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Decribe the major causes of concern regarding cocaine use

Lifetime, Annual, and 30-Day Prevalence, 1975-1990. The pattern of cocaine use is more complicated.

Health Concerns of Cocaine Abuse

Public concern, in contrast, increased dramatically from 1986 to 1989, at just about the same time that survey measures of student consumption were beginning to decline.

College students are surveyed annually in conjunction with the surveys of high school seniors. The decline in illicit drugs evident among high school students also occurred among college students: Current marijuana use was 16 percent in 1989 compared with 34 percent in 1980, and current cocaine use was down to 2.

Similar declines were reflected in the household surveys. Consumption of illicit drugs is most prevalent among young adults ages 18-25 and older. Current marijuana use for this group was 35 percent in 1979, and less than half that in 1988 16 percent.

Similarly, current cocaine use dropped by half, from 9.

  • Moreover, dependence and abuse tend to cluster with many other behaviors that are defined as serious problems;
  • It is not an invalid basis, but it sweeps together many culturally specific differences that are very important;
  • How these trends translate into higher levels of consumption is less certain;
  • In this case, the person may develop the additional challenge of a substance use disorder or addiction;
  • Drug abuse in urban black communities has become a serious problem Watts and Wright, 1983.

It is clear from survey data that the overall profile of household and student population involvement with illicit drugs is down—and down dramatically see Figure 1. How these trends translate into higher levels of consumption is less certain. The 1990 National Household Survey reported that, among those who used cocaine at all in the last year, 10 percent used the drug once a week or more, and 4 percent used it daily or almost daily; among the 1985 past-year users, 5 percent were weekly users and 2 percent daily or almost daily users.

The surveys of high school seniors showed contrasting findings: Thus, even among the general populations covered by these two surveys, there is some question about the degree to which drug involvement at the level of abuse and dependence may be declining, despite the overall drop in rates of use. Moreover, there are some very significant gaps in the population covered by the two surveys, and the poorly represented populations may be behaving differently from those who are well represented. The high school senior surveys, for example, do not include high school dropouts, and there is ample evidence that drug problems are likely to be more severe among segments of the population in which dropout rates are likely to be greatest, such as economically disadvantaged populations in inner cities.

Drugs, Brains, and Behavior: The Science of Addiction

The household surveys also exclude all individuals not living in conventional households, such as those in group quarters, institutions, or transient places. Both surveys rely on individuals voluntarily agreeing to participate in the study; people who are having severe drug problems are undoubtedly less likely to be available and agreeable to participate in a lengthy interview than are unimpaired household members.

Validity and Reliability of Survey Data Any data collection system that relies on self-reports must address the issue of validity—do people tell the truth or know the truth when they are asked to tell a stranger about their own or another's use of illegal drugs? A variety of studies have been undertaken to establish the validity of such surveys Rouse et al. Perhaps the most general conclusion that can be supported is that most people are willing to be reasonably truthful within the bounds of their capability under the proper conditions.

Evidence from other areas of survey research suggests that, when respondents believe they are guaranteed anonymity and confidentiality, when they accept the scientific or practical value of the survey, when they accept the legitimacy of the survey, then they tend to be generally truthful Forman and Linney, 1991; Rouse et al.

Whether these conditions are met in the household drug use survey, the school-based surveys of students, or the mail-out questionnaire follow-up surveys of high school graduates is debatable. The survey operators have worked to develop methods of shielding answers and reassuring respondents, and the federal government has enacted legislation to protect the confidentiality of individual data.

The degree to which confidentiality assurances are believed may vary with social or cultural affiliations and personality characteristics of the respondents. Some of these differences are correlates and predictors of risk for drug use Moncher et al.

Some youth at high risk for drug use may not divulge any illicit drug use if they suspect the interviewer knows who they are for fear of apprehension by legal authorities or punishment by some other social system such as social welfare or education. But even if the precision and validity of the survey are somewhat compromised by biases, other tests suggest the reliability of trend data over time. One such factor is the presumption of constancy of bias; even if individual prevalence estimates are systematically biased downward by underreporting, so long as the bias is relatively constant from year to year, trend estimates may be quite reliable.

The Cause and Effect of Substance Abuse and Mental Health Issues

This presumption is supported by the fact that other responses to drug consumption questions have not drifted away from the self-report trend, as might occur if individuals were becoming increasingly reluctant to self-report. For example, the high school seniors survey asks respondents what proportion of their friends use a given drug.

Even if there were a change in willingness to report self-behaviors, there should be somewhat less change in willingness to report unnamed friends' behaviors. However, seniors' reports of their friends' drug practices parallel very closely the trend in reports of their own use.

