A drugs in the last year, compared with 3.0% in 2007/08. Over the longer term this also shows an increase from 2.7% in 1996.

• Consistent with previous findings, cannabis is the type of drug most likely to be used by adults; 7.9% of 16-59 year olds used cannabis in the last year in 2008/09.

• There have been some decreases over the longer term in the use of non-Class A drugs; between 1996 and 2008/09 use of cannabis, amphetamines and anabolic steroids within the last year among adults declined.

Drug misuse among young adults (16 – 24 years) In England and Wales:

• In 2008/09, around 22.6% of young adults had used one or more illicit drug in the last year, which shows no change from 2007/08. This shows a long term decrease from 1996 when it was 29.7%.

• In 2008/09, 8.1% of young adults had used Class A drugs in the last year, compared with 6.9% in 2007/08. Over the long term, Class A drug use among young people has stabilised since 1996.

• Cannabis remains the drug most likely to be used by young people; 18.7% of
respondents aged 16-24 had used cannabis in the last year in 2008/09.

Drug misuse among children (11 – 15 years) In England:

• There has been an overall decrease in drug use reported by 11- 15 year olds since 2001. The prevalence of lifetime drug use fell from 29% in 2001 to 22% in 2008.

• There were also decreases in the proportion of pupils who reported taking drugs in the last year; from 20% in 2001 to 15% in 2008.

• Reported drug use was more common among older pupils; for example, 4% of 11 year olds said they had used drugs in the last year, compared with 29% of 15 year olds in 2008.

• Cannabis was the most widely used drug in 2008; 9.0% of pupils reported taking it in the last year, a long term decrease from 13.4% in 2001.

• Pupils who had truanted or been excluded from school were more likely to report taking drugs at least once a month than those who had not truanted or been excluded (11% and 1% respectively) in 2008
.
• There was an overall decrease in the proportion of pupils being offered drugs from 42% in 2001 to 33% in 2008. Cannabis was the most commonly offered drug followed by volatile substances and poppers.

• Older pupils were more likely to have been offered drugs, with 11% of 11 year olds
having been offered them compared with 57% of 15 year olds in 2008.

Health outcomes

Individuals who take illicit drugs face potential health risks, as the drugs are not controlled or supervised by medical professionals. As well as health risks, drugs can become addictive and lead to long term damage to the body. Illicit drug users are also at risk of being poisoned by drugs, and overdosing which can lead to a fatality.
In England (unless otherwise stated):

• In 2008/09, there were 5,668 admissions to hospital with a primary diagnosis of a drug-related mental health and behavioural disorder. This number is 15.1% less than in 2007/08 when there were 6,675 admissions. There were more male than female
admissions (3,997 and 1,671 respectively).

• Where primary or secondary diagnosis was recorded there were 42,170 admissions in 2008/09 compared with 40,421 in 2007/08, which shows an increase of 4.3%. There were more male than female admissions in 2008/09 (28,289 and 13,875 respectively).

• Where a primary diagnosis of poisoning by drugs was recorded, 11,090 admissions were reported during 2008/09, an increase of 47.2% from 1998/99 when the number of such admissions was 7,533. This has remained stable since 2007/08. There were more male than female admissions (6,076 and 5,014 respectively).

• The Strategic Health Authorities (SHAs) with the most admissions for drug related mental health and behaviour disorders as the primary or secondary diagnosis were North West SHA (155 admissions per 100,000 population) and Yorkshire and The Humber SHA (98 admissions per 100,000 population).

• During 2008/09, there were 207,580 people in contact with structured drug treatment services (those aged 18 and over). This is a 10.4% increase from the 2007/08 figures, where the number was 187,978.

• In 2008/09, a larger number of men accessed treatment services than women (151,064 men compared to 56,516 women aged 18 or over).

• Those taking opiates only (which includes heroin) was the main type of drug for which people received treatment (48% of all treatments), with a further 31% of treatments for those who have taken both opiates and crack in 2008/09.

• There were 60,386 discharged episodes of treatment by the end of 2008/09 and there were 24,656 (41%) of clients exiting treatment who were no longer dependent on the substances that brought them into treatment; a further 9,002 (15%) were referred on for further interventions outside of community-structured treatment.

• The total number of deaths related to drug misuse in England and Wales was 1,738 in 2008; 78% of those who died were male. The most popular underlying cause of death was from accidental poisoning for both males and females (597 and 166 respectively).

The key findings from Chapter 2 of the BCS (British Crime Survey) report show that:

• Around one in three (36.8%) had ever used illicit drugs, one in ten had used drugs in the last year (10.1%) and around one in 20 (5.9%) had done so in the last
month.

• Levels of Class A drug use were, unsurprisingly, lower than overall drug use, with 15.6% having used a Class A drug at least once in their lifetime, 3.7% having done so in the last year and 1.8% in the last month.

• Consistent with previous findings, cannabis is the type of drug most likely to be used; 7.9% of 16-59 year olds used cannabis in the last year.

• Use of any illicit drug during the last year has shown an overall decrease from 11.1% in 1996 to 10.1% in 2008/09, due in part to successive declines in the use of cannabis between 2003/04 and 2007/08.

• Despite this long-term overall decline, there has been an increase in the number 16-59 year olds who have used Class A drugs within the last year between 1996 (2.7%) and 2008/09 (3.7%).

• Class A drug usage has remained generally stable over this period: year-on-year changes were not statistically significant until most recently; however there was a slight underlying upward trend, which is now significant over the long term.

• The increase in Class A drug usage since 1996 can be understood in terms of an increase in the number of people who have used cocaine powder within the last year (from 0.6% to 3.0%), partly offset by a decrease over the same period in the use of LSD (from 1.0% to 0.2%).

• In 2008/09 methamphetamine was included for the first time but this has no visible impact on the overall prevalence of Class A drug use in that survey year.

• There have been some decreases over the longer term in the use of non-Class A drugs; between 1996 and 2008/09 use of cannabis, amphetamines and anabolic
steroids within the last year among 16-59 year olds declined. Looking at more recent years, key changes between 2007/08 and 2008/09 showed:

• The overall proportion of 16-59 year olds who have used any illicit drug within the last year remained stable (9.6% in 2007/08 compared with 10.1% in 2008/09) but there was an increase in Class A drug use within the last year (from 3.0% to 3.7%).

• For individual types of drug, increases were seen in the use within the previous year of cocaine powder, ecstasy, tranquillisers,anabolic steroids and ketamine.

1.3 Young people
Chapter 3 on pages 19-33 of the BCS report focuses on the use of illicit drugs by
young people aged 16-24 years old.

