This instructor's manual has been prepared for use with Taking Sides: Clashing Views on Controversial Issues in Drugs and Society, 5/e. For each issue, the following have been provided: a synopsis of each author's position on the issue, teaching suggestions, and multiple-choice and essay questions. The teaching hints consist of suggestions for generating class discussion around the themes raised by the clashing essays. The multiple-choice questions are meant to test more than the student's memory of who said what. They are meant to encourage the student to make reasoned choices, or, in other words, to exercise good judgment. The essay questions encourage the student to write organized and coherent analyses of the issues. These questions may also be used in class discussions. At the back of this manual you will find a TAKING SIDES BRIEF EVALUATION FORM. If you plan to use Taking Sides to encourage and develop critical thinking skills in your students but would prefer not to initiate in-class debates, this form is designed to give you another option for using Taking Sides and for evaluating student response to reading assignments from the book. Any comments, good or bad, from professors who have used Taking Sides in the classroom would be appreciated, especially any suggestions as to how it might be improved! Should you want to make recommendations for new issues, selections, or improvements, please write to the Taking Sides Program, \Dushkin, 530 Old Whitfield Street, Guilford, CT 06437, or call 800-243-6532, or e-mail taking_sides@mcgraw-hill.com. If you are looking for general information or wish to request a desk copy of any Taking Sides book, please contact our faculty support center through The McGraw-Hill Companies at 800-338-3987, prompt 3. Lastly, you are invited to visit the Web site for the Taking Sides series at: http://www.dushkin.com/takingsides/. And by all means, let the Taking Sides Program know if there are any links that would be appropriate for the site or your thoughts on how it could better serve your interests. \vskip 12pt \nobreak \begin{flushright} Raymond Goldberg State University of New York College at Cortland \end{flushright} The Drug Reform Coordination Network (DRCNet) http://www.drcnet.org/index.html The Drug Reform Coordination Network is a national network of nearly 20,000 activists and concerned citizens--including parents, educators, students, lawyers, health care professionals, academics, and others--working for drug policy reform from a variety of perspectives, including harm reduction, reform of sentencing and forfeiture laws, medicalization of currently Schedule I drugs, and promotion of an open debate on drug prohibition. .08 BAC Limit http://www.nhtsa.dot.gov/people/injury/alcohol/limit.08/index.html This site of the National Highway Traffic Safety Administration (NHTSA) features a handful of links on .08 blood alcohol concentration (BAC) laws, including a progress report on President Bill Clinton's 1998 initiative to make .08 BAC the national legal limit and three studies evaluating .08 laws. The North American Syringe Exchange Network (NASEN) http://www.nasen.org The North American Syringe Exchange Network (NASEN) is dedicated to the creation, expansion, and continued existence of syringe exchange programs as a proven method of stopping the transmission of blood-borne pathogens in the drug-injecting community. Association of Persons Affected by Addiction (APAA) http://www.apaarc.org The Association of Persons Affected by Addiction (APPA) provides a channel through which the collective voice of the members of the recovery community may be heard in matters directly affecting them. This site includes a discussion forum and many related links to organizations and sites on a variety of addictions. International Drug Control Policy Links and Resources http://www.wola.org/drugpollinks.html This simple site provides links to domestic organizations, foreign policy organizations, U.S. government links, and other resources related to international drug control policies. ISSUE 1 Should Drugs Be Legalized? YES: Ethan A. Nadelmann, from "Commonsense Drug Policy," Foreign Affairs (January/February 1998) NO: Eric A. Voth, from "America's Longest `War,'" The World & I (February 2000) Synopsis Ethan A. Nadelmann, director of the Lindesmith Center, maintains that the war on drugs has been futile and counterproductive. He feels that drug abstinence cannot be achieved through legal mandates and that a pragmatic approach is needed. Eric A. Voth, chairman of the International Drug Strategy Institute, contends that the war on drugs is not a failure and that legalizing drugs would worsen drug-related problems. Voth maintains that a restrictive yet compassionate approach toward drug use is the best policy to adopt. Discussing the Issue Would drug legalization be a rational and productive measure? Nadelmann asserts that we need to stop relying on criminal justice measures to eradicate drug problems because they simply are not working. It has been suggested that the criminalization of drugs has actually contributed to and worsened the social ills associated with drugs. Also, people have argued that legalization would take the emphasis off of criminal law enforcement policies and allow more effort to be put toward education, prevention, and treatment. Voth doubts that the purported benefits of legalization would outweigh the risks. Legalization advocates profess that decriminalizing drugs would decrease profits from the sale of drugs, thereby decreasing the value of and demand for drugs. Using alcohol and tobacco as examples, legalization opponents note that the profits from cigarettes and alcohol are incredibly high. Moreover, the problems with these drugs have not disappeared as a result of legalizing them; alcohol and tobacco still have extremely high addiction rates and a myriad of other problems associated with their use. Another aspect of the debate revolves around the moral considerations of drug criminalization. Legalization advocates believe that adults should be allowed to make their own decisions about drug use and that criminalization is a violation of personal choice. Should adults be allowed to use drugs even when the serious health, social, and economic risks are known? On the other hand, should the government be policing the personal habits of its citizens? Testing on the Issue Web Questions 1. According to Ethan A. Nadelmann, who believes that drugs should be legalized, the government's war on drugs has resulted in a. a reduction in drug use. b. fewer violent crimes being committed by drug users. c. the United States having eight times as many people in prisons for drug-related offenses in 1997 as in 1980. d. greater respect for people who enforce drug laws. 2. According to two studies cited by Eric A. Voth, who does not believe that drugs should be legalized, the highest level of drug use occurred in the a. late 1970s. b. mid-1980s. c. early 1990s. d. years 2000-2001. Multiple-Choice Questions 3. Which of the following people support reducing the penalties for drug use? a. New Mexico governor Gary Johnson b. conservative columnist William F. Buckley c. economist Milton Friedman d. all of the above 4. Nadelmann maintains that most of America's drug problems stem from a. alcohol and tobacco. b. marijuana. c. heroin. d. cocaine. 