Drugs in America, this paper will examine the many drugs that arae being used and abused in the United States. The drugs are being consumed by way of over the counter drugs, prescription filled drugs, and illicit drugs, which are brought on the streets. The high volume of drug abuse in the U. S. not only has a devastating effect on the communities, but it is affecting the health of many Americans. This paper will also look at the prevention programs that are in place to help combat this war on drugs.
Drug abuse in America, Its Effects and affects on Health and Communities Americans are addicted to everything from caffeine, tobacco, and alcohol, to a host of other drugs legal and illegal. All of the above are detrimental to our health, and they also have a negative effect on families and communities. In this paper I plan to examine some of the most popular drugs and their effects on people’s health and also look at how drugs affect communities has a whole. “Drugs destroy lives and communities, undermine sustainable human development and generate crime.
Drugs affect all sectors of society in all countries: in particular, drug abuse affects the freedom and development of young people, the world’s most valuable asset. Drugs are a grave threat to the health and well-being of all mankind, the independence of states, democracy, the stability of nations, the structure of all societies, and the dignity and hope of millions of people and their families. ” (1) In 1998, Mr. Kofi Annan, the then UN Secretary-General delivered this speech in the Special Session of the General Assembly Devoted to Countering the World Drug Problem Together.
During the session, Member States identified the global drug problems as well as outlined solutions and initiatives that would be taken to solve the problems. They established the year 2003 as a “target date for new or enhanced drug demand reduction strategies and programs set up in close collaboration with public health, social welfare and law enforcement authorities” and set the year 2008 as a target date by which “Member States should have made real progress in eliminating or reducing significantly crops of opium poppy, coca and cannabis.
” (1) They listed the numerous consequences of drug abuse, including “adverse effects on health; the upsurge in crime, violence and corruption; draining of human, natural and financial resources that might otherwise be used for social and economic development…” and they committed to reversing the growing trend in drug abuse and production with supply control and demand reduction. (1) Drugs have become has important and detrimental to our society as war is; to the point that it is being discussed at the United Nations Building. This is a world wide problem; however this paper will focus on the problems that drugs are causing in America.
According to an article titled “Current Situation of Drug Abuse in America” written by Chandara Humphry, Drugs in America are a part of the mainstream; they are a part of our culture. As we most know, drugs have been here for hundreds of years, the uses and abuses changing constantly. Because of the media, viability and overall appeal, drugs have taken over America. The most used illicit drug in America comes from the Cannabis sativa plant and is known as marijuana or weed. Other drugs found in use in the U. S. are Methamphetamine, LSD, Ecstasy, Cocaine, Heroin, and even now OxyContin.
More than 20 million people in America are current users of some sort of illicit drug. Many of these users are youths and young people starting at ages below 10 years old. The war on drugs that we previously talked about happening in Hawaii is occurring at a much larger scale all throughout the nation. (1) Of all the drugs used throughout the nation, Marijuana is the most prominent. “According to the 2004 National Survey on Drug Use and Health, approximately 96. 8 million Americans ages 12 and older reported tying marijuana at least once during their lifetimes, representing 40.
2% of the population ages 12 and older. ” Most youths believe, and are told that marijuana is the least dangerous drug. It is not addictive, and it is used in medicine so it must be safe. Both of these and many others are false, but people still listen to them and that is why they begin smoking marijuana. Marijuana is a gateway drug, the younger children are when they first use marijuana the more likely they are to use cocaine and heroin and become dependent on drugs as adults. (1) The statistics on the rest of the drugs America uses are only increasing.
There are many more methamphetamine users, cocaine users and club drug users. Back in the 1960’s to the 1980’s there was a peak in drug abuse in America and there has been a decline, but now it seems that the fame and fortune of drugs are picking up speed. Drug related illness, death, and crime cost the nation approximately 66. 9 billion. Every man, woman, and child in America pays nearly $1,000 annually to cover the expense of unnecessary health care, extra law enforcement, auto accidents, crime, and lost productivity resulting from substance abuse. (1)
According to the Drug Enforcement Agency, there are many administrations and agencies focusing on drugs in America. the DEA, being the primary force has many completed drug eradication operations, and policies concerning drug use in the states. Some of these policies are the Controlled Substance Act, the Federal Trafficking Penalties, and Drug Scheduling. The Controlled Substance Act deals with controlling the distribution and enforcement of drugs and drug related activities. Federal Trafficking Penalties detail consequences of being caught possessing or using specific drugs, where as drug scheduling describes each specific drug.
