In November 2000, California voters passed Proposition 36, known formally as the Substance Abuse and Crime Prevention Act, by a 61 to 39 percent margin. The act allows people who have been convicted of first or second time nonviolent, simple drug possession the opportunity to receive substance abuse treatment in lieu of incarceration. The proposition allocates $120 million annually for five and one half years to pay for treatment services. Studies have suggested that up to thirty-six thousand nonviolent users could be affected each year and that the initiative could save the state and local governments as much as $200 million annually due to reduced prison operation costs. Proposition 36’s overwhelming victory suggests that Americans have become more accepting of the idea that drug addicts suffer from a disease that requires treatment, rather than a character fault that must be punished.
Deciding how to approach drug abuse is especially important given the increasing prevalence of drug use in the United States. According to the 2001 National Household Survey on Drug Abuse, 15.9 million Americans aged twelve or older could be classified as current illicit drug users, meaning that they had used an illegal drug at least once during the previous month. Of those substances, marijuana was the most commonly used, with 12.1 million American adolescents and adults reporting having used it during the pre11 vious month. Current users of cocaine numbered 1.7 million, while 1.3 million had taken hallucinogens and 123,000 Americans had smoked or injected heroin.
Statistics indicate that drug use is especially high among young people. For example, 10.8 percent of Americans between the ages of twelve and seventeen were current illicit drug users, compared to 9.7 percent in 2000. For young adults between the ages of eighteen and twenty-five, the increase was even sharper, rising from 15.9 percent to 18.8 percent. Overall, these two age groups were responsible for 51 percent of all illegal drug use and a disproportionate amount of inhalant and hallucinogenic abuse (76 percent and 86 percent, respectively).
However, not everyone who uses drugs becomes chemically dependent. Although the terms “substance abuse” and “chemical dependency” are often used interchangeably, there are differences between them. According to the Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision, published by the American Psychiatric Division, “substance abuse” is associated with social factors, such as the failure to meet important obligations, multiple legal problems, drug-related arguments, and the use of drugs in dangerous situations. On the other hand, “chemical dependency” is defined by physical factors, such as increased tolerance to drugs, withdrawal symptoms, an inability to control or decrease use, and continued use despite acknowledgement of the drugs’ dangerous effects.
The American view on chemical dependency has long been a dichotomy, wavering between the belief that the freedoms granted to Americans by the Constitution means that they are responsible for their behavior, and the longstanding view that addiction is a disease of the body and mind. According to William L. White, in an article for Counselor, “The cultural perception of opiate addiction evolved over the 19th-century from that of a misfortune, to that of a vice, to proposals that such dependence should be viewed as a disease.” However, in the first half of the twentieth century, the idea that addiction was a sign of weakness reemerged. In the 1930s, most states considered, but then abandoned, antidrug education in schools out of fear that knowledge about drugs would lead to experimentation and addiction. By the middle of the century, according to Laurie LaChance in Alcohol and Drug Use Among Adolescents, “any drug use was considered to be pathological.”
However, medical and scientific discoveries in the past several decades have lent support to the disease model of dependency. Researchers have found that the brains of addicts are different from those of people who are not dependent on drugs, tobacco, or alcohol. In an article for the magazine Current Health, Melissa Abramovitz explains: “Addictive drugs change the brain. Most doctors now agree that addiction is a disease, not a weakness.” Drugs such as cocaine and heroin activate the brain’s reward system, causing the user to experience pleasure and euphoria. Repeated abuse of these substances can alter the brain’s chemistry, which makes people suffering from chemical dependency respond more intensely to drugs. In addition, increased levels of tolerance require that drug users take more of the substance in order to feel the same euphoria, which raises the likelihood of an overdose. Adolescents are most at risk because their brains undergo many changes during puberty. They are also more vulnerable to addiction because they are more likely than adults to take risks. Many youth are also genetically predisposed to addiction.
Not everyone has embraced this view of dependency. Among its doubters are Sally Satel, a lecturer at the Yale University School of Medicine. Writing for the journal Public Interest, she contends that there have been no scientific studies linking drug exposure with changes in the brain. Satel also argues that the brain-disease model ignores the importance of the criminal justice system in ending drug addiction. She writes: “By downplaying the volitional dimension of addiction, the brain-disease model detracts from the great promise of strategies and therapies that rely on sanctions and rewards to shape self-control.”
Despite these qualms, many people support medicallybased drug treatment over jail. In the opinion of the Physician Leadership on National Drug Policy: “Addiction to illegal drugs is a chronic illness. . . . Enhanced medical and public health approaches are the most effective method of reducing harmful use of illegal drugs.” Thus, like other diseases, chemical dependency is often best treated with drugs, among them methadone, which reduces the craving for heroin, and naltrexone, which blocks the effects of heroin on the brain’s receptors and is effective in treating alcohol dependency. Because one element of chemical dependency is the inability to decrease drug use despite knowledge of its deleterious effects, counseling and behavioral modification are also critical facets of drug treatment.
The success of Proposition 36 may determine whether popular support for drug treatment continues. In March 2002, the Drug Policy Alliance (DPA) issued an evaluation of the effects of Proposition 36 in seven California counties. The alliance found that the Substance Abuse and Crime Prevention Act was “on the path to fulfill its promise to the voters to reduce the rates of drug addiction and crime by diverting offenders to drug treatment.” According to the report, 9,500 drug offenders had been referred to treatments in the first six months of the act’s implementation. The DPA believes that the number of qualifying individuals will gradually decrease as participants in programs defeat their drug addictions and get out from under the auspices of the criminal justice system.
Americans have debated the causes and treatments of chemical dependency for centuries. In Chemical Dependency: Opposing Viewpoints, the authors consider these arguments and related controversies in the following chapters: Is Chemical Dependency a Serious Problem? What Causes Chemical Dependency? What Drug Treatment and Prevention Programs Are Effective? Should Drug Laws Be Reformed? In their viewpoints, the authors provide a better understanding of a problem that affects millions of people.