In a predawn raid, a dozen Miami police officers crowd around the front door of a house in a poor, dilapidated neighborhood; three officers station themselves on the back porch. Announcing their presence, they break down the door and storm the house, awakening two startled occupants. The pair is led away, dazed, in handcuffs, to a nearby police van. In a modest working-class Los Angeles community, a former heroin addict enters a small, unobtrusive clinic. She signs a form and is handed a small paper cup containing an orange liquid, and she drinks it down. After exchanging pleasantries with the receptionist, she leaves the clinic and walks outside. In an affluent Long Island suburb, a police officer stops a car with a defective taillight. Peering inside, he sees two teenagers squirming nervously on the front seat. A distinctive, unmistakable odor fills the car. Without asking permission, he searches the glove compartment and finds two marijuana cigarettes. He gives them a lecture, drives them home, and informs their parents about the incident. In Amsterdam, an 18-year-old walks into a "hash" shop and looks around. She sees a dozen teenagers getting high and chatting amiably. She walks to the counter, purchases a small packet of hashish, and puts it into her pocket; nodding to an acquaintance, she leaves.
In Iran, a drug dealer is executed. In Colombia, a judge who has sentenced drug dealers to long terms is assassinated by a drug henchman. In Central Asia, an official is handed an envelope filled with American dollars; a caravan of opium passes through his jurisdiction, unimpeded. In a state capitol, the legislature votes to increase the penalty for the sale of 650 grams of cocaine to life imprisonment. The American military invades Panama, engages in a small war, captures its leader, arrests him, and brings him to trial in the United States; he is convicted of drug selling and sentenced to a long prison term. A U.S. senator calls for an expansion of methadone treatment programs; another calls for cutbacks for treatment programs, harsher penalties, and less judicial discretion for cases involving drug possession and sale. The mayor of Baltimore calls for the legalization of all psychoactive drugs. The San Francisco city council bans smoking in all its public restaurants. A newborn baby tests positive for the presence of cocaine; its mother is arrested for "delivering a controlled substance to a minor," and the baby is placed in a foster home. In Malaysia, an American is apprehended with a substantial quantity of marijuana; over the objections of the president of the United States, he is hanged.
It has become something of a cliché among many observers that our current punitive policy of arrest and imprisonment for drug offenders "hasn't worked." Drug abuse is a medical matter, not a criminal matter, we are toldor, alternatively, that it is "none of the government's business." The United States is excoriated as a nation whose politicians are engaged in "pushing wars on drugs and locking people up" (Molotch, 1994, p.221), as if that were a self-evidently unjust and counterproductive policy. But if "locking people up" were so self-evidently ineffective, why is this not blatantly obvious to all who would examine the evidence? Are some of us incapable of seeing the truth because of our biases and prejudices? Or is it, perhaps, the fact that some of us profit from this ineffective, unjust policy, and we aren't willing to admit its failure? Does our failed policy serve certain functions for portions of the populationsay, political, economic, ideological, moral, or religious functionsthat some of us are reluctant to give up? For instance, do some of us have a need to punish transgressorsin this case, drug offenders, those who have crossed a moral boundary and violated the norms of our society? Or does drug control carve out a domain or an empire for the powers that be that a radically different policy would deprive them of? Do drug offenders serve as a handy scapegoat for the major social problems we can't solve? Or is it possible that the punitive policy doesn't work quite so badly as some critics charge? Or, perhaps, do some of us support a failed drug policy because, although we know our current system of drug control is working badly, we fear what may replace it?
The question of drug policy has become one of the burning issues of our day. What do we do about drugs? And what do we do about which drugs? What should our drug laws look like? Should the possession and sale of drugs be against the law? And should we imprison all drug violators? Or is treatment for all addicts and abusers a wiser policy? Should anyone above a certain age be permitted to purchase drugs legally in commercial and state-controlled establishments much the way we can now purchase alcoholic beverages? Should all drugs be administered by medical prescription? What is our drug policy to be? Should we continue to criminalize? Or legalize?
Last semester, I put questions on what the drug laws ought to be to the 200 students enrolled in my "Alcoholism and Drug Abuse" course. Just over half the members of the class (51 percent) said that the possession, and four out of 10 (39 percent) said that the sale, of marijuana should be legalized. But between 80 and 90 percent said that both the possession and the sale of the harder drugsamphetamine, LSD, cocaine, and heroinshould remain a crime.
