The term drug abuse most often refers to the use of a drug with such frequency that it causes physical or mental harm to the user or impairs social functioning. Although the term seems to imply that users abuse the drugs they take, in fact, it is themselves or others they abuse by using drugs. Traditionally, the term drug abuse referred to the use of any drug prohibited by law, regardless of whether it was actually harmful or not. This meant that any use of \Tmarijuana\t, for example, even if it occurred only once in a while, would constitute abuse, while the same level of alcohol consumption would not. In 1973 the National Commission of Marijuana and Drug Abuse declared that this definition was illogical. The term abuse, the commission stated, "has no functional utility and has become no more than an arbitrary codeword for that drug which is presently considered wrong." As a result, this definition fell into disuse. The term drug is commonly associated with substances that may be purchased legally with prescription for medical use, such as penicillin, which is almost never abused, and \TValium\t, which is frequently abused, or illegal substances, such as \Tangel dust\t, which are taken for the purpose of getting high, or intoxicated, but have no medical use. Other substances that may be purchased legally without prescription and are commonly abused include alcohol (see \Talcoholism\t) and the \Tnicotine\t contained in tobacco cigarettes. This article, however, focuses on a certain type of drugs, called psychoactive drugs. Such substances--legal and illegal--influence or alter the workings of the mind; they affect moods, emotions, feelings, and thinking processes. For a general description of drug types, including an outline of their historical development and use, and their effects on the body, see \Tdrug\t. Drug Dependence Drug abuse must be distinguished from drug dependence. Drug dependence, formerly called drug addiction, is defined by three basic characteristics. First, users continue to take a drug over an extended period of time. Just how long this period is depends on the drug and the user. Second, users find it difficult to stop using the drug. They seem powerless to quit. Users take extraordinary and often harmful measures to continue using the drug. They will drop out of school, steal, leave their families, go to jail, and lose their jobs to keep using their drug. How dependence-producing a drug is can be measured by how much users go through to continue taking it. Third, if users stop taking their drug--if their supply of the drug is cut off, or if they are forced to quit for any reason--they will undergo painful physical or mental distress. The experience of withdrawal distress, called the withdrawal syndrome, is a sure sign that a drug is dependency-producing and that a given user is dependent on a particular drug. Drug dependence may lead to drug abuse--especially of illegal drugs. Psychoactive, or mind-altering, substances are found the world over. The coca plant grows in the Andes of South America and contains 1 to 2 percent \Tcocaine\t. The marijuana plant, Cannabis sativa, contains a group of chemicals called tetrahydrocannabinol, or THC. This plant grows wild in most countries, including the United States. The opium poppy is the source for \Topium\t, \Tmorphine\t, \Theroin\t, and \Tcodeine\t. It grows in the Middle East and the Far East. \Thallucinogens\t (such as \TLSD\t), the \Lamphetamine\ls (speed), and \Lsedative\ls, such as methaqualone (Quaalude, or ludes) and \Lbarbiturate\ls, are manufactured in clandestine laboratories worldwide. As a result, psychoactive drugs are used for the purpose of intoxication practically everywhere. (See also \Tdrug trafficking\t.) The United States is only one among many countries with a drug problem. Drug production and trade are of primary concern to the governments of Pakistan and the so-called golden triangle countries of Burma, Thailand, and Laos. India is one of the largest producers and users of opium, as Mexico, Egypt, and Morocco are of marijuana. The international trafficking of drugs consists of an elaborate network, often involving "official" protection and organized crime. Many drugs enter the United States through illegal channels. For example, a high-grade variety of marijuana grown in Thailand is shipped across the Pacific on great circular routes before approaching the West Coast for distribution. Also, much of the cocaine brought into the country from South America enters through Florida and is driven to the West Coast before being distributed to dealers. In an effort to control the international flow of illicit drugs, the United States has entered into several agreements with