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How Drug Use and Abuse Really Works

Drugs are illegal to prevent drug abuse. It's illegal, so you can't get it, so you can't abuse it. If people didn't believe this, the whole reason for drug prohibition would disappear. So, i'm taking aim at this idea, because it isn't true, and mistaken belief in it costs hundreds of lives every week, and does no one any good.

Addiction is a scary, nasty, horrible thing. It is the leading cause of death in the United States. Oh, you didn't know that? That's because the numbers aren't usually crunched in the way that shows that up. The table below is from a study published in the Journal of the American Medical Association in 2004. Instead of counting deaths by what went wrong in the person's body, like heart failure or cancer, they counted them by what caused it to go wrong.

Actual Causes of Death in the United States in 1990 and 2000
Actual Cause Num. (%) in 1990 Num. (%) in 2000
#1 Tobacco 400 000 (19) 435 000 (18.1)
#2 Poor Diet, Physical Inactivity 300 000 (14) 400 000 (16.6)
#3 Alcohol Consumption 100 000 (5) 85 000 (3.5)
Microbial Agents 90 000 (4) 75 000 (3.1)
Toxic Agents 60 000 (3) 55 000 (2.3)
Motor Vehicle 25 000 (1) 43 000 (1.8)
Firearms 35 000 (2) 29 000 (1.2)
Sexual Behaviour 30 000 (1) 20 000 (0.8)
Illicit Drug Use 20 000 (1) 17 000 (0.7)
Total 1 060 000 (50) 1 159 000 (48.2)

Tobacco is quite a killer. Even more so than people generally think. Alcohol is pretty nasty too. Okay, it's only a distant third among the leading causes of death, but we all know that doesn't count the real cost of booze. It doesn't count the deaths and injuries from drunk driving and other drunken accidents. It doesn't count the family troubles that go along with alcoholic parents. It doesn't count lost jobs, lost opportunities, lost years of health...

If just alcohol and tobacco do so much harm, imagine how bad things would get if all drugs were legal !

Okay, and this is the thing - other things about addiction and heavy drug use will be discussed, but really the main point is this...

The cause of addiction is stress

You don't become addicted because you use a drug (which includes alcohol and tobacco). You become addicted because you feel you need that drug in order to cope. How much you use any drug is directly related to how stressed you feel, either over the short term, or the long term. High stress during childhood, when your brain was forming, leaves pretty permanent marks on your personality. It hugely affects how you cope with things as an adult, which is what determines how much stress there is in your present. Long-term stress is a background mental influence which you may well not even be fully aware of, but rest assured, if you reach too often for a drug, you have your reasons.

low risk of addiction
Low Risk of Addiction
high risk of addiction
High Risk of Addiction
OMG get me some jack right now
Addiction Maybe Good Idea

There are other factors affecting drug use, namely genetics, culture, and the physical addictiveness of a substance. Of the three, physical addictiveness is the least significant, and culture and genetics are less important than stress. If you get to that line, where you've tried a drug a few times and you are tempted to use it more, you don't lose control if you are generally happy, and have confidence in yourself. The people who drift into heavy use and addiction are the ones who have something else going on that is too hard for them, and they escape from it with a drug. Or, for one reason or another, they just have a hole in their lives that the drug seems to fill. A good portion of those who become addicted, or binge, or just use more than they really should, will later overcome their problem - because they find someone, or a few someones, who help them get through it, or because something changes in them that gives them the strength to fight it off. Often, it's just that they get a little older and mature. Half of all addicts in the United States are below the age of 30. Only one-fifth of addicts in America are older than 45. (Source:National Survey on Drug Use and Health, 2008)

Which is to say, even if all mind-altering substances were legal and regulated, like alcohol and tobacco are, there wouldn't be any more addiction than there is now. Some people try to control their problems with drugs and alcohol. Whether the drug they choose is legal or not doesn't change the number of people who feel that need. If you feel that need, you really don't care if the stuff you crave is legal. If all drugs were legal, the number of people addicted to any one drug in particular might change, but the total number of addictions would remain the same. In fact, let's hope that's what would happen, because most illegal drugs are actually much less destructive than alcohol. And tobacco? That stuff is crazy dangerous.

Addiction won't go down until more people are happy enough that they don't feel the need to hide in an addiction. That is a worthy, distant goal. It would be aided by the elimination of drug gangs, and the use of resources currently spent fighting them on something more constructive, and a greater cultural maturity about drug use and drug safety. To get there, drugs need to be legalized.

The Self-Medication Hypothesis is about this relationship between stress and addiction. Here is a description of it, based on the work of David F. Duncan (taken from Wikipedia):

Duncan's work focuses on the difference between recreational and problematic drug use. Data obtained in the Epidemiologic Catchment Area Study demonstrated that only 20% of drug users ever experience an episode of drug abuse (Anthony, Helzer, 1991), while data obtained from the National Comorbidity Study demonstrated that only 15% of alcohol users and 15% of illicit drug users ever become dependent. A crucial determinant of whether a drug user develops drug abuse is the presence or absence of negative reinforcement, which is experienced by problematic users, but not by recreational users. According to Duncan, drug dependence is an avoidance behavior, where an individual finds a drug that produces a temporary escape from a problem, and taking the drug is reinforced as an operant behavior.

