WAR AGAINST SUBSTANCE ABUSE

WAR AGAINST

SUBSTANCE

ABUSE
Overcoming Drug and other Substances addiction
committed to proper understanding and Rehabilitation

Dogan Harry
Dogan Harry
2023

Copyright Page

Dogan Harry © 2023

All Rights Reserved.

 WAR AGAINST SUBSTANCE ABUSE

INTRODUCTION 4

CHAPTER ONE 6

WHAT IS SUBSTANCE ABUSE? 6

CAUSES OF SUBSTANCE ABUSE 11

GENETIC: 12
PHYSICAL: 12
ENVIRONMENT: 12
WHAT ARE THE INDICATORS OF SUBSTANCE ABUSE? 13

CHAPTER TWO 14

SUBSTANCE USE DISORDER (SUD) 14

SUBSTANCE USE DISORDERS: TYPES 17

DRINKING DISORDER 17
DRUG ADDICTION 18
DRUG USE DISORDERS' ROOT CAUSES 19
HOW IS ADDICTION TO SUBSTANCES TREATABLE? 20
HOW TO SUPPORT A FRIEND OR RELATIVE? 22
HERE ARE SOME IDEAS TO GET YOU GOING: 22
HERE ARE A FEW THINGS YOU SHOULD AVOID: 23

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CHAPTER THREE 26

THE ABUSED SUBSTANCES 26

HERE ARE FIVE SUBSTANCES THAT ARE FREQUENTLY ABUSED: 26

CHAPTER FOUR 32

COMBATING SUBSTANCE ABUSE 32

PUBLIC POLICIES AIMED AT COMBATING SUBSTANCE ABUSE 34

REDUCING THE AVAILABILITY OF ADDICTIVE CHEMICALS 36
TREATMENT FOR ADDICTION 38

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INTRODUCTION
It's important to remember that substance abuse is serious.
Alcohol, prescription drugs, and other legal and illicit substances
can cause it if they are used excessively or improperly.

Addiction is not the same as substance abuse. Many people

with addiction issues are able to stop using drugs or alcohol or can
alter their unhealthy habits. On the other hand, addiction is a
disease. It implies that even if your condition harms you, you can't
stop using.

Every aspect of your life is impacted by substance abuse.

You might get hurt, as well as those around you. Relationships and
your financial situation may be destroyed. Drug abuse can result in
addiction, severe health issues, and even death

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CHAPTER ONE

WHAT IS SUBSTANCE

ABUSE?
A pattern of dangerous substance usage for mood-altering
objectives is known as substance abuse. In addition to alcohol and
other drugs (legal or not), "substances" can also refer to various
substances that aren't actually drugs. A substance can be used
"abusively" if it is used contrary to instructions or in excess of
what is recommended. To be clear, a person can use drugs without
becoming addicted to them or even developing a substance use
problem. In other words, if a person regularly drinks or uses more
than they intended to, frequently suffers from hangovers, misses
work or school due to drug use, smokes enough marijuana to lose
friends, or frequently drinks or uses more than they intended to,
their substance use is likely considered misuse or harmful use.

Substance abuse, as it is defined in this text, is the

excessive use of a drug in a way that is harmful to oneself, to
society, or to both. This term covers both psychological and
physical reliance. When a drug is stopped abruptly, withdrawal
symptoms start to appear due to a changed physiological state

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known as physical dependency. In the absence of physical

dependency, psychological dependence is defined as a condition of
overwhelming need to continue using a substance. Alcohol is a
drug that can lead to both physical and psychological dependence,
according to these criteria. Alcohol is regarded as one of several
drugs of abuse in this chapter. It is important to keep in mind,
however, that alcohol is frequently seen as a different category
from other drugs of abuse due to the severity of alcohol-related
issues in the United States.

Many individuals with serious substance addiction issues

will tell you they don't have any issues since they don't realize
they're drug dependent. So, it is crucial to find out how much of
the medication the patient actually takes. Another crucial factor is
how frequently the patient uses medicines that can be abused. If
excessive use looks likely, it is beneficial to seek an extra estimate
from a friend or family member.

