New Approaches to Drug Policies

A Time For Change

Jonathan D. Rosen, Marten W. Brienen, Jonathan D. Rosen, Marten W. Brienen

• Publisher: Palgrave Macmillan
• Year: 2015
• ISBN:
  9781137450999
• Topic: Ciencias sociales
• Subtopic: Criminología

The US-led war on drugs has failed: drugs remain purer, cheaper and more readily available than ever. Extreme levels of violence have also grown as drug traffickers and organized criminals compete for control of territory. This book points towards a number of crucial challenges, policy solutions and alternatives to the current drug strategies.

III

Policy Solutions

9

Drug Use Among American Adolescents: An Examination of Prevention and Intervention Programs

Keri K. O’Neal and Steven L. West

Alcohol and other drug use by children, adolescents, and young adults are notable problems in the US as well as in most other Western nations and have been so for many decades. Although the exact drug of choice and the associated rates of use fluctuate based on location and historical context, such use has been a major concern of public health, public policy, and government bodies since at least the beginning of the 20^th century. In response, hundreds of substance use prevention programs have been developed, with limited success. Federal, state, and local governments have spent billions of dollars on such programs, with the cost of prevention efforts and related programming during the first decade of the 21^st century alone reported in excess of $2 billion.¹ Despite these efforts, the rates of alcohol and other drug use in the US remain sufficiently high to be largely considered unacceptable.

While alcohol and other drug use prevention efforts have shown little to no substantive effect, program initiatives have been found to be successful in reducing other risky behaviors. For example, substantial success has been obtained in public health campaigns to discourage the use of cigarettes and other tobacco products both in younger populations and more generally across society.² Likewise, HIV prevention efforts have had a significant impact among both youth and adult populations, and the rates of new infections have decreased accordingly.

Such efforts have largely succeeded without the legal prohibitions associated with alcohol and other drug use. Alcohol use by minors is prohibited by law, and a variety of other statutes prohibit public intoxication, driving while intoxicated, and driving with open alcohol containers. All related statutes result in various fines and jail sentences in order to dissuade individuals from violating the law. Alcohol and other drug use prevention efforts are also supported by the so-called “war on drugs”; the combined interdiction and policing efforts of a variety of federal, state, and local agencies are designed to reduce availability and punish those engaging in such activities. Sexual relations are not legally forbidden between consenting individuals, and tobacco use is only prohibited for minors. Why, then, has alcohol and other drug use prevention efforts had such limited success?

In this chapter, we provide an overview of the rates of alcohol and other drug use by youth. After examining the empirical evidence, we discuss prevention efforts, what works and what does not, and provide suggestions for the development of efforts to curb substance use.

Alcohol and Other Drug Use by Children and Youths

Alcohol and Drug Use by Children and Adolescents

Although a variety of sources are available to note the rates of alcohol and other substance use by children and youths, the most comprehensive information can be found in the data of the Monitoring the Future (MTF) study funded by the National Institute on Drug Abuse (NIDA). The MTF data comes from an annual survey of a nationally representative sample of school-aged children in the US, asking for information on the use of alcohol and a variety of other drugs. The MTF study provides trend data on alcohol and other drug use from 38 national school-based surveys as well as 36 national follow-up studies.³ The MTF has collected data on high school students from 1975 to the present as well as information on middle school students since 1991. Data is collected on each student group annually and is available for individuals well into adulthood.

Results of the annual MTF studies have found that unlike college students, who have maintained relatively high rates of consumption over the course of many decades (see below), alcohol and other drug use by K-12 students varies more over time. For example, after an increase of illicit drug use into the 1990s, an overall decline began to be observed in 1997 and continued, first for middle school students and subsequently for high school youths, into the early 21^st century. Specifically, the rates of illicit drug use amongst eighth-graders went from 24 percent in 1996 to 13 percent in 2007. The declines were less substantial for tenth-graders (from 39 percent to 28 percent) and twelfth-graders (42 percent to 36 percent) during that same time period. This was followed by a general increase beginning in 2009. Such changes demonstrate the importance of a cohort effect. Although use occurs each year, the beliefs regarding the acceptability of use and actual use itself varies from year to year, forming distinct cohorts. Individuals within these cohorts are similar to one another and to a lesser degree to those similar in age. Such cohorts are generally unique, however, and this inhibits our ability to generalize beyond the groups of reference.