5. Nadelmann states that the most effective treatment for reducing heroin use and associated crime, disease, and death is a. harsher prison sentences. b. self-help programs modeled after Alcoholics Anonymous (AA). c. methadone maintenance. d. solitary confinement of drug addicts. 6. According to Nadelmann, of the more than 600,000 people in the United States arrested for marijuana in 1996, most were arrested for a. selling marijuana. b. growing marijuana. c. trafficking marijuana. d. possessing marijuana. 7. Voth states that the increase in drug use in the 1990s was due to a. the increased availability of drugs. b. the reduced cost of drugs. c. more musicians using drugs. d. complacency and the lack of federal funding for antidrug programs. 8. According to Voth, cities and states that adopted permissive drug policies a. experienced a decrease in drug use. b. experienced an increase in drug use. c. experienced neither an increase nor a decrease in drug use. d. have not determined whether drug use increased or decreased. Essay Questions 9. Some say that drug laws infringe on peoples' rights to dictate their own behavior. Should people be free to engage in behaviors, like drug use, as long as they do not infringe on the rights of others? Explain. 10. Based on the selections by Nadelmann and Voth, do you believe that the benefits of drug legalization outweigh the disadvantages? If you favor drug legalization, what restrictions would you place on its use? Explain your answers. 11. Both Nadelmann and Voth make analogies to the legalization of alcohol and tobacco, although they arrive at different conclusions. Do you feel that such analogies are useful when debating the merits of drug legalization? Why, or why not? Answers 1.c 2.a 3.d 4.a 5.b 6.d 7.d 8.b ISSUE 2 Should the United States Put More Emphasis on Stopping the Importation of Drugs? YES: Barry R. McCaffrey, from The National Drug Control Strategy: 2001 Annual Report (January 2001) NO: Mathea Falco, from "U.S. Drug Policy: Addicted to Failure," Foreign Policy (Spring 1996) Synopsis Barry R. McCaffrey, former director of the Office of National Drug Control Policy, argues that the importation of drugs must be stopped to reduce drug use and abuse. If the supply of drugs being trafficked across American borders is reduced, then there will be fewer drug-related problems. He maintains that a coordinated international effort is needed to combat the increased production of heroin, cocaine, and marijuana. Mathea Falco, president of Drug Strategies, a nonprofit policy institute, asserts that the emphasis should not be on curtailing the availability of drugs but on factors that contribute to Americans' use of drugs. She contends that blaming other countries for drug-related problems in the United States is one way for politicians to deflect criticism from themselves. Moreover, she argues, people involved in the drug trade in other countries have little incentive to end their involvement. Discussing the Issue Drug use has increased since the beginning of the 1990s, although there has been a slight decrease since 1997. Whether or not drug interdiction has been beneficial in slowing the flow of drugs into the United States is debatable. Drugs are crossing U.S. borders at record levels. This can be viewed as a signal that international efforts to stop the production and trafficking of drugs should be strengthened, or it can epitomize the inadequacy of the current strategy to stop the importation of drugs. Thus, should the federal government seek to improve and buttress current measures or try a new approach altogether? McCaffrey maintains that the United States should persist in its funding of foreign governments to combat drugs. He insists that the United States cannot afford to isolate itself from the rest of the world. Falco argues that funds allocated to some foreign governments are wasteful and that economic factors within these foreign countries have more impact on drug production than U.S. efforts. It can be argued that rather than attempting to limit illegal drugs from coming into the United States, more energy needs to be directed at reducing the demand for drugs and improving treatment for drug abusers. Drug dealers in foreign countries would not produce and smuggle drugs like heroin and cocaine into the United States if there was no market for them. Some people maintain that money would be better spent if it was aimed at the social and economic conditions underlying domestic drug problems and that we should not be interfering with foreign governments. On the other hand, some government officials feel that not only should drug users and sellers be prosecuted, but other countries should assist in helping to stem the flow of drugs. To reduce the supply of drugs, international cooperation is necessary. In South American countries like Peru, Colombia, and Bolivia, where coca plants are prevalent, economic assistance is offered to help the governments of these countries fight the cocaine kingpins. One alleged problem is that many government officials in these countries are corrupt or afraid of the cocaine cartel leaders. One program involves giving money to farmers to plant other types of crops, but this type of program can be limited. There has been a huge increase in opium production in many republics that had previously been part of the Soviet Union. These republics are in desperate need of money, and one source of income is opium production. There is little enforcement by police officials in these republics. Some critics believe that even when drug interdiction is successful, drug use is not deterred because users simply use other drugs. Also, if drugs are scarce, their costs escalate. This results in the drug business becoming more lucrative for sellers, who go unarrested. As profits expand, drug-related violence goes up. Some critics question whether or not this is a legitimate reason to retreat from the drug problem. Others feel that drugs morally corrupt people and that their use should be stopped at any cost. This is the approach currently being pursued by federal government officials. Although some money is appropriated for drug treatment and education, the bulk of the funds to tackle the war on drugs is used for prosecution, enforcement, and interdiction. McCaffrey feels that international cooperation is necessary to halt the stream of drugs. Falco believes that an international approach to dealing with the drug dilemma averts attention from the real problems caused by drug abuse. Testing on the Issue Web Questions 1. According to Barry R. McCaffrey, who believes that the United States should put more emphasis on stopping the importation of drugs, the region that results in the greatest amount of drugs coming into the United States is the a. U.S.