critical thinking questions about drugs

Best critical thinking questions about drugs

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Drugs have been a part of human society for centuries, and their use and impact continue to be a topic of debate and concern. Whether it is prescription medication, recreational drugs, or even herbal remedies, the effects and consequences of drug use are wide-ranging and complex. To better understand the various aspects of drugs and their implications, critical thinking questions can help us delve deeper into this subject. By asking thought-provoking questions, we can challenge our assumptions, explore different perspectives, and ultimately expand our knowledge and awareness.

In this article, we will present a list of critical thinking questions about drugs that can encourage thoughtful discussions and reflection. These questions are designed to stimulate critical thinking and promote a deeper understanding of the subject matter. Whether you are an educator, a student, or simply interested in exploring the topic of drugs, these questions can serve as a starting point for meaningful conversations.

Remember, critical thinking involves analyzing information, evaluating arguments, and considering various viewpoints. It is a skill that can be honed through practice and open-mindedness. So, let’s dive into these critical thinking questions about drugs and see where they take us!

See these critical thinking questions about drugs

• What are the main reasons people use drugs?
• How does drug addiction affect individuals and society?
• What are the potential benefits and risks of using prescription medications?
• Should recreational drug use be legalized and regulated?
• What role does culture play in shaping attitudes towards drugs?
• Is drug use primarily a personal choice or a result of external factors?
• What are the ethical implications of using performance-enhancing drugs in sports?
• How does drug use impact mental health?
• Should drug testing be mandatory in workplaces?
• What are the long-term effects of drug use on the brain?
• Should drug education be a mandatory part of school curriculum?
• What factors contribute to the rise of drug abuse among teenagers?
• How does drug use intersect with issues of race and socioeconomic status?
• What role do pharmaceutical companies play in the opioid crisis?
• Should drug users be treated as criminals or individuals in need of help?
• What are the potential consequences of mixing different types of drugs?
• How does drug use impact relationships and family dynamics?
• What are the economic implications of the illegal drug trade?
• Should drug prices be regulated to ensure affordability?
• What alternative approaches to drug addiction treatment exist?
• How does drug use affect academic performance?
• What are the potential dangers of using herbal remedies without medical supervision?
• Should drug testing be implemented in professional sports?
• What are the social stigmas associated with drug use?
• How does drug use impact crime rates?
• Should drug offenders be given rehabilitation or punitive sentences?
• What factors contribute to the rise of prescription drug abuse?
• How does drug use affect driving ability and road safety?
• Should drug patents be limited to ensure affordable access to medication?
• What are the ethical implications of using animals for drug testing?
• How does drug use impact creativity and artistic expression?
• What role does peer pressure play in drug experimentation?
• Should drug use be decriminalized to focus on harm reduction strategies?
• What are the potential risks of using performance-enhancing drugs in the workplace?
• How does drug use affect pregnancy and fetal development?
• Should drug addicts be given access to safe injection sites?
• What are the long-term effects of drug use on physical health?
• How does drug use impact productivity in the workplace?
• Should drug education focus on abstinence or harm reduction?
• What are the potential benefits and risks of psychedelic drugs?
• How does drug use influence criminal behavior?
• Should drug testing be mandatory for welfare recipients?
• What are the potential consequences of using counterfeit drugs?

These critical thinking questions about drugs are just a starting point for exploring this complex and multifaceted topic. By engaging in critical thinking and open dialogue, we can gain a better understanding of the various aspects of drugs and their impact on individuals and society. So, let’s continue asking questions, challenging assumptions, and seeking knowledge to foster a more informed and compassionate approach towards drugs.

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10 Conversation Starters To Spark Authentic Classroom Discussions About Drugs and Alcohol

It’s a difficult task, but an important one. Here are some powerful prompts to start the conversation.

I’m going to be honest with you. Talking to middle-school students about the risks of drugs and alcohol is not my favorite thing to do. It’s awkward. It’s challenging. I don’t know what they’re going to say. Frankly, it scares me a little. But here’s the thing. Not talking to my students about underage use and abuse of drugs and alcohol, and the many tough decisions they’re going to face as teenagers, scares me far more. Here’s why. The average age boys first try alcohol is 11. For girls, the age is 13. Research shows that teens who drink or use drugs regularly are 65 percent more likely to become addicted than those who hold off until age 21.

So, that’s why I talk to my students. I’m in. Even though it’s hard, even though they sometimes roll their eyes, I talk to them about drugs and alcohol because it matters, because it can help them make good choices, it can help to save lives, and because I believe teachers can make a difference. Genuine, ongoing conversations with adults who care—parents of course, but teachers too—can help teens make better decisions on the way to growing up.

Download these free conversation starter  cards I use with my eighth graders. Over the last couple of years, I’ve tried different approaches. Sometimes, I have kids pull a question out of a hat, and we have a class-wide discussion. Other times, I divide a class into groups and give each group a question to chat about. Then, each group reports back to the whole class on their discussion. Below are my most successful “conversation starters” about teen drug and alcohol use, and some tips on how to guide the discussions that follow.

1. Have you been in situations where there were opportunities for drug or alcohol use? Did you feel pressured? Why or why not?

Let students share a few stories. Then guide them to think about peer (or other) pressure. Would they judge someone who says “no” to alcohol and drugs negatively? They will likely say they respect others’ choices, yet they still fear being judged themselves. This dichotomy is a great place to focus the conversation. Ask: “What are your options if you feel pressured?” For example, students can practice what they are going to say so that they feel more comfortable. Suggest they avoid the “pressure zone” or situations that might be uncomfortable. Use the buddy system. Perhaps they can find a friend who shares their values, and they can back each other up.  

2. Why do you think some teens abuse drugs and alcohol? If you asked them, what reasons would they give for using? What other reasons might they have?

Some of the answers you can expect are: peer pressure, escapism, “because it’s fun,” curiosity, or rebellion. Push students to also consider reasons like self-medication, boredom, ignorance of the risks, fear of rejection, depression, recklessness. Ask: “What else can you do for fun or when you need an escape? Everybody needs that sometimes. What are some options besides drugs and alcohol?” (Hint: amusement parks, sports, trying something new like acting or skating.)

3. Imagine that it’s 25 years from now and you have a teenage son or daughter exactly the same age as you are now. What would you say to him or her about drinking and drugs?

You may receive a surprising range of answers to this question, but it will likely provoke an interesting discussion. Ask them to consider the choices about drugs and alcohol they would want a younger sibling or cousin to make. Are they different from the choices they make themselves or they intend to make themselves? Push your students to account for the difference. If they want the best for others, why not for themselves?

4. When you feel down, stressed, lonely or bored, what do you do to feel better? Sometimes people “medicate” with drugs or alcohol to avoid difficult feelings. What are some healthier options?

Your students should be able to come up with a list—everything from “Facetime a friend” to “go out for ice cream.” Afterwards, type up their list of suggestions to share as a handout at the next class .

5. It’s Friday night and you’ve been looking forward to hanging out with your friends all week. Your friend says he’ll give you a ride because he knows you’re stuck. You get there and it’s going great, but then you turn around and your ride is smoking a joint. What are your options? What would you do?