Patients try to be truthful in the majority of their medical

histories because it is obviously in their best health. Nonetheless,
there are significant pressures from social shame and potential
legal repercussions that may cause concealment in the case of
substance misuse. Addiction to drugs or alcohol is frequently seen
as a sign of weakness. Many patients are hesitant to disclose
anything because they fear being judged.

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The doctor must also be aware that a patient who is in

desperate need of medications can lie when giving a history or
otherwise misrepresent anything. For instance, narcotic-dependent
patients may pretend to have kidney stone discomfort in order to
have an opiate injection. The doctor should be aware of any
observable signs that a patient may be abusing drugs, such as
needle marks on the arms and legs of opiate addicts or areas of
fatty necrosis from subcutaneous injections, red eyes and
tachycardia, excitement, tachycardia, increased blood pressure, and
paranoid thinking in amphetamine users, and sensory distortion
like illusions and hallucinations in patients using psychedelic
drugs.

Laboratory tests can be very helpful if a doctor suspects

substance usage despite the absence of these symptoms. The
detection of opiates, amphetamines, barbiturates, cocaine,
phencyclidine, and alcohol may now be done in laboratories with
confidence. An abstinence state that will confirm drug addiction
may occasionally be induced as a diagnostic test with a tiny dosage
of a narcotic antagonist like naloxone.

A lot of addicts use addictive substances to treat their

anxiety or sadness. Asking the patient if they prefer "uppers"
(stimulants) or "downers" is frequently useful (sedatives). Those
who consume drugs primarily for depression tend to favor

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"uppers." Those who are anxious most of the time tend to prefer
"downers".

The doctor should try to ascertain how much drug and

alcohol usage is affecting the patient's performance in work,
family, education, and social interactions before concluding the
investigation in this area.

An estimated 5 to 10% of American adults are claimed to

have a drinking problem, 600,000 people are heroin addicts, and
25 million people have at least tried marijuana. These figures make
it clear that substance abuse is a prominent area of research. The
doctor will encounter several patients in practically every field of
medicine whose use of drugs, alcohol, or both has drastically
reduced their ability to function.

Laws like the Harrison Narcotics Act (1914) that were

passed in the early 1900s set off a pattern of steadily expanding
governmental regulation. At the moment, using illegal drugs is
viewed as a medical and legal issue. Several federal organizations
enforce regulations against drug usage, but the Drug Enforcement
Agency and the Food and Drug Administration are the most well-
known. The National Institute on Drug Addiction and the National
Institute on Alcohol Abuse and Alcoholism are the two federal
organizations that are primarily active in treatment programs for
substance misuse.

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Heroin abuse, in particular, results in a physical condition

that is very challenging to recover from. Almost 90% of patients
who were released from federal drug addiction institutions
relapsed, according to previous data. Today, many heroin users are
receiving treatment in therapeutic communities and methadone
maintenance programs, where the outcomes are noticeably
improved.

Alcoholism or other substance abuse dependence is a very

serious issue for the sufferer. Several presenting disorders,
including dangerous ailments including endocarditis, cirrhosis of
the liver, septicemia, hepatitis, and subdural hematoma, may have
substance addiction as their underlying cause. Even if it wasn't the
main issue that led to the patient's admission for treatment,
substance abuse might make it so difficult for the patient to
participate with therapy that nothing gets done until the addiction
is treated. It is crucial for the doctor to understand whether a
patient is using drugs or alcohol to try to self-medicate an
emotional condition. The doctor must next incorporate methods to
treat the emotional problem into the therapy strategy.

Independence from parents and other adults, as well as a

desire for strong relationships with peers and friends, are
characteristics of adolescence and the transition to adulthood. This
age group is also defined by trying out new concepts, lifestyles,

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and decisions that don't necessarily turn out to be the best ones.
Many times, the results of these experiments are ambiguous, which
prompts some young people to turn to drugs, alcohol, and tobacco
as a way to get away from those circumstances.

Substance abuse results from the misuse of these

substances. Abuse of substances has a wide range of detrimental
physiological and psychological repercussions. Substance misuse
is still used by young people as a coping mechanism for a variety
of socioeconomic and psychological issues. Given the vulnerability
of young people, it is imperative that the world community address
this issue.

