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Technologies for Understanding and Preventing Substance Abuse and Addiction

TECHNOLOGIES FOR UNDERSTANDING AND PREVENTING SUBSTANCE ABUSE AND ADDICTION

US Government Office of Technology Assessment

October 18, 1994

CHAPTER 4 - AVAILABILITY

Availability is a precondition for drug abuse and dependency. A person cannot become a drug abuser unless a drug is available to be used.

Drug availability is often thought of as mere physical presence of an abusable substance. In addition, however, availability is affected by social norms (social availability), prices (economic availability), and personal values (subjective availability) (see table 4-1). Marketing techniques for both licit and illicit drugs can alter social, economic, and subjective availability, and thus are addressed in this chapter (see box 4-1).

A substantial body of literature addressing the relationship between drug availability and drug demand does exist. However, most of this information addresses tobacco and alcohol, rather than illicit drugs. In addition to conducting a literature search (primarily of mass media), the Office of Technology Assessment (OTA) contracted with the National Center for Juvenile Justice (NCJJ) to conduct a survey of juvenile probation officers on the perceived availability of drugs and to conduct a workshop on availability issues (see appendix F for a list of participants).

AVAILABILITY

Availability is a concept usually reserved for the supply- side of the substance abuse policy equation (i.e., making drugs available to supply an already existing demand). However, the proximity of drugs and drug dealers to potential users, and the ease with which these substances can be purchased or otherwise obtained can affect demand, use, and abuse. This is especially true when one considers aggressive marketing efforts by suppliers, who seek to create or expand the demand for drugs by convincing potential consumers of the benefits, acceptability, and availability of these substances. While availability is a concept that applies to the whole range of drugs, most of what we know about its role in drug use and abuse comes from research in the arena of alcohol and tobacco abuse (1,9,10,14) (see box 4-2 and figure 4-1).

Research has shown that when alcohol is more available, the prevalence of drinking, the amount of alcohol consumed, and the heavy use of alcohol all increase (5). Alternatively, the literature also suggests that physical conditions that restrict alcohol availability reduce rates of alcohol consumption (1). A review of alcohol-related literature reveals that availability can be conceptualized in four different, yet related categories.

Physical Availability

Physical availability refers to a basic element--the proximity and accessibility of an abusable substance. Simple logic dictates that if a substance is absent, it cannot be used. Government interdiction and law enforcement policies target the physical availability of illicit drugs. Other policies, such as limitations on the point-of-sale, hours, or age of purchasers, target the physical availability of other abusable drugs, such as tobacco and alcohol products.

Responses to the OTA survey of juvenile probation administrators indicated that respondents perceived two ways in which physical availability is increased: through contamination by outsiders (e.g., youth gangs, tourists, foreigners) bringing drugs into the community, and through proximity to a source of drugs or alcohol.

Gangs and organized drug trafficking were mentioned often by respondents as reasons for increases in the availability of drugs. Respondents from all over the country, representing both rural and urban areas, registered concerns about gangs and their role in marketing and trafficking drugs. A respondent from Canton, Mississippi, for example, attributed the increase in drug availability simply to "gang leaders from California." A respondent from Waterbury, Connecticut, was more explicit about the age and ethnicity of the gang influences, attributing the observed increase in drugs to the "emergence of gang activity for the 12-to-15-year-old age group, particularly in the Hispanic and black ethnic groupings." A respondent from Paducah, Kentucky, said that the "increase in drugs has been from gangs entering the community from Memphis, Tennessee, Arkansas, and Chicago, Illinois." The respondent from Davenport, Iowa, attributed the increase to attempts by "Chicago gang members to establish crack markets in Quad Cities--lots of arrests of Chicago residents including juveniles." Even cities with an established history of youth gangs identified gangs as being responsible for increases in drugs. For example, a respondent from Philadelphia, Pennsylvania, attributed the observed increase to the fact that "gang participation has become increasingly sophisticated."