The Office of National Drug Control Policy, an organization under the executive branch of the United States, has many programs also concerning drug prevention and drug use reduction. Some programs such as the Arrestee Drug Abuse Monitoring program focuses on collecting data and research findings relating to drug use, marketing and rehabilitation. These programs aid policymakers to help think to the future. (1) One of the main ways drug abuse is being treated in America is awareness. Americans deny the drug problem, and claim either they have no problem, or the problem is not theirs.
To combat this enemy America must aid in the prevention and rehabilitation of our youth, young adults and lifetime users. Our children also dropped their guard as drugs became less prevalent and first-hand knowledge of dangerous substances became scarce. Consequently, disapproval of drugs and the perception of risk on the part of young people have declined throughout this decade. Parents and teachers must be aware that drugs can happen to their children/students. There are now stronger drugs then were available 15 years ago, and there are more and more youths trying them each day.
Another way to begin to decrease the number of drug users in America is either to decrease supply or demand. Demand Reduction would be a difficult task to handle, seeing how though people are aware of the risks they still feel the need to take them, awareness, as I spoke previously about though, can help stop a select few from making a wrong choice. Slowing supply could be done to the least. Supply routes must be cut off; the road way must be blocked. Law enforcement and international cooperation must be increased. The drug problem will not solve itself, and will not end over night.
A continuous effort must be made by all American citizens to remedy the disease. (1) Here it is evident that the drug problem in America has a strong impact on the health and social service systems, in particular the health care and criminal justice system. In addition most people do not seem to realize that the drugs they are using are not only causing a slew of health problems for them it also cost the public who has to pay high taxes for public health care systems. For this purpose lets take a look at the health problems that are a result of drug use and abuse.
Here is a brief look at the effects of drugs on the body listing drugs by alphabetical order. Alcohol is defined as a depressant. The use of Alcohol may not become a problem when used moderately. Moderate use of alcohol is defined as up to two drinks per day. The immediate or short-term effects of alcohol include impaired judgment, impaired coordination, impaired vision, slurred speech, dilated pupils, delayed reaction time, and the smell of alcohol on the breath. For pregnant women there is the alcohol related birth defects which the alcohol causes FAS- fetal alcohol syndrome.
The long term health problems of drinking are diseases such as liver disease, heart disease, certain forms of cancer, and pancreatitis of ten develop more gradually and may become evident only after years of heavy drinking. Women may develop alcohol-related problems sooner than men, and from drinking less alcohol than men, because alcohol affects nearly every organ in the body, long term heavy drinking increases the risk of many serious health problems. (2) Cocaine/Crack- the word cocaine refers to the drug in both a powder and crystal form.
It is made from the coca plant and causes a short-lived high that is immediately followed by opposite, intense feelings of depression, edginess, and a craving for more of the drug. Crack smoking produces a sudden and intense rush with an equally intense high or euphoria lasting from 2 to 20 minutes. Tolerance develops to the euphoric effects of cocaine. Physiological effects of cocaine include constricted peripheral blood vessels, dilated pupils, and increased blood pressure and heart rate. Cocaine also produces restlessness, irritability, and anxiety in some users. High doses of cocaine or prolonged use can cause paranoia. (2)
The availability of crack cocaine led to an increase in inhalation as the preferred route of administration for many abusers. In order to avoid the discomfort associated with post-euphoric crash, crack or free base smokers continue to smoke often in marathon binges, until they become exhausted or run out of cocaine supply. The long-term use of inhaled cocaine has led to a unique respiratory syndrome in some abusers, and the chronic snorting of cocaine has led to the erosion of the upper nasal cavity. (2) People who use cocaine often don’t eat or sleep regularly. They can experience increased heart rate, muscle spasms, and convulsions.
If they snort cocaine, they can also permanently damage their nasal tissue. (2) The effects from the use of cocaine in moderate dose are disturbances in heart rhythm, increased heart and respiratory rates, elevated blood pressure, dilated pupils, decreased appetite, excessive activity, talkativeness, irritability, argumentative behavior, nervousness or agitation. (2) In large doses there is loss of coordination, collapse, perspiration, blurred vision, dizziness, and feeling of restlessness, anxiety, delusions, heart attacks, chest pain, respiratory failure, strokes, seizures and headaches, abdominal pain, nausea, paranoia.
