Repost: The War on Drugs Didn't Work, Eh?

Sep 02 2014 Published by under Cannabis, Drug Abuse Science, Public Health

There's a strawman-tilting screed up over at substance.com from my current favorite anti-drug-war-warrior Maia Szalavitz. She's trying to assert that Trying to Scare Teens Away From Drugs Doesn’t Work.

In this she cites a few outcome studies of interventions that last over relatively short periods of time and address relatively small populations. I think the most truthful thing in her article is probably contained in this quote:

Another study, which used more reliable state data from the CDC’s Youth Risk Behavior Survey, concluded that “When accounting for a preexisting downward trend in meth use, effects [of the Montana Meth Project] on meth use are statistically indistinguishable from zero.”

This points out the difficulty in determining broad, population based outcomes from either personal introspection (where a lot of the suspicion about anti-drug messaging comes from, let's face it) or rather limited interventions. Our public policy goals are broad- we want to affect entire national populations...or at least state populations. In my view, we need to examine when broad national popular behavior shifted, if it did, if we want to understand how to affect it in the future.

The following originally appeared 21 July 2008.


If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of "The (US) War on Drugs is a complete and utter failure". Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.

Now I'm open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I'm most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.



I'm following up a story I started in a prior post by putting up the long term trends for cocaine use in the US. These data are from the 2006 Volume II monograph which focuses on the 18 yr old and older populations. As you will recall my hypothesis was / is that the Len Bias fatality had a dramatic effect on cocaine use. I still think this is the case and that this explains much of the timing of a reduction in cocaine prevalence observed consistently from the 18 yr old to 45+ age groups. However Len Bias's death was not an exclusive effect and must be considered in the context of changes in other drug use patterns. That context is something I want to delve into just a little bit.

As always, I depend on the data from the Monitoring the Future survey (www.monitoringthefuture.org) and I am pulling the figures from the 2006 Volume I monograph which focuses on the 8th, 10th and 12th grade populations in contrast to the older age cohorts outlined in the first graph.

Cocaine

2006-Fig5-4e-cocaine.jpgFirst up are the annual prevalence rates for powder cocaine, which I provide for reference to the previous graph for the older age ranges. I apologize for the blurry figures but my imaging skills are not up to any better- luckily, these reports are freely available on the MtF website. (I also encourage you to get the reports yourself because there are slight changes in the questions asked in some cases- if you see a discontinuity in the longitudinal data this is probably why.) The longest term trends are available for 12th graders, additional grades were added into the survey in the early 1990's. Prevalence of cocaine was reasonably steady in the 1979-1986 interval and it is stunningly apparent that cocaine became less popular with 12th graders after 1986 . It is also clear that it took about 5 additional years for prevalence to drop to the most recent nadir. So it wasn't all about Len Bias (he died of cocaine-related cardiac complications on June 19, 1986).

So, if it isn't all about Len Bias, perhaps we should see similar effects on population prevalence of other illicit drugs?

Marijuana and Amphetamine

2006-Fig5-4a-MJ-amp.jpgIt seems reasonable to turn our analysis to two perennial high-prevalence drugs for high school populations; marijuana (duh!) and the amphetamines. (In MtF parlance, the amphetamine class is for tablet or other prescription preparations after 1982.) In this case, the prevalences were at peak in the late 1970s and started to decline in the very early 1980s. Interestingly, there is no evidence of a change in the established trends from 1986-1987 as is observed for powder cocaine; I think this supports the Len Bias hypothesis. Nevertheless we can also see this as additional evidence for something else driving drug use downward.

This brings us to what are illicit drugs for most of these populations but, of course, licit drugs for individuals who have reached the legal age; 21 (alcohol) or 18 (cigarettes; this may be a substantial fraction of 12th graders). In theory, we might use these data to try to dissociate the anti-drug messaging from the drug interdiction / legal penalties side of the equation. Not perfect, but at least a hint.

Alcohol

The trends for annual prevalence of alcohol were very stable from 1978-1988 whereupon a decline was observed (questions were altered in 1993, making further comparison tricky). The trends for 5-drinks-in-a-row (currently the definition of a "binge") in the past two week interval were very stable from 1978-1983 and thereafter exhibited a slow decline until the early 1990s. Very reminiscent of the above mentioned drugs.

Cigarettes

2006-Fig5-4k-cigarettes.jpg In this case, please note that we've shifted to 30-day prevalence rates (any, daily); obviously this is frustrating for direct comparison but this is what they provide in the monographs. Unfortunately the more recent monographs (it is currently on a reliable annual update schedule with available pdfs, the older ones are not available) seem to only start with the 1986 data in the Tables so one is left with their figures for the earlier part of the trends. With that caveat, we can see that cigarette prevalence in the high school population was reasonably stable during the interval in which the prevalence rates for the illicit-for-all drugs mentioned above were in decline.

So Did the War on Drugs Work or Not?