-Mexican border. b. U.S.-Canadian border. c. flights coming into airports in Florida. d. flights coming into New York-Newark airports. 2. Mathea Falco, who does not believe that the United States should put more emphasis on stopping the importation of drugs, thinks the solution to the war on drugs is to a. reduce the supply of drugs entering the United States. b. reduce the demand for drugs. c. increase penalties for people using drugs. d. build more prisons for drug users. Multiple-Choice Questions 3. In recent years, the part of the world that has emerged as the primary supplier of heroin to the United States is a. Southeast Asia. b. Western Europe. c. Latin America. d. Canada. 4. The country that produces the most heroin is a. Russia. b. Colombia. c. Mexico. d. Afghanistan. 5. Since the 1980s, when funds allocated for drug intervention increased substantially, the cost and availability of heroin and cocaine have a. decreased greatly. b. decreased slightly. c. increased. d. stayed about the same. 6. According to McCaffrey, from 1999 to 2000, drug seizures by U.S. Customs Service a. neither increased nor decreased. b. increased by 10 percent. c. decreased by 10 percent. d. decreased by 25 percent. 7. To reduce drug-related problems, Falco feels that the U.S. government should spend more money on a. treatment and prevention. b. crop eradication. c. closing off U.S. borders. d. putting drug users in jail. 8. Falco says that drug prevention programs a. have been shown to be ineffective. b. are a waste of money. c. have had no impact on drug use. d. significantly reduce the number of teenagers using drugs. Essay Questions 9. Some people see the drug problem in the United States as a national problem, while others view it as an international problem. Do you think that the drug problem is a national or international problem? Support your answer with evidence from the selections. 10. McCaffrey argues that international cooperation is necessary to stem the flow of drugs entering the United States. Based on McCaffrey's views, describe the components of this collaborative effort that are needed to achieve this goal. 11. Falco contends that the war on drugs has been unproductive and that attempts to reduce the supply of drugs have been ineffective. List and discuss Falco's reasons for concluding that the U.S. foreign drug policy has failed. Answers 1.a 2.b 3.c 4.d 5.c 6.b 7.a 8.d ISSUE 3 Will a Lower Blood Alcohol Level for Drunk Driving Reduce Automobile Accidents? YES: Ralph W. Hingson, Timothy Heeren, and Michael R. Winter, from "Preventing Impaired Driving," Alcohol Research & Health (Winter 1999) NO: General Accounting Office, from "How Effective Are `.08' Drunk-Driving Laws?" Consumers' Research (August 1999) Synopsis Ralph W. Hingson, Timothy Heeren, and Michael R. Winter, of the Boston University School of Public Health, support lowering the legal limit for drunk driving. They note that many states have had fewer alcohol-related automobile accidents after lowering the blood alcohol level for drunk driving. In addition, they contend that drivers are impaired with a relatively small amount of alcohol in their bloodstream. The General Accounting Office (GAO) states that the evidence supporting the beneficial effects of establishing a lower blood alcohol level for drunk driving is inconclusive. The GAO maintains that the government's methods for determining the effectiveness of instituting a lower blood alcohol level are faulty. Also, rates for drunk driving declined regardless of changes in the legal limits for blood alcohol level. Discussing the Issue Because thousands of people die as a result of their own or others' driving under the influence of alcohol, there is justifiable concern with regard to this matter. There is little disagreement that the issue needs to be addressed because too many people die needlessly from someone else's poor judgment. But the statistics of fatalities from alcohol-impaired drivers are not all bad. Beginning in the 1980s, the number of alcohol-related driving fatalities dropped considerably. Approximately 26,000 people died each year in the early 1980s from someone driving under the influence of alcohol. In 2000, the number of people killed from automobile accidents on American highways because of drunk drivers was just under 16,000. This number represents a significant decline. Absent from this figure are the thousands of people who were killed by drivers who may have been under the influence of alcohol but who were not legally drunk at the time of the accident. A driver can be impaired but not intoxicated. Many studies have shown that driving ability is impaired with a blood alcohol concentration as low as .04. Rather than focus attention only on a blood alcohol concentration (BAC) standard for drunk driving, it may be more fruitful to work on preventing any driving after alcohol has been consumed. Many people may not pay attention to how much alcohol they drink, forget how much they consume, or think they are not too impaired to drive. One aspect of this issue deals with the role of the federal government. U.S. senators have debated whether or not there should be a federal law establishing a .08 BAC for drunk driving. Part of the issue is not whether or not a lower standard is desirable but who should be responsible for its implementation. The proposal before Congress is that states will lose a percentage of highway funds if they fail to adopt a .08 BAC. This type of action occurred in the early 1980s when President Ronald Reagan threatened to withdraw highway funds from states that did not implement a drinking age of 21. Similar to the current issue, that issue raised the question: Should the federal government dictate to individual states what is an acceptable BAC standard? Is the role of government to provide data in order to allow states to make informed decisions? Testing on the Issue Web Questions 1. Ralph W. Hingson, Timothy Heeren, and Michael R. Winter, who believe that a lower blood alcohol level for drunk driving will reduce automobile accidents, found that driving ability can be impaired with a blood alcohol concentration (BAC) of a. .02 percent. b. .05 percent. c. .08 percent. d. .10 percent. 