However, gangs were not the only phenomena associated with increasing the physical availability of drugs and alcohol. Many respondents were concerned with the potential for contamination due to proximity to areas thought to be established drug markets or through proximity to the means for widespread drug distribution (e.g., major highways and roads, prisons).

Physical availability is necessary but not solely responsible for drug use. For example, drugs often are physically available but are not always used. Also, seeking to prevent or reduce drug use solely by eliminating or reducing physical availability may be doomed to failure, since it has proven to be very difficult to keep drugs out of communities. So although the concept of physical availability is important, it is limited, both as a cause and a cure to drug use and abuse.

Economic Availability

Economic availability may be increased when a person has access to surplus income or the costs of drugs are low, illegal drug sales are a key component of the local economy, or the price per unit of a drug or drugs in general is reduced. In describing the difference between "private" and "flagrant" drug markets, one article specified some of the dimensions of the changing economics of addiction:

If cigarettes were sold only by the carton and whiskey only by the case, the effect would be to decrease the total consumption of tobacco and whiskey. Presumably, few people would start smoking cigarettes if the first experimental purchase were a $20 carton rather than a $1 pack. Similarly, fewer poor people would drink if they were required to buy whiskey by the case. A similar effect would, in all likelihood, hold true if open air and flagrant drug markets were eliminated (3).

In addition to overall conditions, economic availability of all substances can be affected by the pricing of products. For licit products such as alcohol and tobacco, economic availability is also affected by taxes levied by federal, state, and local authorities.

In 1989, federal excise taxes on tobacco, alcoholic beverages, and motor fuels raised $24.4 billion in revenue-- about 2.5 percent of total federal revenues (11). Excise taxes--taxes on specific products--while representing a small part of total taxes, are an important consideration in the economic availability of licit substances.

Excise taxes are seen by many as having three impacts:

o to raise revenue for government programs;

o to make certain harmful substances less affordable and, hence, less used and abused; and

o to cover societal costs that accrue from the use of various substances (e.g., environmental costs from the use of gasoline, health costs resulting from smoking and drinking).

Whether taxation of alcoholic beverages and tobacco products is an appropriate means of reducing societal costs caused by their use is a continuing public debate. Some argue that the public health costs and other external costs are so significant as to justify substantial excise taxes. Others counter that such taxes are regressive--impacting the poor more than the rich--and reduce the satisfaction experienced by millions of sensible drinkers without necessarily reducing the harm caused by excessive drinkers (8).

Social Availability

Social availability refers to those factors within the community conducive to drug use. One study explored alternative explanations for reported declines in cocaine use among high school seniors, using questionnaire data from annual nationwide surveys conducted from 1976 to 1988 (2). Results of this analysis indicated that although lifestyle factors showed strong links with the use of marijuana and cocaine, these factors had not developed trends in ways that could account for declines in the use of either drug. Reported physical availability of either drug had not been reduced. Instead, increases in perceived risks and disapproval appear to have contributed substantially to the recent declines in the use of marijuana and cocaine. The study concluded that it was important to lower demand by reducing social availability, as opposed to trying to reduce supply by reducing physical availability.

Increasingly, grass roots community action groups are working to diminish both the subjective and social domains of availability. These efforts usually entail developing and presenting public awareness and fact-based education to consumers and potential consumers, decreasing community tolerance for drug use while increasing collective pride in the community, and developing or otherwise demonstrating alternatives to substance use and abuse.

Subjective Availability

Subjective availability encompasses individual differences in how people perceive their access to substances. For example, an individual may choose to use one type of abusable substance, but not another. Or, an individual may choose to use a drug (e.g., cocaine), but only in certain forms (i.e., a person may choose to snort a line of cocaine but refuse to smoke or inject it). The person who refuses to use illicit drugs has interjected his or her personal values in a way to make illicit drugs unavailable, even if they are physically and economically available.

One reviewer identified four components of subjective availability as it relates to alcohol: 1) willingness to go out of one's way to purchase alcohol, 2) perceived convenience of buying alcohol, 3) discomfort about buying alcohol, and 4)?importance of the price of alcohol. Subjective and social availability were demonstrated to have direct influences on alcohol consumption, and subjective and social aspects of availability can mediate and outweigh the influence of physical availability (1).

