Most social workers will encounter individuals and families who have problems resulting from excessive use of tobacco, alcohol, and other drugs, commonly referred to as substance abuse or, increasingly, as substance misuse problems. This article provides an overview of problems related to substance use worldwide, focusing on the United States population and selected subpopulations, such as young people, the elderly, women, ethnic and racial minorities, and the lesbian, gay, bisexual, and transsexual communities. It discusses the DSM-5 diagnostic criteria for Substance Use Disorders, evidence-based treatment approaches, and relevant policy issues relating to substance use problems. The roles of social workers in addressing these problems are identified.
Shulamith Lala Ashenberg Straussner and Richard Isralowitz
Anna Celeste Burke
Historically, U.S. policy has been characterized by long-standing ambivalence evident in the changing emphasis placed on prohibition as the aim of drug policy, and in debate about the relative merits of various approaches to drug control. Often characterized as supply reduction versus demand reduction efforts, significant changes have occurred over time in these efforts, and in the emphasis placed on them. In the last quarter of the twentieth century, U.S. drug policy adopted a more prohibitionist stance, with increased reliance on a variety of law enforcement, and even military actions, to control the supply and use of drugs, even in the face of evidence for the effectiveness of prevention and treatment, and high costs associated with the burgeoning incarceration rates.
Diane Rae Davis
Harm reduction is a helping strategy that attempts to alleviate the social, legal, and medical consequences associated with unmanaged addiction, and in so doing, limit the harms, such as infectious disease (HIV, hepatitis), violence, criminal activity, and early death, without necessarily attempting to “cure” the addiction. While abstinence may be an ideal outcome from a harm reduction standpoint, abstinence is viewed as only one of several means of improving a person's life. Harm reduction strategies are well known in the U.S. through methadone maintenance and syringe-exchange programs, and are increasingly relied on in the treatment of co-existing disorders.
Helena Salim de Castro
In the early 21st century, the number of women incarcerated in Latin America for drug-related offenses has increased dramatically. Many women are engaging in drug trafficking for different reasons, and in most cases, they play inferior roles in the drug supply chain, working as couriers or carrying drugs inside their bodies, which make them vulnerable to the justice system. This increase in female incarceration is one of the consequences of a repressive and prohibitive framework against the use and trafficking of drugs in the Americas. The “War on Drugs” policy was developed in the 1970s by the U.S. government, almost 50 years ago. This policy spread a regional fight against drug use and trafficking, which was reinforced by the United Nations Conventions on Drugs and committees of the Organization of American States. Even though some international and regional organizations and government institutions have been alarmed by the increase in female incarceration rates, the discussions and documents concerning this issue have some gaps. As analyzed by a feminist and gender literature, stereotypes about femininity persist. The official documents consider women mere victims in the drug world and do not debate their reasons for entering criminality, as an economic necessity, for example. In the same sense, little effort has been made by governments to change the actual repressive anti-drug policy. Focusing just on the lowest level of the drug supply chain, the “War on Drugs” policy continues to drive many people, especially women, younger, and black poor people, to jail.
The drug trade in Mexico and efforts by the Mexican government—often with United States assistance—to control the cultivation, sale, and use of narcotics are largely 20th-century phenomena. Over time, U.S. drug control policies have played a large role in the scope and longevity of Mexico’s drug trade. Many argue that these policies—guided by the U.S.-led global war on drugs—have been fruitless in Mexico, and are at least partially responsible for the violence and instability seen there in the early twentieth century. A producer of Cannabis sativa and the opium poppy, Mexico emerged as a critical place of drug supply following World War II, even though domestic drug use in Mexico has remained low. Since the 1960s and 1970s, the drug trade in Mexico has reached epic proportions due to drug demand emanating from the United States. Mexico’s cultivation of psychoactive raw materials and its prime location—connecting North America with Central America and the Caribbean and sharing a 2,000-mile-long border with the United States—have made it an ideal transit point for narcotics originating from other parts of the Western Hemisphere and the world. Although Mexico implemented a smaller, less organized antidrug campaign in the late 1940s, the inauguration of the global war on drugs in 1971 represents a distinctive shift in its drug control and enforcement policies. The government began utilizing U.S. supply-control models, advice, and aid to decrease the cultivation of drugs inside the country. America’s fight against drug trafficking in Central America and the Caribbean in the 1980s and 1990s shifted the geographic locus of the drug trade to Mexico by the early 2000s. Mexico’s powerful drug cartels proved more than capable of eluding (sometimes colluding with) the Mexican government’s efforts against them in the first decade of the 21st century during the administration of President Felipe Calderón (2006–2012). Calderón’s fight against the cartels brought about a drug war in Mexico, characterized by widespread violence, instability, and an estimated death toll of more than 70,000 people.
Relations between the United States and Mexico have rarely been easy. Ever since the United States invaded its southern neighbor and seized half of its national territory in the 19th century, the two countries have struggled to establish a relationship based on mutual trust and respect. Over the two centuries since Mexico’s independence, the governments and citizens of both countries have played central roles in shaping each other’s political, economic, social, and cultural development. Although this process has involved—even required—a great deal of cooperation, relations between the United States and Mexico have more often been characterized by antagonism, exploitation, and unilateralism. This long history of tensions has contributed to the three greatest challenges that these countries face together today: economic development, immigration, and drug-related violence.