Figure 3.1 on page 20 shows the percentages of 16-24 year olds who have used Class A drugs either in the last year, the last month or ever for 2008/09. Related
information showing these percentages as a time series can be found in Tables 3.1-
3.3 on pages 27-29 and similar information showing actual numbers for 2008/09 can
be found in Tables 3.4- 3.6 on pages 30-32.
Figures 3.2-3.5 on pages 21-24 show the proportion of drugs used in the last year for 16-24 year olds by various drug breakdowns or as a time series. Figure 3.6 on page 25 shows the proportion of this age group classified as frequent drug users
as a time series. Related information on frequent drug use in the last year among
16-24 year olds can be found in Tables 3.7 and 3.8 on page 33 as a time series for any drug and by drug type for 2008/09.

The key findings from Chapter 3 of the BCS report show that:

• Around two in five young people(42.9%) have ever used illicit drugs, nearly one in four had used one or more illicit drugs in the previous year (22.6%) and around one in eight in the last month (13.1%).

• Levels of Class A drug use were, unsurprisingly, lower than overall drug use, with 16.9% of young people having ever used a Class A drug, 8.1% having done so within
the last year and 4.4% in the last month.

• Cannabis remains the drug most likely to be used by young people; 18.7% of respondents aged 16-24 had used cannabis in the previous year. Long and short-term trends for young people aged 16-24 show:

• The proportion of 16-24 year olds having used drugs in the last year fell from 29.7% in 1996 to 22.6% in 2008/09, due in large part to the gradual decline in cannabis use.
Latest figures show no change between 2007/08 and 2008/09.

• The general trend for having used Class A drugs in the last year for young people shows a slight decline since 1996.

• However, Class A drug use rose from 6.9% to 8.1% between 2007/08 and 2008/09; hence Class A drug use among young people is now stable over the long term. In
2008/09 methamphetamine was included for the first time but this has no visible impact on the overall prevalence of Class A drug use in that survey year. Recent trends in types of drugs used show that between 2007/08 and 2008/09:

• There was an increase in use of cocaine powder within the last year (from 5.1% to 6.6%) and ketamine (from 0.9% to 1.9%).

• Use of methadone within the last year, and hence opiates, fell (these figures are based on small numbers).

The key findings from Chapter 4 in the BCS report show that:

• The youngest age groups (16-19 and 20-24 year olds) reported the highest levels of drug use in the last year (22.2% and 22.9% respectively) compared with all older age groups.

• A broadly similar pattern can be seen for Class A drug use, but with the peak for drug use in the last year shifting slightly later to also include the 25-29 age group, with usage then decreasing with increasing age.

• Men continued to report higher levels (around twice as high) than women of drug use in the last year of any illicit drug or any Class A drug use. Looking at trends since the survey began, the self-report drug use data collection in 1996 shows there is a decrease in drug use in the last year for the 16-19 year olds which decreased from 31.7% in 1996 to 22.2% in 2008/09 and, for those aged 20- 24, fell from 28.1% to the latest figure of 22.9%. In general, between 1996 and 2008/09, year-on-year changes in levels of Class A drug use in the last year use were not statistically significant until most recently; however, there was a slight underlying upward trend which is now significant over the long term. There were increases in Class A drug use within the following age groups between 1996 and 2008/09: 25-29 year olds (3.9%
to 8.4%), 30-34 year olds (1.9% to 5.2%) and 35-44 year olds (0.5% to 1.7%).
Looking at change over the last year:

• There were no statistically significant changes in prevalence of any drug use overall in the last year between 2007/08 and 2008/09 for any age group.

• There was a statistically significant rise between 2007/08 and 2008/09 in the proportion of 16-24 (6.9% to 8.1%), 25-29 (6.4% to 8.4%) and 30-34 year olds (3.8% to 5.2%) who took Class A drugs in the last year.

Drug-related mental health and behavioural disorders

During 2008/09 more people aged 25-34 were admitted with a primary diagnosis of drug-related mental health and behaviour disorders than any other age group. This age group accounted for nearly 40% of all such admissions in that year.

Table 3.4 shows that there were 42,170 admissions where there was a primary or
secondary diagnosis of drug-related mental health and behavioural disorders in 2008/09, which is 4.3% higher than 40,421 admissions in 2007/08

England Numbers
Total Under 16 16-24 25-34 35-44 45-54 55-64 65-74 75+

1998/99 24,236 266 7,236 10,850 4,066 1,220 258 141 162
1999/00 24,974 273 7,028 11,027 4,634 1,363 271 144 196
2000/01 25,683 292 6,904 11,357 5,112 1,426 254 116 137
2001/02 28,063 329 7,136 12,355 6,034 1,543 290 151 146
2002/03 31,490 358 7,399 13,772 7,324 1,899 412 118 146
2003/04 34,957 374 7,861 15,061 8,670 2,137 418 156 194
2004/05 35,737 396 7,547 14,872 9,388 2,414 598 204 235
2005/06 38,005 445 7,495 15,752 10,314 2,817 688 181 197
2006/07 38,170 402 6,983 15,330 10,941 3,158 793 232 183
2007/08 40,421 350 7,348 15,540 11,792 3,664 924 270 191
2008/09 42,170 318 6,721 15,817 12,815 4,385 1,181 272 212

Table 3.10 NDTMS clients in treatment, by gender and age, 2008/09

England Numbers / percentages
Total Male Female

All clients 207,580 100 151,064 100 56,516 100
18-24 29,848 14 19,656 13 10,192 18
25-29 43,778 21 31,026 21 12,752 23
30-34 44,713 22 33,031 22 11,682 21
35-39 39,215 19 29,649 20 9,566 17
40+ 50,026 24 37,702 25 12,324 22

Source:

Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2008 – 31
March 2009. National Treatment Agency for Substance Misuse (NTA)
1. National Drug Treatment Monitoring System (NDTMS).
2. Percentages are rounded to the nearest per cent. Totals may not add up to 100 due to rounding

3. Age is calculated at year midpoint (30th September 2008).

Table 3.13 shows the reasons why clients were discharged from treatment. A discharge is classed as successful if an individual is said to have completed their course of treatment (whether drug free or otherwise), or if the individual is referred to another agency

Table 3.13 Treatment exit reasons for individuals not retained in treatment reported to NDTMS, 2008/09

Numbers %

Total (episodes discharged) 60,386 100
Total successful completions 24,656 41

Treatment completed free of dependency 15,676 26
Treatment completed drug free 8,980 15
Referred on 9,002 15
Dropped out/ left 14,822 25
Prison 4,383 7
Treatment declined 1,769 3
Treatment withdrawn 1,328 2
Moved away 1,870 3
Died 905 1
Other 980 2
Not known 159 0
No appropriate treatment 512 1

Source:
Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2008 – 31
March 2009. National Treatment Agency for Substance Misuse (NTA)
Copyright © 2009, re-used with the permission of the National Treatment Agency for Substance Misuse
Copyright © 2009. Health and Social Care Information Centre, Lifestyle Statistics. All rights
Reserved

Snippets

• Drug users aged 16-34 were more likely to have used three or more illicit
drugs in the last year com

The BCS report shows an overall prevalence rate of 4% for use of more than one illicit drug (polydrug use) in the last year amongst adults aged 16-59.