Subjective availability is likely to increase when an individual holds attitudes or values favorable toward use; lives in a community that condones, or even celebrates, drug use; and has ready access to drugs that are highly valued, particularly if those agents are addictive.

ARE DRUGS READILY AVAILABLE?

A number of surveys exists for measuring drug use (see chapter 2). In addressing the question of whether drugs are readily available, several measures exist (e.g., marketing figures related to alcohol and tobacco sales, tallies of illegal drugs seized by law enforcement authorities). In addition to quantitative measures of drug use, many people perceive various drugs to be widely available. In an attempt to measure these anecdotal perceptions, OTA surveyed juvenile probation administrators randomly selected from a database maintained by NCJJ.

The purpose of the survey was to identify communities that have experienced a sudden, observable change in the abuse of drugs or alcohol in the past 12 months and to collect preliminary data about the events and circumstances leading to the change in abuse. Such anecdotal evidence could be gathered from a number of groups; OTA chose to survey juvenile justice officials because of their involvement in drug issues and the availability of a nationwide database of such officials who could be accessed.

Responses were received from 246 juvenile justice administrators across 38 States. The data provide a glimpse at some of the drug and alcohol availability issues being addressed by juvenile courts and probation departments across the United States. Seven findings resulted from the survey:

o Most respondents consider substance abuse to be a serious problem in their communities. Using a scale of 1 (not serious) to 10 (very serious), the respondents, on average, rated the problem of substance abuse among juveniles in their communities at 7.4. In addition, 85.8 percent of the respondents rated substance abuse seriousness at six or above.

o Almost half of the respondents indicated a dramatic increase in availability of drugs and/or alcohol in their communities. A total of 46.7 percent of the survey respondents reported a dramatic increase in the availability of drugs and/or alcohol in their communities. Some 50.8 percent of the respondents indicated "no dramatic changes" in perceived availability of drugs and/or alcohol. Only 2.4 percent indicated a dramatic decrease in availability.

o Factors affecting physical availability (i.e., sales and/or distribution of drugs) were selected most often and were rated highest in terms of increasing availability of drugs. Given an opportunity to select and rate commonly cited reasons for increased availability of drugs and alcohol, the respondents selected items that were strongly associated with the sales and distribution of drugs and alcohol (see table 4-2).

o Crack cocaine and cocaine were much more likely than other drugs to show dramatic increases in availability. Respondents were given an opportunity to report whether they had noticed a change (ranging from a dramatic decrease to a dramatic increase) in the availability of a range of drugs, including alcohol. Crack (24.5 percent) and cocaine (17.8 percent) had the highest percentage of respondents indicating a "dramatic increase" in availability. The next closest were inhalants at 14.6 percent (see table 4-3).

o Economic conditions and the perceived lack of real opportunities for many youths were frequently cited as factors contributing to the increased availability of drugs in many communities (see box 4-3).

o Survey respondents listed several factors contributing to a sense of social availability, including lack of parental/guardian supervision, consequences for alcohol and drug offenses, alternative activities, as well as portrayals of alcohol and drug use by the mass media as a glamorous and healthy activity (see box 4-4).

o Substance abuse prevention and early intervention efforts were rated highest as important community responses to increases in the availability of drugs and alcohol. Over 80 percent of respondents agreed that an increase in prevention and intervention efforts was an important response to an increase in the availability of drugs. Trailing behind prevention and early intervention were increased law enforcement (68.4 percent), increased treatment (68.2 percent), and stiffer judicial penalties (68.0 percent). Respondents were also asked to rate the relative effectiveness of the listed responses to availability on a scale of 1 (not effective) to 10 (very effective). Prevention and early intervention (6.4 percent) was rated the highest in terms of perceived effectiveness, but not much higher than law enforcement (6.2 percent), increased treatment (6.0 percent), and stiffer judicial penalties (6.2 percent) (see table 4-4).

