DISTINGUISHING DRUG USE FROM DRUG ABUSE
Psychoactive drug consumption is a continuing part of human history. Written records from the earliest past and around the world attest to the universal use of psychoactive substances for a variety of reasons -- recreational, therapeutic, artistic, and religious -- in every human population. The only drug-free society known to ever have existed was that of the "Eskimos" of the northernmost region of North America – a population in which alcohol and nicotine addiction became endemic in this population once liquor and tobacco were introduced by Europeans and Americans. Drug consumption can be categorized into the areas of drug use and drug misuse (formerly called drug abuse). Drug use has been defined as taking a drug in such a manner that the sought-for effects are attained with minimal hazard (Irwin, 1973; Duncan and Gold, 1982). If Mary Smith is an adult who drinks a glass of wine with her dinner, finding it a pleasant beverage and social relaxant, then this is an example of drug use. Drug misuse is taking a drug to such an extent that it greatly increases the danger or impairs the ability of the individual to adequately function or cope with their circumstances. If the same Mary Smith were to drink so much wine every evening that she passes out, having argued with her husband and frightened her children, then this would be drug misuse. By definition, then, the negative health consequences of drug consumption are a result of the misuse of these substances, not of their use.
A very important but seldom discussed fact about illicit drug consumption is that most often it is use and not misuse. The sole exception is nicotine use -- the majority of smokers are misusers (i.e., smoke at levels that substantially increase their risk of negative health consequences) and, in fact, are dependant on the drug nicotine. Evidence from the American Epidemiologic Catchment Area Study (Anthony & Helzer, 1991) revealed that, applying accepted psychiatric criteria for drug abuse and drug dependence, only 21.7% of the persons in five community samples who had ever taken illicit drugs had experienced a period of misuse at any time during their drug use history. The prevalence of current drug misuse among persons who reported illicit drug use was 4.2%. The first symptoms of misuse typically occurred within two to three years after beginning illicit drug consumption and the median duration of a clinical case of drug misuse was four to five years, not a lifetime. Subsequent studies in the U.K., Europe, and America have shown even lower prevalences of drug misuse among more representative samples of national populations.
Society suffers substantial negative social, health, and economic consequences from drug misuse in itself as well as from attempts to prevent illicit drug consumption. It is apparent that past and present policies have not effectively dealt with our drug problems and are, in fact, contributing to them. At the heart of many of these policies, laws, and programs has been the assumption that all consumption of illicit drugs is abnormal. This assumption is invalid and thus any policy grounded in it is likely to be ineffective. Meanwhile, prevention of the misuse of legal drugs has received much less official attention, resulting in less than desired outcomes. Current effective harm reduction programs targeted toward alcohol/tobacco consumption (e.g., limits on public smoking, safe driving educational campaigns, etc.) could be expanded and also focused on the currently illicit drugs (e.g., making hospital emergency rooms arrest free zones).
Drug use is historically, clinically and statistically normal behaviour. Individuals can choose whether to engage in this behaviour and most who do consume drugs in a responsible way. A drug-free society is not a feasible possibility but a society that suffers minimally from drug misuse is a possibility. To achieve that possibility we must acknowledge the distinction between drug use and drug misuse and focus our preventative concern on
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