Your students will know that calling their parents is the accepted answer. If they don’t want to do that, what other options are there? Find a different ride, Uber, call a sibling or another adult they trust, walk home, spend the night. Talk to your students about the importance of thinking ahead and anticipating possible outcomes. What can they do to avoid these kinds of situations in the first place?

6. You are at a concert and someone offers you a pill to “enhance the experience.” If you were to take it, what are some of the possible consequences? If you chose not to take it, what would happen?

Encourage your class to list all the possible things that could happen after each choice. Appoint a student to record answers on the board. No doubt, one list will be far longer than the other. There are many negative consequences to taking a drug that they know nothing about. Talk to your students about impulse control and the teenage brain . The teen brain is primed to take risks This means that teens need to be extra aware as they make decisions.

7. Have you ever seen anyone using alcohol or drugs make a fool of themselves? What happened? How would you feel if it were you?

Every hand in the room will go up, and everyone will want to tell a story about the time their uncle fell off the porch into the baby pool. The tricky part here is reining it in, and helping them understand that it’s a lot less funny when the Snapchat video stars your own humiliation. Ask students: How would you feel if that was you? How can you avoid making decisions you regret the next day or perhaps even forever?

8. When do you think people are old enough to make their own decisions about drinking and drugs? Do grownups always make good decisions? If you were in charge of setting the legal age, what would it be?

Ask: Are there other reasons why it’s a good idea for teens to wait until they are 21 before they drink alcohol? What are they? For example, research shows that people who use drugs or alcohol regularly as teens are 68 percent more likely to become addicted than those who hold off use until age 21, after which the chances of addiction drop to 2%.

9. What can teens do to have a good time and to feel a rush of excitement other than doing drugs or drinking? In short, what else can teens be doing on a Saturday night?

Push your students to think beyond movies and concerts. How about indoor rock climbing, mountain biking, going to concerts, playing music, learning to cook, volunteering, filmmaking, cartooning, science experiments, political activism, fundraising, bodybuilding or camping? Encourage your students to see that they can be themselves, have great friends and a great time without resorting to drinking and drugs.

10. Name two things you would like to accomplish by the time you graduate high school. How could drugs and alcohol use get in the way of those goals?

For this question, ask five or so students to share goals, and then have the rest of the class list ways drugs and alcohol could interfere. If the goal is, for example, playing college football, marijuana use could affect physical and mental performance on the field, lower your grades or even get you thrown off the team. Encourage your students to see that the temporary fun of drinking and drugs can come with dangerous risks and unwanted consequences both short- and long-term.

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THE PREEMINENT MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT PROGRAMS FOR ADOLESCENTS AND YOUNG ADULTS

A Parent’s Answers to 9 Common Questions About Drugs

Did you know that nearly 1 in 4 high school seniors has used an illicit drug in the past year? Although teen drug use has declined in recent years, many adolescents and young adults are still experimenting, still binging, and still acting out. And as a result, much of our youth are developing chronic addictions.

Of course, not every teenager today uses drugs. And with the proper education, prevention, and communication in place, your child will be much less likely to do so.

Talking to your teen – openly and honestly – about drugs will undoubtedly have great influence on his or her choices down the road. In fact, numerous studies show that parental involvement is a major factor in preventing early drug abuse. According to DrugFree.org , teens are far less likely to use substances if their parents teach them about the risks of substance abuse early on. Unfortunately, however, more than 1 in 5 teens report they have not yet learned about drugs from their parents.

As a parent, you are also an educator – especially when it comes to your child’s questions about drugs and alcohol. So as a parent, you too should be educated on the risks of teen substance abuse . By being informed, you will also be prepared to answer your teen’s questions about drugs, correctly and compassionately.

Read 9 questions about drugs that are frequently asked by teens, as well as 9 informative answers every parent should keep on hand.

Q: Why do only some people get addicted to drugs?

A: This is a great question, and unfortunately, it is not an easy one to answer. Some people are more vulnerable to addiction than others, but it’s important for you to remember that anyone, at any age, can become addicted to drugs. Because your brain is still developing as a teen, however, you are especially prone to addiction. Drugs and alcohol change the chemicals in your brain. They disrupt how you think, how you act, and how your brain works. It only takes a few hits or few pills to start this cycle. I know you may think it won’t happen to you, but sometimes you just can’t predict it.

Context: There are several risk factors that can stir an addiction, one major one being early exposure to drugs. In fact, 9 out of 10 people who have a substance addiction started using in their adolescence, before their 18th birthday. Other addiction risk factors can include genetics, the availability of drugs, economic status and community, traumatic life events, poor academic performance, and lack of adult supervision growing up.

Q: Are all drugs addictive? What makes them addictive?

A: Each drug of abuse is unique and will act on the brain in a different way. However, all drugs share a something in common – a chemical called dopamine. When a person uses a drug, their brain releases dopamine to produce the feeling of being “high.” But when a person uses drugs repeatedly, their brain adjusts to the surges of dopamine that occur. In time, their bodies get used to this chemical and demand more of it. This is where an addiction starts. The user starts to crave more drugs and less of the once pleasurable things in life, such as good food or friendships. The user also begins to lose the ability to resist these bad cravings, making it harder for him or her to quit.

Context: Different drugs have different effects on the brain and body, but in nearly all cases, repeated drug use will lead to addictive behaviors. Again, drug addiction is very likely to occur in teenagers who regularly use and abuse drugs. Learn about the different effects of substance abuse .

Q: Can I get addicted if I do it just once and a while?

A: Yes, you can. Most people your age only have the intention of using a drug once or “once in a while.” They do not intend to develop an addiction, but many do. This is because addictive drugs chemically change a person’s brain with each time of use. Progressively, your occasional use may turn into frequent use which may turn into regular use over time. This is the cycle of addiction .

Q: You drink alcohol. It can’t be that dangerous, right?

A: As a legal adult, I drink in a way that is responsible and safe for me and for those close to me. As much as I believe you are responsible, I do not feel that alcohol is safe nor healthy for you or any one your age.  Drinking can lead to serious problems, problems that will not only affect you but also the people around you – especially at this time in your life.

The younger you start drinking, the more inexperienced you are in handling alcohol-related problems. Almost 2,000 teenagers under the legal drinking age die from alcohol-induced car accidents each year. On college campuses, up to 95 percent of all violent crimes and sexual assault involve alcohol. The problem is, unanticipated situations can easily get out of hand when you are under the influence and you could end up hurt. If you stay sober, you will be better able to take care of yourself and maybe even others, as well.

Q: Are prescription drugs safe? They are legal and some of my friends at school use them.

A: If your doctor prescribes you a medication, you may take it safely and legally as it is directed. However, it is important to remember that prescription drugs are still drugs, they are addictive, and they are both dangerous and illegal if used nonmedically. You can die from using a prescription drug that was not prescribed to you.

