drugs consumption essay

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The Effects of Drug Addiction on the Brain and Body

Signs of drug addiction, effects of drug addiction.

Drug addiction is a treatable, chronic medical disease that involves complex interactions between a person’s environment, brain circuits, genetics, and life experiences.

People with drug addictions continue to use drugs compulsively, despite the negative effects.

Substance abuse has many potential consequences, including overdose and death. Learn about the effects of drug addiction on the mind and body and treatment options that can help.

Verywell / Theresa Chiechi

Drug Abuse vs. Drug Addiction

While the terms “drug abuse” and “drug addiction” are often used interchangeably, they're different. Someone who abuses drugs uses a substance too much, too frequently, or in otherwise unhealthy ways. However, they ultimately have control over their substance use.

Someone with a drug addiction uses drugs in a way that affects many parts of their life and causes major disruptions. They can't stop using drugs, even if they want to.

The signs of drug abuse and addiction include changes in behavior, personality, and physical appearance. If you’re concerned about a loved one’s substance use, here are some of the red flags to watch out for:

• Changes in school or work performance
• Secretiveness 
• Relationship problems
• Risk-taking behavior
• Legal problems
• Aggression 
• Mood swings
• Changes in hobbies or friends
• Sudden weight loss or gain
• Unexplained odors on the body or clothing

Drug Addiction in Men and Women

Men and women are equally likely to develop drug addictions. However, men are more likely than women to use illicit drugs, die from a drug overdose, and visit an emergency room for addiction-related health reasons. Women are more susceptible to intense cravings and repeated relapses.

People can become addicted to any psychoactive ("mind-altering") substance. Common addictive substances include alcohol , tobacco ( nicotine ), stimulants, hallucinogens, and opioids .

Many of the effects of drug addiction are similar, no matter what substance someone uses. The following are some of the most common effects of drug addiction.

Effects of Drug Addiction on the Body

Drug addiction can lead to a variety of physical consequences ranging in seriousness from drowsiness to organ damage and death:

• Shallow breathing
• Elevated body temperature
• Rapid heart rate
• Increased blood pressure
• Impaired coordination and slurred speech
• Decreased or increased appetite
• Tooth decay
• Skin damage
• Sexual dysfunction
• Infertility
• Kidney damage
• Liver damage and cirrhosis
• Various forms of cancer
• Cardiovascular problems
• Lung problems
• Overdose and death

If left untreated drug addiction can lead to serious, life-altering effects on the body.

Dependence and withdrawal also affect the body:

• Physical dependence : Refers to the reliance on a substance to function day to day. People can become physically dependent on a substance fairly quickly. Dependence does not always mean someone is addicted, but the longer someone uses drugs, the more likely their dependency is to become an addiction.
• Withdrawal : When someone with a dependence stops using a drug, they can experience withdrawal symptoms like excessive sweating, tremors, panic, difficulty breathing, fatigue , irritability, and flu-like symptoms.

Overdose Deaths in the United States

According to the Centers for Disease Control and Prevention (CDC), over 100,000 people in the U.S. died from a drug overdose in 2021.

Effects of Drug Addiction on the Brain

All basic functions in the body are regulated by the brain. But, more than that, your brain is who you are. It controls how you interpret and respond to life experiences and the ways you behave as a result of undergoing those experiences.

Drugs alter important areas of the brain. When someone continues to use drugs, their health can deteriorate both psychologically and neurologically.

Some of the most common mental effects of drug addiction are:

• Cognitive decline
• Memory loss
• Mood changes and paranoia
• Poor self/impulse control
• Disruption to areas of the brain controlling basic functions (heart rate, breathing, sleep, etc.)

Effects of Drug Addiction on Behavior

Psychoactive substances affect the parts of the brain that involve reward, pleasure, and risk. They produce a sense of euphoria and well-being by flooding the brain with dopamine .

This leads people to compulsively use drugs in search of another euphoric “high.” The consequences of these neurological changes can be either temporary or permanent. 

• Difficulty concentrating
• Irritability 
• Angry outbursts
• Lack of inhibition 
• Decreased pleasure/enjoyment in daily life (e.g., eating, socializing, and sex)
• Hallucinations

Help Someone With Drug Addiction

If you suspect that a loved one is experiencing drug addiction, address your concerns honestly, non-confrontationally, and without judgment. Focus on building trust and maintaining an open line of communication while setting healthy boundaries to keep yourself and others safe. If you need help, contact the SAMHSA National Helpline at 1-800-662-4357.

Effects of Drug Addiction on an Unborn Child

Drug addiction during pregnancy can cause serious negative outcomes for both mother and child, including:

• Preterm birth
• Maternal mortality

Drug addiction during pregnancy can lead to neonatal abstinence syndrome (NAS) . Essentially, the baby goes into withdrawal after birth. Symptoms of NAS differ depending on which drug has been used but can include:

• Excessive crying
• Sleeping and feeding issues

Children exposed to drugs before birth may go on to develop issues with behavior, attention, and thinking. It's unclear whether prenatal drug exposure continues to affect behavior and the brain beyond adolescence.  

While there is no single “cure” for drug addiction, there are ways to treat it. Treatment can help you control your addiction and stay drug-free. The primary methods of treating drug addiction include:

• Psychotherapy : Psychotherapy, such as cognitive behavioral therapy (CBT) or family therapy , can help someone with a drug addiction develop healthier ways of thinking and behaving.
• Behavioral therapy : Common behavioral therapies for drug addiction include motivational enhancement therapy (MET) and contingency management (CM). These therapy approaches build coping skills and provide positive reinforcement.
• Medication : Certain prescribed medications help to ease withdrawal symptoms. Some examples are naltrexone (for alcohol), bupropion (for nicotine), and methadone (for opioids).
• Hospitalization : Some people with drug addiction might need to be hospitalized to detox from a substance before beginning long-term treatment.
• Support groups : Peer support and self-help groups, such as 12-step programs like Alcoholics Anonymous, can help people with drug addictions find support, resources, and accountability.

A combination of medication and behavioral therapy has been found to have the highest success rates in preventing relapse and promoting recovery. Forming an individualized treatment plan with your healthcare provider's help is likely to be the most effective approach.

Drug addiction is a complex, chronic medical disease that causes someone to compulsively use psychoactive substances despite the negative consequences.

Some effects of drug abuse and addiction include changes in appetite, mood, and sleep patterns. More serious health issues such as cognitive decline, major organ damage, overdose, and death are also risks. Addiction to drugs while pregnant can lead to serious outcomes for both mother and child.

Treatment for drug addiction may involve psychotherapy , medication, hospitalization, support groups, or a combination.

If you or someone you know is experiencing substance abuse or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357.

American Society of Addiction Medicine. Definition of addiction .

HelpGuide.org. Drug Abuse and Addiction .

Tennessee Department of Mental Health & Substance Abuse Services. Warning signs of drug abuse .

National Institute on Drug Abuse. Sex and gender differences in substance use .

Cleveland Clinic. Drug addiction .

National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction Drugs and the Brain .

American Heart Association. Illegal Drugs and Heart Disease .

American Addiction Centers. Get the facts on substance abuse .

Szalavitz M, Rigg KK, Wakeman SE. Drug dependence is not addiction-and it matters . Ann Med . 2021;53(1):1989-1992. doi:10.1080/07853890.2021.1995623

Centers for Disease Control and Prevention. Drug overdose deaths in the U.S. top 100,000 annually .

American Psychological Association. Cognition is central to drug addiction .

National Institute on Drug Abuse. Understanding Drug Use and Addiction DrugFacts .

MedlinePlus. Neonatal abstinence syndrome .

National Institute on Drug Abuse. Treatment and recovery .

Grella CE, Stein JA.  Remission from substance dependence: differences between individuals in a general population longitudinal survey who do and do not seek help . Drug and Alcohol Dependence.  2013;133(1):146-153. doi:10.1016/j.drugalcdep.2013.05.019

By Laura Dorwart Dr. Dorwart has a Ph.D. from UC San Diego and is a health journalist interested in mental health, pregnancy, and disability rights.

Drug and Substance Abuse Essay

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Introduction

Physiology and psychology of addiction, prescription drug abuse, depressants, hallucinogens.

Drug and substance abuse is an issue that affects entirely all societies in the world. It has both social and economic consequences, which affect directly and indirectly our everyday live. Drug addiction is “a complex disorder characterized by compulsive drug use” (National Institute on Drug Abuse, 2010).

It sets in as one form a habit of taking a certain drug. Full-blown drug abuse comes with social problems such as violence, child abuse, homelessness and destruction of families (National Institute on Drug Abuse, 2010). To understand to the impact of drug abuse, one needs to explore the reasons why many get addicted and seem unable pull themselves out of this nightmare.

Many experts consider addiction as a disease as it affects a specific part of the brain; the limbic system commonly referred to as the pleasure center. This area, which experts argue to be primitive, is affected by various drug substances, which it gives a higher priority to other things. Peele (1998) argues that alcoholism is a disease that can only be cured from such a perspective (p. 60). Genetics are also seen as a factor in drug addiction even though it has never been exclusively proven.

Other experts view addiction as a state of mind rather than a physiological problem. The environment plays a major role in early stages of addiction. It introduces the agent, in this case the drug, to the abuser who knowingly or otherwise develops dependence to the substance. Environmental factors range from violence, stress to peer pressure.

Moreover, as an individual becomes completely dependent on a substance, any slight withdrawal is bound to be accompanied by symptoms such as pain, which is purely psychological. This is because the victim is under self-deception that survival without the substance in question is almost if not impossible. From his psychological vantage point, Isralowitz (2004) argues that freedom from addiction is achievable provided there is the “right type of guidance and counseling” (p.22).

A doctor as regulated by law usually administers prescription drugs. It may not be certain why many people abuse prescription drugs but the trend is ever increasing. Many people use prescription drugs as directed by a physician but others use purely for leisure. This kind of abuse eventually leads to addiction.

This problem is compounded by the ease of which one can access the drugs from pharmacies and even online. Many people with conditions requiring painkillers, especially the elderly, have a higher risk of getting addicted as their bodies become tolerant to the drugs. Adolescents usually use some prescription drugs and especially painkillers since they induce anxiety among other feelings as will be discussed below.

Stimulants are generally psychoactive drugs used medically to improve alertness, increase physical activity, and elevate blood pressure among other functions. This class of drugs acts by temporarily increasing mental activity resulting to increased awareness, changes in mood and apparently cause the user to have a relaxed feeling. Although their use is closely monitored, they still find their way on the streets and are usually abused.

Getting deeper into the biochemistry of different stimulants, each has a different metabolism in the body affecting different body organs in a specific way. One common thing about stimulants is that they affect the central nervous system in their mechanism. Examples of commonly used stimulants include; cocaine, caffeine, nicotine, amphetamines and cannabis. Cocaine, which has a tremendously high addictive potential, was in the past used as anesthetic and in treatment of depression before its profound effects were later discovered.

On the streets, cocaine is either injected intravenously or smoked. Within a few minutes of use, it stimulates the brain making the user feel euphoric, energetic and increases alertness. It has long-term effects such as seizures, heart attacks and stroke. Cocaine’s withdrawal symptoms range from anxiety, irritability to a strong craving for more cocaine.

Cannabis, also known as marijuana , is the most often abused drug familiar in almost every corner of the world, from the streets of New York to the most remote village in Africa. Although its addiction potential is lower as compared to that of cocaine, prolonged use of cannabis results to an immense craving for more.

It produces hallucinogenic effects, lack of body coordination, and causes a feeling of ecstasy. Long-term use is closely associated with schizophrenia, and other psychological conditions. From a medical perspective, cannabis is used as an analgesic, to stimulate hunger in patients, nausea ameliorator, and intraocular eye pressure reducer. Insomnia, lack of appetite, migraines, restlessness and irritability characterize withdrawal symptoms of cannabis.

Unlike stimulants, depressants reduce anxiety and the central nervous system activity. The most common depressants include barbiturates, benzodiazepines and ethyl alcohol. They are of great therapeutically value especially as tranquilizers or sedatives in reducing anxiety.

Depressants can be highly addictive since they seem to ease tension and bring relaxation. After using depressants for a long time, the body develops tolerance to the drugs. Moreover, body tolerance after continual use requires one use a higher dose to get the same effect. Clumsiness, confusion and a strong craving for the drug accompany gradual withdrawal. Sudden withdrawal causes respiratory complications and can even be fatal.

Narcotics have been used for ages for various ailments and as a pain reliever pain. They are also characterized by their ability to induce sleep and euphoria. Opium, for instance was used in ancient China as a pain reliever and treatment of dysentery and insomnia. Some narcotics such as morphine and codeine are derived from natural sources.

Others are structural analogs to morphine and these include heroin, oxymorphone among others. Narcotics are highly addictive resulting to their strict regulation by a majority of governments. Narcotics act as painkillers once they enter the body.

They are used legally in combination with other drugs as analgesics and antitussives but are abused due to their ability to induce a feeling of well being. Their addiction potential is exceptionally high due to the body’s tolerance after consistent use, forcing the user to use and crave for more to get satisfaction. Increase in respiration rate, diarrhea, anxiety, nausea and lack of appetite are symptoms common to narcotic withdrawal. Others include; running nose, stomach cramps, muscle pains and a strong craving for the drugs.

Hallucinogens affect a person’s thinking capacity causing illusions and behavioral changes especially in moods. They apparently cause someone to hear sounds and see images that do not exist. Lysergic acid diethylamide (LSD), which commonly abused hallucinogen, has a low addiction potential because it does not have withdrawal effects. They also affect a person’s sexual behavior and other body functions such as body temperature. There are no outright withdrawal symptoms for hallucinogens.

Isralowitz, R. (2004). Drug use: a reference handbook . Santa Barbara, Clif.: ABC-CLIO. Print.

National Institute on Drug Abuse. (2010). NIDA INfoFacts: Understanding Drug Abuse and Addiction . Web.

Peele, S. (1998). The meaning of Addiction : Compulsive Experience and its Interpretation . San Francisco: Jossey-Bass.

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• Analysis of the Video “Effects of Alcoholism on Children: An Oral History Video”
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• Chicago (A-D)
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IvyPanda. (2018, July 19). Drug and Substance Abuse. https://ivypanda.com/essays/drug-and-substance-abuse/

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IvyPanda . 2018. "Drug and Substance Abuse." July 19, 2018. https://ivypanda.com/essays/drug-and-substance-abuse/.