MARKETING

Standard marketing strategies used to increase consumption of legal goods are used in equally effective ways to increase consumption of illicit drugs. Marketing refers to efforts by individuals interested in the sale or trade of a product to maintain or increase sales by maintaining market shares and opening new markets. Marketing includes efforts to increase the perceived availability of a product or products by enhancing the sense of both subjective and social availability in prospective consumers. To the extent that those efforts are successful, then purveyors of consumer products will attempt to make the supply match the demand (physical availability) at a cost that maximizes both sales to consumers (economic availability) and profits to the sellers.

Illegal Drugs

Illegal drugs are marketed aggressively in the United States. Some of the strategies for marketing illicit drugs are very similar to those strategies for marketing licit products. Sometimes the distinction between licit and illicit products is difficult to determine. Take, for example, the case of so-called head shops. Drug paraphernalia are items sold specifically to promote the preparation, manufacture, or marketing of drugs. Head shops may sell a wide variety of products that are often associated with specific drugs, for example:

o Stash cases, rolling machines, pipes, bongs (marijuana).

o Bottles, concert kits, brass straws, spoons (cocaine).

o Glass pipes, vials, stems, screens, shaker bottles (crack cocaine).

o Testing kits, scales, adulterants (heroin).

o Canisters, balloons, tanks (inhalants).

Head shops represent the most shrewd form of pro-drug marketing by targeting mostly young customers and providing the technology and products required to increase the ability of users to procure, prepare, hide, and ingest drugs. Despite Federal legislation prohibiting the sale of drug paraphernalia (18 USC Ap4), heads shops continue to flourish. These shops can avoid the intention of the law because the definition of what constitutes drug paraphernalia is ambiguous and open to interpretation. Head shop owners will simply emphasize the legitimate use of their products. For example, they may sell a scale designed to weigh drugs as a product to weigh food for dieting purposes. Specifically, head shops contribute to the drug abuse problem by:

o sending a double message--if drugs are so bad, why is drug paraphernalia sold openly?

o operating, in some cases, in the guise of candy stores, exposing children to drug paraphernalia and stimulating curiosity about drugs;

o serving to facilitate the use, marketing, and sale of drugs;

o selling items designed as conversation pieces which serve to glamorize drug use; and

o becoming hubs for drug abusers, indirectly serving to increase crime in the neighborhoods in which they operate.

Another example of a marketing strategy used for licit substances and now being adapted for illicit substances is total marketing, which consists of four basic strategies-- promotion, product, price, and place--to maximize theexposure of a product in a positive light to the most likely consumer groups (4).

A key component of total marketing is promotion, or advertising particular product lines to appeal to particular subpopulations of the consuming public. Promotion is a standard practice in the marketing of legitimate products-- it is also a very powerful force for manipulating consumer habits.

Promotion includes activities like advertising and sponsorship of sporting and entertainment events (7). For illicit drugs, promotional activities may include sponsoring a party in which the illegal drug is dispensed free or at a dramatic discount along with other attractions (e.g., sex, drug paraphernalia) (15).

Total marketing also entails the development of a product line that can be targeted to subpopulations within the larger consumer community. For example, alcohol and tobacco manufacturers will produce an array of products targeted at several consumer groups--premium beers for one group, wine coolers for another, rugged masculine cigarettes for one group, thin feminine cigarettes for another. Similarly, purveyors of illegal drugs have begun to develop product lines--powdered cocaine for one group, crack cocaine for another. The use of brand names is one technique used by marketers to establish a niche in the larger market, which is one reason people become unwilling participants in the marketing wars between Coke and Pepsi or Visa and American Express or even Bud and Bud Light.

A great deal of uniformity exists in the price, quantity, and quality of drugs sold in the same city, especially in the same neighborhood or street market. As a result, a dealer will occasionally try to capture a larger share of the market by increasing the weight or strength of the product and applying a brand name for recognition (3).

