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"A Child's Prayer"
Now I Lay Me Down To Sleep,
I Pray The Lord My Soul To Keep.
If I Should Die Before I Wake,
I Pray The Lord My Soul To Take.

Our Children Are Not Exempt From
The Ugliness Of Drug And Alcohol Abuse.
Teach Them That It Is Right To Reject Harmful Temptations,
And To Exclude People Who Glorify The Dark Side Of Life.

Smoking, Alcohol, and Substance Abuse

Although use of alcohol, tobacco, and psychotherapeutic drugs is rampant, use of illicit drugs such as marijuana, cocaine, and heroin arouses the most public concern. The dire health consequences of illicit drug use—death from overdose, allergic reactions, and cardiac complications—are more unpredictable and sudden than they are for "legal" drugs. While prolonged use of tobacco can result in death from various diseases and alcohol consumption can damage the heart, liver, gastrointestinal tract, and central nervous system, and both decrease life expectancy, no one worries that one drink or one cigarette is going to be fatal. Conversely, users of illicit drugs constantly risk death, and a novice user of cocaine can die from cardiac arrest caused by a dose normally tolerated by habitual users. Deaths of well-known athletes from cocaine are grim reminders of the vagaries of illicit drug use.

The repercussions of illicit drug use have reverberated through society. The U.S. government has spent billions fighting illegal drugs, attempting to destroy supplies as well as apprehend and prosecute drug dealers. Attempts to destroy drugs at their source has embroiled the government in international conflict with Third World nations whose economies benefit from the drug trade. Trafficking in illegal drugs, especially the trade in cocaine, has burdened society with myriad costs: lost job productivity, lives lost to suicide and violence, disrupted families, medical treatment for addicts and babies born to addicted mothers, and drug-related crime.

In recent years more than two-thirds of those arrested for other than drug-related crimes have tested positive for illegal drugs. One study showed that 92 percent of persons arrested for robbery and 80 percent for burglary had illicit drugs in their systems.

Illicit use of crack—a form of cocaine that is smoked—has had a devastating impact on innercity neighborhoods and crime. Use of this particular drug is blamed for much of the skyrocketing crime rate responsible for large increases in prison populations.

Babies born to addicted mothers using IV drugs are often born addicted themselves and/or infected with HIV. Of these unfortunate children, many develop AIDS and die; others are abandoned by their mothers and incur immense medical costs at hospitals. In addition to the personal tragedy that these unwanted children represent, the economic burden of their care is another cost to society from illicit drug use.

Some advocate increases in drug treatment programs for addicts to reduce the demand for these substances. It is estimated that a dollar spent on treatment saves $7 elsewhere in the health care system, and is 7 to 20 times more effective in reducing heavy cocaine use than are funds spend on supply reduction activities.

The use of these drugs is not new. Opiates (of which heroin is one type), cocaine, and cannabis (marijuana) have been used in one form or another for centuries around the world. Government surveys show that the total number of U.S. citizens using illicit drugs peaked in the late 1970s and early 1980s. Although antidrug efforts have sharply reduced marijuana use and nonaddictive use of cocaine, heavy cocaine use remains high and may even be increasing. While illicit drugs were used more widely in the 1970s by youth than they are today, use still remains quite high and in some cases is still increasing:

  • 4 of 5 Americans in their mid-twenties have used illicit drugs at least once.
  • More than 21 million over age 27 have tried illicit drugs at least once.
  • 1 of 5 high school seniors uses marijuana. Marijuana use is at the lowest level since the early 1970s but appears to be on the rise again after decreasing during the 1980s.
  • 3 to 6 million people currently use cocaine. Half of them are age 18 to 25. There are an estimated 2 million cocaine addicts.
  • 600,000 people are addicted to heroin, and the number appears to be rising as cocaine addicts switch to heroin.

  Chronic, heavy users of illicit drugs face serious health hazards including increased danger of accidents and premature death. Even occasional cocaine users face serious consequences. During the past 15 years hospital emergency rooms report sharp increases in cocaine-related visits; the number of individuals entering drug abuse treatment for cocaine has multiplied greatly, as have cocaine-linked deaths.