Negative reinforcement is motivation to do something so you can avoid something else - in the case of addiction, so you can avoid a problem or difficult emotions. That explains why people have addictions that don't involve substances at all - like gambling, sex, or extreme sports. More studies are needed to properly examine the self-medication hypothesis, but there are a handful of population studies based on it, all of which support it.

But hard drugs get you hooked way faster than liquor or smoking. And they really mess you up, too.

This is a really common belief, but it isn't true either. So, let's look at...


Physical Addictiveness and Health Effects

The term 'addictiveness' is so misleading it's a shame we can't get rid of it. It was created by people who study drugs from a pharmaceutical perspective, and who therefore focus very narrowly on chemical reactions in the body resulting from drug use, and nothing else. Don't ask them how important personal issues, chronic stress, and relationships are to addiction, compared to those chemical reactions. That isn't their area. And to be fair, it isn't their fault that the press, government agencies, and possibly their own institution report their findings as though addictions have only to do with those handfuls of quantifiable chemical reactions. Most of them would be much more cautious than that. Unfortunately, the ones who aren't tend to get promoted.

If - and that is only if - you are vulnerable to addiction for the bigger reasons being examined here, there are two properties of a drug that determine how few times you need to repeat your dose of it to provoke physical addiction. If the drug you rely on as a coping mechanism can provoke physical addictions after fewer doses than other drugs, you have a shorter period of time before you have to break a physical addiction in order to reduce your use to safe levels or quit.

The first is potency. The drugs normally described as most addictive share the property of causing highs (at strong doses) that are really high, and resulting crashes that are really low. Right there, we can go ahead and say that only people with certain kinds of personalities, or people in certain kinds of situations, choose extreme highs, especially repeatedly. But leaving that aside, the way your body reacts to such extremes is, unsurprisingly, more extreme. It will lose its ability to compensate and recover from such highs more quickly under that kind of strain. Once your body can no longer recover, it will instead adapt. At that point you are phycially addicted. Your body will have trouble keeping you sufficiently alert, or relaxed, or happy, now that your drug use has overtaxed the systems that do that by forcing them to repeatedly make you super-alert, or super-relaxed, or super-happy. But if you take more of that drug, it will slot into the role those natural systems used to perform - sort of - allowing you to continue to function. Sort of. The most infamous drugs are the ones that lead to such changes after the fewest repetitions - cocaine, methamphetamine, heroin. If the brain systems affected by these drugs are weak in you for whatever reason, you may be more attracted to these drugs than average, and chronic changes in your brain due to their effect may happen more quickly.

The second property is format, often called delivery method. This is actually quite important. A lot of what this site proposes as being the best way to make drug use safe depends on getting the format right. Some formats will get you high very fast, and the high will play out in a much shorter time. That does the same thing to you that high potency does - it makes it harder for your body to compensate and recover. The high 'hits you hard', as they say.

The most intense format is injection. When you inject a dose, you feel its effect at peak intensity in seconds. You also get the entire dose, since it goes straight into your bloodstream. You can inject as much as you want in one quick dose, enough to kill you in the case of most of the drugs that have lethal doses.

Smoking is the next most intense format. Smoke or vapour entering the lungs is absorbed efficiently and quickly. Some of the dose will be exhaled, not absorbed, so you get a bit less 'bang for the buck'. What you do absorb will reach your brain in seconds, slightly faster even than injection. The format of cigarettes is a key aspect of how people become addicted to them so often. (The other key aspects are minimal near-term consequences and social acceptance of tobacco addiction.) Depending on how concentrated the concoction you are smoking is, it may take a large number of puffs to reach a high intensity buzz. If that is the case, smoking is not a problematic format. In fact it has the advantage of allowing you to fine tune your dose. Smoke with a high concentration of a drug is an issue. Heroin, meth, and crack can have a really strong effect after just one puff. This is such an important factor in how these drugs affect users, the same drug or close relatives are accepted prescription medicines when in a different format - cocaine as a topical anaesthetic, opiates as painkiller pills, methamphetamine or amphetamine as pills for narcolepsy, ADHD, or as 'go pills' in the military. But at least unlike injection, you can't inhale enough of anything in one go to lethally or even severely overdose.

Snorting is almost as efficient as smoking. Snorted cocaine hits a bit slower than smoked crack, but not by much. Some of the dose reaches the throat and ends up being swallowed. That portion will be absorbed in the intestines, drawing out the buzz longer, although not in a very noticeable way as it will be a small percentage of what went in the nose. Snorting certain drugs of high purity can potentially lead to severe overdose after just one round, if you really pack it in there and your tolerance isn't high. This can happen with powdered coke.

