Prior to beginning work on this discussion,
Read Chapter 9 in your textbook (Located in attachments below) Reference: DeLisi, M., Schwartz, S., & Klein, E. (2020). Criminal psychology (2nd ed.). Zovio.
Read the webpage articles:
Siegel, E., & Starts With a Bang. (2018, March 20).
Opioid epidemic so dangerous, says CDC, it’s finally killing as many Americans as guns
Lopez, G. (2018, February 6).
Why the opioid epidemic may have fueled America’s murder spike: A researcher explains the potential link between the two crisesLinks to an external site.
. Vox. https://www.vox.com/policy-and-politics/2018/2/6/16934054/opioid-epidemic-murder-violent-crime#
Watch the video:
Warning: This Drug May Kill YouLinks to an external site.
.
The opioid crisis has become a controversial issue that is becoming harder to ignore. In the context of the relationship between psychology and criminal behavior, substance abuse is one of the leading risk factors for criminal behavior. Therefore, criminal psychologists, public health professionals, and the community-at-large are examining the implications of the crisis, the most crucial of which appears to be a relationship between homicide and violent crime rates and opioid abuse.
For this discussion, conduct additional research on the opioid crisis using information from the textbook, article links provided and other credible sources to ensure you are aware of the latest issues in the opioid crisis national debate. Then, briefly debate the issue with your classmates.
Debate the issue below:
Physicians are responsible and have caused the opioid crisis by overprescribing pain medications that are highly addictive.
Remember to provide your insight into whether rising violent crime rates stems from the opioid crisis as asserted in your assigned readings.
Drugs, Alcohol, and Crime
9
gorodenkoff/iStock/Getty Images Plus
Learning Outcomes
After reading this chapter, you should be able to
• Discuss the relationship between substance use and criminal behavior.
• Recognize the criteria for substance use disorder according to the DSM-5.
• Examine several reasons why people use drugs.
• Explore the biological basis of addiction.
• List the types of commonly abused substances.
• Analyze the relationship between substance abuse and criminal behavior.
• Describe strategies for reducing substance abuse and substance-related crime.
165
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Introductory Case Study: Greg’s Alcohol Addiction
Introductory Case Study: Greg’s Alcohol Addiction
Greg is a 47-year-old construction worker and divorced father of two high school–aged children
(whom he rarely sees). Greg enjoys his job and has an exemplary work record; in fact, he was
recently awarded Employee of the Month. Greg’s coworkers do not know a lot about him due to
the fact that he is a private person and keeps to himself. But he joins them one or two nights a
week for happy hour after work.
What Greg’s coworkers don’t know about him is that he had a rough childhood, which has led
to him being very private and a loner. Greg’s parents were heavy drinkers while he was growing
up, which led to Greg having very few friends and not performing well in school. Greg’s school
troubles continued when he went to college, and he was not able to obtain a degree.
Greg found employment, married, and became a father, so it appeared that things were going
well for him. Greg, though, has a secret—he is a heavy drinker himself. He enjoys going home
after work and having a couple of beers, but a couple turned into 6 to 12 per night. This alcohol
dependence eventually led his wife to seek a divorce.
Greg continued his alcohol dependence after his wife left him. He would become upset if there
was not enough beer in the refrigerator, and he would go out and purchase more. In fact, one
night he went out to purchase more and, when he got to the convenience store, realized he forgot
his wallet. Instead of going home to retrieve his wallet, Greg chose to steal a six-pack of beer. He
was caught attempting to leave the store without purchasing the beer. But the owner declined
to press charges against Greg since he was a regular customer and the owner feared he might
lose Greg’s business.
Greg started a dating a woman he met at a bar 18 months ago. She describes Greg as a warm
and caring man but notes that he can act moody and cold toward other people on occasion. But
she also states that she believes Greg suffers from some depression, due to not having a relationship with his children (which he will not discuss). She states that she has noticed throughout
their relationship that Greg becomes restless and has trouble sleeping if he does not drink at
least three or four beers after work. She states that she really cares for Greg and has considered
asking him to slow down on his drinking or quit altogether but fears the repercussions of this
request.
As you read this chapter, consider the following questions regarding this case:
1. Do you think Greg has an addiction to alcohol?
2. Are other people affected by his alcohol use?
3. Where did Greg get his opinions about drinking?
4. Do you think there is an underlying psychological disorder or genetic vulnerability
that is influencing Greg’s drinking?
5. Is Greg’s current attitude about alcohol use reasonable?
6. Do you think Greg is at risk for future criminal behavior?
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Substance Abuse and Addiction: Terminology and Diagnosis
Section 9.2
9.1 Introduction
There is a long-established link between substance (anything that can alter an individual’s
cognition or mood) use and criminal behavior (Bradford, Greenberg, & Motayne, 1992; Tonry
& Wilson, 1990). However, as we will explore in this chapter, it is important to note that there
is no single substance use–crime relationship. In some instances, substance use precedes the
criminal behavior. In other instances, the criminal behavior precedes the substance use. And
sometimes both the substance use and the criminal behavior occur around the same time.
In addition, substances also differ in their criminogenic qualities (crime-causing potential).
For example, a substance like marijuana is less criminogenic compared to a substance like
heroin. However, in specific individual cases, and under certain situational conditions, marijuana can be a highly criminogenic substance.
Substance abuse, in all its forms, impacts an enormous number of people, as well as their
friends and families. Understanding the nature and extent of substance abuse allows us to
make connections between substance abuse and criminal behavior.
9.2 Substance Abuse and Addiction: Terminology
and Diagnosis
Professionals and practitioners in a variety of fields—including psychology, criminal justice,
health care, politics, and law—have tried to clarify terminology and concepts in an effort to
improve public policy, professional standards, and patient care related to substance abuse
(the hazardous or harmful use of substances) and addiction. As discussed in Chapter 2, in the
field of psychology, the primary system that is used to diagnose mental disorders—including
substance abuse and addiction—is the Diagnostic and Statistical Manual of Mental Disorders
(DSM). In the DSM-5, which was published in 2013, the American Psychiatric Association recommends that the term abuse be discontinued in favor of a more informative and less stigmatizing term. However, the term substance abuse remains the most common term in use today,
especially by state and federal governments as well as researchers in the field. We’ll refer to
both abuse and use throughout this chapter, using the terms interchangeably.