While use of one drug does not always lead to use of others, heavy consumption opens the user to an environment that may encourage the use of other illicit substances. Studies of these three "gateway drugs"—alcohol, tobacco, and marijuana—show that adolescents who use one or more of these are at greater risk to go on to use cocaine or heroin. The earlier their use, and the more types are used, the greater the risk of progression.


Cocaine is derived from the leaves of the coca bush, which grows in the Andes of South America. Used for centuries by Indians to combat the effects of hunger, hard work, and thin air, in the mid 1800s its effects were praised by Freud, among others. Until 1906, this substance was a chief ingredient of Coca-Cola and was also used as a topical anesthetic. Widespread use and addiction led to government efforts against cocaine in the early 1900s. The danger associated with cocaine was ignored in the 1970s and early 1980s, and cocaine was proclaimed by many to be safe. With the accumulating medical evidence of cocaine's deleterious effects and the introduction and widespread use of "crack" cocaine, the public and government have become alarmed again about its growing use. To many Americans, especially health care and social workers who deal with crack users and have witnessed the personal and societal devastation it produces, the pervasive use of cocaine is, by far, the most serious drug problem in the United States.

Like the amphetamines, cocaine stimulates the central nervous system. This drug is usually ingested in three ways.

  1. Sniffing or snorting it into the nose, where it is absorbed by the mucous membranes
  2. Injecting it intravenously
  3. Freebase smoking

  (Occasionally this substance may be swallowed or sprayed from an atomizer into the back of the mouth or throat.)

Crack is smoked in cigarettes or glass pipes and sometimes mixed with marijuana. Much of it is laced with other drugs, such as amphetamines.

The effects of cocaine are pleasurable, immediate, and brief. It produces intense but short-lived euphoria and can make users feel more energetic. Like caffeine, cocaine produces wakefulness and reduces hunger. Psychological effects include feelings of well-being and a grandiose sense of power and ability mixed with anxiety and restlessness. As the drug wears off, these temporary sensations of mastery are replaced by depression.

Even though the public is often regaled with highly publicized accounts of deaths from cocaine, many still mistakenly believe the drug, especially when sniffed, to be nonaddictive and not as harmful as other illicit drugs. Cocaine's immediate physical effects include raised breathing rate, raised blood pressure and body temperature, and dilated pupils.

By causing the coronary arteries to constrict, blood pressure rises and the blood supply to the heart diminishes, possibly causing heart attacks or convulsions within an hour after use. Chronic users and those with hypertension, epilepsy, and cardiovascular disease are at particular risk. Studies show that even those with normal coronary arteriograms risk cardiac complications from cocaine. Increased use may sensitize the brain to the drug's effects so that less of the substance is needed to induce a seizure. Those who inject the drug are at high risk for AIDS and hepatitis when they share needles. Allergic reactions to cocaine or other substances mixed in with the drug may also occur.

Other unpleasant side effects of cocaine include:

  • Insomnia and headache
  • Nausea and vomiting
  • Loss of appetite leading to malnutrition and weight loss
  • Cold sweats
  • Swelling and bleeding of mucous membranes
  • Restlessness and anxiety

  In the 1970s cocaine was expensive and considered a "status" drug. The introduction of inexpensive crack increased the accessibility of this substance, and crack has become the drug of choice for many drug users, especially inner-city disadvantaged youth. Crack's convenience, ease of concealment, wide availability, and low cost have increased its use. The fact that it is smoked rather than snorted or injected (ingestion methods associated with the stigma of being a "junkie") has contributed to its popularity.

Crack is particularly dangerous for several reasons.