A second methodological support for validity is that different drugs display different trends over time; self-reported marijuana use declined earlier than did cocaine, and reported use of other drugs including alcohol has not declined. A third type of evidence bearing on trend validity is that different self-report methods produce similar trend results.

Self-administered mail-out questionnaires, group-administered school-based questionnaires, and household interviews using self-completed, sealed answer sheets all provide similar trends. A fourth indication of validity is that the absolute levels of reported drug involvement are substantial; decribe the major causes of concern regarding cocaine use numbers of respondents do freely admit to experiences with illicit drugs; lifetime marijuana prevalence among some age groups is well over 50 percent, demonstrating that most users do indeed admit to this on a self-report basis.

Finally, the data show convergent and predictive validity. That is, reported levels of consumption relate to other variables in ways that seem internally consistent: Crider 1985 compared trends in indicators of heroin epidemics hepatitis-B, heroin-related emergency room visits, heroin-related deaths, and average retail heroin purity with trends based on self-report data from the National Household Surveys.

She found that the trends in indicators were consistent with the household data. And yet there is some evidence to suggest that not all the survey methods are equally accurate.

For example, telephone procedures McAuliffe et al. And some researchers have suggested that physiological test procedures are useful in increasing the validity of self-reports of cigarette smoking among younger students—although not among older students Werch et al. It would be useful to employ methods other than traditional self-report, and a number of alternative or supplementary techniques have been attempted, including randomized response Warner, 1965bogus pipeline Murray and Perry, 1987nomination technique Sirken, 1975and item-count method Miller, 1985.

A number of studies have been devoted to ascertaining the conditions under which respondents tend to be truthful Forman and Linney, 1991and this remains a very active arena for research. Increasing the use of biological validation techniques urine samples, saliva samples, hair samples, breath tests is likely to lead to better methods of objective validation. The difference in self-reported rates of smoking may be confounded by age and experience.

The bogus pipeline, in which respondents are asked to provide a saliva sample only to give the appearance that their verbal reports will be validated by chemical tests for traces of cigarette smoking, was found to increase reporting of drug use by younger people, but only the first time they were surveyed Murray and Perry, 1987.

Physical measures tend to be better indicators of recent heavy use, but they are less sensitive to sporadic or light use. So, for various reasons, the traditional self-report method under the proper conditions continues to be the most practical.

There is a critical need to reinvigorate methodological studies of the validity of standard measures, to reconfirm that some critical findings about validity and reliability from studies in the 1970s remain applicable.

The drug literature needs to be compared with methodological work on validation of self-report methods involving other sensitive subjects, such as sexual behavior, criminal activities, and compliance with medical regimens. Biases in self-reporting need to be reassessed and methodological investigation needs to be supported concerning the differences among results from general population studies, case observations in criminal justice and clinical settings, and ethnographic investigations.

Aside from problems of validity, survey data are subject to nonresponse error due to incomplete population coverage and insufficient response rates. Here, too, an important consideration is consistency over time.

If response rates or coverage were to change from year to year, that could produce spurious changes in apparent prevalence results. Clearly, the surveys do not cover all the affected populations equally well, and they undoubtedly underestimate the number of people involved with drugs at any one point in time. The household and the high school senior survey results seem to accurately represent overall trends in drug use in the general population, but not necessarily in the highest risk groups.

Top 5 Reasons Teens Use Drugs

This fact limits what the committee can conclude from existing trend data in its generalizability to the highest-risk populations, especially school dropouts, those who are unemployed and do not have permanent addresses, and those engaged in illegal activities. Youth at the greatest risk for drug use are those more likely to be absent from school and to cut classes see Hawkins et al. The absence of this high-risk group from the present surveys imposes a limitation on interpretation of the drug estimates.

Research has established higher rates of alcohol and drug use among street kids McKirnan and Johnston, 1986: Since 1989, there has been a rough leveling off or slight to substantial decline in emergency room cocaine incidents in the DAWN cities under NIDA's community epidemiology research program, although quarter-to-quarter trends have fluctuated quite dramatically in both directions, presumably reflecting instabilities in the cocaine market or, possibly, endemic quality control problems in emergency room data collection Community Epidemiology Working Group, 1992a,b.

This probably reflects the overrepresentation of minorities and other high-risk groups in treatment populations, especially in emergency rooms. Not until the last quarter of 1989 was there a downturn in this indicator of problems associated with cocaine abuse, although the medical examiner data showed some evidence of reaching a peak as early as the last quarter of 1988.