Drugs that are swallowed and absorbed through the intestines have the least intense format, and have the highest percentage of wasteage - stuff pooped out without ever entering the circulation. Oral formats first have to reach the intestines (a small number can also be absorbed through the stomach, inluding alcohol). Once they have reached the point of absorption, the process is still drawn out. Chemicals pass the intestinal walls bit by bit. If there is lots of food in your intestines, absorption is a little slower. Even if you are taking a potent drug, taking it in this least intense format slows down the effect enough that your body has a much easier time handling it. Injection is like being swarmed. Oral doses are like when your adversaries politely attack you one at a time, kung-fu movie style. Some drugs that are just as potent as heroin or cocaine have a much milder reputation for addictiveness basically because they can't be smoked, snorted, or injected. Benzodiazepines are an example.

Oral doses are also safest because they can be vomitted. The vomit reflex was specifically developed over millions of years of evolution to prevent poisoning. It works really well. Oral drugs are the only way of dosing that can be mostly reversed. Unfortunately, if you took a really big overdose in pills, especially on an empty stomach, you may not vomit up enough of it to save yourself. But pills are not the only oral option - dilute drinks work even better. Drugs suspended in fluid are absorbed more quickly than drugs in pills, but they vomit super well. The thinner the contents you are trying to puke, the quicker and easier it is to heave that back out in large volumes - you probably know this from personal experience. If alcohol could be consumed in any other format than as an oral liquid, it would be really lethal. The larger the volume of liquid the dose is distributed in, the harder it is to take too much - beer versus overproof whiskey. This will be discussed again in the section Dilution for Safety.

To know if you fall within the population vulnerable to addiction, you can check one thing after taking one of these potent drugs, in an intense format. If the pleasure of the high is more on your mind, and you are much less interested in how bad you felt afterwards, consider yourself at risk. The studies dealing with 'addictiveness' note brain changes sooner with potent drugs and intense formats - very specific changes in very specific areas. However, the brain is huge and everything in it is extremely interconnected. These studies are not capable of taking really any consideration of how the whole great big rest of your brain reacts to those very specific changes. We just don't know enough about the brain to trace all the reactions across the brain linked to a handful of specific changes in one part of it. Anyone who ever tried one of these hard-hitting drug experiences and did not go on to have a drug problem - i.e., the vast majority of users - can tell you how a healthy brain responds. It says 'that was harsh, let's keep that to a minimum'. Brains that don't react that way already have issues. Our understanding of how the brain works is way too primitive to get where and how the brain makes the changes that say 'take it easy there', but it obviously happens.

Other than the three highly potent, high-intensity format drugs mentioned above - cocaine, heroin, and methampethamine - the illegal drugs have to be taken at strong doses at least 3 or 4 times a week for at least a couple of months to produce physical addiction. In the case of the intense, potent trio, you could perhaps get to the point of physical addiction after only maybe a month of that kind of use, and addiction to benzos can happen that quickly also. And there is one other member of this club. Alcohol.

If you experience craving of the drug before that time, the craving is psychological. You like the way it is fitting into your life, you like the way it makes you feel better, and you want more. You could also be so foolish as to think the best way to cure a hangover is to have more. The craving isn't caused by the drug, it's caused by you.

Once you reached physical addiction, your dependence would be mild at first. It could be eliminated with just two to three weeks of somewhat uncomfortable abstinence. If you were addicted to the most potent, intense stuff, withdrawal effects would be somewhat more uncomfortable and might last a few days longer. Some symptoms might not resolve completely for a month or more, like lethargy or apathy, maybe. Basically it is no worse than a bad flu. If you taper your dose over a few weeks, it is actually pretty easy. Except for the psychological bit, which is, once again, not because of the drug.

The longer addiction persists, the more severe the withdrawal will be. Severe, long term addictions can have really nasty withdrawal processes. But let us bear something critical in mind - formal detox programs don't let you taper your dose to minimize withdrawal. They force you to quit cold turkey. They may give you stuff to help with the withdrawal symptoms, but that really isn't very effective when your body is reeling from the absence of a drug it spent a long, difficult time getting used to. Consider what happens when people who have been taking opiate painkillers long-term quit their meds once their condition heals. It is extremely rare for such people to develop a chronic addiction - even though they had an acute addiction, because they were taking strong doses of opiates daily for months. The reason? It is standard practise to taper down the dose they are taking over a number of weeks to minimize withdrawal. They get to ease out of it slowly and carefully, most of them hardly notice it. Heroin addicts are expected to just take the pain. And remember, these people are psychologically vulnerable. They are being kicked when they're down.

The withdrawal symptoms of recovering from addictions to some drugs are pretty mild. If the effect of taking the drug on your mood wasn't dramatic, and didn't spike quickly, withdrawal will be mild. Marijuana withdrawal is no big deal, for instance. But because addiction to it is possible, it is still called 'addictive'.