1. IvyPanda . "Drug and Substance Abuse." July 19, 2018. https://ivypanda.com/essays/drug-and-substance-abuse/.

Bibliography

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Essay on Drug Abuse in 250 and 500 Words in English for Students

• Updated on  
• Apr 2, 2024

Drug abuse refers to the excessive and frequent consumption of drugs. Drug abuse can have several harmful effects on our mental and physical health. Ronald Reagan, the 40th President of the USA, passed the Anti-Drug Abuse Act of 1986 and initiated the War on Drugs . He said, ‘Let us not forget who we are. Drug abuse is a repudiation of everything America is.’

Consuming drugs not only harms the individual himself but also affects society as a whole. Studies have shown that people who consume drugs become addicted to it. This addiction turns into substance abuse, resulting in self-damage, behaviour changes, mood swings, unnecessary weight loss, and several other health problems. Let’s understand what drug abuse is and how to fight it.

Table of Contents

• 1 Essay on Drug Abuse in 250 Words
• 2.1 Why Do People Consume Drugs?
• 2.2 Why Is Drug Abuse Bad?
• 2.3 Laws in India Against Drug Consumption
• 2.4 Steps to Prevent Drug Addiction
• 2.5 Conclusion
• 3 10 Lines Essay on Drug Abuse

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Essay on Drug Abuse in 250 Words

‘When people consume drugs regularly and become addicted to it, it is known as drug abuse. In medical terminology, drugs means medicines. However, the consumption of drugs is for non-medical purposes. It involves the consumption of substances in illegal and harmful ways, such as swallowing, inhaling, or injecting. When drugs are consumed, they are mixed into our bloodstream, affecting our neural system and brain functioning.

The Indian government has taken significant steps to help reduce the consumption of drugs. In 1985, the Narcotics Drugs and Psychotropic Substances Act came into force. This act replaced the Opium Act of 1857, the Opium Act of 1878, and the Dangerous Drugs Act of 1930. 

Drug abuse can lead to addiction, where a person becomes physically or psychologically dependent on the substance and experiences withdrawal symptoms when attempting to stop using it. 

Drug abuse can have serious consequences for the individual and society as a whole. On an individual level, drugs can damage physical health, including organ damage, infectious diseases, and overdose fatalities. Not only this, a person already suffering from mental health disorders will face more harmful aftereffects. Addiction disrupts our cognitive functioning and impairs our decision-making abilities.

To fight drug abuse, we need collective action from all sections of society. Medical professionals say that early intervention and screening programmes can identify individuals at risk of substance misuse and provide them with the necessary support services. Educating people, especially those who are at-risk, about drug abuse and its harmful effects can significantly help reduce their consumption.

Drug abuse is serious and it must be addressed. Drug abuse is killing youth and society. Therefore, it is an urgent topic to address, and only through sustainable and collective efforts can we address this problem.

Quick Read: Success in Life Speech

Essay on Drug Abuse in 500 Words

Drug abuse is known as frequent consumption. In time, these people become dependent on drugs for several reasons. Curiosity drives adolescents and teenagers, who are among the most susceptible groups in our society. Cocaine, marijuana, methamphetamine, heroin, etc. are some of the popular drugs consumed. 

Why Do People Consume Drugs?

The very first question about drugs is: why do people consume drugs? Studies have shown that more than 50% of drug addicts consider drugs as a coping mechanism to alleviate emotional or psychological distress. In the beginning, drugs temporarily relieve feelings of anxiety, depression, or trauma, providing a temporary escape from difficult emotions or life circumstances. 

Some consume drugs out of curiosity, some under peer pressure, and some want to escape the painful experiences. Some people enjoy the effects drugs produce, such as euphoria, relaxation, and altered perceptions. Recreational drug use may occur in social settings or as a form of self-medication for stress relief or relaxation.

Why Is Drug Abuse Bad?

The National Institute on Drug Abuse states that drugs can worsen our eyesight and body movement, our physical growth, etc. Marijuana, one of the most popular drugs, can slow down our reaction time, affecting our time and distance judgement and decreasing coordination. Cocaine and Methamphetamine can make the consumer aggressive and careless.

Our brain is the first victim of drugs. Drugs can disorder our body in several ways, from damaging organs to messing with our brains. Drugs easily get mixed into our bloodstream, and affect our neural system. Prolonged and excessive consumption of drugs significantly harms our brain functioning.

The next target of drug abuse is our physical health and relationships. Drugs can damage our vital organs, such as the liver, heart, lungs, and brain. For example, heavy alcohol use can lead to cirrhosis of the liver, while cocaine use can increase the risk of heart attack and stroke.

Laws in India Against Drug Consumption

Here is an interesting thing; the USA has the highest number of drug addicts and also has strict laws against drug consumption. According to a report by the Narcotics Control Bureau, around 9 million people in India consume different types of drugs. The Indian government has implemented certain laws against drug consumption and production.

The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS), prohibits the production, sale, purchase, and consumption of narcotics and other illegal substances, except for scientific and medical purposes.

Also, Article 47 of the Indian Constitution states that ‘ The State shall endeavour to bring about prohibition of the consumption, except for medicinal purposes, of intoxicating drinks and drugs which are injurious to health.’

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Steps to Prevent Drug Addiction

Several steps can be taken to prevent drug addiction. But before we start our ‘War on Drugs’ , it is crucial to understand the trigger point. Our social environment, mental health issues and sometimes genetic factors can play a role in drug abuse.

• Education and awareness are the primary weapons in the fight against drugs. 
• Keeping distance from people and places addicted to drugs.
• Encourage a healthy and active lifestyle and indulge in physical workouts.
• Watch motivating videos and listen to sound music.
• Self-motivate yourself to stop consuming drugs.
• Talk to a medical professional or a psychiatrist, who will guide you to the right path.

Drug abuse is a serious problem. The excessive and frequent consumption of drugs not only harms the individual but also affects society as a whole. Only a collective approach from lawmakers, healthcare professionals, educators, community leaders, and individuals themselves can combat drug abuse effectively. 

Quick Read: Speech About Life

10 Lines Essay on Drug Abuse

Here is a 10-line essay on drug abuse.

• Drug abuse can significantly affect our physical growth
• Drug abuse can affect our mental functioning.
• Drug abuse may provide instant pleasure, but inside, it weakens our willpower and physical strength.
• Educating people, especially those who are at-risk, about drug abuse and its harmful effects can significantly help reduce their consumption.
•  Drugs easily get mixed into our bloodstream, and affect our neural system. 
• Prolonged and excessive consumption of drugs significantly harms our brain functioning.
• In 1985, the Narcotics Drugs and Psychotropic Substances Act came into force.
• The USA has the highest number of drug addicts and also has strict laws against drug consumption.
• Drug addicts consider drugs as a coping mechanism to alleviate emotional or psychological distress.
•  Adolescents and teenagers are the most vulnerable section of our society and are driven by curiosity.

Ans: Drug abuse refers to the excessive and frequent consumption of drugs. Drug abuse can have several harmful effects on our mental and physical health.

Ans: ‘When people consume drugs regularly and become addicted to it, it is known as drug abuse. In medical terminology, drugs means medicines. However, the consumption of drugs is for non-medical purposes. It involves the consumption of substances in illegal and harmful ways, such as swallowing, inhaling, or injecting. When drugs are consumed, they are mixed into our bloodstream, affecting our neural system and brain functioning.

Ans: Drug abuse is known as frequent consumption. In time, these people become dependent on drugs for several reasons. Adolescents and teenagers are the most vulnerable section of our society who are driven by curiosity. Cocaine, marijuana, methamphetamine, heroin, etc. are some of the popular drugs consumed.  The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS), prohibits the production, sale, purchase, and consumption of narcotics and other illegal substances, except for scientific and medical purposes.

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Understanding reasons for drug use amongst young people: a functional perspective

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Annabel Boys, John Marsden, John Strang, Understanding reasons for drug use amongst young people: a functional perspective, Health Education Research , Volume 16, Issue 4, August 2001, Pages 457–469, https://doi.org/10.1093/her/16.4.457

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This study uses a functional perspective to examine the reasons young people cite for using psychoactive substances. The study sample comprised 364 young poly-drug users recruited using snowball-sampling methods. Data on lifetime and recent frequency and intensity of use for alcohol, cannabis, amphetamines, ecstasy, LSD and cocaine are presented. A majority of the participants had used at least one of these six drugs to fulfil 11 of 18 measured substance use functions. The most popular functions for use were using to: relax (96.7%), become intoxicated (96.4%), keep awake at night while socializing (95.9%), enhance an activity (88.5%) and alleviate depressed mood (86.8%). Substance use functions were found to differ by age and gender. Recognition of the functions fulfilled by substance use should help health educators and prevention strategists to make health messages about drugs more relevant and appropriate to general and specific audiences. Targeting substances that are perceived to fulfil similar functions and addressing issues concerning the substitution of one substance for another may also strengthen education and prevention efforts.

The use of illicit psychoactive substances is not a minority activity amongst young people in the UK. Results from the most recent British Crime Survey show that some 50% of young people between the ages of 16 and 24 years have used an illicit drug on at least one occasion in their lives (lifetime prevalence) ( Ramsay and Partridge, 1999 ). Amongst 16–19 and 20–24 year olds the most prevalent drug is cannabis (used by 40% of 16–19 year olds and 47% of 20–24 year olds), followed by amphetamine sulphate (18 and 24% of the two age groups respectively), LSD (10 and 13%) and ecstasy (8 and 12%). The lifetime prevalence for cocaine hydrochloride (powder cocaine) use amongst the two age groups is 3 and 9%, respectively. Collectively, these estimates are generally comparable with other European countries ( European Monitoring Centre for Drugs and Drug Addiction, 1998 ) and the US ( Johnston et al ., 1997 , 2000 ).

The widespread concern about the use of illicit drugs is reflected by its high status on health, educational and political agendas in many countries. The UK Government's 10-year national strategy on drug misuse identifies young people as a critical priority group for prevention and treatment interventions ( Tackling Drugs to Build a Better Britain 1998 ). If strategies to reduce the use of drugs and associated harms amongst the younger population are to be developed, particularly within the health education arena, it is vital that we improve our understanding of the roles that both licit and illicit substances play in the lives of young people. The tendency for educators, practitioners and policy makers to address licit drugs (such as alcohol) separately from illegal drugs may be unhelpful. This is partly because young illicit drug users frequently drink alcohol, and may have little regard for the illicit and licit distinction established by the law. To understand the roles that drug and alcohol use play in contemporary youth culture, it is necessary to examine the most frequently used psychoactive substances as a set.

It is commonplace for young drug users to use several different psychoactive substances. The terms `poly-drug' or `multiple drug' use have been used to describe this behaviour although their exact definitions vary. The term `poly-drug use' is often used to describe the use of two or more drugs during a particular time period (e.g. over the last month or year). This is the definition used within the current paper. However, poly-drug use could also characterize the use of two or more psychoactive substances so that their effects are experienced simultaneously. We have used the term `concurrent drug use' to denote this pattern of potentially more risky and harmful drug use ( Boys et al. 2000a ). Previous studies have reported that users often use drugs concurrently to improve the effects of another drug or to help manage its negative effects [e.g. ( Power et al ., 1996 ; Boys et al. 2000a ; Wibberley and Price, 2000 )].

The most recent British Crime Survey found that 5% of 16–29 year olds had used more than one drug in the last month ( Ramsay and Partridge, 1999 ). Given that 16% of this age band reported drug use in the month prior to interview, this suggests that just under a third of these individuals had used more than one illicit substance during this time period. With alcohol included, the prevalence of poly-drug use is likely to be much higher.

There is a substantial body of literature on the reasons or motivations that people cite for using alcohol, particularly amongst adult populations. For example, research on heavy drinkers suggested that alcohol use is related to multiple functions for use ( Edwards et al ., 1972 ; Sadava, 1975 ). Similarly, research with a focus on young people has sought to identify motives for illicit drug use. There is evidence that for many young people, the decision to use a drug is based on a rational appraisal process, rather than a passive reaction to the context in which a substance is available ( Boys et al. 2000a ; Wibberley and Price, 2000 ). Reported reasons vary from quite broad statements (e.g. to feel better) to more specific functions for use (e.g. to increase self-confidence). However, much of this literature focuses on `drugs' as a generic concept and makes little distinction between different types of illicit substances [e.g. ( Carman, 1979 ; Butler et al ., 1981 ; Newcomb et al ., 1988 ; Cato, 1992 ; McKay et al ., 1992 )]. Given the diverse effects that different drugs have on the user, it might be proposed that reasons for use will closely mirror these differences. Thus stimulant drugs (such as amphetamines, ecstasy or cocaine) will be used for reasons relating to increased nervous system arousal and drugs with sedative effects (such as alcohol or cannabis), with nervous system depression. The present study therefore selected a range of drugs commonly used by young people with stimulant, sedative or hallucinogenic effects to examine this issue further.

The phrase `instrumental drug use' has been used to denote drug use for reasons specifically linked to a drug's effects ( WHO, 1997 ). Examples of the instrumental use of amphetamine-type stimulants include vehicle drivers who report using to improve concentration and relieve tiredness, and people who want to lose weight (particularly young women), using these drugs to curb their appetite. However, the term `instrumental substance use' seems to be used when specific physical effects of a drug are exploited and does not encompass use for more subtle social or psychological purposes which may also be cited by users. In recent reports we have described a `drug use functions' model to help understand poly-substance use phenomenology amongst young people and how decisions are made about patterns of consumption ( Boys et al ., 1999a , b , 2000a ). The term `function' is intended to characterize the primary or multiple reasons for, or purpose served by, the use of a particular substance in terms of the actual gains that the user perceives that they will attain. In the early, 1970s Sadava suggested that functions were a useful means of understanding how personality and environmental variables impacted on patterns of drug use ( Sadava, 1975 ). This work was confined to functions for cannabis and `psychedelic drugs' amongst a sample of college students. To date there has been little research that has examined the different functions associated with the range of psychoactive substances commonly used by young poly-drug users. It is unclear if all drugs with similar physical effects are used for similar purposes, or if other more subtle social or psychological dimensions to use are influential. Work in this area will help to increase understanding of the different roles played by psychoactive substances in the lives of young people, and thus facilitate health, educational and policy responses to this issue.