The DSM-5 instead characterizes substance use disorders (patterns of symptoms resulting
from the use of a substance that an individual continues to take despite experiencing problems as a result of the substance use) as existing on a continuum from mild (two or three
symptoms) to moderate (four or five symptoms) to severe (six or more symptoms). Each
specific substance is addressed as a substance use disorder (e.g., alcohol use disorder, opioid
use disorder), but nearly all are diagnosed based on the same overarching criteria.
Listed below are the criteria for substance use disorder according to the DSM-5.
1. Taking the substance in larger amounts or for longer than you’re meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
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Why Do People Use Drugs?
Section 9.3
5. Not managing to do what you should at work, home, or school because of substance
use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the
substance. (APA, 2013)
9.3 Why Do People Use Drugs?
In general, any substance that alters the
nervous system (network of nerve cells
and fibers that transmit signals between
different parts of the body; essentially, the
body’s electrical wiring) and mind is considered a drug. (Throughout the chapter,
we’ll refer to the terms drug and substance
interchangeably.) Certain drugs have the
capacity to distort, inhibit, or enhance an
individual’s thoughts or feelings, which
impacts patterns of social functioning
and other behaviors. Drugs are classified
ookawaphoto/iStock/Getty Images Plus
as either licit (legal) or illicit (illegal). For
When tobacco is used infrequently or in
example, coffee, tobacco, and alcohol are
moderation, society generally considers its use
considered licit drugs, as are popular overacceptable. Tobacco is considered a licit drug.
the-counter drugs (e.g., Tylenol, Advil).
When used infrequently or in moderation, these drugs are generally deemed acceptable
by society. On the other hand, drugs like cocaine, heroin, and ecstasy are considered illicit
drugs, which are illegal to use or possess in the United States.
In general, there are four primary reasons why people use drugs.
1. To feel good: Certain drugs can produce a feeling of well-being or elation, known as
euphoria. This feeling of pleasure or euphoria can also be accompanied or followed
by feelings of self-confidence, power, increased energy, satisfaction, or relaxation.
2. To feel better: Some individuals who suffer from depression, stress, or anxiety begin
using certain drugs in an effort to eliminate or reduce those feelings. While people
tend to dismiss the impact of stress, it has been found to play a strong role in individuals starting and continuing substance use, as well as in relapse—a return to
substance use after a period of improvement.
3. To perform better: Some individuals feel pressure to improve their performance in
school, at work, or in a variety of other settings (e.g., athletics). Efforts to improve
performance are a common reason that some people initially try or continue using
stimulants, which will be described later in the chapter.
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Section 9.4
Addiction
4. To conform to peer pressure and satisfy curiosity: These are common reasons for
teenagers, as many teens become familiar with drugs and experience curiosity to try
them. Social pressure from peers can also be a very powerful factor.
For many drugs, a user can be at risk of moving from occasional use to regular use. Similarly,
a user can be at risk of moving from regular use to heavy use, and then from heavy use to
chronic (constantly recurring or long-lasting) use. A chronic substance user may then be at
risk of becoming addicted to the substance, as well as experiencing withdrawal symptoms
(physical and mental symptoms that occur when a substance is absent from the body) whenever the particular substance is not available.
9.4 Addiction
Why do some people become addicted to certain substances while others do not? Why might
someone feel sick from a certain drug that makes other people feel good? As with other mental
health disorders, the likelihood of developing an addiction or substance abuse problem differs from individual to individual. Moreover, there is no single factor that determines whether
an individual will develop an addiction in the future.
People use the terms addiction and addict in everyday speech over a wide range of domains.
For example, have you ever heard anyone refer to themselves as a shopaholic, chocoholic,
or workaholic? Perhaps you have heard someone accuse themselves (or others) of having a
television addiction or a social media addiction. Interestingly, the term addiction is included
as a category in DSM-5 and contains both substance use disorders and non–substance use
disorders, such as gambling disorder.
The American Society of Addiction Medicine published the following definition of addiction
in 2011:
Addiction is a primary, chronic disease of brain reward, motivation, memory
and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in
an individual pathologically pursuing reward and/or relief by substance use
and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in
behavioral control, craving, diminished recognition of significant problems
with one’s behaviors and interpersonal relationships, and a dysfunctional
emotional response. Like other chronic diseases, addiction often involves
cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (paras. 1–2)
Addiction is a chronic disorder with environmental, biological, social, and psychological factors that influence its development and maintenance.
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Section 9.4
Addiction
1. Environmental factors: Society’s views of substance use have a significant effect on
people’s initial and continued use of certain substances.
2. Biological factors: The pharmacology of alcohol and other drug use centers on how
the ingredients of a particular substance affect the body and nervous system and
thus the individual’s experience with the substance.
3. Social factors: The motivation for using a particular substance can be influenced by
a variety of social influences, including peer pressure, deviant peer relationships,
social alienation, bullying, popularity, and association with gangs. The norms and
expectations within families, communities, and subcultures are also strong social
factors.
4. Psychological factors: Researchers have discovered consistent predictors of initial and
continued substance use, including learning factors, personality variables, and higher
order cognitive processes. Alcohol and other drug abuse is highly associated with
affective disorders and other psychiatric diagnoses, although as noted earlier, some
psychological problems (e.g., anxiety and depression) may be effects of the substance
use as well as causal factors. (See Figure 9.1.) Many people who abuse substances
have a history of low self-esteem, impulsivity, deviance, nonconformity, and antisocial
behavior. However, these psychological factors can all be the effects (as opposed to
the causes) of substance abuse.
Figure 9.1: Substance use disorder and mental illness among adults aged 18 or
older: numbers in millions, 2017
Substance use disorder and addiction may cause mental disorders or other psychiatric diagnoses, but
they also may be the effects of the mental disorders. This graph shows the overlap of mental illness
and substance use disorder of adults in 2017.
SUD and mental illness
SUD,
no mental
illness
10.2
million
18.7 million
adults had SUD
8.5
million
38.1
million
Mental illness,
no SUD
46.6 million adults
had mental illness
From Key Substance Use and Mental Health Indicators in the United States: Results From the 2017 National Survey on Drug Use
and Health (p. 41), by J. Bose, S. L. Hedden, R. N. Lipari, and E. Park-Lee, 2018, Rockville, MD: SAMHSA (https://www.samhsa.gov
/data/report/2017-nsduh-annual-national-report).
