Drug Use as a Global Social Problem

Erich Goode. Handbook of Social Problems: A Comparative International Perspective. Editor: George Ritzer. Sage Publications, 2004.

Aperusal of scholarly articles, research monographs, and textbooks verifies that the bulk of discussions of social problems focus on a single country—usually the United States. The subject is rarely taught, and the topic is rarely studied, outside the United States. The purpose of such discussions, insofar as other countries are considered, is to assess the impact of social problems on that single country. In fact, the very definition of what a social problem is in the first place has typically been based on a single country as its unit of analysis. For instance, a major theoretical monograph opens with the following question to its readers: “What do you think are the ten most important social problems in the United States today?” (Loseke 1999:3). The worldwide perspective rarely enters into discussions of social problems.

This book represents a departure from the tradition that social problems need be isolated to a single country or society. Our position is that the most significant social problems are international in scope—indeed, global. Hence, a consideration of social problems from a worldwide perspective has become necessary. This is especially the case with respect to drug use. The cocaine used on the streets of Los Angeles was derived from coca plants grown in Peru, Bolivia, and Colombia. The antismoking campaigns launched in the United States have an impact in lowering the consumption of tobacco in Brazil. Recent declines in the consumption of alcohol and alcohol-related automobile fatalities that have taken place in North America are also observed throughout Western Europe. The de facto legalization of small quantities of cannabis products in the Netherlands is being debated nearly everywhere in the world; the country’s laissez-faire policy toward the drug has attracted visitors and temporary residents from all over the world. More and more, issues, concerns, conditions—in short, social problems—have assumed global dimensions. Hence, in this chapter, I will examine drug use as an international problem.

The process of globalization has an impact on three different yet interconnected aspects of the drug problem: drug trafficking, drug consumption, and reactions to drug trafficking and drug consumption. Globalization influences the production and sale of illicit drugs because of the development of international networks linking their ultimate source, that is, growers and manufacturers, through smugglers and wholesale traffickers, to the retail, sellerto-user connection. Globalization also influences the consumption of drugs not only through trafficking, that is, the process of delivering the substances to the user, but also as a result of broadcasting role models of drug consumption in global media and other modern means of communication; the spread of conceptions of a recreational youth culture, a lifestyle that certain drugs are seen to enhance; and worldwide economic changes that have fostered the growth of large strata of young people with disposable incomes and recreational time on their hands (United Nations [UN] 2001:19). And the internationalization of reactions to drug trafficking and consumption include antidrug social movement activity, such as antidrug media campaigns, news stories on drug arrests and other police activity, reports of the results of drug surveys, and the doings of drug users; the adoption of treatment programs; subdirectories of the UN; Interpol and other international police agencies; and political and military efforts to eradicate drug trafficking and drugs at their source. Here, we shall examine some of these global networks.

Drugs, Drug Abuse, and Drug Dependence: Some Basic Definitions

The term drug may be defined in several ways. Within a medical context, a “drug” is a therapeutic agent physicians use to heal the body; in this sense, penicillin is a drug. Within a legal context, a “drug” is a controlled substance, one whose possession and sale are subject to legal penalties under specified circumstances. Within a psychopharmacological context, a “drug” refers to a substance that is psychoactive, that is, that influences the workings of the mind and has an effect on mood, emotion, and cognitive processes. It is this third definition that I will follow here. Of course, some substances are drugs according to two or even all three of these definitions. For instance, morphine is used by physicians to block pain, is a controlled substance whose possession and sale outside a medical context are illegal, and is psychoactive. Psychopharmacologically, both alcohol and tobacco, although legal and not used for medicinal purposes, are drugs and hence will be considered as such in this chapter.

Researchers distinguish drug “use” from drug “abuse.” Drug use is a neutral term that refers to any effectual consumption of a psychoactive substance. In contrast, drug abuse is defined in various ways, according to the interests of the observer. Nonetheless, most drug specialists follow the dictionary definition of abuse, that is, “to treat in an injurious, harmful way.” Hence, following this definition, drug abuse refers to a level or degree of use of one or more substances that is harmful or that risks a significant measure of harm to the user and/or others. According to this definition, alcoholism is a form of drug abuse, as would be nearly all cigarette smoking. Obviously, abusiveness is a matter of degree; there is no precise cutoff point demarcating “abusive” from “nonabusive” drug use. Nonetheless, as a general rule, the higher the doses and the more frequent the use, the greater the likelihood that it constitutes abuse.

Another crucial distinction is that between use and dependence. “Use” encompasses any and all effectual consumption of psychoactive substances, including experimentation and occasional consumption. In contrast, “dependence” characterizes only the upper reaches of use. Prior to the 1970s, “addiction” referred to a type of dependence on a substance that produces a clear-cut physical withdrawal symptom when use of the drug is abruptly discontinued. Chemically addictive drugs include the narcotics, the sedatives (such as barbiturates), and alcohol, a major sedative. It became clear to researchers that a number of drugs, while not physically addictive, produce a strong pattern of dependence or continued, uncontrollable, harmful use in a substantial proportion of users; cocaine and the amphetamines provide striking examples. Currently, in addition to physical addiction, experts include psychic and behavioral dependence within their scope of drug dependence. Drug dependence is defined as the recurrent yearning for a psychoactive substance such that the user seems incapable of discontinuing its use despite its negative consequences. In clear-cut patterns of dependence, the user’s life revolves around the acquisition of the drug and getting high, thereby undermining or destroying that which was previously valued, such as academic achievement, job and career, income, house, marriage, family, and children. Again, not all drug use is dependence, and not all physical addiction is psychological dependence, and vice versa (McKim 2003:42-3, 74-103). In fact, within the entire circle of at-least-onetime users, for practically every psychoactive substance (except tobacco), persons who are dependent on the drug constitute a minority. Even regular users are more likely to be casual and infrequent in their consumption than heavy, chronic, or compulsive.

What Makes Drug Use a Social Problem?

Nearly all definitions of social problems are based on at least three elements: a real or imagined condition; the feeling on the part of a segment of the population that that condition is bad, wrong, or undesirable; and the attitude that something can, should, and needs to be done to change that presumably undesirable condition (Loseke 1999:5-7). Lurking behind this seeming agreement, however, looms a major rift in the field.

Social problems have been defined in two starkly different ways, objectively (Manis 1974, 1976) and subjectively (Best 1995:3-10; Loseke 1999:3-21). Objectivism adopts an essentialistic approach: A phenomenon is defined by an inner “essence” that is manifested in measurable, concrete ways. Subjectivism adopts a constructionist approach; here, a phenomenon is defined by how it is conceptualized, regarded, perceived, talked about, defined, dealt with, or reacted to by the relevant members of a society.


The essentialistic approach to social problems is that they exist as an objective condition that harms a substantial number of people, whether in a given society or worldwide. By this definition, objective refers to physical, material consequences we can see and lay our hands on. Accordingly, social problems are “measurable and widespread conditions” that harm “living, breathing people” (Loseke 1999:7). This definition holds that these conditions cause harm that can be measured by specific indicators that all unbiased observers agree are undesirable, such as death, illness, injury, incapacitation, hospitalization, loss of productivity, illiteracy, a stunting of potential, monetary cost, or loss to the society. The operational definition of the social problem is the measurable harm a given condition causes. According to this definition, the existence, seriousness, and causes of social problems are decided by experts, persons who have the training and evidence to determine such things (Manis 1976:25). Objectively speaking, for instance, cigarette smoking is a social problem because it kills people; corporate crime is a social problem because people lose money, their health, and sometimes their lives as a result of the greed of executives; racism is a social problem because millions of minority members are denied their full potential as a result of discrimination against them and society loses the full potential of a segment of the population.

Consider drug use and abuse: Objectively, drug use can cause damage to human life. It can kill people, and make it impossible for users to pursue an education, hold down a job, or remain healthy. Caring for or attempting to cure addicts and alcoholics costs society many billions of dollars and diverts money from other important social enterprises. Drug selling is a dangerous activity, not infrequently leading to murder. Whole communities have been held hostage to drug dealers and users; their members live each day in fear that they will be robbed or killed and that their children will get snatched up by lives of addiction and crime. Millions of American workers are dependent on drugs or alcohol—or both; they lose valuable work time to illness and in the case of jobs that require physical coordination, threaten their lives and those of their coworkers. Alcoholism often destroys families and may embitter their members for a lifetime. Thousands of babies are born addicted each year, often prematurely; withdrawal is life threatening to their tiny bodies, and many of them are difficult, problem children when they enter the public school system. Clearly, the problem of drugs and alcohol has an objective dimension; the quality of human life—indeed, its very existence—is often threatened or damaged by the ingestion of psychoactive substances.


The subjective or constructionist definition does not see the social problem as an objective, concrete real-world condition that causes measurable harm to a substantial number of people in a society. Rather, to the constructionist, social problems need not even be based on objectively real conditions at all. This is why constructionists refer to “putative” conditions. According to the constructionist definition, by Best (1995), “The objective status of those conditions is irrelevant” (p. 6). From the constructionist perspective, social problems “are what people view as social problems” (p. 4). The constructionist’s perspective sees the social problem as follows:

A product, something that has been produced or constructed through social activities. When activists hold a demonstration to attract attention to some social condition, when investigative reporters publish stories that expose new aspects of the condition, or when legislators introduce bills to do something about the condition, they are constructing a social problem. (P. 6)

The defining ingredient of the social problem, says the constructionist, is a claim about the undesirability of a given condition, real or imagined, leading to widespread concern about that condition, culminating in a certain type of collective action to do something about it. Conditions become social problems only when they are defined as or felt to be problematic—disturbing, undesirable, and in need of a solution or remedy. Objectively, real conditions are not problems until they are constructed as such by the human mind, called into being or constituted by the definitional process, and translated into collective action. Conditions that do not even exist in the material world—such as witches, the ritual murder of tens of thousands of children by Satanist cabals, the theft of and commerce in human body parts, and alien abductions—are social problems if they generate widespread public concern.