People who understand the nuances of this term can avoid over-reacting. Saying something is addictive doesn't mean the substance CAUSES addiction. It just means addiction to it is POSSIBLE. You also can't assume that because a drug is illegal, it must be addictive. Psychedelic drugs do not cause physical addiction, no matter how much you use them. Examples are LSD, shrooms, and DMT. Even psychological addiction to these drugs is quite rare. They also have no risk of lethal overdose. The most that can happen if you take a whole bunch is you get freaked out by the long hard tripping, and that can be solved by giving you a benzodiazepine so you sleep it off. So then why are these drugs illegal? There is really absolutely no rational explanation.

As for the health risks of illegal drugs, unless you are addicted to them or overdose on them, there is really little risk. The details are discussed on the pages of the Legal List. Overdose is mostly caused under prohibition by buying concentrates of unknown potency from street dealers, cut with possibly harsh additives, possibly even fake versions of what you intended to buy that are more dangerous than the real thing, as when PMA is substituted for MDMA. Legalization would solve that. Chronic heavy use of most recreational drugs will cause health problems of varying severity and reversibility. This issue is made worse by the expense of illegal drugs, the pariah status of people addicted to them, and the likelihood addicts will end up with a criminal record. These extra burdens add poverty and social isolation to health problems, a situation making it much harder to heal. Even so, none of them will physically scar you anything like alcoholism will. Not even close.

Genetics - and Epigenetics

Here's a couple of example of completely innocent things that nevertheless greatly affect the chances you will experience addiction. Genetics probably is mostly the reason why women all over the world drink much less than men, on average. Most cultures are also more permissive of drinking among men, but the difference in alcohol consumption between the sexes is so pronounced and universal that genetics must be the main reason. Would men benefit from being more like women? Well.... No, just kidding. That's a completely crazy idea. Men are often brash and outgoing and seek challenges, and as a result they tend to drink more and do drugs more, but those behaviours are valuable in the context of their lives overall. Most addiction occurs among people in their late teens and twenties, and that is for genetic reasons too. Genes turn on at that age that tell you to test your limits, push boundaries, challenge norms, and prove yourself in front of your peers. That behaviour is critical to establishing your own life separate from your family and the generation that came before, and doing so quickly, so you can then go on to have a family and career of your own. Would it be better if young people were calmed down and reined in? No. Even though the greatest risk for addiction is being a man in his 20's, being a man in his 20's isn't actually a problem. It has its ups and downs. Am i right, boys?

Some genetic traits, such as being more sensitive to a drug, or processing it differently than others, may make it a bit more challenging for you to use a drug in moderation. This is not the sort of factor that underlies life-changing decisions to abuse drugs, it is the kind of thing that can tip the scales if someone already has more compelling reasons to make that choice. Other, broader, elements of how your brain, and thus your personality, are organized can be a much stronger influence on drug-use decisions. Recent research examining addiction and genetics has focused on how brain systems involved in pleasure and reward vary among individuals, and how certain brain differences lead to different experiences of anxiety. It makes sense that there is a link between these things and drug abuse. However they are also complex character traits that affect many aspects of your personality. The talk these days of how genetics affects addiction sometimes falls into the same error as an older discussion about 'addictive personalities'. That older outlook was abandoned because it unfairly implies that some kinds of personalities are inferior. It needs to be remembered that experiencing things like pleasure or anxiety a little differently than other people, or being impulsive or a thrill-seeker, does not spell doom. It could just as easily be a great strength if you manage to fit it into your life in a wholesome way.

The genes that turn on when it is time to enter adulthood are a universal example of how what your genes do changes over time. That example is pre-programmed, most such changes are responses to your environment. Genes turn off and on all the time. When this happens by mechanisms that are permanent, or that can only be reversed with great difficulty, such changes are part of your epigenetics. Your epigenetic traits aren't due to your DNA itself, they are due to chemicals wrapped around your DNA strands turning sections on or off, in a permanent or near-permanent way. But you do inherit such changes from your parents, and you can pass them on to your children. The field of epigenetics was pioneered in the 1990s and has only recently begun to grow quickly. Prominent statistical studies that have been used for decades to postulate a genetic basis for addiction - especially alcoholism - now need to be reconsidered, because they are based on the analysis of medical histories of twins. Twins, even those separated at birth, can share epigenetic traits that make addiction easier for them to fall into, caused by the environment they shared in the womb, and stress in the lives of their parents or even their grandparents that caused epigenetic changes. The evidence points right back to stress.

Here's what happens. If your parents lived a very stressful life, their body decides to manage that by turning on or off certain genes. For instance, if they suffered from chronic hunger, activity of genes for things like fat storage change. In evolutionary terms this is an excellent system - your parents then pass on these epigenetic changes to you, preparing you from the beginning for a food-poor world. So, people can talk about the Irish having some sort of genetic or cultural weakness for drink, but could centuries of harsh discrimination and low-grade war have something to do with it? Hell, yeah. How about the native peoples of the Americas? Wow. Yeah. One epigenetic change that is involved has already been described - inheritance of anxiety through epigenetics.