Many people deem addiction to be an issue of personal weakness that originates out of selfgratification and continues because of an unwillingness or lack of sufficient willpower to stop.
However, within the scientific and medical communities, the theory that addiction is driven
solely by pleasure-seeking behavior has decreased in popularity. Instead, scientists and
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Section 9.4
Addiction
medical experts now believe that people engage in potentially addictive behaviors to escape
emotional and/or physical discomfort. In other words, people commonly use alcohol or drugs
to feel good (or feel better), as we learned in the previous section. Accordingly, the roots of
addiction reside in behaviors associated with self-medicating and sensation seeking.
Emerging evidence suggests that addiction is functional. In other words, addictive behaviors
serve while they also destroy. Addiction is a relationship between a person and an activity or
an object. With addiction, the activity or object becomes increasingly more important, while
previously important activities become increasingly less important. Ultimately, addiction
is about the complex and common struggle between acting on impulse and resisting that
impulse.
Genetics
Numerous scientific advances have shaped our current interpretation of addiction. For example, genetic research has demonstrated that approximately half of the risk for addiction is
biological or genetic, and that some people are predisposed to addiction but not to a specific
type of addiction (Betz, Mihalic, Pinto, & Raffa, 2000; Blum et al., 2000; Potenza, 2001). Genes
influence the degree of reward an individual experiences when initially using a substance
(e.g., cocaine) or engaging in certain behaviors (e.g., gambling). In other words, it may be
more difficult for some people with certain genes to quit using substances compared to other
people. (See Case Study: Joanne.) In addition, some people may experience more severe withdrawal symptoms if they try to quit compared to other people.
Case Study: Joanne
Joanne is a 51-year-old female who is in court-ordered treatment for depression and substance use disorder. While she is not currently using drugs, she acknowledges that her use of
cocaine and alcohol had spiraled out of control in the past year. Over the past several years,
Joanne has been in and out of multiple jails and voluntary treatment programs, and she has
become an expert in rationalizing her drug use.
Joanne had a very difficult upbringing. When she was 3 years old, her father committed suicide, and she was raised by a single mother who had a similar inability to control her drinking
and drug use. Joanne was drinking and using drugs on a daily basis by the time she reached
adolescence. By age 20 her drug use had moved from recreational to the dependent stages of
addiction. Her cravings were so strong that she would skip any social or occupational activity
to get drugs.
For the past year, Joanne has been secretly selling marijuana and antidepressant medication
to several of her son’s classmates. She recognizes that her behavior is wrong, and this is one of
many examples in which she is unable to use sound judgment.
Joanne’s recurrent drug use has resulted in a failure to fulfill major role obligations at work
and at home. In fact, her most recent arrest stemmed from a DUI, which she received while
driving to pick up her 14-year-old son from school. During treatment, Joanne learned that
people with a first-degree relative (such as a parent) who has addiction problems are more
likely to develop an addiction, and her greatest fear is that her son and 12-year-old daughter
will inherit her problems with substance use.
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Section 9.4
Addiction
Genes also affect the way in which the body processes substances. An intensified desire to
reexperience the use of a substance can lead to regular use and exposure, with chronic use
and chronic exposure potentially leading to changes in brain chemistry. These changes may
include negative impacts to impulse control, judgment, memory, and motivation. Moreover,
these changes can lead to increases in cravings for a substance, as well as impairments in the
ability to regulate the impulse, despite the experience and knowledge of the negative consequences associated with addiction.
The Brain and Addiction
Most drugs associated with addiction affect
the release of dopamine (a chemical in
the brain that helps regulate emotional
responses, learning, attention, and movement) in the brain’s reward system, which
contains a set of neural pathways that are
involved in the experience of pleasure. In
addition, brain-imaging technologies have
shown that our brains respond similarly to
different pleasurable experiences, whether
the pleasure is derived from ingesting alcohol or other drugs or from engaging in behaviors such as shopping, gambling, or exercise
(Werme, Lindholm, Thoren, Franck, & Brene,
2002; Werme, Thoren, Olson, & Brene, 2000).
©iStockphoto/Thinkstock
Brain-imaging technologies have shown that
our brains respond similarly to different
pleasurable experiences.
Syndrome Model of Addiction
While most past research has focused on chemical objects of addiction, there is increasing
evidence showing that behavioral objects of addiction (e.g., gambling, exercising) have a similar influence over the reward system. This indicates that seemingly disparate patterns of
addiction, such as heroin addiction and sex addiction, might actually stem from a common
cause. This emerging view among clinicians and addiction experts is known as the syndrome
model of addiction (Shaffer et al., 2004), which supports the philosophy that there is only
one addiction disorder, as opposed to many different addictions.
Furthermore, the syndrome model categorizes addiction as a complex condition with a variety of symptoms and signs that are not always present for every person with the disorder. As a
result, addiction gets expressed in many different ways, including a drug or drug-free activity
(such as exercising, gambling, shopping, etc.). For addiction to develop, the activity or drug
must shift a person’s subjective experience in a personally desirable direction.
These findings suggest that the specific behavior or substance of addiction is less important
than previously thought.
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Major Types of Commonly Abused Substances
Section 9.5
9.5 Major Types of Commonly Abused Substances
Drugs of abuse can generally be described in four different categories: depressants, stimulants, opiates, and hallucinogens. From a biological standpoint, marijuana has depressant,
stimulant, and hallucinogenic effects, and thus it will be considered separately.
Depressants
Depressants reduce nervous system activity, resulting in reduced anxiety and an overall
sense of relaxation. At higher doses, brain activity becomes more disrupted, and these substances can produce stupor or insensibility. Motor skills and logical reasoning are affected,
and fatigue may also result.
Alcohol is the most common depressant, and it is one of the most widely abused drugs in
the United States. Moreover, alcohol abuse is the third leading preventable cause of death in
the United States (CDC, 2014). Alcohol abuse is implicated in many homicides (for both the
victim and perpetrator), automobile accidents, and hospital admissions. Excessive amounts
of alcohol often cause blurred vision, loss of coordination, slurred speech, impaired motor
skills, memory impairment, sudden mood swings, irregular pulse, vomiting, dizziness, and a
progressive loss of inhibitions. One of the main effects on logical reasoning is the inability to
think about possible outcomes of one’s actions, creating a short-sighted view of the world due
to intoxication known as alcohol myopia. Long-term consequences of chronic heavy use may
lead to ulcers, pancreatic damage, cirrhosis (liver failure), arrhythmia (irregular heartbeat),
and high blood pressure.