There was little difference between adult drug users who were single or cohabiting in terms of taking three or more illicit drugs in the last year (both 23%) and both groups were considerably more likely to take three or more illicit drugs than those who were married (married couples accounting for 8% of those who used three or more illicit drugs in the last year).

Reported drug use was more common among older pupils; for example, 4% of 11
year olds said they had used drugs in the last year, compared with 29% of 15 year
olds.

Regular smokers and pupils who have consumed more units of alcohol in the
previous week were very much more likely to have used drugs in the last year..

Deaths related to drug misuse. In 2008, there were1,738 deaths reported as being due to drug misuse. Of those who died, 78% were male. Compared to 1993 the number of male deaths has increased by around 136% in 2008 compared to a 48% increase for females. In recent years however no overall trend is apparent. The highest numbers of deaths due to drug misuse occurred in the 30 to 39 age group for both males and females (490 and 112 respectively).

William L. White

The difference between the right word and the almost right word is the difference between lightning and the lightning bug.—Mark Twain

At every word a reputation dies.—Alexander Pope

By our silence, we let others define us.—Susan Rook (Missouri Recovery Network campaign slogan)

Addiction treatment organizations and a variety of policy-making, planning, and funding authorities are changing their historical focus on acute biopsychosocial stabilization to a broader vision of sustained long-term recovery for individuals and families. This shift can be seen in widespread discussions and practices that embrace “recovery management” and “recovery-oriented systems of care.” This change in organizing concepts and service practices will not be possible without the meaningful involvement of individuals and families in or seeking recovery in the planning and decision-making processes.
The word “consumer” is cropping up more frequently, with references to “our consumers,” “consumer representation,” ”consumer councils,” and “consumer-based” or “consumer-directed” services. This latest term joins a long list of terms—patients, clients, service users/recipients/participants, alumni—that have described people needing, receiving, or completing addiction treatment and recovery support services.
Historically, language applied to and chosen by historically disenfranchised groups evolves over time. People who were recovering from severe mental illness began their own recovery revolution in the 1970s and 1980s and chose to self-designate themselves as “consumers” and “survivors” as a less stigmatizing alternative to “mental patient.” The surge in “consumer” language was a positive development within the history of the mental health recovery advocacy movement—one that at the time was experienced as personally empowering. It is likely that this language will continue to evolve as the mental health recovery advocacy movement continues to evolve.
With the growing integration of addiction treatment and mental health treatment services, the introduction of new medications for the treatment of addiction, and expanded efforts to include coverage for addiction treatment and recovery support services as part of comprehensive health care reform, the use of the word “consumer” is gaining prominence within the addiction treatment and recovery support communities. This brief essay describes why this “consumer” terminology is counterproductive and suggests other ways to describe the critical role that people seeking or in long-term recovery, their families, and friends play in the design, delivery, and evaluation of addiction treatment and recovery support services.

Rejecting the “Consumer” Designation
There are nine reasons to reject the spread of “consumer” language when talking about addiction treatment and recovery support services.

1. The term “consumer” is ill-defined and as such, may create further misunderstanding by the general public and policymakers about people experiencing addiction or who are in long-term addiction recovery. There is no generally understood meaning of what exactly is being consumed, and members of the public may well think the term refers to people who continue to consume excessive amounts of alcohol and/or drugs.
“The ‘consumer’ language suggests that the person in treatment is a social ‘taker,’ that they suck up community resources and give nothing in return—a parasitic relationship to others.”
People in active addiction are often involved in a parasitic process of using (in the manipulative sense) family, friends, and community resources to sustain their alcohol and drug use. “Consumer” is a more apt description of someone in active addiction than of a person in long-term recovery. Furthermore, the most cursory search of “consumer” on the internet reveals meanings that include a person who drinks alcohol to excess (See http://www.thefreedictionary.com/consumer). A person in recovery is more aptly described as a person who ceases being a consumer.

2. The term “consumer” fails to provide an alternative identity for persons attempting to disengage from alcohol/drug-saturated lifestyles and subcultures. Addiction treatment can be a transitional bridge from a culture of addiction to a culture of recovery or a revolving door within a person’s active addiction career. The “consumer” identity tends to reinforce the latter; focusing on the repeated “consumption” of services as well as the “consumption” of alcohol and other drugs. “Person in recovery,” in contrast, builds a new identity for an individual moving forward to a new life. “Consumer” defines a person in terms of a part of the self while ignoring the whole. Participating in addiction treatment is an activity, not who a person is.
The term “consumer” had value at a particular point in time for persons recovering from mental illness. New language that had value within a particular historical context can become old language and stand as an obstacle to progress as contexts change. We need a different term to describe people seeking and in long-term recovery from addiction and people who participate in addiction treatment as part of that long-term journey. Does that mean that any alternative language we embrace today may need to be given up in the future? We need to be open to that possibility.

3. The term “consumer” ties an individual’s identity to a service delivery system, be it a treatment provider or a physician prescribing medications, and can be paternalistic and disempowering. There are words other than “consumer” that can be used to describe a relationship between a person receiving professional care and the caregiver. For example, in the HIV/AIDS community, people who receive medications from a physician often describe themselves as patients when talking about their relationship with their doctor. Similarly, many people using medications in their recovery describe themselves as a “person in long-term recovery using medication,” as a “patient” when describing their relationship with their physician, or as a “client” when describing their relationship with a clinic.
The problem is that when “consumer” is juxtaposed against “professional” or “provider,” as it often is, “consumer” conveys a person of less value and authority and implies that the individual has value only to the extent to which they consume professional services or products. This juxtaposition further creates the delusion that the “provider” is whole/well and the consumer is “broken/sick.” Both are dehumanized by this process, with one denied of weakness and the other denied of strength. The “consumer” designation reflects a hierarchical relational model that rests on twin propositions: 1) “the professional knows best” and 2) the role of the “patient/consumer is to listen and comply.”
“Consumer” also defines a person in terms of his or her problems. It relegates the person to being one, albeit critical, component of a system of care, rather than as the driver of that care and the person around whom all care is to be organized so that the person is able to get well. There is nothing in the term that conveys autonomy (or even healthy interdependence), competence, responsibility, or describes the assets that the person brings to others and the community. “Consumer” does not convey the status of, or hope for, recovery and seems alien when linked to words like liberation, journey, transformation, Higher Power, redemption, spirituality, and service, to name just a few of the words and concepts that are associated with recovery. If we need a name, then let’s use words that convey wholeness and wellness, words like “citizen,” “person in long-term recovery,” or “person seeking recovery.”

