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II. America’s Drug Abuse Profile


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Fewer Americans Are Using Illegal Drugs

An estimated 12.8 million Americans, about 6 percent of the household population aged twelve and older, use illegal drugs on a current basis (within the past thirty days). This number of "past-month" drug users has declined by almost 50 percent from the 1979 high of twenty-five million -- a decrease that represents an extraordinary change in behavior. Despite the dramatic drop, more than a third of all Americans twelve and older have tried an illicit drug. Ninety percent of those who have used illegal drugs used marijuana or hashish. Approximately a third used cocaine or took a prescription type drug for nonmedical reasons. About a fifth used LSD. Fortunately, nearly sixty million Americans who used illicit drugs during youth, as adults reject these substances.1

Drug Use is a Shared Problem

Many Americans believe that drug abuse is not their problem. They have misconceptions that drug users belong to a segment of society different from their own or that drug abuse is remote from their environment. They are wrong. Almost three quarters of drug users are employed. A majority of Americans believe that drug use and drug-related crime are among our nation’s most pressing social problems.2 Approximately 45 percent of Americans know someone with a substance abuse problem.

While drug use and its consequences threaten Americans of every socio-economic background, geographic region, educational level, and ethnic and racial identity, the effects of drug use are often felt disproportionally. Neighborhoods where illegal drug markets flourish are plagued by attendant crime and violence. Americans who lack comprehensive health plans and have smaller incomes may be less able to afford treatment programs to overcome drug dependence. What all Americans must understand is that no one is immune from the consequences of drug use. Every family is vulnerable. We must make a commitment to reducing drug abuse and not mistakenly assume that illegal drugs are someone else’s concern.

Cocaine. The number of cocaine users in the United States has declined dramatically since the high point in 1985. In 1995, 1.5 million Americans were current cocaine users, a 74 percent decline from 5.7 million a decade earlier. In addition, fewer people are trying cocaine. The estimated 533,000 first-time users in 1994 represented a 60 percent decline from approximately 1.3 million cocaine initiates per year between 1980 and 1984. While these figures indicate significant progress, the number of frequent users in 1995 -- estimated at 582,000 (255,000 of whom use crack) -- has not changed markedly since 1985.3 The Rand Corporation estimates that chronic users account for two-thirds of the U.S. demand for cocaine.4 Thus, while the number of cocaine users has dropped, the amount of cocaine consumed in America has not declined commensurably.

Heroin. Some 600,000 people in the United States are addicted to heroin, an increase over the estimated number of addicts during the 1970s and 1980s.5 While injection remains the most practical and efficient means of administering low-purity heroin, the availability of high-purity heroin makes snorting or smoking viable options. As more chronic users turn to snorting heroin, consumption has increased dramatically compared to consumption a decade ago when injection was the only option available.6 The April 1996 Pulse Check, a survey conducted by the Office of National Drug Control Policy, found that while most heroin users are older, long-term drug abusers, growing numbers of teenagers and young adults are using the drug.7

Marijuana. In 1995, an estimated 9.8 million Americans (77 percent of all current illicit drug users) were smokers of marijuana -- making it the most-commonly-used illicit drug. Approximately 57 percent of current illicit drug users limit consumption exclusively to marijuana. In 1995, five million U.S. citizens used marijuana frequently (defined as at least fifty-one days a year), which was a significantly lower figure than the estimated 8.4 million frequent marijuana users in 1985. However, the annual number of marijuana initiates rose since 1991, reaching 2.3 million in 1994.8

Methamphetamine. Methamphetamine use is increasing. An estimated 4.7 million Americans have tried this drug.9 Findings by the National Institute of Justice’s Drug Use Forecasting program, which regularly tests arrestees for drug use in twenty-three cities, suggest that methamphetamine is present in many communities across the country and that its prevalence is greatest in the West, Southwest, and Midwest.10 In 1995, approximately 6 percent of adult and juvenile arrestees, from all sites, tested positive for methamphetamine. Eight locations (San Diego, Phoenix, San Jose, Portland, Omaha, Los Angeles, Denver, and Dallas) reported significant rates of methamphetamine use.