Barbiturates—highly addictive drugs that act as a nervous system depressant—have been
used historically as sleep aids and anxiety-reducing medications. Recently, they have been
replaced in popularity by benzodiazepines, which are less prone to overdose. Benzodiazepine
is a nervous system depressant that is often used to promote sleep and reduce anxiety; the
most common benzodiazepine is diazepam (Valium). Similar to alcohol, both of these drugs
can cause a sense of mild euphoria or relaxation. However, these drugs are highly addictive
and can result in coma or death if taken with alcohol.
Stimulants
Stimulants cause an increase in arousal in the nervous system. They increase blood pressure,
pulse rate, alertness, euphoria, and excitation. Loss of appetite and insomnia are also common
effects of stimulant use. Typically, the stimulant user experiences pleasant outcomes initially,
such as a state of euphoria (“on a high”) with increased energy. It is also common for users to
be talkative, feel restless, be hypervigilant (“on edge”), and have difficulty falling asleep.
Prolonged use of high doses of stimulants can result in brain damage or stroke and may
produce significant personality changes. Other psychological effects associated with longterm stimulant use include anxiety, delusions of grandeur, confusion, paranoia, and violent
behavior.
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Section 9.5
Major Types of Commonly Abused Substances
Major stimulants include cocaine, crack, amphetamine, methamphetamine, and ecstasy.
Minor stimulants include sugar, caffeine, and nicotine, which are (in addition to alcohol) the
most commonly used psychoactive substances in the United States. Moreover, some stimulants are considered to be gateway drugs that, while not necessarily addictive, may lead to
the use of more or other addictive drugs.
Cocaine
Cocaine is a highly addictive illegal stimulant drug of abuse that can be administered in one
of four ways.
• Orally: Users may rub the drug onto
their gums.
• Intravenously: Users may dissolve
the drug in water and inject it.
• Intranasally: Users may snort the
drug.
• Inhalation: Users may smoke the
drug by inhaling its vapor into the
lungs.
Cocaine use ranges from occasional to
repeated or compulsive use. Any of the
routes of administration listed previously
can potentially lead to absorption of toxic
amounts of the drug, causing strokes, seizures, respiratory failure, and heart attacks.
Crack is a form of cocaine that can be
smoked, and it can be especially dangerous
due to its fast and potent effects. It produces
an immediate rush within 5 to 10 seconds
of ingestion, and the high lasts only for a
total of 5 to 15 minutes. This cycle of rapid
“rush” and “crash” creates a cycle of craving
the drug.
Brookhaven National Laboratory/Thinkstock
PET scans of a normal brain (top) and a
cocaine abuser’s brain 10 days (middle)
and 100 days (bottom) after using cocaine.
Bright red and yellow indicates normal
metabolic activity.
Amphetamines and Methamphetamines
Amphetamines cause increased arousal, reduced appetite, and a decreased need for sleep.
Physiological effects include an increase in blood pressure and heart rate, while psychological effects may include anxiety, hypervigilance, euphoria, and paranoia. Prolonged use of high
doses of amphetamines can result in brain damage or stroke, and users commonly suffer from
withdrawal after discontinuation, leading to irritability, depression, and fatigue.
Similarly, methamphetamines are highly addictive illegal stimulant drugs that are commonly used to help people stay awake. Acute effects include loss of appetite, increasing heart
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Major Types of Commonly Abused Substances
Section 9.5
rate, difficulty breathing, irritability, hyperactivity, and insomnia. Long-term effects may
include intense drug cravings and psychotic symptoms, including hostility, paranoia, or auditory hallucinations.
Ecstasy
Ecstasy is a drug with both hallucinogenic (discussed later) and stimulant effects. Physiologically, ecstasy causes increased blood pressure and heart rate, as well as nausea, chills, sweating, teeth clenching, and blurry vision. Psychologically, ecstasy can cause feelings of increased
alertness, euphoria, and an overwhelming sense of connectedness and well-being. While
ecstasy commonly enhances sexual desire, it is also known to impair sexual performance.
Caffeine
Believed to be the most popular drug in the world (it is consumed by approximately 90% of
people), caffeine is a legal nervous system stimulant that occurs naturally in chocolate, tea,
coffee, and other products. It is also artificially added to products like soda.
The effects of caffeine vary based on an individual’s sensitivity to the drug, and it does have
addictive properties. When people who regularly consume caffeine stop abruptly, they can
experience withdrawal symptoms like headaches, irritability, and fatigue. (Sugar has also
been found to be an addictive substance with physiological and psychological effects similar
to those of caffeine.) Fortunately, consumption of neither caffeine nor sugar has been found
to be connected to criminal behavior.
Nicotine
While nicotine—a potent stimulant that is found in tobacco—is highly addictive and considered a gateway drug, its use has also not been found to be connected to criminal behavior.
Nicotine use is often maintained because it helps reduce negative emotional states, including
anger, fear, and anxiety; however, unlike certain other stimulants and substances discussed
in this chapter, heavy use of nicotine has not been found to result in significant psychological
disturbances.
Opiates and Opioids
Opiates consist of naturally occurring, pain-reducing, and highly addictive drugs that are
used in recreational and medical settings. Popular examples of opiates include morphine and
codeine.
Opioids are similar to opiates, except opioids are the synthetic versions of these drugs.
Heroin, hydrocodone, and oxycodone are among the most well-known opioids. These drugs
depress the nervous system and produce a sense of euphoria and decreased reaction to pain.
If taken in a high enough quantity, opioids can lead to stupor, insensibility, and possibly death
by respiratory suppression. See Spotlight: The Opioid Crisis to learn about the problems that
opioids—specifically prescription opioids—have caused in the United States.
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Section 9.5
Major Types of Commonly Abused Substances
Spotlight: The Opioid Crisis
The United States has an opioid crisis. Nearly 130 Americans die every day from an overdose
of opioids, the class of drugs that includes heroin, hydrocodone, oxycodone, morphine, and
codeine. In 2017 more than 70,000 Americans died from drug overdose. In that same year,
opioids killed more than 47,000 people, and 68% of those deaths involved prescription opioids.