  • Because it is inhaled and rapidly absorbed through the lungs, into the blood, and carried swiftly to the brain, the chances of overdosing and poisoning leading to coma, convulsions, and death are greatly increased over other forms of cocaine ingestion.
  • Crack's rapid rush—5 to 7 minutes of intense pleasure— quickly subsides, leading to depression that needs to be relieved by more crack. This cycle enhances the chances of addiction and dependency. Because of the brief high, users are constantly thinking about and devising ways to get more crack.
  • Psychologically, the drug reduces concentration, ambition, and drive, and increases confusion and irritability, wreaking havoc on users' professional and personal lives.
  • Habitual use may lead to cocaine psychosis, causing paranoia, hallucinations, and a condition known as formication, in which insects or snakes are perceived to be crawling under the skin. The paranoia and depression can instigate violent and suicidal behavior.

The side effects of adulterants increase cocaine's risks. The drug is often cut with one or more of any number of other substances, such as the cheaper drugs procaine, lidocaine, and benzocaine, and substances that pose no serious risks, such as sugars (mannitol and sucrose), or starches. However, when quinine or amphetamines are added, the potential for serious side effects increases dramatically.

Treatment for cocaine abuse utilizes counseling and rehabilitation. Individuals who are suicidal, psychotic, or very ill may need hospitalization. Several programs, such as Cocaine Anonymous, which uses AA as a model, provide self-help groups. Certain medications are being researched as alternatives for unsuccessful rehabilitative efforts, but no medication has yet been found to be generally effective.

Cocaine is quickly cleared from the body, and detoxification generally takes several days, but feelings of anxiety and depression may last for weeks. Recovering individuals may mourn the loss of a lifestyle and friendships centered around drugs and may have to confront unpleasant family and economic situations.


Marijuana is the most widely used illegal drug. Derived from the plant Cannabis sativa (the hemp plant), this psychoactive (mind-altering) drug is grown wild and cultivated in many parts of the world.

Marijuana can be put in foods and eaten, but generally it is smoked in cigarettes or "joints," made of the dried leaves, flowers, and small stems of the plant. The active ingredient in this drug is delta-9-tetrahydrocannabinol (THC); the average joint may contain up to 6 percent THC, a substantial rise from the 0.4 percent average content of joints in the early 1970s. Hashish, or hash, is the resinous part of Cannabis, pressed into cakes that are smoked. This much more potent form of the drug contains between 3 and 8 percent THC.

The psychological effects of marijuana are a mild sense of well-being, a disconnected sense of time, a dreamy consciousness and self-absorption, and a reduced ability to think and communicate clearly.

Undesirable mental and physical effects include:

  At doses usually used in this country, marijuana usually does not produce physical addiction, but dependence may result with regular long-term use. The harmfulness of dependence is clearly seen in teen users who suffer impaired learning abilities (both verbal and mathematical), reduced attention span, and lowered problem-solving skills and reading comprehension. Use of this drug between one and three times per day may interfere with acquiring necessary social skills at crucial times of development, and teenagers may turn to the isolation and escapism of the drug rather than developing healthy coping mechanisms.

Teenagers introduced to marijuana by their friends experience social pressure to use the drug, which is reinforced by the ritual of rolling and smoking a joint and by the fact that marijuana is illegal, enhancing its attraction. While marijuana use is often preceded by alcohol use and smoking, the relationship between use of these substances is complex. Heavy marijuana users are more likely than moderate users to use other drugs such as barbiturates, amphetamines, LSD, or cocaine.

Studies show that long-term marijuana use may cause cancer. Marijuana smoke, like any smoke, inflames the lungs, irritates air passages, and impairs pulmonary function. It contains several carcinogenic tars and because smokers hold the smoke in the lungs deeply, lung tissue is exposed to these toxins for a prolonged period. Chronic marijuana use results in metaplasia, a precancerous condition of lung cells.

Pregnant women should not use marijuana because it enters the baby's bloodstream through the placenta. The drug may cause stillbirth or spontaneous abortion, and fetuses exposed to marijuana may be born at lower weight than babies of nonsmoking mothers. Breastfeeding mothers should also abstain since evidence indicates the drug is transferred to breast milk.


Opiates—derived from the opium poppy, grown mostly in Asia—include opium, morphine, and heroin. Opiates were both legal and widely available in the 1800s and were thought to have beneficial effects on disorders such as diabetes, diarrhea, and "women's troubles." After these drugs were used to relieve pain during the Civil War, many wounded soldiers became addicted.