The body of a mother experiencing high levels of anxiety will take steps to prepare the child for a hostile world. Such children are epigenetically programmed to experience anxiety more easily, because evolution shaped this response to make offspring that detect and respond to danger more quickly - they are 'high-strung'. In combination with other triggers in their own lives, this adds up to an addiction much more often than for people who don't have that epigenetic trait. And what group of mothers is highly likely to experience lots of anxiety during pregnancy? Mothers going through an unwanted pregnancy, who have to give up their kids for adoption. The twins of such mothers were studied en masse to determine how much genetic influences affect addiction, because their children were the ones who were separated at birth and grew up in different environments. It would be interesting to revisit those studies and check whether adopted children have a higher incidence of addiction in general, compared to children raised by their birth parents.

Although epigenetic changes usually last a lifetime to several generations, targeted treatments may be able to reverse them quickly. People contemplating such treatments for things like anxiety would have to bear something in mind though - the treatment will probably affect their personality. They'd have to decide if they are okay with that.

Culture

It is easy to accept the idea that your culture affects your decisions on everything, including your use of drugs. It is very hard to know exactly how. In a very broad way, it can be said that your culture either adds to or diminishes the stressfulness of all kinds of things you go through, which changes your chances of escalating from drug use into drug abuse. It also either helps you make good decisions that protect you from drug abuse, or pushes you towards bad decisions that make it more likely.

Drug prohibition itself is a cultural approach to drug use. Anti-drug laws send a statement of society's opinion about them, and the people who use them. Therefore, let us dispense with the idea that prohibition is an effective way of lowering drug use. The table below is from Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, et al. (2008). This is the only paper i´ve found online that has reliable survey data for developing nations, which is nice. Its source is the World Mental Health Survey conducted annually by the WHO. Here we see that the United States has a higher rate of lifetime drug use than any other country listed, yet it also has stricter drug laws than any of them except China. China achieves the lowest rate of all, and perhaps in their case prohibition helps, since they are a police state with no due process where spying on citizens is common. However, for the most part China's low rate of cocaine and marijuana use is due to other factors: China is still very poor and poor nations typically have lower rates of illegal drug use; and China has an East Asian culture very intolerant of illegal drug use (notice that Japan´s usage rate is almost as low). Last but not least, the survey may simply not have asked about the right illegal drugs - probably the most common illegal depressant in China is opium, not marijuana. The most common stimulant is probably methamphetamine, not cocaine.

Bear in mind that this table is showing what percentage of the people in these countries have ever used these drugs - even once. It in no way indicates how many people use these drugs regularly or are addicted to them. That said, the table shows that America´s war on drugs has put more Americans in contact with drugs than any other country on the list, and probably in the entire world.

Nation % of Population that has ever used:
Alcohol Tobacco Cannabis Cocaine
Colombia 94.3 48.1 10.8 4.0
Mexico 85.9 60.2 7.8 4.0
U.S.A. 91.6 73.6 42.4 16.2
Belgium 91.1 49.0 10.4 1.5
France 91.3 48.3 19.0 1.5
Germany 95.3 51.9 17.5 1.9
Italy 73.5 48.0 6.6 1.0
Netherlands 93.3 58.0 19.8 1.9
Spain 86.4 53.1 15.9 4.1
Ukraine 97.0 60.6 6.4 0.1
Israel 58.3 47.9 11.5 0.9
Lebanon 53.3 67.4 4.6 0.7
Nigeria 57.4 16.8 2.7 0.1
South Africa 40.6 31.9 8.4 0.7
Japan 89.1 48.6 1.5 0.3
China 65.4 53.1 0.3 0.0
New Zealand 94.8 51.3 41.9 4.3

Now consider the table below showing alcohol consumption in various countries, taken from the 2004 WHO Global Status Report on Alcohol. All the places listed are stable, wealthy countries. Social conflict, crime and poverty are minimal when compared to developing countries. Alcohol is legal in all these countries, yet Norwegians consume less than half the alcohol Luxembourgers do. The other places on the list have drinking rates scattered all over the wide range between Norway's low and Luxembourg's high. Why is that?