Deaths involving prescription opioids in 2017 were 6 times higher than in 1999 (CDC, 2018).
It is estimated that prescription opioid abuse in the United States costs $78.5 billion a year,
including health care and addiction treatment costs, lost productivity, and law enforcement
involvement (Florence, Feijun, Xu, & Zhou, 2016). Drug overdose is now the leading cause of
accidental death in the United States, and opioid addiction is driving this crisis. (See Figure 9.2.)
Figure 9.2: U.S. opioid overdose deaths over past 20 years
Opioid overdose deaths continue to increase in the United States. From 1999 to 2017,
nearly 400,000 people died from an overdose involving an opioid.
10
Commonly prescribed opioids
Natural and semi-synthetic opioids and Methadone
Deaths per 100,000 population
9
8
Heroin
7
Other synthetic opioids
e.g., Tramadol and Fentanyl, prescribed or illicitly manufactured
6
5
4
3
2
1
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
Year
Wave 1: Rise in
prescription opioid
overdose deaths
Wave 2: Rise in
heroin overdose
deaths
Wave 3: Rise in
synthetic opioid
overdose deaths
From “Understanding the Epidemic,” by the Centers for Disease Control and Prevention, 2018 (https://www.cdc
.gov/drugoverdose/epidemic/index.html).
So, what can be done? Reducing the number of deaths connected to opioid use will require
addressing the issue from multiple angles. For example, in many treatment facilities, clinicians
are attempting to reduce or eliminate patients’ exposure to opioid pain medications.
(continued)
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Section 9.5
Major Types of Commonly Abused Substances
Spotlight: The Opioid Crisis (continued)
Additionally, there has been a dramatic rise in community-based education efforts. These initiatives are typically aimed toward educating people about opioids while helping reduce the
stigma associated with seeking treatment and resources for opioid use disorder.
Community-based education has also assisted local leaders and decision makers in utilizing
resources and building capacity for multifaceted community conversations and policy actions
related to opioid use.
Finally, several states are working to introduce legislation to expand rehabilitation and intervention services for those impacted by the growing opioid crisis. For example, in the state of
Florida, legislation passed in 2019 restricts opioid prescriptions to no more than a 3-day supply (Regulation of Professions and Occupations, 2019).
Hallucinogens
Hallucinogens frequently cause enhancement of sensory experiences and distortions of reality. In other words, these drugs produce a very intense alteration of feelings, thoughts, and
perceptions. Physiological effects include sweating, dilation of pupils, and increased blood
pressure, body temperature, and heart rate. Tolerance to hallucinogens builds rapidly, which
means that people need to take steadily increasing amounts of these drugs to experience
similar effects. LSD and ecstasy are among the most common hallucinogens.
Interestingly, most research indicates that use of hallucinogens does not increase criminal or
violent behavior, although people’s emotional responses can vary greatly. For example, for
some people use of hallucinogens can increase the effects of preexisting psychopathology,
including aggression or violent behavior.
Marijuana
Marijuana is the most widely used illicit
drug, although an increasing number of
states are moving (or have already moved)
toward legalizing the drug. The pros and
cons of this movement continue to be
debated, particularly from public health,
social justice, and law enforcement perspectives. In addition, there are still many
unanswered questions about the economic
impact of legalization.
What does science tell us about the risks
and benefits of marijuana use? Marijuana’s popularity is tied to its mood-altering
effects. Specifically, marijuana produces an
altered state of consciousness characterized
by relaxation and euphoria. It also produces
Seth Michael/iStock/Getty Images Plus
A marijuana farmer examines his plants. A
number of states—including Washington,
Oregon, California, Nevada, Colorado,
Michigan, Alaska, Maine, Massachusetts, and
Vermont—and the District of Columbia have
fully legalized the drug.
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Section 9.6
Relationship Between Substance Abuse and Criminal Behavior
physiological effects, including fatigue, lowered blood pressure, and increased appetite, as
well as perceptual alterations such as impairments to reaction time, motor skills, and shortterm memory. In addition, there is a significant linkage between heavy marijuana use and
criminal involvement.
9.6 Relationship Between Substance Abuse and Criminal
Behavior
Research consistently demonstrates a strong connection between substance abuse and criminal behavior. Most people entering the criminal justice system have substance use problems
and/or are using illicit substances at the time of their arrest (Belenko & Peugh, 2005; Chandler, Fletcher, & Volkow, 2009). In addition, many individuals engage in criminal behavior to
get money to purchase drugs, and the sale of drugs is often likely to take place in situations in
which other crimes may occur. And stimulants such as methamphetamines have psychological and physiological effects that can increase the likelihood of engaging in criminal behavior
(Cartier, Farabee, & Prendergast, 2006).
Table 9.1 provides statistics on how many state and local prisoners are reported to have used
drugs during a crime and a month before a crime. Drug use in the month before and at the
time of property and drug offenses among sentenced jail inmates was slightly higher than for
state prisoners. A third to half of all state and local prisoners had used drugs during or soon
before committing the crimes for which they were arrested.
Table 9.1: Drug use among state prisoners and sentenced jail inmates,
2007–2009
State prisoners
Sentenced jail inmates
Month before
offense
At time of
offense
Month before
offense
At time of
offense
All inmates
Most serious offense
39.3%
42.0%
54.5%
37.2%
Violent
34.4%
39.9%
53.6%
37.2%
Drug
47.1%
50.2%
66.6%
50.6%
Characteristic
Property
DWI/DUI
47.0%
33.5%
50.1%
27.5%
63.4%
24.2%
46.4%
16.8%
Source: From Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007–2009 (p. 6), by J. Bronson, J. Stroop,
S. Zimmer, and M. Berzofsky, 2017. Washington, DC: Bureau of Justice Statistics.
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Relationship Between Substance Abuse and Criminal Behavior
Section 9.6
While it’s not feasible to summarize the entire body of research, there have been two noteworthy meta-analyses (systemic reviews on the literature) and several research studies with
particularly interesting results.
Noteworthy Reviews and Studies
Derzon and Lipsey (1999) conducted a review and an analysis of existing evaluation studies that examined the relationship between marijuana use and problem behaviors, including
juvenile delinquency (i.e., behavior by a young person that is illegal or wrongful; discussed in
Chapter 6). Their review was based on 63 reports that summarized 30 independent studies
and found a significant association between marijuana use and various forms of delinquency,
including property crimes, aggressive behavior, and crimes against a person.
