What does it mean „drug”?

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Zsuzsanna Elekes

Deviant behaviors

Alcohol and other drugs

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Definitions

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What does it mean „drug”?

• A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function

• Illicit drugs (kábítószer): cultivation, manufacture, distribution, sale and sometimes use are controlled distribution, sale and sometimes use are controlled and/or prohibited by low.

– This is the only common property

(4)

• Addiction/dependence from a substance

– Physical dependence

• After a long-term use of a substance, when

withdrawing the substance, individual will experience typical physiological signs and symptoms

– In certain case these symptoms might be mortal

– Psychological dependence – Psychological dependence

• A certain drug seeking behavior, when the everyday life is completely subordinated to getting or using drugs

– Tolerance

(5)

• Dependence from a substance

• Dependence from a behaviour

One sort of behaviour dominate an individual’s life and behaviour, damage one’s mental or

physical health, cause different problems for others

• Types of addictive behaviours:

Gambling, internet, eating, shopping, working,

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• Abuse

– Using substances which does not exist any medical use (volatile substances)

– Using medicines without medical advice (alcohol with pill to get high)

– Using medicines in higher amount as prescribed or normal (too much sedatives)

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Histroy of illicit drug use

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We know different drugs for thousands’ of year

• We have information about the use of opiates already from 4000 B.C. Only a bit leater it was used also in Egypt.

• Cannabis was also known already in 3000 B.C.

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Use of drugs – illicit in our days - was always widespread

Different functions:

• Sacrificial – used as a part of tribunal rites and ceremony

• Curing - painkilling, anesthetic function,

mood improvement, as a caught mixture

• To supplement missing energy – replace food in Chine

• Recreation – India, in our days

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Spread in Europe:

• Napoleon’war (cannabis from Egypte)

• Club des Haschischin (V.

Hugo, Balzac, Baudlaire)

• Franch-prussian war, war in the Krim USA:

USA:

• Artists

• American civil war

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When drug use become a social problem to be solved:

• Beginning of the. XX. – USA

– Fist lows against Chinese immigrants

• 1890: opium might be produced only by US citizens

• 1914: Harrison Act: drug selling only for medical

prescription, drug trade become taxable, manufacturer prescription, drug trade become taxable, manufacturer and trader must be registered

• 1961: UN Single Convention on Narcotic Drugs

• 1971: Convention of Psychotropic Substances

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When the problem is getting deep

• Beat, hippy culture of the 60’s. 70’s

• Use of illicit drugs become an elemental part of this culture, as important like music, dress, or colors

• Using illicit drug is the way and also the symbol of getting member of this culture. Also the symbol of getting member of this culture. Also the symbol of secession from the „right” world

• Represents the refuse of middle-class norms

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90’s: normalisation:

• The number of ever users increases

• Number of regular users also increase

• Drug use and drug users are more accepted, tolerated

• The availability of illicit drugs increases

• Cultural accommodation of drug use – it is a part of everyday normal life. It’s symbolic

meaning has disappeared.

(14)

Drug history in Hungary

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• End of the 60’s: first information about a few young criminals using some substances

• 70’s

– This decade was still characterized by an effort to hush up the problem

– Few professional publication

• Beginning of 80’s:

– well-publicised clinical experiment to treat drug users.

– experiment launched an enormous campaign to solve this problem.

• publicity in press, series of interviews on TV and radio, documentaries and in-depth interviews that elaborated on the gravity and unsolved nature of problem.

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• 1985: Drug use appears as a social problem

– On the 13^th Congress of the Hungarian Socialist Workers' Party (MSZMP) in 1985 even the highest levels of administration have officially admitted the existence of the drug-related problems in Hungary.

– A public opinion survey : drug use is the second most dangerous problem, coming before such issues like the worsening situation of

accommodation, and the deteriorating quality of

(17)

• Second part of 80’s:

– Few treatment center – Campaign in the media

– Criminalization („terrible disease”, „the great enemy”, „the modern plague”)

– Consumption in itself is not punishable, only – Consumption in itself is not punishable, only

keeping or obtaining

– Increasing role of churches in drug treatment

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• 90’s – Political transition

– 1991 – Inter-departmental Committee on Drugs – 1993 amendment of the Penal Code punishes the

production and commerce of drugs more strictly, makes allows the drug user to receive medical

treatment instead of criminal charges (diversion program)

program)

– 1994 – press polemic on the possible legalization of marijuana

– 1996 – ad-hoc committee of Parliament

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– 1998: Ministry of Youth and Sports,

• Co-ordinating Committee of drug Affairs

• Modification of legislation: punishment of consumption – zero tolerance

– Spreading of treatment facilities and methods – Increasing number of NGO-s

– More realistic view in the media Total institutional restructuring

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• Around 2000

– The winning party of the 1998

elections, FIDESZ, gave the issue of solving the drug problem a great importance even in their election campaign.