Other Illicit Drugs. In 1995, the prevalence of current use of other illicit drugs, including hallucinogens, inhalants, and psychotherapeutics, was less than 1 percent. Only hallucinogen use showed any significant change between 1994 and 1995, rising from 0.4 percent to 0.7 percent. Despite last year’s ban on importation, Rohypnol, a powerful sedative, is still found in the Southeast and Mid-Atlantic regions. Ethnographers note that this substance was formerly one of several "club drugs" young people used, which now may be reaching a wider audience.11 Other "club drugs" -- including Ketamine, Quaaludes, Xanax, MDMA, and LSD -- continue to gain popularity among young adults.

Trends in Youth Drug Use

The most alarming trend is the increasing use of illegal drugs, tobacco, and alcohol among youth. Children who use these substances increase the chance of acquiring life-long dependency problems. They also incur greater health risks. Every day, three thousand children begin smoking cigarettes regularly; as a result, a third of these youngsters will have their lives shortened.12 According to a study conducted by Columbia University’s Center on Addiction and Substance Abuse, children who smoke marijuana are eighty-five times more likely to use cocaine than peers who never tried marijuana.13 The use of illicit drugs among eighth graders is up 150 percent over the past five years.14 While alarmingly high, the prevalence of drug use among today’s young people has not returned to near-epidemic levels of the late 1970s. The most important challenge for drug policy is to reverse these dangerous trends.

Early drug use often leads to other forms of unhealthy, unproductive behavior. Illegal drugs are associated with premature sexual activity (with attendant risks of unwanted pregnancy and exposure to sexually-transmitted diseases like HIV/AIDS), delinquency, and involvement in the criminal justice system.

Overall Use of Illegal Drugs. In 1995, 10.9 percent of all youngsters between twelve and seventeen years of age used illicit drugs on a past-month basis.15 This rate has risen substantially compared to 8.2 percent in 1994, 5.7 percent in 1993, and 5.3 percent in 1992 -- the historic low in the trend since the 1979 high of 16.3 percent. The University of Michigan’s 1996 Monitoring the Future study found that more than half of all high school students use illicit drugs by the time they graduate.

Cocaine Use Among Youth. Cocaine use is not prevalent among young people. In 1996, approximately 2 percent of twelfth graders were current cocaine users. While this figure was up from a low of 1.4 percent in 1992, it was still 70 percent lower than the 6.7 percent high in 1985. Among twelfth graders in 1996, 7.1 percent had ever tried cocaine -- up from the 1992 low of 6.1 percent but much lower than the 1985 high of 17.3 percent. However, during the past five years, lifetime use of cocaine has nearly doubled among eighth graders, reaching 4.5 percent in 1996.16 A similar trend is identified in the 1995 National Household Survey on Drug Abuse, which showed a drop in the mean age for first use of cocaine from 23.3 years in 1990 to nineteen in 1994.17

Heroin Use Among Youth. Heroin use is also not prevalent among young people. The 1996 Monitoring The Future study found that 1 percent of twelfth graders had used heroin in the past year, and half of 1 percent had done so within the last thirty days. Encouragingly, both figures were lower than the 1995 findings. However, the 1996 survey showed that the number of youths who ever used heroin doubled between 1991 and 1996 among eighth and twelfth graders, reaching 2.4 percent and 1.8 percent respectively.18

Marijuana Use Among Youth. Marijuana use continues to be a major problem among the nation’s young people. Almost one in four high school seniors used marijuana on a "past-month" basis in 1996 while less than 10 percent used any other illicit drug with the same frequency. Within the past year, nearly twice as many seniors used marijuana as any other illicit drug.19 Marijuana also accounts for most of the increase in illicit drug use among youths aged twelve to seventeen. Between 1994 and 1995, the rate of marijuana use among this age-group increased from 6 percent to 8.2 percent (a 37 percent increase). Furthermore, adolescents are beginning to smoke marijuana at a younger age. The mean age of first use dropped from 17.8 years in 1987 to 16.3 years in 1994.20

Alcohol Use Among Youth. Alcohol is the drug most often used by young people. Approximately one in four tenth grade students and one third of twelfth graders report having had five or more drinks on at least one occasion within two weeks of the survey.21 The average age of first drinking has declined to 15.9 years, down from 1987’s average of 17.4 years.22