The long term effects of cocaine are dependence, eating disorders, impotence, seizures, strikes, severe withdrawal symptoms, malnutrition, and permanent damage to nasal passage. (2) Heroin is a highly addictive drug. It is the most abused and fastest acting of the opiates. Heroin is derived from the seedpod of certain varieties of poppy plants that contain the naturally occurring substance, Morphine. Heroin can be injected, smoked or snorted.
Short term effects of heroin on the body are Analgesia (reduced pain), Nausea, sedation, drowsiness, reduced anxiety, Hypothermia, reduced respiration; breathing difficulties, reduced coughing, and death due to overdose can occur because often the exact purity and content of the drug is not known to the user. An overdose can cause respiration problems and coma. (2) The long term effects of heroin are tolerance: more and more drug is needed to produce the euphoria and other effects on behavior. Addiction: psychological and physiological need for heroin.
Withdrawal: about 8-12 hours after their last heroin dose, addict’s eyes tear, they yawn and feel anxious and irritable. Excessive sweating, fever, stomach and muscle cramps, diarrhea and chills can follow several hours later. (2) Hydrocodone narcotics are able to bring about many bodily effects beyond the notorious addictive euphoria. Hydrocodone represents a narcotic developed to accentuate the cough suppression effect. It is somewhat more effective in this regard than codeine. The general effects of Hydrocodone are muscle relaxation, lowered blood pressure, lowered heart rate, and lowered respiratory rate.
The medical complications are allergic reaction, difficulty breathing, closing of the throat, swelling of the lips, tongue or face, hives, seizures, loss of consciousness, and coma. The long term effects are constipation, dry mouth, respiratory depression, physical tolerance as well as psychological and physical dependence may occur. (2) Marijuana is the most commonly used illicit drug in the U. S. a dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis sativa, it usually is smoked as a cigarette(joint) or in a pipe.
It also is smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug. The main active chemical in marijuana is THC. The membranes of certain nerve cells in the brain contain protein receptors that bind to THC. Scientists have learned a great deal about how TH C acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to organs throughout the body, including the brain. (2)
Marijuana has different effects on different parts of the body such as the effects of marijuana on the heart which the risk of heart attack quadruples in the first hour after smoking marijuana. The researchers suggest that such an effect might occur from marijuana effects on blood pressure and heart rate and reduced oxygen-carrying capacity of the blood. (2) The effects of marijuana on the lungs in a study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work that nonsmokers.
Many of the extra sick days among the marijuana smokers in the study were for respiratory illness. Even infrequent use can cause burning and stinging of the mouth and throat, often accompanied by a heavy cough. Someone who smokes marijuana regularly may have many of the respiratory problems that tobacco smokers do, such as daily cough and phlegm production, more frequent acute chest illness, a heightened risk of lung infections, and a greater tendency to obstructed airways.
Smoking marijuana increases the likelihood of developing cancer of the head or neck, and the more marijuana smoked the greater the increase. A study comparing 173 cancer patients and 176 healthy individuals produced strong evidence that marijuana smoking doubled or tripled the risk of these cancers. Marijuana use also has the potential to promote cancer of the lungs and other parts of the respiratory tract because it contains irritants and carcinogens. In fact, marijuana smoke contains 50 to 70 percent more carcinogenic hydrocarbons than dose tobacco smoke.
It also produces high levels of an enzyme that converts certain hydrocarbons into their carcinogenic form-levels that may accelerate the changes that ultimately produce malignant cells. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which increases the lungs exposure to carcinogenic smoke. These facts suggest that, puff for puff, smoking marijuana may increase the risk of cancer more than smoking tobacco. (2) Some of marijuana’s adverse health effects may occur because THC impairs the immune system’s ability to fight off infectious diseases and cancer.
In laboratory experiments that exposed animal and human cells to THC or other marijuana ingredients, the normal disease-preventing reactions of many of the key types of immune cells were inhibited. In other studies, mice exposed to THC or THC-related substances were more likely than unexposed mice to develop bacterial infections and tumors. (2) As with marijuana, nicotine is another addictive drug that Americans are endangering their health and the health of others, due to the health problems that occur from second hand smoke. An estimated 46.