In Washington, DC, for example, brand name heroin is sold under the name of "Smurf," "Mr. T," "Brown Wrapper," and "Black Poison." Phencyclidine (PCP) is occasionally sold under the brand name "Hinkley" (after John Hinkley, the man who shot Ronald Reagan), "Gofer" (a reference to a television character on the "Love Boat," which is a popular street name for PCP), and "Keys to St. E's" (a reference to a local mental institution). Crack cocaine is sometimes hawked under the brand names of "Conan," "007," and "Baseball."

Pricing is the process of assigning a retail cost to each item in a given product-line that matches the ability of the targeted subgroup to pay. By producing a line of products at a wide range of prices, the purveyor of the goods can maximize the consumer population. For example, whether a consumer of tobacco products is smoking low-priced generic cigarettes from the supermarket or high-priced cigarettes from the tobacconist, that individual is included in the range of consumers. Illegal drug sellers also price their particular products to move. For example, while powdered cocaine may be too expensive for some economically disadvantaged consumers to purchase regularly, almost everyone can afford a $5 vial of crack cocaine. Drug dealers also manipulate the cost for their goods to attract customers.

Once a product has been developed, promoted, and priced to move, a place must be found to most effectively sell the product. Legal nonmedical drugs are packaged and made available at retail outlets in such a way as to make their purchase as convenient as possible.

Wine coolers, for example, are a type of beverage aimed particularly at women and young people. With its sweet, light taste, low prices, and convenient packaging, the wine cooler competes with beer and soft drinks for occasions such as picnics and sports events, where traditional wine products are unlikely to be consumed. Wine cooler ads promote just these types of uses. Packaging has taken on a beer or soft drink look, and the industry is successfully obtaining access to convenience stores and supermarket outlets to make purchases easier (6).

Illicit drugs can also be packaged and made available at "retail" outlets where purchasers can conveniently obtain the product(s) of their choice. One news account suggests that "mass marketing that would have made McDonald's proud" is responsible for the evolution of crack cocaine from a drug derided as "garbage rock" just a few years ago into a national craze.

Crack was not invented, it was created by a sharp crowd of sinister geniuses who took a simple production technique to make a packaged, ready to consume form of the product with low unit price to entice massive numbers of consumers. Cocaine powder required an investment of nearly $75 for a gram, but a hit of crack costs as little as $5. Equally alluring was crack's incredible "high"--an instantaneous euphoria because it was smoked--that could create addicts in weeks (16).

Two kinds of retail drug markets exist in the United States: the private market place and the open-air or flagrant drug markets (3). The private drug market involves transactions that occur between people who are known to one another or are referred by a trusted acquaintance. Referrals in the private marketplace are usually not very far removed from the original connection; they may be classmates in college, business associates, relatives, or persons belonging to the same club.

The familiarity of the parties in the private drug market usually means that there is a reduced level of public exposure and violence. The desire to keep the flow of traffic to the site of transactions at a minimum means that sales in the private marketplace tend to be of larger quantities of drugs than those in street transactions. Because most of the transactions take place "behind closed doors" or in some other clandestine fashion, a high degree of impermeability exists in the dealer-customer relationship (3). Examples of private drug markets include "speak easies" during prohibition and the "traditional" (i.e., before crack) cocaine markets.

Another aspect of the private drug market is the ritualistic aspect of procuring the product. Consider, for example, the ritual associated with purchasing cocaine. One author describes "a day in the office" of a street-level cocaine distribution network. The office itself is a highly structured operation, complete with receptionists to screen potential customers, guards, a "catcher"--held on retainer to retrieve cocaine thrown out of a window during a bust-- and the merchant who sets prices, arranges to barter goods and services, gives credit, and makes day-to-day decisions regarding sales (15).

A typical transaction involves a positive identification of the buyer, a greeting and brief social contact (e.g., handshake, hug, kiss) between the merchant and the buyer, a formal request for an amount of cocaine, and a discussion of method of payment (e.g., cash, barter). Sometimes the transaction involves a brief discussion of the relative quality of the drugs in the street, a sample of the drug available from this particular merchant, and possibly some haggling over price. The public weighing and packaging of the cocaine is central to this type of transaction. The scale, in fact, becomes a central point of power and authority in the business; only those with the highest level of trust and respect can operate the scale (15).

