Humans living in moderately homogeneous traditional cultures in all parts of the world did not encounter drugs and had no way of individually controlling alcohol or other drug intoxication, with rare exceptions. For these reasons, the brain’s hardware in both animals and humans developed with no protections from drug caused risks. Simply human beings have developed the capability to use intoxicating drugs frequently, and only in current times have people learned how to use sanitized, highly potent brain-stimulating drugs.
Drugs flout the brain’s built-in control mechanisms for hazardous behaviors like fear of predators and terror of heights that have developed over millions of years. Traditional values acted to bound exposure to alcohol and drugs as they were experienced in pre-modern cultures. Traditional values of human societies proscribed the use of intoxicating drugs outside medical and spiritual ceremonies. Drug use, in all stable pre-modern cultures, was proscribed not by the individual drug user but by the medical or religious leaders of the community.
Early human communities were comparatively small, isolated, and culturally consistent. The diversity of these communities was restricted as the community shared values concerning the management of aggression, fear, sex, and feeding. Traditional cultures permitted moderately few different roles and little personal choice of behavior. The shared values within these cultures served to restrain the use of alcohol and other drugs to the degree that there was any revelation to these substances.
Thus, cocaine dependence is very frequent in black culture. It is an alkaloid that occurs obviously in the leaves of the Erythroxylon coca shrub, which is native to Peru, Bolivia, Colombia, and Ecuador. The chewing of coca leaves is still practiced by natives of Africa America. Coca leaves themselves hold a very low concentration of cocaine, less than 0.5% to 1%, thus providing a natural obstruction to ingestion of sufficient cocaine to cause toxicity. For eating, the leaves are toasted and then either mixed with an alkaline material, or mixed into an alkali powder (ashes) consisting of the toasted leaves and other burned leaves, and then chewed into a “wad” or “quid,” placed involving the cheek and gum and chewed incessantly, sometimes for hours ( Verebey and Gold, 1988).
The comparatively slow absorption rate and the resultant low concentration of cocaine (less than half that obtained by gasp) results not so much in a high as in a pleasant euphoria (Brown, 1989). Oral use via undeviating application to the gums is also practiced.
Cocaine has two major pharmacological actions, the blocking of sodium channels in the membranes of impulsive neurons and muscle cells, and the blockade of catecholamine reuptake in the brain. The former action generates a local anesthetic effect through interference with the capability of nerve cells to propagate impulses (action potentials), and the latter generates central nervous system effects by escalating the effects of norepinephrine- and dopamine-mediated changes in the nervous system (Commissaris, 1989 ).
Cocaine dependence grew in the 1980s, as the pond of those who had experimented with the drug extended. The probability that someone who experimented with cocaine became a dependent user was about seventeen percent (Anthony, Warner, & Kessler, 1994). Rhodes et al. (1997) estimated that the number of persons using cocaine weekly peaked about 1988 at 3.6 million, several of whom were also heroin dependent. By 1995 that figure can have declined to about 3.3 million, perhaps as so many were incarcerated.
Whether dependence on a stimulant can be sustained as long as narcotic dependence is indistinct, but there are surely many cocaine users who have, over a ten-year period, maintained common use of the drug, although with less regularity than heroin addicts. Desistance early in a career of normal use seems to be stoutly and positively linked with education; thus, those who have sustained to be frequent cocaine users are less educated and more illegitimately active.
Cocaine dependence is greatly concentrated in inner-city minority communities. Though it is regularly, and correctly, asserted that rates of drug use are similar in the main ethnic communities of the United States (African-American, Hispanic, non-Hispanic white), a diversity of imperfect data sources point to a vivid concentration of frequent cocaine use amongst urban African-Americans and Hispanics.
For instance, research has shown that a high percentage of those arrested in large cities are dependent on cocaine and that they account for a large part of the total cocaine-dependent population. The detained population is inexplicably drawn from young minority males. The same inference concerning the concentration of cocaine dependence can be drawn from data on the composition of the populations in handling and those seeking help in emergency rooms for cocaine-related problems.
Under current conditions, several of the adverse effects linked with drug use in the United States are the crime and morbidity/mortality arising from proscription or its enforcement. As, a large share of those who commit crimes are common users of drugs, as revealed by the Drug Use Forecasting (DUF) system [now Arrestee Drug Abuse Monitoring (ADAM) system]; in most cities over half test encouraging for some drug other than marijuana, usually cocaine (National Institute of Justice, 1997).
Nor is this just a reflection of the spending preferences of the criminally active. Drug use exacerbates the criminal activity of those who are regular users of expensive drugs; the same person can commit five times as many offenses while using drugs as when abstinent.