Previous work has suggested that the perceived functions served by the use of a drug predict the likelihood of future consumption ( Boys et al ., 1999a ). The present study aims to develop this work further by examining the functional profiles of six substances commonly used by young people in the UK.

Patterns of cannabis, amphetamine, ecstasy, LSD, cocaine hydrochloride and alcohol use were examined amongst a sample of young poly-drug users. Tobacco use was not addressed in the present research.

Sampling and recruitment

A snowball-sampling approach was employed for recruitment of participants. Snowball sampling is an effective way of generating a large sample from a hidden population where no formal sampling frame is available ( Van Meter, 1990 ). A team of peer interviewers was trained to recruit and interview participants for the study. We have described this procedure in detail elsewhere and only essential features are described here ( Boys et al. 2000b ). Using current or ex-drug users to gather data from hidden populations of drug using adults has been found to be successful ( Griffiths et al ., 1993 ; Power, 1995 ).

Study participants

Study participants were current poly-substance users with no history of treatment for substance-related disorders. We excluded people with a treatment history on the assumption that young people who have had substance-related problems requiring treatment represent a different group from the general population of young drug users. Inclusion criteria were: aged 16–22 years and having used two or more illegal substances during the past 90 days. During data collection, the age, gender and current occupation of participants were recorded and monitored to ensure that sufficient individuals were recruited to the groups to permit subgroup analyses. If an imbalance was observed in one of these variables, the interviewers were instructed to target participants with specific characteristics (e.g. females under the age of 18) to redress this imbalance.

Study measures

Data were collected using a structured interviewer-administered questionnaire developed specifically for the study. In addition to recording lifetime substance use, questions profiled consumption patterns of six substances in detail. Data were collected between August and November 1998. Interviews were audiotaped with the interviewee's consent. This enabled research staff to verify that answers had been accurately recorded on the questionnaire and that the interview had been conducted in accordance with the research protocol. Research staff also checked for consistency across different question items (e.g. the total number of days of drug use in the past 90 days should equal or exceed the number of days of cannabis use during the same time period). On the few occasions where inconsistencies were identified that could not be corrected from the tape, the interviewer was asked to re-contact the interviewee to verify the data.

Measures of lifetime use, consumption in the past year and past 90 days were based on procedures developed by Marsden et al . ( Marsden et al ., 1998 ). Estimated intensity of consumption (amount used on a typical using day) was recorded verbatim and then translated into standardized units at the data entry stage.

Functions for substance use scale

The questionnaire included a 17-item scale designed to measure perceived functions for substance use. This scale consisted of items developed in previous work ( Boys et al ., 1999a ) in addition to functions derived from qualitative interviews ( Boys et al ., 1999b ), new literature and informal discussions with young drug users. Items were drawn from five domains (Table I ).

Participants were asked if they had ever used a particular drug in order to fulfil each specific function. Those who endorsed the item were then invited to rate how frequently they had used it for this purpose over the past year, using a five-point Likert-type scale (`never' to `always'; coded 0–4). One item differed between the function scales used for the stimulant drugs and for alcohol and cannabis. For the stimulant drugs (amphetamines, cocaine and ecstasy) the item `have you ever used [named drug] to help you to lose weight' was used, for cannabis and alcohol this item was replaced with `have you ever used [drug] to help you to sleep?'. (The items written in full as they appeared in the questionnaire are shown in Table III , together with abbreviations used in this paper.)

Statistical procedures

The internal reliability of the substance use functions scales for each of the six substances was judged using Chronbach's α coefficient. Chronbach's α is a statistic that reflects the extent to which each item in a measurement scale is associated with other items. Technically it is the average of correlations between all possible comparisons of the scale items that are divided into two halves. An α coefficient for a scale can range from 0 (no internal reliability) to 1 (complete reliability). Analyses of categorical variables were performed using χ 2 statistic. Differences in scale means were assessed using t -tests.

The sample consisted of 364 young poly-substance users (205 males; 56.3%) with a mean age of 19.3 years; 69.8% described their ethnic group as White-European, 12.6% as Black and 10.1% were Asian. Just over a quarter (27.5%) were unemployed at the time of interview; a third were in education, 28.8% were in full-time work and the remainder had part-time employment. Estimates of monthly disposable income (any money that was spare after paying for rent, bills and food) ranged from 0 to over £1000 (median = £250).

Substance use history

The drug with the highest lifetime prevalence was cannabis (96.2%). This was followed by amphetamine sulphate (51.6%), cocaine hydrochloride (50.5%) (referred to as cocaine hereafter) and ecstasy (48.6%). Twenty-five percent of the sample had used LSD and this was more common amongst male participants (χ 2 [1] = 9.68, P < 0.01). Other drugs used included crack cocaine (25.5%), heroin (12.6%), tranquillizers (21.7%) and hallucinogenic mushrooms (8.0%). On average, participants had used a total of 5.2 different psychoactive substances in their lives (out of a possible 14) (median = 4.0, mode = 3.0, range 2–14). There was no gender difference in the number of different drugs ever used.

Table II profiles use of the six target drugs over the past year, and the frequency and intensity of use in the 90 days prior to interview.

There were no gender differences in drug use over the past year or in the past 90 days with the exception of amphetamines. For this substance, females who had ever used this drug were more likely to have done so during the past 90 days than males (χ 2 [1] = 4.14, P < 0.05). The mean number of target drugs used over the past 90 days was 3.2 (median = 3.0, mode = 3.0, range 2–6). No gender differences were observed. Few differences were also observed in the frequency and intensity of use. Males reported drinking alcohol more frequently during the three months prior to interview ( t [307] = 2.48, P < 0.05) and using cannabis more intensively on a `typical using day' ( t [337] = 3.56, P < 0.001).

Perceived functions for substance use

There were few differences between the functions endorsed for use of each drug `ever' and those endorsed for use during `the year prior to interview'. This section therefore concentrates on data for the year prior to interview. We considered that in order to use a drug for a specific function, the user must have first hand knowledge of the drug's effects before making this decision. Consequently, functions reported by individuals who had only used a particular substance on one occasion in their lives (i.e. with no prior experience of the drug at the time they made the decision to take it) were excluded from the analyses. Table III summarizes the proportion of the sample who endorsed each of the functions for drugs used in the past year. Roman numerals have been used to indicate the functions with the top five average scores. Table III also shows means for the total number of different items endorsed by individual users and the internal reliability of the function scales for each substance using Chronbach's α coefficients. There were no significant gender differences in the total number of functions endorsed for any of the six substances.

The following sections summarize the top five most popular functions drug-by-drug together with any age or gender differences observed in the items endorsed.

Cannabis use ( n = 345)

Overall the most popular functions for cannabis use were to `RELAX' (endorsed by 96.8% of people who had used the drug in the last year), to become `INTOXICATED' (90.7%) and to `ENHANCE ACTIVITY' (72.8%). Cannabis was also commonly used to `DECREASE BOREDOM' (70.1%) and to `SLEEP' (69.6%) [this item was closely followed by using to help `FEEL BETTER' (69.0%)]. Nine of the 17 function items were endorsed by over half of those who had used cannabis on more than one occasion in the past year. There were no significant gender differences observed, with the exception of using to `KEEP GOING', where male participants were significantly more likely to say that they had used cannabis to fulfil this function in the past year (χ 2 [1] = 6.10, P < 0.05).

There were statistically significant age differences on four of the function variables: cannabis users who reported using this drug in the past year to help feel `ELATED/EUPHORIC' or to help `SLEEP' were significantly older than those who had not used cannabis for these purposes (19.6 versus 19.0; t [343] = 3.32, P < 0.001; 19.4 versus 19.0; t [343] = 2.01, P < 0.05). In contrast, those who had used cannabis to `INCREASE CONFIDENCE' and to `STOP WORRYING' tended to be younger than those who did not (19.0 versus 19.4; t [343] = –2.26, P < 0.05; 19.1 versus 19.5; t [343] = –1.99, P < 0.05).

Amphetamines ( n = 160)

Common functions for amphetamine use were to `KEEP GOING' (95.6%), to `STAY AWAKE' (91.3%) or to `ENHANCE ACTIVITY' (66.2%). Using to help feel `ELATED/EUPHORIC' (60.6%) and to `ENJOY COMPANY' (58.1%) were also frequently mentioned. Seven of the 17 function items were endorsed by over half of participants who had used amphetamines in the past year. As with cannabis, gender differences were uncommon: females were more likely to use amphetamines to help `LOSE WEIGHT' than male participants (χ 2 [1] = 21.67, P < 0.001).

Significant age differences were found on four function variables. Individuals who reported using amphetamines in the past year to feel `ELATED/EUPHORIC' were significantly older than those who did not (19.9 versus 19.0; t [158] = 2.87, P < 0.01). In contrast, participants who used amphetamines to `STOP WORRYING' (18.8 versus 19.8; t [158] = –2.77, P < 0.01), to `DECREASE BOREDOM' (19.2 versus 19.9; t [158] = –2.39, P < 0.05) or to `ENHANCE ACTIVITY' (19.3 versus 20.1; t [158] = –2.88, P < 0.01) were younger than those who had not.

Ecstasy ( n = 157)

The most popular five functions for using ecstasy were similar to those for amphetamines. The drug was used to `KEEP GOING' (91.1%), to `ENHANCE ACTIVITY' (79.6%), to feel `ELATED/EUPHORIC' (77.7%), to `STAY AWAKE' (72.0%) and to get `INTOXICATED' (68.2%). Seven of the 17 function items were endorsed by over half of those who had used ecstasy in the past year. Female users were more likely to use ecstasy to help `LOSE WEIGHT' than male participants (Fishers exact test, P < 0.001).

As with the other drugs discussed above, participants who reported using ecstasy to feel `ELATED/EUPHORIC' were significantly older than those who did not (19.8 versus 18.9; t [155] = 2.61, P < 0.01). In contrast, those who had used ecstasy to `FEEL BETTER' (19.3 versus 20.0; t [155] = –2.29, P < 0.05), to `INCREASE CONFIDENCE' (19.2 versus 19.9; t [155] = –2.22, P < 0.05) and to `STOP WORRYING' (19.0 versus 19.9; t [155] = –2.96, P < 0.01) tended to be younger.

LSD ( n = 58)

Of the six target substances examined in this study, LSD was associated with the least diverse range of functions for use. All but two of the function statements were endorsed by at least some users, but only five were reported by more than 50%. The most common purpose for consuming LSD was to get `INTOXICATED' (77.6%). Other popular functions included to feel `ELATED/EUPHORIC' and to `ENHANCE ACTIVITY' (both endorsed by 72.4%), and to `KEEP GOING' and to `ENJOY COMPANY' (both endorsed by 58.6%). Unlike the other substances examined, no gender or age differences were observed.

Cocaine ( n = 168)

In common with ecstasy and amphetamines, the most widely endorsed functions for cocaine use were to help `KEEP GOING' (84.5%) and to help `STAY AWAKE' (69.0%). Consuming cocaine to `INCREASE CONFIDENCE' and to get `INTOXICATED' (both endorsed by 66.1%) were also popular. However, unlike the other stimulant drugs, 61.9% of the cocaine users reported using to `FEEL BETTER'. Ten of the 17 function items were endorsed by over half of those who had used cocaine in the past year.

Gender differences were more common amongst functions for cocaine use than the other substances surveyed. More males reported using cocaine to `IMPROVE EFFECTS' of other drugs (χ 2 [1] = 4.00, P < 0.05); more females used the drug to help `STAY AWAKE' (χ 2 [1] = 12.21, P < 0.001), to `LOSE INHIBITIONS' (χ 2 [1] = 9.01, P < 0.01), to `STOP WORRYING' (χ 2 [1] = 8.11, P < 0.01) or to `ENJOY COMPANY' of friends (χ 2 [1] = 4.34, P < 0.05). All participants who endorsed using cocaine to help `LOSE WEIGHT' were female.

Those who had used cocaine to `FEEL BETTER' (18.9 versus 19.8; t [166] = –3.06, P < 0.01), to `STOP WORRYING' (18.6 versus 19.7; t [166] = –3.86, P < 0.001) or to `DECREASE BOREDOM' (18.9 versus 19.6; t [166] = –2.52, P < 0.05) were significantly younger than those who did not endorse these functions. Similar to the other drugs, participants who had used cocaine to feel `ELATED/EUPHORIC' in the past year tended to be older than those who had not (19.6 versus 18.7; t [166] = 3.16, P < 0.01).

Alcohol ( n = 312)

The functions for alcohol use were the most diverse of the six substances examined. Like LSD, the most commonly endorsed purpose for drinking was to get `INTOXICATED' (89.1%). Many used alcohol to `RELAX' (82.7%), to `ENJOY COMPANY' (74.0%), to `INCREASE CONFIDENCE' (70.2%) and to `FEEL BETTER' (69.9%). Overall, 11 of the 17 function items were endorsed by over 50% of those who had drunk alcohol in the past year. Male participants were more likely to report using alcohol in combination with other drugs either to `IMPROVE EFFECTS' of other drugs (χ 2 [1] = 4.56, P < 0.05) or to ease the `AFTER EFFECTS' of other substances (χ 2 [1] = 7.07, P < 0.01). More females than males reported that they used alcohol to `DECREASE BOREDOM' (χ 2 [1] = 4.42, P < 0.05).

T -tests revealed significant age differences on four of the function variables: those who drank to feel `ELATED/EUPHORIC' were significantly older (19.7 versus 19.0; t [310] = 3.67, P < 0.001) as were individuals who drank to help them to `LOSE INHIBITIONS' (19.6 versus 19.0; t [310] = 2.36, P < 0.05). In contrast, participants who reported using alcohol just to get `INTOXICATED' (19.2 versus 20.3; t [310] = –3.31, P < 0.001) or to `DECREASE BOREDOM' (19.2 versus 19.6; t [310] = –2.25, P < 0.05) were significantly younger than those who did not.

Combined functional drug use

The substances used by the greatest proportion of participants to `IMPROVE EFFECTS' from other drugs were cannabis (44.3%), alcohol (41.0%) and amphetamines (37.5%). It was also common to use cannabis (64.6%) and to a lesser extent alcohol (35.9%) in combination with other drugs in order to help manage `AFTER EFFECTS'. Amphetamines, ecstasy, LSD and cocaine were also used for these purposes, although to a lesser extent. Participants who endorsed the combination drug use items were asked to list the three main drugs with which they had combined the target substance for these purposes. Table IV summarizes these responses.

