A new analysis of data from the National Survey on Drug Use and Health once again confirms a point I emphasize in my book Saying Yes: The vast majority of illegal drug users do not fit the stereotype of addiction and degradation promoted by the government and the news media. Based on data from the 2004, 20005, and 2006 surveys, the Substance Abuse and Mental Health Services Administration (SAMHSA) calculated the percentage of people who became "dependent" on various drugs within two years of trying them. Here are the dependence rates, in ascending order:
Tranquilizers (nonmedical use): 1.2%
Sedatives (nonmedical use): 2.4%
Painkillers (nonmedical use): 3.1%
Cocaine Powder: 3.7%
Stimulants (nonmedical use): 4.7%
Crack Cocaine: 9.2%
In some ways these results track conventional wisdom. Heroin comes out on top, which conforms to traditional thinking if not to more recent scare mongering about crack and methamphetamine, each of which was said to be at least as addictive, if not more so. But even in the case of heroin, a large majority of users were not deemed "dependent," and most (69 percent) had not even used the drug in the previous year. Likewise, crack looks more addictive than cocaine powder, but 76 percent of the people who tried crack were not using it at all a year later, quite a feat with a drug that's said to be instantly addictive. The comparable rate for cocaine powder was 58 percent, which could mean that a) people find it more appealing than crack, b) people find it easier to integrate into their lives because the experience is less intense, or c) people find it more appealing because it's easier to integrate into their lives. I think most people would be surprised to see that "stimulants," which included methamphetamine, rate lower on this addiction scale than heroin, crack, and even marijuana, and that narcotic painkillers, described as overwhelming and irresistible in press coverage of the OxyContin "epidemic," look no more addictive than alcohol.
A few notes of caution:
1. SAMHSA measures drug dependence through questions based on the American Psychiatric Association's diagnostic criteria, which require three or more of seven indicators: 1) tolerance, 2)withdrawal, 3) taking the drug in larger amounts or over a longer period than intended, 4) a persistent desire or unsuccessful efforts to cut back, 5) a lot of time spent getting, using, or recovering from the effects of the drug, 6) disruption of important social occupational, or recreational activities, and 7) persistent use despite serious drug-related physical or psychological problems. To qualify for the label, a patient is supposed to be suffering from a "maladaptive pattern of substance use" that leads to "clinically significant impairment or distress," which is difficult to assess at a distance through a survey. But the major line of criticism I've seen indicates that, if anything, applying the "clinically significant" criterion would generate lower rates of substance dependence.
2. This particular analysis covers just a few years, and serious drug problems may take longer to develop (although that's certainly not the impression left by the government's anti-drug propaganda). Studies covering longer periods, such as the National Comorbidity Survey (which I cite in my book), do find higher addiction rates. But they still indicate that addiction is not a typical result of drug use.
3. It's risky to assume that the addiction rate associated with a substance has to do with its inherent properties, as opposed to the sort of people who like to use it. It seems plausible that people who are attracted to an extreme, notorious practice like heroin injection, for example, are different from people who aren't in ways (tastes, preferences, personality traits, circumstances) that affect their likelihood of using the drug heavily.
[via the Drug War Chronicle]