4. Using the term “consumer” to convey the involvement of people in recovery and their families in advisement or decision-making roles narrowly restricts the pool of people considered for such participation. For example, the term “consumer” would not include individuals/families in need of recovery who have never sought professional help, individuals who did not complete and may have had a “bad” experience in treatment, and individuals and families who achieve long-term recovery without the aid of professional treatment. Referring to such people as “consumers” (of addiction treatment services) is simply inaccurate. Individuals in treatment constitute only a small, unrepresentative sample of those who have experienced and/or have resolved alcohol and other drug problems. Too often, “consumer” represents an even smaller sample: individuals who have successfully “graduated” from treatment and, out of deep gratitude for their personal recovery, can offer testimony to a particular program’s effectiveness.
“Consumer” councils that guide federal, state, or local recovery-focused initiatives must include a wide range of voices as part of the advisory process. The term “consumer” does not adequately describe the scope of needed representative. Voices must be heard who represent diverse levels of problem severity/complexity, recovery capital, and pathways and styles of long-term recovery. The homogenous designation “consumer” ignores the distinct cultural histories and the enormous diversity of needs and circumstances people bring to the experiences of recovery initiation and recovery maintenance.

5. The “consumer” designation inadvertently serves as a mechanism of “outing.” To routinely introduce someone as a “consumer representative” or a member of “our consumer council” discloses the person’s status as a former treatment recipient or person in recovery and places the institution rather than the individual in control of when, where, to whom, and under what circumstances his or her recovery status is disclosed. For professional treatment institutions, such communications often constitute an inadvertent breach of ethics (confidentiality) and etiquette (respect, privacy, discretion). For the people serving in this role, the “consumer representative” designation diminishes and restricts how they are perceived by others and how they perceive themselves.

6. Terms such as “consumer,” “client,” “patient,” and “previously incarcerated person (PIP)” are inappropriate in the context of peer-based recovery support services. These terms imply a hierarchical service relationship model that is incongruent with peer-based recovery support. For example, when a recovery coach commented to a treatment professional that they did not refer to the people they served as “clients” or “consumers,” the professional asked, “Well then, what do you call them?” The simple response was, “Collectively, we call them people; individually, we call them by their names.” This response indicates a different relationship—not only one of mutual respect, but one that embraces the reciprocity that is at the core of peer recovery support relationships. The term “consumer” reflects the role dichotomy of helper (a producer of services) and helpee (a user of services); in the world of peer recovery support services, each person both gives and receives.

As more people return to communities from prison in search of sustained recovery, new acronyms are popping up. Unfortunately, these names and acronyms continue to objectify and turn individuals into an aggregate object, e.g., previously incarcerated persons (PIPs) and formerly incarcerated persons (FIPs). Such names and acronyms have no place in the world of addiction treatment and recovery support services.
( Referrals from the criminal justice system increased from 38% of total referrals in 1990 to 59% of referrals in 2004. During this same time period, referrals from welfare and child protection systems increased from 8% to 16%. McLellan, A.T. (2006). Addiction is changing: How changes in systems and customers may affect the Betty Ford Institute. Presentation to Betty Ford Institute Executive Council, February, Rancho Mirage, CA)
.
7. Embracing this term in the addiction treatment and addiction recovery support arenas may amplify stigma by pairing the stigma already attached to addiction with the stigma attached to mental illness.
Given the dominance of the term “consumer” within the mental health field over the past two decades and the existing Consumer Advisory Councils for people with mental illness in each state, “consumer” has become a code word for mental illness. Joint use of “consumer” by the two fields may compound social stigma by inadvertently signaling that all “consumers” have histories of both mental illness and alcohol/drug addiction.
The use of “consumer,” because of its association with the mental health field, may also reinforce the view that addiction is a symptom of mental illness and not a primary disorder. It is critical that people with co-occurring addiction and mental illness receive the specialized and integrated services that they need to achieve long-term recovery. However, it is imperative that addiction is recognized and treated as a primary disorder.

8. The term “consumer” used in the context of addiction treatment mistakenly conveys the image of a seller-buyer relationship, with an informed customer having substantial autonomy, power, and choice and rights of redress if the product or service is faulty. This is not an accurate depiction of most persons entering addiction treatment in the United States today. The growing percentages of people entering treatment via external coercion, the substantial power differential between addiction professionals and their “patients,” the limited choices available to those forced into treatment, the lack of knowledge about those choices, the absence of lobbyists and advocacy organizations representing individuals and families in addiction treatment, and the lack of any significant mechanisms of redress for ineffective or harmful treatment are all obscured by referring to those entering addiction treatment as “consumers.” The term “consumer” is used in few other contexts in which choice and redress are so limited.

9. The term “consumer” has a commercial/marketing/sales connotation that overemphasizes the business aspects of addiction treatment and is particularly ill-suited for people involved in volunteer, peer-based recovery support services provided by recovery community organizations.
The term “consumer,” perhaps not unexpectedly, came into prominence in the roaring “greed is good” days of the 1980s when addiction treatment organizations were told they needed to shift their identity from that of a service program to one of a business.
( Acker, C.J. (1993). Stigma or legitimation? A historical examination of the social potentials of addiction disease models. Journal of Psychoactive Drugs, 25(3), 193-205, quotation from page 203.
“Americans are urged through ubiquitous advertising to construct their identities through consumerism; they are expected to be positive economic actors through consumption.”)

The commodification of addiction treatment and its accompanying language has been a corrupting force within the treatment field and set the stage for calls to de-commercialize and re-humanize the service relationship. The “consumer” designation is incongruent with the sustained person-professional and peer-peer partnerships being advocated as the ideal models of long-term recovery support. The commercial/commodity aspects of the term “consumer” are also part of a value system that attributes personal value to the possession/consumption of goods and services. It conflicts with a recovery value system that defines personal identity in terms of humility, restitution (paying rather than incurring debt), service (an emphasis on giving rather than owning), and simplicity.

Final Reflection
The addictions field could learn much from the larger disabilities movement of recent decades. Some of the central ideas of this movement include the following:

• Language matters. It is far more than superficial concerns about political correctness.

• Language is imbedded with values and judgments of a culture; cultural change involves a transformation in language.

• The labels applied to individuals affect how they are perceived by others and how they perceive themselves.

• Language is a vehicle of social control and social isolation. Stigma and discrimination are couched in a language that reinforces stereotypes and elicits fear.

• Recovery and community integration require claiming one’s own language.

• Language that focuses on the person is more respectful and less stigmatizing than language that defines a person in terms of an illness.

It will be interesting to see how the language of addiction treatment and recovery evolves in tandem with the dramatic changes that are unfolding within these worlds. I hope we will not be talking much longer about “consumers” or “consumer councils” but will instead be talking about people in recovery and recovery (or citizen) advisory councils. I also hope that the paternalistic “our patients,” “our clients,” and “those we treat” will evolve in the near future to “people we serve.”