For the treatment of drug and alcohol problems, there is

now a vast network of commercial, federal, and state institutions
that offer both inpatient and outpatient options. It is important for
doctors to get familiar with these organizations so that appropriate
referrals can be made. In addition, the private group of Alcoholics
Anonymous has been of enormous aid to many alcoholics. As
many patients with drug addiction are unwilling to acknowledge
that they have a problem, the doctor frequently needs to employ a
skillful combination of persuasion and pressure to persuade the
patient that assistance must be sought.

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Causes of Substance Abuse

The likelihood that someone will develop a drug addiction

depends on a variety of factors. A number of elements that interact
to foster abuse are among the components that contribute to
addiction. An individual has a higher possibility of developing an
addiction if they have more risk factors.

Genetic:
About half of our susceptibility to addiction is determined
by our innate genes along with environmental factors.

Physical:
Some substances found in drugs interfere with how nerve
cells usually transmit, receive, and process information by using
the brain's communication system. The longer a person abuses
drugs, the greater the chance that the drugs could permanently
harm this system and possibly cause the body to produce less
naturally occurring neurotransmitters, the brain's primary means of
communication, which would then result in a physical dependence
on drugs.

Environment:
Early drug experimentation increases the likelihood that a
person would become addicted later in life. Moreover, peer
interactions where drug use is common might result in drug misuse
drug experimentation. Others may discover that using drugs for

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recreational purposes helps them temporarily relax from some of

the unpleasant stressors in life.

What are the indicators of substance abuse?

Consider the following red flags if you're worried that

you're using drugs dangerously for your health or if you're worried
about someone you care about:

 being acquainted with new people who might

promote drug use
 stealing from family and friends, or borrowing
money or goods in order to purchase drugs
 giving up previous endeavors or pastimes that don't
include using drugs
 It's a good idea to get a second opinion if you have
any questions.
 lying about using drugs
 avoiding close friends and family who are critical of
drug use
 Underage drinking and driving
 breaching the law or getting into legal trouble

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CHAPTER TWO

SUBSTANCE USE

DISORDER (SUD)
The repeated, hazardous use of any substance, including
alcohol and narcotics, is known as substance use disorder. The
chemicals could be legal, prescribed drugs, illegal drugs, or even
compounds that aren't even considered drugs. When you use a
substance incorrectly or take more than the advised dosage, this is
considered substance use and abuse.

Uncontrolled substance usage despite negative effects is a

complex condition known as substance use disorder (SUD).
Individuals with SUD have a strong concentration on using a
particular substance or substances, such as alcohol, cigarettes, or
illegal narcotics, to the point where it interferes with their capacity
to function in daily life. Even when they are aware that the
substance is causing or will cause issues, people continue to use it.
The most serious SUDs are occasionally referred to as addictions.

A substance use problem can lead to impaired thinking and

actions in a person. Those who experience strong cravings,
personality changes, odd movement patterns, and other behaviors

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do so as a result of changes in the structure and function of their

brains. The areas of the brain associated with judgment, decision-
making, learning, memory, and behavioral control show changes in
brain imaging investigations.

Substance abuse on a regular basis can alter how the brain

works. These alterations may last for a considerable amount of
time after the drug's initial effects subside, or after the intoxication
stage. When a substance is consumed, intoxication results from the
great pleasure, euphoria, tranquility, enhanced perception, and
other feelings that are brought on by the substance. Each chemical
produces a particular set of intoxication symptoms.

When a person has a substance use disorder, they

frequently develop a tolerance to the substance, requiring higher
doses to produce the desired effects.

People start using drugs for a variety of reasons, says the

National Institute on Drug Abuse, including

 to experience a positive emotion, such as a "high"

or "intoxication."
 To relax, forget about issues, or experience
numbness.
 to perform better or think better.
 experimentation, peer pressure, or curiosity.

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People can become addicted to habits such as gambling in

addition to substances (gambling disorder).

Even if they wish to stop and attempt, those who are

addicted to substances or behaviors may not be able to do so. In
addition to interpersonal issues with coworkers and friends, family
members, and friends, addiction can lead to physical and
psychological issues as well. One of the major national
contributors to preventable illness and early mortality is the use of
alcohol and other drugs.