Constructionists argue that what makes a given condition a problem is the “collective definition” (Blumer 1971) of a condition as a problem, the degree of felt public concern over a given condition or issue. While there are differences among constructionists, there is a common core to their thinking: Conditions become social problems only when they are defined as or felt to be problematic—disturbing in some way, undesirable, and in need of solution or remedy. Social problems do not exist “objectively” in the same sense that a rock, a frog, or a tree exists; instead, they are constructed by the human mind, called into being or constituted by the definitional process (Schneider 1985; Spector and Kitsuse 1973, 1977). Say Spector and Kitsuse (1973), “The existence of objective conditions does not in itself constitute social problems” (p. 5). Fuller and Myers (1941) go on to state, “Social problems are what people think they are, and if conditions are not defined as social problems by the people involved in them, they are not problems to these people, although they may be problems to outsiders or scientists” (p. 320). More contemporaneously, Spector and Kitsuse (1977) define social problems as “the activities of individuals or groups making assertions of grievances and claims with respect to some putative conditions” (p. 75).

To the constructionist, the subjective dimension of a social problem can be measured, manifested, or indicated in at least the following five ways. First, the organized, collective efforts on the part of some members of a society to protest or change a given condition—in short, “social problems as social movements” (Mauss 1975). Second, the introduction of bills in legislatures to criminalize the behavior and the individuals presumably causing the condition (Becker 1963:135ff.; Gusfield 1963). Third, the ranking of a condition or an issue in the public’s rank order of the most serious problems facing the country. Fourth, public discussion of an issue in the media in the form of magazine and newspaper articles and editorials and television news stories, commentary, documentaries, and dramas (Becker 1963:141-43; Ben-Yehuda 1986; Himmelstein 1983:152-54). And fifth, the steps a society takes to deal with, prevent, or remedy the supposed causes or consequences of the condition, in the form of police, prisons, jails, clinics, hospitals, psychiatrists, public education programs, research projects, and so on. Thus, just as to the objectivist, the reality of a social problem can be measured concretely—by death and disease, for instance—to the constructionist, public concern is manifested in what people think, say, or do about a given condition.

It is extremely important to emphasize that the constructionist approach does not argue that because social problems are defined by the social constructionist, they are “just” or “only” constructed—in other words, that they cause no material or objective harm (Best 2000). Social constructions do not deny or contradict objective reality; the two are separate and independent of one another. Conditions may—or may not—exist; they may—or may not—be objectively serious. Saying that problems are constructed does not automatically deny their existence or seriousness; it treats them as an open question. Hence, to say that the drug problem is constructed does not mean that drug abuse does not cause material harm to users and the rest of the society. What is important from the constructionist perspective is to understand what is made of the information of the material world that members of the society process to put together an image and a course of action about a given condition or imputed condition. Likewise, to say that social problems are constituted by claims about supposedly problematic material-world conditions does not mean that those claims are false. Indeed, a claim may be true but not accepted or valorized by the general public, social movement activists, or legislators. The acceptance and implementation of a claim is socially patterned and must be understood as such. A claim about the problemhood of a given condition or putative condition—as well as its acceptance or rejection of that claim—is what the constructionist of social problems investigates, independent of its objective validity. And drug abuse, objectively a serious social problem, also attracts claims that demand systematic investigation.

To determine the objective worldwide problemhood of drug use and abuse, it is necessary to spell out its scope, size, and extent. And to understand how widespread it is on a global scale, it is necessary to understand the forces, factors, or variables that make for one absolutely necessary condition for use: the worldwide distribution of or trafficking in drugs. How do psychoactive substances reach the hands, and bodies, of their eventual consumers?

Factors Facilitating Worldwide Drug Trafficking

If we are to consider worldwide drug-trafficking patterns, we must make a distinction between legal and illegal drugs. How drugs are distributed depends on a variety of factors, and chief among them is their legal status. The fact is, the distribution patterns of legal products are very different from those of illegal products. Moreover, we can have vastly more confidence in the figures on the sale of legal products, which are taxable and whose transactions are recorded, than on the figures pertaining to the distribution of illicit products, whose transactions are not recorded any place to which the researcher has access.


Of all aspects of the global picture involving the sale of legal products, the marketing of tobacco around the world is probably the most interesting. In 1964, the year of the Surgeon General’s Report on Tobacco and Health, 511 billion tobacco cigarettes were sold in the United States, for a per capita sale, among persons age 18 and older, of 4,195. By 1999, only 430 billion were sold, and per capita sales had dropped to 2,136 (Centers for Disease Control [CDC] 1999). In addition, during the 1990s, the news media investigated the tobacco industry and found that its executives had lied about their knowledge of the harm that cigarettes caused; lawsuits began piling up, and the tobacco industry had to pay multi-billion-dollar fines. Clearly, the cigarette companies—and their profits—were in deep trouble. For decades, they had attempted to enter the Asian market, with mixed success; recent developments have spurred them on to redouble their efforts. Half the world’s commercially manufactured cigarettes are sold in Asia. But American companies must compete with Asian brands, which tend to be cheaper. In addition, some Asian countries, such as China, severely restrict the sale of American products, promulgating their own brands.

Perhaps the most interesting feature of marketing cigarettes in Asia—aside from how widespread smoking is there—is its sex-graded pattern of smoking. In Asia, an extremely high percentage of men smoke: In the Philippines and Vietnam, 75 percent; in Indonesia, 66 percent; in China and Taiwan, 55 percent; in South Korea, 54 percent; in Japan, 52 percent; and so on (Bartecchi, MacKenzie, and Schrier 1995; Stesser 1993). Brand loyalty is very important to smokers; hence, for the most part, getting men to switch brands is unlikely to be very successful. But a much lower percentage of Asian women than men smoke: In the Philippines, 18 percent; in Vietnam, 4 percent; in Indonesia, 2 percent; in China, 4 percent; in Taiwan, 3 percent; in South Korea, 5 percent; and in Japan, 10 percent. Cambodia’s smokers display the sharpest sex gradation in the world; there, 90 percent of the men but only 3 percent of the women smoke (Struck 2000). Hence, to get Asian women hooked on cigarettes became a major goal of the tobacco industry. Campaigns to link smoking to women’s liberation (a technique also tried in the United States) are a major thrust of Asian advertising. With chic, fashionably dressed young women advertising and even distributing cigarettes to Asian women, the message is clear: Smoke cigarettes and you will become modern, Western, and liberated. In addition, enticing Asian youngsters to smoke before they adopt a brand became a major objective of American cigarette manufacturers; hence, American cigarette companies have sponsored (as they have in the United States) racing-car teams, athletic events, rock concerts, and fashion shows to appeal to youngsters.

Richard Peto, an Oxford University medical epidemiologist, estimates that between 1990 and 2020, the number of deaths from tobacco-related diseases in Asia will triple; 50 million Chinese now alive, he says, “will eventually die from diseases linked to cigarette smoking” (Shenon 1994:16). If you look at the number of deaths, says Judith Mackay, a British physician, a consultant to the Chinese government helping to develop an antismoking program, “The tobacco problem in Asia is going to dwarf tuberculosis, it’s going to dwarf malaria, it’s going to dwarf AIDS [acquired immune deficiency syndrome], yet it’s being totally ignored” (Shenon 1994:16). Paradoxes such as these intrigue the student of social problems.

Illegal Drugs

The distribution of illegal drugs has been systematically globalized much more recently than for the licit drug markets. Each illicit drug has its own unique source, and each reaches the ultimate customer in a strikingly different way. Moreover, patterns of distribution are labile and shift from year to year, according to law enforcement practices, changes in the weather, and the development of innovations by growers, traffickers, and sellers. In addition, systematic and valid information on trafficking is difficult to come by, and different estimates may contradict one another. Here are two estimates of the countries of origin of cocaine and heroin, one advanced by the UN and the second, by the Abt Associates, under a research contract from a division of the White House, the Office of National Drug Control Policy. The two estimates on cocaine’s origins are the same; the estimates on the origins of heroin are very different.

Drug Trafficking: Varying Estimates

As of 2000, according to the estimate provided by the UN in its publication, Global Illicit Drug Trends 2001, 70 percent of the illicit global production of opium originates in Afghanistan. Myanmar, formerly known as Burma, accounts for 23 percent of the total. (Since the fields in Afghanistan are considerably more productive, roughly half the global opium poppy cultivation areas are located in Myanmar, and roughly a third are in Afghanistan.) Other Asian countries, mainly Pakistan and the former Soviet republics of central Asia, account for 5 percent of worldwide opium production, and Mexico and Colombia, about 2 percent. Bolivia, Peru, and Colombia account for more or less the entire world’s supply of coca; 70 percent of that total originates from Colombia.

In contrast, Abt Associates estimates that 67 percent of the heroin consumed in the United States originates from South America, 23 percent is from Mexico, 6 percent comes from Southwest Asia (Pakistan and Afghanistan), and 2 percent from Southeast Asia (Bruen et al. 2002:1). While it is highly likely that the vast majority of the heroin used in Southwest Asia also originates from Southwest Asia and the vast majority of the heroin used in Southeast Asia originates from Southeast Asia, and it is also true that most of the world’s heroin consumption takes place in Asia, nonetheless, the UN and Abt figures are too divergent to be reconciled. Their divergence underscores the difficulty of accumulating valid information about behavior whose participants wish to conceal. All (or virtually all) the cocaine consumed in the United States, says Abt Associates, originates from Colombia, Peru, and Bolivia (Layne, Johnston, and Rhodes 2002), which is in agreement with the UN’s estimates.

All observers agree, however, that the origin and production of most of the other drugs tends to be much more decentralized and hence, more difficult to estimate. More specifically, according to the UN (2001, 2002), the production of herb cannabis (marijuana) is scattered all over the globe. The majority of the marijuana consumed around the world originates either from domestic or intraregional (that is, from one country to a nearby or adjoining country) production. For instance, more than half the marijuana consumed in the United States is grown domestically; this proportion has been increasing for at least three decades (Pollan 1995). However, some overseas commerce in marijuana does take place, for instance, from West and South Africa and Thailand to Europe, and from Colombia and Jamaica to North America. In contrast, the production of resin cannabis (hashish) is more centralized; worldwide, the majority comes from North Africa (mainly Morocco) and western Asia (Afghanistan and Pakistan). Recently, the former Soviet republics of central Asia have begun exporting both leaf and resin cannabis to Europe.

Since the chemical process is relatively simple, the production of, and hence trafficking in, amphetamine and methamphetamine tends to be largely domestic and intraregional, for instance, within the United States; from Mexico to the United States; within Australia; within China; from one country to another in Southeast Asia; among the countries of Eastern Europe; and from one country to another in Western Europe. However, in the late 1990s, several shipments of methamphetamine manufactured in Thailand have been seized in West Europe and the United States. This may prove to be a growing trend.