Overall functions for drug use

In order to examine which functions were most popular overall, a dichotomous variable was created for each different item to indicate if one or more of the six target substances had been used to fulfil this purpose during the year prior to interview. For example, if an individual reported that they had used cannabis to relax, but their use of ecstasy, amphetamines and alcohol had not fulfilled this function, then the variable for `RELAX' was scored `1'. Similarly if they had used all four of these substances to help them to relax in the past year, the variable would again be scored as `1'. A score of `0' indicates that none of the target substances had been used to fulfil a particular function. Table V summarizes the data from these new variables.

Over three-quarters of the sample had used at least one target substance in the past year for 11 out of the 18 functions listed. The five most common functions for substance use overall were to `RELAX' (96.7%); `INTOXICATED' (96.4%); `KEEP GOING' (95.9%); `ENHANCE ACTIVITY' (88.5%) and `FEEL BETTER' (86.8%). Despite the fact that `SLEEP' was only relevant to two substances (alcohol and cannabis), it was still endorsed by over 70% of the total sample. Using to `LOSE WEIGHT' was only relevant to the stimulant drugs (amphetamines, ecstasy and cocaine), yet was endorsed by 17.3% of the total sample (almost a third of all female participants). Overall, this was the least popular function for recent substance use, followed by `WORK' (32.1%). All other items were endorsed by over 60% of all participants.

Gender differences were identified in six items. Females were significantly more likely to have endorsed the following: using to `INCREASE CONFIDENCE' (χ 2 [1] = 4.41, P < 0.05); `STAY AWAKE' (χ 2 [1] = 5.36, P < 0.05), `LOSE INHIBITIONS' (χ 2 [1] = 4.48, P < 0.05), `ENHANCE SEX' (χ 2 [1] = 5.17, P < 0.05) and `LOSE WEIGHT' (χ 2 [1] = 29.6, P < 0.001). In contrast, males were more likely to use a substance to `IMPROVE EFFECTS' of another drug (χ 2 [1] = 11.18, P < 0.001).

Statistically significant age differences were identified in three of the items. Those who had used at least one of the six target substances in the last year to feel `ELATED/EUPHORIC' (19.5 versus 18.6; t [362] = 4.07, P < 0.001) or to `SLEEP' (19.4 versus 18.9; t [362] = 2.19, P < 0.05) were significantly older than those who had not used for this function. In contrast, participants who had used in order to `STOP WORRYING' tended to be younger (19.1 versus 19.7; t [362] = –2.88, P < 0.01).

This paper has examined psychoactive substance use amongst a sample of young people and focused on the perceived functions for use using a 17-item scale. In terms of the characteristics of the sample, the reported lifetime and recent substance use was directly comparable with other samples of poly-drug users recruited in the UK [e.g. ( Release, 1997 )].

Previous studies which have asked users to give reasons for their `drug use' overall instead of breaking it down by drug type [e.g. ( Carman, 1979 ; Butler et al ., 1981 ; Newcomb et al ., 1988 ; Cato, 1992 ; McKay et al ., 1992 )] may have overlooked the dynamic nature of drug-related decision making. A key finding from the study is that that with the exception of two of the functions for use scale items (using to help sleep or lose weight), all of the six drugs had been used to fulfil all of the functions measured, despite differences in their pharmacological effects. The total number of functions endorsed by individuals for use of a particular drug varied from 0 to 15 for LSD, and up to 17 for cannabis, alcohol and cocaine. The average number ranged from 5.9 (for LSD) to 9.0 (for cannabis). This indicates that substance use served multiple purposes for this sample, but that the functional profiles differed between the six target drugs.

We have previously reported ( Boys et al. 2000b ) that high scores on a cocaine functions scale are strongly predictive of high scores on a cocaine-related problems scale. The current findings support the use of similar function scales for cannabis, amphetamines, LSD and ecstasy. It remains to be seen whether similar associations with problem scores exist. Future developmental work in this area should ensure that respondents are given the opportunity to cite additional functions to those included here so that the scales can be further extended and refined.

Recent campaigns that have targeted young people have tended to assume that hallucinogen and stimulant use is primarily associated with dance events, and so motives for use will relate to this context. Our results support assumptions that these drugs are used to enhance social interactions, but other functions are also evident. For example, about a third of female interviewees had used a stimulant drug to help them to lose weight. Future education and prevention efforts should take this diversity into account when planning interventions for different target groups.

The finding that the same functions are fulfilled by use of different drugs suggests that at least some could be interchangeable. Evidence for substituting alternative drugs to fulfil a function when a preferred drug is unavailable has been found in other studies [e.g. ( Boys et al. 2000a )]. Prevention efforts should perhaps focus on the general motivations behind use rather than trying to discourage use of specific drug types in isolation. For example, it is possible that the focus over the last decade on ecstasy prevention may have contributed inadvertently to the rise in cocaine use amongst young people in the UK ( Boys et al ., 1999c ). It is important that health educators do not overlook this possibility when developing education and prevention initiatives. Considering functions that substance use can fulfil for young people could help us to understand which drugs are likely to be interchangeable. If prevention programmes were designed to target a range of substances that commonly fulfil similar functions, then perhaps this could address the likelihood that some young people will substitute other drugs if deterred from their preferred substance.

There has been considerable concern about the perceived increase in the number of young people who are using cocaine in the UK ( Tackling Drugs to Build a Better Britain 1998 ; Ramsay and Partridge, 1999 ; Boys et al. 2000b ). It has been suggested that, for a number of reasons, cocaine may be replacing ecstasy and amphetamines as the stimulant of choice for some young people ( Boys et al ., 1999c ). The results from this study suggest that motives for cocaine use are indeed similar to those for ecstasy and amphetamine use, e.g. using to `keep going' on a night out with friends, to `enhance an activity', `to help to feel elated or euphoric' or to help `stay awake'. However, in addition to these functions which were shared by all three stimulants, over 60% of cocaine users reported that they had used this drug to `help to feel more confident' in a social situation and to `feel better when down or depressed'. Another finding that sets cocaine aside from ecstasy and amphetamines was the relatively common existence of gender differences in the function items endorsed. Female cocaine users were more likely to use to help `stay awake', `lose inhibitions', `stop worrying', `enjoy company of friends' or to help `lose weight'. This could indicate that women are more inclined to admit to certain functions than their male counterparts. However, the fact that similar gender differences were not observed in the same items for the other five substances, suggests this interpretation is unlikely. Similarly, the lack of gender differences in patterns of cocaine use (both frequency and intensity) suggests that these differences are not due to heavier cocaine use amongst females. If these findings are subsequently confirmed, this could point towards an inclination for young women to use cocaine as a social support, particularly to help feel less inhibited in social situations. If so, young female cocaine users may be more vulnerable to longer-term cocaine-related problems.

Many respondents reported using alcohol or cannabis to help manage effects experienced from another drug. This has implications for the choice of health messages communicated to young people regarding the use of two or more different substances concurrently. Much of the literature aimed at young people warns them to avoid mixing drugs because the interactive effects may be dangerous [e.g. ( HIT, 1996 )]. This `Just say No' type of approach does not take into consideration the motives behind mixing drugs. In most areas, drug education and prevention work has moved on from this form of communication. A more sophisticated approach is required, which considers the functions that concurrent drug use is likely to have for young people and tries to amend messages to make them more relevant and acceptable to this population. Further research is needed to explore the motivations for mixing different combinations of drugs together.

Over three-quarters of the sample reported using at least one of the six target substances to fulfil 11 out of the 18 functions. These findings provide strong evidence that young people use psychoactive drugs for a range of distinct purposes, not purely dependent on the drug's specific effects. Overall, the top five functions were to `help relax', `get intoxicated', `keep going', `enhance activity' and `feel better'. Each of these was endorsed by over 85% of the sample. Whilst all six substances were associated to a greater or lesser degree with each of these items, there were certain drugs that were more commonly associated with each. For example, cannabis and alcohol were popular choices for relaxation or to get intoxicated. In contrast, over 90% of the amphetamine and ecstasy users reported using these drugs within the last year to `keep going'. Using to enhance an activity was a common function amongst users of all six substances, endorsed by over 70% of ecstasy, cannabis and LSD users. Finally, it was mainly alcohol and cannabis (and to a lesser extent cocaine) that were used to `feel better'.

Several gender differences were observed in the combined functions for recent substance use. These findings indicate that young females use other drugs as well as cocaine as social supports. Using for specific physical effects (weight loss, sex or wakefulness) was also more common amongst young women. In contrast, male users were significantly more likely to report using at least one of the target substances to try to improve the effects of another substance. This indicates a greater tendency for young males in this sample to mix drugs than their female counterparts. Age differences were also observed on several function items: participants who had used a drug to `feel elated or euphoric' or to `help sleep' tended to be older and those who used to `stop worrying about a problem' were younger. If future studies confirm these differences, education programmes and interventions might benefit from tailoring their strategies for specific age groups and genders. For example, a focus on stress management strategies and coping skills with a younger target audience might be appropriate.

Some limitations of the study need to be acknowledged. The sample for this study was recruited using a snowball-sampling methodology. Although it does not yield a random sample of research participants, this method has been successfully used to access hidden samples of drug users [e.g. ( Biernacki, 1986 ; Lenton et al ., 1997 )]. Amongst the distinct advantages of this approach are that it allows theories and models to be tested quantitatively on sizeable numbers of subjects who have engaged in a relatively rare behaviour.

Further research is now required to determine whether our observations may be generalized to other populations (such as dependent drug users) and drug types (such as heroin, tranquillizers or tobacco) or if additional function items need to be developed. Future studies should also examine if functions can be categorized into primary and subsidiary reasons and how these relate to changes in patterns of use and drug dependence. Recognition of the functions fulfilled by substance use could help inform education and prevention strategies and make them more relevant and acceptable to the target audiences.

Structure of functions scales

Profile of substance use over the past year and past 90 days ( n = 364)

Proportion (%) of those who have used [substance] more than once, who endorsed each functional statement for their use in the past year

Combined functional substance use reported by the sample over the past year

Percentage of participants who reported having used at least one of the target substances to fulfil each of the different functions over the past year ( n = 364)

We gratefully acknowledge research support from the Health Education Authority (HEA). The views expressed in this paper are those of the authors and do not necessarily reflect those of the HEA. We would also like to thank the anonymous referees for helpful comments and suggestions on an earlier draft of this paper.

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• > Drug Abuse
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Book contents

• Frontmatter
• Acknowledgments
• SECTION ONE CONCEPTS AND CLASSES OF DRUGS
• 1 Concepts of Drugs, Drug Use, Misuse, and Abuse
• 2 Further Classifications Relevant to Substance Abuse and Dependence
• 3 Types of Drugs, History of Drug Use and Misuse, and Costs of Drug Misuse
• SECTION TWO ETIOLOGY
• SECTION THREE PREVENTION
• SECTION FOUR CESSATION
• SECTION FIVE CONCLUSIONS AND THE FUTURE
• Author Index
• Subject Index

1 - Concepts of Drugs, Drug Use, Misuse, and Abuse

Published online by Cambridge University Press:  18 December 2009

First the man took a drink, then the drink took a drink, then the drink took the man.

This first chapter provides a discussion and clarification of various concepts relevant to drug abuse. Although we attempt clarification of many terms and concepts, it is important to note that there are different substantive distinctions and “fuzzy” boundaries between the concepts. For example, distinctions between drug misuse and abuse, and terms such as street drugs or hard or soft drugs are somewhat ambiguous and perhaps dependent on sociocultural contexts. The chapter begins by providing an overview of a definition of a drug, drug use, and drug action and then distinguishes drug use from misuse and provides terms used to refer to drugs that might be misused.

What Is a Drug and Drug Use?

A drug is a substance that can be taken into the human body and, once taken, alters some processes within the body. Drugs can be used in the diagnosis, prevention, or treatment of a disease. Some drugs are used to kill bacteria and help the body recover from infections. Some drugs assist in terminating headaches. Some drugs cross the blood–brain barrier and affect neurotransmitter function. The varieties of drugs that produce a direct or indirect effect on neurotransmitter function in the brain are of primary interest in this book.

Drugs are processed by the body in four steps, and these drugs also may have various effects on each other when used together.

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• Concepts of Drugs, Drug Use, Misuse, and Abuse
• Steve Sussman , University of Southern California , Susan L. Ames , University of Southern California
• Book: Drug Abuse
• Online publication: 18 December 2009
• Chapter DOI: https://doi.org/10.1017/CBO9780511500039.002

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• Introduction
• The functions of psychotropic drugs
• Popular misconceptions
• Physiological effects of addiction
• Addiction, habituation, and dependence
• Psychological dependence
• Other affects on mental health
• International controls
• National controls
• Extent of contemporary drug abuse

Conflicting values in drug use

Youth and drugs.

• History of opiates
• Physiological effects of opiates
• Opiate addiction
• Means of administration
• Therapy for opiate addiction
• Types of hallucinogens
• History of hallucinogens
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• Hallucinogen abuse
• Barbiturates
• Amphetamines
• Tranquilizers
• Types of cannabis preparations
• History of cannabis use and regulation
• Physiological and psychological effects of cannabis

• Should the minimum age for alcohol consumption be lowered from 21 to a younger age?

Social and ethical issues of drug abuse

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• National Institute on Drug Abuse - Understanding Drug Use and Addiction
• Table Of Contents

There are many social and ethical issues surrounding the use and abuse of drugs. These issues are made complex particularly because of conflicting values concerning drug use within modern societies. Values may be influenced by multiple factors including social, religious, and personal views. Within a single society, values and opinions can diverge substantially, resulting in conflicts over various issues involving drug abuse .

Since the 1960s, drug abuse has occupied a significant place in the public consciousness . This heightened awareness of drugs and their consequences has been influenced largely by campaigns and programs oriented toward educating the public about the dangers of drug abuse and about how individuals and societies can overcome drug-related problems. One of the most hotly contested issues concerning contemporary drug abuse centres on whether currently illicit drugs should be legalized. Another major area of concern involves the abuse of drugs in sports, which can send conflicting messages to young generations whose idols are professional athletes.