Signs of substance use disorder are classified into four

categories:

 A yearning or strong drive to use the substance, a

desire or failed attempts to cut down or manage
substance use are all signs of impaired control.
 Social issues include the inability to finish
important responsibilities at work, school, or home
due to substance use, as well as the reduction or
cessation of social, professional, or recreational
activities.
 Risky use is when a substance is used in dangerous
circumstances and is continued despite knowing
issues.

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 Effects of drugs include tolerance (the requirement

for higher doses to have the same effect) and
withdrawal symptoms (different for each
substance).

Substance use disorder frequently coexists with another

psychiatric condition. Substance use disorder frequently develops
after another psychiatric disorder, or using drugs or alcohol may
cause or exacerbate another psychiatric disorder.

Substance Use Disorders: Types

Alcohol use disorder and drug use disorder are the two
main categories of substance use disorders. While some people are
addicted to both drugs, others abuse just one of them.

Drinking disorder
The most frequently abused drug in America is alcohol.
One in twelve adults, or more than 17 million people, experience
the crippling effects of alcohol abuse. Alcohol use disorders,
sometimes known as alcoholism, are characterized by obsessive
drinking, a loss of control over their intake, and withdrawal
symptoms when they stop. Heavy drinking and binge drinking are
two types of problem drinking that frequently result in alcohol
addiction. Binge drinking is when a large amount of alcohol is

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consumed in a single day. Alcohol consumption disorder

symptoms include:

 Angry and abrupt mood changes

 making justifications for drinking, like that it helps
you unwind or deal with stress
 being cut off from family and friends
 Lies about the amount of alcohol consumed
 disregarding obligations in work, home, or school
 drinking in private or secret
 experiencing short-term memory loss or blackouts

Drug addiction
Drug use disorder, sometimes known as a drug addiction,
can involve either prescription pharmaceuticals or illicit drugs
alone or a mix of both. The extremely addictive substances
cocaine, heroin, methamphetamine, benzodiazepines, steroids, and
inhalants can all swiftly result in a substance use disorder. Drug
users persist in using despite the devastation done to their health,
relationships, and employment because drugs alter how the brain is
wired and interfere with its natural reward system. Following are
symptoms of a drug use disorder:

 lost cash or valuables

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 abrupt alterations in conduct

 Absences from work or school on a regular basis
Loss of vigor and motivation
 Unexpected weight reduction
 speaking is challenging
 neglecting one's looks and hygiene

Drug Use Disorders' Root Causes

Although genetics are estimated to be responsible for 40%

to 60% of a person's risk, the exact origin of substance use
disorders is still unknown. In early adolescence or youth, substance
use frequently gets its start as a method to feel good or out of
curiosity. Increased tolerance brought on by frequent use of the
substance opens the door to addiction and substance use disorders.
With a co-occurring mental disease like depression, anxiety, or
bipolar disorder, some individuals who acquire substance use
disorders start abusing drugs or alcohol to treat their symptoms.
Other risk factors that could result in a substance use disorder are
as follows:

 Addiction in the family

 issues with sleep
 enduring pain

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 Financial challenges
 Loss of a loved one or divorce
 long-term use of tobacco
 tense climate at home
 childhood without maternal attachment
 issues in relationships

Of course, none of these risk factors alone makes someone

more likely to develop a substance misuse disorder, but they all
work together to raise the chance of addiction dramatically.

Does a member in your family struggle with substance

abuse? Aid is accessible.

More than 20 million Americans battle chemical

dependencies on alcohol or drugs. Regrettably, very few people
who require treatment really reach out for assistance.

All patients in our care receive the counseling, instruction,

and recovery support services they need to lead a happy, healthy
life, whether your loved one needs the secure, supervised setting of
inpatient drug treatment or the adaptability of an outpatient
program.

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How is Addiction to Substances Treatable?

There are efficient therapies for substance use problems.

Identifying the issue is the first step. When a person is unaware of
their problematic substance use, the rehabilitation process may be
prolonged. Self-referrals are always welcomed and encouraged,
even though interventions by concerned friends and family
members frequently lead to treatment.