I do think the jury is still out on this one and the problem of shifting definitions about goals and successes is quite difficult. I feel confident the comments will stray afield a bit and explore some of these issues. However, as I intimated at the outset,
for those of you who insist vociferously that the War on Drugs (considered inclusively with the Just Say No, D.A.R.E, main-stream media reporting, and all that stuff that is frequently rolled into a whole by the legalization crowd) is an abject failure...for those of you who insist vociferously that you cannot tell teenagers anything about the dangers of recreational drugs and expect them to listen to you...
I would like these data explained to me.
__
Update 7/23/08: Followup post from Scott Morgan at StoptheDrugWar.org


Updating the data/charts referred to in this post: The recent trends for marijuana use in the US haven't experienced any dramatic change from the levels reached in the 1990s after the great rebound. The Annual Use [PDF] and Daily Use [PDF] charts for 8, 10 and 12 graders from Monitoring the Future show us that. The trend for alcohol [PDF] and cigarette [PDF] use in the past 30 days continues to trend downward, with only a slight blip in the early 90s, instead of the lasting directional change for marijuana. As always, go over to the Monitoring the Future site to look up your favorite drugs for yourself.

The linked PDFs combine the prevalence charts with ratings of Risk, Disapproval and Availability. I would draw your attention to the way estimates of Risk for trying a psychotropic drug once or twice correlate with substance use. This, and the aforementioned Len Bias situation, address Maia's thesis in a way.

It isn't that scaring people off drugs doesn't work. It's just that they have to actually be scared.

On a conciliatory note, I agree emphatically with Maia's point here:

Let’s face it: The real problem with teen marijuana use is not a high school kid smoking a joint on a Friday night—it’s a kid who can’t get through the school day without one.

Those MtF data [PDF] show that about 7% of high-school seniors are using marijuana almost* daily.

A typical US public high school classroom will have what, 40 kids in it? 30-50 as a range estimate? So your average kid is in class, easily, with 99 other kids. SEVEN of them are smoking pot every damn day.

And being noddingly familiar with the profile, that "daily" is going to mean all day, every day in a significant subset of those individuals. Compare those daily rates to the annual rates across time. Notice how they trend along with each other?

Remember that when some cannabis denialist type comes along and tries to claim that wider spread availability and incidence doesn't matter because it is only the "addictive personality" that drives compulsive marijuana use and "everybody that wants to smoke marijuana already does anyway".

We may not be able to draw an absolutely direct line between daily use, addiction and a serious drug problem but they sure as hell are correlated.

Legalization, medical marijuana woo and cannabis denialism in general reduce the perception of risk. This drives greater use. Broader availability drives broader use. More use gets you to more daily use. More daily use leads to dependence. Dependence increases the incidence of people with a cannabis problem, no matter how an individual construes that.

Conversely, people being scared** of bad outcomes reduces use, therefore reduces the incidence of frequent use, dependence and, ultimately, the individuals with a cannabis problem.

This is the hypothesis the actual long term epidemiological evidence supports.

The fact that it doesn't tell us how to actually scare** people off a given substance doesn't affect this reality.
__
*25 of 30 days IIRC.

**so to speak

10 responses so far

  • Chris says:

    "Legalization, medical marijuana woo and cannabis denialism in general reduce the perception of risk. This drives greater use."

    The data from MtF do not at all support this assertion... Perception of risk has significantly decreased (about 50% relative) over the past two decades, yet Daily and Annual use rates have remained relatively unchanged.

    "Broader availability drives broader use."

    Again, the MtF data do not support this.

  • drugmonkey says:

    I find it fascinating how consistently the cannabis denialist type refuses to look at the full data set. Absolutely refuses to engage with the actual point being made here. Go check out the comments on the original version of the post for similar.

  • Chris says:

    Why do you bother blogging if you dismiss valid comments? Or, better yet, why do I bother reading the blog of someone who does?

  • drugmonkey says:

    As to why you bother, well, I surmise from your dismissive Twitter comment that you find even the weakest of "trolling attempts" to be irresistible. That's on you, my friend. You may need help with that.

    I don't "dismiss" valid comments. What I do is get pissy with people who very clearly are not addressing the thrust of the argument, nor the points at hand.

    The main point of this original article, and indeed the reposting of it, is to ask what caused the long decline of drug use during the 80s, when the much scorned anti-drug messaging was in its heyday. In addition, what caused the rebound in the early 90s.

    Your failure to address this is not uncommon, but it puts you squarely in the category of cannabis denialist that comments on my posts. Let's just say that the conversations always go a certain way. Feel free to startle me with your actual engagement of the points.

    Failing that, by all means, marshal your evidence for why I am wrong, rather than simply disagreeing that a single limited set of evidence points in the direction I suggest that it does.

    Read the MtF data, click through to my Len Bias post. Do the bloody reading.

    The data from MtF do not at all support this assertion... Perception of risk has significantly decreased (about 50% relative) over the past two decades, yet Daily and Annual use rates have remained relatively unchanged.