Modern industrialized societies are certainly not neutral with regard to the voluntary nonmedical use of psychotropic drugs. Whether one simply takes the position of American psychologist Erich Fromm , that people are brought up to desire and value the kinds of behaviour required by their economic and social system, or whether one goes further and speaks of the Protestant ethic , in the sense that German sociologist Max Weber used it to delineate the industrialist’s quest for salvation through worldly work alone, it is simply judged not “right,” “good,” or “proper” for people to achieve pleasure or salvation chemically. It is accepted that the only legitimate earthly rewards are those that have been “earned” through striving, hard work, personal sacrifice, and an overriding sense of duty to one’s country, the existing social order, and family. This orientation is believed to be fairly coincident with the requirements of industrialization.

But the social and economic requirements of many modern societies have undergone radical change in the last few decades, even though traditional values are still felt. In some places, current drug controversies are a reflection of cultural lag, with the consequent conflict of values being a reflection of the absence of correspondence between traditional teachings and the view of the world as it is now being perceived by large numbers within society. Thus, modern societies in a state of rapid transition often experience periods of instability with regard to prevailing views on drugs and drug use.

Cultural transitions notwithstanding, the dominant social order has strong negative feelings about any nonsanctioned use of drugs that contradicts its existing value system. Can society succeed if individuals are allowed unrestrained self-indulgence? Is it right to dwell in one’s inner experience and glorify it at the expense of the necessary ordinary daily pursuits? Is it bad to rely on something so much that one cannot exist without it? Is it legitimate to take drugs if one is not sick? Does one have the right to decide for oneself what one needs? Does society have the right to punish someone who has done no harm to himself or herself or to others? These are difficult questions that do not admit to ready answers. One can guess what the answers would be to the nonsanctioned use of drugs. The traditional ethic dictates harsh responses to conduct that is “self-indulgent” or “abusive of pleasure.” But how does one account for the quantities of the drugs being manufactured and consumed today by the general public? It is one thing to talk of the “hard” narcotic users who are principally addicted to the opiates . One might still feel comfortable in disparaging the widespread illicit use of hallucinogenic substances. But the sedatives and stimulants are complications that trap the advocate in some glaring inconsistencies. It may be asked by partisans whether the cosmetic use of stimulants for weight control is any more legitimate than the use of stimulants to “get with it,” whether the conflict-ridden adult is any more entitled to relax chemically (alcohol, tranquilizers, sleeping aids, sedatives) than the conflict-ridden adolescent, and whether physical pain is any less bearable than mental pain or anguish.

Billions of pills and capsules of a nonnarcotic type are manufactured and consumed yearly. Sedatives and tranquilizers account for somewhere around 12 to 20 percent of all doctor’s prescriptions. In addition there are many different sleeping aids that are available for sale without a prescription. The alcoholic beverage industry produces countless millions of gallons of wine and spirits and countless millions of barrels of beer each year. One might conclude that there is a whole drug culture; that the problem is not confined to the young, the poor, the disadvantaged, or even to the criminal; that existing attitudes are at least inconsistent, possibly hypocritical. One always justifies one’s own drug use, but one tends to view the other fellow who uses the same drugs as an abuser who is weak and undesirable. It must be recognized that the social consensus in regard to drug use and abuse is limited, conflict ridden, and often glaringly inconsistent. The problem is not one of insufficient facts but one of multiple objectives that at the present moment appear unreconcilable.

Young people seem to find great solace in the fact that adults often use drugs to cope with stress and other life factors. One cannot deny that many countries today are drug-oriented societies, but the implications of drug use are not necessarily the same for the adult as they are for the adolescent. The adult has already acquired some sense of identity and purpose in life. He or she has come to grips with the problems of love and sex, has some degree of economic and social skill, and has been integrated or at least assimilated into some dominant social order. Whereas the adult may turn to drugs and alcohol for many of the same reasons as the adolescent, drug use does not necessarily prevent the adult from remaining productive, discharging obligations, maintaining emotional and occupational ties, acknowledging the rights and authority of others, accepting restrictions, and planning for the future. The adolescent, in contrast, is apt to become ethnocentric and egocentric with drug usage. The individual withdraws within a narrow drug culture and within himself or herself. Drug usage for many adolescents represents a neglect of responsibilities at a time when more important developmental experiences are required. To quote one observer:

It all seemed really quite benign in an earlier time of more moderate drug use, except for the three percent who became crazy and the ten percent we described as socially disabled. Since then, however, more and more disturbed kids have been attracted to the drug world, resulting in more unhappy and dangerous behavior. Increasingly younger kids have come into the scene. Individuals who, in psychoanalytic terms, are simply lesser people, with less structure, less ego, less integration , and hence, are less likely to be able to cope with the drugs. Adolescents are at a crisis period in their lives, and when you intrude regularly at this point with powerful chemicals, the potential to solve these problems of growing up by living them through, working them out, is stopped.

Adults being drug users has important implications in terms of the expectations, roles, values, and rewards of the social order, but society as a whole does not accept drug use as an escape from responsibility, and this is a fact of fundamental importance in terms of youth . Drugs may be physiologically “safe,” but the drug experience can be very nonproductive and costly in terms of the individual’s chances of becoming a fully participating adult.

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Essay on Drug Addiction | Drug Addiction Essay for Students and Children in English

February 12, 2024 by Veerendra

Essay on Drug Addiction: Addiction refers to the harmful need to consume substances that have damaging consequences on the user. Addiction affects not just the body but also on the person’s mental health and soundness of mind. Addiction is one of the most severe health problems faced around the world and is termed as a chronic disease. A widespread disorder ranges from drugs, alcohol addiction to gambling, and even phone addiction.

You can read more  Essay Writing  about articles, events, people, sports, technology many more.

One of the most unfortunate yet common addictions that affect millions today is drug addiction. Also referred to as substance – use disorder, it is the addiction to substances that harm neurological functioning and a person’s behavior. The essay provides relevant information on this topic.

Long and Short Essay on Drug Addiction in English for Students and Kids

There are two essays listed below. The long essay consists of 500 words and a short essay of 200 words.

Long Essay on Drug Addiction in English 500 words

Drug addiction, also known as substance–use disorder, refers to the dangerous and excessive intake of legal and illegal drugs. This leads to many behavioral changes in the person as well as affects brain functions. Drug addiction includes abusing alcohol, cocaine, heroin, opioid, painkillers, and nicotine, among others. Drugs like these help the person feel good about themselves and induce ‘dopamine’ or the happiness hormone. As they continue to use the drug, the brain starts to increase dopamine levels, and the person demands more.

Drug addiction has severe consequences. Some of the signs include anxiety, paranoia, increased heart rate, and red eyes. They are intoxicated and unable to display proper coordination and have difficulty in remembering things. A person who is addicted cannot resist using them and unable to function correctly without ingesting them. It causes damage to the brain, their personal and professional relationships. It affects mental cognition; they are unable to make proper decisions, cannot retain information, and make poor judgments. They tend to engage in reckless activities such as stealing or driving under the influence. They also make sure that there is a constant supply and are willing to pay a lot of money even if they are unable to afford it and tend to have erratic sleep patterns.

Drug addiction also causes a person to isolate themselves and have either intense or no food cravings. They stop taking care of their hygiene. Drug addiction affects a person’s speech and experience hallucinations. They are unable to converse and communicate properly; they speak fast and are hyperactive. Those addicted have extreme mood swings. They can go from feeling happy to feeling sad quickly and are incredibly secretive. They begin to lose interest in activities they once loved. Substance abusers also undergo withdrawal symptoms. Withdrawal symptoms refer to the symptoms that occur when they stop taking the drug. Some withdrawal symptoms include nausea, fatigue, and tremors. They stop and starting using again, an endless cycle that could be life-threatening. Drug addiction can be fatal if not treated timely. It can cause brain damage and seizures as well as overdose, heart diseases, respiratory problems, damage to the liver and kidneys, vomiting, lung diseases, and much more.

Though chronic, treatment is available for drug addiction. Many techniques are used, such as behavioral counseling, medication to treat the addiction, and providing treatment not just for substance abuse but also for many factors that accompany addiction such as stress, anxiety, and depression. Many devices have developed to overcome addiction. There are rehabilitation centers to help people. After treatment, there are numerous follow-ups to ensure that the cycle does not come back. The most important is having family and friends to support the effect. It will help them build confidence and come over their addiction.

The United Nations celebrates International Day against Drug Abuse and Illicit Trafficking on the 26th of June. Drug addiction impacts millions and needs to be treated carefully to prevent further harm to the individual and letting them live a better life.

Short Essay on Drug Addiction in English 250 words

Drug addiction refers to taking substances that are harmful to our bodies. They cause changes to a person’s behavior as well. Many people take these drugs to feel happier and better about themselves. These dangerous substances make the brain produce a chemical that makes us happy, called dopamine. Producing large amounts of these causes the person to take the drug consistently.

Some of the drugs include alcohol, nicotine, and other unhealthy substances. Taking these substances can lead to many symptoms. These include unable to think correctly, cannot remember things, and unable to speak clearly. They steal and keep secrets from their close ones. Those addicted cannot sleep; they become happy and sad quickly. They stop doing the activities that they liked doing. They are not aware of their surroundings. Taking these dangerous substances can cause many health problems such as vomiting, unable to breathe, brain, and lung damage. It also affects their family, friends, and work.

Drug addiction is life-threatening. However, people with this addiction can be treated and helped with therapy, counseling, and taking medicines along with rehab centers. They do follow-ups to ensure that they never retake these drugs. They must have their family and friends to support them as they recover.

10 lines About Drug Addiction Essay in English

• Drug addiction refers to taking harmful substances that affect a person’s brain functions and behavior. It involves taking legal and illegal drugs, and the person is unable to stop using them. It is also referred to as substance- use disorders
• Harmful drugs include alcohol, cocaine, heroin, opioids, painkillers, nicotine, etc.
• The harmful drugs cause an excessive release of dopamine or the happy hormone, which causes the person to take more.
• Drug addiction can affect mental cognition, including decision making, judgments, and memory. It also causes speech problems.
• It can cause anxiety paranoia and increased blood pressure. They have erratic sleep patterns and isolate themselves. It causes problems in their personal and professional relationships.
• Those addicted become moody, hyperactive, and hallucinate. They also engage in reckless activities.
• They experience withdrawal symptoms when they try to stop using substances. These include nausea, fatigue, and tremors.
• It can have many effects on the body, such as brain damage, seizures, liver and kidney damage, respiratory and lung issues.
• Treatment is available. It includes behavioral therapy, medication, rehabilitation, as well as a follow-up to prevent relapse.
• The United Nations celebrates International Day against Drug Abuse and Illicit Trafficking on the 26th of June.

Frequently Asked Questions on Drug Addiction Essay

Question  1. What is drug addiction?

Answer: Drug addiction, also known as substance – use disorder, refers to the dangerous and excessive intake of legal and illegal drugs. This leads to many behavioral changes in the person as well as affects brain functions.

Question 2. Why does drug addiction occur?

Answer: People become addicted to these drugs because they want to feel happier. The drugs cause a chemical called dopamine, which induces happiness to be released. The brain starts to increase dopamine levels, and thus the person becomes addicted to the drug to match the increasing levels.

Question 3. What is the difference between dependence and addiction?

Answer: Dependence and addiction vary. While dependence is an intense craving for the drug by the body, addiction also refers to the changes in behavior and bodily functions due to repeated use of the drug, which has severe consequences.

Question 4. Can we treat drug addiction?

Answer: Yes, drug addiction can be treated. The various treatment methods are behavioral counseling, medication, and treatment of anxiety and depression. There are rehabilitation centers available. This is followed by a check-up to prevent relapse.

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• v.54(1); 2022

How the war on drugs impacts social determinants of health beyond the criminal legal system

Aliza cohen.

a Department of Research and Academic Engagement, Drug Policy Alliance, New York, NY, USA

Sheila P. Vakharia

Julie netherland, kassandra frederique.

b Drug Policy Alliance, New York, NY, USA

Associated Data

Data sharing is not applicable to this article as no new data were created or analysed in this study.

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the “war on drugs” in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that “drug war logic” has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.
• The U.S. drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.
• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

Introduction

Social determinants of health (SDOH) are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” [ 1 ] There is a growing recognition in the fields of public health and medicine that SDOH play a key role in driving health inequities and disparities, such that a focus on individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. For instance, differences in access to nutritious foods, safe neighbourhoods, stable housing, well-paying job opportunities, enriching school environments, insurance, and healthcare can lead to differential health outcomes for individuals, their families, and their communities. And as these mid- and downstream SDOH have gained more attention, we must also focus on more macro SDOH in order to understand “how upstream factors, such as governance and legislation, create structural challenges and impose downstream barriers that impact the ability and opportunity to lead a healthy lifestyle.” [ 2 ]

One underexplored upstream SDOH is the “war on drugs” in the United States and how it exacerbates many of the factors that negatively impact health and wellbeing, disproportionately affecting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism [ 3 ]. President Richard Nixon launched the contemporary drug war in the U.S. in 1971 when he signed the Controlled Substances Act and declared drug abuse as “public enemy number one.” [ 4 ] Since the declaration of the U.S. drug war, billions of dollars each year have been spent on drug enforcement and punishment because it was made a local, state, and federal priority [ 5 ]. For the past half century, the war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating access to adequate resources and supports to live healthy lives.

Drug offences remain the leading cause of arrest in the nation; over 1.1 million drug-related arrests were made in 2020, and the majority were for personal possession alone [ 6 ]. Black people – who are 13% of the U.S. population – made up 24% of all drug arrests in 2020, despite the fact that people of all races use and sell drugs at similar rates [ 6–8 ]. While incarceration rates for drug-related offences skyrocketed in the 1980s and 1990s, they have decreased in recent years motivated both by cost savings and criminal legal reform efforts to promote a public health approach to drug use. However, estimates still suggest that roughly 20% of people who are incarcerated are there for a drug charge, and racial disparities in incarceration persist [ 9 , 10 ].