To determine whether a substance use disorder is present, a

medical practitioner should perform a formal assessment of the
symptoms. Regardless of how severe, moderate, or mild the illness
is, all individuals can benefit from treatment. Regrettably, many
people who fulfill criteria for a substance use disorder and could
benefit from treatment don't obtain care.

Several forms of treatment are frequently needed for SUDs

since they have an impact on so many facets of a person's life. The
majority of the time, a mix of medicine plus individual or group
treatment works well. The best treatment strategies for promoting
long-term recovery are those that take into account each patient's
unique circumstances and any co-occurring medical, mental, and
social issues.

Drug cravings are managed with medications, along with

withdrawal symptoms and relapse prevention. Psychotherapy can
assist people with SUD in addressing underlying mental issues,

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improving self-esteem, coping with stress, and understanding their

behavior and motivations better.

A person's recovery plan is personalized to their

requirements and may include methods not offered through official
treatment. They could include: Hospitalization for the purpose of
managing medicinal withdrawal (detoxification).

Sober living facilities or therapeutic communities (strictly

supervised, drug-free environments).

Psychotherapy and medication management in outpatient

settings.

programs for intensive outpatient care.

(Rehab) Residential treatment.

Mutual-aid organizations are beneficial to many people

(Alcoholics Anonymous, Narcotics Anonymous, SMART
Recovery).

How to Support a Friend or Relative?

Here are some ideas to get you going:

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 Find out everything you can about drug and alcohol abuse
and addiction.
 Speak up and express your support: Inform the person of
your worries and express your desire to be of assistance,
including by going with them to seek assistance. The earlier
addiction is addressed, like other chronic conditions, the
better.

Don't wait for your loved one to "hit bottom" before expressing
your affection and worry; you might encounter justifications,
denial, or wrath. Be ready to answer with concrete instances of
actions that worry you.

Expecting someone to stop on their own is unrealistic

because previous promises to cut down or stop have failed. To beat
alcohol and drug addiction, one needs therapy, support, and new
coping mechanisms.

Support recovery as a continuous process by staying

involved once your friend or relative has started undergoing
treatment or attending meetings. Continue to express your care for
the long-term success of his or her recuperation.

Here are a few things you should avoid:

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 Don't lecture: Avoid lecturing, threatening, bribing,

preaching, or moralizing.
 Don't be a martyr: Refrain from making emotional
pleas that might just make you feel guiltier and
more driven to drink or take other drugs.
 Don't lie, dissimulate, or rationalize their actions.
 Don't take on their duties since doing so shields
them from the fallout of their actions.
 Avoid arguing with someone who is under the
influence of drugs or alcohol since they won't be
able to reason with you at that time.
 You are not to blame for their actions, therefore
don't feel bad about it.
 Don't join them: don't try to keep up with them by
drinking or using.

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CHAPTER THREE

THE ABUSED

SUBSTANCES
Chemicals in both legal and illicit drugs have the potential
to change how your body and mind function. They may
temporarily make you feel good, reduce your tension, or assist you
in averting issues in your life. All commonly abused substances
have the potential to cause tolerance and dependence, which means
that a greater dose is needed to achieve the same level of
intoxication.

Here are five substances that are frequently abused:

1) Alcohol: Alcohol is a depressant of the central nervous

system. Many people start drinking regularly to temporarily reduce
their tension and worry. Yet excessive and frequent drinking might
raise the risk of an accident or harm. Binge drinking, which is
defined as consuming five or more drinks for men and four for
women in a single sitting, may be detrimental to both your physical
and emotional health in many different ways.

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Alcohol's short-term consequences on mental health

include insomnia, a loss of control, poor judgment, confusion, and
mood swings. Yet, regular alcohol drinking alters the chemistry of
the brain by lowering levels of serotonin, a crucial molecule in the
development of depression. When someone binges, a vicious cycle
sets in where they drink to cope with their depression, which
lowers their serotonin levels and makes them feel even worse.

Alcohol is related with numerous major social and

developmental concerns, such as traffic accidents or violent
conduct, child neglect and abuse, and bad effects on co-workers,
relatives, friends, or strangers.

