Notes

1. Abuse or dependence is an unusual consequence of the use of any drug.

Below are the number (mn = million) of people estimated to have ever used four prominent drugs followed by the government estimate of the number and percentage who met the definition of abuse or dependence (A or D) in 2009.

    Alcohol 220 mn    18.6 mn 8 %

   Cocaine    37 mn    1.1 mn    3 %

Heroin 3.7 mn 0.4 mn       11%

  Marijuana    104 mn     4.3 mn 4 %

(further discussion)

2. Abuse and dependence are dominated by alcohol, which accounts for about 5 out of every 6 cases. About 70 percent is alcohol alone and 14 percent is alcohol in conjunction with other drugs. Of the rest, many have a previous history of alcohol abuse or dependence. Alcohol is a major factor in some 90 percent of all cases. The drug effects of alcohol are the worst of any drug in terms of many important effects on others, including the victims of alcohol induced violent behavior, damage to the fetus and the loss of mental and physical control that contributes to so many rapes, assaults and accidents.

In 2009, an estimated 8.9 percent of persons aged 12 or older were classified with abuse or dependence in the past year.

Total 22.5 mn % of total

   Alcohol    18.6 mn    83 %

   Cocaine    1.1 mn 5 %
   (includes crack - 2%)

   Heroin    0.4 mn 2 %

Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2009

In 2009, an estimated 22.5 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8,9 percent of the population aged 12 or older).

-15.4 million were dependent on or abused alcohol but not illicit drugs. [68 percent of 22,5 million]

- 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs [14 percent]

- 3.9 million were dependent on or abused illicit drugs but not alcohol [17 percent]

(DPFT note: However, of the 3,9 million not currently abusing or addicted to alcohol, about 3.3 million had a previous history of alcohol abuse or addiction.

DPFT note: "Illicit drugs" includes prescription drug abuse. Excluding marijuana, prescription drug abuse is greater than the abuse of all prohibited drugs.

A large majoriy of people who are addicted to illegal drugs have a concurrent alcohol disorder<

Cocaine dependence	89 %

Amphetamine dependence	78 %

Opioid dependence	74 %

Cannabis dependence	68 %

(from NESARC Tab 3):
Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions
(NESARC) 2001-2002 survey by NIAAA

Full report: Alcohol Research & Health , Spring, 2006

Percent Of People With Other Drug Use Disorders

Who Also Have An Alcohol Use Disorder (AUD)

(From Table 3 )

Any drug use disorder

55 %

Any drug abuse

49 %

Any drug dependence

68 %

Sedative use disorder

40 %

Sedative abuse

52 %

Sedative dependence

23 %

Tranquilizer use disorder

58 %

Tranquilizer abuse

66 %

Tranquilizer dependence

43 %

Opioid use disorder

58 %

Opioid abuse

50 %

Opioid dependence

74 %

Amphetamine use disorder

63 %

Amphetamine abuse

52 %

Amphetamine dependence

78 %

Hallucinogen use disorder

79 %

Hallucinogen abuse

77 %

Hallucinogen dependence

100 %

Cannabis use disorder

58 %

Cannabis abuse

55 %

Cannabis dependence

68 %

Cocaine use disorder

79 %

Cocaine abuse

69 %

Cocaine dependence

89 %

Solvent/inhalant abuse

60 %

Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2009

"In 2009, an estimated 22.5 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.9 percent of the population aged 12 or older) (Figure 7.1). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.4 million were dependent on or abused alcohol but not illicit drugs."

Prevalence of lifetime alcohol use disorder (AUD) among individuals with selected lifetime substance use disorders (SUD)

From NIAAA / NESARC graph p. 9 at
http://www.apa.org/about/gr/science/spin/2009/10/nih-suaa.pdf

Figure 7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2009

"Alcohol is the only psychoactive drug that in many individuals tends to increase aggressive behavior temporarily while it is taking effect." - The Panel on the Understanding and Control of Violent Behavior, National Academy of Sciences, 1994 (more at CRIME and DRUGS)

"Throughout almost 20 years of research, none of us has identified a recognizable condition, syndrome or disorder that should be termed 'crack baby.' This is in contrast to Fetal Alcohol Syndrome, which has a narrow and specific set of criteria for diagnosis." - 30 medical and psychological researchers (more at "Crack Baby Myth)".