In this book, I intend to examine several variations on the legalization proposal and the debate they have stirred up. In so doing, I will also contrast the current system of control with these proposals, as well as consider alternatives to both outright legalization and our current more-or-less punitive or punishment-oriented system.
Most people have an opinion about what is the wisest legal policy to pursue on drug control. And yet, not everyone has access to the relevant facts. True, no conceivable quantity of facts could possibly settle the question in everyone's mind. At the same time, facts are relevant to the case; we have no right to close our mind off to information that bears on the question of drug legalization versus criminalization. And while a simple accumulation of the facts will not definitively decide how most of us feel on the issue, the facts should rule out some of the less realistic policies. Still, when all is said and done, for many of us, the question of drug policy boils down to what symbolic message one or another policy conveys. Regardless of whether it reduces crime or not, does endorsing methadone maintenance clinics for all addicts who wish to enroll tell you the society is too "soft" on drugs? Do needle exchange programs seem to encourage drug use? Regardless of whether it reduces drug abuse or not, does permitting the police to break down doors and roust residents on mere suspicion strike you as unjust? Does it strike you as too much like a military dictatorship? Does the term "legalization" sound like an endorsement of drug use to you? Does locking up street junkies sound harsh and inhumane? The balancing act between ideology and fact will continue to dog us throughout any exploration of the issue of drug policy.
And yet, we must decidesomeone will decidewhat drug policy we will have. Drug suspects will be arrestedor they will not. Drug laws will be passedor defeated. Needles will be exchanged with government support and approvalor they will not. Methadone clinics will continue to function, increase in numberor be closed down. Drug education programs will be fundedor zeroed out. Decisions like these will be made at the federal, state, and local levels all around the countryand throughout the world as well, for we now live in a "global village," an international community, all of whose lives are affected by what happens continents away. And regardless of what we think, others are making, and will continue to make, decisions concerning what to do about drugs. Do we really want to remain aloof from the issue? Can we afford to?
The issue of whether or not to legalize the production, sale, and possession of the currently illegal drugs has become one of the more hotly debated topics within the larger question of drug policy. It may have cooled off a bit since the early 1990s, but it remains a fiercely contested bone of contention. At present, the likelihood that any major jurisdiction of the United States will sanction full legalization for any of the presently illegal drugs is next to nil. Some observers claim that this makes the question of legalization a trivial, marginal issue. Not so. Legalization is not an all-or-nothing proposition; there are different degrees and aspects of legalization. Its proponents have offered certain specific reforms that do have some hope of implementation. Our present system of attempting to control drug abuse through the criminal law is vulnerable to criticism; it isn't working well, it costs a great deal of money, it has harmful side effects, and it is badly in need of repair. It is possible that some of the criticisms offered by the legalizers will be adoptedin a watered-down versionby advocates of more-mainstream positions. It could be that bits and pieces of the proposals offered by the legalizers will eventually be approved in one or another jurisdiction. It is possible that the legalizers are laying the foundation for a climate of opinion that will bear legislative fruit sometime in the twenty-first century. In any case, the legalization debate has enriched the discourse on the topic of drug policy and reform. And, to a sociologist, the debate itself is also fascinating for what the advocates of both sides are saying and for what that reveals about both their location in the society and, more generally, the nature of the society in which we live.
In considering the feasibility of one proposal on public policy versus another, it is absolutely crucial to pay attention to the sociological concept of unanticipated consequences. As Robert Merton reminds us, we must distinguish between the conscious motivations for social behavior and objective or concrete consequences (1957, pp.60-61). Legislators, experts, reformers, and the general public can have the most noble and idealistic intentions imaginable for supporting and enacting a given policy, but ideals are not the same thing as results. All too often, a convergence of real-life forces works to undo what planners and reformers had in mind. We cannot anticipate exactly how a policy will unfold when it is put into practice; often, it has the opposite consequences from those that were intended. When American and Peruvian officials attempted to eradicate cocaine from the highlands of Peru, could they have anticipated that this would assist a terrorist organization, Sendero Luminoso, which was aimed at bringing down the Peruvian state and fomenting a worldwide Maoist revolution, by creating a "power vacuum" in the region (Gonzales, 1992)? In the 1970s and 1980s, when the United States backed Afghan rebels in their fight against the then-Soviet Union, could they have known that this would help finance a terrorist organization involved in illegal opium production and dedicated to the destruction of the United States (Weaver, 1995; Weiner, 1994)?