2. The General Accounting Office (GAO), which does not believe that a lower blood alcohol level for drunk driving will reduce automobile accidents, questions the value of a .08 BAC because a. some people drive more carefully after drinking alcohol. b. such a law would be unenforceable. c. there is insufficient research showing that driving is impaired at .08. d. tests to measure how much alcohol is in one's blood are inaccurate. Multiple-Choice Questions 3. In most states the legal BAC limit is a. .05. b. .08. c. .10. d. .15. 4. The country that has established .02 as its legal BAC limit is a. Canada. b. Sweden. c. Ireland. d. Germany. 5. In 1997 the majority of drivers killed in traffic crashes who tested positive for alcohol had a BAC of __________ or higher. a. .02 percent b. .05 percent c. .08 percent d. .15 percent 6. Since the 1980s the rate of alcohol-related traffic fatalities has a. stayed about the same. b. increased greatly. c. increased slightly. d. decreased. 7. In 1997 the number of people who died because of drunk driving was approximately a. 10,000. b. 12,000. c. 16,000. d. 26,000. 8. The GAO argues that it would support a lower BAC level for drunk driving if a. there was more emphasis on education and prevention also. b. public transportation was improved. c. the legal drinking age was lowered to 18. d. none of the above Essay Questions 9. Do you feel that the federal government should impose a national blood alcohol level for drunk driving? What are the implications of passing such a law? 10. Besides lowering the blood alcohol level for drunk driving, what other measures can be implemented to reduce the number of people who are killed by drunk drivers? 11. One aspect of the proposed law governing drunk driving is to withhold federal highway money from states that do not adopt a .08 blood alcohol level. Do you feel that the federal government is justified in withholding highway funds? If not, what penalties, if any, do you feel would be appropriate? Answers 1.a 2.c 3.c 4.b 5.d 6.d 7.c 8.a ISSUE 4 Should Needle Exchange Programs Be Supported? YES: David Vlahov and Benjamin Junge, from "The Role of Needle Exchange Programs in HIV Prevention," Public Health Reports (June 1998) NO: Office of National Drug Control Policy, from "Needle Exchange Programs: Are They Effective?" ONDCP Bulletin No. 7 (July 1992) Synopsis In their review of various studies, professor of epidemiology and medicine David Vlahov and Benjamin Junge, evaluation director for the Baltimore Needle Exchange Program, found that needle exchange programs successfully reduced the transmission of the virus that causes AIDS. In addition, many people who participated in needle exchange programs reduced their drug use and sought drug abuse treatment. The Office of National Drug Control Policy, an executive agency that determines policies and objectives for the U.S. drug control program, sees needle exchange programs as an admission of defeat and a retreat from the ongoing battle against drug use, and it argues that compassion and treatment are needed, not needles. Discussing the Issue The second leading cause of AIDS in the United States is drug injection. Both selections acknowledge that the spread of AIDS is a monumental problem and that injecting drugs is a major factor in the disease; however, the authors disagree on the best course of action to prevent people from injecting drugs and reduce the transmission of AIDS. Is it better to set up more drug treatment facilities or to induce people who inject drugs either to exchange or to clean their needles? Needle exchange programs generate a number of legal questions. For example, because it is illegal to use heroin and cocaine, it can be argued that giving needles to people for the purpose of injecting these drugs contributes to illegal behavior. Opponents of needle exchange programs are concerned that these programs send the wrong message and encourage drug use. Also, if such programs are implemented, who should organize and finance them? Should the government be in charge? Should public funds be used? This issue leads to a related question: Should drug addicts be considered criminals or victims who need compassion? Should they be incarcerated or treated? Because the majority of drug users involved in needle exchange programs are members of minority groups, it has been argued that needle exchange programs promote the continuation of drug use and the enslavement of minorities, rather than providing healthier alternatives to drug use. It is doubtful that needle exchange programs will prevent drug addicts from sharing needles, since needle sharing is part of the drug culture. Also, even though clean needles are available, this does not necessarily mean that drug addicts will use them. Do students feel that needle exchange programs fail to attack the underlying problems that cause people to become drug addicts in the first place? Testing on the Issue Web Questions 1. According to David Vlahov and Benjamin Junge, who believe that needle exchange programs should be supported, the first federally funded needle exchange program, in New Haven, Connecticut, decreased the incidence of HIV injection by a. 5 percent. b. 12 percent. c. 20 percent. d. 33 percent. 2. According to the Office of National Drug Control Policy (ONDCP), which does not believe that needle exchange programs should be supported, illegal drug use by Americans in the 1980s a. increased. b. decreased. c. stayed about the same. d. did not affect the incidence of AIDS. Multiple-Choice Questions 3. In comparison to Australia and Great Britain, the United States has a. fewer needle exchange programs. b. about the same number of needle exchange programs. c. twice as many needle exchange programs. d. three times as many needle exchange programs. 4. Vhalov and Junge report that needle exchange programs have resulted in a. more people experimenting with drugs. b. more discarded needles being found in streets. c. an overall reduction in needle sharing. d. a decrease in HIV but an increase in rates of hepatitis. 