Context:  51 percent of teenagers believe that because prescription drugs are legal, they must be safe. 21 percent also assume that their parents won’t care as much if caught. In truth, the risks of prescription drug abuse are very high.  Every day, nearly 7,000 people in the U.S. are treated in emergency departments for misusing prescription drugs. 

Q: What about marijuana? It’s a plant, it’s natural.

A: Marijuana may be a plant but there are real and concerning health risks associated with the drug. Just because it is a plant does not mean it is harmless. In fact, more adolescents are in drug treatment for marijuana addiction than any other illegal drugs combined. Approximately 1 in every 11 young adults become addicted to smoking marijuana.

Q: Is medical marijuana safer than the pot that’s on the street?

A: According to the National Institute on Drug Abuse , the marijuana plant has not been approved by the FDA for the treatment of any medical condition. While a pill form of THC (the primary chemical in marijuana) is used to alleviate certain conditions or treatments such as cancer chemotherapy, the medical benefits are still being deliberated by professional scientists. Nonetheless, smoked marijuana is not an ideal treatment because of its addictiveness and propensity to harm the lungs.

Q: How do I know if someone is addicted to drugs?

A: There are many different signs of addiction, and every drug has its own, unique symptoms and side effects. If you think that someone you know has an addiction, pay attention to how he or she acts and looks. If you notice any of these behavioral or physical signs of drug addiction , it is important to talk to your friend as well as tell a trusted adult who can help.

Q: What can I do to help my friend who is addicted to drugs?

A: If you think your friend has a serious drug problem, the most immediate thing you can do is offer him or her support. Talk to your friend and let them that you are concerned, that you are there for them. Encourage them to seek help from a trusted adult, such as a school counselor, a doctor, or an addiction professional. You can also talk to me, and together we can figure out how to find professionals who can get your friend healthy again. If you feel that your friend is in danger, this is especially important. You can help save your friends’ life if you recognize there is a problem. You can be a positive influence.

For more tips on how to talk to your teen or answer your teen’s questions about drugs, please don’t hesitate to call Turnbridge at 877-581-1793. For more answers to questions about drugs, you may also visit the NIDA for Teens website.

Substance Use and Abuse

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Critical Thinking Questions

The negative health consequences of both alcohol and tobacco products are well-documented. A drug like marijuana, on the other hand, is generally considered to be as safe, if not safer than these legal drugs. Why do you think marijuana use continues to be illegal in many parts of the United States?

One possibility involves the cultural acceptance and long history of alcohol and tobacco use in our society. No doubt, money comes into play as well. Growing tobacco and producing alcohol on a large scale is a well-regulated and taxed process. Given that marijuana is essentially a weed that requires little care to grow, it would be much more difficult to regulate its production. Recent events suggest that cultural attitudes regarding marijuana are changing, and it is quite likely that its illicit status will be adapted accordingly.

Why are programs designed to educate people about the dangers of using tobacco products just as important as developing tobacco cessation programs?

Given that currently available programs designed to help people quit using tobacco products are not necessarily effective in the long term, programs designed to prevent people from using these products in the first place may be the best hope for dealing with the enormous public health concerns associated with tobacco use.

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The upshot | short answers to hard questions about the opioid crisis.

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Short Answers to Hard Questions About the Opioid Crisis

By JOSH KATZ UPDATED August 10, 2017

On Thursday, President Trump said he intended to declare the opioid crisis a national emergency , as previously recommended by his opioid commission.

With the death toll from drugs rising faster than ever , you might feel that you could use a little catching up. For a quick refresher, and more on the practical effects of a formal declaration of an emergency, here are answers to 12 critical questions.

How bad is it?

Drug overdoses are the leading cause of death for Americans under 50, and deaths are rising faster than ever, primarily because of opioids.

Overdoses killed more people last year than guns or car accidents, and are doing so at a pace faster than the H.I.V. epidemic at its peak. In 2015, roughly 2 percent of deaths — one in 50 — in the United States were drug-related.

Percentage of deaths classified as drug-related

Overdoses are merely the most visible and easily counted symptom of the problem. Over two million Americans are estimated to have a problem with opioids . According to the latest survey data , over 97 million people took prescription painkillers in 2015; of these, 12 million did so without being directed by a doctor.

What is an “opioid”?

That’s not really a helpful answer.

The first such drug, and the one from which the opioid receptors get their name, was opium. Opium, a narcotic obtained from a kind of poppy, has been used in human societies for thousands of years. From opium people derived a whole host of other drugs with similar properties: first morphine, then heroin, then prescription painkillers like Vicodin, Percocet and OxyContin. Opium along with all of these derivatives are collectively known as opiates .

Then there are a handful of compounds that act just like opiates but aren’t made from the plant. Opiates along with these synthetic drugs — chiefly methadone and fentanyl — are grouped together into the category of substances called opioids .

Opioid receptors regulate pain and the reward system in the human body. That makes opioids powerful painkillers, but also debilitatingly addictive.

So is this crisis about prescription painkillers or heroin?

The crisis has its roots in the overprescription of opioid painkillers, but since 2011 overdose deaths from prescription opioids have leveled off. Deaths from heroin and fentanyl, on the other hand, are rising fast. In several states where the drug crisis is particularly severe, including Rhode Island , Pennsylvania and Massachusetts , fentanyl is now involved in over half of all overdose fatalities.

Drug overdose deaths involving ...

While heroin and fentanyl are the primary killers now, experts agree that the epidemic will not stop without halting the flow of prescription opioids that got people hooked in the first place.

Show me one way the epidemic has changed.

The latest iteration of the opioid epidemic has been especially deadly among adults in their 20s and early 30s.

Distribution of drug deaths by age

In 2000, the most common age for drug deaths, including those not involving opioids, was around 40. This was the generation that first grew addicted to prescription opioids in large numbers — white people especially so. Now there’s evidence that the opioid epidemic is dividing into two waves, with a new group of younger drug users growing addicted to, and dying from, heroin or fentanyl rather than prescription pills.

Where is the worst of the problem?

There’s a lot of geographic variation in the rate of drug deaths, with the highest overdose rates clustered in Appalachia, the Rust Belt and New England.

Teasing out the reasons for the geographical differences is not easy. In certain places, the ways in which people use drugs could be more dangerous (you’re more likely to die from injecting heroin than you are from smoking it, for example).

But it’s clear that a significant portion of the variation in deaths, if not necessarily in use, is being driven by the appearance of fentanyl in the drug supply. Fentanyl, a highly potent opioid, affects heroin users and pill users both, the latter often falling victim to counterfeit pills that look like prescription painkillers.

So far, the white population has been hardest hit, but this is beginning to change. Several critics have been quick to point out that the country’s response was not nearly as public-health-oriented during the crack cocaine epidemic in the 1980s, which disproportionately affected African-Americans.

Why has this problem gotten so much worse in recent years?

Addiction to opioids goes back centuries, but the current crisis really starts in the 1980s. A handful of highly influential journal articles relaxed long-standing fears among doctors about prescribing opioids for chronic pain. The pharmaceutical industry took note, and in the mid-1990s began aggressively marketing drugs like OxyContin. This aggressive and at times fraudulent marketing, combined with a new focus on patient satisfaction and the elimination of pain, sharply increased the availability of pharmaceutical narcotics.