Once we become aware of the yawning gulf between intention and consequence, we begin to ask questions we didn't think about before. Does the punishment of convicted criminals rehabilitate themor intensify their commitment to crime? Does criminalizing drugs discourage people from using themor increase their price and make them profitable to sell? Would reform of the present drug laws have the consequences we intend? Or will unanticipated consequences rear its ugly head here, too? Will needle exchanges inadvertently stimulate use? Will legalization announce to the members of the society that it is acceptable to use drugs? Will taxes on cigarettes encourage smuggling and illegal sale? We can't assume we know the answers in advance; these are empirical questions which demand evidence. The point is, drug policies shouldn't just look good on papershouldn't, that is, simply sound good or make sense to intelligent observers. A lot of policies that "sound good" or "make sense" turn out to be disastrous when put into effect. When we keep the notion of unanticipated consequences in mind, we will be forever inoculated from a foolish optimism that will dupe us into thinking we have the perfect solution to America's drug problem. While the concept of unanticipated consequences has often been applied to the ironic and undesired impact of drug criminalization (Reinarman, 1994; Steinberg, 1994), far less often has such systematic discussion been devoted to how it would play out under legalization.
As more than one observer has pointed out (Grasmick et al., 1992; MacCoun, 1993,p.508;), much of the American public's support for retribution against or punishment of the criminal (the drug offender included) transcends the rational or deterrent effect. That is, regardless of whether or not a given law and its enforcement discourage crime, the very fact that a punishment is called for is extremely important for a substantial proportion of Americans. As I said earlier, the law has a strong symbolic function. For instance, most Americans cast their support for the death penalty in deterrence termsthat is, they claim it discourages murder. But most who support it are actually impervious to evidence which shows that execution does not deter murder more effectively than life imprisonment does. This is because the retributive or revenge function of punishing the offender is far more important to them than the deterrence function (MacCoun, 1993, p.508). It is almost certain that the same prevails for drug offenses. Regardless of its utilitarian effect, the legalization of the currently illegal drugs "would send a message"a symbolic messagethat many Americans find completely unacceptable. Somehow, many observers reason, it legitimates drug abuse. To the extent that this is so, much of the evidence that supports or undermines the legalization position is beside the point. Still, such empirical evidence has a rhetorical functionit is wielded as a weapon in the debate. And some observers are convinced by it, one way or another. (I know I have been.) While evidence may not be decisive for manyperhaps mostobservers of the drug scene, it cannot be ignored, either.
IDEOLOGY AND MORALITY
The nonempirical or symbolic factor operates in both directions, of course. The legalizers, too, raise some issues that are largely beyond the reach of empirical documentation. As a number of observers have remarked (Kleiman and Saiger, 1990, pp.532-533; Moore, l990a, p.l5) advocates of legalization are making two very different argumentsthe first, utilitarian or consequentialist, and the second, moral. The utilitarian side of the argument says that legalization will improve the society in a direct, concrete, real-world fashion by reducing some of the pathologies associated with drug abuse: drug-related violence, medical illness and death, moneymaking crimes, bloated criminal justice budgets, overcrowded prisons, and so on. Although we cannot directly or definitively prove or disprove this aspect of the argument with evidence, there is abundant evidence to address it. But on the other hand, the moral side of the argument is quite beyond the reach of empirical evidence. It says that enforcing a law against the possession and sale of illegal substances, which may be less harmful than substances that are legal, is inherently unjustregardless of its practical or utilitarian consequences. And, they say, society has no right to pass or enforce laws against behavior that is harmful to no one except the individual who engages in it (McWilliams, 1993; Szasz, 1992). Such laws are, by their very nature, unjust and unfair they do not deserve to exist. Legalization promotes the good society, its advocates would say, because it would represent the repeal of a law that is inherently in violation of a major feature of the good society. There is no empirical or factual evidence that could possibly be gathered that would test or even address this aspect of the legalization argument; one is free to accept or ignore it according to one's personal taste.