For instance, Ball et al. (1982) followed 243 Baltimore addicts for 11 years and found that they committed crimes on 248 days every year while using heroin and only on 41 days when abstinent. Moreover, there is a good base for believing that a large fraction of those now dependent on cocaine and heroin are illegitimately active. An interesting way of stating this is that over half of all cocaine and heroin is possibly purchased by users who were properly under the control of the criminal justice system (Kleiman, 1997). Frequent use of marijuana, without involvement with cocaine or heroin, does not seem to be criminogenic itself, though it can be prognostic, inasmuch as it increases the probability of involvement with cocaine and heroin.
Drug selling has become a widespread activity among poor minority urban males. For Washington, DC, it is estimated that almost one-third of African-American males born in the 1960s were charged with drug selling between the ages of 18 and 24 (Saner, MacCoun, & Reuter, 1995). This signifies a serious problem in many dimensions for the communities in which they live as drug selling itself generates high levels of violence and creates criminal records for those who contribute at a young age. Additionally, though most sellers make modest incomes, the prospective for fabulous earnings probably reduces incentives for finishing high school as well as seeking legal work and contributes to the extraordinarily low labor force participation rates in so many center city poverty communities (Wilson, 1996).
It is hard to evaluate drug enforcement in modern America without reference to race (Tonry, 1995). Those arrested for drug selling are mainly minority; that disproportion is even higher for prison sentences. In 1992, African-Americans constituted two thirds of those admitted to state prison for drug offenses, compared to some extent less than one-half for all non-drug offenses; African Americans comprise 12 percent of the general population.
The disproportion in sentences for crack offenses, for which arrests are devastatingly of African-Americans and Hispanics, has been a main political issue. At the federal level, Congress in 1996 affirmed its views by determinedly rejecting a possible downward revision in the 100 to 1 disparity in the amount of drug generating a five-year sentence for crack and for powdered cocaine, in spite of the recommendation by the Sentencing Commission, a body usually given to great sentencing severity, that the difference be considerably reduced. President Clinton also spoken his disagreement with the Sentencing Commission’s recommendation. Though drug problems are disproportionately concentrated in minority urban communities, the sentencing disparities have also been extremely divisive. Edsall and Edsall (1991, p. 237) reported that focus groups in the late 1980s found that many African-Americans believed that drug enforcement was part of an effort by the white community to oppress African Americans.
Nor is this the only division in society arising from hard drug policies. For the young, the growing severity of rhetoric and policy to marijuana, arrests for simple possession having doubled in the last five years, reduces the integrity of government generally. The claims concerning marijuana’s dangers, both in public oratory and school prevention programs, seem revoltingly exaggerated and indeed lack much scientific basis. As a minimum one senior Clinton administration official has equated marijuana and crack in awfulness.
Studies found that the majority of the children of alcoholics or drug addicts do not themselves become alcoholics or drug addicts. Various addicted people do not have parents or siblings who were addicted to alcohol or other drugs. To the extent that addiction is innate, what is passed on from one generation to the next is the susceptibility to addiction, not the addiction itself. The development of addiction to alcohol and other drugs needs many other forces, comprising those that are environmental and experiential.
The substance being used affects the danger of addiction. Cocaine and heroin are far more probable to produce addiction than is alcohol, given the equivalent level of use, genetic susceptibility, and social tolerance. Routes of administration are as well important in setting up relative risk of addiction. Cocaine is more addictive while smoked or injected than when it is sniffed up the nose. As these factors, and many others, govern relative risk of addiction, all people are susceptible to addiction. Diversity of risk does not mean that some people are susceptible to addiction and others are not, but it does mean that some people are moderately more vulnerable than others.
To the extent that people, particularly young people, are exposed to non-medical drug use in comparatively permissive environments, the drug problem worsens. Exposure to drugs in settings that are proscribed by medical or religious traditions is less perilous in terms of addiction.
Family of cocaine dependent constantly suffers a lot due to the suffering of their young ones. Addicts are characteristically egotistical and irresponsible. They also often appear to be sociable and self-confident. They are commonly appearing to be self-deprecating and sometimes even shy.
Many physicians, health care workers, and other human ser vice professionals, including teachers, are dependent people who are living out their family-based roles as caregivers in their work lives. Often they found that they were not capable despite their most heroic efforts, to save their own captivated family members. Later they, usually unconsciously, try to save others through altruistic, dedicated, and tireless human service work. Though this is not a bad motive to enter into a life of social responsibility, it is wise to understand our own motives and to expect the ways in which they can distort relationships with those being served. For instance while the best efforts of the codependent caregiver are rejected or ignored, this can recur earlier traumatic experiences and lead to inapt and sometimes dangerous responses from the frustrated, overstressed codependent human service professional.
Drug dependence is a disease of lost selfhood, of having one’s self and self-esteem distinct by someone else’s behavior. The dependent person is as captivated on the addict as the addict is hooked on the alcohol or other drug. Dependents overlook their own inner, deeper needs as they try diligently but futilely to fix themselves by fixing the addicted person in their lives. Dependent people have problem thinking of themselves without thinking of their addicts. Their lives and self-concepts, considerably, are defined by their relationships with their addicts.