Alcohol is more intoxicating than other drugs. Intoxication is the loss of mental or physical control and "crazed" behavior. This helps explain the frequent presence of alcohol "intoxification" in driving and boating accidents. Compare Addictive Properties of 6 Common Drugs, NIDA includes comparative intoxification.

High-Risk College Drinking Consequences Every Year: students between the ages of 18 and 24

Death: 1,825 alcohol-related

Injury: 599,000 unintentionally injured under the influence of alcohol

Assault: 696,000 assaulted by student who has been drinking

Sexual Abuse: 97,000 victims of alcohol-related SA or date rape

Sex: 400,000 had unprotected sex

Sex: 100,000 too intoxicated to know if they consented

http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx

3. Age is a critical factor in SUD. SUD peaks at age 21 at over three times the normal rate. About half of SUD is gone by age 26. There are very few new cases of problem use after age 30. No policy can produce any significant increase in adult drug abuse. Policy must focus on the period from birth to 21.

National Survey on Drug Use and Health (NSDUH). Data for 2005 :

Age Group Percent SUD

12 to 17 8.0 %

18 to 25 21.8 %

26 or older 7.1 %

The most difficult cases that last after age 25 usually begin before age 17. Ideal prevention begins long before any drug is ever used

Table G.20 – Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month, by Detailed Age Category: Percentages, 2005 and 2006
Age Category	TYPE OF ALCOHOL USE
	Heavy Alcohol Use
	2006
12	*
13	0.5
14	0.7
15	1.7
16	4.5
17	6.7
18	12.8
19	14.4
20	14.0
21	19.5
22	17.3
23	17.2
24	16.1
25	13.2
26-29	11.9
30-34	8.4
35-39	7.3
40-44	6.7
45-49	7.0
50-54	6.7
55-59	4.6
60-64	2.7
65 or Older	1.6

Extract. For full chart see Charts, Table G.20

Figure 2.3 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2006

4. Recovery from abuse and dependence is normal. There are dramatic increases in abuse and dependence from ages 18 to 21 and dramatic rates of recovery from 21 to 25. Despite over 7 million new drug users each year, rates of abuse and dependence have been stable for at least the eight years from 2002 through 2009.

Despite some 3 million new illicit drug users (includes prescription drug abusers) each year the rates of abuse do not change much. The same is true of the 4.3 million new users of alcohol each year.

" ... a striking and unexpected finding from NESARC is that 72 percent of people who develop alcohol dependence in their lives have a single episode lasting 3 to 4 years on average, after which it goes away and does not recur (Hasin et al. 2007). " http://pubs.niaaa.nih.gov/publications/arh40/55-63.htm

National Survey on Drug Use and Health (NSDUH). Data for 2005 :

"There were no changes between 2002 and 2005 in the percentages of persons with dependence on or abuse of illicit drugs (3.0 percent in 2002 and 2.8 percent in 2005) and dependence on or abuse of alcohol (7.7 percent in 2002 and 7.7 percent in 2005).

The overall rate of current illicit drug use among persons aged 12 or older in 2005 (8.1 percent) was similar to 2002 (8.3 percent)."

5. Illegal [prohibited] drugs have been readily available to any teen who wanted them for over 30 years. Except for marijuana, almost all refuse to use them.

This may be the most important single fact. It defines the total failure of a central purpose of our policy, to limit the supply and availability of drugs to teens.

Availability is defined as "easy to get" by 12th graders.

<http://www.monitoringthefuture.org/data/06data/pr06t13.pdf>

Use figures are approximate 5 year averages for two age groups from 2002-2006. The 18 to 25 age group has much higher use rates than the group age 26 or older (not shown).

