The Report of the National Commission on Marihuana and Drug Abuse

Drug Use In America: Problem in Perspective

Commissioned by President Richard M. Nixon, March, 1972

Table of Contents

Letter of Transmittal

Introduction

Chapter One -- Defining the Issues

Definitional Confusion: What is Drug Abuse?
- "Drug"-The All-Purpose Concept
- Drug Abuse: Synonym for Social Disapproval
- The Roots of a "Problem"
The Social Response: False Premises and the Perpetuation of a Problem
- The Assumptions and Premises of Present Policy
- Elimination of Non-Medical Drug Use
- Risk-Taking and Health
- Motivation for Mood Alteration
- Drugs and Individual Responsibility
An Overview of the Present Response
- Risk-Education
- Coercion
- Sickness
- Perpetuating the Problem
Defining the Problem
- The Meaning of Drug Use
  - The Incidence of Drug Use
  - Drug Using Behavior
  - Drug-Related Risk
    - Risks to Individual Health
    - Drug-Induced Behavior
    - Dependence Liability
- Evaluating the Social Consequences of Drug Use
- Defining America's Drug Problem
- The Limits of Social Control
The Commission's Role

Chapter Two - Drug Using Behavior in the United States

I. Drug Use in the General Population
- Tobacco and Alcohol
- Use of Proprietary and Ethical Psychoactive Substances
  - Incidence and Prevalance
  - Demographic Characteristics
  - Motivations for Use
  - Multi-Drug Use
    - Alcohol, Ethical and Proprietary Psychoactive Drugs
    - Marihuana and Ethical and Proprietary Psychoactive Drugs
    - Concurrent Drug Usage
- Illicit Drug Use in the General Population
  - Marihuana
  - LSD, Other Hallucinogens
  - Glue, Other Inhalants
  - Cocaine
  - Heroin
  - Multi-Drug Use
II. Drug Use Among Students
- Survey Methodology
- Comparative National Survey Student Data
- Incidence of Student Drug Use
  - Alcohol
  - Marihuana
  - Inhalants
  - Hallucinogens
  - Stimulants
  - Depressants
  - Opiates
- Patterns of Student Drug Use
  - Present and Future Drug Involvement
  - Frequency and Intensity of Drug Use
  - Duration of Student Drug Use
  - Multi-Drug Use
III. A Typology of Drug-Using Behavior
- Experimental Use
- Social-Recreational Use
- Circumstantial-Situational Use
- Intensified Drug Use
- Compulsive Drug Use
IV. Psychosocial and Institutional Influences on Drug-Using Behavior
- Broad Cultural Influences
- Drugs and Youth
  - Experimentation, Availability and Need
  - Personal Dissatisfaction and the Search for "Something of Value"
  - Age and Responsibility
  - The Impact of Extended Education
  - Institutional Sources of Identity
- Mood Alteration in America
- Factors Bearing on Drug Dependence
- A Final Note

Chapter Three The Social Impact of Drug Dependence and Drug-Induced Behavior

I. Drug Dependence
- Terminological Confusion
  - Addiction
  - Habituation
  - The Search for Precision
  - Drug Dependence
  - Excising "Addiction"
- Toward a Functional Understanding of Drug Dependence
  - Psychological Dependence: The Primary Reinforcer
  - The Pharmacological Component: Reinforcement Potential
  - Psycho-Social Components
  - The Development of Dependence: Conditioning
  - The Dependence Continuum
  - Measuring the Degree of Dependence: Psychological Components
  - Physical Dependence: The Secondary Reinforcer
  - Summary
- Evaluating the Social Impact of Drug Dependence
  - Dependence, Health and Behavior
  - The Vulnerability Factor
  - The Relevance of Social Response
- Present Social Impact
  - Alcohol
  - Heroin
  - Barbiturates
  - Amphetamines and Related Stimulants
  - Cocaine
  - Hallucinogens
  - Cannabis
II. Drug Induced Behavior
- Impact on Perception
- Impact on Memory
- Alteration of Mental States
- Impairment of Psychomotor Function
- Summary
III.Impact on Public Safety
- Drugs and Crime
  - Drugs and Their Criminogenic Effects
    - Alcohol
    - Marihuana
    - Barbiturates
    - Amphetamines
    - Opiates
    - Cocaine
    - Hallucinogens
    - Other Psychoactive Substances
    - Summary
- Psychosocial Characteristics of Drug-Dependent Persons: Implications for Public Safety
- Social and Demographic Characteristics
  - Age
  - Educational Status
  - Income, Occupation and Employment Status
  - Home Environment and Marital Status
  - Psychological Characteristics
- Problems in Inferring Causation
- The Costs of Heroin Dependence
  - Cost to the Heroin-Dependent Person
  - Cost to Society from Criminal Activity
  - Criminal Justice Costs: Processing the Drug-Dependent Person
- The Effect of Drug Treatment on Crime
  - Current Research Findings
  - A Realistic Appraisal
- Drugs and Driving
  - Research Limitations
  - Research Findings
    - Alcohol
    - Marihuana
    - Other Psychoactive Substances
IV. Impact on Public Health and Welfare
- Public Health and Welfare: A Preventive Concept
- Assessing the Public Health and Welfare Impact of Drug Use
  - The Population of Heavy Alcohol Users
  - Economic Loss
  - Death
    - Alcohol
    - Heroin
    - Barbiturates
  - Medical Complications of Chronic Drug Use
  - Impact on the Family Structure
  - Compensatory Social Costs
- Framing a Public Health Response