Tobacco Use Among Youth. Despite a decline in adult smoking, American youth continue to use tobacco products at rising rates. In 1996, more than a third of high school seniors smoked cigarettes, and more than one in five did so daily. These percentages are greater than at any time since the 1970s.23

Other Illicit Drug Use Among Youth. After marijuana, stimulants (a category that includes methamphetamine) are the second-most-commonly used illicit drug among young people. About 5 percent of high school students use stimulants on a monthly basis, and 10 percent have done so within the past year. Encouragingly, the use of inhalants -- the third-most-common illicit substance -- declined among eighth, tenth, and twelfth graders in 1996. LSD however, was used by 8.8 percent of twelfth graders during the past year.24

Consequences of Illicit Drug Use

The social and health costs to society of illicit drug use are staggering. Drug-related illness, death, and crime cost the nation approximately $66.9 billion. Every man, woman, and child in America pays nearly $1,000 annually to cover the expense of unnecessary health care, extra law enforcement, auto accidents, crime, and lost productivity resulting from substance abuse.25 Illicit drug use hurts families, businesses, and neighborhoods; impedes education; and chokes criminal justice, health, and social service systems.

Health Consequences

Drug-Related Medical Emergencies Are at a Historic High. The Drug Abuse Warning Network (DAWN), which studies drug-related hospital emergency room episodes, provides a useful snapshot of the health consequences of America’s drug problem. In 1995, DAWN estimated that 531,800 drug-related episodes occurred -- slightly more than the 518,500 incidents in 1994. The 1995 figure marks the first time in the past five years that drug-related emergency department episodes did not rise significantly.26

DAWN also found that cocaine-related episodes remain at a historic high. Heroin-related emergencies increased between 1990 and 1995 by 124 percent. While no meaningful change occurred in the number of methamphetamine-related episodes between 1994 and 1995, a marked increase did occur between 1991 and 1994 when the figure rose from five thousand to nearly eighteen thousand.

Nearly 40 percent of deaths connected with illegal drugs strike people between age thirty and thirty-nine, a group with elevated rates of chronic problems due to drug abuse.27 Overall rates are higher for men than for women, and for blacks than for whites.28 AIDS is the fastest-growing cause of all illegal drug-related deaths. More than 33 percent of new AIDS cases affect injecting drug users and their sexual partners.29

The Consequences of Heroin Addiction are Becoming More Evident. Heroin-related deaths in some cities increased dramatically between 1993 and 1994 (the most recent year for which these statistics are available). In Phoenix, heroin fatalities were up 34 percent, 29 percent in Denver, and 25 percent in New Orleans.30 The annual number of heroin-related emergency room mentions increased from 34,000 in 1990 to 76,023 in 1995.31

Maternal Drug Abuse Contributes to Birth Defects and Infant Mortality. A survey conducted between 1992 and 1993 estimated that 5.5 percent, or about 221,000 women, used an illicit drug at least once during their pregnancy.32 Marijuana was used by about 2.9 percent, or 119,000; cocaine was used by about 1.1 percent, or 45,000.33 Infants born to mothers who abuse drugs may go through withdrawal or have other medical problems at birth. Recent research also suggests that drug-exposed infants may develop poorly because of stress caused by the mother’s drug use. These children experience double jeopardy: they often suffer from biological vulnerability due to prenatal drug exposure, which can be exacerbated by poor caretaking and multiple separations resulting from the drug user’s lifestyle.

Maternal substance abuse is associated with increased risk of infant mortality or death of the child during the first year of life. An in-depth study of infant mortality conducted on women receiving Medicaid, in the state of Washington from 1988 through 1990, showed an infant mortality rate of 14.9 per one thousand births among substance-abusing women as compared to 10.7 per one thousand for women on Medicaid who were not substance abusers.34 In addition, this research indicated that infants born to drug-abusing women are 2.5 times more likely to die from Sudden Infant Death Syndrome (SIDS).

Chronic Drug Use is Related to Other Health Problems. The use of illegal drugs is associated with a range of other diseases, including tuberculosis and hepatitis. Chronic users are particularly susceptible to sexually-transmittable diseases and represent "core transmitters" of these infections. High risk sexual behavior associated with crack and injection drug use has been shown to enhance the transmission and acquisition of both HIV and other STDs.

