PHARMACOLOGY Drug Paradox MIDTERM
STUDY GUIDE 2024
What is the Drug Paradox?
● Licit substances often viewed with less contempt and are often an accepted part of cultural
activities
● Illicit substances typically viewed as dangerous despite evidence to suggest licit drugs are a far
greater social and public health issue compared to illicit drugs
● This drug paradox exists in the minds of the public and in historic and contemporary policy
responses
● Canada has a long history of public health traditions and progressive laws protecting human
rights; however, when it comes to substance use and users, the laws and policies have tended to
reflect more punitive, stigmatizing approaches
Defining Core Concepts
● PSYCHOACTIVE DRUG
○ Psychoactive drugs are substances that alter our central nervous system
■ They can also affect our autonomic nervous system, thus having the potential to
either balance our systems or disrupt core biological functions
■ They can disrupt our ability to sleep and dream
○ Any psychoactive substance, licit or illicit, is used for the intended or unintended purpose
of altering one’s mind and bodily functions
● DRUG DEPENDENCY
○ Just as some people define drugs differently, there is considerable debate and confusion
regarding the differences between drug use, drug abuse, drug dependence, and drug
addiction
○ The general public and researchers alike use these terms interchangeably, leading people
to make inaccurate and harmful judgments about substance use and substance users
○ Drug dependence is a classification of drug use that was controversially used for several
years in the medical community to refer to the physical and psychological aspects of
substance use
○Previous versions of the DSM defined drug dependence as consisting of three or more of
the seven criteria displayed in the DSM Criterion chart
○ The American Psychiatric Association’s fifth edition of the DSM (2013) combines
substance abuse and substance dependence into one disorder with mild and severe
categories
○ In order to be diagnosed as having an addictive disorder, a person only requires two
symptoms to be present
● DRUG ADDICTION
, ○ Prior to the 19th and 20th centuries, addiction, or rather “habituation,” was not deemed a
significant social problem
○ With the onset of the industrial revolution in North America, the Temperance Movement,
and Prohibition, the concept of individual addictive behaviour, alcoholism in particular,
became connected to both morality and workplace productivity
○ Dr. Benjamin Rush considered addiction to be an indiscriminate disease caused by the
substance itself and individuals unable to control their urges
■ He believed the only solution or cure for this problem was complete abstinence
● DISEASE/MEDICAL MODEL OF ADDICTION
○ Dr. Benjamin Rush’s framework of addiction marked the beginning of the medical or
disease model of addiction that still retains a prominent place in public and academic
discourse
○ However, researchers from a number of academic disciplines have actively challenged
the medical or disease model of addiction because it focuses exclusively on the biological
basis of addiction
○ Addiction is a holistic concept that encompasses biological, psychological, and
sociological factors
● FREE WILL/MORAL MODEL OF ADDICTION
○ The free will/moral model of addiction suggests substance use and any problems
resulting from substance use rest within the individual’s moral agency
○ The individual is solely responsible for making pro-social or asocial choices regarding
substance use
○ Many of our policies and programs remain rooted in this free will/moral model
○ Such individualized framing of the problem fails to acknowledge the sociocultural
influences that are just as important as, if not more important than, the individual
The Social Reality of Drugs and Drug use
Social Costs of Drugs and Drug use
● The social costs of drugs are far greater for alcohol and tobacco than all illicit drugs combined
● According to the Canadian Center for Substance Abuse’s most recent societal cost analysis, the
social cost of substance abuse in Canada in 2002 was almost $40 billion
, ● Tobacco accounted for approximately $17 billion, followed by alcohol costing just under $15
billion and all of the illegal drugs (including cannabis) accounting for just over $8 billion
● These estimates include both direct (health care, law enforcement) and indirect (productivity
losses, premature mortality) costs posed by the use of these substances
Economic Costs of Drugs anf Drug Use
● Productivity losses were the largest expense to Canada, with approximately $24.3 billion, 61% of
the overall costs of substance use, being attributed to this indirect cost
● The second highest cost was for health care, amounting to $8.8 billion, which is 22% of the
overall costs
● The third most expensive cost was for law enforcement, which amounted to $5.4 billion or about
14% of the overall costs
● Of this, almost one third was alcohol related, whereas approximately 22% was attributed to illicit
drugs
The Cost of Human Life
● In the same study, the net deaths from the use of alcohol were 4,258; there were 8,103 deaths
caused by alcohol and 3,845 deaths prevented by the moderate use of alcohol
● 1,695 deaths were attributable to all of the illegal drugs combined, 44% of the number attributed
to alcohol
● 37,209 deaths were attributable to tobacco in 2002