Chapter Four - Toward a Coherent Social Policy

Introduction
- The Process
- Goals and Premises
  - Drugs and Social Responsibility
  - Irresponsible Use
  - Discouragement and Social Tolerance
  - Responsible Decision Making
  - Risks and Perceived Advantages
  - Designing a Differential Response to Drug Use
I. The Availability Decision
- Models of Availability
- The Calculus: An Overview
  - Relative Social Cost
  - Efficacy of Controls
  - Cost of Controls
  - The Social Context of the Availability Decision
- The Present System
  - Availability Not Limited As To Purpose of Consumption
  - Availability Limited As To Purpose of Consumption
  - Substances Not Available For Consumption
- Specific Recommendations
  - Opiates
  - Cocaine
  - Amphetamines
  - Barbiturates
  - Non-Barbiturate Sedatives
  - Minor Tranquilizers
  - Hallucinogens
  - Marihuana
  - Alcohol
- Implementing Restrictions on Availability
  - The Role of International Agreements
  - Federal Enforcement Policy
  - State Enforcement Policy
II. The Consumption-Intervention Decision
- An Overview of the Possession Offense
- Deviance, Deterrence and Symbolism
  - Philosophical Conflict
  - Constitutionality
  - Functional Overview
  - Deterrence
  - Social Costs of Enforcement
  - Possession and Supply
  - Symbolism
- Sickness and Treatment
  - Origins of the Cult of Curability
  - Addiction and Treatment: The Early Days
  - The Therapeutic Premise Takes Hold
  - Therapeutic Intervention Comes Under Attack
  - Harnessing the Therapeutic Response
  - Involuntary "Civil" Commitment: The Problems of a Therapeutic Response
  - Therapy and the Criminal Process
- Dangerousness and Prevention
  - Crime and the Public Safety
  - Contagion and the Public Health and Welfare
  - The Appropriate Role of Preventive Intervention
- Conclusion: The Possession Offense and Its Enforcement
  - Functional Enforcement
  - Role of the Police
III. Defining the Government's Role
- Governmental Competence
- General Guidelines
- Analyzing the Government Response
  - An Overview of the Government Response
  - The Special Action Office: A Stopgap
  - Failures of the Present System
    - Identification of the Nature and Extent of Drug Use
    - Definition of goals and objectives for drug-related functions
    - Effective planning
    - Affective control of resource allocation
    - Coordination among federal agencies
    - Drug-related functions within agencies whose primary mission is not solving drug problems
    - Evaluation of programs in terms of their effectiveness
    - Evaluation of programs in terms of efficiency
    - Separation of drug and alcohol activities
- Reorganizing the Governmental Response
  - Bringing the Drug Effort Under Control
  - The Structure of the Unified Approach
  - Organization of Response at the Community Level
IV. Treatment and Rehabilitation
- An Overview of the Present Response
  - Uncertainty About the Illness
  - Uncertainty About the Objective of Treatment
  - Diversity of Method
- History of the Treatment of Opiate Dependence
  - 1870-1900: The Early Years
  - 1900-1915: Years of Optimism
  - 1915-1930: Confidence Wanes
  - 1930-1960: The Dry Years
  - The Sixties: Society Turns to Therapy Again
- Present Methods and Models of Treatment
  - Hospitalization
  - Ambulatory Drug-Free Treatment
  - Therapeutic Communities
  - Methadone Maintenance
  - Antagonist Treatment
  - Multi-Modality Programs
  - Treatment for Non-Opiate Drug Dependence
- The Role of the Law in Treatment
  - Legal Controls as Therapy
    - Civil Procedures
    - Criminal Procedures
- Legal Control of the Treatment Process
- Heroin Maintenance
- Conclusions and Recommendations on Treatment of Dependence
  - Federal Funding and Services
  - Federal Evaluation
  - State Treatment Programs
  - The Role of the Legal System in State Programs
  - Uniformity of State Law
  - Emergency Treatment of Drug Users
V. Prevention
- The Information-Education Explosion
- Goals of Information-Education Prevention
- Information Policy
- Education
- Training
- The Media and Drug Use Prevention
- Other Prevention Strategies and Techniques
- Summary and Conclusion
VI. Research
- A New Interest in Research
- The Need for a Directed Research Plan
  - Incidence, Frequency and Intensity of Drug Use
  - Etiology and Consequences of Drug Use
  - The Role of the Criminal Justice System
  - Efficacy of Treatment
  - Other Areas
VII. The Private Response
- The Health Professions
- Pharmaceutical Industry
- Alcohol Industry
- Legal Profession
- Industry
- Colleges and Universities
- Mass Media
- The Religious Community
- The Family

Chapter Five - Looking Ahead

The Immediate Future: The Goal of the Commission's Recommendations
- Changing Attitudes
- Filling the Informational Gaps
- Unifying the Government Response
- Developing the Private Response
- Improving Controls on Availability
- Rationalizing Consumption Controls
- Expanding Treatment, Rehabilitation and Prevention Services
The Immediate Future
Policy Making Over the Long Term
- Confronting the Basic Question
- Reappraisal: The Need for Evaluation

Sources

Bibliography

Consultants

Contractors and Contributors

Research Papers Prepared for Commission

Recommendations

Index of First Year Recommendations

Index of Second Year Recommendations

Contents | Feedback | Search | DRCNet Home Page | Join DRCNet

DRCNet Library | Schaffer Library | Major Studies |

Drug Use in America, Problem in Perspective