*Alcohol from sources not counted officially, such as that which is bought or consumed out-of-country, brewed at home, or smuggled.
**Luxembourg has negative unrecorded alcohol because of the large amount of cross-border shopping that occurs there.
Litres of Pure Alcohol Consumed Per Person, by Nation, 2004
Nation Alcohol Consumption
Official Unrecorded* Total
Norway 5.81 L 2 L 7.81 L
Sweden 6.86 L 2 L 8.86 L
Japan 7.38 L 2 L 9.38 L
United States 8.51 L 1 L 9.51 L
Canada 8.26 L 2 L 10.26 L
Italy 9.14 L 1.5 L 10.64 L
United Kingdom 10.39 L 2 L 12.39 L
Finland 10.43 L 2 L 12.43 L
Spain 12.25 L 1 L 13.25 L
Germany 12.89 L 1 L 13.89 L
France 13.54 L 1 L 14.54 L
Ireland 14.45 L 1 L 15.45 L
Luxembourg 17.54 L -1 L** 16.54 L

Norway, Sweden and Finland all tax alcohol highly, and sell it only through government-run stores with restricted hours (but beer can be sold anywhere, and light beer is taxed lightly) - yet Finns drink 60% more than Norwegians. Finns drink the same amount as Brits, although the price of alcohol in Britain is far lower, because of much lower taxes and especially the tendency of stores to offer big price cuts on beer. Japan is the only country in the world where alcohol can be bought from a vending machine, and it taxes booze lightly, yet has the third lowest consumption rate on the list. Canada taxes alcohol much more heavily and restricts it's sale far more than it's southern neighbour, the United States, yet Canadians drink more than Americans. In Italy, Spain, and France, children typically begin drinking during meals with their families when they are quite young, and all three countries have a relaxed attitude about alcohol laws - but for every 3 drinks drunk in Italy, 4 are drunk in France. Italy's liberal attitude towards alcohol gives it a drinking rate below that of the Finns, despite the many restrictions on alcohol in Finland. Interestingly, Italians feel that their young people have begun to drink more due to exposure to the binge-drinking culture of foreign tourists, especially Americans and Brits. In traditional Italy, deliberately drinking to get drunk was considered immature, and was uncommon.

The countries that tax and legally restrict liquor more tend to have lower rates of consumption than ones that don't, overall. Countries that take stronger measures to limit alcohol use also place greater social value on sobriety. That attitude comes first, the laws follow. Maybe the social values are actually more important. For instance, Japanese culture is very tolerant about drinking, but it is not tolerant at all about missing work or in any way being unprofessional. Plus, when and where you drink is governed by social convention to a high degree. These things limit consumption. Another factor to consider is that the average yearly intake of a country is often not associated with a higher incidence of problem drinking. The social conventions of most of the countries with higher averages is that it is normal to have one alcoholic drink with a meal. Many people in these places typically have two drinks a day, but don't often get drunk. Here too, it is social life on a personal scale that works to limit alcohol abuse, even though alcohol laws are quite lax. The closer you look at this question, the more complexity you see. It recommends an approach that doesn't rely on a few laws and regulations, but on shaping societal attitudes in a way that recognizes the complexity of the issue.

To reinforce that idea, let's look now at how different cultural groups in the same country differ in their use of illicit drugs. This is another graph taken from the National Survey on Drug Use and Health, done annually in the United States. It looks at variations in illicit drug use among racial groups. Each of these racial groups has a different rate of illicit drug use because each one has its own culture. Note how big the differences are, even though these are sub-cultures within a larger culture that is the same for all of them.

differences in drug use among different races, United States, 2008

Some might want to blame these differences on genetics, but this chart is showing who used a drug, even once, which in no way indicates how many had an addiction. Although genetics and especially epigenetics can account to some degree for rates of addiction, it is hard to argue they have influence on drug use in general. Fans of the idea that addiction is heavily based in genetics sometimes point to certain genes that affect responses to certain chemicals being common in certain races. That link is weak even when only looking at addiction rates to the chemical in question. Include all recreational chemicals, and all users instead of only addicts, and that factor becomes tiny.

The much higher use of illegal drugs among people belonging to more than one race is a definite outlier on this graph. Several possible reasons come to mind - that people whose families are a combination of two or more races come from family cultures that are okay with defying cultural norms, or, that people who would identify themselves as belonging to more than one race tend to be young, the age at which most drug use occurs, or, that people who come from families formed of two or more races tend to experience more stress due to lack of community acceptance and confusion regarding cultural identity. Maybe the reason is a mix of all these things plus stuff i missed.

Going from left to right on the rest of the graph, though, shows up a 100% consistent pattern. The average closeness of families predicts how often members of a race use drugs. Asians are famous for keeping a close eye on their kids and being involved in everything they do. Latinos still maintain the tradition of extended families, and tend to be very involved with all their relations - cousins, aunts, nephews, whatever. Hawaiians and Pacific Islanders are similar, especially in Hawaii where they still dominate the local culture, but are also more relaxed and give their kids a longer leash. Whites invented the ideas of 'personal space' and 'individualism'. They tend to allow their kids more freedom and privacy than the previous groups. Native Americans suffer a very high incidence of broken families due to the cold weight of racism they have so long endured. But at least they often have communities that try to preserve their culture and watch out for each other, especially on the reserves, bleak as these places often are. Black families suffer from absent fathers at an alarming rate, basically because their country has seen it fit to throw them in jail en masse. Mostly for drug offences. That is mighty hard on their kids. Now, the idea here being that moderate drug use is fine, this isn't to say any one of these cultural approaches is better than the others. The point is that the biggest influence on behaviour is family ties. Intolerance of drug use is a value all these different racial groups get from their national culture, the races with closer-knit families more consistently pass on that value to their kids. The lesson: if you want success reducing abuse of drugs (as opposed to simple use of drugs), take a personal approach. Don't just make laws, make contact.