European and Asian nations to share intelligence and coordinate law-enforcement activities. Federal efforts to reduce the trafficking of narcotics in the United States have called for the establishment of several regional task forces. Classification of Psychoactive Drugs Pharmacologists, who study the effects of drugs, classify psychoactive drugs according to what they do to those who take them. Drugs that speed up signals passing through the nervous system, which is made up of the brain and spinal cord, and produce alertness and arousal and, in higher doses, excitability, and inhibit fatigue and sleep, are called \Lstimulant\ls. They include the amphetamines, cocaine, caffeine, and nicotine. Drugs that retard, slow down, or depress signals passing through the central nervous system and produce relaxation, a lowering of anxiety, and, at higher doses, drowsiness and sleep, are called depressants. They include sedatives, such as barbiturates, methaqualone, and alcohol, and tranquilizers, such as Valium. One distinct kind of depressants are those which dull the mind's perception of pain and in medicine are used as painkillers, or analgesics. These drugs are called narcotics. They include heroin, morphine, opium, and codeine. In addition to their painkilling properties, these depressants also produce a strong high and are intensely dependency-producing. Some drugs cannot be placed neatly in this stimulant-depressant spectrum. Hallucinogens include \TLSD\t, mescaline, and psilocybin. They produce unusual mental states, such as psychedelic visions. Marijuana is generally not regarded as belonging to any of these drug categories and exists as a drug type unto itself. History of Drug Abuse in the United States During the 19th century there were virtually no controls on the importation, sale, purchase, possession, or use of psychoactive drugs. Dangerous substances such as opium, cocaine, and morphine were basic ingredients in patent medicines that could be purchased by anyone for any reason, without a prescription. These nostrums were used to cure headaches, toothaches, depression, nervousness, alcoholism, menstrual cramps--in fact, practically every human ailment. As a result of the ready availability of addicting drugs, and as a result of their heavy use for medical problems, many individuals became addicted to the narcotics contained in these patent medicines. In fact, in 1900, there were more narcotics addicts, proportionate to the population, than there are today. At that time, most of the users who became addicts were medical addicts. Very few abusers took drugs for "recreational" purposes. In 1914, in an effort to curb the indiscriminate use of narcotics, the federal government passed the Harrison Act, making it illegal to obtain a narcotic drug without a prescription. During the 1920s the Supreme Court ruled that maintaining addicts on narcotic drugs, even by prescription, was in violation of the Harrison Act. Some 30,000 physicians were arrested during this period for dispensing narcotics, and some 3,000 actually served prison sentences. Consequently, doctors all but abandoned the treatment of addicts for nearly half a century in the United States. The use of narcotic drugs dropped sharply in the United States between the 1920s, when there were as many as half a million addicts, and 1945, when the addict population was roughly 40,000 to 50,000. The recreational use of other drugs, such as marijuana, cocaine, stimulants, hallucinogens, and sedatives, which are used so frequently today, also remained at extremely low levels during this period. Until the 1960s, recreational drug use was confined to a tiny minority of the population. The 1960s, however, was a watershed decade. The use of most illegal drugs increased tolerance for a wide range of unconventional behavior, including the growth of movements that stood in opposition to the war in Vietnam and to mainstream American culture, the coming into popularity of rock music and its attendant life-style, and enormous media publicity devoted to drugs, drug users, and drug proselytizers. A vigorous drug subculture came into existence. During this time some social groups viewed drug use in positive terms, evaluated individuals on the basis of whether or not they used illegal drugs, and believed it a virtue to "turn on" someone who did not use drugs. This subculture was a powerful force in recruiting young people into the use of illegal psychoactive drugs. Although media attention to drugs and drug use declined between the late 1960s and late 1970s, the actual use of drugs did not. Surveys point to a strong increase during this period. The late 1970s and early 1980s probably represent another turning point in the