In contrast, for most of the countries of the world, Western Europe, mainly the Netherlands and Belgium, remains the principal source for Ecstasy (MDMA). However, recently, seizures of Ecstasy in Latin America indicate that clandestine labs have begun to manufacture MDMA domestically. This may presage a large-scale future development.

Three Models of Drug Trafficking

Three “models” of drug trafficking can be delineated: the pure agricultural model, the pure chemical model, and the mixed model. The “pure agricultural” model refers to systems of trafficking that harvest a product that requires little or nothing (aside from drying and separating parts of the plant) in the way of converting it into the ultimate product; it is consumed more or less as grown. Clearly, marijuana offers the best example here. The “pure synthetic” model refers to a chemical product that does not have its origin as an agricultural product at all, but is developed, from beginning to end, in the lab. And the “mixed” model refers to a product that begins as agricultural produce, which is then synthesized or converted into a chemical, eventually becoming what is consumed by the customer. Heroin (which begins as the Oriental poppy or opium plant) and cocaine (which begins as the coca plant) provide paramount examples here. Each of these “models” harbors some variation, of course, depending, in the case of agricultural products, on the hardiness of the plant and hence whether it can be grown locally or must be imported from abroad, and in the case of synthetic products, the complexity and difficulty of the chemical process. The discussion below applies mainly to the “mixed” model, which requires funneling the produce of many farms (raw opium and coca leaves) to a fairly small number of labs, through high-level traffickers and smugglers, fanning out once again from higher-level to lower-level dealers. The other two models present their own special social and economic structures that make generalizing about them a very different proposition.

Factors Facilitating Worldwide Drug Trafficking

Worldwide drug-trafficking patterns have evolved into their present form and continue to develop along certain lines for a complex mix of reasons. Some of these factors are local, such as climate and indigenous cultural patterns, while others can be generalized to settings all over the world. One master principle that has influenced the sale of illicit substances all over the world is the emergence of worldwide networks that link the source of drugs with their ultimate customers. International and intersocietal commerce have existed for thousands of years. However, it was not until late in the twentieth century that the distribution of the currently illicit drugs took on a truly global complexion. Prior to the early 1970s, international drug linkages tended to be fairly simple: Marijuana was imported into the United States from Mexico; opium, grown in Turkey, was processed into heroin in Marseilles and smuggled into New York; and cocaine, produced in labs in Colombia from leaves gathered in Peru and Bolivia, was brought into the United States and Western Europe.

Perhaps the watershed event that transformed drug distribution to its present, global form was the dismantling in 1972 of the “French Connection” heroin-trafficking network by the French police, U.S. federal agents, and officers in the New York Police Department. The cartel had previously supplied 80 percent of the heroin sold in the United States, and its demise generated a drug “panic,” creating an enormous, importunate demand for the drug. This opened up an economic opportunity that many daring, unscrupulous entrepreneurs all over the world could not pass up. In the past three decades, the routes through which heroin specifically (and perhaps as a by-product, illegal drugs generally) travel, the number of source countries and the number of countries through which drugs move, and the national and ethnic groups involved in drug trafficking have virtually exploded (Stares 1996:25, 27-8). Since the 1970s, the international drug trade has been transformed from “a cottage industry” to a global enterprise whose profits are greater than three-quarters of the national economies of the world, estimated at between 180and300 billion annually (Stares 1996:2). While some of the preconditions for this development existed previously, the conjunction of several key factors made this development possible specifically during the last quarter of the twentieth century. Some of these developments include the following.

The Collapse of the Soviet Union. Authoritarian regimes such as the former Soviet Union have generally fared better than open democratic countries in suppressing drug market activity because the state plays a more intrusive and repressive role in almost all aspects of daily life. By contrast, the capacity of liberal democratic states to reduce the availability of drugs is clearly limited by their commitment to the very principles and values upon which they are based. (Stares 1996:74)

While the Soviet Union, its constituent republics, and the Eastern Bloc nations were never completely successful in suppressing crime and, more specifically, illicit drug trafficking, the collapse of the Soviet Union has produced a power vacuum into which has stepped an array of unscrupulous, ruthless actors willing to violate the law to earn a substantial profit. In the Central Asian republics, for instance,

Thousands of acres have been given over to the cultivation of opium poppies and cannabis…. Hungary and Czechoslovakia have become major transit countries for Asian heroin destined for West Europe…. Polish health officials warned that a dramatic rise in intravenous drug abuse in Warsaw has unleashed criminal networks engaged in drug trafficking. (Flynn 1993:6)

The “unraveling of socialism and the move toward freer trade among industrialized countries has created a fertile environment for international business” (Flynn 1993:6), including, perhaps especially, illicit ones. The collapse of the Iron Curtain has produced “torrents of people, goods, and services… pouring across borders. In their midst, drug shipments… move with little risk of detection by customs authorities” (Flynn 1993:6). The central Asian republics, especially Turkmenistan, Uzbekistan, and Tajikistan, have become major opium-growing areas for heroin bound for Eastern Europe. Georgia and Kazakhstan have become major leaf-cannabis-growing areas. And Russia, Bulgaria, and Poland have become major amphetamineand methamphetamine-producing and – distributing countries (UN 2001).

Economic Privatization. Since the collapse of the Soviet Union and the end of the Cold War, economies all over the world have become increasingly privatized, liberalized, and deregulated (Flynn 1993). China has opened “free trade zones” in a number of port cities, in which state control and even monitoring of commerce has been lifted and an extreme version of laissez-faire capitalism now operates. In 1989, Mexico deregulated the trucking industry, liberalizing barriers to entry into the country and permitting free movement into every city, port, and railroad station. Within two years, the number of registered trucks increased 62 percent. Soon after, Chile and Argentina followed suit. In 1991, Mexico allowed private companies to construct and operate their own ports (Stares 1996:56). The creation of the European Union (EU) in 2002 created a single currency for most of Western Europe and free and open trade across national boundaries. The North American Free Trade Agreement (NAFTA) has removed thousands of trade barriers between the United States and Mexico and the United States and Canada. Worldwide economic deregulation has expedited the flow of goods, both licit and illicit, across national borders. It has proved to be a major shot in the arm for the global drug trade.

Money Laundering. Banking is a major worldwide industry. In some countries, banks operate under a principal of extreme secrecy. “Don’t ask, don’t tell” is their watchword. Clients may deposit bundles of cash totaling millions of dollars, and the bank releases no record of the transaction to the government. Offshore banks, such as those in Aruba and the Cayman Islands, and banks located in tiny European countries, such as Liechtenstein and Luxembourg, as well as those located in Hong Kong, Cyprus, and Panama, offer “financial secrecy and client confidentiality” (Stares 1996:58). Liechtenstein has more post office box corporations (72,000)—a high percentage of them are banks—than people (23,000). The emergence, indeed, the immense expansion, of such banks has permitted traffickers to launder money earned in the illicit drug trade back into the legitimate economy, thereby avoiding official detection, and, in effect, nullifying a major arm of law enforcement.

Globalization. Globalization is both a relatively recent product of political, economic, technological, cultural, and social changes taking place nearly everywhere on earth and an umbrella concept whose material manifestations have enormously accelerated the illicit drug trade during the past quarter century or so. During that time, international commerce, travel, and communication have multiplied exponentially; the huge increase in the worldwide illicit drug trade is one consequence of internationalization.

According to the U.S. Department of Commerce, in 1970, the value of exports from the United States to foreign countries totaled 42 billion; its imports from other countries were valued at 40 billion. In the year 2000, these figures were 782billionand1.2 trillion respectively, an increase of roughly 20 times; adjusting for inflation, this represents an increase of four times. According to the International Trade Administration, the number of tourists entering the United States doubled between 1986 (26 million) and 2000 (51 million); each year, the number of persons simply crossing the country’s borders (more than 400 million) is greater than the number of its residents (280 million). In 1991, the first Internet browser was released. By 1994, there were 3 million users of the Internet, nearly all of them in the United States. Today, according to the Computer Industry Almanac, there are nearly a half billion Internet subscribers worldwide; by 2005, the Almanac estimates, there will be over a billion. According to the International Telecommunication Union, international phone traffic, as measured by billions of minutes, increased from 33 in 1990 to 130 in 2002. In the United States, cell phone subscribers increased from 340,000 in 1985 to 109 million in the year 2000. In trade, travel, and communication, the world has become a global village. We have become, in effect, a “borderless” world (Stares 1996:5).

The movement of persons, goods, and messages across national borders has created a superhighway for traffickers to transport drugs from source to using countries. The sheer volume of bodies and freight coming into every country in the world from every other makes it quite literally impossible for officials to monitor and stem the tide of illicit products. Instant communication to and from every point on the globe enables traffickers to convey information on transactions practically without detection. As a result, the drug trade

has increasingly become a transnational phenomenon, driven and fashioned in critical ways by transnational forces and transnational actors. Thus the global diffusion of technical expertise and the internationalization of manufacturing have made it possible to cultivate and refine drugs in remote places of the world and still be within reach of distant markets. (Stares 1996:5-6)

The huge worldwide expansion in trade, transportation, and tourism has facilitated trafficking in established drug-using areas and “opened up new areas of the world to exploit” (Stares 1996:6). Huge increases in international travel, the mass media, and telecommunications “have undoubtedly increased the global awareness of drug fashions around the world” (Stares 1996:6).

Globalization permits enormous flexibility with respect to where illicit drugs may be grown or manufactured and how they may be delivered to their ultimate markets. If law enforcement shuts down an operation in a given province or country, entrepreneurs in another province or country quickly move into the economic vacuum. As we saw, the dismantling of the “French Connection” in 1972 created opportunities for growers and traffickers in other areas of the world to provide the opium and heroin necessary to supply American addicts. Whereas in 1972, Turkey supplied 80 percent of the botanical source of heroin used in the United States, today, according to the UN (2001), the worldwide source of heroin is mainly Afghanistan (70 percent) and Burma, now Myanmar (23 percent); and according to Abt Associates (Bruen et al. 2002:1), it is mainly South America (67 percent in the United States specifically) and Mexico (23 percent in the United States).