2) Cannabis, sometimes known as marijuana, is a

commonly used psychoactive substance. It is seen as a legitimate
kind of medicine and entertainment in several parts of the world.
When smoked, marijuana immediately penetrates the blood-brain
barrier and enters the bloodstream, giving the user a "high" (chilled
out, happy, relaxed, talkative, or laughing more than usual).

Marijuana's effects on mental health: The detrimental

effects of marijuana or cannabis on mental health include:

 slower reflexes and thinking

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 memory issues
 a lack of drive
 Panic and anxiety attacks
 Paranoia
 Psychosis
 Hallucinations
 Delusions

The psychological reliance

The significant risk of mental health issues produced by

marijuana should be avoided by anyone who already has a mental
health condition such depression, psychosis, bipolar disorder, or
anxiety.

3) Prescription and Over-the-Counter (OTC) Drugs

Abuse of prescription and over-the-counter (OTC) drugs

includes:

 using a medication for a use other than that for

which it was intended
 exceeding the dosage advised on the product
 using a prescription drug that was issued to
someone else

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 Using the medicine for a non-medical reason

These medications have the potential to be just as harmful

and addictive as illicit substances.

Most commonly abused prescription drugs include:

 Painkillers, such as opioid painkillers (e.g.,

oxycodone, morphine, fentanyl)
 Benzodiazepines and barbiturates (stress and
anxiety-related medications)
 tranquilizers and hypnotics (sleeping pills)

The urge to feel relaxed or the need to "switch off" or

forget stressful thoughts or feelings are two common reasons why
these substances are abused.

Prescription drug abuse's negative impacts on mental health

include drowsiness, slurred speech, loss of coordination, irritability
or mood swings, difficulties focusing or thinking clearly, memory
issues, involuntary eye movements, and a lack of inhibition.

Dextromethorphan, a component of cough syrups, and

codeine, a typical over-the-counter medication, are used to treat
mild to moderate pain as well as coughing and diarrhea. Physical
dependence, drug cravings, insomnia, irritability, dissociative
states, coordination issues, slurred speech, seizures, and

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hallucinogenic effects can all result from prolonged use of these

drugs.

Prescription medications like opioids, which are second

only to marijuana in terms of abuse, claim more lives each day
from overdoses than fatal shootings and traffic collisions
combined.

4) Stimulants: These medications are used to treat obesity,

attention deficit hyperactivity disorder (ADHD), narcolepsy, and
mood disorders. Stimulants include amphetamines, cocaine, and
crystal meth. These medications elevate central nervous system
activity (CNS). They increase the amount of dopamine in the area
of the brain that regulates pleasure, a natural chemical messenger
in our bodies. Effects of high amounts of dopamine include a
sensation of extreme happiness, enhanced energy, attentiveness,
alertness, sociability, increased self-esteem, and joyful mood. They
are only transient impacts, though.

Effects of stimulants on mental health: Use of stimulants

can lead to serious behavioral or psychological problems. They
may consist of:

 Euphoria

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 Hyper-vigilance
 Irritability and anger
 interpersonal awareness
 hallucinations involving sound
 paranoid ideas
 recurring motion
 seizures and tremors
 Mood issues

5) Inhalants: Inhalants are volatile chemicals often present

in many household goods. Paint thinners, nail polish removers,
aerosol sprays like deodorants, hair spray, air fresheners, and gases
like gasoline, ether, chloroform, halothane, and nitrous oxide are
among the inhalants that are frequently abused.

Inhalant-related consequences on mental health: Mind-

altering effects result from inhalants. Young people frequently
abuse them because they are readily available and legal. In
contrast, inhalants are extremely toxic and can lead to depression,
memory loss, damage to the nerve and cardiovascular systems,
unconsciousness, and unexpected death.

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CHAPTER FOUR

COMBATING SUBSTANCE

ABUSE
Some of the initiatives to lower drug abuse have been
successful. Yet, a sizable population continues to abuse addictive
substances. Also, changes among teenagers haven't always tracked
with those among adults. In fact, even when adult use was
dropping for the majority of the last 15 years, adolescent use was
rising. Trends for adolescents and adults have just recently started
to drop for the majority of addictive substances.