Open air and flagrant drug markets, on the other hand, tend to be far more impersonal and much less ritualistic than the private marketplace. Many of the concepts used by mass marketers of licit products are used in the flagrant marketplace--targeted consumer groups, small and widely affordable units of sale, prepackaged goods with fixed prices, convenient retail outlets. One research team describes the mechanics of a typical open-air drug market transaction:

A car drives down a residential street with enormous apartment buildings on either side. Young men wave to the car; a few of the more aggressive dealers step into traffic to signal autos to stop. Even before the wheels have stopped rolling, several young men are at the window; "You looking?" says one. "Smoke, smoke. I've got crack. Whatever you want" says the other peering over his shoulder. The answer from the driver is simple and short: "Two dimes." Two small brown glass vials are exchanged for a 20 dollar bill and the transaction is over in a matter of seconds (3).

Although the exact method for conducting a transaction may vary slightly from place to place around the country, the essence of the transaction is remarkably similar across the United States. Flagrant or open-air drug markets have many of the same structural characteristics as legal marketplaces: demographic and product segmentation, brand loyalty, cartel pricing, aggressive salesmen working on commission, and careful recruitment of loyal and productive employees (3).

Alcohol and Tobacco

The marketing of legal yet addictive substances, especially tobacco and alcohol, has become controversial in recent years. Issues stemming from the marketing of licit substances include advertising, taxation, and labeling.

Advertising

Alcohol and tobacco products have long been advertised in the United States. In the 1950s and 1960s, these products were advertised with minimal restrictions. Following the Surgeon General's report on the hazards of smoking in 1964 (13), public sentiment against cigarette advertising increased. The most famous example of Federal regulation is the ban on broadcast cigarette advertising in January 1971 resulting from the passage by Congress of the Public Health Cigarette Smoking Act of 1969 (Public Law 91-222). In recent years, attention has focused on legislative proposals to ban all forms of cigarette advertising, and to control the advertising of alcoholic products.

Taxation

The federal government currently levies excise taxes on alcoholic beverages and tobacco products. Excise taxes on all types of alcoholic beverages were raised in 1990 to their current levels. Currently, for example, beer (six pack 12-ounce cans) carries a 33 cent federal excise tax, a 750 ml bottle of wine carries a 21 cent federal excise tax. A pack of cigarettes carries a federal excise tax of 24 cents.

A number of studies in the 1980s focused on the impact of federal excise taxes on cigarette consumption. A 1986 study concluded that an 8- to 16-cent increase in the federal cigarette excise tax would encourage from 1 to 2 million young persons and 8,000 to 1.5 million adults to quit smoking or not to start. Thus, a tax increase could prevent hundreds of thousands of premature smoking-related deaths, while a tax decrease would contribute to the disease burden of tobacco (14). The General Accounting Office, in a review of the literature on teenage smoking and excise taxes, concluded that an increase in the cigarette excise tax would be an effective way to reduce teenage smoking (12).

Labeling

Federal law addresses the labeling of both cigarettes and alcoholic beverages. In both cases, Congress declared that the purpose of such labeling is to make sure the American public is informed about the potential health hazards that may result from consumption (36 USC 1331; 27 USC 213). Manufacturers of cigarettes must use one of four rotating warnings on each package, while manufacturers of alcoholic beverages must post a prescribed warning (see box 4-5). Proponents of labeling have stated that such warnings do not create legal restrictions, but only help to inform the consumer about possible health risks. Opponents of labeling have argued that no scientific proof exists to link labeling with reduced use or improved health.

SUMMARY

The second set of preconditions for drug abuse and dependency includes availability and marketing. A person cannot become a drug abuser unless a drug is physically available to be used. In addition, however, availability is affected by social norms (e.g., factors within the community conducive to drug use, including level of parental or guardian supervision, lack of consequences for alcohol and drug offenses, lack of alternative activities, portrayals of alcohol and other drug use by friends and the media as a glamorous and healthy activity), prices (economic availability), and personal values (subjective availability).