The figures below show that only a very small fraction of those who say the drugs are "easy to get" actually use the drugs. "Availability" is generally higher now than in 1975 but even a huge decrease in supply would have left far more drugs available than was needed to meet the demand.

Availability Use In Past Month 2002 - 2006

1975 2006 age : 12 to 17 18 to 25

Marijuana 88 % 85 % 7.5 % 16.5 %

Cocaine 37 % 47 % 0.5 % 2.2 %

Heroin 24 % 27 % 0.1 % 0.2 %

It is obvious that even if "Availability" was much lower, any teen interested enough to ask a few fellow students could easily get the drugs.

Prohibition has made the drugs more available to teens than would a reasonable system of regulated supply to adults by tempting over a million teens into drug sales. Incarceration of low level dealers only facilitates that process by creating job openings which are filled almost instantly.

"In 2003 ... more than 900,000 (3.6 percent) youths [ages 12 to 17] sold illegal drugs, and more than 900,000 (3.6 percent) youths carried a handgun during the past year."

"Alcohol Use and Delinquent Behaviors among Youths" <http://www.oas.samhsa.gov/2k5/alcDelinquent/alcDelinquent.cfm>

This problem received the attention of the National Academy of Sciences (NAS) in 1982, "An Analysis of Marijuana Policy:

"The advantages of a policy of regulation include the disappearance of most illegal market activity ... The possibility of illegal markets selling to young people remains, but today's kind of illegal market for marijuana would probably shrink greatly under a regulatory system in the same way that illegal alcohol distribution systems have become so scarce. ... Such a development would make marijuana selling a less profitable and status-producing occupation among the young."

NAS also pointed out the market "gateway" of prohibition:

"Another major cost of attempts to prohibit the supply of marijuana is related to the fact that many illegal sellers of marijuana also sell other illegal drugs, e.g., PCP, amphetamine, and barbiturates (Blum, 1971). It is likely, therefore, that prohibition of the supply of marijuana increases access to and use of other illegal drugs through the creation of an illegal marketing system for all drugs." ... "It is clear, however, that there are many small-scale marijuana dealers, that many sellers service only their friends and acquaintances, and that those who sell marijuana are thereby more likely to come into contact with users and sellers of more dangerous drugs, to use such drugs, and to make them available to their clientele (Blum, 1971)."

"Moreover, there is reason to believe that marijuana sellers may become socialized into other illegal activities."

http://www.druglibrary.org/schaffer/library/studies/nas/markets.htm

"We believe, further that current policies directed at controlling the supply of marijuana should be seriously reconsidered. The demonstrated ineffectiveness of control of use through prohibition of supply and the high costs of implementing such a policy make it very unlikely that any kind of partial prohibition policy will be effective in reducing marijuana use significantly below present levels."

http://www.druglibrary.org/schaffer/library/studies/nas/conclusions.htm

An Analysis of Marijuana Policy

National Research Council of the National Academy of Science, 1982

http://www.druglibrary.org/schaffer/library/studies/nas/AMPMenu.htm

6. Among teens who do choose to use prohibited drugs, nearly all use is experimental and quickly stops. Prohibition dramatically increases the risks.

The major point here is that most youthful drug use will end quickly and voluntarily but prohibition makes this brief period of experimentation much more likely to turn teen curiosity into a disaster - possibly death - because the drugs are unregulated and thus made far more dangerous. What is the potency? Does it contain other drugs or dangerous contaminants? Is it possibly some other drug entirely? With prohibited drugs a user will seldom know.

The majority of those who have ever used a specific illicit drug report using that drug ten or fewer times in their lifetimes. Even the vast majority of those who used an illicit drug more than 10 times have not used that drug 200 times in their entire lives. Use of a drug more than 200 times in a lifetime does not define abuse or dependence(addiction). All figures are for people age 25 and older who are able to look back at their drug use.