Pill mills began popping up around the country as communities were flooded with prescription opioids. Over the next decade, a growing number of people grew addicted to the drugs, whether from prescriptions or from taking them recreationally. For many, what started with pills evolved into a heroin addiction.

At the same time, the heroin market was changing. The price plummeted. Newly decentralized drug distribution networks pushed heroin and counterfeit pharmaceuticals into suburban and rural areas where they had never been. Everywhere the suppliers went, they found a ready and willing customer base, primed for addiction by decades of prescription opiate use.

Then in 2014, fentanyl began entering the drug supply in large amounts.

Drug seizures containing fentanyl

What is fentanyl and why is it killing people?

Heroin is derived from opium, a plant. That means its growers need fields and labor to harvest the crop. They are tied to land, weather and time.

Fentanyl is purely synthetic. Think chemistry, not agriculture. It’s commonly used for surgical anesthesia and is prescribed to treat pain, but almost all of the fentanyl on the streets is illicitly manufactured. According to the Drug Enforcement Administration, the majority of illicit fentanyl in the United States is manufactured either in China or in Mexico using precursors bought from China. And at least some portion of it comes to the United States in the mail, ordered from dark web sources like the recently shuttered AlphaBay . But we don’t know how much.

Fentanyl is a fine-grained powder, meaning that it’s easy to mix into other drugs. This is how most people are exposed to illicit fentanyl: It will be mixed into, or made to look like, powdered heroin or it will be used to produce counterfeit prescription pills.

It’s super potent, meaning you’re dealing with very small quantities . That makes it almost impossible to control supply. Though most of the fentanyl in America is thought to originate in China, the fact that it’s synthetic means it’s much harder to know where the drugs are coming from. With heroin, investigators could rely on regionally specific chemical markers to indicate where the drugs had been produced. With drugs synthesized in a lab, it’s harder to tell .

Why would people take fentanyl? It does not sound fun.

From a dealer’s perspective, fentanyl is easier to get and more profitable to sell. Some law enforcement officials argue that drug users will seek out batches of drugs that contain fentanyl or that are known to have killed people, as that demonstrates the drugs’ potency.

While that is certainly true for some number of drug users , research suggests that they are a minority . Most are exposed to fentanyl inadvertently — it’s difficult to know just what is in the drugs they are buying (many dealers don’t know themselves), one more risk in a dangerous pursuit of a high.

For long-time drug users, their continued use underlines the grip of addiction and the agony of withdrawal: They know it could kill them but do it anyway. Casual drug users are also at risk of fentanyl poisoning, particularly with increased reports of fentanyl-adulterated cocaine.

So shouldn’t we just stop prescribing opioids?

Opioids are a vital component of modern medicine that have measurably improved the quality of life for millions of people, particularly cancer patients and those with acute pain. But their efficacy in treating chronic pain is less clear , especially when weighed against the risks of overdose and addiction.

Though prescription opioid consumption has been decreasing in the United States since 2010 or 2011, it remains high. According to the International Narcotics Control Board , if the amount of opioids prescribed per year were averaged out over each person living in America, everyone would get about a two-week supply. (Or a three-week supply, according to the C.D.C . Different ways of measuring what counts as a daily opioid dose give different values.) Either way you count, it’s higher than anywhere else in the world.

Average days of opioid use per resident per year

At the same time, some chronic pain patients now struggle to fill their prescriptions. Solving the opioid problem requires controlling prescription opioid distribution while maintaining access for patients with legitimate medical needs. Suddenly removing access to opioids from those who are dependent on them to function could easily push people to illicit opioid sources, like heroin or counterfeit pills.

What can be done?

Experts agree fixing the opioid epidemic will take a combination of solutions. But it’s a question of priorities: Which approaches will be most effective and most efficient? What is the best use of resources?

Officials want to use state prescription drug monitoring programs to reduce the supply of prescription opioids that end up being used recreationally while maintaining adequate access for current chronic pain patients. More broadly, experts say we need to improve the way our medical system manages pain. Remember the 12 million people we said took prescription painkillers outside of medical use? Roughly two-thirds of those did so to relieve physical pain . A more holistic approach to pain treatment would lessen the need for opioids .

On the treatment side, experts stress the importance of having treatment readily available for those who are already addicted. Often that means going to where the people are, not waiting for them to seek out treatment themselves. And addiction treatment doesn’t just mean counseling or an inpatient clinic. Studies show the most effective treatment for opioid addiction often requires opioid medications like methadone or buprenorphine .

In the meantime, widespread distribution of naloxone — an overdose antidote — will save lives in acute cases.

There isn’t agreement about other possible measures that could help. Public health experts advocate things like safe injection sites , where people could use drugs under medical supervision, and drug checking services that people could use to test drugs for fentanyl , but many in law enforcement remain reluctant to adopt such measures.

Will the commission’s recommendations help?

The commission laid out a series of recommendations in its interim report, with a final report expected in October.

Some of the recommendations — like enhancing prescription drug monitoring programs and mandatory physician education on the dangers of opioids — are aimed at prevention. Some — expanding access to and funding development of medication-assisted treatment, eliminating Medicaid barriers to in-patient addiction treatment and enforcing laws that prevent health insurance companies from limiting mental health coverage — are aimed at treatment. The commission’s report also called upon the president to mandate that naloxone be carried by every American law enforcement officer.

Of course, these are only recommendations. It’s up to the president and the various executive agencies to implement them. Experts know how to attack the problem. It’s just a matter of having the will to put those policies into practice.

What does declaring a national emergency actually do?

The commission’s “ most urgent recommendation ” was for Mr. Trump to declare a national emergency. One way this could work is through the National Emergencies Act and a law called the Public Health Service Act .

During a public health emergency, this law gives the secretary of health and human service broad authority to make grants, conduct investigations and waive or amend a variety of health regulations.

For example, the opioid commission argued that the H.H.S. secretary would be able to waive the I.M.D. exclusion, an obscure rule that bars Medicaid reimbursement for patients in mental health facilities with more than 16 beds. Since Medicaid pays for a significant portion of inpatient drug addiction treatment, the exclusion is a major obstacle.

Many states have been granted waivers from this regulation, but the onus is on each state to prove that it qualifies for one. The commission asserted that an emergency declaration would give the H.H.S. secretary the power to grant a waiver to any state that requests one, but it’s not clear that this is the case.

Do you have questions that we didn’t answer? Please let us know .

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Vol. XXVIII, No. 4, Summer 2012

Eight Questions for Drug Policy Research

By Mark A. R. Kleiman , Jonathan P. Caulkins , Angela Hawken , Beau Kilmer

The current research agenda has only limited capacity to shrink the damage caused by drug abuse. Some promising alternative approaches could lead to improved results.