recreational use of marijuana, hallucinogens, sedatives, and amphetamines. Recent studies show a considerable drop in the use of most drug types through the 1980s. Cocaine and its derivative, crack, however, seem to be major exceptions, as their use and abuse continue to grow. Crack is the smokable form of cocaine. First appearing in the mid-1980s, it rapidly became the most widely abused illicit drug in the United States. New forms of older drugs continue to appear. "Ecstasy" (see \TMDMA\t) is a methamphetamine that was first synthesized some 70 years ago as an appetite suppressant. It is a mild hallucinogen whose negative effects can be long lasting. "Ice," a smokable methamphetamine, is as addictive as crack, but its side effects may be even more devastating. Patterns of Drug Abuse It is not always easy to determine exactly when simple drug use becomes abuse. Thus it is far easier to study who uses illegal psychoactive drugs than it is to study who abuses them. When researchers describe patterns of drug abuse, then, they usually describe the more general phenomenon of drug use, whether it leads to abuse or not. The illegal use of psychoactive drugs is vast and extensive in the United States. Some 70 million Americans age 12 and over have tried at least one or more prohibited drugs for the purpose of getting high. The illegal drug trade represents an enormous economic enterprise. Sales of illegal drugs in the United States may have totaled $100 billion in 1986, more than the total net sales of the largest American corporation, and more than American farmers earned from all crops combined. About 60% of the illegal drugs sold worldwide end up in the United States. By far the most commonly used illegal drug is marijuana. Roughly half of the total of all episodes of illegal drug use are with marijuana alone. Studies sponsored by the federal government show a significant drop-off in marijuana use, however, and a substantial decline in daily or near-daily use throughout the 1980s. In 1985 roughly 75 percent of all Americans under the age of 26 had at least tried marijuana; in 1988, that proportion had shrunk to 56 percent. Cocaine is the second most commonly used drug in the United States. In 1988, 13 percent of Americans aged 12 to 25 had used cocaine at least once. Heroin is one of the least-often used of the well-known drugs. It has been used at least once by fewer than 1 American in 100. Most people who have taken illegal drugs have done so on an experimental basis. They typically try the drug once to a dozen times and then stop. Of all illegal drugs, marijuana is the one users are most likely to stick with and continue using. Even most regular users of illegal drugs are moderate in their use. The typical regular marijuana smoker is a casual, once-in-a-while user. Still, a sizable minority does use the drug frequently, to the point of abuse. With cocaine, even fewer users are heavy, chronic abusers. A pattern of episodic, regular use characterizes nearly all drug use for the purpose of recreation. This does not deny the problem of the heavy, chronic abuser of these drugs. Indeed, there are roughly a half a million heroin addicts in the United States alone. Drug Law Enforcement In 1970 the U.S. Congress passed the Comprehensive Drug Abuse Prevention and Control Act. Most of the states followed suit by basing their state legislation on the federal model. The Control Act distinguishes among several categories of drugs based on their abuse potential and their medical utility. Drugs that supposedly have a high potential for abuse and no currently accepted medical use, including heroin, \TLSD\t and the other hallucinogens, and marijuana, may be used legally only in a federally approved scientific research experiment. Because of their high abuse potential, these drugs are tightly controlled by federal and state laws. Such drugs as morphine, cocaine, methaqualone, the amphetamines, and short-acting barbiturates are also regarded as having great abuse potential, although they do have accepted medical use. Rigid prescription procedures are employed to maintain tight controls over their use. Such medically prescribed drugs as long-acting barbiturates and nonnarcotic painkillers are considered to have a lesser abuse potential, although they may lead to low physical dependence or high psychological dependence. These drugs have more relaxed controls, as do tranquilizers, such as Valium, and are classified as having low abuse potential. There has been a remarkable drop in the number of prescriptions written for psychoactive drugs from the 1970s to the 1980s. In the 1980s the prescription use of the short-acting barbiturates, for example, was only a quarter of what it was