5 million adults in the United States smoke cigarettes even though this single behavior will result in death or disability for half of all regular users. Cigarette smoking is responsible, in some form, for more than 400,000 deaths each year; that’s one in every five deaths. Additionally if current patterns of smoking persist, over 5-million people currently younger than 18 will die prematurely from a tobacco-related disease. (2) Nicotine is one of more than 4,000 chemicals found in tobacco smoke and is the primary component that acts on the brain.
Smokeless tobacco product such as snuff and chewing tobacco also contain high levels of nicotine as well as many other toxins. (2) In addition, there is an enormous health toll which is the economic burden of tobacco use: more than $75 billion in medical expenditures and another $80 billion in indirect costs. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1-1/2 packs (30 cigarettes) daily gets 300 hits of nicotine to the brain each day.
These factors contribute considerably to nicotine’s highly addictive nature. (2) The general effects of tobacco and nicotine are elevated heart rate and blood pressure, and respiratory rate, decreased appetite and skin temperature, physical and psychological dependence. The long term effects are cancer of the lungs, mouth, and throat; respiratory disease, heart attack, stroke, stomach ulcers, and numerous others. (2) Another drug that causes health problems and is an American problem is Chloral Hydrate, which is the oldest of the hypnotic (sleep inducing) depressants.
Chlora hydrate was first synthesized in 1832. Marketed as syrups of soft gelatin capsules, chloral hydrate takes effect in a relatively short time (30 minutes) and will induce sleep in about an hour. A solution of chloral hydrate and alcohol constituted the infamous “knockout drops” or “Mickey Finn. ” At therapeutic doses, chloral hydrate has little effect on respiration and blood pressure; however, a toxic dose produces severe respiratory depression and very low blood pressure. Chronic use is associated with liver damage and a severe withdrawal syndrome.
Although some physicians consider chloral hydrate to be the drug of choice for sedation of children before diagnostic, dental, or medical procedures, its general use as a hypnotic has declined. (2) Another popular drug among young people is Dextromethorphan (DXM), which is a cough-suppressing ingredient in a variety of over-the-counter cold and cough medications. Dextromethorphan, a semi synthetic narcotic, is an ingredient found in any cold medicine with “DM” or “Tuss” in the title or name. there are approximately 70 different products on the market that contain DXM.
DXM acts centrally to elevate the threshold for coughing. At the doses recommended for treating coughs 1/6 to 1/3 ounce of medication, containing 15mg to 30mg dextrolmethorphan, the drug is safe and effective. At much higher doses, dextromethorphan produces disassociate effects similar to those of PCP and ketamine. Tolerance and physical dependence may develop with prolonged use. Withdrawal symptoms include restlessness, muscle or bone aches, insomnia, vomiting, and cold flashes with goose bumps. Teens have reported to drink three or four bottles of cough syrup in one day and take up to 20-30 tablets of Coricidin at once.
There have been reported cases of overdoses that have resulted in coma and death. (2). Again another drug popular with young adults is Ecstasy which is known as the party drug, however the effects of this drug is far from being a party drug. Ecstasy is an illegally manufactured variation of mescaline and amphetamine. It is considered a designer drug- a substance on the drug market that is a chemical analogue or variation of another psychoactive drug. There is no accepted medical use for Ecstasy in the U. S. The majority of the drug is being smuggled into the U. S. but it has been produced in illicit laboratories domestically.
Ecstasy is taken as a feel good drug. Devotees say it produces profoundly positive feelings, empathy for others, elimination of anxiety, and extreme relaxation- hence the nickname “hug drug” or “love drug. ” Ecstasy is also said to suppress the need to eat, drink, or sleep, enabling club scene users to endure all-night and sometimes two, or three-day parties. (2) Tablets sold as Ecstasy are not always pure. As demand for Ecstasy has increased, so has the appearance of Ecstasy “fakes” often containing other substances such as amphetamine, caffeine, codeine, DXM, ephedrine/ephedrine, ketamine, MDA, methamphetamine, and PCP.