Words can elicit fear, contempt, anger, or pity, but they can also elicit understanding, compassion, and respect. Individuals and families in recovery are awakening culturally and politically. As they do, they will forge their own language to collectively convey their “experience, strength, and hope.” They will challenge the traditional language that has been used culturally and professionally to depict alcohol and other drug problems and their resolution. Most importantly, they will claim entitlement to select the words used to refer to those who have experienced addiction and recovery.

Source: Daily Dose 21st July 2009

In England, the proportion of young people aged between 11-15 who reported having drunk alcohol decreased from 62% to 54%, between 1988 and 2007. However, the amount consumed by the young people who drink increased from 6.4 units per week in 1994 to 12.7 units per week in 2007 [1]. The largest increase was seen in 14 year olds who increased their alcohol consumption from 6.1 to 9.9 units per week over this period. Furthermore, this increase was not gender specific. For both boys and girls there was a substantial increase in
the amount of alcohol consumed [1]. Moreover, one in four young people aged 14 reported consuming over 10 units of alcohol on their last drinking occasion; this level of consumption increased to one in three by the age of 15 [2]. In 2001 it was reported that young people’s drinking tends to be confined to fewer days than adults, and in particular at weekends .

Thus young people (aged 11-15), who drink, tend to do less frequently but at a higher intensity than adults.

In young people (aged 16-24), the latest NHS Information Statistics on Alcohol (2008) reported that 26% of males and 24% of females drink over the recommended weekly limits for low risk drinking in adults, which are 21 units for men and 14 units for women. Moreover it is shown that 9% of young males and 6% of young females drank over 50 units per week which is indicative of high risk drinking in adults . It is not clear whether current adult guidance on low risk drinking is pertinent to young people or if specific recommendations are required for individuals who are in the midst of ongoing physiological and emotional
development.

During the last 30 years the number of deaths due to chronic liver disease and cirrhosis has risen steadily in England and this trend is particularly marked in the 25-34 year group with the number rising from 16 in 1970 to 68 in 2000 for men and from 7 in 1970 to 60 in 2000 for women . The majority of liver disease in this country is due to heavy drinking . However, the most significant physical health risks associated with alcohol consumption in young people at the present moment are those relating to accidents and injuries. The ESPAD study reported that 13% of all 15-16 year olds had been involved in an accident or had an injury as a result of drinking .

In Scotland, it has been reported that on a daily basis, 15 children under the age of 17 attend Emergency Departments, intoxicated and in need of medical assistance or treatment .Indeed an audit of 21 emergency departments over a 6 week period showed that 648 children and young people under the age of 17 required medical treatment; 15 of these cases were below the age of 12 and one was as young as 8 years old. On average these young people had consumed 13 units of alcohol within the 24 hours leading up to their attendance . If this number were to be extrapolated for England it would give an estimate of around 1245 young people per week requiring medical assistance or treatment in England (64,750 per year).

In England some 35,472 young people aged 16-24 were admitted to hospital in 2005 with alcohol-related conditions . The largest proportion (19,533) were male and the figures increased with increasing age. Whilst it is clear from these figures that excessive drinking by young people is a significant concern in the UK, it is not clear what impact this alcohol misuse has on their health and well-being beyond the immediate hospital episode.

Heavy drinking by young people is more pronounced in areas with high social deprivation. The highest levels of alcohol consumption are reported by young people in the North-East of England and Yorkshire and Humberside where they are 1.5 times more likely to have drunk alcohol during the last week than young people living in the rest of England . In 2008, a survey of 1,250 young people living in deprived communities in Britain found that over a third did not know what a unit of alcohol was and did not understand the term binge drinking. Of
these young people, 39% drank up to 20 units per week and 15% drank over 20 units per week . Thus the adverse effects of social deprivation on young people may be compounded by possible health and social problems related to heavy drinking.

In a survey of school children aged 15 and 16 from the North West of England, participants reported that being aged 16, receiving a greater amount of income per week and not having a hobby or being a member of a club or sports team was associated with higher levels of alcohol . In addition, a higher percentage of girls reported drinking in public places whilst a higher percentage of binge drinkers were male . The 2005/2006 Health Behaviour in School-aged Children (HBSC) Survey (on patterns of health among young people in 41 countries and regions across Europe and North America) provides an international comparison . Notably, findings suggest that young people in the UK have some of the
highest rates of drunkenness internationally. England had the highest proportion of girls (24%) that reported that they had first been drunk at the age of 13 or younger. Rates for English boys were also high 23% reported they had been drunk at age 13 or younger .

Thus there are clear grounds for concern about alcohol consumption in young people in England and it seems that many aspects of young people’s drinking may be situational or culturally determined. Moreover, whilst there is some evidence that parents’ attitudes about alcohol may shape their children’s views (particularly in younger children) about drinking, it seems that other direct mechanisms such as access to pocket money and involvement in diversionary activities (or not) may also determine if, when and how much their children
drink. However, it is currently not clear to parents what risks arise for their children from early exposure to, or different levels of, alcohol consumption. Many parents may feel that early introduction to alcohol by them is preferable to its use in unsupervised experimentation.

However, there is currently insufficient information to base such decisions on.
In adults there are some health and social benefits associated with alcohol consumption. However, the health benefits are linked to cardio-protective effects of low to moderate consumption of alcohol which have generally been identified in older adults, that is men aged over 40 and post-menopausal women . The positive social effects of drinking are well known to the majority of the adult population that chooses to drink alcohol, although these effects are rarely studied in research terms. In young people, it is not clear whether there is any health benefits associated with drinking in early life. It is likely that young people will
perceive positive social effects of drinking . However, it is possible that these may be tempered by adverse consequences that may arise from drinking at an age before alcohol is legal.

On the basis of current epidemiological evidence on adverse consequences of drinking, particularly in young people who become intoxicated, the alcohol harm reduction strategy for England has highlighted that underage drinking is a major public health priority and outlined three objectives for tackling it:

• 1.Delaying the onset of regular drinking, primarily by changing the attitudes of 11-15 year olds and their parents about alcohol.
• 2. Reducing harm to young people who have already started to drink.
• 3. Creating a culture in which young people feel they can have fun without needing to drink.