The moral argument is not insignificant. However, this book is a sociological essay on the legalization debate; hence, the practical, utilitarian, or consequentialist argument will be weighed more heavily than the moral argument. Given what we know about drug use in America at the present time, what is likely to happen if the presently illegal drugs were to be legalized? What are the costs of legalization likely to be, compared with the costs we now suffer with the current system? What alternatives to legalization do we have at our disposal?
Nonempirical ideological and moral values operate at a second level as well. Not only do different drug policies represent or symbolize different values to different observers; in addition, as we'll see, different policies produce a different and unique package of consequences. And choosing among those consequences entails choosing one value over another, not applying some objective scientific or medical measuring rod. Says Mark Kleiman, during Prohibition, hundreds of Americans died in gangland "beer wars," and 8,400 died of cirrhosis of the liver; after the repeal of Prohibition, the "beer wars" were gone, along with their murders, but 2,500 more Americans died of cirrhosis of the liver during a comparable period of time. Asks Kleiman: "Was that an improvement?" (1992b, p.17). He implies that the answer to this question is far from obvious. If cocaine were to be legalized, warfare among rival drug gangs would probably end. "But how many more would die from taking cocaine?" he asks (p.17). How do we measure one harm against another? What if a change in the drug laws results in fewer deaths and more addicts? Less crime and more drug use? What if our policy helps one social category but harms another? Too often, observers assume that their solution to the existing problems will produce nothing but positive results. But how do they juggle a mixture of positive and negative results? These questions are neither trivial nor facetious, nor is the answer to them self-evident. Again, choosing one value over another never represents a simple application of a scientific or medical principle. Morality and ideology always play a central role in matters of legal and public policy.
Humans have been ingesting psychoactive or psychotropicmind-influencing or mind-alteringsubstances for well over 10,000 years, but not until the last few hundred have people attempted to control the distribution of such substances through the criminal law. Not all these attempts have been successful; it is entirely possible that there have been at least as many failures as successes.
DRUG LAWS: AN INTRODUCTIONIn the 1600s, after Europeans brought tobacco products back from the Western Hemisphere, rulers from England to Japan banned the sale and consumption of tobacco. These efforts failed everywhere and were quickly abandoned (Blum, 1969).Between 1841 and 1855, in North America, 13 of the United States and two provinces of Canada banned the sale of alcoholic beverages in less than a decade, the legislatures of these jurisdictions repealed their laws, modified them to allow liquor sales, or permitted them to languish unenforced (Lender and Martin, 1987).In 1875, a city ordinance was passed in San Francisco forbidding opium smoking; within a half-dozen years, similar laws were enacted from coast to coast.In December 1914, the Harrison Act required all persons who produced or sold cocaine and opium products (heroin and morphine included) to register with the government and keep records of the manufacture and sale of these drugs.In 1920, national alcohol prohibition became the law of the land in the United States; in 1933, widely regarded as a disastrous failure, it was repealed.During the 1920s, Canada passed a series of anti-opium laws which seemed to target specifically Chinese immigrants.During the 1920s, half the states of the United States had passed a law outlawing the possession and sale of marijuana; by 1937, every state in the Union had passed such a law, and during that year, a federal law, the Marihuana Tax Act, was enacted.In the 1980s, two conservative American presidents, Ronald Reagan and George Bush, waged a "War on Drugs." Congress passed a series of harsh penalties for a wide range of drug violations. This figurative war even became a literal one: The military was enlisted, for surveillance, apprehension, and search-and-destroy missions. By the late 1980s, it was clear that this war had failed; heroin and cocaine were cheaper, purer, and more abundant than ever, and, according to several key indicators, abuse of these two dangerous drugs had actually increased during this period.
Long before any drug policy is put in place, its merits and demerits are debatedin the media; by intellectuals and academics; by the medical fraternity and scientific researchers; by officials, politicians, and agents of social control; and by the general public.
On the one hand, there are a number of questions for which the disciplines that study drug use have a fairly reliable and valid answer. For instance, pharmacology, the field that studies drug effects, has learned a great deal about how drugs get users highthey know, that is, about the various drugs' mechanism of action (Goldstein, 1994). For each drug currently in use, we can predict the short-term and long-term effects that are likely to take place and at which dosage levels these effects occur. Epidemiologists, medical scientists who study the distribution of diseases (including, by extension, drug abuse and addiction) in the population, have shown which drugs users are more likely to become dependent on, and for which drugs that potential is low. They have also found out that some drugs carry a higher than average risk of death by overdose and that, for others, that likelihood is relatively low. Sociologists and other social scientists have determined what percentage of the population, as well as which categories in the population, are more likely to use which drugs, and which ones use them less.
