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A United Nations report (United Nations 2003) estimated a worldwide total of 34 million people who regularly abuse amphetamine-like stimulants and 8 million who use ecstasy. This exceeds the number of heroin and cocaine abusers combined. D-Amphetamine and D-methamphetamine are among the most widely used of all illicit drugs, ranking second in popularity only to cannabis in many countries. It is now generally recognized that amphetamines are drugs of addiction. This chapter reviews the evidence for this and explores the underlying brain mechanisms. It also reviews the social history of amphetamine abuse in various parts of the world.

For many years, Mexico has had to deal with an illicit drug economy and the extreme violence associated with it. The biggest changes in the country's drug trade occurred in the early 1980s, when cocaine flows from the Caribbean were rerouted toward Mexico. As a result, the value and thus the corrupting power of the market for illicit drugs radically increased. The history of drug trafficking in Mexico can be divided into three main periods: the emergence of a local illicit drug economy, followed by the emergence of a centrally regulated illicit market and the eventual transition to a privatized and increasingly violent drug economy. This chapter explores the emergence and evolution of the illicit drug market in Mexico, focusing on the factors that change the relations underlying illicit markets. It then looks at some of the main arguments on how illicit drug markets give rise to violence before concluding with a discussion on the dynamics of violence in an effort to highlight the dilemmas currently faced by Mexican authorities.

This chapter examines the role of western tourists and hippies in globalizing Afghanistan’s illicit drug trade. Throughout the 1960s, thousands of westerners flocked to Afghanistan to buy and consume hash. This chapter shows that by the 1970s the growing demand for hashish in western markets led to a greater influx of drug traffickers in Afghanistan. Afghanistan was ideal for those involved in the illicit drug trade, because of its cheap and abundant supply, as well as the lax or ineffective enforcement of drug laws. Ultimately, this chapter demonstrates that the hash trade was critical in building the global trafficking networks that would later link western demand for opium and heroin with producers and traders in Afghanistan.

This chapter rounds up the discussion of Richard M. Nixon's role in illicit drug use in the United States. It can be noted that Nixon was re-elected partly due to his administration's approach to law and order concerns, as well as drug abuse and crimes related to it. It first studies one of the most controversial 1972 initiatives of Nixon, the Office of Drug Abuse Law Enforcement (ODALE), which served to allow the federal government to help local government units prod addicts to enter treatment and enforce drug laws. It then turns to the issue of legalizing marijuana and the efforts that were put in place to catch attention for Nixon's anti-narcotics programs. This chapter also looks at Nixon's other efforts to solve the drug use issue, the collaboration between ODALE and the Special Action Office for Drug Abuse Prevention (SAODAP), and the de-emphasis process for the 1972 federal drug abuse control policy. The chapter ends with a discussion of Nixon's resignation on August 8, 1974.

This chapter discusses other forms of substance abuse (i.e., illicit drugs and prescription medications) in late life, in general, and in relation to retirement, in particular. Drawing from the results of the authors’ own 10-year study as well as from other studies, the chapter seeks to answer such questions as the following: How widespread is drug abuse/misuse in the older population, and what are the consequences of such behavior for individuals, their families, and society? What individual characteristics and demographic factors (e.g., age) might influence the use of illicit drugs or misuse of prescription drugs in late life? And can factors related to retirement (bridge employment, age at retirement) be identified as affecting individuals’ vulnerability to abusing substances other than alcohol?

Five types of morbidity and mortality have been identified as the main health expressions of health harm associated with illicit drug use: 1) overdose; 2) other injury; 3) non-communicable physical disease; 4) mental disorders; and 5) infectious disease. Burden of disease estimates combining years of life lost due to premature mortality and disability indicate that illicit drugs ranked eighth among causes of disease, death, and disability in developed regions of the world. Opioids, cocaine, and amphetamines entail greater risks, especially when they are injected. Many harmful consequences are not completely intrinsic to the properties of the drug, but instead are associated with the physical and social environment in which drug use takes place. These epidemiological considerations need to be taken into account in the allocation of resources for prevention programmes, treatment, and social services.

In this chapter we present two examples of longitudinal studies. Both studies utilize an etic–emic approach and both are underway in urban, cosmopolitan areas. In both studies the etic approach stems from the use of standardized, previously validated instruments and a design that called for a specific research protocol. We describe how the emic perspective was incorporated into the respective projects through a detailed discussion of how positive working partnerships were formed and maintained and the ways by which the questionnaires were constructed, pilot tested, and revised. We note that for both projects being culturally sensitive to the populations had more to do with our paying attention and being sensitive to language, gender, age, race and ethnicity, and poverty. In this chapter we also provide a brief conceptual discussion of data analytic considerations for longitudinal data.

