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Review Essays of Academic, Professional & Technical Books in the Humanities & Sciences



The Real Drug Abusers by Fred Leavitt (Rowman & Littlefield), with a Ph.D. in psychopharmacology and 20 years of service at Cal State University in Hayward , sorts out facts about drug abuse from fantasy, intentional misrepresentation, and public policy.

  • Drug abuse causes havoc over the entire globe and is considered one of the most pressing social problems in the United States .
  • It is the number one health prob­1em in the United States . According to the Substance Abuse and Mental Health Services Administration, it causes more deaths, illnesses, and disabilities than any other preventable health condition.

The news media thrive on lurid reports of drug-related dissolution and degra­dation. Readers and viewers avidly follow sensational stories about pushers solic­iting junior high school children, strung-out addicts mugging people and terrorizing businesses, girls and young women turning to prostitution to support their habits, police officers being corrupted by the lure of easy money, inform­ants turning on friends and relatives, gangs killing each other in wars over drug territory, and entire neighborhoods being destroyed while kingpins live in island villas with fleets of luxury cars and pleasure craft. But media reports often go well beyond what the facts about drugs warrant. The media are concerned more with ratings than accuracy, and sensationalized stories sell. The stories draw large au­diences, whereas original research findings, described in technical language and published in specialized journals with limited readership, have little direct influ­ence on public opinion.

Public opinion is also shaped by politicians, bureaucrats working within gov­ernment agencies, and representatives from drug company marketing departments. They often refer to research findings and comment on isolated incidents involving drugs, but their pronouncements too often reflect vested interests rather than ded­ication to the truth. Nevertheless, they are influential and help keep the public woe­fully misinformed about the nature of drug abuse. For example, the view that drug addicts arc qualitatively different from other people is entrenched in the public consciousness despite there being little support from research in biochemistry, neu­roscience, psychology, sociology, or anthropology.

Societies differ in their strategies for making beneficial drugs available and restricting the use of harmful drugs. All societies have unique sets of behavioral norms, methods for discouraging de­viation from the norms, and attitudes toward violators. Although drug abuse cuts across socioeconomic boundaries, certain groups—the mentally ill, the homeless, and people who do not receive proper medical care, who lack skills or motivation to find meaningful work, and who have been or merely feel oppressed—are espe­cially vulnerable to relying on drugs in attempts to cope. Disparities in education, wealth, and power occur in all societies, but attitudes toward people at the lower end of the continuum differ greatly. Responses to both licit and illicit drugs, the likelihood that casual use will turn into addiction, and the harms caused by ad­diction depend to a great extent on these cultural factors.

The Molecule Is Not the Message. Advertisements directed at both doctors and laypersons suggest that drug actions depend almost exclusively on molecular structure. Authors describe effects in minute detail: “LSD, 1966, a presumptuous little pill, causes dilated pupils, increased heart rate, and vivid hallucinations of used car salesmen.” The authors make subtle distinctions between structurally similar molecules, disregarding the fact that even experienced users cannot discriminate between heroin and mor­phine or between injected amphetamine and cocaine. They consider humans passive respondents, little different from litmus paper or other forms of labora­tory apparatus. Just as litmus paper reliably changes color if dipped into an acidic substance, human neurons change in reliable ways following exposure to certain drugs. But this perspective ignores the fact that changes in brain chemistry de­pend on many factors and are not the sole determinants of how recipients re­spond to drugs. People’s expectations affect their responses to all experiences. Consider two studies by Martin Orne that do not involve drugs:

  • Most subjects in early sensory deprivation experiments reported extreme stress. Orne manipulated expectations by asking some subjects to sign a frightening release form and showing them a panic button they could press if the stress became too great. Then he ushered them into a quiet room and told them to sit there. He treated control subjects identically except for the release form nd button. The experimentals experienced considerable stress, and many pressed the panic button. The controls did not. (As further evi­dence of the power of expectations, Suedfeld gave positive instructions to sensory-deprivation subjects and induced relaxation and calm.)
  • Orne told only one of two groups of students that the dominant hand of hypnotized subjects becomes rigid. The information is false. Later, he asked for volunteers from both groups to be hypnotized. Several of the stu­dents in the first group and none in the second developed dominant hand rigidity.

Expectations can be manipulated so that sugar pills (placebos) affect recipients as though they are powerful drugs. Expectations induced by living in a particular so­ciety shape responses to real drugs. Among these The Real Drug Abusers discusses 1) Alcohol, 2) Caffeine, 3) LSD, and 4) Marijuana.