Underage Use of Alcohol and Tobacco Can Lead to Premature Death. Eighty-two percent of all people who try cigarettes do so by age eighteen.35 Approximately 4.5 million American children under eighteen now smoke, and every day another three thousand adolescents become regular smokers.36 Seventy percent of adolescent smokers say they would not have started if they could choose again.37 In excess of 400,000 people die every year from smoking-related diseases -- more than from alcohol, crack, heroin, murder, suicide, car accidents, and AIDS combined.38

Alcohol has a devastating impact on young people. Eight young people a day die in alcohol-related car crashes.39 According to the National Highway Traffic Safety Administration, 7,738 intoxicated drivers between the ages of sixteen and twenty were fatally injured in 1996.40 The younger an individual starts drinking and the greater the intensity and frequency of alcohol consumption, the greater the risk of using other drugs.41 Two and-a-half million teenagers reported they did not know that a person can die from alcohol overdose.42

Drug Abuse Burdens the Workplace. Seventy-one percent of all illicit drug users aged eighteen and older (7.4 million adults) are employed, including 5.4 million full-time workers and 1.9 million part-time workers.43 Drug users decrease workplace productivity. An ongoing, nationwide study conducted by the U.S. Postal Service has compared the job performance of drug users versus non-users. Among drug users, absenteeism is 66 percent higher, health benefit utilization is 84 percent greater in dollar terms, disciplinary actions are 90 percent higher, and there is significantly higher employee turnover.44

The workplace can function as a conduit for information on substance-abuse prevention and identification both to adults -- many of whom, as parents, are not being reached through more traditional means -- and to youth who are employed while attending school. The threat of job loss remains one of the most effective ways to motivate substance abusers to get help. The workplace provides many employees (and families) who seek help for a substance-abuse problem with access to treatment. Since evidence shows that substance-abuse treatment can reduce job-related problems and result in abstinence, many employers sponsor employee-assistance programs (EAPs), conduct drug testing, or have procedures for detecting substance-abuse and promoting early treatment.

The Cost of Drug-Related Crime

Drug abuse takes a toll on society that can only be partially measured. While we are able to estimate the number of drug-related crimes that occur each year, we can never determine fully the extent to which the quality of life in America’s neighborhoods has been diminished by drug-related criminal behavior. With the exception of drug-related homicides, which have declined in recent years, drug-related crime is continuing at a strong and steady pace.

Numerous Drug-Related Arrests Occur Each Year. In 1994, state and local law enforcement agencies made an estimated 1.14 million arrests for drug law violations. The largest percentage of these arrests were for drug possession (75.1 percent).45

Arrestees Frequently Test Positive for Recent Drug Use. The National Institute of Justice Drug Use Forecasting (DUF) program calculates the percentage of arrested individuals whose urine indicates drug use. In 1995, DUF data collected from male arrestees in twenty-three cities showed that the percentage testing positive for any drug ranged from 51 percent to 83 percent. Female arrestees ranged from 41 percent to 84 percent. Among males, arrestees charged with drug possession or sale were most likely to test positive for drug use. Among females, arrestees charged with prostitution, drug possession or sale were most likely to test positive for drug use. Both males and females arrested for robbery, burglary, and stealing vehicles had high positive rates.46

Drug Offenders Crowd the Nation’s Prisons and Jails. At midyear 1996, there were 93,167 inmates in federal prisons, 1,019,281 in state prisons, and 518,492 in jails.47 In 1994, 59.5 percent of federal prisoners were drug offenders48 as were 22.3 percent of the inmates in state prisons.49 The increase in drug offenders accounts for nearly three quarters of the total growth in federal prison inmates since 1980. Most drug offenders are imprisoned for possessing more drugs than possibly could be consumed by one individual distributing drugs or committing serious crimes related to drug sales. In 1995, for example, only 4,040 people were sentenced in federal courts for marijuana-related charges; 89.1 percent of those offenders were facing trafficking charges.50

Inmates in Federal and State Prisons were often under the Influence of Drugs when they Committed Offenses. A 1991 survey of federal and state prisons, found that drug offenders, burglars, and robbers in state prisons were the most likely to report being under the influence of drugs while committing crimes. Inmates in state prisons who had been convicted of homicide, assault, and public order offenses were least likely to report being under the influence of drugs. With the exception of burglars, federal prison inmates were less likely than state inmates to have committed offenses under the influence of drugs.51