Can that work? We have a perfect example to show it does, and very well. Tobacco.

Tobacco, being the number one killer in the whole world, is the only drug that has been addressed in a comprehensive way by any culture. Yet no country has banned tobacco, and in fact the laws restricting it are light. Tobacco users have the highest rate of addiction of any drug, why haven't we banned it? We realize that would just cause smuggling, and that in any case users don't deserve to be treated like criminals. (Exactly.) Instead, nation after nation embarked on a project to de-glamorize smoking, create true public awareness of how dangerous it is, and to offer treatments that help with quitting, in some places subsidizing the costs of such treatments. The result: cigarette smoking is steadily declining in every single country that has taken this approach. It is now less than half the rate it was at its peak in many countries, and still going down.

Perhaps you are saying 'but wait, we have lots of PSAs and educational stuff about illegal drugs too, and lots of treatment programs, and that hasn't worked'. The main difference between awareness campaigns for tobacco and those for illegal drugs is that the tobacco ones are TRUE. The ones for illegal drugs are full of errors, perhaps even lies. So people stop listening, that's just common sense. As for the treatments, well tobacco treatments often don't work either, but at least they aren't basically fancy, costly versions of going cold turkey. Most drug detox programs are.

The Drugs Aren't the Problem - Proof in Stats

The table below is tabulated from the results of the 2007 National Survey on Drug Use and Health in America (NSDUH). What it shows is that over the short term, illegal drug users become addicted more often than alcohol users, but over the long term, they also cure themselves of addiction more often than alcohol users, so much so that the rates of recent addiction among people who have ever drunk alcohol are actually the same or higher than those rates for any illegal drug. (Except heroin, whose figures are so close to the study's margin of error they are unreliable, so some results are shown as ranges. The pain relievers in the chart are drugs closely related to heroin - morphine, codeine, oxycodone. They have much lower rates, based on much more reliable figures, so probably the rate for heroin is similar.)

It should also be noted that because of the way the survey asked about drug dependence, the addiction rates it came up with are too high. The real rates must be lower, but there is no way to say by how much. (The details of that take a while to explain - go here if you are interested.)

Psychoactive Drug % of U.S.A. Population % of Past Year Users with Past Year Depen-dence % of Life-time Users with Past Year Depen-dence
Drug Use Life-time Drug Use Past Year Drug Use Past Month Depen-dence Past Year
Marijuana and Hashish 40.6 10.1 5.8 1.0 10 2
Cocaine 14.5 2.3 0.8 0.5 22 3
Heroin 1.5 0.1 0.1 0.1 33 to 100 3 to 10
Hallucinogens 13.8 1.5 0.4 0.0 <3 <1
Inhalants 9.1 0.8 0.2 0.0 <6 <1
Non-medical Use of Psycho-therapeutics:
- Pain Relievers 13.3 5.0 2.1 0.5 10 4
- Tranquilizers 8.2 2.1 0.7 0.1 5 1
- Stimulants 8.7 1.2 0.4 0.1 8 1
-- Metham-phetamine* 5.3 0.5 0.2 NA NA NA
- Sedatives 3.4 0.3 0.1 0.0 <17 <1
Alcohol 91.6** 51.1 NA 3.4 7 4
*Methamphetamine use is part of Stimulants use. 2007 was one of the first years meth data was gathered seperately, and they did not collect dependence data for it. From the data that is shown, one can make an educated guess that meth addiction isn't that common.
**For some reason, this study did not ask people whether or not they had ever drunk alcohol. So this figure is from the 2008 WHO World Mental Health Survey
Links to this study: Drug Dependence, Drug Use, Alcohol Use, Alcohol Dependence,

According to this study, all the illegal drugs listed have a higher incidence of addiction than alcohol among recent users. Although these figures are higher than the reality, that probably is true. The people who are most clean-cut and mainstream don't try illegal drugs for ideological reasons, and have low rates of addiction because of the general stability of their lifestyle. The absence of this population from illegal drug users already means addiction figures among them will be higher. Equally, most people would never take the drugs that are most taboo. If you have ever had cocaine even once, one way or another you were on the fringe. If you have ever taken heroin, well you were really out there. The kind of people who try strong drugs are automatically at a higher risk for addiction than average because of their personality. Being willing to take such a drug means you have one or more of the following qualities: thrill-seeking, rebellious, impulsive, emotionally volatile or sensitive. While not problematic on their own, any one of these qualities can react with an unstable or unhappy life to make you more vulnerable to addiction than the rest of us.

Over time, most people who succumb to addiction find better ways to get along in life, and recover. You can see this by looking at the percentage of lifetime users dependent in the year of the study. If that was a typical year, then a higher proportion of lifetime users of illegal drugs go through addiction than users of alcohol, but more of them recover from their addiction than do alcoholics. Usually many more.