Recent NICE guidelines on alcohol interventions in schools and the Government’s recent Youth Alcohol Action Plan also set out clear priorities concerning alcohol and young people under the age of 18. One of the actions in the Action Plan is to issue advice to parents about young people and alcohol, which will include guidelines for low risk drinking

This ‘guidance will also offer wider information on the health and social impacts of
drinking at young ages, sources of help and support for parents including evidence-based approaches for them to use with their children. Furthermore, the 2007 Chief Medical Officers Report recognised that young people’s health is the key to the nation’s future. He identified six priority risk-taking areas of which one was alcohol and drugs . In order to inform the proposed guidelines on alcohol and young people, this review was commissioned to identify published evidence on both the harms and benefits of drinking in early life. Given that there was a limited time-frame available for the work, the commissioning brief asked for a focus on existing reviews in this field. The purpose of this work was to provide an assessment of this evidence to an expert group of clinicians/researchers
convened by the Department for Children, Families and Schools to enable them to make recommendations to parents about their children’s drinking.

The aim of the study were to:

• produce a thorough review of the most up-to-date, robust and reliable evidence on the harms and benefits of alcohol consumption for children and young people;
• undertake a systematic search of existing reviews and weigh-up the quality of the evidence base;
• communicate and discuss the findings with the expert panel on alcohol and young people;
• support the Department in accurately and appropriately interpreting and using the evidence;
• ensure the guidance for parents is based on a firm evidence base; and
• identify evidence gaps that longer term research needs to address.

The following electronic databases were searched for relevant reviews:

• ETOH Alcohol and Alcohol Problems Science database (1972-2003)
• TRIP (May 2008)
• MEDLINE (1950-May 2008)
• EMBASE (1980-May 2008)
• CINAHL (1982-May 2008)
• PsycINFO (1806-May 2008)
• Social Science Citation Index (1970-May 2008)
• Science Citation Index (1970-May 2008)
• Scopus (1996-May 2008)

We also used key words (see below) to search the following websites

• Institute http://www.intute.ac.uk/
• Department for Children, Schools and Families http://www.dcsf.gov.uk/
• Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/index.htm
• Home office http://www.homeoffice.gov.uk/rds/alcohol1.html
• UK Statistics Authority http://www.statistics.gov.uk
• EU Statistics UK http://www.eustatistics.gov.uk/
• NHS Information Centre http://www.ic.nhs.uk/
• UK Data Archive http://www.data-archive.ac.uk/
• NICE http://www.nice.org.uk/
• WHO http://www.who.int/topics/alcohol_drinking/en/
• Alcohol Concern http://www.alcoholconcern.org.uk/
• Alcohol Education and Research Council http://www.aerc.org.uk/
• National Center on Addiction and Substance Abuse http://www.casacolumbia.org/
• Alcohol and Drug Abuse Institute http://depts.washington.edu/adai/
• Australian Drug Information Network http://www.adin.com.au/
• SoRAD http://www.sorad.su.se/
• Diversity Health Institute Clearinghouse

http://www.dhi.gov.au/clearinghouse/default.htm

• European Alcohol Policy Alliance http://www.eurocare.org/
• ADCA library http://tinyurl.com/4t8ds2
• DrinkandDrugs.net http://www.drinkanddrugs.net/
• Daily Dose http://www.dailydose.net/
• Google and Google Scholar http://www.google.co.uk
• NIAAA: http://www.niaaa.nih.gov/

It’s not unusual any more to see people in Libertarian circles attacking the war on drugs as a waste of tax dollars and an infringement on personal liberties. In my opinion, that is misguided thinking that comes from trying to apply unworkable theoretical concepts in the real world.
For example, you often hear advocates of drug legalization say that we’re never going to win the war on drugs and that it would free up space in our prisons if we simply legalized drugs. While it’s true that we may not ever win the war against drugs, we’re not ever going to win the war against murder, robbery and rape either. Moreover, it’s true that it would free up lots of space in our prisons if we legalized drugs, but you could say the same thing about most crimes. In fact, we could reduce the crime rate to zero and save enormous amounts of money on police, lawyers, and courts if we simply made everything legal. But, that doesn’t mean it would be a net plus for society.
Another point that’s often brought up is that if we legalized drugs, we’d be able to tax them and bring in more revenue for the state. But, how is that working out with alcohol and cigarettes? In 2004 and 2005, 39% of all traffic-related deaths was related to alcohol consumption and 36% of convicted offenders “had been drinking alcohol when they committed their conviction offense.” When it comes to cigarettes, adult smokers “die 14 years earlier than nonsmokers.” But, will we ever get rid of tobacco or alcohol? No, both products are too societally accepted for that and perhaps more importantly, the government makes enormous amounts of revenue from their sale. Do we really want to get into that same position with Crack, Acid, or Meth? Do we really want to be sitting around 10 or 15 years from now saying, “Gee, we’d like to get rid of heroin, but how could we replace the revenue we make from taxing it at an exorbitant rate?”
Moreover, the drug legalization crowd claims that we can manufacture drugs here in the U.S., tax them heavily, thereby making money for the government, and yet still be able to sell the drugs cheaper than the dealers can. That would seem to be a dubious proposition. Drug dealers who pay no taxes, have no unions, and don’t have to pay their labor the minimum wage, may very well be able to produce drugs more cheaply than corporations in the U.S. that will be under strict FDA guidelines (It typically costs a billion dollars to bring a new drug to market), that will be faced with a never ending stream of lawsuits, that will have to pay taxes, and then, additionally, will have to sell a product that will be taxed to the high heavens. That means it’s entirely possible that the cost of illegal drugs could go up, not down, with the government running the show and that would be a problem in and of itself because currently, “16% of convicted jail inmates said that they committed their offense to get money for drugs.”
Of course, the number of people using what are currently illegal drugs would skyrocket if they were legalized, so we’d see a new wave of drug addled burglars if we “legalized it.” Now, maybe you think that’s not the case. Some people certainly argue that if illicit drugs were legalized, their usage would drop. However, the fact that drugs are illegal is certainly holding down their usage. Just look at what happened during prohibition if you want proof of that. Per Ann Coulter in her book, “How to Talk to a Liberal if you Must:”
“Prohibition resulted in startling reductions in alcohol consumption (over 50 percent), cirrhosis of the liver (63 percent), admissions to mental health clinics for alcohol psychosis (60 percent), and arrests for drunk and disorderly conduct (50 percent).” — P.311
That’s what happened when alcohol was made illegal. However, on the other hand, if we make drugs legal, safer, easier to obtain, more societally accepted, and some people say even cheaper as well, there would almost have to be an enormous spike in usage.
Certainly that’s what happened in the Netherlands where “consumption of marijuana…nearly tripled from 15 to 44% among 18-20 year olds” after the drug was legalized.
But, some people may say, “so what if drug usage does explode? They’re not hurting anyone but themselves.” That might be true in a purely capitalistic society, but in the sort of welfare state that we have in this country, the rest of us would end up paying a significant share of the bills of people who don’t hold jobs or end up strung out in the hospital without jobs — and that’s even if you forget about the thugs who’d end up robbing our houses to get things to pawn to buy more drugs. Even setting that aside, we make laws that prevent people from harming themselves all the time in our society. In many states there are helmet laws, laws that require us to wear seatbelts, laws against prostitution, and it’s even illegal to commit suicide. So banning harmful drugs is just par for the course.
And make no mistake about it, drugs do wreck a lot of lives. Of course drugs aren’t the only things that wreck lives and not every person who does drugs ends up as a crackhead burglar or a dirty bum living in an alley. Heck, Barack Obama, a man some people would like to see as our next President has used cocaine — and doesn’t it seem like every few weeks we read about another celebrity who comes out of rehab and goes on to have a successful career?
Sure, that’s true. But, every person who plays Russian Roulette doesn’t end up with a bullet in his head either. Look at the flip side of the equation. How many homeless people are drug addicts? How many women have had crack babies? How many people are in jail today because they got high and committed a crime? How many lives have been wrecked in some form or fashion by drug use? There’s probably not a person reading this column who doesn’t know someone who has faced terrible consequences in his life because of drug use.
That’s why once, way back when William Bennett was the drug czar, he responded like so to a caller on the Larry King show who told him that he should “behead the damn drug dealers.”
“I mean what the caller suggests is morally plausible. Legally, it’s difficult. But somebody selling drugs to a kid? Morally, I don’t have any problem with that at all.” — Bill Bennett
Bennett was right then, he’s right now, and my guess is that most parents, upon finding out that someone was peddling drugs to their kid, would agree with him. Since that’s the case, do we really want the federal government to take over the role of a pusher and get our kids hooked on drugs to make a profit? No, we don’t.
Source: www.rightwingnews.com Jan 2007