After “Operation Intercept,” when the U.S. border guards searched every car and person entering the country for drugs (1969), the cultivation of homegrown American marijuana increased dramatically (Inciardi 2002:54-5; Pollan 1995). Today, it is well over half the volume of the marijuana consumed in the United States. Observers refer to this phenomenon as the “push down/pop up” factor (Nadelmann 1988:9), that is, whenever drug trafficking is “pushed down” in one area, it “pops up” in another. The reason for this is, of course, the enormous profits that are to be made in the illicit drug trade and the unlimited supply of people willing to take the legal risk to earn those profits. It is possible that globalization is the single factor most responsible for the enormous expansion in the drug trade during the past three decades. If it were much more burdensome and problematic to move drugs and money across borders, traffickers would not have the same degree of flexibility to adapt to changing legal, political, and economic circumstances around the world.

Poverty. While upper-level drug dealers tend to be wealthy, almost beyond comprehension, the foot soldiers of the drug trade at either end of the distribution spectrum tend to be poor. As the worldwide economic crisis deepens, exacerbating the enormous gap between the industrialized, developed countries of Western Europe, North America, Australia, New Zealand, the Asian “tigers,” and a few oil-rich Persian Gulf states and the poorer, developing nations of the world, poverty assumes an increasingly greater role in drug trafficking. At the source end, the opium poppy, from which heroin is derived, and the coca bush, which yields cocaine, tend to be grown by poor peasant farmers cultivating small plots of land, whose livelihood depends on the illicit crop. (Most of the world’s opium and coca, it should be said, is grown for the production of legal substances.) Very few substitute crops are capable of growing on most of such land, and practically no other crop can get to a sufficiently nearby market to support the peasant’s family at subsistence earnings. This generalization about the poverty of the majority of hands-on growers does not apply to the leaf cannabis or marijuana grown in North America and Europe, since that industry is extremely decentralized, but it does apply to the resin cannabis or hashish that comes from Western Asia. In the middle of the distribution chain, likewise, much (though almost certainly not most) of the illicit drugs smuggled into a country where they are sold are brought across the border by poor couriers (“mules” or “smurfs”) who carry them on their person, often by swallowing drug-filled condoms. And at the lowlevel, seller-to-consumer end, especially in poor neighborhoods, petty street dealers likewise tend to be poor, typically addicts themselves, barely earning enough on their transactions to pay for their own drug habits. There are, of course, middle-class drug dealers who sell directly to consumers, but they tend to take fewer risks because they usually sell to persons they know, in fairly substantial quantities a small number of times, indoors, in places of residence, and in settings in which violence rarely takes place (Dunlap, Johnson, and Manwar 1994:5-6).

To put the matter another way, the poorer an area, society, or community, the greater the likelihood that the production, trafficking, and sale of illegal drugs will flourish. This is because while the affluent are willing to take moderate risks to earn a great deal of money, the poverty-stricken are willing to take much greater risks to earn relatively little money. A small fraction of 1 percent of the wholesale price of heroin and cocaine goes to the grower. For instance, the coca leaf necessary to produce a kilo of cocaine costs 300 in South America. Refined and smuggled into the United States, that kilo sells for 150,000 retail, that is, sold at $100 per unit in one-gram units that are two-thirds pure (Reuter 2001:19). This represents a markup of 500 times. Clearly, it is the major trafficker and wholesaler who earn the lion’s share of the illicit drug profits; the industry’s foot soldiers take the most risk and earn the least profit. The poor, with little in the way of economic prospects, are most likely to take such risks. Hence, poverty must be counted as a major factor in the production, distribution, and sale of illicit drugs.

Weak or Corrupt Local and Federal Governments. When the central government does not control major areas of a country and when the police and the army cannot enter an area for fear of being shot, they cannot control illegal activity within that country’s borders, and drug lords are free to grow botanicals from which drugs are extracted and to distribute and sell them at will. Major territories of Burma (Myanmar) have been under the control of private drug armies for decades. In Colombia, the army cannot enter major territories that are controlled by rebels, who use drug revenues to finance their operations. In Afghanistan, likewise, local tribes, not the federal government, control the extremely rugged, mountainous terrain where most of the world’s opium is grown. In Mexico, until the election of the Vincente Fox regime, the corruption of the police and the army was vast and extensive, reaching up to the president’s family. Border assignments were bought and sold with the expectation that an officer would earn substantial sums from bribes by drug dealers in exchange for immunity from arrest. In such weak or corrupt regimes, honest law enforcement is a virtual impossibility, and drug trafficking is able to flourish.

The Prevalence of Drug Use

A variety of agencies around the world collect information on the prevalence of drug use. Among them must be counted the Department of Health and Human Services of the U.S. government, the Australian Institute of Health and Welfare, and the British Home Office. In addition, the UN and the European Monitoring Centre for Drugs and Drug Addiction (EMCDD) distribute surveys to health experts on the consumption of illicit substances and collate and tabulate the information they receive. Though not all of these surveys are without flaw, there is nonetheless a wealth of information on drug use around the world.

Surveys on Drug Use

Monitoring the Future (MTF). Researchers find that the earlier drugs are used during the life cycle, statistically speaking, the greater the likelihood that the user will be involved in behavior that will become a problem to the society. In addition, researchers on adolescence believe, young people are not as moderate in their use of drugs and not as capable of dealing with their effects as are adults. Hence, drug use among youth is of special importance to the student of social problems. Every year since 1975, a large, nationally representative sample of 12th graders has been asked about legal and illegal drug use, availability, and attitudes. In the years following, college students and young adults not in college were added to the sample, and in 1991, 8th and 10th graders were added. Respondents are asked about lifetime, annual, 30-day, and daily prevalence for more than a score of drugs. The 2001 survey of schoolchildren was based on a sample of over 44,000 students in 424 schools. The study’s methodological limitation is that its samples do not include runaways, school dropouts, and absentees during the day the survey was conducted, and research indicates that these are the adolescents who are most likely to be drug users. Nonetheless, the majority of drug researchers believe that for teenagers, MTF’s survey on drug use is the most reliable and valid study on the consumption of psychoactive substances in existence.

In 2001, according to MTF’s survey, 27 percent of American 8th graders, 46 percent of 10th graders, and 54 percent of 12th graders had used one or more illicit drugs one or more times during their lives (“lifetime prevalence”); 20 percent, 40 percent, and 49 percent had done so with marijuana; and 15 percent, 23 percent, and 29 percent had done so with any illicit substance aside from marijuana. The percentage using any illicit drug in the past year was 20 percent for 8th graders, 37 percent for 10th graders, and 41 percent for 12th graders. Comparable figures for use in the past 30 days were 12 percent, 23 percent, and 26 percent. All of these figures represent a substantial rise since 1991, when MTF began studying 8th and 10th graders (Johnston, O’Malley, and Bachman 2002). It is clear that a substantial proportion of American teenagers are taking illegal drugs, and a sizable minority among them are taking these drugs on a fairly regular basis.

In addition to MTF’s figures on illicit drug use, the use of substances that are legal for adults but illegal for minors should be of concern to the social problems observer. In 2001, 1 out of 10 12th graders (10 percent) smoked half a pack of cigarettes daily, 80 percent had drunk alcohol at least once in their lives, two-thirds (64 percent) had been drunk at least once, half (50 percent) had drunk at least one alcoholic beverage in the past month, and a third (33 percent) had been drunk in the past month. An astounding 30 percent had consumed five or more drinks in a row during the past two weeks; 13 percent of 8th graders and 25 percent of 10th graders said that they had done so (Johnston et al. 2002). In terms of numbers and percentages, it seems that among American teenagers, objectively speaking, alcohol and cigarettes represent an even more substantial problem than is true of the illicit drugs.

National Household Survey on Drug Abuse (NHSDA). Every year, the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of U.S. federal government, sponsors a drug survey based on a nationally representative sample of the population. Its sample has one major drawback: It does not include people who do not live in a household. Hence, homeless people are excluded, as are teenage runaways, military personnel, inmates in jail, prison, and mental institutions, and obviously, nonrespondents. The federal Office of National Drug Control Policy, which issues a yearly report, estimates that the excluded populations are more than twice as likely to use and abuse psychoactive substances as the general population. Hence, this problem has an impact most specifically on estimates of heroin and crack cocaine addicts. In sum, then, the National Household Drug Survey hugely underestimates the addict population (Fenrich et al. 1999). Hence, the segment of drug users the student of social problems is most interested in is least likely to be counted. In addition, the survey’s adolescents (age 12 to 18) are interviewed in the same household at the same time as their parents or caregivers; thus, their answers may be influenced by that fact.

In 2001, according to the National Household Survey on Drug Abuse (SAMHSA 2002b), not quite 4 Americans in 10 had used at least one illicit drug in their lifetimes (39 percent) and 1 in 4 (24 percent) had done so with at least one illegal drug other than marijuana. Marijuana was, of course, the most popular illegal drug; a third (34 percent) had taken it once or more during their lives. Cocaine (11 percent) and LSD (9 percent) followed at a considerable distance. Only marijuana was used during the past month by substantially more than 1 out of 100 Americans (5 percent). The legal drugs were used by vastly more Americans; 29 percent had used tobacco, and 47 percent had drunk alcohol during the past 30 days.

The British Crime Survey (BCS). Since 1994 every two years, and after 2001 every year, the Home Office has conducted a study on drug use in the general population under the auspices of the British Crime Survey, or BCS (Ramsay et al. 2001). In 2000, its sample size was 13,000, and the age range of its respondents ran from 16 to 59. In 2001 and afterward, its sample size will be 40,000. In the year 2000, roughly a third of its sample had used at least one illicit drug once or more in their lives (34 percent); a tenth (11 percent) used during the previous year; and roughly half this latter figure (6 percent) used in the past month. The figures for cannabis were 27 percent, 9 percent, and 6 percent and for cocaine, 5 percent, 2 percent, and 1 percent. In short, most respondents did not use illicit drugs, and of those who did, marijuana was by far the most popular substance.

Australia’s National Drug Strategy Household Survey. In 2001, the Australian Institute of Health and Welfare conducted a household survey on drug use. Its sample was 27,000, and its age range was 14 and older. In their lifetimes, 38 percent of Australians used at least one illicit drug. In the past year, 82 percent of Australians used alcohol once or more, 23 percent did so with tobacco, and 17 percent consumed at least one illegal substance. Cannabis was by far the most popular drug, with 13 percent of the population taking it at least once during the past year. The figure for Ecstasy was 3 percent; for amphetamine, 3 percent; for cocaine, 1.3 percent; and for heroin, 0.2 percent. Many of the findings turned up in the Australian study were parallel to those of the BCS.