Opiates can be eaten, inhaled, smoked, and injected (sometimes called "mainlining"). They act as painkillers and tranquilizers and produce euphoria in experienced users; pleasurable sensations are not usually reported by first-time users. Long-term users may experience pleasure when administration of opiates quells the drug's withdrawal symptoms such as shakes, sweating, tremors, hot and cold flashes, anxiety, and craving.

Unlike alcohol, which produces alcoholism only in susceptible individuals over a period of time ranging from 5 to 10 years, opiates can rapidly produce addiction in almost any regular user. Effects of chronic use include:

Injections of opiates may result in:

  • Skin abscesses and ulcers
  • Phlebitis
  • Excessive scarring
  • Bacterial endocarditis
  • AIDS if an infected needle is used
  • Death from overdose when the central nervous system is depressed and the heart rate is arrested

Heroin addicts are often treated with methadone, a synthetic opiate that eases withdrawal and, when administered as part of a comprehensive outpatient program at a clinic or hospital, may help addicts stay off the street and begin the recovery process. Whereas some heroin addicts are able to do well on methadone, successfully detoxify, and stay drug-free, others must stay on methadone for years in order to remain off heroin. Even though methadone causes physical dependence, chronically maintained individuals can work, refrain from illegal drugs and activities, and appear normal. However, use of other drugs such as cocaine and alcohol is a problem in many methadone programs. The narcotic antagonist Naltrexone is not addicting and blocks the effects of heroin. It has been especially useful in the treatment of employed addicts with family support and needs to be given only three times a week.

Nondrug treatments such as therapeutic communities work well as long as addicts remain in residence, but the dropout rate is high.

Craving for heroin can be triggered in times of stress, anxiety, or depression, even if the addict has been drugfree for years. Research continues on the possible social, psychological, and biological causes of heroin addiction, and on appropriate treatment and recovery programs.


The term psychedelic refers to mind-expanding or mind-manifesting substances. The psychedelic drugs include lysergic acid diethylamide (LSD or acid), mescaline derived from the peyote cactus, and psilocybin, which comes from certain mushrooms.


These substances are almost always taken orally, although liquid forms of LSD may be injected wtih great potential hazard.

The main effects are psychological rather than physical and vary according to the user's mood and expectations, and the environment in which the drug is ingested. The highly unpredictable effects include:


Unpleasant experiences on these drugs ("bad trips") may cause paranoia, feeling out of control, panic, and viewing other people as grotesque distortions.

Psychedelics do not produce physical or psychological addiction. However, some individuals may experience prolonged psychosis and may require therapy or institutionalization. Whether these drugs cause this condition or merely expose a previous tendency is unknown.

LSD users are susceptible to "flashbacks" of the drug experience up to a year afterward, and many experience spontaneous recurrence of visual or sensory distortions. The long-term effects of heavy use include impaired mental function and distorted abstract reasoning.


Inhalants are volatile substances that, while never intended to be used as drugs, are abused because of their mind-altering effects. The chief abusers of inhalants are children from 7 to 17, who sniff these household products because they are easily available at home or at the supermarket.

The inhalants include solvents like gasoline, cleaning fluids, liquid shoe polish, lacquer, nail polish remover, and airplane glue; aerosols like spray paint, insecticides, and hair spray; and anesthetics like nitrous oxide (laughing gas). Also abused are the volatile nitrates such as amyl nitrate, which is used to treat chest pains in heart patients by dilating blood vessels and accelerating heart rate. Amyl nitrate is packaged in covered vials (poppers or snappers) that are broken open and inhaled. Butyl nitrate is the over-the-counter version of amyl nitrate.


Inhalants temporarily stimulate before they depress the central nervous system. Their immediate effects include:


  Death, which can occur from first-time use, may result from instant heart failure, from sniffing substances in high concentrations (oxygen is displaced in the lungs), and suffocation from the depression of respiratory functions. Long-term effects include weight loss, fatigue, muscle fatigue, and, in certain cases, damage to the nervous system, liver, kidneys, blood, and bone marrow.