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Correct answers located at the end of the chapter.

MULTIPLE CHOICE - Choose the one alternative that best completes the statement or answers the question.

1) Alcohol is

A) not a drug.

B) often overlooked in terms of damages from abuse, binge drinking, and alcoholism.

C) not as bad on you as hard drugs.

D) a central nervous system stimulant.

2) According to this chapter, which statement is true regarding "the supplyside approach" to the drug problems?

A) It has reduced drug use.

B) It has increased drug prices and reduced availability.

C) A supply-side approach alone is ineffective.

D) The supply-side approach is coordinated with the demandside approach.

3) According to this chapter, which of the following is true?

A) Drug problems of people of color are often ignored.

B) People of color are at risk for alcohol/drug problems due to socioeconomic inequities and injustices.

C) People of color have been blamed for drug problems.

D) All of the answers are correct.

4) The legalization of marijuana, has

A) created a concern as research has been limited.

B) had no impact on abuse.

C) reduced use by young adults.

D) caused decreases in use by all ages, young and old.

5) In the context of the major perspectives of alcohol/drug abuse, the perspective that focuses on prevention, intervention, and drug treatment is the

A) moral-legal perspective.

B) psychosocial perspective.

C) spiritual perspective.

D) None of the answers is correct.

6) In the context of the major perspectives of alcohol/drug abuse, the perspective that attempts to adapt the environment to meet the needs of the individual is the

A) moral-legal perspective.

B) social-cultural perspective.

C) medical-health perspective.

D) existential perspective.

7) The Harvard School of Public Health’s College Alcohol Study (CAS) found that

A) 40 to 45 percent of college students binge drink.

B) very few women involve in binge drinking.

C) six Americans die each day from “alcohol poisoning” due to binge drinking.

D) alcohol is involved in 5 to 10 percent of cases of intimate partner violence.

8) Potential consequences of alcohol consumption by college students includes

A) property damage.

B) dying by suicide.

C) accidents.

D) All of the answers are correct.

9) The most dangerous time of the year for college students in terms of the risk for binge bringing, especially freshman, is

A) the first six weeks of college.

B) summer school.

C) graduation.

D) holidays.

10) An example of a "simplistic" approach to drug abuse, is

A) "just say no" approach.

B) peer pressure.

C) "tough love" approach.

D) stopping gateway drugs like marijuana.

11) The historical association of drugs with minority groups, includes

A) heroin with African Americans.

B) opium with the Chinese.

C) alcohol with urban Catholic immigrants.

D) All of the answers are correct.

12) Psychedelics are being researched to be used a remedy for

A) treatment-resistant depression (TRD).

B) birth defects.

C) the coronavirus.

D) only women in labor.

13) A psychedelic acts on the part of the brain that is the source of fear and feeling of threat, which is the

A) basal ganglia.

B) cortex.

C) amygdala.

D) hippocampus.

14) In the context of the major perspectives of alcohol/drug abuse, which of the following perspectives majorly focuses on keeping specific drugs away from people by reducing the availability of drugs?

A) the moral-legal perspective

B) the psychosocial perspective

C) the medical-public health perspective

D) the social-cultural perspective

15) In the context of the major perspectives of alcohol/drug abuse, which of the following statements is true of the social-cultural perspective?

A) This perspective is primarily the viewpoint of politicians, law enforcement, and the criminal justice system.

B) The underlying assumption of this perspective is that alcohol/drug use is due to the frustration and hopelessness of people’s lives.

C) The major focus of this perspective is to keep specific drugs away from people by reducing the availability of drugs.

D) This perspective assumes that people will seek good health practices.

16) Which of the following is the most problematic drug people know of today in terms of the sheer number of people it affects?

A) ecstasy

B) alcohol

C) marijuana

D) tobacco

17) Which of the following is a consequence of college student drinking?

A) added academic rigor

B) legal repercussions

C) low time demands on staff

D) student retention

18) Which of the following is a factor contributing to young drivers’ greater crash risk?