Dependence is comparatively easy to see, once you distinguish the disorder. Drug dependents are in a trap from which they cannot break out. The harder codependents struggle to free themselves by trying to control the conduct of an addicted person, the more profoundly they are enslaved in this family disease. Love itself pushes them ever deeper into this trap. Their behavior calls out, “I cannot let this go on. It is too excruciating to watch this person I love destroy him (or herself). I must act. I should save him (or her), and you have to help me do it right now. We haven’t a minute to spare!”
People who grew up in families subjugated by addiction and other dysfunctional behaviors developed their own characters around the intensely held belief that if they could live their lives right in their own marriages, by controlling the addict’s behavior, then the addict would not be an addict at all. By their work as well as their love in their own marital families, they thought they could resolve this deadly problem that they had not been able to solve in the family in which they grew up. As children growing up, they often felt a hidden shame concerning their parents, their homes, and, eventually, themselves. Dependents concluded, unconsciously, that they could trounce their hidden shame by finally solving the problem of addiction in their spouses or their children.
Many children, destined to become codependent adults, could not take their friends into their homes as of the embarrassment they felt when their friends saw their alcoholic parents. While they went out to find a mate, they sought, typically without being aware of the process, someone who had several of the characteristics of their alcoholic parent. They loved that parent particularly, and wanted as children to be competent to make life right for that addicted parent, to live out the family romance they dreamed of with a happy home for both parents and children.
The future dependents acted as if they thought that this time, in their own marriages and with their own children, it would all work out the right way. They would work it so that their own spouses and children would not become alcoholics or addicts, and in doing that they could defeat the shame that they felt, first in relation to their addicted parent and then as a extremely rooted part of themselves as failures at the most significant challenge of their lives, their efforts to save an addicted parent or sibling. The fundamental belief of these budding codependent people was that their sense of worth, their self-esteem, was dependent on what their captivated spouse or child did or did not do. Further, they believed that through selfless work and love, and whatever else it took, they could control their spouse’s or their child’s addictive behavior (Kleiman, M. A. R. 1997).
Sometimes the spouse was an active alcoholic, but more often, the spouse was, at the time of courtship, a budding addicted person who had distinctiveness of the addicted parent but who had not yet developed the full pattern of addiction to alcohol and other drugs. In some cases it appeared as if the codependent spouse acted in ways that unintentionally promoted the developing of addiction, for instance, by making drug or alcohol use easy or by making excuses for early problems that arose from the excessive use of drugs or alcohol. Another all-too-common pattern was for the person who grew up in an alcoholic or drug-addicted family to extend his or her own addiction to alcohol and other drugs, thus repeating the role of both parents all together—the addicted spouse and the enabling spouse.
This story of drug dependence in the family life cycle hardly ever had a happy ending. The most general pattern was for the development of addiction in the spouse of the codependent person. As the addiction worsened, the codependent spouse sought to develop the addict’s behavior in an anxious, ever-worsening cycle of futile control.
First the codependent worked to control the addict with love and, as this failed, with bribery and exploitation, and finally with anger, resentment, and eventually a punishing withdrawal of affection. The codependent spouses acted as if they could feel good concerning themselves only if their addicts got well. Typically, the addiction just got worse. Family life gradually deteriorated into recriminations, wounded pride, and anger, deepening the codependent person’s shame moreover feelings of failure. The codependent person became isolated and deflated as his or her greatest childhood pain was repeated as an adult (Tonry, M. 1995).
The addicted family member felt persecuted by this gradually more extreme behavior of the dependent spouse. He or she felt that the spouse was trying to control him or her and that the spouse did not understand or revere the addict. The addicted family member felt that he or she was being pursued by a mean spouse who had become a parole officer bent on shaping his or her life to convene the spouse’s own excessive needs. The addict used the anger and anger he or she felt as one more good excuse to drink alcohol and use other drugs. The addict’s behavior, and often his or her words, said, “You made me do it by your nagging and by your suspicions.” The same process often has been played out by parents of addicted children, sometimes while the children were teenagers, sometimes when they were adults. In these cases, the codependent parents sought to control their obsessed children in fruitless, self-defeating ways.
Many professionals working in the field of addiction have renowned this pattern in families and have developed methods for helping families afflicted by alcohol and drugs to get well through use of the Al-Anon program. The first step on the road to revival is to distinguish that addiction in the addict is not simply physical dependence or even just a result of alcohol or drug use. The addict’s disease is a disease of the self, rooted in the addict’s egotistical sensitivity, and sustained by dishonesty. Getting well for the alcoholic or drug addict means really caring about others and becoming honest. The same is true for the codependent person, whose dishonesty, like his or her own egotism, is usually totally hidden.
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