Drug abuse—of licit and illicit drugs alike—is a big medical and social problem and attracts a substantial amount of research attention. But the most attractive and most easily fundable research topics are not always those with the most to contribute to improved social outcomes. If the scientific effort paid more attention to the substantial opportunities for improved policies, its contribution to the public welfare might be greater.

The current research agenda around drug policy concentrates on the biology, psychology, and sociology of drugtaking and on the existing repertoire of drug-control interventions. But that repertoire has only limited capacity to shrink the damage that drug users do to themselves and others or the harms associated with drug dealing, drug enforcement, and drug-related incarceration; and the current research effort pays little attention to some innovative policies with substantial apparent promise of providing improved results.

At the same time, public opinion on marijuana has shifted so much that legalization has moved from the dreams of enthusiasts to the realm of practical possibility. Yet voters looking to science for guidance on the practicalities of legalization in various forms find little direct help.

All of this suggests the potential of a research effort less focused on current approaches and more attentive to alternatives.

The standard set of drug policies largely consists of:

• Prohibiting the production, sale, and possession of drugs
• Seizing illicit drugs
• Arresting and imprisoning dealers
• Preventing the diversion of pharmaceuticals to nonmedical use
• Persuading children not to begin drug use
• Offering treatment to people with drug-abuse disorders or imposing it on those whose behavior has brought them into conflict with the law
• Making alcohol and nicotine more expensive and harder to get with taxes and regulations
• Suspending the drivers’ licenses of those who drive while drunk and threatening them with jail if they keep doing it

With respect to alcohol and tobacco, there is great room or improvement even within the existing policy repertoire for example, by raising taxes), even before more-innovaive approaches are considered. With respect to the currently illicit drugs, it is much harder to see how increasing or slightly modifying standard-issue efforts will measurably shrink the size of the problems.

The costs—fiscal, personal, and social—of keeping half a million drug offenders (mostly dealers) behind bars are sufficiently great to raise the question of whether less comprehensive but more targeted drug enforcement might be the better course. Various forms of focused enforcement offer the promise of greatly reduced drug abuse, nondrug crime, and incarceration. These include testing and sanctions programs, interventions to shrink flagrant retail drug markets, collective deterrence directed at violent drug-dealing organizations, and drug-law enforcement aimed at deterring and incapacitating unusually violent individual dealers. Substantial increases in alcohol taxes might also greatly reduce abuse, as might developing more- effective treatments for stimulant abusers or improving the actual evidence base underlying the movement toward “evidence-based policies.”

These opportunities and changes ought to influence the research agenda. Surely what we try to find out should bear some relationship to the practical choices we face. Below we list eight research questions that we think would be worth answering. We have selected them primarily for policy relevance rather than for purely scientific interest.

1) How responsive is drug use to changes in price, risk, availability, and “normalcy”?

The fundamental policy question concerning any drug is whether to make it legal or prohibited. Although the choice s not merely binary, a fairly sharp line divides the spectrum of options. A substance is legal if a large segment of he population can purchase and possess it for unsupervised “recreational” use, and if there are no restrictions on who can produce and sell the drug beyond licensing and routine regulations.

Accepting that binary simplification, the choice becomes what kind of problem one prefers. Use and use-related problems will be more prevalent if the substance is legal. Prohibition will reduce, not eliminate, use and abuse, but with three principal costs: black markets that can be violent and corrupting, enforcement costs that exceed those of regulating a legal market, and increased damage per unit of consumption among those who use despite the ban. (Total use related harm could go up or down depending on the extent to which the reduction in use offsets the increase in harmfulness per unit of use.)

The costs of prohibition are easier to observe than are its benefits in the form of averted use and use-related problems. In that sense, prohibition is like investments in prevention, such as improving roads; it’s easier to identify the costs than to identify lives saved in accidents that did not happen.

We would like to know the long-run effect on consumption of changes in both price and the nonprice aspects of availability, including legal risks and stigma. There is now a literature estimating the price elasticity of demand for illegal drugs, but the estimates vary widely from one study to the next and many studies are based on surveys that may not give adequate weight to the heavy users who dominate consumption. Moreover, legalization would probably involve price declines that go far beyond the support of historical data.

Furthermore, as Mark Moore pointed out many years ago, the nonprice terms of availability, which he conceptualized as “search cost,” may match price effects in terms of their impact on consumption. Ye t those effects have never been quantitatively estimated for a change as profound as that from illegality to legality. The decision not to enforce laws against small cannabis transactions in the Netherlands did not cause an explosion in use; whether and how much it increased consumption and whether the establishment of retail shops mattered remain controversial questions.

This ignorance about the effect on consumption hamstrings attempts to be objective and analytical when discussing the question of whether to legalize any of the currently illicit drugs, and if so, under what conditions.

2) How responsive is the use of drug Y to changes in policy toward drug X?

Polydrug use is the norm, particularly among frequent and compulsive users. (Most users do not fall in that category, but the minority who do account for the bulk of consumption and harms.) Therefore, “scoring” policy interventions by considering only effects on the target substance is potentially misleading.

For example, driving up the price of one drug, say cocaine, might reduce its use, but victory celebrations should be tempered if the reduction stemmed from users switching to methamphetamine or heroin. On the other hand, school based drug-prevention efforts may generate greater benefits through effects on alcohol and tobacco abuse than via their effects on illegal drug use. Comparing them to other drug-control interventions, such as mandatory minimum sentences for drug dealers, in terms of ability to control illegal drugs alone is a mistake; those school-based prevention interventions are not (just) illicit-drug–control programs.

But policy is largely made one substance at a time. Drugs are added to schedules of prohibited substances based on their potential for abuse and for use as medicine. Reformers clamor for evidence-based policies that rank individual drugs’ harmfulness, as attempted recently by David Nutt, and ban only the most dangerous. Ye t it makes little practical sense to allow powder cocaine while banning crack, because anyone with baking soda and a microwave oven can convert powder to crack.

Considerations of substitution or complementarity ought to arise in making policy toward some of the so-called designer drugs. Mephedrone looks relatively good if most of its users would otherwise have been abusing methamphetamine; it looks terrible if in fact it acts as a stepping stone to methamphetamine use. But no one knows which is the case.

Marijuana legalization is in play in a way it has not been since the 1970s. Various authors have produced social-welfare analyses of marijuana legalization, toting up the benefits of reduced enforcement costs and the costs of greater need for treatment, accounting for potential tax revenues and the like.

Yet the marijuana-specific gains and losses from legalization would be swamped by the uncertainties concerning its effects on alcohol consumption. The damage from alcohol is a large multiple of the damage from cannabis; thus a 10% change, up or down, in alcohol abuse could outweigh any changes in marijuana-related outcomes.

There is conflicting evidence as to whether marijuana and alcohol are complements or substitutes; no one can rule out even larger increases or decreases in alcohol use as a result of marijuana legalization, especially in the long run.

Marijuana legalization might also influence heavy use of cocaine or cigarette smoking. But again, no one knows whether that effect would be to drive cocaine or cigarette use up or down, let alone by how much. If doubling marijuana use led to even a 1% increase or decrease in tobacco use, it could produce 4,000 more or 4,000 fewer tobacco related deaths per year, far more than the (quite small) number of deaths associated with marijuana.