In a subsequent review, Bennett, Holloway, and Farrington (2008) examined the results of
30 studies that presented findings on the relationship between measures of substance use
and measures of crime. The results showed that the likelihood of engaging in criminal behavior was approximately 3 to 4 times greater for substance users than non-substance users. In
addition, the researchers discovered that the relationship between substance use and crime
varied widely depending on the substance that was used. For example, crack cocaine use
displayed the strongest relationship with criminal behavior, followed by heroin and powder
cocaine. Recreational substance use was also found to be connected with criminal behavior,
but at a much lower level than frequent use. In addition, marijuana users were found to be
1.46 times more likely to commit crimes compared to non-marijuana users, and amphetamine
users were 1.93 times more likely to engage in crime compared to non-amphetamine users.
In addition to these meta-analyses, three distinct types of research have also helped establish
the relationship between substance use and criminal behavior: general surveys of substance
use, studies of criminal behavior in substance-abusing populations, and studies on substance
abuse in criminal populations.
General Surveys of Substance Use
As an example of a general survey, the CDC’s 2017 Youth Risk Behavior Surveillance consisted
of a nationally representative sample of thousands of students enrolled in private and public
high school students throughout the United States. According to this survey, 5.5% indicated
that they had driven a car under the influence of alcohol, and 13% indicated that they had
driven a car under the influence of marijuana. In addition, compared to other students, more
than 2 times as many students who reported significant substance use also indicated that
they carried a weapon or had gotten into a fight in the past 30 days. Take a look at Tables 9.2
and 9.3 for a breakdown of the statistics for males and females according to race and grade
level.
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Section 9.6
Relationship Between Substance Abuse and Criminal Behavior
Table 9.2: Percentage of high school students who drove
after drinking alcohol*
Category
Female
Male
Total
White
3.8
6.3
5.0
Hispanic
Grade
5.4
9
11
Race/Ethnicity
Black
10
12
4.2
4.1
4.1
8.5
7.0
2.4
4.0
3.2
4.1
6.9
5.5
2.4
5.9
4.9
3.2
10.4
8.1
*In a car or other vehicle, one or more times during the 30 days before the survey, among
the 62.6% of students nationwide who had driven a car or other vehicle during the 30 days
before the survey.
Source: From “Youth Risk Behavior Surveillance—United States, 2017,” by the Centers for
Disease Control and Prevention, 2018, Surveillance Summaries, 67.
Table 9.3: Percentage of high school students who drove
after using marijuana*
Category
Female
Male
Total
White
10.2
13.7
11.9
Hispanic
Grade
13.6
9
11
Race/Ethnicity
Black
10
12
13.3
14.1
13.7
15.9
14.8
4.5
10.2
7.3
11.7
12.8
8.9
16.5
13.5
11.3
20.1
18.3
12.3
*In a car or other vehicle, one or more times during the 30 days before the survey, among
the 62.6% of students nationwide who had driven a car or other vehicle during the 30 days
before the survey.
Source: From “Youth Risk Behavior Surveillance—United States, 2017,” by the Centers for
Disease Control and Prevention, 2018, Surveillance Summaries, 67.
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Section 9.6
Relationship Between Substance Abuse and Criminal Behavior
Studies of Criminal Behavior in Substance-Abusing Populations
There is a vast amount of research regarding criminal behavior in substance-abusing populations. For example, a study involving more than 200 heroin users determined that more than
95% of those heroin users were engaged in other illegal activities (Johnson, Maher, & Friedman, 2001). A separate study determined that approximately 99% of those heroin users had
committed at least one crime in the past year (Inciardi, 1986). While the majority of crimes
included drug sales and property offenses, thousands of burglaries, robberies, and assaults
also occurred. Additionally, a study focused on opiate abusers reported that nearly 95% of
heroin users were engaged in other criminal behaviors and that their participation in crimes
was highest during their periods of heaviest heroin abuse (Nurco, Hanlon, Kinlock, & Slaght,
1989).
As you can see, there is a significant amount of research that has investigated the relationships between criminal behaviors and types of substance use. This is true both in the United
States and internationally. In an Australian study, Makkai (2001) found that arrestees testing
positive for opiate use were more than 4 times as likely to be charged with a property offense
compared to arrestees who were non-opiate users. Additionally, arrestees who tested positive for cocaine use were more than 2 times as likely to be charged with a violent offense.
In a study conducted in the United States, Johnson, Natarajan, Dunlap, and Elmoghazy (1994)
conducted interviews with more than 1,000 substance abusers and found differences between
the abuser types. For example, crack users were found to be more likely than non-substance
abusers to report shoplifting offenses (21% compared to 9%). In a separate study, Johnston,
O’Malley, and Eveland (1978) found a strong relationship between substance abuse and different types of criminal behavior, including interpersonal violence. Specifically, the
drugs that were most strongly correlated
with interpersonal violence were cocaine,
heroin, amphetamines, and barbiturates.
More recently, Bennett and Holloway
(2005) found that users of cocaine and
heroin were nearly 5 times more likely to
commit shoplifting offenses than nonusers.
Also, marijuana users were nearly twice as
likely to commit nonresidential burglaries compared to non-marijuana users and
approximately 3 times as likely to commit
drug-supply offenses.
vchal/iStock/Getty Images Plus
Bennett and Holloway (2005) found that users
of cocaine and heroin were nearly 5 times
more likely to commit shoplifting offenses.
Studies on Substance Abuse in Criminal Populations
Studies on substance abuse with incarcerated offender populations have also yielded informative results. For example, Karberg and James (2005) surveyed more than 600,000 prisoners and found that 68% of them met criteria for substance abuse. The results of this study also
indicated that more extensive substance use by prisoners was correlated with a more extensive history of criminal behavior. In addition, the Arrestee Drug Abuse Monitoring Program
was an excellent resource in establishing the prevalence of substance use among arrestees.
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Relationship Between Substance Abuse and Criminal Behavior
Section 9.6
In 2001 the research program identified several key findings related to substance use and
criminal behavior, including the following.
1. Urine tests of people arrested indicated that 65% tested positive for at least one
illegal substance.