Meanwhile, the illicit drug supply has become increasingly unpredictable and contaminated due to drug supply disruptions, contributing to an exponential increase in drug overdose deaths [ 11 , 12 ]. Estimates suggest that one million people died of a drug-involved overdose between 1999 and 2020, with over 100,000 deaths occurring in a calendar year for the first time in 2021 [ 13 , 14 ]. Since 2015, overdose deaths have disproportionately impacted racial and ethnic minorities; Black people have had the biggest increase in overdose fatality rates, and today, Black and Native people have the highest overdose death rates across the U.S [ 15 ]. The most recent “fourth wave” of the overdose crisis can be attributed to a fentanyl-contaminated drug supply caused by drug prohibition; criminalisation that leads to stigma and fear of punishment that deters people from getting support they might need; and a lack of robust, scaled-up investment in harm reduction and evidence-based treatment services [ 16 , 17 ]. Although harm reduction interventions, including supervised consumption spaces (also called supervised injection facilities, drug consumption rooms, or overdose prevention centres) and heroin-assisted treatment have been widely studied and found effective outside of the U.S., these strategies have not been widely adopted in this country [ 18–21 ].

The drug war has also become deeply embedded within many of the systems and structures of U.S. life well beyond the criminal legal apparatus [ 3 ]. Since the health impacts of incarceration have been studied elsewhere, this paper will specifically discuss the impacts of criminalisation in other facets of life [ 22 ].

We argue that an underlying drug war logic has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the U.S. We define drug war logic as a logic that prioritises and justifies drug prohibition, criminalisation, and punishment to purportedly address the real and perceived health harms of drug use over a public health approach to address these issues. In coining this term, we hope to make more visible the implicit assumptions about drug use that are often unnamed but common in the policies and practices across different institutions. We acknowledge that many actors in these settings where drug war logic is embedded, including physicians and other healthcare providers, are often well-intentioned yet unaware of how they may be perpetuating this logic through their own actions. We argue that drug war logic defies and contradicts widely accepted understandings of addiction as a health issue and has, in many cases, made a public health approach more challenging to implement [ 23 ]. Notably, the American Society of Addiction Medicine defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.” [ 24 ] As this paper will outline, drug war logic undermines rather than supports the health of people who use drugs, their families, and their communities by treating drug use as a criminal issue.

Drug war logic is made concrete, not just within criminal legal systems, but also through mandated drug reporting and monitoring systems in treatment and healthcare settings, compulsory drug testing in employment and for the receipt of social services, the proliferation of zero-tolerance workplaces and school zones, mandated treatment in order to receive resources or avoid loss of benefits, background checks for work and housing, and numerous other measures which will be discussed in detail below. As a result, the drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others who are required to engage in these forms of surveillance and punishment.

This commentary will use a SDOH lens to explore a number of systems where the drug war and its logic have taken root, impacting individual and community health and subjecting many people in the U.S. to surveillance due to suspected or confirmed drug use. Healthcare providers must have a robust understanding of the impact of drug war logic in employment, housing, education, public benefits, the family regulation system (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system because these deeply impact the health of their patients, particularly their patients who use drugs (For the purposes of this paper, we are using the term “Family Regulation System,” coined by Emma Williams and used by other scholars, instead of the more commonly used term “Child Welfare System” to reflect the fact that, particularly for low-income families and families of color, state intervention often occurs in order to regulate their families rather than to prioritize the welfare of the entire family unit, of which the child is a part).

Employment, with its link to income and health insurance, is an important determinant of health. However, drug testing, criminal background checks, and exclusions of those with criminal histories from certain professions create significant barriers to obtaining and maintaining employment. Beginning in the 1980s, employment-based drug testing became widespread. In a 1994 report, the National Research Council noted that “[i]n a period of about 20 years, urine testing has moved from identifying a few individuals with major criminal or health problems to generalized programs that touch the lives of millions of citizens.” [ 25 ] Between 2017 and 2020, the National Survey on Drug Use and Health found that approximately 21% of respondents were tested as part of the hiring process, and 15% were subject to random employee drug testing [ 26 ].

Despite the widespread use of testing, less than 5.5% of results are positive for any drug, according to data from Quest Diagnostics, one of the largest testing companies in the country [ 27 ]. There is little evidence that these policies are effective in reducing drug use, improving workplace safety, or increasing productivity [ 28–30 ]. Notably, drug tests cannot specify how much of a drug was consumed, whether the person is currently intoxicated or impaired, or if they have a SUD. Drug tests cannot indicate if drug use will impact a person’s ability to perform their work or if they present a safety risk. Rather, drug tests simply show whether or not someone has a particular metabolite in their system [ 31–35 ].

Beyond workplace drug testing, hundreds of thousands are excluded from stable, well-paid work because of drug-related convictions. Over 70 million people – more than 20% of the U.S. population – have some type of criminal record [ 36 ]. A drug arrest or charge, even without a conviction, can be a barrier to getting a job because it can appear in many web searches and background checks [ 37 ]. Criminal background checks have become cheaper and easier to access, even though these records are notoriously inaccurate [ 38 , 39 ]. In addition, more than a quarter of jobs in the U.S. require some kind of licence, and a drug conviction history can automatically prevent people from getting a professional licence for their trade, like trucking or barbering [ 40 ].

These employment barriers disproportionately affect Black men, who already face additional impediments to employment and who are most harmed by the drug war and criminalisation [ 41 ]. The federal Equal Employment Opportunity Commission issued guidance stating that denying employment based on criminal records could be a form of racial discrimination because people of colour are more likely to be targeted by law enforcement and thus more likely to have an arrest or conviction record [ 42 , 43 ]. As a recent report by the Brennan Centre points out: “the staggering racial disparities in our criminal justice system flow directly into economic inequality” [ 36 ]. This same report found that those with a history of imprisonment earned 52% less than those with no history of incarceration.

Employment is a health issue that should be of concern to healthcare providers because it provides income, access to health insurance and medical treatment, and social connection [ 44 ]. Precarious employment and low income are linked to poor health, and some research has shown that people who use drugs and who are precariously employed face increased vulnerability to violence and HIV infection [ 45–47 ]. Being unemployed can lead to poverty and negative health effects and is associated with increased rates of drug use and SUDs [ 48 ].

Rather than supporting people who use drugs in accessing employment and the health benefits attached to it, drug war logic in employment settings can erect barriers. Eliminating or greatly restricting workplace drug testing as well as banning criminal background checks and professional licencing restrictions are important steps towards restoring access to employment and the many health benefits it confers.

Housing is another key SDOH that is significantly impacted by drug war policies and practices. Drug war surveillance in housing began with the passage of the Anti-Drug Abuse Act of 1988, which prohibited public housing authorities (PHAs) from allowing tenants to engage in drug-related activity on or near public housing premises and deemed such activity grounds for immediate eviction [ 49 ].

The Cranston-Gonzalez National Affordable Housing Act of 1990 expanded on this so that if a tenant’s family member or guest - regardless of whether they live on-site - engages in drug-related activity, the tenant and their household can be evicted [ 50 ]. Additionally, the Act states that evicted households must be banned from public housing for a minimum of three years unless the tenant completes an agency-approved drug treatment program or has otherwise been “rehabilitated successfully.” [ 50 ]

Six years later in 1996, Congress passed the Housing Opportunity Program Extension Act, which established “One Strike” laws and expanded on previous acts to give PHAs the authority to evict tenants if they or a guest was suspected of using or selling drugs, even outside of the premises [ 51 ]. This series of public housing policies requires neither a drug arrest nor proof that a tenant or their guest is involved in drug use, sales, or activity [ 52 ].

Private housing markets can also enforce zero-tolerance drug policies. In over 2,000 cities across the U.S., landlords can certify their property as “crime-free” by taking a class, implementing “crime prevention” architecture, and including clauses in their leases that allow for immediate eviction should a tenant, family member, or guest engage in “criminal activity,” particularly drug-related activity, on or off the premises [ 53 , 54 ]. Landlords, in close partnership with law enforcement, can invoke these laws by claiming to enforce crime-free ordinances, regardless of whether the alleged drug-related activity is illegal. In states across the U.S., private landlords have evicted tenants following an overdose [ 55–59 ]. In practice, these programs and ordinances increase the surveillance and displacement of low-income Black and Latinx tenants while not decreasing crime and potentially deterring someone from calling 911 for medical assistance in case of an overdose [ 55 ].

Evictions can lead to unstable housing or homelessness, which is associated with a host of chronic health problems, infectious diseases, emotional and developmental problems, food insecurity, and premature death [ 60–63 ]. Lacking a permanent address and reliable transportation makes it more difficult to receive and store medications and travel to a hospital or clinic; this is compounded with the stigma and discrimination that unhoused people often face from healthcare providers [ 64 ]. Being unhoused or housing unstable is also associated with difficulty obtaining long-term employment and education [ 65–67 ]. Longitudinal studies have found that family eviction has both short- and long-term impacts among newborns and children, including adverse birth outcomes, poorer health, risk of lead exposure, worse cognitive function, and lower educational outcomes [ 68 ]. These negative health outcomes are compounded for people with SUDs [ 69 ]. Unhoused people who use drugs are often forced into more unsafe, more unsanitary, and riskier injection and drug-using practices to avoid detection [ 70 ]. Evictions and homelessness are also associated with increased risk of drug-related harms, including non-fatal and fatal overdose, infectious diseases, and syringe sharing [ 71–73 ]. In addition, evictions can disrupt relationships between users and trusted sellers, making an already unregulated drug supply even more unpredictable [ 70 ].

While housing is understood as a key component of health and safety for all people, including people who use drugs, drug war logic can encourage and facilitate displacement, making it hard for housed people to remain so and creating barriers for those who are unhoused to find safe, affordable housing options. Solutions for improving housing access include ending evictions and removing housing bans based solely on drug-related activity or suspected activity, restricting landlords from using criminal background checks to exclude prospective tenants, and ending collaborations between housing complexes and law enforcement. Housing interventions that can improve the health of people who use drugs, in particular, include investing in Housing First programs and permanent supportive housing, providing eviction protection to people who call for help during an overdose emergency (i.e. expanding 911 Good Samaritan laws), and establishing overdose prevention centres.

Education is also understood as a strong predictor of health [ 74–76 ], but drug war logic in educational settings can subject young people who use drugs to punishment rather than needed support. Adolescent substance use is associated with sexual risk behaviour, experience of violence, adverse childhood experiences, and mental health and suicide risks, which should justify greater mental health and support services in schools [ 77 ]. Despite this, punitive responses to suspected or confirmed drug use, ranging from surveillance and policing to drug testing and expulsion, are commonplace in the field of education.

In 2018, 94% of high schools used security cameras, 65% did random sweeps for contraband, and 13% used metal detectors [ 78 ]. Twenty-four states and the District of Columbia have almost as many police and security officers in schools as they do school counsellors [ 79 , 80 ]. Drug use is one of the most common sources of referrals of students to police [ 80 ]. And recent estimates show that over a third of all U.S. school districts with middle or high schools had student drug testing policies [ 81–83 ].

Drug war policies also impact higher education, which is integral to economic mobility [ 84 ]. Prior to December 2020, federal law prohibited educational grants and financial aid to people in prison, one-fifth of whom were there for a drug offence, and drug convictions could lead to temporary or indefinite suspension of federal financial aid for students [ 85 ]. Still today, fourteen states have some temporary or permanent denial of financial aid for college or university education for people with criminal records [ 86 ].

These education policies – surveillance, policing, drug testing, zero tolerance, and barriers to financial aid – restrict access to education and ultimately impede economic wellbeing and positive health outcomes. For example, dropout risk increases every time a student receives harsh school discipline or comes into contact with the criminal legal system, including through school police officers [ 87 ]. Dropping out, in turn, is associated with higher unemployment and chronic health conditions [ 88 ]. In addition, discipline, such as expulsion for a drug violation, can contribute to more arrests for drug offences or the development of SUDs [ 89–91 ]. In contrast, school completion can help reduce higher risk substance use patterns [ 92 ], and education is a strong predictor of long-term health and quality of life [ 93 ].

Rather than supporting young people in completing their education and getting the support they may need, drug war logic prioritises punishing them in schools while often restricting access to financial aid and educational services for those seeking higher education. If we want to improve the health of young people, we need to reverse these policies. For example, the American Academy of Paediatrics opposes the random drug testing of young people based on an exhaustive review of the literature finding it did more harm than good [ 94 ]. Removing police from schools, ending zero-tolerance policies, and offering young people who use drugs counselling and support, instead of expulsion, could also help improve completion rates, ultimately leading to better health outcomes.

Public benefits

Though economic and food insecurity are linked with poor health outcomes, decades of drug policies have restricted access to public assistance programs. In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) [ 95 ], and one of the stated goals was to facilitate the transition from reliance on public assistance to full-time employment [ 96 ]. This law restricted benefits for people who use drugs, people with prior drug convictions, and their families in several ways.

The PRWORA introduced a lifetime ban on Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) cash assistance benefits for people with felony drug convictions, unless the state modified or opted out of the ban. Today, one state - South Carolina - fully bars people with felony drug convictions from receiving SNAP, and twenty-one states have instituted a modified SNAP ban [ 97 ]. Seven states fully bar people with felony drug convictions from receiving TANF, and seventeen states and the District of Columbia have instituted modified TANF bans [ 97 ]. Common features of modified bans can include mandatory drug treatment, drug testing, and parole compliance [ 98 , 99 ]. These zero-tolerance bans have discriminatory and disproportionate impacts among Black and Latinx people and women, who are disproportionately incarcerated for federal and state drug offences [ 100 ].

Drug testing of public benefits applicants is less discussed in the peer-reviewed literature [ 101 ]. Although the PRWORA authorised, but did not require, drug screenings of public benefits applicants, today 13 states drug test TANF applicants [ 102 , 103 ]. States that drug test as a condition of receiving TANF can only test if drug use is suspected. For example, some states automatically require people with felony drug convictions to take a drug test [ 104 ], while other states require all applicants to undergo a drug screening questionnaire and then require a test if there is suspicion of drug use [ 105 ]. Many TANF applicants, who are already low income, are expected to pay for their drug tests. The impact of drug testing on people with felony drug convictions is compounded since they are already disproportionately poor, unemployed, and food insecure compared to people who have never been incarcerated [ 106–108 ].

In most states that test, a positive drug test can temporarily or permanently disqualify a person from receiving TANF benefits [ 105 ]. Even if cash assistance is allocated to other household members (e.g. children) through a different parent or guardian, overall benefits for the family can be reduced. In some cases, a person who tests positive for drugs may still receive benefits but only if they complete mandated, abstinence-based treatment [ 105 ]. Such policies and practices can deter many eligible candidates and those in need of support from ultimately seeking these public benefits altogether [ 109 ].