[Methamphetamine is a typical "Stimulant"]

Marijuana Cocaine Stimulants

# times used

1 or 2 27 % 25 % 16 %

3 to 5 14 % 17 % 16 %

6 to 10 13 % 15 % 15 %

*1 to 10 totals 54 % 57 % 47 %

11 to 49 14 % 18 % 21 %

50 to 99 9 % 10 % 9 %

100 to 199 5 % 6 % 8 %

** % late stops 61 % 79 % 72 %

200 + 18 % 9 % 15 %

* Percent of users who tried a particular drug but never used it more than 10 times in their lives.

** Percent of users who used a particular drug more than 10 times in their lives but stopped before using it 200 times.

Data from NHSDA, 1993 is cited by The Drug Policy Project of the Federation of American Scientists. FAS, Issue 3, "How Prevalent Are 'Very Light' Drug Users?" by Jonathan Caulkins http://www.fas.org/drugs/issue3.htm#2

7. Whether a drug is legal or illegal appears to have little impact on its use.

Teen drug use occurs at an age when all drug use is illegal. It also occurs when all drugs are readily available (see 5. above) and the first try is likely to be free.

First use appears in no particular order and seems to depend on cost and convenience. Inhalants and pharmaceuticals are found in abundance in most homes. Friends may share. Cigarettes are easily pilfered and concealed and their continued use seems to be the best indicator of later use of other drugs. Sometimes alcohol or marijuana is easily obtained.

The fact that over 80 percent of teens break the law to use alcohol indicates how little the laws deter use. Ironically, alcohol abuse peaks around age 21 and then goes down sharply by age 25 just about the time it has become legal to use. (see Table G.20 at 3. above ) Many experts believe that "forbidden fruit" actually makes drug use more appealing to those groups of teens who are most curious, rebellious or thrill seeking.

The striking figures in 1. above show that 90 percent of cocaine users refuse to use heroin (About 70 percent also refuse to use crack.) The same is true of some 96 percent of marijuana users, 65 percent of whom also refuse to use cocaine. If currently prohibited drugs were to become regulated, it is not credible that those who have never used cocaine and heroin would begin to use them at rates anywhere near as high as those who have already broken the law to use some other drug. Any change at all would be no more than marginal. Moreover, any increases would likely be offset by less use of alcohol.

This also applies to the young as seen below..

A Day in the Life of American Adolescents: Substance Use Facts <http://www.oas.samhsa.gov/2k7/youthFacts/youth.htm> (Cigarette, Alcohol, and Illicit Drug Use) is a report from SAMHSA that says on an average day, about 631,000 Americans aged 12 to 17 drink alcohol, and 586,000 use marijuana 13,000 use cocaine (including "crack"), and 3,800 use heroin. Compared to alcohol, this means that there is 93 percent as much use of marijuana but only two percent for cocaine and less than one percent ( 0.6 %) for heroin. Yet marijuana is the most easily detected by smell or test and thus most subject to punishment. Moreover, arrests for marijuana have steadily risen from 30,000 per year to over 800,000 per year in 40 years while use has bobbed up and down for no apparent reason beyond faddish behavior.

Despite ready availability, teen choices about whether or not to use marijuana, cocaine or heroin show dramatic differences and - since all are illegal - the choices are obviously driven by other factors. This also is true for the population as a whole.

Age 12 or older (percentages ) as of 2005 [ NSDUH 2006]

ever used used over 25 days in past year

Marijuana 40.0 % 5.6 %

Cocaine 13.7 % 0.8 %

Heroin 1.4 % 0.0 % *

* The figure of 0.0 for heroin reflects use lower than 0.05 %

The National Drug Threat Assessment of 2005 reported that all drugs are readily available throughout the country. Fortunately, very few of us are at all interested in using them and are therefore blissfully unaware of how easy it is to obtain them.

http://www.usdoj.gov/ndic/pubs11/12620/index.htm

8. Marijuana has an especially vital and unique place in discussions of drug policy.

The importance of marijuana prohibition is about a great deal more than the drug itself. Some 100 million users combined with inflated prices have produced an enormous market.