in the early 1970s. The prescription use of the amphetamines dropped by over half during this same period. Many other countries have also placed severe restrictions on the prescribing of drugs by doctors and have thus greatly reduced the frequency of amphetamine abuse. In Canada, Australia, and most Scandinavian countries, amphetamines are banned from use in medicine except in rare cases. While restricting psychoactive pharmaceuticals has brought about a reduction in the number of legal prescriptions written for them, the picture for illegal street drugs is far more complicated. The illicit use of barbiturates and other sedatives, methaqualone, and tranquilizers dropped significantly only between the early to the mid-1980s, lagging behind a decline in their legal prescription use by at least half a decade. The illegal use of stimulants, however, may be as high as it was a decade ago, at least in the high schools. The demand for drugs for illegal purposes remains high in spite of law-enforcement efforts. For example, between 1970 and 1977, the number of arrests on marijuana charges in the United States more than doubled, from 188,000 to 457,000. During this same period, however, the percentage of the American population who had ever used marijuana also doubled for most age categories. Arrest did not seem to deter marijuana use. Likewise, the number of arrests on the charge of narcotics possession and sale increased from 533,000 in 1980 to over 850,000 in 1988. Yet the use of heroin and the other narcotics held its own during this period, while the use of cocaine exploded. Nonetheless, in the face of mounting public concern, Congress passed strong new drug laws and enforcement measures, along with treatment and education programs, in 1986. Drug Testing in the Workplace Drinking on the job is a social and economic problem with a long history. With the growing popularity of illegal drugs in the 1960s and 1970s, it was to be expected that their use in the workplace would emerge as a major issue by the 1980s. Estimates of employee drug use vary greatly, ranging from 10 percent to 25 percent for the proportion of workers who use drugs occasionally on the job. The safe performance of some occupations--among them, airline pilot, air traffic controller, truck driver, and physician--can be compromised by drug use. In 1986, President Reagan's Commission on Organized Crime recommended that all U.S. companies routinely test their employees for drug use. The question of drug testing has become a major issue in American politics. Conservatives contend that the danger of drugs on the job is so great that everyone should be tested. Workers caught with traces of drugs in their bloodstream or urine should be fired or treated. In this way, they say, the incidence of drug use can be substantially reduced. Conservatives argue that the U.S. Constitution does not guarantee a pilot, for example, the right to risk the lives of hundreds of passengers. Liberals insist that the risk to individual rights (particularly to the freedom from unreasonable search guaranteed by the 4th Amendment) posed by indiscriminate and random testing makes the program unacceptable. The government has no right, they say, to invade the workplace and monitor the bodies of workers for the presence of drugs. Some drugs leave traces in the bloodstream for weeks after use. Moreover, the tests are not completely accurate or reliable. Some companies and government agencies have instituted drug testing programs for their employees. Drug testing is commonplace in the armed forces and is often cited as a major factor in reducing the use of drugs among military personnel. nonetheless, the practice of testing will never become universal for at least two reasons. First, with most jobs, an intoxicated worker is no more dangerous than a worker who is not under the influence, because the jobs themselves involve no hazard. Workers resent the intrusion of testing, particularly random testing. Although the U.S. Supreme Court ruled (1989) that the federal government could require drug-testing of both private and government employees whose work involved public safety or law enforcement, the question of the constitutionality of the random testing of most workers still remains. In addition, depending on the type of test used, a single urine test for the presence of drugs may cost $250 or more, a cost that would seem to prohibit large-scale testing programs. Treatment From the 1920s until the 1960s, treatment of drug abuse in the United States was practically nonexistent. During this period many officials did not believe that treatment was effective or necessary. The prevailing policy was punitive. Drug abusers and sellers were