The seeming divergence between the two systems in trends related to cocaine the household and high school senior surveys showing declines from 1985-1991 when the DAWN data showed increases is perhaps due to their differing sensitivities to use versus abuse and dependence. Individuals who report use at a given point in time may escalate to abuse or dependence after an interval of several years, so that changes in abuse and dependence indicators may lag behind shifts in the onset of use by several years.

Thus the increased use rates observed in surveys through the mid-1980s would not be expected to result in a peaking of the medical problems typical of dependence until the late 1980s.

The decline observed in the last quarter of 1989 is consistent with the peak-lag hypothesis. Data from the first quarter of 1990 continue the decline Adams, 1990. The fact that decribe the major causes of concern regarding cocaine use was essentially a flattening prior to the decline lends further credence to the belief that cocaine problems are receding in the wake several years after of the general recession in use.

However, it is equally plausible that the patterns of abuse and dependence tapped by DAWN are decoupled from the general population trends, representing population subgroups whose drug involvement has not changed in the same way that the general population has.

Data on Treatment Demand Although treatment data have not been collected systematically enough during the 1980s to make clear statements about trends see Gerstein and Harwood, 1990there is little doubt that demand for treatment, particularly for cocaine abuse, increased during the latter 1980s, as use prevalence statistics declined.

As with the DAWN data, one likely explanation has to do with the time lag between the onset of use and the development of dependence; the alternative explanation is that treatment populations are distinct from the general population. Another problem associated with drug consumption is the delayed effect of perinatal exposure, especially to crack cocaine.

More pregnant women are said to be using crack cocaine in particular, and some hospitals have reported high proportions of drug-exposed newborns Chasnoff, 1989; Chasnoff et al. Whether the proportions of affected newborns are currently increasing or decreasing is hard to know, although the absolute levels are clearly unacceptably high, "Crack babies" are believed to have specific affective, cognitive, and behavioral problems Chavez et al.

Some school systems are now developing training programs to help teachers deal with the influx of such children into the education system Barth, 1991. It is difficult to ascertain the extent to which the problems of crack babies are due to drug effects as such rather than other negative exposures in the child's environment such as poor hygiene, poor nutrition, lack of medical care, haphazard and neglectful parenting, etc. Moreover, there is a "bias against the null hypothesis"; that is, the tendency for journals to publish results decribe the major causes of concern regarding cocaine use studies that show effects more often than studies that fail to show effects Koren et al.

Nevertheless, it is clear that widespread crack consumption among young, economically disadvantaged women has substantially exacerbated the problem of perinatal exposure to illicit drugs.

It has also substantially removed the earlier neonatal advantage associated with lower marijuana use by young black than by young white women. Sharing HIV-contaminated needles is the way in which this infection has spread.

AIDS is thought to be transmitted by small amounts of blood contained in needles, syringes, or bottle cap "cookers" shared among drug users Friedman and Klein, 1987. The rates of needle sharing are high.

One study found that 70 percent of intravenous drug users shared needles with others, and 86 percent had shared a cooker Booth et al. Intravenous drug users do not use condoms regularly, placing their partners at high risk for contracting AIDS through sexual contact Feucht et al.

As many as two-thirds of this high-risk group have never used a condom Booth et al. Although each estimate of the number of intravenous drug users has a fairly wide confidence interval Spencer, 1989a number of estimates converge on a figure of approximately 1.

Most are heterosexual and sexually active. A second group that runs a very high risk of becoming infected with AIDS are crack cocaine users who exchange sex for drugs Fullilove and Fullilove, 1989.

  1. Nearly 23 percent of these cases were classified as having serious impairment.
  2. Similarly, 83 percent of violent offenders were using drugs daily in the month prior to their committing the offense Chaiken and Chaiken, 1982.
  3. Family members who have had a mental illness Personal history of mental health problems Experience of childhood trauma or other trauma, including violence, neglect, or abuse Brain injury or damage Exposure to toxins, including substance abuse These predispositions do not necessarily mean that a person will develop a mental health disorder, but they can increase the likelihood that one will.

As a drug, crack cocaine does not necessarily dispose users to heightened sexuality. But the way in which this drug is marketed has fatal long-term consequences. Many women who have become dependent on the trade of sex for drugs, and many young male sellers receive payment in sexual favors. Among a sample of black adolescent crack users, 25 percent reported the exchange of sex for drugs or money, the rates being similar for both males and females.

One study found the rate of exchange of sex for drugs or money to be higher among females than males Feucht et al. Only 26 percent of males and 18 percent of females had used a condom in their last sexual encounter, and over one-third of males and over one-half of females reported a history of sexually transmitted diseases.