5. With regard to funding needle exchange programs, the federal government a. gives money only to federally funded hospitals. b. funds all programs that have proven to be effective. c. allocates no money for any needle exchange programs. d. only funds programs located in poor neighborhoods. 6. AIDS is spread among drug users through the sharing of a. hypodermic syringes, or needles. b. cotton that was contaminated with the AIDS virus. c. water that was contaminated with the AIDS virus. d. all of the above 7. According to the ONDCP, needle exchange programs a. may violate the law in many states and jurisdictions. b. should be funded by community social agencies. c. are a good way to reduce the incidence of AIDS. d. should be financed through state and local governments. 8. According to the ONDCP, addicts can purchase clean needles cheaply but a. often fail to do so. b. only through federally approved pharmacists. c. only once they are proven to be addicted to drugs. d. only after they have entered a drug treatment program. Essay Questions 9. If people inject dangerous drugs into their bodies and know the risks associated with this behavior, then they should live (or die) with the consequences of their actions. Do you agree with this statement? Why, or why not? 10. The ONDCP contends that there are nine significant problems with research regarding needle exchange programs. Name four of them. What are they? How might these problems be addressed? 11. The ONDCP proposes three alternatives to needle exchange. What are the pros and cons of each of these alternatives? Do you support these alternatives over needle exchange programs? Defend your answer. Answers 1.d 2.b 3.a 4.c 5.c 6.d 7.a 8.a ISSUE 5 Should Pregnant Drug Users Be Prosecuted? YES: Paul A. Logli, from "Drugs in the Womb: The Newest Battlefield in the War on Drugs," Criminal Justice Ethics (Winter/Spring 1990) NO: Drew Humphries, from Crack Mothers: Pregnancy, Drugs, and the Media (Ohio State University Press, 1999) Synopsis Paul A. Logli, an Illinois prosecuting attorney, argues that it is the government's duty to enforce every child's right to begin life with a healthy, drug-free mind and body. Logli maintains that pregnant women who use drugs should be prosecuted because they may harm the life of their unborn children. He feels that it is the state's responsibility to ensure that every baby is born as healthy as possible. Researcher Drew Humphries argues that the prosecution of women who use drugs while pregnant has resulted from overzealous efforts on the part of a handful of state prosecutors. Humphries asserts that the prosecution of pregnant drug users is unfair because poor women are more likely to be the targets of such prosecution and that these cases do not hold up to legal standards. Discussing the Issue The effects of drug exposure on a fetus can be mild and temporary or very severe and permanent depending on the type of substance used, the stage of fetal development when the drug crosses the placental barrier and enters the bloodstream of the fetus, and the frequency of drug use by the mother. Exposure of the fetus to drugs and the long-term involuntary physical, emotional, and intellectual effects are troublesome. In addition, the social, medical, and economic costs to treat and care for babies born exposed or addicted to drugs while in utero warrant serious concern. Is the issue of what to do about pregnant drug users a legal problem or a medical problem? Should pregnant women be prosecuted like other criminals, or should they be afforded proper medical attention and drug treatment for the sake of their health and the health of their infants? Those who profess that it is necessary to prosecute pregnant drug users insist that it is the role of the legal system to deter pregnant women from future criminal drug use and to protect the best interests of the infant. But will prosecution result in more or less protection for the fetus? If the mother stops using drugs for fear of prosecution, then the fetus benefits. If the mother avoids prenatal care because of potential legal punishment, then the fetus suffers. Some argue that prosecuting pregnant drug users is discriminatory; paternal drug use may also harm the fetus. Should fathers be held responsible? Also, it has been argued that removing the child from the custody of its mother at birth may be more detrimental to the child in the long run. Do students agree with this assertion? Legal drugs like alcohol and nicotine--as well as illegal drugs like cocaine, crack, and marijuana--are increasingly responsible for incidents of premature births, congenital abnormalities, fetal alcohol syndrome, mental retardation, and serious birth defects. If students agree that women should be prosecuted for using illegal drugs during pregnancy because they are harming the fetus, then should women who smoke cigarettes and drink alcohol be prosecuted also? Testing on the Issue Web Questions 1. Paul A. Logli, who believes that pregnant drug users should be prosecuted, uses the term cocaine babies to refer to children a. who are addicted at birth to narcotic substances or otherwise affected by maternal drug use during pregnancy. b. who are addicted at birth to cocaine only. c. whose mothers leave cocaine around the house. d. who are abandoned at the hospital by their addicted mothers. 2. Drew Humphries, who does not believe that pregnant drug users should be prosecuted, contends that many cases against these women are motivated by a. a desire to help the woman and her fetus. b. a desire to lower taxes since these babies have many long-term health problems. c. a strong sense of indignation that pregnant women would use drugs. d. political aspirations. Multiple-Choice Questions 3. Women who are most likely to be prosecuted for using drugs while pregnant are a. low-income women of color. b. middle-class white women. c. professional women, such as physicians and attorneys. d. women living in the Northeast. 4. Logli uses the term boarder babies to refer to children a. whose blood tests are borderline for cocaine addiction. b. who are abandoned at the hospital by their addicted mothers. c. whose mothers have borderline personalities as a result of their drug addiction. d. whose mothers get their cocaine from Mexico. 5. According to Logli, a child has a legal right to a. be given cocaine at birth, which will be tapered off gradually to ease withdrawal from the drug. b. "divorce" his or her parents if he or she is addicted to drugs. c. begin life with a sound mind and body. d. use cocaine if that is what he or she chooses. 