Trends change throughout time as a result of both attitudes

toward substances and specific measures made to discourage use.
Reviewing these developments reveals how crucial timely
prevention and care may be. For instance, the Surgeon General
published a study in 1964 stating that smoking cigarettes was bad
for one's health. Then, each pack of cigarettes had to bear the
Surgeon General's warning. A relatively cheap technique of
prevention that significantly affected the reversal of a more than
60-year trend in the per capita consumption of cigarettes was the
undertaking of the research to support the warning and the need

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that the warning be advertised. When the nicotine patch was

introduced in 1991, it considerably assisted smokers in cutting
back and breaking their addiction.

USE OF CIGARS.

Limiting the availability of cigarettes to minors has not

been as effective. Counter-advertising and limits on the sale of
cigarettes were less effective than advertising aimed at promoting
youth smoking. Only recently, after severe restrictions on cigarette
promotion, has the pattern of youth smoking started to resemble
that of adult smoking (see Figure 3). This is partly a reaction to the
ban on direct advertising, but it also goes hand in hand with
expanded and coordinated school- and community-based measures
to deter youth smoking and increasing cigarette prices.

USE OF ALCOHOL.

Since 1980, the per-person consumption of alcohol has

been falling. Use of distilled alcohol has decreased most
dramatically. It is likely not a coincidence that the distributors of
distilled alcoholic beverages voluntarily stopped doing radio and
television advertisements for a significant portion of this time.
Television networks recently decided to reevaluate allowing
distilled liquor advertising after pressure from Congress and
special interest groups in 1997 brought it back to television and
radio. Meanwhile, community-based advocacy and education

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organizations, such as Mothers Against Drinking and Driving

(MADD), have grown more successful in influencing school-based
initiatives to not only educate children but to also sponsor alcohol-
free options on the weekends. These initiatives' social marketing
effects have increased public awareness of the dangers of drinking
and driving and have helped to curb overall alcohol consumption.
The 1990s saw a steady drop in alcohol usage among 8th graders,
as well as a slight decline for 12th graders, but not for 10th
graders.

ILLEGAL DRUGS USAGE.

While the percentage of the population who uses marijuana

and cocaine has decreased, it climbed during the majority of the
1990s among students in the 8th, 10th, and 12th grades. Only
recently, with the advent of more community-based initiatives,
have these patterns among teens appeared to reverse. For the
previous ten years, heroin consumption has been largely stable
among all age groups. However, both teenagers and adults are
increasingly using MDMA (ecstasy) and methametaphines.

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Public Policies Aimed at Combating Substance

Abuse

Generally, public policies to prevent drug usage fall into

one of the following categories:

 Making it more difficult to obtain addictive

chemicals;
 Preventing people, especially adolescents, from
using addictive substances;
 Aiding those who are hooked to stop using them.
 preventing teenagers from beginning

Adolescents must be taught about the risks and usage

patterns, shown how to say no in a healthy way, and morally
persuaded in order to be discouraged from starting. It has been
demonstrated that multi-pronged community-based initiatives that
involve the school, parents, and targeted counter-advertising are
successful in persuading teenagers to significantly postpone or
refrain from using addictive substances. 7 One-on-one screening
and counseling, school-based initiatives, and advertising to
highlight the risks or lessen the incentives to experiment with these
substances are crucial elements of these efforts. Successful
educational initiatives typically concentrate on teaching kids that
not everyone uses such substances and giving them practical
strategies for overcoming temptation. Children learn to say "no" in

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a good way with the use of role-playing, films, and workbooks.

With the aid of information, they can see that the vast majority of
their classmates do not use these substances. If adolescents believe
that lots of their classmates are using these substances, they are
more likely to desire to use them too. Parents who are involved in
their children's life are considerably less likely to let them
experiment with addictive substances.

Reducing the availability of addictive chemicals

Adolescents are prone to use addictive substances,

therefore moral persuasion, social marketing, and the ability and
confidence to say no are unlikely to be effective deterrents. Further
restrictions on addictive substances might be required.

They include:

• Makes the product's production and distribution

prohibited.

• Making it unlawful for anyone younger than a specific

age to purchase the product (and also limiting the sites at which
legal purchases are permitted).

