The Report of the National Commission on Marihuana and Drug Abuse
Drug Use In America: Problem in Perspective
Commissioned by President Richard M. Nixon, March, 1972
Table of Contents
Letter of Transmittal
Introduction
Chapter One -- Defining the Issues
- Definitional Confusion: What is Drug Abuse?
- "Drug"-The All-Purpose Concept
- Drug Abuse: Synonym for Social Disapproval
- The Roots of a "Problem"
- The Social Response: False Premises and the Perpetuation of a Problem
- The Assumptions and Premises of Present Policy
- Elimination of Non-Medical Drug Use
- Risk-Taking and Health
- Motivation for Mood Alteration
- Drugs and Individual Responsibility
- An Overview of the Present Response
- Risk-Education
- Coercion
- Sickness
- Perpetuating the Problem
- Defining the Problem
- The Meaning of Drug Use
- The Incidence of Drug Use
- Drug Using Behavior
- Drug-Related Risk
- Risks to Individual Health
- Drug-Induced Behavior
- Dependence Liability
- Evaluating the Social Consequences of Drug Use
- Defining America's Drug Problem
- The Limits of Social Control
- The Commission's Role
Chapter Two - Drug Using Behavior in the United States
- I. Drug Use in the General Population
- Tobacco and Alcohol
- Use of Proprietary and Ethical Psychoactive Substances
- Incidence and Prevalance
- Demographic Characteristics
- Motivations for Use
- Multi-Drug Use
- Alcohol, Ethical and Proprietary Psychoactive Drugs
- Marihuana and Ethical and Proprietary Psychoactive Drugs
- Concurrent Drug Usage
- Illicit Drug Use in the General Population
- Marihuana
- LSD, Other Hallucinogens
- Glue, Other Inhalants
- Cocaine
- Heroin
- Multi-Drug Use
- II. Drug Use Among Students
- Survey Methodology
- Comparative National Survey Student Data
- Incidence of Student Drug Use
- Alcohol
- Marihuana
- Inhalants
- Hallucinogens
- Stimulants
- Depressants
- Opiates
- Patterns of Student Drug Use
- Present and Future Drug Involvement
- Frequency and Intensity of Drug Use
- Duration of Student Drug Use
- Multi-Drug Use
- III. A Typology of Drug-Using Behavior
- Experimental Use
- Social-Recreational Use
- Circumstantial-Situational Use
- Intensified Drug Use
- Compulsive Drug Use
- IV. Psychosocial and Institutional Influences on Drug-Using Behavior
- Broad Cultural Influences
- Drugs and Youth
- Experimentation, Availability and Need
- Personal Dissatisfaction and the Search for "Something of Value"
- Age and Responsibility
- The Impact of Extended Education
- Institutional Sources of Identity
- Mood Alteration in America
- Factors Bearing on Drug Dependence
- A Final Note
Chapter Three The Social Impact of Drug Dependence and
Drug-Induced Behavior
- I. Drug Dependence
- Terminological Confusion
- Addiction
- Habituation
- The Search for Precision
- Drug Dependence
- Excising "Addiction"
- Toward a Functional Understanding of Drug Dependence
- Psychological Dependence: The Primary Reinforcer
- The Pharmacological Component: Reinforcement Potential
- Psycho-Social Components
- The Development of Dependence: Conditioning
- The Dependence Continuum
- Measuring the Degree of Dependence: Psychological Components
- Physical Dependence: The Secondary Reinforcer
- Summary
- Evaluating the Social Impact of Drug Dependence
- Dependence, Health and Behavior
- The Vulnerability Factor
- The Relevance of Social Response
- Present Social Impact
- Alcohol
- Heroin
- Barbiturates
- Amphetamines and Related Stimulants
- Cocaine
- Hallucinogens
- Cannabis
- II. Drug Induced Behavior
- Impact on Perception
- Impact on Memory
- Alteration of Mental States
- Impairment of Psychomotor Function
- Summary
- III.Impact on Public Safety
- Drugs and Crime
- Drugs and Their Criminogenic Effects
- Alcohol
- Marihuana
- Barbiturates
- Amphetamines
- Opiates
- Cocaine
- Hallucinogens
- Other Psychoactive Substances
- Summary
- Psychosocial Characteristics of Drug-Dependent Persons: Implications for Public Safety
- Social and Demographic Characteristics
- Age
- Educational Status
- Income, Occupation and Employment Status
- Home Environment and Marital Status
- Psychological Characteristics
- Problems in Inferring Causation
- The Costs of Heroin Dependence
- Cost to the Heroin-Dependent Person
- Cost to Society from Criminal Activity
- Criminal Justice Costs: Processing the Drug-Dependent Person
- The Effect of Drug Treatment on Crime
- Current Research Findings
- A Realistic Appraisal
- Drugs and Driving
- Research Limitations
- Research Findings
- Alcohol
- Marihuana
- Other Psychoactive Substances
- IV. Impact on Public Health and Welfare
- Public Health and Welfare: A Preventive Concept
- Assessing the Public Health and Welfare Impact of Drug Use
- The Population of Heavy Alcohol Users
- Economic Loss
- Death
- Alcohol
- Heroin
- Barbiturates
- Medical Complications of Chronic Drug Use
- Impact on the Family Structure
- Compensatory Social Costs
- Framing a Public Health Response
Chapter Four - Toward a Coherent Social Policy
- Introduction
- The Process
- Goals and Premises
- Drugs and Social Responsibility