The data presented by Parker et al. (1995) and Graham and Bowling (1995) indicate that, for young people, having used a drug is a far from unusual experience. By the time that the majority of Parker et al (1995) respondents were 15, 42% of them indicated that they had, at some point in their lives, used at least one illicit drug. This increased to 51% by the time they were 16. Turning to the national position, over a third (36%) of the ISRD respondents (all of whom were aged 14—21) reported ever having used a drug (Graham and Bowling 1995).

Given that proponents of the normalisation thesis have tended to concentrate on measures of lifetime use (whether a respondent has used an illicit drug at some time in their life) it is worth noting that the extent to which such measures illuminate young people’s drug using habits is limited. Arguments based on such measurements should be interpreted extremely cautiously. The inflexibility of lifetime measures means that they cannot capture the processual character of people’s drug-use (Becker 1963). As a consequence, not only are they unable to distinguish one-off use from regular polydrug use but they also fail to distinguish between current and ex-users. Given these problems it is reasonable to suggest that measures based on shorter time-frames — such as the previous year or month — are likely to provide somewhat more reliable estimates of the extent of current or regular use. Parker et al. (1995) included questions about drug use during the year and the month prior to each of their surveys, and the ISRD asked respondents about their drug use during the previous year (1992).

Inevitably, data concerning drug-related behaviour during the last year/month give a more conservative picture than those based on lifetime measures. As Figure 1 shows, in Parker et al’s second and third surveys, when the majority of the respondents were aged 15 and 16 respectively, drug use during the previous year was limited to approximately two fifths of the sample. During the month preceding the respective surveys, it was limited to about a quarter of them. Following their third survey, Parker et al. (1995:19) estimated that 20 per cent of respondents (approximately three quarters of past month users) were ‘regular users’.
We have already mentioned the fact that Parker and colleagues recognise that their research is unlikely to be typical of the national picture. The situation relating to the nation as a whole is outlined in Figure 2. According to the ISRD slightly less than a third of males and less than a quarter of females aged 14—21 used drugs in 1992 and could, therefore, be thought of as ‘current’ users (Graham and Bowling 1995). While respondents aged 18—21 were, by some way, the most likely to have used a drug in 1992, less than half of the males and less than a quarter of the females in this age category had done so.

As indicated earlier, it is the work of Howard Parker and colleagues (Parker et al. 1995; Measham et al. 1994) that has been most influential in this area. Beginning in 1991 their major study to date involved three surveys conducted annually which recorded the drug-related experiences of a group of 776 young people who were first contacted during the penultimate year of their compulsory education when most were 14 years old. These surveys were administered in the metropolitan North-West of England, an area which includes Manchester, the ‘rave capital of Great Britain’ (Coffield and Gofton 1994:5), and the researchers have acknowledged the dangers of extrapolating from their data to the national situation. Referring to the area’s higher than average levels of smoking, drinking and heroin use, they note that ‘we must therefore anticipate that young people from this region are likely to report higher levels of illicit drug use during the l990s than their peers elsewhere’ (Parker et al. 1995:21). Although the location of their research is therefore in this sense ‘unusual’, this is not the basis of our criticism of the conclusions they draw.

In order to reflect upon the national situation we have drawn, in some detail, upon the domestic element of the International Self—Report Delinquency Study (ISRD) which, focusing on the 14-21
age range, is the most recent survey of a representative sample of the nation’s youth to consider drug use (Howling et al. 1994;Graham and Bowling 1995). We will also consider, albeit more briefly, the evidence from the 1994 British Crime Survey, although it should be noted that this focuses on people aged 16 and above and is not a specialist youth survey (Ramsey and Percy 1996). Although Parker et al. (1995) survey, the ISRD and British Crime Survey vary in the details of their administration, they are similar in that the drugs components of these surveys are all based on a self-completion approach in which respondents are provided with a list of drugs or illicit substances and asked about their knowledge and use of them.

Although more illuminating than measures of lifetime use, those which focus on behaviour during the last year or month are of limited use if they fail to distinguish between different types of drug. Measures which aggregate a variety of different drugs simplify the decisions that young people make and fail to acknowledge the discerning approach many young people take towards drug use. That young people distinguish between different drugs is clearly reflected in their patterns of use. Both Parker et al. (1995) and the ISRD found that levels of use varied greatly by type of drug. Thus, reflecting its position as ‘undoubtedly the most widely used drug in the UK’ (ISDD 1994:28), cannabis had been used by 45 per cent of respondents to Parker et al’s (1995) third survey, when the majority of them were aged 16, and 33 per cent of ISRD respondents. At the other end of the popularity spectrum are heroin and cocaine. Lifetime use of cocaine was limited to 4 and 3 per cent of Parker et al’s (1995) respondents when they were aged 15 and 16 respectively, and 2 per cent of ISRD respondents. Heroin use was even more unusual: 3 and 1 per cent respectively of Parker et al’s respondents disclosed lifetime heroin use as did 1 per cent of ISRD respondents.The rise of the dance/rave scene (Redhead 1993) and its associated drug use has a special position within the normalisation thesis (Coffield and Gofton 1994; Measham et al. 1993). The late 1980s and early 1990s did witness an apparently significant increase in the use of ‘dance drugs’, which became a relatively important part of the youth drug scene (Measham 1993; Clements 1993). In the case of ecstasy and LSD, however, this increase started from a very low baseline (Clements 1993) and the popularity of these drugs can easily be overstated.
Even though LSD was the most popular dance drug among Parker et al’s (1995) respondents when they were aged 15 and 16 (and the second most widely used drug by them) it had only ever been used by approximately a quarter of them. In view of ecstasy’s high media profile it is worth noting that only one in twenty respondents to Parker a al’s (1995) third survey, when the majority of them were aged 16, had used this drug. Nationally, use of dance-drugs appears to be limited to a small sub-section of the youthful population.