Primary source: National Drug Intelligence Center (NDIC), National Drug Threat Assessment (NDTA 2005)

Key Points:

a) Marijuana is the backbone of the illegal drug trade. This increases our vulnerability to violent crime. Most is grown in the US. (more below)

b) Marijuana enforcement places an enormous burden on our courts and police reducing their effectiveness and misallocating resources. This too increases our vulnerability to violent crime. (more below)

c) There are major financial losses in taxes spent and in taxes not collected. See 500 Economists Ask President Bush for Open and Honest Debate

d) Marijuana's economic role - not the drug - accounts for the "Gateway" and facilitates the spread of other illegal drugs via an established distribution system. (See 5. above)

More at Gateway

e) Marijuana as a drug is discussed at

<http://www.dpft.org/marijuana.htm>

This examines the inherent hypocrisy of prohibiting a drug clearly less dangerous than alcohol, the exaggerations about potency and more.

In Charts: Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2009 we see that marijuana is used far more than all other prohibited drugs combined.

The National Drug Intelligence Center (NDIC) reports:

"... the prevalence of marijuana use among [adolescents] was still considerably higher in 2003 than in 1991... Use among young adults increased overall since 1991, not peaking until 2002."

"The steady supply of and demand for marijuana overall and the strong, stable market for its distribution often allow for the financial stability of drug traffickers, many of whom traffic marijuana to bankroll other criminal activity, such as producing or distributing other illicit drugs like methamphetamine and cocaine. ... In many areas, drug distributors sell marijuana along with other drugs such as methamphetamine, crack cocaine, and heroin."

The future appears to be bleak.

"The market for marijuana is strong and stable throughout the United States and should remain so given the drug's wide appeal to users and consistent profitability for distributors as well as producers."

"Marijuana production levels appear to be increasing despite continuing eradication efforts in this country and abroad."

Over half of the marijuana is probably grown in the US. Some estimates call it our number one cash crop. <http://www.drugscience.org/Archive/bcr2/cashcrops.html>

"Demand is higher for marijuana than for any other illicit drug ... Such a sizable user population, encompassing persons of wide-ranging ages, both genders, and diverse origins residing in areas urban to rural, equates to steady profits."

"Preliminary interagency estimates suggest that anywhere from 12,000 to 25,000 metric tons of marijuana, including domestic and foreign, were available in the United States in 2002, up from an estimated 10,000 to 24,000 metric tons in 2001. These estimates are speculative. While current estimates are not precise, these ranges nevertheless underscore the magnitude of marijuana's availability in the United States and indicate that the amount available is increasing. ... production in the United States could range from 6,000 to 19,000 metric tons annually."

"Marijuana production within the United States should increase as DTOs and criminal groups continue to establish or expand large-scale domestic cultivation operations."

Moreover, distribution increases our vulnerability to violence:

"Midlevel marijuana distribution is dominated less by large trafficking organizations and more by criminal groups, street gangs, local independent dealers, and OMGs [outlaw motorcycle gangs]."

b) Marijuana enforcement places an enormous burden on our courts and police reducing their effectiveness and misallocating resources. This increases our vulnerability to violent crime.

The overwhelming burden of marijuana on law enforcement is evident in the relative quantities estimated to be used in the US each year:

Marijuana 25,000 tons

Cocaine 300 tons

Heroin 20 tons

This raises the question of how we can possibly criticize foreign countries for failing at a much more difficult task than the one we ourselves have so obviously failed to accomplish for decades.

Growing arrest numbers alarmed The National Commission on Marihuana and Drug Abuse in 1972 :

"Another consequence of marihuana possession laws is the clogging of judicial calendars. President Nixon has noted that one of the major impediments to our nation's efforts to combat serious crimes is the fact that the judicial machinery moves so slowly."

"Swift arrests, prosecution, trial and sentence would significantly improve the deterrent effect of law. Yet the judicial system is overloaded with petty cases."