• Increasing the cost of the good, typically by the

application of an excise tax.

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Depending on the substance and between countries,

different approaches are adopted and enforced to different degrees.
The majority of law enforcement efforts are directed on illegal
substances. Because of this, 63 percent of all inmates are there
because they made, sold, or bought illegal drugs.

It has been difficult to prevent minors under a certain age

from obtaining legal substances. To make sure that store owners
adhere to the law, authorities must be vigilant. In a youth study
conducted in 1995, the majority of teenagers reported being able to
buy cigarettes without being questioned for identification.

Excise taxes at the federal, state, and local levels have been
utilized not merely to increase income but also to deter people
from buying alcohol and cigarettes. Both the federal and state
excise taxes are far lower today in actual terms than when they
were first enacted, and neither one automatically rises with the cost
of living. In the United States, the total excise tax on cigarettes is
less than 12% of the retail price, whereas in Argentina, France, and
Spain, for instance, the tax is more than 50% of the retail price.

Each of these actions—increasing the excise cost, raising

the legal drinking age, directing purchases to specific locations like
liquor stores, or banning vending machines—has had an
appreciable impact on cigarette and alcohol consumption. Very

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little alcohol was consumed during the period of prohibition. More

recently, when the drinking age was raised from 18 to 21, there
was a decrease in alcohol usage. Due in large part to the sharp rise
in cigarette prices, teen smoking has reached a 10-year low.
Teenagers can still buy drugs that are not allowed for them to buy,
though.

Treatment for addiction

Some people still develop addictions despite efforts at

prevention and access restrictions. Addiction therapy can be
effective and is less expensive than incarceration, lost wages, or
lost property. But, for treatment to be effective, it must be made
accessible and supported. It is unfortunate that treatment takes
time, and family involvement is crucial for youth treatment to be
successful.

The most effective long-term smoking cessation rates,

according to evaluations of cessation programs, are achieved when
FDA-approved drugs are combined with clinically administered
social support, skills-training, or problem-solving programs,
reinforced by employer no-smoking rules. Programs for addiction
to alcohol and other drugs have also been shown successful. It has

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been demonstrated that treatment for illicit drug use considerably

lowers crime and reduces drug use by 40 to 60 percent.

There aren't many resources for folks who are addicted on

alcohol, drugs, or tobacco. In actuality, demand for these programs
is much higher than supply. This is mostly due to how funding for
treatment programs has been allocated. While the majority of
medical care is either insured or funded by government health care
programs, addiction treatment services are frequently excluded.
Less than 25% of the public money for alcohol and drug treatment
programs comes through Medicaid or Medicare, while around 70%
of all funding for such programs is provided by the government.
Clients contribute 10%, private insurance plans finance 14%, and
the remaining 5% is provided by charitable organizations.

The majority of health insurance plans offered by

employers do not cover treatment, and many of those that do have
constrained coverage. The scope of coverage is left up to each of
Medicare's financial intermediaries on an individual basis, despite
the fact that Medicare is more comprehensive than the majority of
commercial insurance policies. States differ in their Medicaid
coverage as well. Far less likely to be funded are programs for
quitting smoking. Medicare and half of the Medicaid programs run
by the states do not provide coverage for quitting smoking.

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It is common for those who struggle with substance misuse

to simultaneously suffer from mental health issues. A minimum of
one mental health issue is present in about 53% of drug users and
36% of alcohol users. The mental condition was present before
drug addiction in the majority of these people (80%). Due to this,
providing coverage for mental health services is equally as crucial
as providing coverage for addiction treatment. There are likely to
be substantial limitations on mental health coverage in insurance
plans and public programs that provide restricted coverage for drug
abuse treatment.

Individuals who seek treatment need as much assistance as

they can get, yet there are few treatment options available.
Individuals may have to wait months before they can access a
service, and many smaller communities lack any programs at all.
The length of treatment and number of visits are restricted by a
lack of resources and insurance coverage. It is fairly unusual for
patients to need several attempts at treatment before they are
entirely recovered. Unfortunately, the cost of treatment for drug
and alcohol abuse is much lower than the societal expenses.

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