6. Logli states that the legal issue of "right to privacy" a. provides an exception to prosecution of those who use or possess narcotics if they are pregnant. b. means a woman can take drugs if she desires regardless of her pregnancy status. c. has never formed an absolute barrier against state prosecutions of those who use or possess narcotics. d. has been changed as a result of the recent overturning of the Roe v. Wade decision. 7. According to Humphries, the drug that was responsible for initiating many of the cases against pregnant drug users was a. heroin. b. crack. c. LSD. d. ecstasy. 8. Humphries indicates that the cases against pregnant drug-using women failed because a. it could not be proved that the drugs caused harm to the fetus. b. the fetus does not have the same legal rights as a person who is already born. c. tests proving these women used drugs were inaccurate. d. juries were sympathetic toward these women. Essay Questions 9. Consider whether prosecuting pregnant drug users is a legal problem or a medical problem. In your opinion, should these women be prosecuted as criminals, or should they be afforded medical attention and drug treatment? Defend your answer. 10. If the law dictated that pregnant drug users were to be prosecuted for their actions, do you think that this should apply not only to illegal drugs but also to legal drugs such as alcohol and nicotine? Why, or why not? 11. It has been stated that the root of drug abuse among pregnant women lies with social conditions like poverty, inadequate health care, and poor education. Do you think that poor social conditions is a reason or an excuse for drug abuse? Explain your answer. Answers 1.a 2.d 3.a 4.b 5.c 6.c 7.b 8.b ISSUE 6 Is Drug Addiction a Choice? YES: Jeffrey A. Schaler, from Addiction Is a Choice (Open Court, 2000) NO: Alice M. Young, from "Addictive Drugs and the Brain," National Forum (Fall 1999) Synopsis Psychotherapist Jeffrey A. Schaler maintains that drug addiction should not be considered a disease, a condition over which one has no control. Schaler states that diseases have distinct characteristics and that drug addiction does not share these characteristics. Classifying behavior as socially unacceptable does not prove that it is a disease, according to Schaler. Professor of psychology Alice M. Young points out that a small number of drugs produce pleasurable sensations in the brain, increasing the likelihood that drug-taking behavior will be repeated. In addition, tolerance and dependency may result when drugs are taken frequently. If tolerance develops, then the drug user must increase the dosage level to achieve the desired effect, increasing the possibility of dependency. Discussing the Issue A fundamental issue is whether drug addiction is caused by an illness or by an inappropriate behavioral pattern. Whether drug addiction is the result of a disease over which we have no control or the result of behaviors over which we can exert control is extremely important because it has legal and medical implications. Should people be held legally accountable for behaviors that stem from an illness? If a person cannot help being an alcoholic and hurts someone as a result of being drunk, should the person be treated or incarcerated? If one's addiction is due to loss of control rather than to a disease, should taxpayer money go to pay for that person's treatment? It can be argued that the disease concept of drug addiction legitimizes or excuses behaviors. If addiction is an illness, then blame can be shifted to the disease and not the person's behavior. Are maladaptive behaviors symptoms of the disease? Should people be held legally accountable or blamed for conditions over which they have no control? Moreover, if drug addiction is incurable, can people be responsible for their behavior? Others argue that addicts cannot exert control over their lives. Addiction, whether it is to drugs, sex, food, exercising, gambling, or shopping, is a way of life, they say. It is a cycle, an obsession that cannot be broken. Moreover, addiction cannot be broken because it offers addicts the illusion of fulfillment; drug addiction provides relief. Addicts also have the mistaken belief that drugs help them. Further, drug addicts develop a relationship with drugs, and overcoming drug addiction is beyond the capabilities of drug addicts. Many argue that outside intervention is necessary since addicts lack the requisite skills to help themselves. An important step for addicts to receive and benefit from treatment is for them to admit that they are powerless over their addiction. They need to acknowledge that their drug addiction controls them and that addiction is a lifelong problem. The implication of this view is that addicts are never cured. Addicts must abstain from drugs for their entire lives. This view contradicts the idea that drug addicts can control their use of drugs. In essence, do drugs cause addiction, or are there other factors that cause addiction? How much control do drug addicts have over their use of drugs? Testing on the Issue Web Questions 1. According to Jeffrey A. Schaler, who believes that drug addiction is a choice, most drug treatment specialists believe that drug addiction a. stems from a lack of desire to stop taking drugs. b. is a disease. c. is caused by being raised in a single-parent household. d. arises from being raised in poverty. 2. Alice M. Young, who does not believe that drug addiction is a choice, contends that one becomes a drug addict by a. being labelled deviant as a youth. b. being rejected by one's parents during one's formative years. c. trying to live up to unrealistic expectations from parents, teachers, and oneself. d. a combination of psychological and biological factors. Multiple-Choice Questions 3. The federal government classifies alcohol addiction as a. a disease. b. an unfortunate behavior. c. a failure in our educational system. d. a moral weakness. 4. Chemicals in the brain that determine whether or not drugs are addictive are called a. synapses. b. euphoriants. c. stimulators. d. neurotransmitters. 5. According to Schaler, many behaviors, such as excessive shopping, videogame playing, and alcohol use, are called diseases because a. one is genetically predisposed to these behaviors. b. certain chemicals in the brain are stimulated when people engage in these behaviors. c. they are socially unacceptable behaviors. d. scientific research demonstrates these behaviors to be diseases. 