UN Estimates of Global Drug Use. Estimates of illicit drug use by the populations of member states are requested by the UN Office for Drug Control and Crime Prevention. They are based on local studies, special population group studies, and law enforcement agency assessments. The UN issues these estimates regularly in its publications, World Drug Reports and Global Illicit Drug Trends. As the UN admits, these estimates are highly variable in quality; the North American and Western European data are fairly accurate, while those in most of the Asian and African countries are little more than “guesstimates.” On the basis of the figures it receives, the UN estimates that in 2000, 207 million people used one or more illicit drugs worldwide; this makes up 3 percent of the world’s population or 4 percent of the population age 15 and older. Of this number, the vast majority (147 million) used marijuana or other cannabis drugs; 13 million used cocaine; 12.8 million used opiates (mostly heroin); and 33 million used “amphetamine-type stimulants”: amphetamine, methamphetamine, and Ecstasy. The UN’s global survey on drug consumption (see Table 29.1) includes the following observations:

  • More than 60 percent of the world’s heroin users live in Asia, 20 percent in Europe, and 14 percent in North and South America.
  • In 2001, there were more than 900,000 registered drug addicts in China, 83 percent of whom used heroin; it is possible that the number of unregistered addicts is even higher. This figure has been growing sharply over the past decade (it was 70,000 in 1990) and is likely to increase well into the twenty-first century.
  • Nearly half the people in the world who used cocaine during the past year (6 out of 13 million) live in the United States. In the United States, annual prevalence is 2 percent. The figure for all of South America is slightly less than half the total for the United States (2.8 million), and in Western Europe, only 2.8 million people used cocaine during the previous year.
  • Among all countries of the world, the annual prevalence of abuse of amphetamine is greatest in Australia (3.6 percent) and the United Kingdom (3.0 percent); figures for Honduras (2.5 percent), the Philippines (2.2 percent), and New Zealand (2.0 percent) are lower, but substantial nonetheless.
  • Of all regions of the world, proportionally speaking, marijuana consumption is greatest in Oceania, where one in five residents (19 percent) used a cannabis product in the past year. This figure is 30 percent for Papua New Guinea, 29 percent for the Micronesian Federal State, 18 percent for Australia, and 15 percent for New Zealand. Cannabis consumption is also high for two African countries, Ghana (22 percent) and Sierra Leone (16 percent), and a Caribbean country, St. Vincent Grenadines (19 percent). The proportion is roughly 1 in 10 for the United States (9 percent) and the United Kingdom (9 percent). Except for Ireland (8 percent), Switzerland (7 percent), and Spain (7 percent), for most countries of Western Europe, the proportion is in the 3 to 5 percent range. Systematic data from Latin America are sparse, though the annual prevalence rate for El Salvador is 9 percent and for Honduras, 6 percent.
  • More than half the people in the world who have used Ecstasy live in Western Europe. It is especially popular among teenagers and young adults. Among 15to 20-year-olds living in Oslo, the lifetime prevalence rate is 5 percent (UN 2001, 2002).

Table 29.1 Annual Prevalence, 1998-2000 (Numbers in Millions)

Opiates Cocaine Cannabis Amphetamine
# % # % # % # %
Oceania 0.14 0.63 0.2 0.9 4.4 18.8 0.6 2.8
West Europe 1.2 0.33 2.8 0.9 20.6 6.4 2.4 0.7
East Europe 2.7 0.99 0.3 0.1 10.5 3.3 0.9 0.3
Asia 6.3 0.26 0.9 0.2 41.6 2.1 22.3 0.9
North America 1.25 0.41 6.3 2.0 20.4 6.6 2.6 0.8
South America 0.34 0.12 2.8 1.0 13.0 4.7 2.2 0.8
Africa 0.95 0.19 0.9 0.2 36.9 8.1 2.4 0.5
Global 12.88 0.31 13.4 0.3 147.4 3.4 33.4 0.8
Source: United Nations Office for Drug Control and Crime Prevention 2002:224, 244, 254, 260.
Note: # is total number of people in the population, in millions, who used the indicated drug; % is percentage of the population age 15 and older who use the indicated drug.

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The European Union (EU), a political and economic entity encompassing nearly all the countries of Western Europe along with Greece, has roughly 380 million inhabitants. Each year, its constituent countries report on their population’s drug use; health consequences of their drug use; law enforcement measures; illicit drug seizures; prices and purity; national and international strategies to combat illicit drug distribution; diseases caused by drug abuse; and the use and distribution and consequences of the use of synthetic drugs. And each year, the Centre publishes its Annual Report on the State of the Drugs Problem in the European Union. As with other surveys, cannabis consumption is higher than for that of any other illicit substance; in most countries, the lifetime prevalence rate is in the 20 to 25 percent range. Amphetamines have been taken once or more by between 1 and 4 percent of the adult population of EU countries, with the exception of the United Kingdom, where it stands at 1 in 10. Lifetime Ecstasy use is between 0.5 and 4 percent, and cocaine, between 0.5 and 3 percent. As is true elsewhere, less than 1 percent of the adult population of EU countries has even tried heroin (EMCDDA 2001).

The Prevalence of Drug Use: Summary

Only a minority of the population of nearly every country on earth uses illicit drugs. For some countries, however (for instance, Papua New Guinea), this minority is huge—and it may be substantially larger than is indicated by the available surveys; for others (in all likelihood, Saudi Arabia, where drug dealers are executed in public), it is considerably lower. In contrast, the legal drugs, alcohol and tobacco, attract a much higher proportion and number of users and hence, from the point of view of the potential harm they can inflict, constitute a much more serious social problem. Nonetheless, even a small minority of the society is capable of causing significant harm to the rest of the population. Hence, although the issue of the number of users is relevant and important to any student of social problems, ultimately, what counts is how the lives of users intersect with the substances they use, and how that intersection affects the lives of the population at large.

Substance Abuse as a Social Problem: Physical and Economic Harm

It is important to stress that by itself, drug use does not constitute a problem for any society. It is only when the consumption of psychoactive substances, from the point of view of the objectivistic approach, produces physical or economic harm or, from the constructionist perspective, attracts societal concern that drug use becomes a problem. Here, I will focus on the kinds of harm caused by the consumption of illicit substances. Drug-related harm can be measured in countless ways. The first and most basic way is, of course, death; secondarily, disease; third, injury; fourth, predatory, criminal, and violent behavior; and fifth, monetary cost to the society.

Drug-Related Harm

United States Centers for Disease Control (CDC). The federal U.S. Centers for Disease Control estimates that roughly 440,000 people die in the United States each year as a result of cigarette smoking. They estimate the figure for alcohol consumption at roughly 100,000, and for all the illicit drugs added together, according to the Robert Wood Johnson Foundation, about 16,000 (Horgan, Skwara, and Strickler 2001:6). Data on the worldwide picture are patchy and incomplete, but they are certainly several times these figures, and very possibly more or less proportionate as well. With respect to magnitude, therefore, it might seem that cigarette smoking is by far the globe’s most serious social problem. But drugs cause harm in different ways; by itself, death does not encompass the entire spectrum of harm. For instance, the victims of tobacco tend to be middle-aged to elderly; hence, the number of years of life lost to tobacco per smoker is comparatively smaller. In contrast, since alcohol consumption is implicated in accidental death, homicide, and suicide, as well as disease, its victims tend to be considerably younger, and hence, the number of years lost per victim is considerably greater. Deaths caused by illicit drugs tend to strike younger victims than is true for tobacco and even alcohol; hence, again, the number of years of life lost is correspondingly greater. According to the CDC, smokers lose roughly a decade of life in comparison with nonsmokers. In fact, in the United States, a smoker is less likely to reach the age of 65 than a nonsmoker is to reach the age of 75. As far as monetary harm is concerned, some analysts argue that the cost of cigarette smoking is considerably less than seems to be the case, since smokers tend to die before they collect old-age benefits (in the United States, social security) and hence, society saves more money as a result of their demise than it pays for the increased cost of their medical care (Viscusi 2002:60ff).

Drug Abuse Warning Network (DAWN). Obviously, one major measure of the harm that drugs do, and hence the problemhood of drug use/abuse, is lethal and nonlethal drug “overdoses,” that is, untoward effects that result in medical intervention and at the most extreme level, death. The Drug Abuse Warning Network (or DAWN) is a federal data-collection program that tabulates and publishes figures on both nonlethal and lethal untoward drug reactions. With the single exception of admissions to drug treatment programs, DAWN focuses mostly on acute effects, that is to say, those that occur within the time frame of a single episode of use, rather than chronic or long-term effects. Thus, deaths from AIDS, lung cancer, and cirrhosis of the liver do not appear in DAWN’s data, while death from administering an overly potent dose of heroin does.

DAWN’s data on nonlethal reactions come to the attention of and are tabulated by emergency departments in the country’s metropolitan areas; these reactions include unconsciousness, panic reactions, and suicide attempts. Up to four drugs can be mentioned in a given case or “episode.” The results are published yearly in the Department of Health and Human Services’ publication Emergency Department Data from the Drug Abuse Warning Network. At last tally (the year 2001), there were just over 600,000 emergency department (ED) episodes and, at 1.8 drugs per episode, slightly more than a million emergency department drug mentions (SAMHSA 2003a).

In addition, DAWN tallies lethal “overdoses.” Medical examiners in all counties in the United States conduct an autopsy in all cases of “nonroutine” deaths. If one or more drugs are detected in the decedent’s body and are believed to have been responsible for (or associated with) the death, they are tabulated as a “drug-induced” death or as having played a “contributing” role in the death. Up to six drugs may be mentioned in drug-related medical examiner (ME) episodes. DAWN issues a yearly volume, Drug Abuse Warning Network Annual Medical Examiner Data, tabulating the number of drug-related deaths in metropolitan areas. At last count, 11,000 drug abuse deaths were counted in the United States, and, at 2.5 drugs per episode, there were nearly 29,000 drug mentions (SAMHSA 2003b).

Table 29.2 Emergency Department (ED) Episodes, 2000
Percentage of Episodes Number of Mentions
Alcohol-in-combination 34 204,524
Cocaine 29 174,896
Heroine/morphine 16 97,287
Total number of ED episodes 601,776
Total number of drug mentions 1,100,539

Source: Drug Abuse Warning Network (DAWN), Emergency Department Data, 2001.