Offenders Often Commit Offenses to Support Drug Habits. According to a 1991 joint survey of federal and state prison inmates, an estimated 10 percent of federal prisoners and 17 percent of state prisoners reported committing offenses in order to pay for drugs.52

Drug Trafficking Generates Violent Crime. Trafficking in illicit drugs is often associated with violent crime. Reasons for this relationship include competition for drug markets and customers, disputes among individuals involved with illegal drugs, and the location of drug markets in disadvantaged areas where legal and social controls against violence tend to be ineffective. The proliferation of lethal weapons in recent years has also made drug violence more deadly.

Drug-Related Homicides Have Declined. There was a steady decline in drug-related homicide between 1989 and 1995. The Uniform Crime Reports (UCR) indicated that of 21,597 homicides committed in 1995 in which the circumstances of the crime were known, 1,010 (or 4.7 percent) involved drugs. This figure was significantly lower than 7.4 percent in 1989.53

Money Laundering Harms Financial Institutions. Money laundering involves disguising financial assets so they can be used without the illegal activity that produced them being detected. Money laundering provides financial fuel not only for drug dealers but for terrorists, arms dealers, and other criminals who operate and expand criminal enterprises. Drug trafficking generates tens of billions of dollars a year; the total amount of money involved cannot be calculated precisely. In September 1996, the Internal Revenue Service (IRS) estimated that 60 percent of the money laundering cases it investigated during that fiscal year were drug-related.54

Illegal Drugs Remain Available

Illegal drugs continue to be readily available almost anywhere in the United States. If measured solely in terms of price and purity, cocaine, heroin, and marijuana prove to be more available than they were a decade ago when the number of cocaine and marijuana users was much higher.

Cocaine Availability. Colombian drug cartels continue to manage most aspects of the cocaine trade from acquisition of cocaine base, to cocaine production in South America and transportation, to wholesale distribution in the United States. Polydrug trafficking gangs in Mexico, which used to serve primarily as transporters for the Colombian groups, are increasingly assuming a more prominent role in the transportation and distribution of cocaine. Wholesale cocaine distribution and money laundering networks are typically organized into multiple cells functioning in major metropolitan areas. Domestically, retail level sales are conducted by a wide variety of criminal groups. These sellers are often organized along regional, cultural, and ethnic lines that facilitate internal security while serving a demand for drugs that permeates every part of our society.

Gangs -- including the Crips, Bloods, and Dominican gangs as well as Jamaican "posses"-- are primarily responsible for widespread cocaine and crack-related violence. The migration of gang members and "posses" to smaller U.S. cities and rural areas has caused an increase in drug-related homicides, armed robberies, and assaults in those areas. According to the National Narcotics Intelligence Consumers Committee (NNICC) Report, the price and availability of cocaine in the United States remain relatively stable. In 1995, cocaine prices ranged nationally from $10,500 to $36,000 per kilogram. The average purity of cocaine at the gram, ounce, and kilogram level also remains high. Purity of the gram (retail level) in 1995 was approximately 61 percent while purity per kilogram (wholesale) was 83 percent.55

Heroin Availability. Heroin continues to be readily available in many cities. Nationally, in 1995 wholesale prices ranged from $50,000 to $260,000 per kilogram. This wide range reflected such variables as buyer-seller relationship, quantity purchased, frequency of delivery, and transportation costs. Data obtained from DEA’s Domestic Monitor Program, a retail heroin purchase program, indicates that high-purity Southeast Asian heroin dominates the U.S. market. However, the availability of South American heroin has increased steadily, reflecting the fact that Colombian traffickers have gained a foothold in the U.S. heroin market.56

The NNICC Report also reveals that heroin purity levels have risen considerably. In 1995, the average purity for retail heroin from all sources was 39.7 percent nationwide, which was much higher than the average of 7 percent reported a decade ago. The retail purity of South American heroin was the highest of any source, averaging 56.4 percent nationwide and 76 percent in New York City, a major importation and distribution center. Heroin purity was generally highest in the Northeast where a large percentage of the nation’s users live.