• 4 points out of their 40-point programme dealt with the drug problem.

– their first actions was to modify the legislation concerning drugs.

• Also the use of illicit drugs is punishable (only in USA)

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• 2000: National Strategy on Drugs

– “Society must become sensitive to effectively deal with the drug-related problems, and local communities must increase their problem-solving skills to curb drugs

(community, co-operation)

– the youth must be given a chance to be able to form a positive lifestyle, and say no to drugs (prevention).

positive lifestyle, and say no to drugs (prevention).

– Individuals and families that are affected by drug-related problems must be assisted (treatment, rehabilitation)

– The availability of drugs must be lowered (reducing supply) ”

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• 2002

– New election: changes in the legislation

• Restoration of the situation before 1998: occasional drug users can also receive medical treatment

• Until the beginning of 2000’s drug problem was in focus for politics and the public in Hungary

focus for politics and the public in Hungary

– It was an important issue in party struggles, and election campaigns,

– also appeared as in the public's mind as an important social problem.

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• After 2002

– Decreasing interest

– Some important treatment institution end functioning – Decreasing financial possibilities

– More realistic view in the media – Less condemning public attitude

• Possible explanation for changing interest:

– The new and unknown problem of the 60’ is well-known already

– Changes in the spread of drug use – Changes in „typical” drug users

– Dealing with drug problems had some distracting function in a changing society

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Drug use in Hungary

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• First information about young drug users: late 60s

• 70s, 80s sporadic researches:

medicines, sniffing, home made poppy derivates, home-grown cannabis

derivates, home-grown cannabis

• 90s: more accurate information

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• Types of indicators:

1. Indirect indicators – statistical informations 2. Direct indicators – normal population

surveys based on self report

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Number of treated drug users in Hungary 1999-2007 (OSAP)

12765 12789

12049 12777

14993

14165 14793 15480

13453

8000 6319 10000 12000 14000 16000 18000

5770

4701 4342 4717

5958 5655 6319

5673

4036

0 2000 4000 6000 8000

1999 2000 2001 2002 2003 2004 2005 2006 2007

registered newly registered

(28)

Number of treated population by types of illicit drugs

3000 4000 5000 6000 7000

0 1000 2000

1999 2000 2001 2002 2003 2004 2005 2006 2007

(29)

Number of drug related deaths in 2006

male female total

heroin 21 1 22

methadon 1 1 2

Cocaine 1 0 1

Illicit total 23 2 25

Sniffing 10 1 11

Tranquilizers/sedatives 80 95 175

Polytoxicomany 5 2 7

Total direct 141 102 243

Indirect, illicit 7 1 8

(30)

Number of criminals in relation of illicit drugs

4000 5000 6000 7000 8000

0 1000 2000 3000

(31)

Statistical data refer more to changes in attention paid to the problem, the

institutional development and changes in statistical recording system

statistical recording system

(32)

• Comparative survey on adolescent substance use 1995, 199, 2003, 2007

European School Survey Project on Alcohol and other Drugs

• Representative sample of 16 years old students

• 2007: 35 participating countries

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Hungary

• Every third student think that marijuana is easy to obtain

• Every 4th think that ecstasy is easy to

Europe

•Every third student think that marijuana is easy to obtain

•Every 5th think that

ecstasy is easy to ecstasy is easy to obtain

• 15% of students have already tried some

illicit drugs ecstasy is easy to

obtain

•20% of students have already tried some

illicit drugs

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Lifetime prevalence rates of illicit drugs (Hibell et al. 2009)

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Changes in lifetime prevalence rates 1995-2007

13

18

21

18

12

16

15

10 12 14 16 18 20 22 24

5

2 4 6 8 10

1995 1999 2003 2007

Europe Hungary

(36)

Lifetime prevalence rate of tranquillizers/sedatives without prescription (Hibell et al. 2009)

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• The lifetime prevalence rate of illicit drugs increased more than threefold in Hungary

between1995 and 2003. The prevalence rate stabilized between 2003 and 2005 and

decreased between 2005 and 2007.

• Changes between 1999 and 2007 are mostly

due to the changes in marijuana consumption

(both increase and decrease).