Societal norms and laws related to drugs have widespread ramifications. Societal norms and laws have impacts that extend far beyond shaping the re­sponses of drug users. They influence long-range prospects of users of illegal drugs, treatments of those in need of medical drugs, and people’s general atti­tudes toward seeking alternatives to medical drugs and experimenting with recre­ational ones. The norms and laws affect safety, taxes, and quality of life for most citizens. Therefore, they should be frequently reevaluated. U.S. norms have changed dramatically during the past century. Several trends are clear for three different categories of drugs. The Real Drug Abusers discusses 1) Illegal Drugs, 2) Prescription Drugs, and 3) Over the Counter Drugs That Do Not Require a Prescription.

Drug abuse—an expanded perspective. Drug abuse, narrowly conceived, is any use of illicit substances or excessive use of legal ones. That is how government agencies define the term. But, though pro­scribed personal use makes headlines and gets people sent to prison, several less-publicized activities involving drugs cause great harm to the general public. Chapters of The Real Drug Abusers discuss examples from each of the following categories:

  • Too many pharmacological researchers face strong conflicts between finan­cial gain and accurate reporting of their findings.
  • Individuals and institutions distort and suppress information to promote their objectives.
  • The prescribing habits of some doctors depend less on the medical literature than on how drugs are promoted to them. Their diagnoses and prescriptions often demonstrate sexist and racist biases.
  • Some Health Maintenance Organizations (HMOs) are multidrug abusers. Many require their doctors to choose from a preselected formulary of drugs, with price overriding effectiveness as a criterion for inclusion in the fortulary. Most HMOs arc biased toward prescribing drugs for psychiatric patients rather than giving them lengthier, costlier (and proba­bly more effective) access to someone to listen to their problems.
  • Hundreds of thousands of patients in U.S. hospitals experience bad drug re­actions each year, and thousands die. The reported figures are probably an undercount, because many errors go undocumented and unreported. The problem keeps growing, as doctors rely increasingly on drugs and pharmacists’ workloads get heavier and heavier. Between 1983 and 1993, deaths due to medication errors more than doubled among hospital patients and increased eightfold among outpatients. A high proportion of residents of nursing facilities receives inappropriate prescriptions.
  • Patients in chronic pain, and especially the elderly, are often medicated in­adequately. Health care professionals share an unwarranted fear that they will create narcotics addicts if they administer too much. So doctors under­prescribe, and nurses underadminister pain medications to many patients, especially the elderly.
  • Politicians and other government officials are guilty of drug-related abuse when they spread misinformation and disinformation about drugs. Entire societies abuse by encouraging the use of drugs for falling asleep, waking up, losing weight, overcoming shyness, and having bowel movements with clocklike regularity. The same societies, and the United States in particular, sentence staggering numbers of nonviolent drug offenders to longer prison terms than are given to rapists and murderers. Alexander Shulgin writes: “Our generation is the first ever to have made the search for self-awareness a crime, if it is done with the use of plants or chemical com­pounds as the means of opening the psychic doors.” Shulgin’s belief that the search for self-awareness should be encouraged can be con­trasted with the view of Gerald Smith, who wrote a pamphlet distributed to schoolchildren in Utah . Entitled “How Parents Can Help Children Live Marijuana Free,” the pamphlet includes a preface by Utah Senator Orrin Hatch and offers parents the following tip on how to recognize drug use by their children: “Excessive preoccupation with social causes, race relations, environmental issues, etc.”
  • Various state and federal asset-forfeiture laws allow government agencies to confiscate assets of convicted traffickers. A New Hampshire family with three small children had their home seized for growing four marijuana plants in the back garden. The practice has outraged civil libertarians.
  • Many unethical medical experiments were conducted in the not-too-distant past. Powerful, dangerous, experimental drugs were administered to unwit­ting prisoners, soldiers, and civilian victims, including the mentally retarded and psychotic. Such abuses probably continue, although the extent may never he known.

The various categories of abuse can be traced to three types of causes: 1) Human error, 2) Lack of information, misinformation, and disinformation, and 3) Money. Leavitt discusses each of these in detail.

Each of the chapters is headed with an assertion about one aspect of drug abuse. The text provides evidence and argument for the assertion. The Real Drug Abusers is a must read for anyone who cares to sort out, in detail, what is, in fact, known about drug use and misuse and what is not. Be warned, however, side effects of reading this book include paranoia.

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