The most important feature of DAWN’s ED (emergency department tallies of nonlethal untoward effects) and ME (lethal “overdoses” tallied by medical examiners) cases is that, almost by definition, they represent use at its most abusive level. Relatively few recreational users show up in DAWN’s statistics. DAWN’s cases tend to be users who take their drug or drugs frequently, heavily, abusively, and chronically. And by definition, they are the users who, objectively speaking, represent the most serious social problem for the society. They are the ones who die, get sick, are most likely to commit crimes against their fellow citizens, require medical intervention and treatment, and on whom a disproportionately large proportion of the government’s drug treatment budget is expended.

In the United States at the beginning of the twenty-first century, there are three drugs that stand head and shoulders above all others in causing or being associated with serious untoward drug reactions: heroin, cocaine, and alcohol. For ED or nonlethal untoward reactions, alcohol (in combination with another drug) is mentioned in roughly one-third (or 34 percent) of all episodes; cocaine is mentioned in about 3 out of 10 episodes (29 percent); and heroin (or morphine) in 16 percent of all cases. Hence, according to one measure of objective problemhood, nonlethal untoward drug effects, alcohol, cocaine, and heroin rank as the top three drugs with respect to causing harm to users. In the latest ME publication, for the year 2000, for lethal drug reactions, cocaine was mentioned in 43 percent of all episodes; heroin/morphine appeared in 39 percent of all ME episodes; and alcohol-in-combination was mentioned in 37 percent of all cases (SAMHSA 2002a). In other words, objectively speaking, three substances—heroin, cocaine, and alcohol—cause or are associated with the lion’s share of one important measure of America’s drug problem, acute death. No other single drug comes close to these three (although all the other narcotics added together surpass heroin and alcohol in being present in the bodies of drug overdoses). Hence, from the point of view of causing acute deaths, these three drugs are American society’s most serious social problems. Tables 29.2 and 29.3 present DAWN’s overdose data for ED and ME cases. Epidemiologically, DAWN’s ME cases tend to be male rather than female (75 percent vs. 25 percent), older rather than younger (70 percent are age 35 and older, unlike users in general), and disproportionately black (27 percent, as opposed to 13 percent in the U.S. population).

The European Monitoring Centre for Drugs and Drug Addiction. The EMCDDA (2002) estimates that in the EU between the early 1990s and 2000, the number of acute drug-related deaths (alcohol and tobacco excepted) has stabilized at between 7,000 and 8,000. In some countries, such as Greece, the trend has been upward, while in others, such as France, there has been a decline; but for almost a decade, the trend has been more or less flat. The use of opiates, including heroin, is most strongly associated with drug-related mortality. The Centre reports that the mortality rate for opiate users in the EU is 20 times higher than is true of the general population of the same age. The huge discrepancy is due not only to drug overdoses but also accidents, suicides, AIDS, and other infectious diseases. In addition, opiate users are more likely to take other drugs, and most specifically, depressants and alcohol. Opiate injectors stand a two to four times greater likelihood of dying as compared with noninjectors. Given its strong relationship with death and disease, the Centre defines “problem” drug use as “injecting drug use or long-duration/regular use of opiates, cocaine, and/or amphetamines.” According to this definition, problem drug use varied between 7.1 and 7.8 per 1,000 in the population in Italy to between 1.4 and 2.7 in Germany. The Pompidou Group, which monitors drug abuse and its consequences in European countries, tabulates heroin overdose deaths on a year-by-year basis. The country with the highest rate and number on the continent is Norway. In 2001, with only 4.5 million residents, 453 Norwegians died of a heroin overdose, a rate roughly six times that tallied by DAWN in the United States.

Table 29.3 Medical Examiner (ME) Reports, 2000, Number of Mentions and Deaths by Drug
Number of Deaths Percentage of Deaths
Cocaine 4,782 43
Heroin 4,398 39
Alcohol 4,081 37
Total ME mentions 28,846
Total ME deaths 11,168

ADAM (Arrestee Drug Abuse Monitoring). The conjunction of drug use with criminal behavior represents a major social problem for all societies. Does drug use cause criminal behavior? Or is a criminal lifestyle associated with the use of psychoactive substances? Or are the drug laws responsible for the link between drug use and criminal behavior? Most researchers believe that although the use of illicit substances does not “initiate” criminal behavior, it tends to “intensify and perpetuate” it (Inciardi 2002:190).

In more than two dozen cities around the United States, a sample of arrestees charged with drug, property, and violent crimes is approached, and each is asked if he or she is willing to be interviewed; 30,000 males and 10,000 females were included in the most recent sample. Over 8 in 10 who are asked agree to be interviewed. These interviewees are then asked if they can be drug tested; again, roughly 80 percent agree. There are no legal consequences of testing positive. This program is referred to as the Arrestee Drug Abuse Monitoring Program, or ADAM. One aspect of ADAM is that the likelihood of testing positive varies according to the half-life of the particular drug. Cocaine and opiates are not detected beyond three days after use; in contrast, marijuana can be detected a week afterward for a casual user, and a month later for a chronic user.

Perhaps ADAM’s most noteworthy finding is that men and women who have been arrested for a crime are massively more likely to have recently used psychoactive drugs than is true of the population at large. In 1999, in the median city, roughly twothirds of ADAM’s arrestees tested positive for the presence of one or more drugs (64 percent for males, 67 percent for females). As we saw, only 6 percent of the American population used one or more illicit drugs in the past month; over 10 times as many of ADAM’s arrestees tested positive and hence used (depending on the drug) within the past several days.

These figures indicate that drug use and criminal behavior are extremely closely linked. There are four additional crucial points made by ADAM’s data: (1) between 1990 and 2000, cocaine declined in popularity; in 1990, in the median city, 45 percent of the male and 49 percent of the female arrestees tested positive for cocaine, but by 2000, these figures had declined to 29 percent and 33 percent; (2) during this same decade, marijuana increased in popularity—from 20 percent (males) and 12 percent (females) for 1990 to 41 percent and 27 percent respectively in 2000; (3) opiates remain a relatively infrequently used drug among arrestees; in 2000, only 6 percent of the males and 8 percent of the females tested positive for any of the opiates, heroin included; and (4) methamphetamine is still not only a relatively rarely used illicit drug (nationally, in the median city, 2 percent of the men and 5 percent of the women tested positive for methamphetamine); its use is highly regionalized, that is, it is used almost not at all in some cities and by as much as a quarter or even a third in others (ADAM statistics from U.S. Department of Justice 2003).

Problem Drug Use in Australia. According to Australia’s National Drug Strategy Household Survey (Australian Institute of Health and Welfare 2002), in the past 12 months, 13 percent of Australians said they drove a motor vehicle under the influence of alcohol; males were twice as likely to have done so, 18 percent versus 8 percent; and 4 percent said that they had done so under the influence of illicit drugs. One percent admitted to having “physically abused someone” while under the influence of alcohol, and 5 percent said that they had been physically abused by someone else who was under the influence. Fourteen percent said that they had been “put in fear” by someone under the influence of alcohol, and 9 percent by someone under the influence of an illicit drug. Three percent said that they were sufficiently abused by someone under the influence of either alcohol or an illegal drug as to require hospital admission. The Australian Institute of Health and Welfare estimated that in 1998, there were 17,671 deaths and 185,558 hospital episodes related to illicit drug use. The Institute puts the cost of drug abuse both legal and illegal at slightly above 1billion:833 million for tobacco, 145million for alcohol, and 43 million for illicit drugs. Australia’s population is 20 million.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA). Since 1971, every three years or so, the U.S. National Institute on Alcohol Abuse and Alcoholism, a division of the Department of Health and Human Services, has issued summary reports assessing alcohol’s impact on health. At this writing, the most recent volume was released in 2000 (NIAAA 2000). To put its findings in perspective, it should be kept in mind that just under half the American population consumes a dozen or more alcoholic drinks a year; approximately 7 percent of the population drinks abusively, according to NIAAA’s criteria. Alcohol is used by more people than any other drug, although tobacco is consumed more often. Alcohol is consumed 5 to 10 times as often as is true of all the illicit drugs combined. According to NIAAA’s summary of the available data:

  • The total cost of alcohol abuse in the United States is $185 billion.
  • Roughly 16,000 people annually are killed in automobile accidents caused by the immoderate consumption of alcohol.
  • Alcohol alone is involved in substance-related violence in one-quarter of all incidents, a total of 2.7 million acts of violence per year.
  • About 900,000 residents of the United States suffer from cirrhosis of the liver, mainly caused by the heavy use of alcohol, and 26,000 die of the disease each year.
  • Excess alcohol consumption is related to immune deficiencies, causing a susceptibility to certain infectious diseases, such as tuberculosis, pneumonia, HIV (human immunodeficiency virus), AIDS, and hepatitis.
  • Heavy drinkers (those who consumed 29 or more drinks per week) had twice the risk of mental disorder as compared with abstainers.

These highlights do not exhaust NIAAA’s list of harms caused by alcohol. Estimates of the total number of people killed by the consumption of alcohol range between 100,000 and 150,000. Human life is undermined, threatened, corrupted, and destroyed by alcohol abuse. NIAAA does point out that moderate alcohol consumption is not only not harmful but may actually confer certain health benefits on the drinker. For some diseases, the morbidity of moderate drinkers is actually lower than that of abstainers, and moderate drinking is far more common than heavy drinking. Nonetheless, as a psychoactive substance, alcohol stands below (albeit far below) tobacco as a major source of death and disease, and stands virtually alone as a source of violence and accidents. By any reasonable objective criteria, immoderate drinking represents a major social problem in the United States.

Drug Use as an Objective Problem: Summary

In 1996, the World Health Organization (WHO) announced that by the early years of the twenty-first century, 10 million people per year worldwide will die of diseases caused by cigarette smoking. With respect to death and disease, objectively speaking, tobacco is the world’s number-one drug problem, killing more people than all other drugs combined, and by a considerable margin. At the same time, the consumption of tobacco tends to kill older users, and it is not associated with violence or accidental injury or death (except for fire-related accidents). Objectively speaking, alcohol is the globe’s numbertwo drug problem. Its consumption is associated with death and disease, and accidents and violence; worldwide, the monetary cost of drinking runs into the hundreds of billions of dollars. The consumption of illicit drugs stands far below the legal drugs with respect to medical harm and monetary cost. Nonetheless, the abuse of two drugs, heroin and cocaine, although used far less frequently, causes overdose deaths roughly on a par with alcohol; criminals use illicit drugs at a rate vastly higher than is true of the population at large; and drug-related illnesses include HIV/AIDS, hepatitis, and pneumonia. Unlike the legal drugs, the worldwide distribution of illicit drugs is associated with political corruption and social disorganization, and holding communities, regions, and entire countries hostage to the rapacious greed of ruthless traffickers. Whether drug legalization would be a solution to the chaos caused by the sale and use of illicit drugs (Nadelmann 1988) is debatable. In short, the consumption of psychoactive substances causes or is associated with a long list of harmful consequences. Objectively speaking, worldwide, drug use is a major social problem, a worthy subject of inquiry to the interested student of social problems.