This uncertainty makes it impossible to produce a solid benefit/cost analysis of marijuana legalization with existing data. That suggests both caution in drawing policy conclusions and aggressive efforts to learn more about cross-elasticities among drugs prone to abuse.

3) Can we stop large numbers of drug-involved criminal offenders from using illicit drugs?

Many county, state, and federal initiatives target drug use among criminal offenders. Ye t most do little to curtail drug use or crime. An exception is the drug courts process; some implementations of that idea have been shown to reduce drug use and other illegal behavior. Unfortunately, the resource intensity of drug courts limits their potential scope. The requirement that every participant must appear regularly before a judge for a status hearing means that a drug court judge can oversee fewer than 100 offenders at any time.

The HOPE approach to enforcing conditions of probation and parole, named after Hawaii’s Opportunity Probation with Enforcement, offers the potential for reducing use among drug-involved offenders at a larger scale. Like drug courts, HOPE provides swift and certain sanctions for probation violations, including drug use. HOPE starts with a formal warning that any violation of probation conditions will lead to an immediate but brief stay in jail. Probationers are then subject to regular random drug testing: six times a month at first, diminishing in frequency with sustained compliance. A positive drug test leads to an immediate arrest and a brief jail stay (usually a few days but in some jurisdictions as little as a few hours in a holding cell). Probationers appear before the judge only if they have violated a rule; in contrast, a drug court judge participates in every status review. Thus HOPE sites can supervise large numbers of offenders; a single judge in Hawaii now supervises more than 2,000 HOPE probationers.

In a large randomized controlled trial (RCT), Hawaii’s HOPE program greatly outperformed standard probation in reducing drug use, new crimes, and incarceration among a population of mostly methamphetamine-using felony probationers. A similar program in Tarrant County, Texas (encompassing Arlington and Fort Worth), appears to produce similar results, although this has not yet been verified by an RCT, as has a smaller-scale program (verified by an RCT) among parolees in Seattle. Reductions in drug use of 80%, in new arrests of 30 to 50%, and in days behind bars of 50% appear to be achievable at scale. The last result is the most striking; get-tough automatic-incarceration policies can reduce incarceration rather than increasing it, if the emphasis is on certainty and celerity rather than severity.

The Department of Justice is funding four additional RCTs; those results should help clarify how generalizable the HOPE outcomes are. But to date there has been no systematic experimentation to test how variations in program parameters lead to variations in results.

Hawaii’s HOPE program uses two days in jail as its typical first sanction. Penalties escalate for repeated violations, and the 15% or so of participants who violate a fourth time face a choice between residential treatment and prison. No one is mandated to undergo treatment except after repeated failures. The results suggest that this is an effective design, but is it optimal? Would some sanction short of jail for the first violation—a curfew, home confinement, or community service—work as well? Are escalating penalties necessary and if so, what is the optimal pattern of escalation? Is there a subset of offenders who ought to be mandated to treatment immediately rather than waiting for failures to accumulate? Should cannabis be included in the list of drugs tested for, as it is in Hawaii, or excluded? How about synthetically produced cannabinoids (sold as “Spice”) and cathinones (sold as “bath salts”), which require more complex and costly screening? Would adding other services to the mix improve outcomes? How can HOPE be integrated with existing treatment-diversion programs and drug courts? How can HOPE principles best be applied to parole, pretrial release, and juvenile offenders?

Answering these questions would require measuring the results of systematic variation in program conditions. There is no strong reason to think that the optimal program design will be the same in every jurisdiction or for every offender population. But it’s time to move beyond the question “Does HOPE work?” to consider how to optimize the design of testing-and-sanctions programs.

4) Can we stop alcohol-abusing criminal offenders from getting drunk?

Under current law, state governments effectively give every adult a license to purchase and consume alcohol in unlimited quantities. Judges in some jurisdictions can temporarily revoke that license for those with an alcohol-related offense by prohibiting drinking and going to bars as conditions of bail or probation. However, because alcohol passes through the body quickly, a typical random-but-infrequent testing regiment would miss most violations, making the revocation toothless.

In 2005, South Dakota embraced an innovative approach to this problem, called 24/7 Sobriety. As a condition of bail, repeat drunk drivers who were ordered to abstain from alcohol were now subject to twice-a-day breathalyzer tests, every day. Those testing positive or missing the test were immediately subject to a short stay in jail, typically a night or two. What started as a five-county pilot program expanded throughout the state, and judges began applying the program to offenders with all types of alcohol-related criminal behavior, not just drunk driving. Some jurisdictions even started using continuous alcohol-monitoring bracelets, which can remotely test for alcohol consumption every 30 minutes. Approximately 20,000 South Dakotans have participated in 24/7—an astounding figure for a state with a population of 825,000.

The anecdotal evidence about the program is spectacular; fewer than 1% of the 4.8 million breathalyzer tests ordered since 2005 were failed or missed. That is not because the offenders have no interest in drinking. About half of the participants miss or fail at least one test, but very few do so more than once or twice. 24/7 is now up and running in other states, and will soon be operating in the United Kingdom. As of yet there are no peer-reviewed studies of 24/7, but preliminary results from a rigorous quasi-experimental evaluation suggest that the program did reduce repeat drunk driving in South Dakota. Furthermore, as with HOPE, there remains a need to better understand for whom the program works, how long the effects last, the mechanism(s) by which it works, and whether it can be effective in a more urban environment.

Programs such as HOPE and 24/7 can complement traditional treatment by providing “behavioral triage.” Identifying which subset of substance abusers cannot stop drinking on their own, even under the threat of sanctions, allows the system to direct scarce treatment resources specifically to that minority.

Another way to take away someone’s drinking license would be to require that bars and package stores card every would be to require that bars and package stores card every buyer and to issue modified driver’s licenses with nondrinker markings on them to those convicted of alcohol-related crimes. This approach would probably face legal and political challenges, but that should not discourage serious analysis of the idea.

There is also strong evidence that increasing the excise tax on alcohol could reduce alcohol-related crime. Duke University economist Philip Cook estimates that doubling the federal tax, leading to a price increase of about 10%, would reduce violent crime and auto fatalities by about 3%, a striking saving in deaths for a relatively minor and easy-to-administer policy change. There is also evidence that formal treatment, both psychological and pharmacological, can yield improvements in outcomes for those who accept it.

There is also strong evidence that increasing the excise linked. Among people with drug problems who are also crimtax on alcohol could reduce alcohol-related crime. Duke Uni- inally active, criminal activity tends to rise and fall with drug versity economist Philip Cook estimates that doubling the consumption. Reductions in crime constitute a major benfederal tax, leading to a price increase of about 10%, would efit of providing drug treatment for the offender population, reduce violent crime and auto fatalities by about 3%, a strik- or of imposing HOPE-style community supervision. ing saving in deaths for a relatively minor and easy-to-ad- Reducing drug use among active offenders could also minister policy change. There is also evidence that formal shrink illicit drug markets, producing benefits everywhere, treatment, both psychological and pharmacological, can yield from inner-city neighborhoods wracked by flagrant drug improvements in outcomes for those who accept it.