On the other hand, the answers to some other issues are not nearly so clear-cut; they remain controversial. The question of drug policy is one of these controversial issues. How do we deal with or control substances that affect the mind? The possession and sale of which substances should be controlled by the criminal law? Should the public be permitted legal access to certain psychoactive drugs? Do the drug laws do more harm than good? How do we measure the effectiveness of one policy against another? What should the government do about use, possession, and sale of substances that affect the mind? Change the present drug laws? Make the penalties for violations harsher or more lenient? Leave the laws on the books as they are? Enforce them more vigorouslyor less? Use more judicial discretion in sentencingor less?
Over the last decade, the legalization of the currently illegal drugs has been seriously proposed by a wide range of observers, commentators, and critics. The details vary from one specific proposal to another, and we'll look at several momentarily. One expert has referred to legalization as "a frustratingly vague and often confused term which means very different things to different interpreters" (Currie, 1993, p.l64). Still, the broad outlines of all legalization proposals are essentially the same: the removal of one or more criminal penalties from the possession and sale of one or more currently illegal psychoactive substances. In turn, such proposals have been met with a range of responses from observers in different quarters.
Even before we tackle the issue of drug policy, it might be a good idea to address the question of what a drug is in the first place. There are many ways to define drugsat the very least, as medical substances, as illegal or controlled substances, as publicly defined substances, as substances taken for a certain effect. Some definitions even rely on a subjective criterion: A drug is what the members of a society say or think it is. There is no single definition that is definitive or correct for all contexts. At the same time, some definitions are a great deal more useful for certain purposes than others. And some definitions actually prevent us from reaching a sound understanding of drug use and what the most productive policy toward drugs might be.
DEFINITIONS: WHAT IS A DRUG?
The first distinction we should make is between definitions of drugs that are based on the legal status of a substance and those based on psychoactivity. Some definitions rely on whether substances are legal or illegal. In contrast, a definition based on psychoactivity refers to the fact that some substances influence the workings of the mind. Let's look at these two definitions of drugs, one based on legal status and one based on psychoactivity, in a bit of detail.
Once again, a legalistic definition holds that drugs are defined by the law. For instance, it is the policy of the federal government that the drug problem is made up only of the illegal drugs. The consumption of alcohol and cigarettes may be a problem in themselves, but since alcohol and cigarettes are not illegal, to the legalistic definition, they are not drugs therefore, the problems caused by them are not part of "the drug problem." By wrapping a definition of a drug up in its legal status, one is judging alcoholism and the addiction to tobacco cigarettes to be irrelevant to the drug problembeside the point. The legalist seems to be saying that the drug problem is defined by a violation of the law, not by harm to the society. In effect, according to the legalistic definition, the user of an illegal drug is seen as engaging in "a species of treason" (Zimring and Hawkins, 1992, p.9); he or she becomes "a declared enemy of the state" (p.9). What seems to concern the legalist "is the threat that illegal drugs represent to the established order and political authority structure. In this view, it is the consumption of the prohibited substance rather than any secondary consequences that might ensue that is the heart of the matter. The taking of drugs prohibited by the government is an act of rebellion, of defiance of lawful authority, that threatens the social fabric" (p.9).
The legalistic approachwhich focuses on illegal but ignores legal psychoactive substances as drugsprovides the foundation-stone for the campaign funded by the Partnership for a Drug-Free America, which accepts millions of dollars from legal drug manufacturers but overlooks the harm caused by alcohol, tobacco, and pills (Cotts, 1992). It was behind the then-First Lady Nancy Reagan's 1986 statement that "Drug use is a repudiation of everything that America is," and her 1988 declaration that the casual drug user is an "accomplice to murder." Like the Partnership for a Drug-Free America, Nancy Reagan does not regard the legal psychoactive substances as drugs at all, in spite of their impact on the mind and the harm their use causes. The legalistic definition is behind the federal government's policy statement, the National Drug Control Strategy (issued in 1989), which it regards as the nation's blueprint for controlling drug abuse. In it, we are told that "drugs represent the gravest present threat to our national well-being," that "there is no such thing as innocent drug use," that "more police" and "more prisons" are needed in the War on Drugsbut, again, alcohol and tobacco are excluded. (Indeed, the concept "drug" is not defined anywhere in this crucial document's 150 pages!)