With moderate use, marijuana remains the most benign substance on the drug scene, safer not only than cocaine or heroin but alcohol, pharmaceuticals, and certainly cigarettes. Most teenagers have tried smoking cigarettes or drinking a beer at some point in their younger years. A much smaller number drink to excess or have tried hard drugs. Substance use follows distinct trends, with certain substances moving up the charts (marijuana) while others almost disappear (heroin). Marijuana use has become more common over the years than the use of other illicit drugs. All of these substances are subject to supply and demand, as well as to regulation and law enforcement. This chapter analyzes drug use by American teenagers, beginning with smoking and alcohol use and then moving on to harder or illegal drugs. It also discusses five examples of programs that had an impact on smoking and substance abuse.

This chapter introduces the core arguments and narrative of the book, and how drugs produced in Afghanistan were initially embraced by a series of Afghan rulers, legally or not, as a vehicle to grow the Afghan economy. Over time, particularly because of American influence, Afghan rulers adopted more stringent forms of drug control. This books reveals that Afghan rulers adopted the prohibition of drugs to foster better diplomatic relations with the US to help build the Afghan state, but at the expense of Afghans who were increasingly dependent on the drug trade. The illicit drug trade emerged, not simply because of a failed state, but rather, in reaction to the abandonment of the legal opium trade and the gradual adoption of more coercive forms of drug control.

This chapter illustrates the conduct of population-based studies by describing the implementation of a large school-based survey of substance use in several Central American countries. The project's methodology followed an etic approach although considerable work was conducted to validate and harmonize the instrument across countries and sites. The project's implementation involved a number of activities that required collaborators to navigate different cultural and geopolitical situations, some of them of a very sensitive nature, some of which we describe in this chapter. Through these examples, we hope readers will acquire a better understanding of the inner workings of these complicated multi-national projects. We also highlight the importance of building partnerships between country researchers and international organizations, including a discussion of protection issues for human subjects, and we provide an example of power analyses and an analytic strategy of accounting for clustering when conducting statistical analyses with these large studies.

The use of addictive substances dates back to the beginning of recorded history. Since 1990 consumption of addictive substances has rapidly increased, especially in developing countries, leading to increases in the mortality and morbidity burdens, especially for tobacco, alcohol, and illegal and non-medical drug consumption. However, for many conditions, the relationship between the use of addictive substances and health consequences is complex and causality has not yet been established. This is especially true for mental health conditions. In 2010 tobacco use was the third largest contributor to the burden of disease, alcohol was the fifth largest contributor, and illicit and non-medical drug use was the eighth largest contributor. Research on the health effects of pathological gambling disorder is currently sparse, making burden calculations for this disorder impossible. Therefore, additional research on and quantification of the physical and mental health impacts of this disorder are needed at the population level.

The use of psychoactive substances is commonplace in many parts of the world, despite the efforts of policymakers, government officials, public health advocates, and concerned citizens to prevent, eliminate, or control it. If previous experience can serve as a guide, in the future many countries will face periodic drug-use epidemics, followed by aggressive policy responses to suppress them. Continued endemic drug use generates a patchwork of policy responses that never quite keep up with the problem. The scientific evidence on the impact of policy constitutes the core interest of this book and consists of three broad approaches: programmes to prevent drug use, treatment and harm-minimization services that help heavy drug users change their behaviour, and supply control programmes to restrict access to illicit substances. This book suggests that public health concepts provide an important vehicle to coordinate supply control and demand reduction.

Binge-drinking and illicit drug use are highly prevalent among European youth. Through mapping and a systematic review of reviews it is concluded that there is little review-level evidence to support the majority of approaches currently adopted and delivered by many Europe countries to address youth substance-related harm. Although some individual prevention programmes show beneficial effects on addictive behaviour outcomes, it is not currently possible to generalize beyond implementation of specific interventions to recommend any broad policy approaches based upon the underpinning principles of these programmes. Currently, recommendations with regard to effective approaches for addressing young people’s addictive behaviours can only be made with reference to ‘promising’ approaches. A further challenge lies in the practical need to balance the evidence base with what is feasible and desirable in the real world. Recommendations are provided to address these challenges, including a number of recommendations for future research.

Among the 47 options reviewed in this book, most show some evidence of effectiveness in at least one country, but the evidence is less than definitive for many others, either because the interventions are ineffective, or the research is inadequate. Unfortunately, policies that have shown little or no evidence of effectiveness continue to be the preferred options of many countries and international organizations. The evidence reviewed in this book supports two overarching conclusions. First, an integrated and balanced approach to evidence-informed drug policy is more likely to benefit the public good than uncoordinated efforts to reduce drug supply and demand. Second, by shifting the emphasis toward a public health approach, it may be possible to reduce the extent of illicit drug use, prevent the escalation of new epidemics, and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.