The problem of alcohol and other drugs is one of abuse and not merely of use. Various drugs have various effects, and the effects depend on the method of administration, the amount taken, and the social situation as well as the chemical composition of the drug. Alcohol is the most widely used drug, and its effects can be extremely deleterious. Many experts consider alcohol abuse much more serious than abuse of other drugs.

Around 1980, drug use of all kinds began to decline for the first time in two decades. In the 1990s, patterns of use fluctuated. Although less than in the peak years, use and abuse are still quite high. More than one-half of all Americans drink, and more than a third say that drinking has been a source of trouble in their families. Millions of Americans indicate that they are current users of marijuana. There is a tendency for multiple drug use. Most alcohol abusers are young and male but not poor, whereas other drug addicts tend to be young, male, poor, and a minority.

The meaning of the drug problem for the quality of life is seen in the consequences for physical health, psychological health, interpersonal relationships, and economic costs. Abusers suffer various undesirable effects in all areas, and they inflict suffering on others. The nation as a whole also suffers great economic cost because billions of dollars per year are involved in lost services and in efforts to combat the deleterious effects of abuse.

Various structural factors contribute to the problem. An important one is group norms. Integration into a group that approves drug use is one of the most reliable predictors of use. Role problems, including role conflict and undesirable role change, create stress in the individual and that stress can lead to abuse. Abusers are more likely to come from homes where family members are abusers, from broken homes, or from homes where there are problematic relationships. The government's definition of many drugs as illegal has several implications: More people are classified as criminal; previously classified criminals become deeply involved in the drug traffic; the criminal justice system is strained; and users and abusers are led into various kinds of undesirable behavior. Finally, the suppliers of illegal drugs are organized effectively and take advantage of corruption, so that there always will be a supply available when there is a demand and profits are high.

Among social psychological factors is the alienation of users from the larger society. Many people believe drug use produces desirable psychic effects. These positive attitudes toward drug use combine with group norms and various ideologies that develop in groups. The ideologies explain and validate drug use.

In treating the problem, efforts to help the individual abuser or reduce the supply available to users have far exceeded efforts to get at the social roots of the problem. If it is to be dealt with effectively, both approaches are needed--attacks on the social factors as well as treatment of individual abusers.