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• There is a new increase in the consumption of other substitutes (inhalants, patron/ballon)

• Changes in attitudes show similar tendencies like changes in consumption habits

• Several figures indicate that worsening

tendencies of the nineties and beginning of

2000s have been changed. Some data indicate

a certain stabilization others show improving

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Adults:

• About every 15th adult have already used some kind illicit drug in Hungary

• 40 % of ever users are actual users

• Tipical drug users are young male living in Budapest

• On the basis of lifetime and actual prevalence rates drug use is less widespread in Hungary than in other European countries.

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History of alcohol problem

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Why is it a problem?

• 2001: 6,7% of male and 3,7 % of female death cases is due to liver diseases

• 27 % of male death cases at the age of 35-64

years is connected to alcohol consumption

(42)

• Alcohol is known for 10 thousand years (beer without hops and drinks made from honey)

• Wine is known for 5-6 thousands years (Noé - Bible)

• Viticulture became widespread in Italy only

from 2

^nd

century BC.

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Alcohol consumption has had different function in different time and culture

1. Crucial role –rites and ceremonies

• Crucial role of wine in Christianisme has helped the spread of wine cultivation and helped the spread of wine cultivation and drinking

• Torah discuss alcohol as a gift from God

2. Celebration

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3. Nutritive function

• Part of our eating

• Gives energy – Diet

– morning „pálinka” drinking

• Recover our needs in fluids

• Recover our needs in fluids – Middle Ages

– It kept quality when while shipping

– Water was often unhealthy or infected for human

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4. Curing function

• Cato (200BC): wine for different health problems

• XVIII century: English doctors used wine for treating gout and different infections

• From the XIII century acqua vita in nordic

• From the XIII century acqua vita in nordic countries (used also again Spanish flue)

• Sedative function to day

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The intention of controlling alcohol use and production has also a very longue history

• Hammurabi (1700BC): adulteration of alcohol is forbidden

• Torah has also described how alcohol can lead to

• Torah has also described how alcohol can lead to violence and the loss of consioussness

• Slaves have nearly always been forced to be abstinent

(47)

Alcohol use appears as a real social problem in the XVIII

^th

century

• Alcohol was more available, stronger and cheaper than even before

• Drunkennes became more common, more public, and more associated with powerty

and more associated with powerty

• 1816 Spirit Act in Norway allows home destillation fivefold increase in consumption

• Mass movements in the XIX^th century

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Temperence Movements

• At the beginning it focused on moderate alcohol consumption

• Later: for total prohibition

• Strong relation with working-class movements and with feminists

and with feminists

• Alcohol drinking is a moral question

• Alcohol is the reason of any other social

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• End of the XIXth century:

– Drinking might be also a medical problem – The first medical recognition of addiction

• The first voluntery home for inebriates in US.

• Compulsory asilumes

• Beginning of XXth several homes and asylumes in several European Countris

several European Countris

• 1930 – Jellinek: „alcoholism is a dease”

– Against the moral approach of Temperence Movement – Against punishment of alcoholics

– Must be treated – Must be studied

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• Results of the desease concept:

– Moderate the criminalization, and moral condemnation of alcoholics

• Critics:

– It reduce the problem for alcohol addict and for – It reduce the problem for alcohol addict and for

the treatment of sick people,

– It defines intemperate alcohol use only as a

medical problem, and offer only medical solution (health problem only)

(51)

70’s: Total consumption model

• Ledermann 1956 (consumed alcohol and alcoholism is in relation)

• Kettil Bruun et al. 1975:

– Addiction is only a small part of the problem

– Alcohol related problems and problematic alcohol use – Drinking is a social activity

– Other’s drinking influence own’s drinking – Other’s drinking influence own’s drinking

– Total consumption and problematic drinking is in correlation

– It has to deal with the consumption of the total population

• On the level of politics: supply reduction

• Researches on the total population

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• 80’s – critics of the total consumption model

– Prevention paradox

• Moderate drinkers report about more problems

– Not neceserely the quantity but the way and circoumstances of drinking cause the problems, circoumstances of drinking cause the problems, – Harm reduction

• To reduce dangereous form and condition of drinking

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Hungary

• Among our earliest records

– „Kumisz” – fermented horse milk in the time of the settlements of Magyars

• First restriction in the XVIth century:

– Protestant church (Transylvania and the Uplands – Protestant church (Transylvania and the Uplands

of Hungary) – Army

– Moral approach

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• Temperance Movement – beginning of XXth century

– Worker class movement

– Freemason lodge – Good Templar 1901 – Antialcohol Labor Union

– Abstinent medical society – Abstinent medical society

– Asylum in Rákospalota with 25-30 bed for alcoholics

• 1919 Hungarian Soviet Republic

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• 50’s

– Alcoholism is a remnant of capitalism

– The complete lack of special institution, and specialists for for any kind of social problem