5) How concentrated is hard-drug use among active criminals?

Literally hundreds of substances have been prohibited, but the big three expensive drugs (sometimes called the “hard” drugs)—cocaine, including crack; heroin; and methamphetamine— account for most of the societal harm. The serious criminal activity and other harms associated with those substances are further highly concentrated among a minority of their users. Many people commit a little bit of crime or use hard drugs a handful of times, but relatively few make a habit of either one. Despite their relatively small numbers, those frequent users and their suppliers account for a large share of all drug-related crime and violence.

The populations overlap; an astonishing proportion of those committing income-generating crimes, such as robbery, as opposed to arson, are drug-dependent and/or intoxicated at the time of their offense, and a large proportion of frequent users of expensive drugs commit income-generating crime. Moreover, the two sets of behaviors are causally linked. Among people with drug problems who are also criminally active, criminal activity tends to rise and fall with drug consumption. Reductions in crime constitute a major benefit of providing drug treatment for the offender population, or of imposing HOPE-style community supervision.

Reducing drug use among active offenders could also shrink illicit drug markets, producing benefits everywhere, from inner-city neighborhoods wracked by flagrant drug dealing to source and transit countries such as Colombia and Mexico.

A back-of-the envelope calculation suggests the potential size of these effects. The National Survey on Drug Use and Health estimates users in the household population. The Arrestee Drug Abuse Monitoring Program measures the rate of active substance use among active offenders (by self-report and urinalysis). Two decades ago, an author of this article (Kleiman) and Chris Putala, then on the Senate Judiciary Committee staff, used the predecessors of those surveys to estimate that about three-quarters of all heavy (morethan-weekly) cocaine users had been arrested for a nondrug felony in the previous year.

Applying the Pareto Law’s rule of thumb that 80% of the volume of any activity is likely to be accounted for by about 20% of those who engage in it—true, for example, about the distribution of alcohol consumption—suggests that something like three-fifths of all the cocaine is used by people who get arrested in the course of a typical year and who are therefore likely to be on probation, parole, or pretrial release if not behind bars.

Combining that calculation with the result from HOPE that frequent testing with swift and certain sanctions can shrink (in the Hawaii case) methamphetamine use among heavily drug-involved felony probationers by 80%, suggests that total hard-drug volume might be reduced by something like 50% if HOPE-style supervision were applied to all heavy users of hard drugs under criminal-justice supervision. No known drug-enforcement program has any comparable capability to shrink illicit-market volumes.

By the same token, HOPE seems to reduce criminal activity, as measured by felony arrests, by 30 to 50%. If frequent offenders commit 80% of income-generating crime, and half of those frequent offenders also have serious harddrug problems, such a reduction in offending within that group could reduce total income-generating crime by approximately 15 to 20%, while also decreasing the number of jail and prison inmates.

The Kleiman and Putala estimate was necessarily crude because it was based on studies that weren’t designed to measure the concentration of hard-drug use among offenders. Unfortunately, no one in the interim has attempted to refine that estimate with more precise methods (for example, stochastic-process modeling) or more recent data.

6) What is the evidence for evidence-based practices?

Many agencies now recommend (and some states and federal grant programs mandate) adoption of prevention and treatment programs that are evidence-based. But the move toward evidence-based practices has one serious limitation: the quality of the evidence base. It is important to ask what qualifies as evidence and who gets to produce it. Many programs are expanded and replicated on the basis of weak evidence. Study design matters. A review by George Mason University Criminologist David Weisburd and colleagues showed that the effect size of offender programs is negatively related to study quality: The more rigorous the study is, the smaller its reported effects.

Who does the evaluation can also make a difference. Texas A&M Epidemiologist Dennis Gorman found that evaluations authored by program developers report much larger effect sizes than those authored by independent researchers. Yet Benjamin Wright and colleagues reported that more than half of the substance-abuse programs targeting criminal-justice programs that were designated as evidence-based on the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Registry of Evidence Based Programs and Practices (NREPP) include the program developer as evaluator. Consequently, we may be spending large sums of money on ineffective programs. Many jurisdictions, secure in their illusory evidence base, could become complacent about searching for alternative programs that really do work.

We need to get better at identifying effective strategies and helping practitioners sort through the evidence. Requiring that publicly funded programs be evaluated and show improved outcomes using strong research designs—experimental designs where feasible, well-designed historicalcontrol strategies where experiments can’t be done, and “intent-to-treat” analyses rather than cherry-picking success by studying program completers only—would cut the number of programs designated as promising or evidence-based by more than 75%. Not only would this relieve taxpayers of the burden of supporting ineffective programs, it would also help researchers identify more promising directions for future intervention research.

The potential for selection biases when studying druginvolved people is substantial and thus makes experimental designs much more valuable. Small is key. It avoids expense, and equally important, it avoids champions with bruised egos. It is difficult to scale back a program once an agency becomes invested in the project. Small pilot evaluations that do show positive outcomes can then be replicated and expanded if the replications show similarly positive results.

7) What treats stimulant abuse?

Science can alleviate social problems not only by guiding policy but also by inventing better tools. The holy grail of such innovations would be a technology that addresses stimulant dependence.

The ubiquitous “treatment works” mantra masks a sharp disparity in technologies available for treating opiates (heroin and oxycodone) as opposed to stimulants (notably cocaine, crack, and meth). A variety of so-called opiate-substitute therapies (OSTs) exist that essentially substitute supervised use of legal, pure, and cheap opiates for unsupervised use of street opiates. Methadone is the first and best-known OST, but there are others. A number of countries even use clinically supplied heroin to substitute for street heroin.

OST stabilizes dependent individuals’ chaotic lives, with positive effects on a wide range of life outcomes, such as increased employment and reduced criminality and rates of overdose. Sometimes stabilization is a first step toward abstinence, but for better and for worse the dominant thinking since the 1980s has been to view substitution therapy as an open-ended therapy, akin to insulin for diabetics. Either way, OST consistently fares very well in evaluations that quantify social benefits produced relative to program costs.

There is no comparable technology for treating stimulant dependence. This is not for lack of trying. The National Institute on Drug Abuse has invested hundreds of millions of dollars in the quest for pharmacotherapies for stimulants. Decades of work have produced many promising advances in basic science, but with comparatively little effect on clinical practice. The gap between opiate and stimulant treatment technologies matters more in the United States and the rest of the Western Hemisphere, where stimulants have a large market, than in the rest of the world, where opiates remain predominant.

There are two reactions to this zero-for-very-many batting average. One is to redouble efforts; after all, Edison tried a lot of filament materials before hitting on carbonized bamboo. The other is to give up on the quest for a chemical that can offset, undo, or modulate stimulants’ effects in the brain and pursue other approaches. For example, immunotherapies are a fundamentally different technology inasmuch as the active introduced agent does not cross the blood-brain barrier. Rather, the antibodies act almost more like interdiction agents, but interdicting the drug molecules between ingestion and their crossing the blood-brain barrier rather than interdicting at the nation’s border.

