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Almost every drug abuse prevention program fails to make the critical distinction between drug use and drug abuse. This paper argues that such a distinction should be the basis for drug abuse prevention. If it is drug abuse that we want to prevent, we must consider cultivating drug use among those who choose to take drugs. This does not mean encouraging drug taking, but does mean encouraging those who take drugs to so in ways which minimize the probability of hazards or of addiction.
A Critical error made by almost every drug abuse prevention effort has been the failure to distinguish in any meaningful way between drug use and drug abuse. Too often a purely legalistic distinction is accepted. In the words of the Drug Abuse Council (1980, p. 149), "Drug abuse instead of referring to a typology of drug-using behaviors, has become a shorthand term society uses to differentiate between licit and illicit drug use."This is a repetition of the finding of the National Commission on Marihuana and Drug Abuse (1973) that the term drug abuse merely expressed societies disapproval of a particular drug.
From such a purely legalistic perspective, drinking a dozen cups of coffee a day is not seen as drug abuse but taking a few puffs off a marijuana cigarette is. The person who occasionally takes those few puffs with friends is seen as being as much an abuser as the person who can't get through the day without stopping to smoke marijuana several times. The businessman who needs two martinis at lunch and several more at home in the evening to "unwind" is not an abuser; but if his underage daughter and a few of her friends have a couple beers apiece after the senior prom, she is another teenage alcohol abuser. Such inconsistencies raise serious questions about the very basis of our preventive and treatment efforts. Rockett (1981), raising this issue in regard to drug education, predicts that, "programs that ignore such questions, or worse, provide pat answers, generally will be doomed to failure in the next decade."
Drug abuse is a matter of an interaction among the person, the drug and the circumstances. "A failure to distinguish between the misuse and the use of drugs creates the impression that all use is misuse or 'drug abuse.' This is particularly true in the case of illicit drugs" (Drug Abuse Council, 1980). It is not realistic to say that all use of any particular drug, however socially disapproved it may be, is necessarily abuse. In fact, the users of most drugs outnumber the abusers of the same drug by at least a ratio of nine to one. Heroin, for all its bad reputation can be used with no significant hazards, as the "British system" of treatment of heroin addicts has demonstrated for years. Zinberg (1979) has demonstrated that heroin is used regularly by many persons who do not become addicted to it. Even tobacco is used by some individuals without either addiction or apparent harm, although it seems to be a rare instance of a drug for which abuse is more common than use.
In summing up its seven year long examination of drug-related issues, the Drug Abuse Council (1980) reported that, "to state it plainly, the challenge facing America regarding drugs is to determine how best to live with the inevitable availability of psychoactive drugs while mitigating the harmful aspects of their misuse." To this end, I suggest that drug abuse prevention in the eighties should turn to a strategy of cultivating drug use. I am using the term cultivation in the same sense that the term might be used by a gardener--promoting healthy growth, keeping within proper limits, and keeping free as possible from deleterious influences, be they weeds or bugs or whatever. I don't mean encouraging drug taking but I do mean encouraging. those who choose to take a drug to use rather than abuse that drug.
Effective prevention of drug abuse must begin with a clear recognition of the distinction between use and abuse of a drug. Discussions of this distinction can be found in Irwin (1971, 1973, & 1974), in Zinberg, Harding, and Winkeller (1977), and in Duncan and Gold (1982, p. 178-183) and the reader is referred to these sources for elaboration on this critical issue.
We must recognize that experimentation with drugs (as with so many other new experiences) is a normal part of a healthy adolescence. Trying to prevent such experimentation only serves to drive it "underground''-- cutting it off from any possibility of adult guidance, making it seem more daring, and increasing the risk of abuse. We must accept the reality that while some of the experimenters will try a drug a few times and never use it again, others will become users (social-recreational users or occasional situational-circumstantial users), and a few will become abusers. It should be our goal to provide the guidance, support and education which will minimize the numbers who become abusers.
Drug education must be factual and relevant. We must not continue to use the sort of scare tactics which have undermined a great deal of our credibility in the past. We must. earn back our credibility in the eyes of the young by carefully avoiding biased presentations of the .facts or moralizing in drug education and we must show ourselves willing to admit to ignorance when we to not know the answers.
We need to teach people how to use and not abuse drugs. In the past, drug education has told a great deal about abuse and our mass media have portrayed abuse, but we 'have provided very little in the way of models for healthy use. We need to teach about responsibility in drug use (see Duncan & Gold, 1982, ch. 18; or Engs, 1979, ch. 2) and about the roles and rituals which can help the user to maintain a controlled and harm-free level of drug use (Zinberg et al, 1977; Duncan & Gold, 1982, pp. 178-179).
Such education need not be prescriptive --we need not tell people how to use drugs with an implied message that they should use drugs. What we should do, however, is to give users and their behavior at least equal time with abusers in our drug education. We should portray users accurate in the mass media as normal healthy people whose use of drugs is constrained by certain conventons and by rational decision-making.
Above all, we must stop exaggerating the power and importance of drugs. Drug abuse isn't a drug problem it is a people problem,. our focus is, and.should be, on addictive behaviors and abusive behaviors rather than on the substances those behaviors are concerned with.We need to convey that focus to the public. We need to teach the public that where most of the psychoactive drugs are concerned people can control drug effects much more than drugs can control people.
Everyone should become familiar with the concepts of set and setting as major determinants of the effects of any drug. Decisions of whether to use and if so when and how to use should be made with these concepts in mind. Learning to make such rational decisions, based on these concepts and on accurate information, should be a major goal both of the treatment of abusers and of the cultivation of users.
We also need to recognize the importance of self-esteem, affectionate relations and stress coping skills in the avoidance of drug abuse. Prevention of drug abuse is inextricably tied to the promotion of mental health. Psychologists have developed various models for the teaching of stress coping skills and communications skills to groups. These programs can be- applied in a variety of settings -- in the schools, adult educacation programs, church and civic groups, and professional organizations.
The key to such a strategy is to focus on strengths rather than weaknesses. We want to enhance people's ability to make their own choices and their strengths and abilities to act wisely and well on those choices. Some of them will choose to take the drugs we are concerned with (in truth, we all take drugs;we just don't all take the same drugs -- my caffeine, your alcohol, someone elses cocaine) but the important thing is whether they use or abuse the drug. If they don't abuse it, they aren't hurt, no one is hurt. It will be our task to help there keep thieir drug taking healthy,to help them keep it within limits, and to help them avoid the weeds and pests--the adulterants, the adverse combinations, etc. .
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