The Commission noted with horror that "marihuana" arrests had grown from 19,000 in 1965 to 189,000 in 1970; in 2006 the number had soared to 830,000, 739,000 for simple possession. As marijuana arrests grew to exceed arrests for all violent crime combined, clearance rates for violent crimes have plunged to all time lows.

Moreover, these arrests do not deter use except to a minor extent among the more casual users.

See: Comparisons of Dutch and US marijuana policy

and

Deter

Prisons

9. Comparisons of other drugs with alcohol provide a vital missing dimension in discussions of drug policy.

U.S. officials are determined to avoid comparisons with alcohol, which is arguably the most dangerous of the drugs. This deprives the public of their most logical basis for assessing other drugs. Alcohol is always readily available and most who are dependent on prohibited drugs are already dependent on alcohol too. In view of 2. above, it seems clear that a policy that does not emphasize alcohol abuse (and teen age vulnerability, 3. above) cannot have any significant impact on drug abuse and dependence.

Alcohol also provides an example of the wide range of responses that occur among different users of the same drug. Defining what a drug "does" or "is" relies heavily on the dosage, the individual user, and the social setting surrounding use. This is true of all drugs, contrary to the mythology dominating discussions of drugs.

One point in the comparison below is that it is "intoxification," that defines the degree to which a drug causes the user to lose mental and physical control. Alcohol is a leading candidate for "worst drug" in this respect.

Two Independent Studies Of Drug Addiction: Henningfield, National Institute on Drug Abuse, and Benowitz [B], University of California at San Francisco, Ratings [Lowest number = most serious effect]

	Withdrawal	Reinforcement	Tolerance	Dependence	Intoxification

Heroin	2	2	1	2	2
B	2	2	2	2	2

Alcohol	1	3	3	4	1
B	1	3	4*	4	1

Cocaine	4	1	4	3	3
B	3*	1	1	3	3

Nicotine	3	4	2	1	5
B	3*	4	4*	1	6

Caffeine	5	6	5	5	6
B	[5]	5	3	5	5

Marijuana	6	5	6	6	4
B	[6]	6	[6]	6	4

* = shared rank with another listed drug

[#] = ranking adjusted by DPFT to reflect lower shared rankings

DPFT Note: Other than some variations in the tolerance rankings, the two studies produced virtually identical results. The studies were cited in presentations to the Senate-House Task Force on National Drug Policy in 1996.

Withdrawal: Presence and severity of characteristic withdrawal symptoms.

Reinforcement: A measure of the substance's ability, in human and animal tests, to get users to take it again and again, and in preference to other substances.

Tolerance: How much of the substance is needed to satisfy increasing cravings for it, and the level of stable need that is eventually reached.

Dependence: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance and the degree to which the substance will be used in the face of evidence that it causes harm.

Intoxication: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do.

The evidence in this entire section helps explain the ratings below:

The French National Institute of Health, INSERM, consulted with experts from other countries and rated drugs by their danger in 1998 at government request. They established 3 groups:

[a] "most dangerous" - heroin, alcohol, and cocaine

[b] "next most dangerous" - tobacco, amphetamines, and others

[c] "least dangerous" - cannabis [marijuana], since it has "low toxicity, little addictive power and poses only a minor threat to social behavior," and others

-- from "Alcohol as bad as heroin and worse than pot," Reuters, 6-16-98

ALCOHOL Rated As Most Dangerous Drug

by Independent Scientific Committee on Drugs

The Lancet, Volume 375, Issue 9716, Page 724, 27 February 2010

The ‘overall harm’ table:

1	alcohol	72
2	heroin	55
3	crack	54
4	crystal meth	33
5	cocaine	27
6	tobacco	26
7	amphetamine/speed	23
8	cannabis (marijuana)	20
	<snip>

Heroin, crack and crystal meth were the most harmful drugs to the individual.

Alcohol, heroin and crack were the most harmful to others.

Further analysis showed alcohol is almost three times as harmful as cocaine or tobacco.

More at

Marijuana And Alcohol Compared

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