The primary focus of U.S. antidrug policy has been to attack the physical availability of illicit drugs through law enforcement efforts aimed at disrupting the production, transport, and sale of drugs. While this focus has increased drug-related arrests--nearly half of newly sentenced federal inmates in 1991 were imprisoned on drug charges--illicit drugs are still widely available.

Marketing techniques for both licit and illicit drugs can alter social, economic, and subjective availability. Key components of marketing include the promotion and advertising of particular product lines to appeal to particular subpopulations of the consuming public; development of a product line that can be targeted to subpopulations within the larger community of consumers; pricing strategies to attract new buyers; and identification of retail outlets for sales.

Federal law regulates the merchandising of licit yet abusable substances such as tobacco, alcohol, and prescription drugs by placing a variety of restrictions on how such products may be marketed. Despite current restrictions, debate continues as to whether and how a variety of legal drugs should be marketed.

BOX 4-1: What Is Marketing?

Marketing includes any activity involved in moving goods from producer to consumer. In the context of drugs, marketing includes a variety of activities covering a wide range of licit and illicit substances.

For licit substances, such as alcohol, tobacco, and inhalants, it includes market research, advertising, pricing, and taxation. A number of government policies in the marketing arena--taxes, advertising restrictions, point- of-sale controls, and age restrictions on certain products-- directly affects the availability of licit, yet abusable, substances.

For illicit drugs, such as marijuana, cocaine, and hallucinogens, marketing techniques can include street markets, gang activity, and private, closely controlled distribution and sales systems. Government control in this area--prohibiting the possession, use, and sale of such substances--likewise affects the availability of these substances.

SOURCE: Office of Technology Assessment, 1994.

Box 4-2: Availability and Tobacco

The evolution of tobacco from a relatively rare product requiring preparation, thought, and ritual to a product that is ubiquitous, prepackaged, and consumed without much fanfare provides a graphic illustration of how increased physical availability of a product can dramatically increase drug use, abuse, and addiction. Three major developments in the history of tobacco use paved the way for making this drug imminently available for use by consumers: the invention of the cigarette manufacturing machine, the invention and perfection of matches, and the proliferation of the use of vending machines to sell tobacco products.

The first successful cigarette manufacturing machine was developed in 1881 by James A. Bonsack. This machine had the capacity to produce more than 200 cigarettes per minute. Prior to the advent of this machine, smokers had to roll each cigarette by hand, a time-consuming and often ritualistic process.

Once rolled, a cigarette must be lit to be consumed. This was no easy task prior to the introduction of the safety match, first invented in 1896 but not perfected until 1912. Without matches, smokers were required to enter cigar stores to light cigarettes from gas or oil lamps provided specifically for the purpose of lighting tobacco products. These developments changed forever the way that cigarettes were consumed by making them readily available for consumption at any moment during the day. Instead of a thoughtful, often ritualistic exercise, cigarette consumption has evolved for some into an almost unconscious habit. Following the invention of the manufacturing machine and the safety match, the rate of cigarette consumption soared during the late 19th and early 20th century.

The use of vending machines may be the most revolutionary aspect of tobacco availability. First introduced in 1926, vending machines require no sales person, are not restricted by selected hours of operation, and are not concerned with the age or legality of the purchaser. Vending machines make cigarettes available almost anywhere, appearing in bars, hotels, train and bus stations, airports, hotels, and restaurants. By 1953, nearly half a million cigarette machines existed and were responsible for sales of more than 3 billion packs of cigarettes a year. The upward trend in sales from cigarette machines continued through the mid- 1970s: by 1973 more than 900,000 vending machines were in operation, selling almost 5 billion packs per year. Some early research indicated that the existence of vending machines throughout the physical environment is a major inducement to impulse smoking.