    First, consider the entire trend since 1975. Second, you aren't even right in your cherry picking. A correlation of trends doesn't mean an exact 1:1 correspondence. At all. There are going to be other contributing factors that might be present at one time and not another (say, medical marijuana legalization). The correspondence of risk and use trends is very clear from 1975 until 2005 at the very least. Up, down, up, flat is matched by down, up, down, flat. how you can miss this, I do not know. From 2006-9 to 2013 there is an upward trend in use and a downward trend in "risk" estimate. The fact that 12th graders are flatlined for the past three years is a "we'll see where this goes" result, that may be the start of a new trend, or no. It is not strong evidence for rejecting the entire rest of the longitudinal correlation. unless you are ...you know....looking for support rather than illumination.

  • Chris says:

    I didn't mean to detract from the truly fascinating Len Bias-cocaine data and the overarching points of the post, rather just that the MtF data doesn't support your "Perceived MJ Risk correlates to MJ Use" arguments... which I pointed to in my initial post, and which you immediately dismissed.

    I plotted the Monitoring the Future data to make it easier to see/compare - see it here: https://twitter.com/InfectiousChris/status/506995170668478464/photo/1.

    I figure it's worth letting your readers know, contrary to your assertions, the MtF data show's basically zero change in 30-Day prevalence for MJ over the past 20 years. There are rather significant decreases in perceived risk over that same period, while availability is essentially unchanged. Seems pretty clear. At least a lot more so than your MJ Risk correlates to MJ Use argument. If there's "better" data, then cool! How useful are surveys of teens anyways? I obviously like data, please share it with the group.

    If pointing out fallacies makes me a "denialist" and your reaction is to be dismissive and make gross generalizations then I can live with that...

  • Gumble says:

    The problem with your post is not your interpretation of the data, but the tense of the verb you used: "Did the war on drugs work?" OK, maybe all that warin' did reduce cocaine, MJ and amphetamine use in the 80s and 90s. Fine. But those lines look pretty flat ever since then, even though we continue to spend billions of dollars annually on the war. You might argue that all those billions are what's keeping the drug use rates lower than a few decades before, but (a) the point is debatable (maybe it's something else that's keeping drug use low), and (b) the drug war comes at the cost of throwing lots of people in jail who don't deserve to be there, and generally wreaking havoc and ruin on black neighborhoods all over the country.

    Even if one believes that the war on drugs reduced drug use in the past, the more important questions is whether the current tactics are effective and whether their costs exceed their benefits.

  • drugmonkey says:

    Are we spending the effort on the same things Grumble? No change in that around the early 90s?

  • The end of the Cold War caused the resurgence in drug usage? If so, we should be glad of Putin and his attempts at restarting it again.

  • The War on Drugs has always been a complete failure. Look at who profits. The DEA, Banksters,the ATF, who sent guns to the Mexican cartels, US Border Patrol, the Prison Industrial Complex and the rise of private prisons, and the militarization of our local law enforcemnet agencies.

    Our inmate population has increased 700% for males and 800% for females. Private prisons stepped in to fill the need. They are a great investment if you want to cash in on misery. Barbara Bush is a major investor. Private prisons undercut state facilities on their per diems, making them seem like a good alternative. They wrote contracts penalizing the state for empty beds. They can undercut by employing smaller staffs and using electronic surveillance. They also contract with industry who use compulsoray inmate labor. Inmates make all of the military uniforms and gear They make all of the bullet proof vests. This may be a good deal for taxpayers but they also manufacture for private industry. Inmates are paid from less than $1.00 an hour to less than $5.00 an hour. Victorias Secret, McDonalds, Starbucks, United Grocer, all computer companies except Apple, all of the telecoms, and national banks. The list goes on and on. These are jobs that should go to the free market and companies that use them don't pass a thin dime of savings to the consumer. Inmates get no benefits or vacation time and this is why some drugs have enhanced sentencing.

    I have used marijuana since the 1960's. I quit the years I was working as a nurse because I wanted to do the work and it would have been stupid to use working where randoms are a constant. I was never around marijuana and I did great. But it is psychologically addictive and that is worse than physically. After withdrawal the physical addiction is over. I am retired and a medical marijuana patient now. I wish I lived in Colorado so I didn't have to pay $300.00 a year to the state of Arizona. I hope to live long enough to see the end of federal prohibition. I don't know or care if I am addicted to marijuana It relieves my pain and increases my quality of life. If I use a heavy indica it helps me sleep and I have had insomnia since childhood. I like to wake and bake and to use again before bed. It is not as harmful as alcohol and alcohol is legal. I do not drive when I am high. I say"I'm too high to drive right now." But I have had a lot of drunk people tell me they were fine to drive. I would love to see the War On Drugs end, but it is too profitable to get any support. Thank you.

  • Hapless Postdoc says:

    A much more important task in the "war on drugs" is not reducing the rates of teenagers trying drugs or using occasionally, but rather decreasing the rates of addiction and overdose. At least in the case of overdose, the war on drugs appears to be a disturbingly miserable failure, especially when you consider all the collateral damage:

    http://blogs.cdc.gov/ncipc/2010/06/24/stop-overdose-deaths-involving-prescription-drugs-a-multi-faceted-approach/

Leave a Reply