A) absence of other teenagers in the car

B) presence of parents in the car

C) pessimistic attitude

D) overconfidence

19) In the context of psychedelic-assisted psychotherapy (PAP), which of the following is a result of the administration of psychedelics?

A) decrease in dopamine

B) increase in cortisol

C) decrease in oxytocin

D) increase in serotonin

20) Which of the following is the preferred psychedelic for treatment-resistant depression?

A) ibogaine

B) ayahuasca

C) psilocybin

D) ecstasy

21) Which of the following words did Sigmund Freud use to describe feelings of shame?

A) humiliation

B) anxiety

C) guilt

D) embarrassment

22) Which of the following is true of shamebased individuals?

A) They have an inside-out orientation.

B) They perceive themselves as trapped.

C) Their sense of self is formed by their judgments of their own behavior.

D) Their major focus is on choice.

23) Which of the following is a way in which parents can avoid instilling shame in their young children?

A) Avoid involving teachers or counselors when “shame-based” family issues arise.

B) Recognize that at times parenting is overwhelming.

C) Do not use discipline in parenting.

D) Minimize or rationalize “shamebased” family issues.

Answer Key

Test name: Chapter 01

C 14) A 15) B 16) B 17) B 18) D 19) D 20) C 21) C 22) B 23) B

Chapter 1 Putting Drugs in Perspective

Chapter Overview

The chapter begins with an overview of the four major perspectives on alcohol/drug use. A fifth perspective discussed is the perspective of the student. The next section discusses the widespread abuse of alcohol, especially among young people and on college campuses. The problems related to alcohol consumption such as binge drinking, sexual assault and rape, intimate partner violence, injuries and deaths, and drinking and driving are also discussed in this section. The chapter also discusses the role of trauma in the development of substance use disorders (SUDs). The chapter also discusses psychedelic-assisted psychotherapy and how it has led to the decriminalization of the possession of certain drugs. A short discussion on deaths due to drug overdose is also included in the chapter. The next section discusses how shame contributes to the development of SUDs and subsequent relapses among people. The legalization of medical marijuana is also discussed in the chapter. Also emphasized are the most recent trends in alcohol and drug use by high school students. The chapter also highlights certain other factors that are useful in expanding one’s perspective about alcohol/drug use. These include misplaced governmental priorities that have historically aggravated the problems associated with drugs, such as the neglect of the demand for drugs and alcohol, the myth of there being a simple solution to the problem of drugs and alcohol, the use of scare tactics, racism, and the failure of the educational system. The chapter ends with a small message on the role of purpose and hope in combating this issue.

Chapter Outline

I. Introduction

• Chapter 1 emphasizes the problems in perception that have misdirected efforts toward an effective approach to alcohol/drug prevention, intervention, and treatment efforts.

II. The Four Major Perspectives of Alcohol/Drug Use

• In Drugs Demystified, Nowlis (1975) described four major perspectives on alcohol/drug use:

o The moral-legal perspective is primarily the viewpoint of politicians, law enforcement, and the criminal justice system as well as religious institutions.

o The medical-public health perspective is held by physicians, nurses, and the medical

and health treatment fields.

o The psychosocial perspective is a common viewpoint shared by a variety of agencies that specialize in addressing the demand side of alcohol/drugs.

o The socio-cultural perspective is held by most social agencies and institutions.

o The fifth perspective: It’s your own personal perspective.

Key Teaching Points

1. Have your students complete “Your Perspective Questionnaire” during class (pages 4 and 5 of the text). The questionnaire identifies the students’ own personal perspectives on alcohol/drug issues. This will help the instructor in identifying and generating discourse on some of the students’ perspectives on the issue.

2. How can efforts such as supporting the community prevent alcohol and drug problems?

III. Alcohol: The Most “Problematic” Drug

• Alcohol abuse and alcoholism are major problems that are often minimized or overlooked as not being a part of the “war on drugs.”