There is evidence from clinical trials showing that some cognitive-behavioral therapies can reduce stimulant consumption for some individuals. Contingency management also takes a behavioral rather than a chemical approach, essentially incentivizing dependent users to remain abstinent. The stunning finding is that, properly deployed, very small incentives (for example, vouchers for everyday items) can induce much greater behavioral change than can conventional treatment methods alone.

The ability of contingency management to reduce consumption, and the finding that even the heaviest users respond to price increases by consuming less, profoundly challenge conventional thinking about the meaning of addiction. They seem superficially at odds with the clear evidence that addiction is a brain disease with a physiological basis. Brainimaging studies let us see literally how chronic use changes the brain in ways that are not reversed by mere withdrawal of the drugs. So just as light simultaneously displays characteristics of a particle and a wave, so too addiction simultaneously has characteristics of a physiological disease and a behavior over which the person has (at least limited) control.

8) What reduces drug-market violence?

Drug dealers can be very violent. Some use violence to settle disputes about territory or transactions; others use violence to climb the organizational ladder or intimidate witnesses or enforcement officials. Because many dealers have guns or have easy access to them, they also sometimes use these weapons to address conflicts that have nothing to do with drugs. Because the market tends to replace drug dealers who are incarcerated, there is little reason to think that routine drug-law enforcement can reduce violence; the opposite might even be true if greater enforcement pressure makes violence more advantageous to those most willing to use it.

That raises the question of whether drug-law enforcement can be designed specifically to reduce violence. One set of strategies toward this end is known as focused deterrence or pulling-levers policing. These approaches involve lawenforcement officials directly communicating a credible threat to violent individuals or groups, with the goal of reducing the violence level, even if the level of drug dealing or gang activity remains the same. Such interventions aim to tip situations from high-violence to low-violence equilibria by changing the actual and perceived probability of punishment; for example, by making violent drug dealing riskier, in enforcement terms, than less violent drug dealing.

The seminal effort was the Boston gun project Ceasefire, which focused on reducing juvenile homicides in the mid-1990s. Recognizing that many of the homicides stemmed from clashes between juvenile gangs, the strategy focused on telling members of each gang that if anyone in the gang shot someone (usually a member of a rival gang) police and prosecutors would pull every lever legally available against the entire gang, regardless of which individual had pulled the trigger. Instead of receiving praise from colleagues for increasing the group’s prestige, the potential shooter now had to deal with the fact that killing put the entire group at risk. Thus the social power of the gang was enlisted on the side of violence reduction. The results were dramatic: Youth gun homicides in Boston fell from two a month before the intervention to zero while the intervention lasted. Variants of Ceasefire have been implemented across the country, some with impressive results.

An alternative to the Ceasefire group-focused strategy is a focus on specific drug markets where flagrant dealing leads to violence and disorder. Police and prosecutors in High Point, North Carolina, adopted a focused-deterrence approach, which involved strong collaborations with community members. Their model, referred to as the Drug Market Intervention, involved identifying all of the dealers in the targeted market, making undercover buys from them (often on film), arresting the most violent dealers, and not arresting the others. Instead, the latter were invited to a community meeting where they were told that, although cases were made against them, they were going to get another chance as long as they stopped dealing. The flagrant drug market in that neighborhood, as David Kennedy reports, vanished literally overnight and has not reappeared for the subsequent seven years. The program has been replicated in dozens of jurisdictions, and there is a growing evidence base showing that it can reduce crime.

A third approach recognizes the heterogeneity in violence among individual drug dealers. By focusing enforcement on those identified as the most violent, police can create both Darwinian and incentive pressures to reduce the overall violence level. This technique has yet to be systematically evaluated. This seems like an attractive research opportunity if a jurisdiction wants to try out such an approach.

An especially challenging problem is dealing-related violence in Mexico, now claiming more than 1,000 lives per month. It is worth considering whether a Ceasefire-style strategy might start a tipping process toward a less violent market. Such a strategy could exploit two features of the current situation: The Mexican groups make most of their money selling drugs for distribution in the United States, and the United States has much greater drug enforcement capacity than does Mexico. If the Mexican government were to select one of the major organizations and target it for destruction after a transparent process based on relative violence levels, U.S. drug-law enforcement might be able to put the target group out of business by focusing attention on the U.S. distributors that buy their drugs from the target Mexican organization, thereby pressuring them to find an alternative source. If that happened, the target organization would find itself without a market for its product.

If one organization could be destroyed in this fashion, the remaining groups might respond to an announcement that a second selection process was underway by competitively reducing their violence levels, each hoping that one of its rivals would be chosen as the second target. The result might be—with the emphasis on might—a dramatic reduction in bloodshed.

Whatever the technical details of violence-minimizing drug-law enforcement, its conceptual basis is the understanding that in established markets enforcement pressure can have a greater effect on how drugs are sold than on how much is sold. So violence reduction is potentially more feasible than is greatly reducing drug dealing generally.

Drug policy involves contested questions of value as well as of fact; that limits the proper role of science in policymaking. And many of the factual questions are too hard to be solved with the current state of the art: The mechanisms of price and quantity determination in illicit markets, for example, have remained largely impervious to investigation. Conversely, research on drug abuse can provide insight into a variety of scientifically interesting questions about the nature of human motivation and self-regulation, complicated by imperfect information, intoxication, and impairment, and engaging group dynamics and tipping phenomena; not every study needs to be justified in terms of its potential contribution to making better policy. However, good theory is often developed in response to practical challenges, and policymakers need the guidance of scientists. Broadening the current research agenda away from biomedical studies and evaluations of the existing policy repertoire could produce both more interesting science and more successful policies.

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Critical Thinking Questions

People with psychological disorders have been treated poorly throughout history. Describe some efforts to improve treatment, include explanations for the success or lack thereof.

Usually someone is hospitalized only if they are an imminent threat to themselves or others. Describe a situation that might meet these criteria.

Imagine that you are a psychiatrist. Your patient, Pat, comes to you with the following symptoms: anxiety and feelings of sadness. Which therapeutic approach would you recommend and why?

Compare and contrast individual and group therapies.

You are conducting an intake assessment. Your client is a 45-year-old single, employed male with cocaine dependence. He failed a drug screen at work and is mandated to treatment by his employer if he wants to keep his job. Your client admits that he needs help. Why would you recommend group therapy for him?

Lashawn is a 24-year-old African American female. For years she has been struggling with bulimia. She knows she has a problem, but she is not willing to seek mental health services. What are some reasons why she may be hesitant to get help?

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• Authors: Rose M. Spielman, William J. Jenkins, Marilyn D. Lovett
• Publisher/website: OpenStax
• Book title: Psychology 2e
• Publication date: Apr 22, 2020
• Location: Houston, Texas
• Book URL: https://openstax.org/books/psychology-2e/pages/1-introduction
• Section URL: https://openstax.org/books/psychology-2e/pages/16-critical-thinking-questions

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