There are numerous negative health consequences associated with food and economic insecurity [ 110–112 ]. In particular, studies have found that loss or reduction of SNAP is associated with increased odds of household and child food insecurity and increased odds of forgoing health or dental care [ 113 ]. Loss or reduction of TANF is associated with increased risk of hunger, homelessness or eviction, utility shutoff, inadequate medical care, and poor health [ 114 ].

When people are seeking financial and nutritional support to better care for themselves and their families, especially in crisis, drug war logic justifies more barriers to SNAP and TANF and the discontinuation of assistance precisely when people need it the most. To better support financial and economic security of low-income people, advocates can support removing TANF and SNAP bans for people who have felony drug convictions, ending drug testing requirements for public assistance, eliminating mandatory drug treatment requirements for public benefits applicants and recipients, and adequately investing in public benefit programs to ensure they provide enough assistance for families.

Family regulation

The family regulation system (FRS) often treats any drug use as a predictor of child abuse or neglect, even though research shows that poverty is one of the largest predictors of adverse infant and child health outcomes [ 115 ]. Drug war logic within the FRS justifies the separation and punishment of families for drug use even absent evidence of abuse or neglect. Half of all states and the District of Columbia require healthcare professionals to report any suspected drug use during pregnancy to FRS authorities, and eight states require them to drug test patients suspected of drug use [ 116 ]. Statutes in nineteen states and the District of Columbia define any drug use during pregnancy as a form of child maltreatment [ 117 ]. These policies exist even though most people who use drugs use them infrequently and do not meet criteria for SUDs [ 118 ]. Additionally, evidence proving causal links between prenatal drug use and child harm and maltreatment is limited. Research finds that in utero exposure to drugs may not have long-term negative developmental impacts on the child and that confounding variables, like poverty and food insecurity, have significant and often stronger impacts on child development than drug use [ 117 ].

Drug testing, mandatory reporting, and the prospect of punishments result in poorer health outcomes for pregnant people who use drugs, especially if they struggle with their use. A fear of punishment and family separation leads some pregnant people who use drugs to avoid honest, open conversations about healthcare needs or how to reduce drug use harms so that many delay, avoid, or forgo prenatal care altogether [ 119 , 120 ].

Like healthcare professionals, most school teachers, counsellors, social workers, and mental healthcare providers are required by law to report any suspicion of child maltreatment or neglect, which then initiates an FRS investigation [ 121 ]. A child can be removed from their home if the caregiver tests positive for drugs, even absent any other evidence of mistreatment or abuse. In addition, a positive drug test can lead to a parent being mandated to complete abstinence-based treatment even if the parent does not meet criteria for a diagnosable SUD [ 122 ]. Intervention by the FRS, such as placing children in foster care, can lead to adverse education, employment, and mental and behavioural health outcomes among children; increased parental mental illness diagnoses; and increased parental drug use to cope with the trauma of family separation [ 123–125 ].

These policies have disproportionate impacts on Black people. Black pregnant women are more likely to be tested for drug use, and Black women are reported to the FRS at higher rates than white women [ 126–128 ]. Over half of Black children will experience an FRS investigation at some point during their lifetime [ 129 ]. One study that analysed cumulative foster system removals between 2000 and 2011 found that 1 in 17 U.S. children, 1 in 9 Black children, and 1 in 7 Indigenous children will experience foster placement before they turn 18, and data show that many FRS cases involve allegations of parental drug use at some point [ 130 ]. These disparities in FRS involvement are not because Black parents are using drugs or mistreating their children at higher rates; rather, it’s because Black families, especially poor Black families, more often encounter state systems – like public hospitals and public benefits offices – and mandated reporters within these systems that monitor behaviour and drug use [ 131 ].

Drug war logic prioritises separation, coercion, and punishment in families where drug use occurs or is suspected. For pregnant people and parents who do use problematically, their use should be treated as a public health issue, according to international bodies like the United Nations General Assembly Special Session on drugs [ 132 ]. Advocates can support legislative policy changes to prohibit removals based on drug tests alone, eliminate mandatory reporting for drug use alone, and repeal laws that define drug use during pregnancy as de facto child abuse or maltreatment. Healthcare professionals can also advocate to only allow drug testing when medically necessary and when the parent provides informed consent; support practices that keep parents and infants together, like breastfeeding and skin-to-skin contact, that can mitigate the effects of neonatal abstinence syndrome [ 133 , 134 ]; and create programs providing both perinatal healthcare and SUD treatment to improve access and continuity of care as well as initiation and maintenance of medications for addiction treatment.

Substance use treatment system

Substance use treatment can be an essential lifeline for people with SUD working towards recovery. Yet surveillance and punishment are embedded into SUD treatment through the numerous constraints placed upon clients because of the role of institutional referral sources in treatment, such as the criminal legal system, the FRS, social services, and others. Studies suggest that roughly 25% of clients in publicly funded treatment were referred from the criminal legal system as a condition of their probation, parole, or drug court program [ 135 ]. This has led to therapeutic jurisprudence: the belief that the criminal legal system can support and facilitate efforts towards rehabilitation using the threat of incarceration [ 136 ]. Another 25% of clients are referred to treatment by other sources, including the FRS, social services, schools, and employers [ 133 ]. Criminal legal controls such as those from the courts, or formal social controls such as those from the other aforementioned institutions, coerce clients to either comply with treatment or face other harsh consequences, like incarceration, the termination of parental rights, or losing public benefits [ 137 ].

Treatment providers monitor client compliance and abstinence by conducting and observing routine urine drug tests, and providers are often in regular contact with referral sources about client progress in treatment. Any drug use or negative progress reports can be used as grounds to sanction those on probation, parole, or in drug court which can lead to incarceration and, in cases of drug courts, longer sentences than if participants had accepted a jail sentence [ 136 ]. Clients referred by other sources can also face ramifications for positive drug tests or treatment non-compliance, impacting child custody hearings as well as their ability to secure certain social services and resources, stay enrolled in school, or remain employed.

Referral sources influence the type of care that clients receive in facilities, including evidence-based treatments. Research suggests that only 5% of clients with opioid use disorder (OUD), who were referred to treatment from the criminal legal system, received either methadone or buprenorphine, compared to nearly 40% those who were not referred by the system [ 138 ]. This represents an extension of a broader problem within the criminal legal system wherein access to these gold standard medications for OUD is almost nonexistent in most jails and prisons across the U.S [ 139 ].

Drug war logic is also deeply rooted in the restrictions for prescribing and dispensing methadone and buprenorphine since they are controlled substances under the oversight of the Drug Enforcement Agency, a federal law enforcement entity. When taken in effective doses, these life-saving medications can cut the risk of overdose and all-cause mortality dramatically among people with OUD [ 140 ]. However, due to tight federal restrictions and guidelines for these controlled medications, patients can be subjected to routine drug testing, counselling requirements, daily clinic visits, and observed or highly monitored medication dispensing. Patients deemed non adherent to medications or who test positive for other drugs can then be subjected to dose reductions, required to attend treatment more frequently, or even terminated from care altogether [ 141 ]. The tight restrictions on both methadone and buprenorphine, combined with the oversight of the DEA, create obstacles for prescribers and stigmatise these medications by conveying that they cannot be used like other medications in routine healthcare [ 142 ]. These policies have also contributed to striking racial disparities in who receives buprenorphine versus methadone due to costly co-pays and insurance coverage issues [ 143 ]. Studies also suggest that the DEA’s involvement in monitoring buprenorphine has made pharmacies reluctant to stock the medication or to dispense it to patients for fear of triggering an investigation [ 144 , 145 ]. Ultimately, it is estimated that only 10% of all people with OUD receive these medications [ 146 ].

Providers can take steps to extract the drug war from our substance use treatment system, through their conscious and judicious documentation of treatment progress since those records could be used by criminal legal and other referral sources in decisions about clients and their families. In addition, eligible buprenorphine prescribers should begin prescribing to patients and join advocacy efforts to change policies to expand access to buprenorphine and methadone through looser restrictions.

Healthcare system

People with SUDs often have high rates of co-occurring medical needs requiring treatment, including psychiatric disorders, infectious diseases, and other chronic health conditions. However, research suggests that people with SUDs are often deterred from seeking healthcare to address their medical needs due to prior negative and stigmatising experiences with providers, and that having experienced discrimination in healthcare is associated with greater risk behaviours, psychological distress, and negative health outcomes among people who use drugs [ 147–149 ]. Some of these challenges are due to a lack of training on how to work with patients with SUDs, in addition to pre-existing personal biases and stigmatising views held by healthcare professionals, which impacts the type of care they provide [ 142 ].

The widespread use of drug testing in healthcare settings also creates ethical challenges and conflicts for providers and patients since results are often entered into the electronic health record (EHR). While EHRs are typically thought of as beneficial and intended for greater transparency and access, they also pose challenges surrounding patient privacy, confidentiality, and autonomy; they can, therefore, make patients reluctant to disclose drug use or consent to drug testing [ 150 ]. For instance, medical records that include drug test results, can be accessed by a wide variety of actors in the medical system, subpoenaed for court, and used in future medical decision making without the patient’s knowledge or consent. Providers might not receive adequate training to weigh the need for these tests as part of treatment adherence monitoring with the potential social or legal ramifications of these tests for the patient. Patients might also not be adequately informed of these potential consequences prior to testing.

Universal drug screening and testing in obstetric and gynecological care is an example wherein testing intersects with the role of most healthcare providers as mandated reporters. Mandated reporting for suspected child abuse or neglect due to parental drug use is purported to protect the foetus or children in the parents’ custody, yet this can often be a deterrent for patients to seek medical treatment altogether if they believe that they may lose their children or be subject to other mandates. The racial and class disparities in how such testing is used, as well as the punitive measures used against families, have been noted earlier in the text but is a compelling reason for healthcare providers to consider making recommendations for counselling or supportive case management in order to address family challenges.

Healthcare providers need more training and resources to work with patients with SUDs to ensure that they are engaging them in evidence-based treatments and treating their complex medical needs while avoiding some of the lifelong and harmful ramifications that can occur when drug testing, health records, and mandated reporting deter patients from seeking and receiving care.

Because of the social, economic, and health effects of drug policies, the work of ending the drug war cannot be situated within criminal legal reform efforts alone. The drug war and a punitive drug war logic impact most systems of everyday life in the U.S., subjecting people to surveillance, suspicion, and punishment and undermining key SDOH, including education, employment, housing, and access to benefits. Combined, these have resulted in poorer health outcomes for individuals, families, and communities, particularly for people who use drugs. These policies and practices, while race-neutral as written, are not [ 151 ]. The targeted effects on people of colour further entrench health and economic disparities. As the public and policymakers call for a health approach to drug use, it is vital to recognise how systems meant to care and support are often unable to serve their intended purposes; rather than help people who use drugs or are suspected of using drugs, they frequently punish them.

In their day-to-day practice, healthcare professionals must understand the deep roots of the drug war as well as their role in both perpetuating and undermining drug war logic and practices. Healthcare providers can treat people who use drugs with dignity, respect, and trust and ensure that healthcare and treatment decisions are made in partnership with individuals. Medical professionals can also work to situate drug use within a larger social and economic context [ 152 ], understanding that drug-related harms often stem from lack of resources – like housing and food precarity, economic insecurity, and insufficient healthcare – rather than from drugs themselves. Treatment need not be the only antidote for people who experience drug-related harms but should be one option among an array of health services, resources, and support.

At the mezzo- and institutional levels, healthcare providers can advocate to shift hospital and programmatic policies around drug testing, mandatory reporting, and collaborations with law enforcement. As outlined in this paper, drug testing is not an effective monitoring strategy for care and support, but rather, it is more often a punitive tool of surveillance. If drug testing cannot be eliminated, at the very least, patients should have the right to understand the implications of drug testing and provide explicit consent for the test. To the extent possible, providers should not share private patient information with police or state agencies. Healthcare professionals should understand the implications of reporting positive drug tests and suspicion of use and should work to change these policies where possible and inform their patients of them. Providers can ensure that their patients who use drugs have access to evidence-based, non-coercive harm reduction and treatment options in addition to robust and supportive primary healthcare. Healthcare professionals involved with medical education and licensure can work to ensure that all students graduate with a deep understanding of SDOH and the impact of the drug war on individual and community health.

Finally, healthcare providers can get involved with policy-level changes to end drug testing, mandatory reporting, zero-tolerance policies, coerced treatment, and denial of services and resources based on arrest or conviction records at the municipal, state, and federal levels. Providers can follow the leadership and expertise of people who use drugs, some of whom have organised themselves into user unions [ 153 ]. Policy advocacy can include drafting and joining sign-on letters, delivering expert testimony, speaking to media, writing op-eds, and lobbying medical professional organisations to release policy statements. Providers, who see firsthand the consequences of the war on drugs, are well positioned to be effective advocates in undoing these harmful policies that have for too long undermined key SDOH [ 154 ]. In order to improve individual and collective health, healthcare providers should resist drug war logic and work to transform these systems so they can truly promote health and safety.

For the purposes of this paper, we are using the term “Family Regulation System,” coined by Emma Williams and used by other scholars, instead of the more commonly used term “Child Welfare System” to reflect the fact that, particularly for low-income families and families of color, state intervention often occurs in order to regulate their families rather than to prioritize the welfare of the entire family unit, of which the child is a part.

Authors contribution

All authors (AC, SV, JN, KF) were involved in the conception and drafting of the paper, revising it critically for intellectual content; and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Disclosure statement

All authors are employed by the Drug Policy Alliance, a non-profit policy advocacy organisation. No other interests to disclose.

Data availability statement

The views expressed in the submitted article are those of the authors.

Calling supervised consumption sites ‘drug dens’ is inflammatory, unhelpful rhetoric

Federal Conservative Leader Pierre Poilievre speaks to the media in a school park during a press conference in Montreal on July 12. Christinne Muschi/The Canadian Press

“Justin Trudeau must immediately close this hard-drug injection site to protect our families,” Conservative Leader Pierre Poilievre said Friday in a playground beside the Maison Benôit Labre shelter in Montreal’s working-class Saint-Henri district.