- Irresponsible Use
- Discouragement and Social Tolerance
- Responsible Decision Making
- Risks and Perceived Advantages
- Designing a Differential Response to Drug Use
- I. The Availability Decision
- Models of Availability
- The Calculus: An Overview
- Relative Social Cost
- Efficacy of Controls
- Cost of Controls
- The Social Context of the Availability Decision
- The Present System
- Availability Not Limited As To Purpose of Consumption
- Availability Limited As To Purpose of Consumption
- Substances Not Available For Consumption
- Specific Recommendations
- Opiates
- Cocaine
- Amphetamines
- Barbiturates
- Non-Barbiturate Sedatives
- Minor Tranquilizers
- Hallucinogens
- Marihuana
- Alcohol
- Implementing Restrictions on Availability
- The Role of International Agreements
- Federal Enforcement Policy
- State Enforcement Policy
- II. The Consumption-Intervention Decision
- An Overview of the Possession Offense
- Deviance, Deterrence and Symbolism
- Philosophical Conflict
- Constitutionality
- Functional Overview
- Deterrence
- Social Costs of Enforcement
- Possession and Supply
- Symbolism
- Sickness and Treatment
- Origins of the Cult of Curability
- Addiction and Treatment: The Early Days
- The Therapeutic Premise Takes Hold
- Therapeutic Intervention Comes Under Attack
- Harnessing the Therapeutic Response
- Involuntary "Civil" Commitment: The Problems of a Therapeutic Response
- Therapy and the Criminal Process
- Dangerousness and Prevention
- Crime and the Public Safety
- Contagion and the Public Health and Welfare
- The Appropriate Role of Preventive Intervention
- Conclusion: The Possession Offense and Its Enforcement
- Functional Enforcement
- Role of the Police
- III. Defining the Government's Role
- Governmental Competence
- General Guidelines
- Analyzing the Government Response
- An Overview of the Government Response
- The Special Action Office: A Stopgap
- Failures of the Present System
- Identification of the Nature and Extent of Drug Use
- Definition of goals and objectives for drug-related functions
- Effective planning
- Affective control of resource allocation
- Coordination among federal agencies
- Drug-related functions within agencies whose primary mission is not solving drug
problems
- Evaluation of programs in terms of their effectiveness
- Evaluation of programs in terms of efficiency
- Separation of drug and alcohol activities
- Reorganizing the Governmental Response
- Bringing the Drug Effort Under Control
- The Structure of the Unified Approach
- Organization of Response at the Community Level
- IV. Treatment and Rehabilitation
- An Overview of the Present Response
- Uncertainty About the Illness
- Uncertainty About the Objective of Treatment
- Diversity of Method
- History of the Treatment of Opiate Dependence
- 1870-1900: The Early Years
- 1900-1915: Years of Optimism
- 1915-1930: Confidence Wanes
- 1930-1960: The Dry Years
- The Sixties: Society Turns to Therapy Again
- Present Methods and Models of Treatment
- Hospitalization
- Ambulatory Drug-Free Treatment
- Therapeutic Communities
- Methadone Maintenance
- Antagonist Treatment
- Multi-Modality Programs
- Treatment for Non-Opiate Drug Dependence
- The Role of the Law in Treatment
- Legal Controls as Therapy
- Civil Procedures
- Criminal Procedures
- Legal Control of the Treatment Process
- Heroin Maintenance
- Conclusions and Recommendations on Treatment of Dependence
- Federal Funding and Services
- Federal Evaluation
- State Treatment Programs
- The Role of the Legal System in State Programs
- Uniformity of State Law
- Emergency Treatment of Drug Users
- V. Prevention
- The Information-Education Explosion
- Goals of Information-Education Prevention
- Information Policy
- Education
- Training
- The Media and Drug Use Prevention
- Other Prevention Strategies and Techniques
- Summary and Conclusion
- VI. Research
- A New Interest in Research
- The Need for a Directed Research Plan
- Incidence, Frequency and Intensity of Drug Use
- Etiology and Consequences of Drug Use
- The Role of the Criminal Justice System
- Efficacy of Treatment
- Other Areas
- VII. The Private Response
- The Health Professions
- Pharmaceutical Industry
- Alcohol Industry
- Legal Profession
- Industry
- Colleges and Universities
- Mass Media
- The Religious Community
- The Family
Chapter Five - Looking Ahead
- The Immediate Future: The Goal of the Commission's Recommendations
- Changing Attitudes
- Filling the Informational Gaps
- Unifying the Government Response
- Developing the Private Response
- Improving Controls on Availability
- Rationalizing Consumption Controls
- Expanding Treatment, Rehabilitation and Prevention Services
- The Immediate Future
- Policy Making Over the Long Term
- Confronting the Basic Question
- Reappraisal: The Need for Evaluation
Sources
Bibliography
Consultants
Contractors and Contributors
Research Papers Prepared for Commission
Recommendations
Index of First Year Recommendations
Index of Second Year Recommendations
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