• Administrations have been distracted, focusing on drugs, often forgetting to include alcohol as a drug.

o Excessive alcohol consumption is the third leading preventable cause of death in the United States and is associated with multiple adverse health consequences, including liver cirrhosis, various cancers, unintentional injuries, and violence. (Centers for Disease Control 2004)

• Binge drinking on college campuses often spirals into other high-risk behaviors and the end results cause damage to the individuals and others.

• Binge Drinking is at once the most important public health problem on our campuses and a critical challenge to institutional mission. (Keeling 2002)

• Research indicates that 40 to 45 percent of college students binge drink.

• The first 6 weeks of the school year have been cited as the most dangerous with respect to drinking behavior due to the increased stress levels associated with a new environment and the pressure to be accepted by a peer group. (Bonnie and O’Connell 2004)

• According to the National Institute of Justice Survey on Sexual Assault on Campus (2010) and a number of other studies, alcohol use is most commonly associated with sexual assault on campus.

• It is estimated that alcohol is involved in 25 to 50 percent of cases of intimate partner violence (IPV).

• Many women entering substance abuse treatment have a history of physical violence with a

family member or significant other.

• Accidental injury is the leading cause of death among older adolescents and young adults, and binge drinking is involved in many of these accidents.

• Drinking alcohol and driving continues to be a major problem as evidenced by the many traffic fatalities while people are under the influence of alcohol.

IV. Trauma: A Major Contributor to SUDs

• Trauma exposures (TEs) can include a variety and wide range of experiences, with varied depths, frequencies, and durations.

• The common elements of TE are significant fear and threats to the person’s safety and well-being.

• Over the past few years, trauma has been expanded to identify what are called “big T” trauma, and “little t” trauma.

o Many little “t” traumas can begin in early and middle childhood.

• The research tends to support the view of the “self-medication” theory of trauma rather than the “high risk” theory caused by SUDs.

• Unresolved trauma treatment often results in significant increases in alcohol/drug sobriety relapses.

Key Teaching Points

1. Ask the class to identify the negative consequences of binge drinking.

Students’ answers should include the following consequences:

• Academic problems

• Property damage

• Sexual assaults

• Personal injury

• Death

2. Ask the class to identify the factors that increase crash risk with young drivers

Students’ answers should include the following factors:

• A lack of driving experience

• Overconfidence

• Presence of other teenagers in the car

3. Ask the class to identify other high-risk behaviors as a result of binge drinking on campus.

Students’ answers should include the following high-risk behaviors:

• Sexual assault

• Drinking and driving

• Antisocial behaviors

• Psychosocial problems

4. Alcohol is involved in intentional and accidental deaths, driving accidents, and high-risk behaviors.

5. At least half of the sexual assaults on college campuses involve alcohol consumption by the perpetrator, the victim, or both.

6. Ask students if they know whom to approach or where to go on their campus in case of intimate partner violence.

7. Research project: There is an abundance of current leading headlines pointing out the inequalities among people of color. Have your students bring in news articles to the class.

8. Research project: Historically, drug use by people of color and minorities has been neglected. It is only when drugs impact mainstream Americans (as opposed to the oppressed) that the government seems willing to create programs and make funding available.

9. Have your students further examine the historical association of drugs with repressed minorities. Students can examine the following:

• Opium dens and the Chinese

• Cocaine and the Black Americans

• Alcohol and the urban Catholic immigrants

• Heroin with urban immigrants and Black Americans

• Marijuana, phencyclidine (PCP), and the Latinos

10. Denial in the family: If one parent is alcoholic, then the probability of the children becoming alcoholics is four times higher; the probability becomes eight times higher if both the parents are alcoholics

11. Academic failure can lead to alcohol use/abuse.

Student Activity

Have students identify the possible consequences of DWI (driving while intoxicated) or DUI (driving under the influence) in their state. Students can search the internet for the consequences if they are unaware of them. Many states have passed laws that have targeted 18- to 21-year-olds who drink and drive. Ask students to find the expenses associated with being convicted of DWI, including court costs, attorney fees, and mandated classes.