It was a politically savvy move. The community drop-in centre for homeless people and transitional-housing project has been in the local news a lot lately, and none of the coverage has been flattering: open drug use, violence and encampments, all in close proximity to a playground and elementary school.

During the press conference, Mr. Poilievre was, naturally enough, asked about his party’s policy on “safe injection sites” more broadly.

“We will close them, we will close safe injection sites close to schools, playgrounds, and anywhere else they endanger lives,” he said.

But then the Conservative Leader paused and corrected himself. “By the way, they’re not safe injection sites. I’m sorry I used your dishonest language,” he replied to a reporter , before launching into a tirade about the “radical Liberal-NDP activists, lobbyists and bureaucracy” who have created the “drug dens” that his government will defund.

“There will not be a single taxpayer dollar from the Poilievre government going to drug dens . Every single penny will go to treatment and recovery services to bring our loved ones home drug-free.”

Mr. Poilievre makes some good points. The public is indeed fed up with the chaos and disorder that the toxic drug crisis has wrought on cities and neighbourhoods.

He is also correct that while the Supreme Court of Canada rebuffed an attempt by Stephen Harper’s government to close supervised (not “safe”) consumption sites, the court said restrictions on their locations are allowed. The activities around these facilities are not meant to be a free-for-all. People defecating, having sex, or injecting drugs in schoolyards or playgrounds or other public spaces is not acceptable.

But Mr. Poilievre is not served well by his inflammatory language and over-the-top rhetoric.

Supervised consumption sites like the one at Maison Benôit Labre are facilities where drug users can consume drugs (that they bring themselves) under the supervision of health professionals such as nurses. These sites offer clean needles (to reduce the risk of disease transmission) and overdose prevention and treatment (to reduce the burden on first responders), and they are a key conduit to getting users into detox and treatment.

To call health centres that practice harm reduction “drug dens” is insulting to those who do great work there. There are 39 supervised consumption sites across Canada and they have overseen 4.6 million visits and treated 55,693 overdoses to date (and counting).

(There is another common form of supervised consumption site called bars, where people consume the drug alcohol. Should we, for consistency’s sake, call them “gin mills” and shut them down?)

To say, as Mr. Poilievre did, that safe consumption sites are “drug dens and they’ve made everything worse” is patently untrue.

The promise (or threat) to cut federal funding is also a hollow one, as the federal government does not provide core funding to supervised consumption sites. What it does is provide exemptions from drug laws that allow them to operate.

“Bringing our loved ones home drug-free” is an admirable goal, but we need to keep people alive if they’re going to have any hope of treatment and recovery, and that’s the goal of harm-reduction services.

It’s disingenuous to suggest that closing supervised consumption sites, stopping decriminalization pilot projects, ending safer supply programs , or any other singular measure will magically clean up the streets, or that we can solve this complex problem with more addiction treatment alone.

The encampments that have mushroomed in North American cities in recent years have a multitude of causes that include a profound lack of affordable housing, a lack of mental health services and an ever-worsening toxic drug crisis.

More than ever, we need to embrace the “four pillars” strategy : Prevention, harm reduction, enforcement, and treatment.

In recent years, we have probably focused too much on the harm-reduction part of the puzzle, and not enough on enforcement and treatment.

No one benefits from city streets that are a combination of open-air drug markets, encampments and garbage dumps. We need to recognize that these problems are sometimes more acute where services such as supervised consumption sites operate.

But we also have to recognize that if supervised consumption sites are closed, drug use won’t end. It will simply move, to an even greater extent, into more streets, alleyways, parks and other public spaces.

Ultimately, we need to tackle public disorder and the toxic drug crisis simultaneously. And these complex problems require sophisticated solutions, not just colourful catchphrases.

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Alcohol, tobacco & other drugs in Australia

Australian Institute of Health and Welfare (2024) Alcohol, tobacco & other drugs in Australia , AIHW, Australian Government, accessed 16 July 2024.

Australian Institute of Health and Welfare. (2024). Alcohol, tobacco & other drugs in Australia. Retrieved from https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia

Alcohol, tobacco & other drugs in Australia. Australian Institute of Health and Welfare, 10 July 2024, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia

Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2024 [cited 2024 Jul. 16]. Available from: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia

Australian Institute of Health and Welfare (AIHW) 2024, Alcohol, tobacco & other drugs in Australia , viewed 16 July 2024, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia

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Amphetamines and other stimulants

On this page, key findings.

In 2022–2023, 1% of people in Australia aged 14 and over had recently consumed methamphetamine and amphetamine

Consumption

Recent cocaine use was similar between 2019 (4.2%) and 2022–2023 (4.5%)

Australia had the sixth highest average total stimulant consumption when compared with 24 countries across Europe, Oceania, Asia and the United States of America (1 city)

International comparisons

The rate of hospitalisations for amphetamines and other stimulants rose from 38.8 to 55.1 per 100,000 population between 2015–16 and 2020–21, then fell to 39.1 per 100,000 in 2021–22

Hospitalisations

There has been a rapid increase in the number of deaths involving methamphetamine and other stimulants, with the death rate in 2022 almost 4 times higher than that in 2000 (1.8 deaths compared with 0.5 deaths per 100,000 population, respectively)

In 2022–23, amphetamines were the second most common principal drug of concern for which people received treatment (24% of episodes)

View the Amphetamines and other stimulants in Australia fact sheet >

Stimula nts are a group of drugs that produce stimulatory effects by increasing nerve transmission in the brain and body (Nielsen & Gisev 2017). Included in this group are:

• Amphetamines used for therapeutic purposes to treat attention deficit-hyperactivity disorder (ADHD), but may also be used non-medically, non-medical use of these substances is included in Pharmaceuticals. 
• Methamphetamine (also referred to as methylamphetamine) – a potent derivative of amphetamine that is commonly found in 3 forms: powder (speed), base and its most potent form, crystalline (ice or crystal).
• 3, 4-methylenedioxymethamphetamine (MDMA) – commonly referred to as ‘ecstasy’ – is an amphetamine derivative. (Note ecstasy may contain a range of other drugs and substances and may contain no MDMA at all).
• Cocaine – produced from a naturally occurring alkaloid found in the coca plant.

The focus in this section is on the illicit use of amphetamines and other stimulants (Box STIM 1).

Box STIM 1: Defining amphetamines and other stimulants

Data sources on methamphetamine, amphetamine and other psychostimulants contain a variety of terms; in some instances, these terms cover similar, but not the same range of drugs. This can be confusing when interpreting results across different data sources.

Below is a description of each term used in these data sources and the types of drugs they encompass:

Amphetamine-type stimulants (ATS) covers a large range of drugs, which includes amphetamine, methylamphetamine and phenethylamines (a class of drug that includes MDMA or ‘ecstasy’).

Amphetamines refers to a broad category of substances. According to the Australian Standard Classification of Drugs of Concern (ASCDC) (ABS 2011), this includes amphetamine, methylamphetamine, dexamphetamine, amphetamine analogues and amphetamines not elsewhere classified. This is the term used in the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS). 

Methamphetamine (also methylamphetamine) also comes in different forms, including powder/pills (speed), crystal methylamphetamine (crystal meth or ice), a sticky paste (base), and a liquid form.

Methamphetamine and amphetamine includes methylamphetamine and amphetamine and is the term used in the National Drug Strategy Household Survey (NDSHS). Prior to 2022–2023, the NDSHS asked about the use of “Meth/amphetamines”, which also included the non‑medical use of pharmaceutical amphetamines, such as Ritalin (methylphenidate) and pseudoephedrine based cold and flu tablets. The change in terminology was implemented to improve national estimates for use of methamphetamine and amphetamine and improve the understanding of the questions among people who had used methamphetamine and amphetamine. The change represents a break in the timeseries. Results for methamphetamine and amphetamine in 2022–‍2023 should not be compared to meth/amphetamines results from previous survey waves.

Ecstasy (also MDMA) is often consumed in the form of a tablet or capsules but can also be in powder or crystal form.

Cocaine is commonly consumed in powder form, which can be snorted or dissolved in water so it can be injected.

Psychostimulants (also stimulants) includes ecstasy, methamphetamine, cocaine, and new psychoactive substances (NPS). This is the sampling criteria for participants of the Ecstasy and related Drugs Reporting System (EDRS).

Availability

People who regularly use illicit drugs report that methamphetamine and other stimulants are easy to obtain in Australia.

Findings from the Illicit Drug Reporting System (IDRS) show that people who inject drugs commonly report it is ‘easy’ or ‘very easy’ to obtain methamphetamine and other stimulants. Specifically in 2023:

• Over 9 in 10 (94%) people who had recently used crystal methamphetamine reported that it was ‘easy’ or ‘very easy’ to obtain (Sutherland et al. 2023b, Figure 15).
• Over 2 in 3 (68%) people who had recently used cocaine reported that it was ‘easy’ or ‘very easy’ to obtain (Sutherland et al. 2023b).

Similarly, data from the 2023 Ecstasy and Related Drugs Reporting System (EDRS) show that most people who use ecstasy and other stimulants report that methamphetamine, ecstasy, and cocaine are ‘easy’ or ‘very easy’ to obtain (Sutherland et al. 2023a). Findings show that:

• Perceived availability was the highest for crystal methamphetamine (95% of participants rated it ‘easy or very easy’ to obtain), a small increase from 2022 (92%). Perceived availability for powder methamphetamine increased to 2023 (68% of participants rated availability as it ‘easy or very easy’ to obtain).
• In 2023 a significant change in the perceived availability of ecstasy in all forms was reported relative to 2022. For capsules 77% of participants rated it ‘easy’ or ‘very easy’ to obtain, an increase from 49% in 2022. Powder forms increased to 63% from 42%, crystal increased to 72% from 42%, and pills to 63% from 48% in 2022.
• Perceived availability of cocaine remained stable relative to 2022; 80% of participants in 2023 who could comment rated it ‘easy’ or ‘very easy’ to obtain.
• The main approach for arranging the purchase of any illicit or non-prescribed drugs by participants in the previous 12 months was face-to-face (72%), an increase from 69% in 2022. Social networking applications (such as Facebook, Wickr, WhatsApp, SnapChat, Grindr, Tinder) were used by 71% of participants, a small decrease from 2022 (73%) (Sutherland et al. 2023a).

Please see the data quality statements for the EDRS and the IDRS for data collection during COVID-19 and comparability across years.

The Australian Criminal Intelligence Commission (ACIC) collects national illicit drug seizure data annually from federal, state and territory police services, including the number and weight of seizures to inform the Illicit Drug Data Report (IDDR). According to the latest IDDR, in 2020–21, around one-third of national illicit drug seizures (28,503 or 27%) were amphetamine-type stimulants (ATS) (including MDMA). Additionally:

• The number of national ATS seizures has increased by 88% over the last decade, with 28,503 seizures in 2020–21, up from 15,191 in 2011–12.
• In 2020–21, ATS accounted for 15% of the total weight of illicit drugs seized nationally. 
• The total weight of ATS seized nationally has increased 300% over the last decade, from 1,573 kilograms in 2011–12 to 6,287 kilograms in 2020–21 (ACIC 2023a, Figure 8).

Amphetamines accounted for the majority of ATS seizures in 2020–21:

• 25,745 national amphetamines seizures accounted for 90% of the total number of seizures
• 5,892 kilograms accounted for 94% of the weight of seizures (ACIC 2023). 

Nationally, in 2020–21, there were:

• 1,753 amphetamine-type stimulant (excluding MDMA) detections at the Australian border, weighing 5,290 kilograms (ACIC 2023a, Figure 1).
• 1,773 MDMA (ecstasy) detections, weighing 106 kilograms (ACIC 2023a, Figure 2). 
• 2,578 MDMA seizures (9% of total ATS seizures), weighing 249 kilograms (4% of the total weight of ATS seized) (ACIC 2023a).

Over the last decade, cocaine detections at the Australian border increased:

• from 979 detections in 2011–12 to 2,169 detections in 2020–21 (an increase of 122%). 
• The weight of cocaine detected increased by 228%, from 786 kilograms in 2011–12 to a record 2,576 kilograms in 2020–21 (ACIC 2023a, Figure 19).

The number and weight of national cocaine seizures has also increased over the last decade:

• from 1,336 seizures in 2011–12 to a record 6,452 in 2020–21 (a 383% increase).
• The weight of cocaine seized increased over the same period, from 956 kilograms in 2011–12 to 4,421 kilograms in 2020–21 (a 362% increase) (ACIC 2023a, Figure 22).

Research (ACIC 2019) has shown the impact of seizures on consumption – see Supply reduction – Prohibited substances (ACIC 2023a).

For related content on amphetamines and other stimulant consumption by region, see also:

Data by region: Use of illicit drugs

There are differences in trends and patterns of consumption in Australia according to the type of stimulant used.

Methamphetamine and amphetamine

• The 2022–2023 NDSHS reported 1.0% of people aged 14 and over in Australia had used methamphetamine and amphetamines in the last 12 months, whereas 7.5% had used methamphetamine and amphetamines in their lifetime (AIHW 2024b, tables 5.2 and 5.6).
• The 2022–2023 NDSHS found that most people who had used methamphetamine and amphetamine recently had used powder/speed at some point in their lifetime (67%), followed by crystal/ice (55%) (AIHW 2024b, Table 5.85).
• 30% of participants in the EDRS reported use of any form of methamphetamine in the previous 6 months, stable relative to 2022 (31%) (Sutherland et al. 2023a). 
• 81% of participants in the IDRS reported use of any form of methamphetamine in the previous 6 months, stable relative to 2022 (81%) (Sutherland et al. 2023b).

Participants in the EDRS reported a decrease in the use of crystal methamphetamine in the preceding 6 months (29% in 2012 to 18% in 2022) (Sutherland et al. 2022a, Figure 16).

Figure STIM 1: Recentᵃ use of cocaine or ecstasy, people aged 14 and over, by age and gender, 2001 to 2022–2023 (per cent)

The figure shows the proportion of people who recently used meth/amphetamine in the last 12 months by age group from 2001 to 2019. Between 2001 and 2019, there were decreases for age groups of 14–19, 20–29, and 14 and over who had recently used meth/amphetamine. Over the same period, the proportion of people aged 30–39, and 50 and over who recently used meth/amphetamine remained stable. In 2019, people aged 20–29 (2.4%) and 30–39 (2.0%) were most likely to have recently used meth/amphetamine.