• 1966 – setting up a treatment system

– Voluntary treatment

– Compulsory treatment - ordered by local authority – Compulsory treatment - ordered by local authority – Forced cure – ordered by criminal court

– Detoxification

• 70’s

– First researches

– Clubs for Antialcoholism

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• 80’s: Alcohol problem became a political issue – Gorbacsov’s anti-alcohol policy

– Polish solidarity’s anti-alcohol efforts – Hungarian opposition:

• Government and the political system is responsible for the high alcohol consumption

– Some measure for demand reduction:

• Schools, and health institutions

• Workplaces

• Prohibition of alcohol selling until 9 a.m.

• rise in prices of spirits

– Institutions (Methodological Centre, Institute of

(57)

• 90’s

– Decreasing social and political interest – Abolition of prohibition till 9. 0.m.

– Privatization increase the number of outlets selling alcoholic beverages

– New low allows the advertising of alcoholic beverages

beverages

– Prices of alcoholic drinks are relatively low – Legal age: 18

– Blood alcohol level: 0

– No official organ of alcohol problem – Positive attitude

(58)

• Other former socialist countries

– Alcohol policy has been always subordinated to economical interests

– Before transition: to increase revenues + to engage household incomes

engage household incomes

• Poland: 10% of GDP was coming from alcohol selling.

15-18 % of household incomes was spent for alcohol

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– After the transition: alcohol industrie and alcohol selling firstly got out from state monopol

• Latvia: number of alcohol outlets increase by 80 % between 1993-1995

• Poland: Number of alcohol outlets increases from 30 000 to 100 000 after the transition.

• Only exeption: blood alcohol level: 0 in all former

• Only exeption: blood alcohol level: 0 in all former socialist countries

(60)

Alcohol use in Hungary

(61)

Trends in per capita consumption

(62)

Total per capita alcohol consumption in EU

(63)

Per capita alcohol consumption in pure alcohol - Hungary

8 10 12 14

0 2 4 6

l950 l960 l970 l980 l985 l990 l991 l992 l993 l994 l995 l996 l997 1998 l999 2000 2001 2002 2003 2004 2005 2006

wine beer spirit total

(64)

Liver cirrhosis mortality is some EU countries

80 100 120 140

Ausztria Horvátország

Csehország Franciaország

Németország Magyarország

40 60

Olaszország Lengyelország

Románia Szlovákia

(65)

Alcohol consumption by the ESPAD

• 90% of students have drunk alcohol at least once during their lifetime

• 82% have drunk in the last 12 months

• 61% have drunk in the last 30 days

– Significant country differences: Iceland 31

%, Austria 80%

• The figures for lifetime, past 12 months and past 30 days prevalences are similar for boys and girls

• Higher frequencies are reported in higher proportion by boys

(66)

Alcohol use during the last 30 days (Hibell et al. 2009)

(67)

Heavy drinking and drunkenness

• Half of the ESPAD students have been intoxicated at least once during their life

• For 18% of the students this had happened during the past 30 days

• 43% of the ESPAD students reported heavy episodic drinking (5+ drinks) during the past 30 days

drinking (5+ drinks) during the past 30 days

• On the average EASPAD level there were no gender differences in drunkenness, while heavy episodic drinking is more common among boys

• Gender differences of heavy drinking are diminishing

(68)

Having been drunk during the last 30 days (Hbell et al. 2009)

(69)

Results from adult surveys:

• Different demographic groups differ from each other in the nature of alcohol

consumption

• Older people or those with higher education

level are characterized by a more frequent,

but smaller-quantity consumption which

seldom causes problem

(70)

• Young people and those with lower education manifest less frequent but bigger-quantity

consumption

• Not the objective but rather the subjective

evaluation of the financial situation can be

connected to the more problematic forms of

alcohol consumption

(71)

• Western part of the country:

• Higher quantities

• Higher frequencies

• Wine consumption

• Northeastern part of the country:

• Smaller quantities

• Smaller frequencies

• Problems

• Spirit consumption

(72)

• In Hungary we can observe both the dry and wet consumption habits.

• The difference between the various social groups and regions can be identified primarily through the nature of drinking

• Subjective evaluation of the individual situation has a direct connection with problematic consumption

• In contrast with the results of 1986’s survey alcohol

• In contrast with the results of 1986’s survey alcohol consumption today can be less readily connected to the deprived layers of society. Problematic

consumption today is found in a wider group of soociety

(73)

Thank you for attention!

May 2011