6. Schaler maintains that people stop using heroin and cocaine because a. they find no meaning in using these substances. b. they fear going to jail. c. they can no longer afford to buy these drugs. d. their physicians tell them to stop. 7. According to Young, drug users repeat their behavior because a. of boredom. b. drugs produce some type of pleasurable response. c. it helps them avoid unpleasant memories. d. they derive spiritual fulfillment through drugs. 8. Young contends that drug addiction is affected by a. biological or genetic vulnerability. b. the setting and one's expectations when taking drugs. c. stress in one's life. d. all of the above Essay Questions 9. Young refers to animal studies to support her position on drug addiction. Describe the benefits and limitations of using animal studies. 10. Do you believe that drug addicts are always in control of their addictions? Which author, Schaler or Young, provides a more persuasive argument, and why? 11. Schaler maintains that drug addiction is a matter of free will, while Young asserts that it is a disease. What are the advantages and disadvantages to both of these viewpoints? Answers 1.b 2.d 3.a 4.d 5.c 6.a 7.b 8.d ISSUE 7 Is Harm Reduction a Desirable National Drug Control Policy Goal? YES: Robert J. MacCoun, from "Toward a Psychology of Harm Reduction," American Psychologist (November 1998) NO: Grazyna Zajdow, from "Harm Reduction for Whom?" Arena Magazine (April 1999) Synopsis Robert J. MacCoun, an associate professor in the Graduate School of Public Policy at the University of California, Berkeley, supports efforts to minimize problems associated with drugs. He states that a harm reduction approach will not resolve all drug problems, but he feels that reducing those problems is a desirable goal. Sociology professor Grazyna Zajdow questions a policy that strives to reduce the harm of drugs. She maintains that drug use will remain a serious health problem regardless of whether or not harm reduction is the goal. Zajdow contends that using methadone to help heroin addicts overcome their addiction is merely the replacement of one addiction for another. Discussing the Issue Millions of Americans have used tobacco, alcohol, cocaine, marijuana, solvents, and heroin. The question is not whether or not drug use is detrimental to the individual or even if drug use is the cause of many problems seen in society. Rather, one needs to ask: What approach is most likely to limit or reduce problems resulting from drug use? Is it more desirable to teach people how to use drugs in order to reduce or minimize their personal and social hazards, or is it more desirable to strive for abstinence and limit access to drugs? Two approaches that can be taken to address drug use are "harm reduction" and "supply reduction." The harm reduction approach tries to reduce the hazards of drug use. That is, since millions of people take drugs, and many will continue to take drugs regardless of legal prohibitions, they need to be taught how to lessen the problems associated with their use. Harm reduction attempts to curtail drug-related problems while also trying to diminish drug use. Advocates point out that current restrictive policies that focus on reducing the supply of drugs by stressing drug enforcement, prosecution, and interdiction have been ineffective. Goals of harm reduction include reducing violence related to the drug trade, lowering death rates directly attributable to drugs, reducing infectious diseases caused by drug use, and preventing the ravages of drugs from affecting family members. Another benefit may be economical in that less money would go for enforcement and prosecution, although more funds would be needed for drug prevention and treatment. Opponents of the harm reduction approach argue that society would benefit more by improving and expanding enforcement of existing drug laws and that a harm reduction approach may result in greater drug use and more people seeking drug treatment. They maintain that stiff drug laws act as important deterrents to drug use. They accuse harm reduction advocates of hypocrisy because at the same time they are calling for more stringent policies regarding tobacco advertising, smoking restrictions, and driving while under the influence of alcohol, they are also calling for a reduction in the penalties for illegal drug use. Drug prohibition proponents state that after decriminalization of marijuana in the Netherlands, there was an increase in shootings, robberies, and car thefts as well as a rise in rates of drug addiction. Even if the evidence clearly demonstrated that decriminalization of marijuana in the Netherlands had beneficial effects there, would it mean that marijuana decriminalization in the United States would have the same effect? Ask students to debate this question. Testing on the Issue Web Questions 1. Robert J. MacCoun, who believes that harm reduction is a desirable national drug policy goal, maintains that harsh drug enforcement policies a. need to become even more harsh. b. are a source of many drug-related harms. c. have virtually eliminated illegal drug use. d. have had very little impact on the harms caused by the drug trade. 2. Grazyna Zajdow, who does not believe that harm reduction is a desirable national drug policy goal, indicates that people who argue on behalf of harm reduction maintain that drug abuse is a a. legal problem. b. social problem. c. political problem. d. health problem. Multiple-Choice Questions 3. Methadone a. was developed in San Francisco to treat diabetes. b. is a permanent cure for heroin addiction. c. is addicting. d. is used for cocaine addiction. 4. General harm reduction goals include all of the following except a. reducing the number of infants affected by drugs by testing all pregnant women. b. reducing the violence related to drug distribution. c. reducing the prevalence of infectious diseases among drug dependent individuals. d. distributing needles to drug dependent individuals to stem the rise in the human immunodeficiency virus (HIV). 5. In essence, MacCoun says that the federal government's "war on drugs" focuses primarily on a. treatment. b. prevention. c. law enforcement. d. education. 6. In promoting harm reduction, MacCoun is attempting to a. eliminate all illegal drug use. b. legalize drugs that are currently illegal. c. increase enforcement of existing drug laws. d. minimize drug-related problems. 