2. Cocaine or opiate use was found in 29% of people arrested.
3. Repeat offenders accounted for 15% of those arrested; they indicated regular use of
crack or heroin.
4. Users of crack and heroin represented less than 25% of the sample yet were responsible for more than 60% of the illegal income reported.
5. Of those arrested, 40% acknowledged a relationship between their own substance
use and criminal behavior. (National Institute of Justice, 2006)
Research conducted on substance abuse in both criminal populations and their victims supports a strong relationship between criminal behavior and substance abuse. For example, the
National Crime Victimization Survey presents national data on an annual basis about criminal victimization in the United States. One of the questions asked on this survey to victims is
whether they believed the perpetrator was under the influence of alcohol or drugs at the time
of the crime. Consistently, victims have indicated that approximately 50% of the perpetrators
appeared to be under the influence at the time of the crime (Bureau of Justice Statistics, 2018).
The results of research in this area are highly consistent in determining that people who commit crimes are far more likely to abuse substances than people who do not commit crimes.
Consequences of Criminal Behavior Related to Substance Abuse
The use of illicit substances exposes people to criminal prosecution by local, state, and federal authorities. Immediate penalties can include fines, loss of driving privileges, and possible
time in prison. Moreover, people who abuse substances in early adulthood may establish patterns of behavior that later disrupt their careers and limit their ability to maintain healthy
family and social lives.
Substance abuse undoubtedly constitutes a major problem in the United States and around
the world. Substance abuse can lead to a variety of negative outcomes, including a longlasting decrease in occupational and social functioning, as well as rates of greater morbidity
and early mortality. Out of every 100,000 people around the world, 33 are estimated to die
from alcohol-related causes, and 7 are estimated to die from illegal drug use (Peacock et al.,
2018). The Bureau of Justice Statistics (2018) reports that 3.9% of the 14,831 homicides
that were committed in 2007 were substance related. From 2000 to 2010, the CDC (2012)
reported a 55% increase in heroin-related deaths.
Overall, the consequences of criminal behavior related to substance abuse are astounding.
The emotional costs to individuals with substance use disorders, their families, and the victims of their crimes are incalculable. In addition, substance abuse involves great financial
costs for societies, including direct and indirect costs associated with criminal activity, law
enforcement, accidents, hospitalization, and treatment. The National Institute on Drug Abuse
(NIDA, 2017) estimates that the total crime-, work-, and health care–related costs of substance abuse were more than $740 billion annually.
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Strategies for Reducing Substance Abuse and Substance-Related Crime
Section 9.7
9.7 Strategies for Reducing Substance Abuse and
Substance-Related Crime
Substance use disorders are among the most preventable health issues in the United States.
Strong empirical evidence over the past several decades has consistently demonstrated that
substance abuse treatment reduces criminal behavior. Treatment might include individual
counseling and/or family-based treatment. For some people in need of alcohol or other drug
treatment, contact with the criminal justice system can sometimes represent their first opportunity for treatment. Moreover, legal incentives (e.g., consequences) may motivate someone
to get treatment who was otherwise resistant.
For other people, getting arrested or incarcerated is part of a recurring cycle of substance
abuse and criminal behavior. People with ingrained patterns of maladaptive beliefs and coping skills may require a more intensive treatment approach, particularly among people with
a prolonged history of substance abuse and criminal behavior. Illicit substance abuse also
increases the likelihood of continued involvement in crime, with high rates of relapse and
criminal recidivism among offenders. In fact, research has shown that 68% of substancerelated offenders are rearrested within 3 years of release from jail (Levin, 2006). Fortunately,
there are effective treatment models for prisoners and, in addition to beneficial effects for
public health and safety, substance abuse treatment has been shown to improve outcomes for
substance-abusing offenders.
The NIDA (2014) has been a key supporter of research on substance abuse treatment for
individuals involved in the criminal justice system, and findings have shown that providing
comprehensive substance abuse treatment is effective in reducing both substance abuse and
recidivism. Moreover, based on a comprehensive review of the research literature, as well as
consensus from experts in substance abuse research and practice, the NIDA has developed a
monograph summarizing several key principles for effective treatment. Specifically, the NIDA
recommends the following.
1. Treatment must be long enough to produce stable behavioral changes.
2. Services should be tailored to fit the needs of the individual.
3. Treatment should be carefully monitored.
4. Continuity of care is critical as criminals make the transition back into the community.
Supply, Demand, and Harm Reduction Treatment Model
Additionally, the U.S. government has developed several important strategies for reducing
substance abuse, including supply reduction, demand reduction, and harm reduction. The
most effective way of tackling the substance abuse problem and crime problems in the United
States involves a comprehensive, coordinated, and balanced approach, in which supply reduction, demand reduction, and harm reduction all reinforce each other.
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Section 9.7
Strategies for Reducing Substance Abuse and Substance-Related Crime
The supply reduction approach attempts
to put actions and policies in place that
are designed to reduce the production and
supply of illicit substances. One example
of an effective supply reduction policy is
interdiction, which involves intercepting
or destroying supplies of illicit substances
across U.S. borders.
The demand reduction strategy involves
minimizing the actual demand for illicit
substances. A prominent example of the
demand reduction approach is educational
youth programs that are designed to reinforce attitudes, behaviors, skills, and values
associated with resisting substance use.
mofles/iStock/Getty Images Plus
Interdiction involves intercepting or destroying
supplies of illicit substances across U.S. borders.
Finally, harm reduction is a set of ideas and public health strategies aimed at reducing negative consequences associated with substance abuse. Philosophically, harm reduction accepts
that a continuing level of substance use (both legal and illegal) in society is inevitable. Thus,
its objectives are reducing negative economic, social, and health outcomes. An example of
harm reduction is to provide individuals with information aimed at reducing the harmful
consequences of the behavior when it occurs.
Biopsychosocial Model of Treatment
In terms of treatment, the most successful substance abuse and addiction treatment programs
utilize strategies to manage triggers, reduce cravings, enhance coping, and prevent relapse.
Recovery requires an approach that systematically considers the biological, psychological,
and social aspects of substance abuse. In psychology, this is referred to as the biopsychosocial
model of treatment.
Consider the following example. One of the coauthors of this textbook had a colleague who
once suffered a workplace injury that required long-term pain management. This colleague
had a social circle of friends that encouraged the use (and abuse) of alcohol and opiates, which
ultimately resulted in a life-changing drug addiction.