● Relatively speaking, there are greater social costs for tobacco and alcohol
Government Research on Drugs and Drug use
● The general public and policy makers alike still believe that illegal drugs are far worse than
alcohol, while the evidence clearly indicates the opposite
● This is partly attributable to the kinds of research being conducted and the manner in which it is
being presented to the public
● For instance, the Harper Conservatives heavily influenced the type of research that was
disseminated to the public by firing and muzzling scientists and processing evidence through a
bureaucratic vetting process
● Scientific evidence contrary to the government mandates was actively repressed
Prevalence and Social Reality of Drugs
● The 2012 findings of the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS)
indicate that approximately 2% of illicit drug users reported experiencing harm connected to their
drug use (physical health, social life, finances, etc.) in the past year
● Yet, the findings also indicate that approximately 14% of people reported being harmed
physically, verbally, and/or emotionally because of someone else’s drinking
● This is not to suggest that illegal drugs do not pose significant harm, though again, the notion of
licit and illicit is a social construct rather than an objective fact
, Sociological Perspetive on
● Regardless of the legal or model status of a substance, drug use cannot be fully understood from
within a single framework or discipline
● Though the disciplines of biology and psychology have historically dominated the discourse
surrounding drugs, sociology also has extensive insight and evidence to offer in providing an
understanding of drugs in society
● Central to developing a sociological understanding of substance use and misuse in society are
gender, age, social class, sexual orientation, sexual identification, and racial and ethnic origins
Week 2
History of Drug Use & Drug Control
Drugs Through the Ages
● Oldest substance consumed by human beings was called “mead”
● Opium and its derivatives also have a long history (4000BC)
○ “Joy plant” consumed by ancient greeks for medicinal purposes
○ 19th-century literary figures
● Cocaine first emerged around 500BC
○ Associated with Indigenous tribes “Incas” chewing on cocoa to release pressure from
high mountains
● Caffeine, the most widely used drug today, was documented around 900AD
○ Not always viewed with tolerance
○ “Gateway drug to narcotics”
● Cannabis dates back to 4000BC in China and was brought to NA in 1611 for the cultivation of its
fiber, an important part of the agricultural economy at the time
**drugs is a cultural universal, goes back about 10,000 years
Need for Drugs
STUDY GUIDE 2024
What is the Drug Paradox?
● Licit substances often viewed with less contempt and are often an accepted part of cultural
activities
● Illicit substances typically viewed as dangerous despite evidence to suggest licit drugs are a far
greater social and public health issue compared to illicit drugs
● This drug paradox exists in the minds of the public and in historic and contemporary policy
responses
● Canada has a long history of public health traditions and progressive laws protecting human
rights; however, when it comes to substance use and users, the laws and policies have tended to
reflect more punitive, stigmatizing approaches
Defining Core Concepts
● PSYCHOACTIVE DRUG
○ Psychoactive drugs are substances that alter our central nervous system
■ They can also affect our autonomic nervous system, thus having the potential to
either balance our systems or disrupt core biological functions
■ They can disrupt our ability to sleep and dream
○ Any psychoactive substance, licit or illicit, is used for the intended or unintended purpose
of altering one’s mind and bodily functions
● DRUG DEPENDENCY
○ Just as some people define drugs differently, there is considerable debate and confusion
regarding the differences between drug use, drug abuse, drug dependence, and drug
addiction
○ The general public and researchers alike use these terms interchangeably, leading people
to make inaccurate and harmful judgments about substance use and substance users
○ Drug dependence is a classification of drug use that was controversially used for several
years in the medical community to refer to the physical and psychological aspects of
substance use
○Previous versions of the DSM defined drug dependence as consisting of three or more of
the seven criteria displayed in the DSM Criterion chart
○ The American Psychiatric Association’s fifth edition of the DSM (2013) combines
substance abuse and substance dependence into one disorder with mild and severe
categories
○ In order to be diagnosed as having an addictive disorder, a person only requires two
symptoms to be present
● DRUG ADDICTION
, ○ Prior to the 19th and 20th centuries, addiction, or rather “habituation,” was not deemed a
significant social problem
○ With the onset of the industrial revolution in North America, the Temperance Movement,
and Prohibition, the concept of individual addictive behaviour, alcoholism in particular,
became connected to both morality and workplace productivity
○ Dr. Benjamin Rush considered addiction to be an indiscriminate disease caused by the
substance itself and individuals unable to control their urges
■ He believed the only solution or cure for this problem was complete abstinence