Marijuana Availability. Marijuana is the most readily available illicit drug in the United States. While no comprehensive survey of domestic cannabis cultivation has been conducted, the DEA estimates that much of the marijuana consumed in the United States is grown domestically. Cannabis is frequently cultivated in remote locations and on public lands. Major outdoor cultivation areas are found in Tennessee, Kentucky, Hawaii, California, and New York. Significant quantities of marijuana are also grown indoors. The controlled environments of indoor operations enable growers to use sophisticated agronomic techniques to enhance the drug’s potency. The majority of the marijuana in the United States comes from Mexico, much of it being smuggled across the southwest border. However, marijuana shipments from Colombia and Jamaica are increasing.

Marijuana production and distribution in the United States are highly decentralized. Trafficking organizations range from complex operations that import the drug, grow it domestically, and trade within the U.S., to individuals cultivating and selling at the retail level. High quality marijuana is widely available in all parts of the United States. Prices vary with quality and range from forty to nine hundred dollars per ounce.57 Over the past decade, marijuana prices have dropped even as the drug’s potency has increased.

Methamphetamine Availability. Domestic methamphetamine production and trafficking are concentrated in the western and southwestern regions of the United States. Clandestine methamphetamine laboratories operating within Mexico and California are primary sources of supply for all areas of the United States. Mexican polydrug trafficking groups dominate wholesale methamphetamine distribution in the United States, saturating the western U.S. market with high-purity methamphetamine. These groups have also become a source of supply for Hawaii, threatening to displace traditional Asian suppliers.

LSD Availability. LSD in retail quantity can be found in virtually every state, and availability has increased in some states. LSD production facilities are thought to be located on the West Coast in the northern California and Pacific Northwest areas. A proliferation of mail-order sales has created a marketplace in which distributors have no personal contact with buyers.

Availability of Other Drugs. PCP production is centered in the greater Los Angeles metropolitan area. Los Angeles-based street gangs, primarily the Crips, continue to distribute PCP to a number of U.S. cities through cocaine trafficking operations. MDMA -- a drug related to methamphetamine and known by such street names as Ecstasy, XTC, Clarity, Essence, and Doctor -- is produced in west Texas and on the West Coast. It is distributed across the country by independent traffickers through the mail or commercial delivery services. MDMA is often sold in tablet form with dosage units of 55 to 150 milligrams. Retail prices range from six to thirty dollars.58

In 1995, an influx of flunitrazepam (Rohypnol) tablets reached the Gulf Coast and other areas of the United States. Manufactured legally by Hoffman-LaRoche in Colombia, Mexico, and Switzerland, Rohypnol has been reported to be combined with alcohol and cocaine, and is becoming known as the "date rape" drug. Illegal in the United States, it sells wholesale for a dollar a tablet and retail from $1.25 to three dollars a tablet.59

While Progress Has Been Made, More Remains to be Done.

We have made progress in our efforts to reduce drug use and its consequences in America. While America’s illegal drug problem is serious, it does not approach the emergency situation of the late 1970s or the cocaine epidemic in the 1980s. Just 6 percent of our household population age twelve and over was using drugs in 1995, down from 14.1 percent in 1979. Fewer than 1 percent were using cocaine, inhalants, or hallucinogens. The most- commonly-used illegal drug was marijuana, taken by 77 percent of drug users.60

As drug use became less prevalent through the 1980s, national attention to the drug problem decreased. The Partnership for a Drug-Free America suggests that an indicator or that decreased attention was the reduced frequency of anti-drug public service announcements (PSAs) on TV, radio, and in print media. Our children also dropped their guard as drugs became less prevalent and first-hand knowledge of dangerous substances became scarce. Consequently, disapproval of drugs and the perception of risk on the part of young people has declined throughout this decade. As a result, since 1992 more youth have been using alcohol, tobacco, and illegal drugs.

A disturbing study prepared by CASA suggests that adults have become resigned to teen drug use. In fact, nearly half the parents from the "baby-boomer" generation expect their teenagers to try illegal drugs.61 Forty percent believe they have little influence over teenagers’ decisions about whether to smoke, drink, or use illegal drugs. Both of these assumptions are incorrect. Parents have enormous influence over the decisions young people make.