simply arrested and imprisoned, thereby discouraging use. The dramatic explosion in the use and abuse of a wide range of different drugs during the 1960s demonstrated the weakness of this theory. As a result, two treatment programs were developed during the 1960s. They were aimed mainly at narcotic, especially heroin, addiction. These programs are methadone maintenance and the therapeutic community. \Tmethadone\t is a synthetic narcotic and is used to combat narcotic addiction. Methadone is also addictive. The purpose of the program is to administer methadone to heroin addicts in a controlled setting, such as a hospital or a clinic. The drug is taken orally, usually dissolved in artificial orange juice. Taken this way, the addict does not get high. In addition, methadone blocks the action of narcotic drugs so that addicts cannot become high, even if they were to inject heroin. As a consequence, according to this treatment program's rationale, addicts will stop taking heroin. Although they will still be addicted to methadone, they can live a normal life, since their supply of methadone is steady and secure. There are no impurities in what they take, they only have to take methadone once a day, because it is a very slow-acting drug, and they do not get high. Because the program is inexpensive to administer, methadone has become a very popular form of treatment. Early studies on the effectiveness of the methadone treatment program were optimistic, showing a success, or cure, rate of more than 90 percent. These studies were flawed, however. Program directors had purposely selected addicts who were highly motivated to do well in the program; they had selected older addicts, many of whom discontinue narcotic addiction even without entering a treatment program; and they had not included in their results many of the patients who had dropped out of the program and returned to a life of addiction on the street. Later, more careful studies have shown that methadone maintenance is not the cure-all it was once thought to be. Improvement in the lives of addicts in the program tends to be very modest, and most addicts show little or no improvement at all. Addicts often use methadone programs to tide themselves over when heroin is difficult to obtain on the street. Unlike methadone maintenance, therapeutic communities (TCs), such as Daytop Village in New York and Walden House in San Francisco, advocate a completely drug- and alcohol-free existence. Addicts in therapeutic communities are live-in residents of the program. Most of the administrators in therapeutic communities are ex-addicts, who can best understand the thinking of the addict residents. The view of all TCs is that the addict is an immature, emotionally disturbed individual who uses drugs as a crutch. TCs attempt to resocialize the addict by inculcating a value system that is the opposite of that which prevailed on the street: no drugs, no deception, no stealing, and an emphasis on honesty, responsibility, and treating others as human beings rather than as objects to be exploited. Discipline in therapeutic communities is strict, penalties for breaking rules are severe, peer pressure is unrelenting, and the program assumes the role of a benevolent dictator. Because of the strictness of the program, many residents leave against the advice, and without the permission, of the staff. The therapeutic community is an effective program for a limited segment of the addict population, usually those who are young, come from a middle-class background, and are highly motivated to discontinue drug abuse. TCs are expensive programs to administer; there are far fewer patients in them than in methadone-maintenance programs. Erich Goode Bibliography: Abadinsky, Howard, Drug Abuse (1989); Arterburn, Stephen, Growing Up Addicted (1989); Bakalar, James B., and Grinspoon, Lester, D., Drug Control in a Free Society (1985); Garrett, R. C., et al., The Coke Book (1984); Gold, M. S., 800-Cocaine (1984); Goode, Erich, Drugs in American Society, 3rd ed. (1988); Grilly, David M., Drugs and Human Behavior (1989); Johnson, B. D., et al., Taking Care of Business: The Economics of Crime by Heroin Users (1985); MacGregor, Suzanne, Drugs and British Society: Responses to a Social Problem in the 1980s (1989); Musto, David F., The American Disease: Origins of Narcotic Control (1987); O'Brien, Robert, and Cohen, Sidney, The Encyclopedia of Drug Abuse (1984); Ray, Oakley, Drugs, Society, and Human Behavior, 3d ed. (1983); Sugarman, Barry, and Spindler, George, eds. Daytop Village: A Therapeutic Community (1983); Trebach, A. S., The Great Drug War (1987); Weil, Andrew, and Rosen, Winifred, Chocolate to Morphine: Understanding Mind-Active Drugs (1983);