Source: Michael Shiner and Tim Newburn
pub. ‘Sociology’ Vol.31 No. 3. Aug 97

Figure 2 – Drug use by young people in England and Wales during 1992 (percentage use) Source: Graham & Howling (1995:26)

 

 

By Maxie Richards, Glasgow, Scotland
Director, Maxie Richards Foundation
www.maxirichards.org

Two-and-a-half-year-old, weakened by starvation, cold, deprivation, and physical abuse, paid the scapegoat price for
this careless society and gave up the fight to live. Scott was a victim of malignant neglect, not just by his drug-crazed parents, but
by the society into which he was born, where neglect, in various forms, has become commonplace. A parent’s’ right to choose, at any
cost, a pleasure-seeking lifestyle, rules, while laws change to allow drug-taking on an unprecedented scale. The silent sufferers are the children.

The long-term effect becomes all too clear, as children, unable to cope with the chaos in their lives, become aggressive and disruptive, serving an
apprenticeship for addiction. This Government’s answer is so-called “harm reduction.” This evil drug policy has been in place for 30 years or so. Its cornerstone is free choice for individuals to take drugs, and it promotes “safe use” – whatever that means. It focuses on the individual, never the family, the dependants, or the community. This policy promotes the lie that drugs are here to stay, and there is nothing we can do about it except “reduce harm.” Addicts are enabled to take drugs and are given, at the taxpayers’ expense, all necessary means.

“Harm reduction” adherents are fanatical about protecting this system,even though it has been responsible for the drug crisis in society. We have
built a gigantic business on the backs of drug addicts (called ‘clients’), and people grow fat on the proceeds. The tax-paying public remains in denial. Perhaps people believe this couldn’t be happening. It is. Parents of addicted children, exploited by the system, live the nightmare daily. The society we are creating through malignant neglect is not one we will want to live in. Scott Saunders is not the first to endure a living hell and prolonged death. Unless we act, the rot won’t stop.

Forty years ago, the Scandinavian countries looked at “harm reduction.” Their findings led them to scrap any notion of adopting such a policy.
Every government agency had to adopt a drug-free stance and promote drug prevention. It was made abundantly clear that drug addiction was not an acceptable way of living. Sweden set up European Cities Against Drugs, developing strategies for a safe, drug-free society, and proving that it can be done.

In Rutherglen, an outwardly respectable neighbourhood of Glasgow, Scott Saunders was subjected to appalling abuse and neglect. One hundred fifty wounds were found on his body; he had been systematically deprived of food, and his eventual death from starvation came after he had been left alone in the house for three days.

We must be brave enough to face up to our failures and to the treason yes, treason – which is undermining our way of life, canceling our workforce,and damaging, often terminally, our young people, while imperceptibly luring us into accepting the unacceptable. Don’t believe the lies, the platitudes,the excuses, the cover-up of so-called “harm reduction” drug policies. We are all responsible for the death of Scott through negligence.

Back to Papers

In Brief

• In 2004, an estimated 14% of youths aged 12 to 17, approximately 3.5 million youths, had experienced at least one major depressive episode (MDE) in their lifetime

• Over 7%, an estimated 1.8 million youths, had lifetime MDE and thought about killing themselves at the time of their worst or most recent episode

• An estimated 712,000 youths had tried to kill themselves during their worst or most recent MDE; this represents 2.9% of those aged 12 to 17

In 2003, suicide was the 11th leading cause of death among persons of all ages in the United States. However, among young people aged 15 to 24, suicide, or intentional self-harm, was the third leading cause of death, with 3,921 deaths, following accidents/unintentional injuries (14,966 deaths) and assaults/homicides (5,148 deaths).

The 2004 National Survey on Drug Use and Health (NSDUH) asked youths aged 12 to 17 about symptoms of depression, including thoughts about death or suicide. Major Depressive Episode (MDE) is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least five of the nine symptoms of depression as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The suicide-related questions asked youths if (during their worst or most recent episode of depression) they thought it would be better if they were dead, thought about killing themselves, and, if they had thought about killing themselves, whether they made a plan to kill themselves and whether they tried to kill themselves. This report presents estimates of the prevalence of lifetime MDE among youths. The report also presents the numbers and percentages of youths who had both lifetime MDE and suicidal thoughts.

Prevalence of MDE

An estimated 14% of youths aged 12 to 17, approximately 3.5 million youths, had experienced at least one MDE in their lifetime (Table 1). Almost 20% of females aged 12 to 17 and 8.5% of males had at least one of these depressive episodes. Rates of lifetime MDE were similar among racial/ethnic groups and increased with age.

MDE and Suicidal Thoughts

Among youths aged 12 to 17, about 9%, an estimated 2.3 million youths, had experienced MDE in their lifetime and thought, during their worst or most recent MDE, that it would be better if they were dead. Over 7%, an estimated 1.8 million youths, thought about killing themselves at the time of their worst or most recent MDE.

Females aged 12 to 17 were significantly more likely than their male peers to have had MDE and to report thinking about suicide and believing it would be better if they were dead (Figure 1).

Both 14 or 15 year olds and 16 or 17 year olds were significantly more likely than those aged 12 or 13 to have had MDE accompanied by thoughts that it would be better if they were dead and thoughts about committing suicide (Figure 2).

MDE with suicidal thoughts did not vary by urbanicity.4 Youths in large metropolitan areas, small metropolitan areas, and non-metropolitan areas were equally likely to have MDE with suicidal thoughts.

Figure 1. percentages of Youths Aged 12 to 17 with Major Depressive Episode (MDE) in Their Lifetime and Suicidal Thoughts, by Gender: 2004	Figure 2. percentages of Youths Aged 12 to 17 with Major Depressive Episode (MDE) in Their Lifetime and Suicidal Thoughts, by Age Group: 2004
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MDE and Suicide Attempts

An estimated 900,000 youths, or 3.6% of 12 to 17 year olds, made a plan to kill themselves at the time they were having their worst or most recent MDE. An estimated 712,000 youths had tried to kill themselves during such an episode; this represents 2.9% of those aged 12 to 17.

Female youths were more likely than male youths to have had MDE and made a plan to kill themselves (5.6% of females and 1.7% of males) or to have attempted suicide (4.7% of females and 1.1% of males).