The legalistic definition is based on a double standard from the point of pharmacology, the study of drug effects; it is a definition that is based on ideology and morality, not on the effects of drugs themselves. By excluding the legal substances from a definition of drugs, the legalist emphasizes that what matters in the issue of drug control is not what a drug does to the body or mind but how a drug is classified by the law. Says Mark Kleiman, any drug policy that omits alcohol and tobacco from consideration "is about as useful as a... naval strategy" that omits the Atlantic and the Pacific oceans (1992b, p.7). I agree. I believe that the legalistic definition of drugs represents a barrier to our understanding of the drug legalization debate. In effect, the legalistic definition closes off the debate on legalization. If the currently illegal drugs were legalized, would that mean that, overnightaccording to this definitionthey would magically cease to be drugs? This is what the legalization definition would be forced to say. In contrast, many observers feel, it is more useful to think of the legal status and psychoactive properties of substances as distinct qualities that overlap but are not dependent on one another.
One of the most commonly promulgated definitions of what a drug isand the one I've used from the very beginning of this discussionis: any and all substances that influence or alter the workings of the human mind. What I have been referring to as "drugs" are psychoactive (or psychotropic) substances, that is, substances that influence mood, emotion, feeling, sensation, perception, and thinking. This does not mean that substances that are not psychoactive are not drugs in some other essential or concrete way. In fact, definitions are neither wrong nor right in some abstract, objective sense; a "correct" definition is one that is both widely adopted and useful. When I say that we will agree that psychoactivity defines what drugs are, I mean that this definition is the one that is most relevant for an understanding of what the most viable and workable drug policy is. Other definitions may be perfectly valid in other contexts. Thus, penicillin and antibiotics, which are not psychoactive but are used in medical therapy, will not be discussed as drugs in this discussion, but alcohol and tobacco will be. According to the definition of psychoactivity, any substance that influences the workings of the human mind in a significant way must be considered a drug; anything that does not should not be considered a drug and, hence, will not enter into our discussion at all, except, perhaps, by way of comparison.
Of course, psychoactivity is a matter of degree. Some drugs influence the mind in significant and profound ways, while others are far milder. Coffee is an extremely mild psychoactive agent; LSD is an extremely potent one. In addition, some substances generate a psychic or emotional state that causes a dependency that is very hard to break; here, cigarettes provide an excellent example. In contrast, other substances are given up extremely readily. Our interest here will be focused on the substances that cause significant transformations of the mind that, in turn, produce behavior that some of the members of the society wish to control. The psychoactivity of drugs is important to us because it is often at the root of social policy: Because some of us get high or become dependent on such substances, others want to step in and prevent our use of them. It is from this starting point that our story unfolds.
Thus, alcohol can produce an intoxication at moderate doses; hence, it is a drug. Tobacco produces a dependency; hence, it is a drug. (The same is true of alcohol.) In addition, tobacco produces a sensation of well-being which one drug expert has dubbed "a low-key high" (Goldstein, 1994, p. 111). Users take marijuana, cocaine, and heroin to get high; hence, they are drugs. Psychoactivity influences use and abuse in crucial ways; and how drugs are used and abused, in turn, influences why they are, whether they can be, and whether they should be, legally controlled. But let's be clear about this: The distinction between legal and illegal drugs is an artificial or humanly fabricated distinction. The law does not decide what effects drugs have, or what their dangers are (although the law may influence how and under what circumstances drugs are taken and, therefore, can influence how harmful they become). There is absolutely no natural or pharmacological distinction between alcohol and nicotine on the one hand and the illegal drugs, viewed as a whole. All influence the workings of the mind, all can produce a dependency or addiction, and all can be dangerous. Thinking that alcohol and tobacco are not illegal and, therefore, are not drugs implies that they are perfectly safe, while only the illegal "drugs" are dangerous (Goldstein, 1994, p.2); this is a monumental fallacy. It is entirely possible, for instance, that public policy has been too lenient toward the legal drugs and too harsh toward those that are illegal. These are issues that need to be explored here.
Chapter 2. Drug Use in America: An Overview