This is especially good news because alcohol permanently damages the health of addicted people more than any illegal drug. (That may in fact be a significant reason WHY alcohol addictions persist more.) People who recover from the illegal addictions can look forward to a longer, healthier life on average than a recovered alcoholic. If these drugs were legal, the numbers in that last column would change, as patterns of drug use shift. No longer would it be only people who have certain extremes in their life or their personality who try these drugs, lots of people with more stable lives would start using them too. That would push the incidence of addiction among users down, because stable people don't get addicted. On the other hand, people who currently use alcohol to cope and get addicted to it would use other drugs more once the stigma, legal risk and expense of using them disappear, and many of them would develop addiction to one of those other drugs instead. That would be good, because those drugs would be easier on their bodies, but it would push the incidence of addiction to those drugs up. My guess - nay, my hope - is that a legal system will reduce the number of alcohol addictions as some vulnerable people instead get addicted to depressants that act in a manner similar to alcohol.

This study of cocaine users in Amsterdam in the '80's adds more evidence that it isn't drugs that make people addicted, but people who get addicted to drugs. It was a study of typical cocaine users. They weren't 'deviant' users such as prison inmates, treatment clients, or hot-line callers. There are very few drug-use studies that manage to examine typical use, and that fact deeply skews their results. We'll look at that after the table, but first let's look at what this study showed.

To qualify for the study, you had to be an 'experienced' user, meaning you had used cocaine at least 25 times. (But the definition was changed for their second survey, in 1991, so 24 of the 268 total respondents had only used cocaine a minimum of 10 times.) Half of these experienced users never took more than half a gram of cocaine per week. They were never inclined to do coke more than occasionally. 19% of them went through a period of addiction. Considering 90% of the people surveyed had used cocaine a minimum of 25 times, that means that if all cocaine users were considered, including those who only experimented with it a few times and then lost interest, the overall lifetime addiction rate for all users would likely be several percentage points lower than that. The vast majority of those who experienced addiction later lowered their use back to a casual level or stopped using cocaine altogether - and they did so on their own. None of these users ever went for treatment. Only 7 users, or under 3%, were still addicted to cocaine at the times of the surveys. Note that of those 7, 3 are people who started abusing cocaine from the first year they tried it - and there were only 5 such people, so 60% of the people that got addicted quickly, stayed addicted for a long time. That's pretty strong circumstantial evidence on its own that the personal motivation for drug use is the key factor in addiction. It is also worth noting that 64% of the survey respondents were 30 years old or less, and 95% were 40 years old or less - meaning youth is the thing most likely to cause someone to use drugs. No shock there. Also, the survey respondents were far, far more likely than the average to have used a wide variety of illegal drugs, which backs up the assertion above that, under prohibition especially, the kind of people who use hard drugs are also the kind of people most likely to become addicted to them.

typical cocaine use by casual users

Drugs are illegal, so it is difficult to study their use. The authors of this study mention some of the mistakes that causes. To find people to participate in a study of an illegal drug, the easiest thing is to go where drug use isn't or can't be hidden - addiction treatment centres, prisons, and drug help hotlines. That means that almost all studies are based on addicts and heavy users, not casual users. The people who do the studies are also usually clinicians working in the area of drug abuse, and that means they are prone to an error known as 'clinician's error'. Clinician's error is the name for the tendency of clinicians to think that because the patients they treat suffer in a certain way from a condition, all people with that condition suffer in that same way. The truth is, clinicians only see the worst examples. They see the people who had to go in for treatment. There could be a lot of other people who handle the condition just fine, and this is the case with drug use. Then there is the matter of getting funding. Pretty much the only organizations that fund drug studies are governments. Governments have a strong tendency to fund organizations who have viewpoints similar to their own. After 40 years of drug war, not many people who might get government research grants don't believe in the drug war cause. (That is slowly changing. You can probably thank the internet.)

The other source of information on illegal drugs is animal studies. Animal studies are based on caged animals who are given free access to a mind-altering substance and monitored to see how much of it they take. If you lived alone in a small cage with nothing but a water bottle and maybe some food pellets, how much would you do drugs? A lot. Especially if you were also a rat. But wait - rats clearly abuse some drugs and not others. They only abuse the drugs that are involved in the brain's reward system, which is to say, the ones that really feel good. Okay, so we've learned that some drugs are better than others for brightening a rat up from the stuck-in-a-cage blues. That doesn't mean it wasn't the blues that made the rat abuse the drug in the first place. If the rat's problem wasn't that it was stuck alone in a small space, but that it was constantly being chased by cats, the appeal of a free supply of heroin would completely disappear. If you gave it the option to instead take steady doses of caffeine, that's what it would do.

Now, let's move on and look at the best reason of all to legalize drugs: drug prohibition causes a world of hurt.

Next: Prohibition Kills