We Must Act Now to Prevent a Future Drug Epidemic

The United States has failed to forestall resurgent drug use among children in the ‘90s. This problem did not develop recently. The 1993 Interim National Drug Control Strategy highlighted the problem of rising drug use among American youth, quoting the 1992 Monitoring The Future study which found that eighth graders and college students were "... reporting higher rates of drug use in 1992 than they did in 1991. Further, fewer eighth graders in 1992 perceived great risk with using cocaine or crack than did eighth graders in 1991." The continuation of these trends has been substantiated by every significant survey of drug use since 1993.

Our challenge is to reverse these negative trends. America cannot allow the relapse we have experienced to signal a return to catastrophic illegal drug use levels of the past. The government has committed itself to that end; so have non-governmental organizations such as Community Anti-Drug Coalitions of America (CACDA); the Partnership for a Drug-Free America (PDFA); Columbia University’s Center on Addiction and substance-abuse (CASA), the National Center for the Advancement of Prevention (NCAP), the Parent’s Resource Institute for Drug Education (PRIDE), and many others. Working together, we can succeed.

ENDNOTES

1. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse (Rockville, Md.: U.S. Department of Health and Human Services, 1996).

2. The Gallup Organization, Consult with America: A Look at How Americans View the Country’s Drug Problem, Summary Report (Rockville, Md.: March 1996).

3. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

4. Rand Corporation, Modeling the Demand for Cocaine (Santa Monica, Calif.: Rand Corporation, 1994).

5. W. Rhodes, P. Scheiman, and K. Carlson, What America’s Users Spend on Illegal Drugs, 1988-1991 (Washington, D.C.: Abt Associates, Inc., under contract to the Office of National Drug Control Policy, 1993).

6. National Narcotics Intelligence Consumers Committee, The NNICC Report 1995: The Supply of Illicit Drugs to the United States (Washington, D.C.: Drug Enforcement Administration, August 1996).

7. Office of National Drug Control Policy, Pulse Check, National Trends In Drug Abuse (Washington, D.C.: Executive Office of the President, Spring 1996).

8. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

9. Ibid.

10. National Institute of Justice, 1995 Drug Use Forecasting, Annual Report on Adult and Juvenile Arrestees (Washington, D.C.: U.S. Department of Justice, 1996).

11. Office of National Drug Control Policy, Pulse Check, National Trends In Drug Abuse (Washington, D.C.: Executive Office of the President, Spring 1996).

12. Substance Abuse and Mental Health Services Administration, 1995 National Household Survey on Drug Abuse, unpublished data.

13. J.C. Merrill, K. Fox, S.R. Lewis, and G.E. Pulver, Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use (New York, N.Y.: Center on Addiction and Substance Abuse at Columbia University, 1994).

14. Lloyd Johnston, Monitoring the Future Study - 1996, press release (Ann Arbor, Mich.: University of Michigan, December 1996).

15. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

16. Lloyd Johnston, Monitoring the Future Study - 1996, press release.

17. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

18. Lloyd Johnston, Monitoring the Future Study - 1996, press release.

19. Ibid.

20. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

21. Lloyd Johnston, Monitoring the Future Study - 1996, press release.

22. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

23. Lloyd Johnston, Monitoring the Future Study - 1996, press release.

24. Ibid.

25. Dorothy P. Rice, Sander Kelman, Leonard S. Miller, and Sarah Dunmeyer, The Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985, report submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration (San Francisco, Calif.: Institute for Health & Aging, University of California, U.S. Department of Health and Human Services, 1990).

26. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the Drug Abuse Warning Network, 1995 Preliminary Estimates of Drug-Related Emergency Department Episodes, Advance Report Number 17 (Rockville, Md.: U.S. Department of Health and Human Services, August 1996).

27. U.S. National Center for Health Statistics, Alcohol and Drugs: Advance Report of Final Mortality Statistics, 1989, Monthly Vital Statistics Report, Vol. 40, No. 8, Supplement 2 (Hyattsville, Md.: U.S. Department of Health and Human Services, 1992).

28. Centers for Disease Control and Prevention, Monthly Vital Statistics Report, Advance Report of Final Mortality Statistics, 1994, Vol. 45, No.3., Supplement (Hyattsville, Md.: U.S. Department of Health and Human Services, September 30, 1996).