The most effective treatment for this individual would be one that explores the biopsychosocial factors involved in the abuse of and ultimate addiction to alcohol and opiates. As noted in
Figure 9.3, some of these factors may have been financial stress, a negative life event (workplace accident), age, and poor social support.
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Summary and Conclusion
Figure 9.3: Biopsychosocial model of health
The biopsychosocial model considers biological, psychological, and social factors and their complex
interactions in understanding substance use and abuse.
Psychological factors:
Unemployment,
financial stress,
negative life event,
pill burden, smoking,
lack of regular
physical exercise
Social factors:
Socioeconomic status,
educational status,
marital status, major
family conflict, poor
social support
Health
Biological factors:
Age, sex, comorbid disease,
genetics, physical health,
personality/temperament
Engle’s biopsychosocial model of health and disease adapted for our study by Tesfa Dejenie Habtewold, used under CC BY /
Adapted from original.
Summary and Conclusion
The relationship between substance abuse and crime is complex. There are four primary
reasons why people use drugs and other substances: to feel good, to feel better, to perform
better, and to conform to peer pressure or satisfy curiosity. There is always a risk that an
individual may move from regular to chronic substance abuse and develop an addiction.
Substance use and addiction are influenced by broad cultural, economic, environmental,
social, and situational contexts that influence the likelihood of crime occurring. While the
exact mechanisms underlying addiction are not fully understood, it is hypothesized that
the contribution of differing factors (biological, psychological, social) varies between individuals. The current classification system that is primarily used to diagnose addiction and
substance use disorders is the DSM.
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Summary and Conclusion
This chapter also provided a brief overview of the major types of commonly abused
substances—depressants, stimulants, opiates and opioids, hallucinogens, and marijuana—
and their links to criminal behavior. Alcohol and drugs are commonly found in both offenders and victims of crimes. Substance abuse is highly associated with criminal behavior; there
is strong evidence that substance abusers are more likely than non-substance abusers to
engage in criminal behavior and that people who commit crimes are more likely to be substance abusers than people who do not commit crimes.
Major strategies for reducing substance abuse and substance-related crime include supply
reduction, demand reduction, and harm reduction. Supply reduction involves implementing
policies that are designed to reduce the production and supply of illicit substances. Demand
reduction involves reducing the actual demand for illicit substances, primarily by working
with youth and teaching them to resist drug use. Harm reduction aims to reduce negative
economic, health, and social consequences associated with substance abuse.
Critical Thinking Questions
1. If a person abuses an illicit substance, should she or he be treated as a criminal? Or
should the person be treated as someone who has a disease?
2. Is the relationship between substance use and mental illness important when thinking about crime? Why or why not?
3. Do you think parents should be prosecuted when their children (under the age of
18) abuse illicit substances? Why or why not?
Key Terms
addiction A chronic disorder with
environmental, biological, social, and
psychological factors that influence its
development and maintenance.
alcohol myopia The inability to think about
possible consequences of one’s actions due
to alcohol intoxication.
amphetamine A nervous system stimulant
that causes physiological effects such as
increased arousal, a reduction in appetite, a
decreased need for sleep, and psychological
effects such as anxiety, euphoria, and
paranoia.
barbiturate A highly addictive drug that
acts as a nervous system depressant and is
often used for insomnia and anxiety.
benzodiazepine A nervous system
depressant that is often used to promote
sleep and reduce anxiety.
caffeine A legal nervous system stimulant
naturally occurring in chocolate, tea, coffee,
and other products.
chronic Constantly recurring or persisting
for a long time.
cocaine An addictive stimulant drug that
increases arousal in the nervous system and
results in a euphoric high.
crack A powder form of cocaine that can
be smoked. Produces an immediate “rush”
within 5 to 10 seconds of ingestion and a
subsequent “crash.”
demand reduction A drug reduction policy
that involves actions and strategies designed
to decrease or eliminate an individual’s
desire to use illicit substances.
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Summary and Conclusion
depressant Any substance that reduces
functioning of the nervous system. Produces
reduced anxiety and an overall sense of
relaxation.
dopamine A chemical in the brain that
helps regulate emotional responses,
learning, attention, and movement.
drug Any substance that alters the
functioning of the nervous system and mind.
ecstasy An illegal drug with stimulant and
hallucinogenic effects.
euphoria A feeling of well-being or elation.
gateway drugs Habit-forming drugs that,
while not necessarily addictive, may lead to
the use of more or other addictive drugs.
nicotine A potent stimulant that is found in
tobacco.
opiates Naturally occurring, painreducing, and highly addictive drugs used in
recreational and medical settings.
opioids The synthetic versions of opiates.
relapse A return to substance use after a
period of improvement.
reward system The set of neural pathways
in the brain that are involved in the
experience of pleasure.
stimulant A drug that causes an increase in
arousal of the nervous system. These include
cocaine, amphetamines, methamphetamines,
ecstasy, caffeine, and nicotine.
hallucinogens A diverse group of
drugs that alter feelings, thoughts, and
perceptions.
substance Anything that can alter an
individual’s cognition or mood.
interdiction An effective supply reduction
policy that involves intercepting or
destroying supplies of prohibited items.
substance use disorders Patterns of
symptoms resulting from the use of a
substance that an individual continues
to take despite experiencing problems as
a result of the substance use. This is the
current terminology used in the DSM-5.
harm reduction A set of ideas and
strategies aimed at reducing negative
consequences associated with substance
use.
marijuana A drug that produces moodaltering effects such as relaxation and
euphoria. Though illegal in some states,
an increasing number of states are moving
toward legalizing it for recreational or
medical use.
methamphetamine A highly addictive and
potent nervous system stimulant commonly
used to help people stay awake.
nervous system The network of nerve cells
and fibers that transmit signals between
different parts of the body. Essentially the
body’s wiring.
substance abuse The hazardous or
harmful use of substances. This term is no
longer included in the DSM-5; however, it
is still commonly used by researchers and
government officials.
supply reduction A drug reduction policy
that involves actions and strategies designed
to reduce the production and supply of illicit
substances.
syndrome model of addiction A theory
that suggests there is one addiction that is
associated with multiple expressions.
withdrawal symptoms Physical and/or
psychological symptoms that occur when a
substance is absent from the body.
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