SOURCE: Office of Technology Assessment, 1994, based on J. Mosher, "The Environmental Approach to Prevention," The California Prevention Network Journal 3, 42-44 (1990); R. Tenant, The American Cigarette Industry: A Study in Economic Analysis and Public Policy (New Haven, CT: Yale University Press, 1950); R. Sobel, They Satisfy: The Cigarette in American life (Garden City, NJ: Anchor Press/Doubleday, 1978); Marshall, M.V., Automatic Merchandising; A Study of the Problems and Limitations of Vending (Cambridge, MA: The Riverside Press, 1954).

BOX 4-3: Survey Comments, Economic Availability

Economic factors impact on perceptions of availability in a number of ways. For example, because Sioux Falls, South Dakota, was experiencing a "strong economy . . . juveniles have had an abundance of cash available for alcohol/drug usage." More frequent, however, were comments stating the opinion that a poor economy increased the economic availability of drugs and alcohol:

Frankfort, Kentucky: "Profit motive due to national economy and lack of job training/jobs. Lack of hope and opportunity for some causes increased sale of drugs due to high profit."

Barbourville, Kentucky: "Drug dealers that cannot make it flipping hamburgers, but are successful at selling drugs and have a lot of material evidence of their success. Law enforcement needs to confiscate these material items in prosecution of case. Also, involvement of drug dealing by law enforcement and politicians is a problem. "

Harrisburg, Pennsylvania: "Teenaged drug dealers have status, money, jewelry, cars, designer clothes, etc., which many of their peers cannot afford."

Fort Worth, Texas: "Depressed economic conditions--Lack of legitimate means to obtain income. It's easy money with minimal consequences for conviction."

SOURCE: Office of Technology Assessment, 1994.

BOX 4-4: Survey Comments, Social Availability

Conway, New Hampshire: "Our law enforcers are known and make little inroads towards prosecuting drug traffickers or sellers. Many young adults supply liquor and drugs to underage kids in our area."

Mount Holly, New Jersey: "The legal system does not fairly prosecute offenders. It gives some juveniles the message that depending upon your circumstances it is OK to use and sell drugs."

Muskogee, Oklahoma: "The lack of prosecutive vigor in alcohol-related offenses (Minor in possession, public intoxication, D.U.I.). District attorney does not vigorously pursue and law enforcement treats D.U.I. as public intoxication."

Prineville, Oregon: "This community is basically a blue collar community. There is an attitude of acceptance of juveniles using alcohol. Kind of a boys will be boys attitude."

South Bend, Indiana: "We have seen an increase in alcohol consumption that appears to be tolerated or even encouraged by adults (primarily parents)."

Hillsboro, Illinois: "Lack of education, interest, cooperation of parents. Not enough interest with higher officials (e.g., school teachers, church members, government officials, businesses, and senior citizens)."

Baraboo, Michigan: "Lack of appropriate teen activities. Lack of parental interest."

Jacksonville, Illinois: "Decrease in the ability and willingness of individual family units to educate, instruct, and monitor juvenile behaviors."

Nicholasville, Kentucky: "Alcohol is supplied willingly to juveniles by a large number of adults. Inhalants are available at any department store."

Brownstown, Indiana: "Children, mostly high school age, come in contact with adults, ages 18-23, who are very willing to buy alcohol or sell drugs to their younger friends. In addition, these children who do not have money on hand are likely to steal items and trade them for drugs or cash to buy alcohol and drugs."

SOURCE: Office of Technology Assessment, 1994.

BOX 4-5: Cigarette and Alcoholic Beverage Warnings

It is unlawful for any person to manufacture, package, or import for sale or distribution within the United States any cigarettes the package of which fails to bear one of the following labels:

SURGEON GENERAL'S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy.

SURGEON GENERAL'S WARNING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health.

SURGEON GENERAL'S WARNING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, And Low Birth Weight.

SURGEON GENERAL'S WARNING: Cigarette Smoke Contains Carbon Monoxide.

It is unlawful for any person to manufacture, import, or bottle for sale or distribution in the United States any alcoholic beverage unless the container of such beverage bears the following statement:

GOVERNMENT WARNING: (1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.

SOURCE: 36 USC 1331; 27 USC 213. _

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Technologies for Understanding and Preventing Substance Abuse and Addiction