Drug Use and Sale as a Socially Constructed Problem

From the constructionist perspective, drug use is a problem for the society because a substantial percentage of the population is concerned about it, the media depict it as a problem, the public regards it as a problem, and officials and social movement organizations take steps to deal with it. Constructionists regard assertions of social problemhood by social actors as “claims” that may or may not be valorized by other members of a society. The constructionist perspective is especially relevant to a global approach to drug use as a social problem because public concern and social movement and government claims, as well as concrete steps to deal with drug use and distribution, are communicated worldwide, from one country to another. Claims about the socially problematic nature of specific conditions, drug use included, are diffused cross-nationally (Best 2001).

One of the major emphases of the constructionist approach to social problems is on the discrepancy between the subjective concern generated by certain conditions and the objective harm caused by those conditions. These discrepancies apply from one time period to another and from one condition to another. For instance, when we compare concern with harm historically, the sudden emergence of the imputed problemhood of a certain condition at a particular point in time focuses the researcher’s attention on how and why that condition came to be regarded as a social problem but was not so regarded earlier. What produced the upsurge in concern? Why did claims that were ignored or rejected previously come to be valorized today? Likewise, when we compare the enormous public concern surrounding a given condition that is less harmful than another about which there is less concern, observers are forced to ask why. In other words, the constructionist approach problematizes the attribution of problemhood. This discrepancy is not an essential component of the constructionist’s definition of a social problem—as we saw, social constructions are not “just” social constructions, but may have an objective referent as well (Best 2000)—but to the constructionist, it is a theoretically interesting and frequent accompaniment.

Along these lines, then, we learn that the effort to define coffee drinking, a relatively benign activity, as a social problem emerged in the 1970s and was to a certain extent and for a period of time successful (Troyer and Markle 1984). Vested interests—specifically the dairy industry—for a time during the 1930s and 1940s successfully albeit briefly managed to define the production, sale, and consumption of margarine as a “menace” and therefore a problem to society (Ball and Lilly 1982). In the 1970s, the criminal victimization of the elderly came to be seen as a major social problem—when, in fact, this has been the segment of the population that is least likely to be victimized by street crime (Fishman 1978). In the 1960s, the physical abuse of children by their parents or caretakers, which had remained a major source of death, injury, and mutilation for millennia, was “discovered,” widely recognized as a social problem, and attacked as a pathological condition in need of remedy (Pfohl 1977). In the 1960s and 1970s, after centuries of use and concomitant disease and death, cigarette smoking came to be defined as undesirable, harmful, and deviant, a problem very much in need of correction, control, and elimination (Markle and Troyer 1979; Troyer and Markle 1983). In 1982, while drug abuse among Israeli adolescents remained stable at an extremely low level, national concern over illicit psychoactive drug use developed and lasted for approximately a month, and just as swiftly disappeared (Ben-Yehuda 1986). It was not until the 1970s—after causing millions of deaths on the highway during the course of this century—that drunk driving came to be seen as a major problem facing the country, and movements sprang up to deal with the problem (Gusfield 1981).

In short, a number of relatively harmful conditions have existed for extremely long periods of time without being defined as problems, yet at a particular point in time, as a result of the influence of an array of forces, they come to be seen as troublesome to the society, conditions that are very much in need of remedy. In a like vein, the public has come to be concerned about some relatively benign conditions and fearful of those that either do not exist or that cause very little objective harm. Clearly, then, there is a measure of independence between the objective and the subjective dimensions for certain specific concrete or putative conditions. Moreover, in each case, the process and outcome of defining a given condition as a social problem is sociologically patterned and structured, the elucidation of which is theoretically strategic. Conditions become successfully defined as social problems not at random, nor solely as a result of their objective seriousness, but because specific segments or interest groups are successful at generating, stimulating, or guiding widespread public concern about them. Claims that these conditions are social problems in need of remedy come to be accepted and acted upon. This is the approach that the constructionist of social problems adopts.

This same discrepancy between objective seriousness and subjective concern obtains with drug use as a social problem. For instance, the Australian 2001 National Drug Strategy Household Survey (Australian Institute of Health and Welfare 2002) revealed that only 3 percent of its respondents designated the use of tobacco as the major drug problem in Australia; 8 percent did so for alcohol, and 90 percent did so for illicit drugs. Yet, as we saw, the use of tobacco costs Australian society almost 6 times as much as alcohol and 20 times as much as the use of illegal drugs, and these drugs kill Australians in roughly the same proportions. More or less the same picture prevails for the United States (Horgan et al. 2001:6). Hence, for the analyst of social problems, the question becomes: Why the discrepancy? What generates so much more societal concern over illicit drug use than is true for legal drug use? And why are the members of a society more concerned about drug use at one point in time than at another? And how are such concerns and claims about the harmful effects of drug use diffused across national boundaries?

The study of the global diffusion of claims making about the problemhood of drug use/abuse is in its infancy. Yet the importance of the issue is undeniable. Worldwide, there are more than a billion cigarette smokers; on average, they stand to lose a decade of life because of their use of a harmful chemical substance, nicotine. Yet, in some countries, the claim that smoking is a serious social problem is not publicly valorized, nor do the governments of these nations take steps to curtail this form of abusive addiction. Why have claims of the social problemhood of smoking spread to some countries but not others? Why has the claim that the immoderate consumption of alcohol is harmful and problematic to the society been widely accepted in some countries but virtually ignored in others? Why have some countries been slow to respond to the worldwide challenge of AIDS, while for others, the deadly disease is regarded both publicly and governmentally as a social problem of major dimensions. Why does the U.S. government regard the consumption of marijuana as a threat, a gateway drug, a substance whose use calls for attention, legal intervention, and research demonstrating pathological effects, while the Dutch government has adopted a policy of domestication and tolerance by law enforcement? In short, why do some claims of the social problemhood of drug use and abuse fail to spread to certain countries, or cross-nationally, while others come to be valorized worldwide?

Diffusion of Claims of Social Problemhood

Japan’s Antismoking Campaign. The failure of Japan to accept smoking as a serious threat exemplifies the contingencies entailed in the diffusion or nondiffusion of claims of social problemhood. Roughly 30 percent of the Japanese population smokes—half of its men and 10 percent of its women. (In the United States, the figure is substantially lower, roughly one-fourth, and the difference between men and women is small.) And while the smoking rate in the United States has declined since 1964, in Japan, it has risen; between 1950 and the end of the twentieth century, cigarette sales increased five times in Japan, while its population increased only 50 percent (Ayukawa 2001:215). More to the point, the Japanese government has not taken steps to valorize smoking’s harmful effects, the population of Japan does not regard smoking as a serious threat to public health, and social movement organizations’ efforts to ban smoking in public places are ineffective. This inaction is all the more remarkable given Japan’s acceptance of cultural innovations from abroad, especially from the United States—where smoking has been regarded as a social problem for four decades. The question is, why has the claim that smoking is a major social problem not diffused from the United States to Japan?

The fact is, the monopoly that administers the manufacture, importation, and sale of tobacco, Japan Tobacco, while technically private, is largely owned by a government agency, the ministry of finance. Hence, the Japanese government “has a direct stake in tobacco sales” (Ayukawa 2001:216). In 1985, the Tobacco Enterprise Law was introduced “to strive for the sound development of the tobacco enterprise and to contribute to the stability of income revenue and the sound development of the national economy.” In point of fact, the law advocated that the Ministry of Finance “promote tobacco sales in order to increase revenue from tobacco” (Ayukawa 2001:216). In 1999, cigarette taxes generated 8.5 billion in national tax revenues on Japan Tobacco product sales (Struck2000:31). In contrast, excise taxes on tobacco in the United States, a country with twice Japan′s population, earned 5.2 billion. As a result of tobacco’s profitability for the Japanese government, antismoking campaigns, including those launched by the ministry of health, have been defeated nearly everywhere. After 1985, warning labels on packages of cigarettes read only “Smoking by minors is prohibited” and “Be careful not to smoke too much as it may do harm to your health,” the latter implying that moderate smoking is not harmful. The government feels that the ministry of health “has no right to put medical messages on cigarette packages” (Ayukawa 2001:217). Two massive reports were issued, in 1987 and 1993, by the ministry of health. However, neither was recognized by the government as an official document, and both had to be published privately.

In 1998, Japan was the only industrialized country that broadcast television cigarette commercials, and the government has never put pressure on the networks or cigarette companies to discontinue them. That year, they were withdrawn, possibly because of international embarrassment. Nonetheless, programs often depict characters smoking, a way of introducing “stealth” advertising. Attractive young women distribute cigarettes in public places and even light them for smokers. In 2000, on Respect the Elderly Day, roughly 15 million cigarettes were distributed by Japan Tobacco—to the residents of nursing homes (Struck 2000). Lawsuits by plaintiffs to restrict smoking have been almost universally dismissed. During the late 1980s and early 1990s, lawsuits to force schools to provide nonsmoking lounge and lunch rooms for teachers were dismissed three times, once by Japan’s Supreme Court. Since 1979, lawsuits to force the national railway to mandate that half of its cars be nonsmoking, again, have been consistently dismissed; a voluntary decision by the railway to designate 30 percent of its cars as nonsmoking ended the lawsuit. In Japan, not a single family of a deceased smoker has sued a tobacco company (Ayukawa 2001:229). And information about the hazards of smoking, a major weapon in the hands of antismoking groups in the United States, is extremely difficult to obtain in Japan (Ayukawa 2001:225). In short, the public and governmental concern about smoking that prevails in the United States has not diffused to Japan. Efforts to restrict the use of cigarettes have failed partly because of a variety of cultural and structural factors (for instance, unlike the United States, Japan has very few lawyers, and lawsuits, regarded as unseemly and inappropriately confrontational, are extremely rare there) but largely because of the Japanese government’s direct involvement in the sale of tobacco. Antismoking social movement activity remains ineffective, and concerns about the threat of smoking have not even remotely reached American levels. It might seem that restricting tobacco consumption in Japan represents a negative case in the diffusion of social problem—in a sense, the failure of globalization.