When used alone, MDMA (Ecstasy) is dangerous. It is even more dangerous when used in combination with other substances, as the physical and psychological effects are difficult to determine or predict. (2) The short term effects increased heart rate and blood pressure, increased body temperature, possible hyperthermia, jaw and teeth clenching, muscle tension, hypertension, dehydration, chills and or sweating, nausea, blurred vision, faintness, dizziness, confusion, insomnia, and paranoia.
The long term effects rash, depression, sleep disorders, drug craving, and persistent elevation of anxiety, paranoia, aggressive and impulsive behavior. The medical complications are muscle breakdown, hyperthermia, kidney failure, cardiovascular system failure, liver damage, and paralysis. (2). Next on the list of illicit drugs is Methamphetamine, which is a powerful stimulant that activates certain systems in the brain. It is closely related chemically to amphetamine, but the central nervous system effects of methamphetamine are greater.
Both drugs have some medical uses, primarily in the treatment of obesity, but their therapeutic use is limited. The central nervous system actions that result from taking even small amounts of methamphetamine include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hypothermia, and euphoria. Other effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hyperthermia and convulsions can result in death. Illicit methamphetamine, which is almost exclusively methamphetamine hydrochloride, is sold in powder, ice, and tablet forms.
Powder methamphetamine, the most common form available in the United States, is produced domestically and also is smuggled into the country from Mexico. (2) The general effects of this drug is increased heart rate, blood pressure, and respiratory rate, decrease in appetite, elevated alertness, aggression, paranoia, depression, and irritability. The long-term effects is inflammation in the lining of the heart, damage to blood vessels from injection, paranoia, delusions, and mood disturbances may exist long after its use has been discontinued.
Parkinson’s disease-like symptoms may also occur after prolonged use. Strong psychological dependence with varying degrees of physical tolerance, malnutrition, skin abscesses, mood disturbances and psychosis; kidney damage; heart and nerve damage, irregular heart beat, elevated blood pressure, and stroke-producing damage to small blood vessels in the brain. (2) Last but certainly not the least is Methadone, this drug was produced by German scientists during World War II because of a shortage of morphine. Although chemically unlike morphine or heroin, methadone produces many of the same effects.
Introduced into the Unite States in 1947 as an analgesic (Dolophinel), it is primarily used today for the treatment of narcotic addiction. The withdrawal syndrome develops more slowly and is less severe but more prolonged than that associated with heroin withdrawal. Ironically, methadone used to control narcotic addiction is frequently encountered on the illicit market and has been associated with a number of overdose deaths. Methadone is rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.
For more than 30 years this synthetic narcotic has been used to treat opiate addiction. It is, however, only effective in cases of addiction to heroin, morphine, and other opiate drugs, and it is not an effective treatment for other drugs of abuse. Methadone reduces the cravings associated with heroin use and blocks the high from heroin, but it dose not provide the euphoric rush. Consequently, methadone patients do not experience the extreme highs and lows that result from the waxing and waning of heroin in blood levels.
Ultimately, the patient remains physically dependent on the opiate but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts. (2) Methadone maintenance treatment provides the heroin addict with individualized health care and medically prescribed methadone to relieve withdrawal symptoms, reduces the opiate craving, and brings about a biochemical balance in the body. Important elements in heroin treatment include comprehensive social and rehabilitation services. (2)
The side of using methadone are as follows; hypertension, unstable gait, kidney failure, seizures, allergic reactions, skin rash, and depression. The symptoms of an overdose from methadone include but are not limited to the following: constipation, weak pulse, low blood pressure, drowsiness, disorientation, coma, and death. (3) As a result of all of these health problems due to drug use it has put a tremendous strain on the health care system in this country, and it has caused the average worker to pay higher taxes to help to relieve the burden of paying for this health care.
In fact drug use also has a negative affect on the communities where drugs are most prevalent. For example research by the American Public Health Association shows its objectives; the study examined differences between the visibility of drugs and drug use in more than 2100 neighborhoods, challenging an assumption about drug use in poor, minority, and urban communities. The methods: a telephone survey assessed substance use and attitudes across 41 communities in an evaluation of a national community- based demand reduction programs. Three waves of data were collected from more than 42000 respondents.
The results; measures of neighborhood disadvantage, population density, and proportion of minority residents explained more than 57% of the variance between census tracts in visibility of drug sales but less than 10% of tract-to-tract variance in drug use. Visible drug sales were 6. 3 times more likely to be reported in the most disadvantaged neighborhoods than in the least disadvantaged, while illicit drug use was only 1. 3 times more likely. Conclusions: the most disadvantaged neighborhoods have the most visible drug problems, but drug use is nearly equally distributed across all communities.