Cohort effects are linked to a variety of issues not wholly explained by the effects of substances themselves. As new drugs become available, such as ecstasy (MDMA), their use tends to increase but often notably decreases shortly after they appear in the MTF data. For example, recent MTF surveys have noted a substantial increase in the use of synthetic marijuana as this new substance became available and was first discovered and used by older populations and, subsequently, adolescents and pre-teens. Likewise, use of existing substances vary over time in response to factors such as cost, general availability, social stigma, and the targeting of such substances by prevention and interdiction professionals. Cohort effects also extend over time. As individuals age, there is a general reduction in the use of all substances across cohorts. Although some individuals continue to use heavily and some extend their use to the point of addiction, most individuals “age out” of their youthful rates of use due to the demands of careers, family, and other obligations. Such reductions are likewise impacted by the costs, the overall social acceptance of particular substances, and other factors. According to the MTF, reductions in alcohol and other drug use occur across various groups.

Despite these cohort variations over time, illicit substance use by children and adolescents has been and continues to be of notable concern. Lifetime use of any illicit drug has never fallen below 18 percent for eighth-graders, 29 percent for tenth-graders, and 45 percent for twelfth-graders. Such use has plateaued at rates as great as more than 29 percent of eighth-graders, 47 percent of tenth-graders, and 54 percent of twelfth-graders. Although alcohol use is generally common in all cohorts of the MTF, the use of alcohol can also be seen through the lens of various cohorts. Monthly use of alcohol dropped precipitously from 1980 to 1992, as did daily drinking and heavy episodic, or binge, drinking. Still, alcohol use is common across all MTF cohorts and all age groups. Since 1975, the lowest rates of binge drinking were 5 percent for eighth-graders, 16 percent of tenth-graders, and 24 percent of twelfth-graders. Alcohol use has been reported for at least 30 percent, 54 percent, and 69 percent of eighth-, tenth-, and twelfth-graders, respectively.

Alcohol and Drug Use by College Students

The impact of alcohol and drug use among college students is well documented, is associated with a number of negative outcomes, and has been noted to be an extreme problem both in terms of prevalence and the consequences students face as a result of such use. It has also been found to be linked with more severe problems than virtually any other issue facing college students today.⁴ Such issues range from academic factors to a host of health and functioning problems that collectively impact college students in substantial and often life-threatening ways.

Nearly a quarter of all college students report having experienced academic problems as a result of alcohol and other drug use each year. Such negative consequences include missing classes, doing poorly on exams and assignments, and failing classes altogether.⁵ Not surprisingly, it has been reported that thousands of college students fail out of school each year as a result of substance use.⁶

The problems college students face as a result of alcohol and other drug use are not merely academic in nature, as many students have been seriously injured, sometimes fatally, as a result of substance abuse. A recent report highlights some of the dramatic consequences college students face as a result of substance use.⁷ For example, about 1,700 college students die each year as a result of unintentional injuries associated with alcohol use, and nearly 600,000 are unintentionally injured while under the influence. Additionally, nearly 700,000 students are assaulted and receive injuries each year by another student under the influence.⁸ Alcohol and other drug use are major factors affecting the physical and mental health of college students as well. As many as 240,000 college students attempt suicide due to alcohol/other drug use annually.⁹ In addition, over 150,000 students develop alcohol-related health problems of sufficient scope to warrant a physician visit each year.¹⁰ Studies have shown that alcohol and other drug use are not only extreme among college students but that such use routinely rises to the level of clinical significance. Using DSM criteria, it has been estimated that over 30 percent of college students meet the criteria for alcohol abuse, and some 6 percent meet the criteria for alcohol dependence; still more meet the criteria for other drug abuse/dependence.¹¹ Well over two million college students drink and drive each year, and campus police report having contact with roughly 795,000 students as a result of substance use, with over 100,000 arrests each year for alcohol- and other drug-related issues.¹²

As seen with child and teen populations, the overall rates of college student drinking and other drug use has fluctuated slightly over the course of the last several decades. However, national indices have remained relatively constant. Given the continued scale of the problem and the potential for life-altering negative consequences, the search for efficacious prevention efforts has been constant.

Prevention Efforts

Prevention Efforts in Primary and Secondary Schools

Prevention efforts aimed at children in the K-12 age group have historically been information driven and largely ineffective. Alcohol and other drug use prevention efforts came to fruition during the rise of illicit drug use in the late 1960s and proliferated widely in the 1970s. Driven by the nation’s concern over the rising rates of alcohol and other drug use, school administrators and government officials pushed for programs to protect children from the harmful effects of drug us...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• List of Tables
• Acknowledgments
• Notes on Contributors
• Introduction
• I: Case Studies
• II: Themes
• III: Policy Solutions
• Index