29. Centers for Disease Control and Prevention, HIV and AIDS Trends, Progress in Prevention (Hyattsville, Md.: National Center for Health Statistics, 1996).

30. 1994, Drug Abuse Warning Network, Statistical Series, Series 1, No. 14-B, Annual Medical Examiner Data.

31. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the Drug Abuse Warning Network, 1995 Preliminary Estimates of Drug-Related Emergency Department Episodes, Advance Report Number 17.

32. National Institute on Drug Abuse, 1992-93 National Pregnancy & Health Survey: Drug Use Among Women Delivering Livebirths (Rockville, Md.: U.S. Department of Health and Human Services, 1996).

33. Ibid.

34. L. Schrager, J. Joyce, and L. Cawthon, Substance Abuse, Treatment, and Birth Outcomes for Pregnant and Postpartum Women in Washington State (Olympia, Wash.: Washington State Department of Social and Health Services, 1995).

35. Office on Smoking and Health, Preventing Tobacco Use Among Young People, A Report of the Surgeon General (Rockville, Md.: Center for Disease Control and Prevention, U.S. Department of Health and Human Services, July 1994).

36. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

37. American Cancer Society, Facts About Children and Tobacco Use (Atlanta, Ga.: American Cancer Society, 1997).

38. J.M. McGinnis and W.H. Foege, "Actual Causes of Death in the United States," Journal of the American Medical Association, Vol. 270, No. 18, (Chicago, Ill.: 1993), pp. 2207-2212.

39. Center for Substance Abuse Prevention (CSAP), Teen Drinking Prevention Program (Rockville, Md.: U.S Department of Health and Human Services, 1996).

40. National Highway Traffic Safety Administration, Fatal Accident Reporting System (Washington, D.C.: U.S. Department of Transportation, July 1996).

41. Center for Substance Abuse Prevention (CSAP), Teen Drinking Prevention Program.

42. J.C. Merrill, K. Fox, S.R. Lewis, and G.E. Pulver, Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use.

43. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

44. National Institute on Drug Abuse, Research on Drugs and the Workplace: NIDA Capsule 24 (Rockville, Md.: U.S. Department of Health and Human Services, 1990).

45. Federal Bureau of Investigation, Crime in the United States; 1995: Uniform Crime Reports (Washington, D.C.: U.S. Department of Justice,1996).

46. National Institute of Justice, Drug Use Forecasting, Annual Report on Adult and Juvenile Arrestees 1995.

47. Bureau of Justice Statistics, Prison and Jail Inmates at Midyear 1996 (Washington, D.C.: U.S. Department of Justice, January 1997).

48. Bureau of Prisons (Washington, D.C.: U.S. Department of Justice), unpublished data.

49. Bureau of Justice Statistics, Correctional Populations in the United States, 1994, (Washington, D.C.: U.S. Department of Justice, June 1996).

50. K. Maguire and A.L. Pastore, eds., Sourcebook of Criminal Justice Statistics 1995 (Washington, D.C.: Bureau of Justice Statistics, U.S. Department of Justice, 1996).

51. Bureau of Justice Statistics, Comparing Federal and State Prison Inmates, 1991 (Washington, D.C.: U.S. Department of Justice, September 1994).

52. Ibid.

53. Federal Bureau of Investigation, Crime in the United States; 1995: Uniform Crime Reports.

54. Internal Revenue Service, unpublished data.

55. National Narcotics Intelligence Consumers Committee, The NNICC Report 1995: The Supply of Illicit Drugs to the United States.

56. Ibid.

57. Ibid.

58. Ibid.

59. Office of National Drug Control Policy, Fact Sheet: Rohypnol (Rockville, Md.: Drugs and Crime Clearinghouse, September 1996).

60. Substance Abuse and Mental Health Services Administration, Preliminary Estimates from the 1995 National Household Survey on Drug Abuse.

61. Luntz Research Companies, National Survey of American Attitudes on Substance Abuse II, Teens and Their Parents (New York, N.Y.: Center on Addiction and Substance Abuse, September, 1996).

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Transmittal Letter | Foreword | Table of Contents
Chapter 1 | Chapter 2 | Chapter 3 | Chapter 4 | Chapter 5 | Chapter 6