● DISEASE/MEDICAL MODEL OF ADDICTION
○ Dr. Benjamin Rush’s framework of addiction marked the beginning of the medical or
disease model of addiction that still retains a prominent place in public and academic
discourse
○ However, researchers from a number of academic disciplines have actively challenged
the medical or disease model of addiction because it focuses exclusively on the biological
basis of addiction
○ Addiction is a holistic concept that encompasses biological, psychological, and
sociological factors
● FREE WILL/MORAL MODEL OF ADDICTION
○ The free will/moral model of addiction suggests substance use and any problems
resulting from substance use rest within the individual’s moral agency
○ The individual is solely responsible for making pro-social or asocial choices regarding
substance use
○ Many of our policies and programs remain rooted in this free will/moral model
○ Such individualized framing of the problem fails to acknowledge the sociocultural
influences that are just as important as, if not more important than, the individual
The Social Reality of Drugs and Drug use
Social Costs of Drugs and Drug use
● The social costs of drugs are far greater for alcohol and tobacco than all illicit drugs combined
● According to the Canadian Center for Substance Abuse’s most recent societal cost analysis, the
social cost of substance abuse in Canada in 2002 was almost $40 billion
, ● Tobacco accounted for approximately $17 billion, followed by alcohol costing just under $15
billion and all of the illegal drugs (including cannabis) accounting for just over $8 billion
● These estimates include both direct (health care, law enforcement) and indirect (productivity
losses, premature mortality) costs posed by the use of these substances
Economic Costs of Drugs anf Drug Use
● Productivity losses were the largest expense to Canada, with approximately $24.3 billion, 61% of
the overall costs of substance use, being attributed to this indirect cost
● The second highest cost was for health care, amounting to $8.8 billion, which is 22% of the
overall costs
● The third most expensive cost was for law enforcement, which amounted to $5.4 billion or about
14% of the overall costs
● Of this, almost one third was alcohol related, whereas approximately 22% was attributed to illicit
drugs
The Cost of Human Life
● In the same study, the net deaths from the use of alcohol were 4,258; there were 8,103 deaths
caused by alcohol and 3,845 deaths prevented by the moderate use of alcohol
● 1,695 deaths were attributable to all of the illegal drugs combined, 44% of the number attributed
to alcohol
● 37,209 deaths were attributable to tobacco in 2002
● Relatively speaking, there are greater social costs for tobacco and alcohol
Government Research on Drugs and Drug use
● The general public and policy makers alike still believe that illegal drugs are far worse than
alcohol, while the evidence clearly indicates the opposite
● This is partly attributable to the kinds of research being conducted and the manner in which it is
being presented to the public
● For instance, the Harper Conservatives heavily influenced the type of research that was
disseminated to the public by firing and muzzling scientists and processing evidence through a
bureaucratic vetting process
● Scientific evidence contrary to the government mandates was actively repressed
Prevalence and Social Reality of Drugs
● The 2012 findings of the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS)
indicate that approximately 2% of illicit drug users reported experiencing harm connected to their
drug use (physical health, social life, finances, etc.) in the past year
● Yet, the findings also indicate that approximately 14% of people reported being harmed
physically, verbally, and/or emotionally because of someone else’s drinking
● This is not to suggest that illegal drugs do not pose significant harm, though again, the notion of
licit and illicit is a social construct rather than an objective fact
, Sociological Perspetive on
● Regardless of the legal or model status of a substance, drug use cannot be fully understood from
within a single framework or discipline
● Though the disciplines of biology and psychology have historically dominated the discourse
surrounding drugs, sociology also has extensive insight and evidence to offer in providing an
understanding of drugs in society
● Central to developing a sociological understanding of substance use and misuse in society are
gender, age, social class, sexual orientation, sexual identification, and racial and ethnic origins
Week 2
History of Drug Use & Drug Control
Drugs Through the Ages
● Oldest substance consumed by human beings was called “mead”
● Opium and its derivatives also have a long history (4000BC)
○ “Joy plant” consumed by ancient greeks for medicinal purposes
○ 19th-century literary figures
● Cocaine first emerged around 500BC
○ Associated with Indigenous tribes “Incas” chewing on cocoa to release pressure from
high mountains
● Caffeine, the most widely used drug today, was documented around 900AD
○ Not always viewed with tolerance
○ “Gateway drug to narcotics”
● Cannabis dates back to 4000BC in China and was brought to NA in 1611 for the cultivation of its
fiber, an important part of the agricultural economy at the time
**drugs is a cultural universal, goes back about 10,000 years
Need for Drugs