But we should make a distinction between effort and success. Social movement activity in Japan and in other Asian countries is not so impotent as to be virtually nonexistent. Not only are antismoking campaigns active and ongoing—although, in comparison with the United States, far less effective—they also incorporate successful tactics borrowed from the United States. WHO advisers to the organization’s Asian antismoking efforts say that they have evidence on what strategies have worked in the United States and they apply them to their Asian campaign, for instance, putting antismoking messages on packs of cigarettes. In Thailand, a label on a cigarette pack states that “smoking reduces sexual ability.” In Vietnam, cigarette advertising and the handing out of free samples by “cigarette girls” have been banned. Even in China, the world’s leader in cigarette sales (1.7 trillion cigarettes sold annually), restrictions on advertising have been put in place. Says Stephen Tamplin, who coordinates the WHO’s antismoking campaign in Asia, “We don’t underestimate the battle here; it’s huge…. But we’re encouraged. We think there’s renewed interest in tobacco control” (Struck 2000: A21, A31).

Interpol. A contrary case is provided by Interpol, an acronym referring to the International Criminal Police Organization. Interpol is dedicated to the proposition that drug abuse around the world is harmful and should be curtailed or eliminated—in short, that it constitutes a social problem. Founded in 1914, suspended during the Nazi era, and reconstituted in 1946 with its headquarters in Paris, Interpol provides 179 member nations with information on the whereabouts of international criminals, offers seminars on scientific crime detection, and helps national police departments to apprehend criminals. (Interpol’s agents do not themselves make arrests.) Its most effective efforts are in combating counterfeiting, forgery, smuggling—and illicit narcotics. One of Interpol’s goals is to alert the international community to the threat that drug abuse poses globally, as well as advancing and facilitating what it considers the most effective policy to control illicit drug distribution and use. According to the Web site materials it posts, the mission of Interpol’s Drugs Sub-Directorate is as follows:

[To] enhance Cooperation among member countries and to stimulate the exchange of information between [and among] all national and international enforcement bodies concerned with countering the illicit production, traffic and use of narcotic drugs and psychotropic substances. (http://www.interpol.int)

This includes collecting information, responding to international drug investigation inquiries, collecting relevant intelligence data and disseminating them to member states, identifying international trafficking organizations, and organizing meetings on a regional or worldwide basis on relevant topics.

Among the many avenues Interpol employs to pursue that end is to act “as a clearing-house for the collection, collation, analysis and dissemination of drug-related information.” Interpol’s Web site mentions four drugs or drug types as specific targets: cannabis, cocaine, heroin, and synthetic drugs. It identifies the major drug-producing and market nations, routes taken to transport illicit substances, techniques of concealment, and figures on the production and seizure of illegal drugs. Although its informational Web site is low-key and focused more or less on communicating relevant objectively determinable drug-related assertions, there is no doubt in the reader’s mind that in posting it, Interpol is engaged in a claims-making activity, that is, defining illicit drug use as wrong, harmful, and a worldwide social problem about which readers need to be aware and on which the agency’s efforts are focused. Says Interpol about the consumption of heroin: “The abuse of heroin among youth is a serious problem. Children as young as 13 have been found involved in heroin abuse. According to statistics in 1999, heroin overdose has caused more deaths than traffic accidents.” Today’s youth culture, says Interpol, “demands stimulants—today, recreational use is no longer limited to weekends,” a statement that argues that use inevitably becomes abuse and both justifies Interpol’s concern over the consumption of psychoactive substances and its communication of that concern to the public. Of morphine-like synthetic drugs, Interpol states that “attempts to separate the analgesic effects from the euphoria-producing effects, which are those associated with compulsive abuse, have been unsuccessful,” arguing both that the medical use of such drugs inevitably creeps into recreational street use and that use based on euphoria-seeking inevitably becomes abuse—again, justifying the agency’s concern and its claim that illicit drug use is a social problem in need of remedy. Just as globalization characterizes the distribution of both licit and illicit substances, efforts to define drugs as a social problem and to curtail their distribution and their harmful consequences are likewise globalized.

The United Nations. Another case of international cooperation in defining drug abuse as a social problem is provided by the efforts of the UN. The UN sponsors several organizations that have launched campaigns dedicated to the proposition that drug abuse is a major global problem that must be combated through a variety of programs. According to the UN’s Web page, the UN Drug Control Programme (UNDC), founded in 1991, “works to educate the world about the dangers of drug abuse,” strengthening international action against drug trafficking and drug-related crime “through alternative development projects, crop monitoring and antimoney laundering programmes” (http://www.undc.org). In addition, UNDC provides statistics on drug use and trafficking and, though its Legal Assistance Programme, helps to draft legislation and train judicial officials and acts as a liaison with international law enforcement partners, such as Interpol. The UN Commission on Narcotic Drugs (CND), established in 1946, “analyzes the world drug abuse situation and develops proposals to strengthen international drug control.” The UN’s Global Monitoring Programme of Illicit Crops assists member states to provide data on illicit crops and “integrates aerial surveillance, on-the-ground assessment and satellite sensing.” These data, says the UN, will enable member states “to eliminate or significantly reduce the cultivation of drug crops” within a few years. Examples of the UN antidrug abuse campaign include the following.

Worldwide, over 40 million people are infected with HIV/AIDS; according to the UN, 1 in 20 were infected through intravenous (IV) drug injection. In partnership with the Brazilian government, the UNDCP has sponsored a peer-educator anti-AIDS educational campaign to “reach out to targeted groups” such as prostitutes, prisoners, adolescents, drug abusers in treatment centers, miners, and truck drivers, delivering the message that the IV use of drugs can lead to diseases such as AIDS. Since 1991, the percentage of AIDS cases reported in Brazil among injecting drug users, according to year of diagnosis, has been cut in half, from 25.5 to 12.4 percent.

The UNDCP has focused on the remote villages in the Nonghet District of Laos, a leading opium producer, for its antidrug campaign. Opium is the primary source of income for 85 percent of the villages of the district; a cash crop makes it possible for the villagers to purchase food during periods of a rice shortage. Addiction among villagers is extremely high. The UNDCP, working on the assumption that poverty is a major reason for opium production, has worked with villagers to help them cultivate rice, corn, vegetables, fruit, and livestock. In addition, it has helped them build irrigation ditches to water their crops and roadways to get crops to market. Drinking water, medicine, and teacher training are also facilitated. The UN’s figures show that in the past four years, opium cultivation in the district has declined 78 percent.

The UN Office for Drug Control and Crime Prevention has produced and distributes video spots in which sports figures, including National Basketball Association stars Dikembe Mutombo, a native of Congo, and Vlade Divac, a Yugoslavian; Khodadad Azizi, a soccer player from Iran; and Hidestoshi Nakata, a Japanese soccer player, emphasize the message, “Sports Against Drugs.” The video spots are available in 20 languages. The UN hopes that its antidrug message, delivered by revered sports figures, will convince young people to avoid peer pressure to use drugs, avoid sharing needles, use condoms, and become involved in healthful alternative activities.

Global Diffusion of Antidrug Campaigns: A Summary

The campaigns supported by agencies of the UN and Interpol represent global efforts to define drug abuse as a major social problem and reduce or eliminate its incidence as well as the occurrence of some of its most harmful effects. In short, from a constructionist perspective, the UN and Interpol make claims about the problemhood of drug abuse that have successfully diffused cross-nationally, taking root all over the world. Their efforts have alerted officials to the threat posed by drugs and enabled them to take steps to combat that threat. The UN and Interpol antidrug campaigns represent examples of the global diffusion of drug abuse as a social problem. In Japan, social movement activity and the ministry of health’s efforts to define smoking as a social problem have been far less successful, although in Japan, as well as in Asia generally, such efforts are ongoing and occasionally result in small victories.


Social problems are defined in two radically different ways: objectively, that is, by the harm that conditions cause, and subjectively, that is, by the concern that conditions generate, the claims made about them by spokespersons, and the steps proposed or taken to remedy them. The consumption of psychoactive substances, including tobacco, alcohol, and illicit drugs, is a material-world condition that causes or is associated with an array of related social costs. And drug use, likewise, is a phenomenon that attracts public concern, claims of problemhood, and solutions to remedy the putative problem. Although social problems texts nearly always mention drug use as a major problem, the study of social problems from a global perspective is in its infancy. Drug use offers a dramatic case of the value and richness of the global perspective. Worldwide, changes are taking place that render previous approaches obsolete.

A global explosion of youth with disposable income, sufficient time to engage in recreational activities, and a subculture endorsing hedonism has generated the skyrocketing use of a range of psychoactive chemicals that have come to be called “club drugs”: methamphetamine, Ecstasy, ketamine, GHB, and rohypnol, to name only a few of the more widely publicized substances. Not only have global changes generated this reservoir of drug-receptive youth, films and other media disseminated around the globe have communicated the message that drug-induced hedonism is a positive value to be pursued. Worldwide networks of traffickers link Tajik farmers with Nigerian middlemen with Dutch business executives, Lao villagers with Chinese smugglers with Hispanic American dealers, and Belgian chemists with affluent, suburban American high school students. What was once a small cottage industry with fairly simple international links has become, in effect, a major multinational corporation with profits running into the hundreds of billions of dollars and an immense payroll of employees in nearly every country of the world.

Definitions of the problemhood of drug abuse, likewise, are diffused worldwide. While some claims of problemhood fail to take hold because of the influence of local factors (as is the case with smoking in Japan), for the most part, messages that drug use is a harmful condition that must be remedied are disseminated worldwide, from social movements in the United States to the Brazilian government, from the UN to every country on earth, from Interpol headquarters in Paris to every one of its member nations, and from the WHO to Africa. The fact is, drug abuse as a social problem can no longer be studied in any way except globally. Our borderless world, which offers all citizens on earth the cultural richness of every other nation, is Janusfaced. Globalization guarantees the flow of people, ideas, and goods across borders, but it has a dark side as well, and one of its nastier spawn is the flood of psychoactive substances, both licit and illicit, around the world. One thing is certain: Globalization is here to stay; we will be dealing with its consequences, for good or ill, for centuries to come. It has become an ineradicable feature of the human condition. Its impact on drug distribution, use, and abuse and proposed solutions to these problems will forever involve the entire world community.