V. Psychedelic-Assisted Psychotherapy (PAP): A “Breakthrough Therapy”

• In 1992, the National Institute of Drug Abuse (NIDA) and the Food and Drug Administration’s (FDA) advisory committee permitted research to resume on psychedelicassisted psychotherapy for treatment-resistant depression (TRD).

• The FDA labeled PAP as a “breakthrough” therapy that demonstrates substantial improvement over available therapies for treatment-resistant depression (TRD).

• In recent years there has been what is described as a renaissance of interest in psychedelics as a therapeutic treatment for a variety of mental health conditions. (See Table 1.2 on page 12 of the text).

• Some of the beneficial effects of psychedelic therapy are:

o dissolving of the ego

o seeing life in a more positive perspective

o increased optimism, positive mood, and hope

o ability to experience the “awe” in life and nature

o kindness, empathy, and compassion toward self and others

o increases in the plasticity of the brain

o reduction in fear, anxiety, and threat

o open-heartedness and spiritual awakening

• Lyons, et al. (2018) describe PAP as a process of shifting the negative and pessimistic biases of depressive ruminating to a more realistic and more manageable perspective.

• One week after treatment the patients’ pessimism was alleviated and their depressive symptoms greatly subsided.

• Depression also involves a poor future orientation.

o After PAP, the patient is able to more accurately foresee a positive, hopeful future.

• PAP is often described as an “awakening” (see Table 1.3 of the text).

• PAP sessions are a three phase process.

o Phase 1 Preparation and Assessment

o Phase 2 Psychedelic Medication Sessions

o Phase 3 Integration

• Psilocybin is a plant-based alkaloid derived from a variety of mushroom species. It is the

preferred psychedelic for treatment-resistant depression.

• MDMA is a class of pharmacological agents, called enactogens.

o It is described as a psychostimulant with serotonergic qualities and can be described as a mood-enhancing stimulant.

• Ayahuasca is a preparation of two plants native to the Amazon Basin

• In 2019, Denver was the first U.S. city to decriminalize possession of psilocybin.

o More than 60 bills to decriminalize the possession of psilocybin have been introduced in over 19 states.

VI. Drug Overdose Deaths: A Crisis That Continues

• Drug overdose deaths have risen fivefold over the past 2 decades.

• These alarming increases, especially in fentanyl overdose deaths, continue to rise.

VII. Shame: Fuels SUDs and Relapse

• Shame is a deep-rooted feeling, often a result of traumatic childhood experiences that are excessively shaming (e.g., sexual, physical, and emotional abuse). (See Table 1.4 of the text)

• Shame is a feeling that has an integral role in the individual’s development.

• Growing up in an alcohol/addict family system or an imbalanced family system creates a foundation of shame.

• Fossum and Mason (1986) make the distinction between shame and guilt.

o The key point is that shame affects the core of a person’s being, whereas guilt is about things they have done.

• Shame-based messages that are internalized have a major impact on feelings.

o When shame is attached to normal, everyday feelings, it tends to escalate those feelings.

o Shame-based messages by parents, schools, institutions, and peers may be devastating to adolescents and delay the development of a secure sense of sexual identity

VIII. Marijuana: Need for More Current Research

• Medical marijuana is the single most significant change in recent drug history.

• The federal government is leaving it up to the states to legalize medical marijuana and approve medical marijuana dispensaries.

• The problem is the limited research on medical marijuana.

o “A review by researchers in Canada (where medical marijuana is legal) identified only 31 studies [that] focused on medical benefits of the drug.

o A separate review by the American Medical Association (AMA) also concluded that the research base remains sparse.”

• There is no denying the many benefits and applications of marijuana for medical conditions (see Table 1.8 on page 23 of the text).

Key Teaching Points

1. Marijuana use has increased among high school students.

2. Medical marijuana has been legalized in many states, and the impact is expected to result in its more widespread use.

3. Student discussion: Divide your class into groups; have each group list the pros and cons of legalizing and/or decriminalizing marijuana.

4. DVD: The Union provides an excellent overview of the history of marijuana use.

5. Research project: Have your students research the most recent statistics on states that have legalized medical marijuana use and the federal government’s response to such legislation.