Thus, efforts to address drug-related problems in poorer areas need to take into account the broader drug market served by these neighborhoods. (4) With this in mind let’s take a look at an article written for the American Journal of Psychiatry, title Ethnic Disparities in Unmet need for Alcoholism, Drug Abuse, and Mental Health Care. Objective: recent policy has focused on documenting and reducing ethnic disparities in availability and quality of health care. The authors examined differences by ethnic status in unmet need for alcoholism, drug abuse, and mental health treatment.
Method: data were from a follow-up-survey of adult respondents to a 1966-1997 national survey. Non-Hispanic whites, African Americans, and Hispanics were compared in access to alcoholism and drug abuse treatment and mental health care (primary or specialty), unmet need for care, satisfaction with care, and use of active treatment for alcoholism, drug abuse, and mental health problems in the prior 12 months. Results: a total of 31. 9% of whites, 28. 1% of African Americans, were more likely to have no access to alcoholism, drug abuse, or mental health care (25. 4% versus 12.
5%), and Hispanics were more likely to have less care than needed or delayed care(22. 7% versus 10. 7%). Among those with need, whites were more likely than Hispanics or African Americans to be receiving active alcoholism, drug abuse, or mental health treatment (37. 6% versus22. 4%-25. 0%). Conclusions: the authors document greater unmet need for alcoholism and drug abuse treatment and mental health care among African American and Hispanics relative to whites. New policies are needed to improve access to and quality of alcoholism, drug abuse, and mental health treatment across diverse populations.
(5) According to an article in Pub-Med. a service of the national library of Medicine and the National Institutes of Health the rising level of drug abuse and health problems is the outcome of a program of “planned shrinkage” and implemented against African-American and Hispanic communities, and implemented through systematic and continuing denial of municipal services particularly fire extinguishment resources essential for maintaining urban levels of population density and ensuring community stability. This work complements a recent study by McCord and Freeman (1. New Engl. J. Med.
332,173, 1990) on Harlem, and suggests the present overburdening of New York’s criminal justice system arises from almost exactly the same causes as its accelerating inability t o meet demands for acute medical service, so-called “medical gridlock” in that both are expressions of the increasing social disorganization of poor communities initiated and continued in considerable part by government policy. The critical role played by improper policy in triggering the syndrome suggests ecologically informed interventions, particularly essential service restoration, may hold the potential for great impact.
(6) With this in mind the next step is to look at the leadership and team effectiveness in community coalitions for the prevention of alcohol and other drug abuse. According to the AOD which is the alcohol and drug abuse prevention services comprehensive community coalitions or partnerships are increasingly being developed in this country to coordinate and expand the AOD, while case study evidence suggests that some coalitions are effective, there is very little theory development or empirical research on factors contributing to successful coalitions.
A theoretical model of coalition team effectiveness hypothesizing that empowering styles of leadership increase member satisfaction and perceptions of team efficacy which ultimately increases team effectiveness. And this would ultimately produce more effective coalitions in combating the drug problems in our neighborhoods. (7) Again alcohol, tobacco, and other drug (ATOD) use have devastating effects on African American and Hispanic communities.
Large numbers of people smoke, drink alcohol, or use illicit drugs, and although recent data suggest that prevalence of ATOD use is declining, the numbers are still alarming. In 1994, more than 48 million people smoked, 110 million used alcohol, and 12 million had used an illicit drug. Much progress is needed to achieve the Healthy People 2000 objectives to reduce the use of these harmful substances and the associated health risks. (8) The difficulty of eliminating substance abuse and tobacco use is related to the complex, multiple factors that contribute to the behavior.
The traditional health promotion emphasis on changing the individual’s behavior to eradicate or reduce health problems has proved unsuccessful. The recent trend in health promotion evokes a socioecological understanding of ATOD use in which the locus for change is on the contextual factors that contribute to or enforce unhealthy behaviors, as well as on the individual. Drug and tobacco industries targeting youth, the willingness of health care providers to give prevention or treatment counseling, and economic deprivation can influence an individual’s decision to use substances. Theref