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The National Center on Addiction and Substance Abuse boldly claims that “a child who reaches age twenty-one without smoking, abusing alcohol or using drugs is virtually certain never to do so.” Many policy makers and drug abuse professionals do not take the center’s claim lightly. In antidrug campaigns and programs, children and adolescents are repeatedly advised to resist the influences of peer pressure, popular music, and films, and to abstain from underage drinking, smoking, and marijuana use. Efforts are especially aimed at keeping young people from using marijuana due to the “gateway theory” belief that using marijuana increases one’s likelihood of using harder drugs. A committee of the American Academy of Pediatrics, for example, claims that “adolescents who use marijuana are 104 times more likely to use cocaine compared with peers who never smoked marijuana,” and that “marijuana’s role as a ‘gateway drug’ for some teenagers must be considered.” Some suggest that marijuana users go on to try other drugs because they grow tolerant of marijuana’s effects. According to columnist Phyllis Schlafly, “The ‘high’ from pot gradually diminishes and pot smokers often take other drugs to get a kick.” However, detractors contend that the gateway theory fails to hold up when drug abuse patterns are examined closely. Professors Lynn Zimmer and John P. Morgan state, “Over time, as any particular drug increases or decreases in popularity, its relationship with marijuana changes. . . . Cocaine became very popular in the early 1980s as marijuana use was declining.” Others suggest that drug abuse is linked more strongly to the traits of the abuser than the use of a gateway drug. “We’ve long known that everyone reacts to drugs differently,” says writer Cynthia Cotts, “and that the risk of addiction is predicted by many factors, such as genetic hard-wiring and social status.” These and other issues are debated in the following chapter, which examines the factors that contribute to drug abuse.
Drug Addiction Is a Disease
by Alan I. Leshner About the author: Alan I. Leshner, former deputy director of the National Institute of Mental Health, is director of the National Institute on Drug Abuse. Dramatic advances over the past two decades in both the neurosciences and the behavioral sciences have revolutionized our understanding of drug abuse and addiction. Scientists have identified neural circuits that subsume the actions of every known drug of abuse, and they have specified common pathways that are affected by almost all such drugs. Researchers have also identified and cloned the major receptors for virtually every abusable drug, as well as the natural ligands for most of those receptors. In addition, they have elaborated many of the biochemical cascades within the cell that follow receptor activation by drugs. Research has also begun to reveal major differences between the brains of addicted and nonaddicted individuals and to indicate some common elements of addiction, regardless of the substance. That is the good news. The bad news is the dramatic lag between these advances in science and their appreciation by the general public or their application in either practice or public policy settings. There is a wide gap between the scientific facts and public perceptions about drug abuse and addiction. For example, many, perhaps most, people see drug abuse and addiction as social problems, to be handled only with social solutions, particularly through the criminal justice system. On the other hand, science has taught that drug abuse and addiction are as much health problems as they are social problems. The consequence of this gap is a significant delay in gaining control over the drug abuse problem. Part of the lag and resultant disconnection comes from the normal delay in transferring any scientific knowledge into practice and policy.