6. Reference Figure 1.3: “States with Legalized Marijuana” (page 22 of the text). The data in the figure is subject to change with more states passing legislation.

IX. Trends in High School Alcohol and Drug Use

• The Monitoring the Future survey of high school students’ drug use has been conducted for the past 48 years by the University of Michigan Institute of Social Research, Ann Arbor, Michigan.

o The 2022 survey had a sample size of 32,260 students from 319 public and private high schools.

• A major finding was that high school student drug use during the pandemic was significantly reduced.

o However, in 2022, drug use rebounded but not to the levels of 2019 and 2020.

• Cocaine, hallucinogens, and heroin had significant increases in 12th grade for past 30-day use in 2022.

• The prevalence of inhalant use is higher in the lower grades.

• In 2022, anabolic steroid use in the past 30 days (without a doctor’s prescription) showed significant increases for all grade levels.

• Hallucinogens (excluding LSD) have shown “an unusual pattern of increasing prevalence in both 2021 and 2022 for both lifetime and past 12-month use (though none of these single year increases is statistically significant” (Monitoring the Future, 2023).

X. Other Factors Expanding Your Perspective

• The U.S. administrations continued to fail to develop a comprehensive and cohesive drug policy.

o Most of the administrations put a major emphasis on the supply side of the drug problem and significantly neglected the demand side.

o Emotional and political biases of these administrations caused them to be blind to the many causes of drug dependence and resulted in an adherence to “ a simple, magical solution” that was politically advantageous.

• Often a complicated, emotionally laden problem elicits a simple solution.

o A simple solution is easily understood and immediately reduces anxiety, shame, and emotional discomfort.

o However, a simple solution will not resolve the insidious, multifaceted problems of substance abuse and addiction

• Scare tactics a politically biased approach that alienated young people began in 1937 and continue to this day, in a variety of forms.

o One example of scare tactics is the 1936 movie Reefer Madness

o For most young people, however, scare tactics proved to be an ineffective approach because much of the information was exaggerated, overgeneralized, or sensationalized.

• In the late 1960s and early 1970s, President Richard Nixon declared his famous war on drugs.

• Drug-specific approaches heightened curiosity and alleviated the fears associated with drug use, resulting in increase of drug use by young people.

• Historically, there has been prejudice and oppression of people of color, scapegoating of minorities, and neglect of substance abuse problems in the inner city.

o Unfortunately, as long as drugs were confined to minority populations, funding and treatment resources were limited.

o It wasn’t until the 1960s, when white middle- and upper-class young adults and college students were using marijuana, hallucinogens, and other drugs, that the modern drug war began.

• Until the more dramatic issues of socioeconomic inequities, racial prejudice and the oppression of minorities, inequities in pay and occupational opportunities, and other related issues are resolved, the inner city will continue to be a breeding ground for the abuse of

alcohol/drugs.

• The inequities in socioeconomic opportunities have created bitterness, racial conflict, and a general rebelliousness and hopelessness, which fuel the desire to use alcohol/drugs.

• The U.S. educational system has become so neglected that the rates of academic failure and dropout are continually rising.

Key Teaching Points

1. A major problem in understanding alcohol/drug abuse is the often dichotomous view of alcohol versus drugs. Drugs are often categorized as either good versus bad, licit versus illicit, or hard drugs versus soft drugs. This causes a lack of an accurate perception of grouping drugs into categories and not treating them all as “drugs”: licit, illicit, and alcohol.

2. The continued emphasis on the supply side of drugs fails to adequately fund programs that deal with the prevention, intervention, and treatment of individuals having problems with alcohol/drugs. A balanced approach is necessary to impact drug use, abuse, and addiction.

XI. Purpose and Hope

• Purpose serves to align and focus on gifts, passion, and values.

• Lost hope, or hopelessness, leads to depression and disconnection, contributing to SUDs and drug overdoses.

• Reestablishing hope is a process of resolving and healing trauma and shame and establishing emotional and spiritual growth and healthy relationships.