7. Zajdow's doubts with regard to the effectiveness of the harm reduction approach are based on a. the lack of evidence that it is effective. b. her visits to families of drug abusers. c. the increasing number of people who are arrested for drug possession. d. all of the above 8. Zajdow asserts that methadone maintenance programs have a. reduced deaths from heroin by 25 percent. b. experienced an increase in deaths as methadone availability increases. c. reduced violence associated with heroin use. d. eliminated heroin use for those in the programs. Essay Questions 9. It is known that legal drugs like alcohol and tobacco kill more people than illegal drugs. Can a harm reduction approach be used to minimize the problems of alcohol and tobacco? Do you feel that applying a harm reduction approach to alcohol and tobacco would affect the use of illegal drugs? Explain. 10. The Netherlands is often used as a model to illustrate the effects of making drug laws more liberal. Do you feel that it is appropriate to use the experiences of other countries as a basis for drug policies in the United States? Why, or why not? 11. MacCoun feels that the harm reduction approach reduces the problems associated with drugs while Zajdow feels that this approach has been ineffective. Which of the two positions do you support, and why? Answers 1.b 2.d 3.c 4.a 5.c 6.d 7.a 8.b Smoking From All Sides http://smokingsides.com This site contains links about all perspectives of smoking. Links include smoking cessation, smoking glamour, tobacco history, prosmoking documents, and statistics. The Medical Marijuana Arguments Page (Pro and Con) http://www.cheeo.com/medical_marijuana.htm This site provides dozens of links to sites on both sides of the medical marijuana debate. How Caffeine Works http://www.howstuffworks.com/caffeine.htm This HowStuffWorks page was written by Marshall Brain, the founder, chairman, and CEO of HowStuffWorks. In it, Brain discusses what caffeine is, how caffeine affects the body, caffeine in the diet, and more. This site includes links to related articles and books. Ritalin Links http://www.scn.org/~bk269/rball_links.html This site contains a wealth of links on Ritalin and the Ritalin controversy, including laws against school system Ritalin abuse, attention deficit disorder (ADD) information, and alternative remedies to Ritalin. EthicAd http://www.ethicad.org EthicAd is an independent, nonprofit organization dedicated to helping the consumer, the health care professional, and the pharmaceutical and advertising industry in the area of direct-to-consumer (DTC) advertising for prescription drugs. ISSUE 8 Are the Adverse Effects of Smoking Exaggerated? YES: Stephen Goode, from "Cato's Levy Challenges Federal Tobacco Myths," Insight on the News (January 31, 2000) NO: World Health Organization, from The World Health Report 1999: Making a Difference (1999) Synopsis Author Stephen Goode interviews Robert Levy, of the Cato Institute, who maintains that government statistics distort and exaggerate the dangers of cigarette smoking. Levy argues that smokers are less likely to eat nutritional meals or exercise and that many are poor and uneducated. Thus, factors besides smoking may contribute to the poor health and decreased longevity of many tobacco users. The World Health Organization's report on the increase in smoking delineates the health and economic expense of tobacco use throughout the world. The report indicates that one barrier to stemming smoking is a lack of information about the risks of tobacco use. The report also states that tobacco is addictive and that tobacco manufacturers are expanding because of the tremendous profits they make. Discussing the Issue Because many people, including the World Health Organization (WHO), maintain that tobacco is addictive and threatens the health of people, there is a call to have far more restrictions on it. If, however, the dangers of cigarette smoking are exaggerated, then the restrictions on tobacco products may be unwarranted. The current restrictions on tobacco products include the following: cigarette packages must include warning labels describing the adverse effects of tobacco; tobacco products cannot be advertised on television or radio; and laws curbing young people from buying tobacco products are enforced. In the meantime, the Food and Drug Administration (FDA) believes that there should be even tighter enforcement. Tobacco proponents note that some people derive benefits from nicotine. Tobacco was used to ward off many ailments and misfortune in previous centuries. Nicotine provides a sense of euphoria and allays anxiety and stress in some people. Some smokers use nicotine to lose weight because it reduces appetite and increases metabolic activity. Others feel that cigarettes help them to concentrate better. Tobacco critics maintain that the consequences outweigh the benefits. They state that tobacco accounts for about 30 percent of deaths for people between ages 35 and 69; that it is the principal cause of premature death within the developed world; that the link between cigarette smoking and cardiovascular disease is well documented; that as few as one to four cigarettes daily increases the risk of fatal coronary heart disease; that cigarettes reduce blood flow and high density lipoprotein cholesterol; that more than 85 percent of lung cancer cases and 30 percent of all cancer deaths have been tied to smoking; that the risk of cancer is twice as great for smokers as nonsmokers; and that tens of thousands of people die from pulmonary diseases like pneumonia, chronic airway obstruction, bronchitis, and emphysema each year. According to attorney Robert Levy, the government's statistics distort and exaggerate the dangers of smoking. Even if smoking is harmful and smokers recognize its dangers, should they not be permitted to smoke if they wish? Critics claim that the FDA and politicians are trying to infringe on the rights of smokers. Conversely, due to nicotine's addictive properties, tobacco critics assert that smokers do not have the capacity to end their detrimental behavior. Economics is part of the tobacco debate. Taxpayers financially assist smokers in need of medical assistance due to their tobacco use. Taxes on tobacco are considerable, but several billion dollars are paid every year for Medicaid costs resulting from smoking-related illnesses. Thousands of people work in the tobacco industry, and what would be done to help these people whose livelihoods would be impacted by greater restrictions on the tobacco industry? Testing on the Issue Web Questions 1. According to Stephen Goode, who believes that the adverse effects of smoking are exaggerated, the government's statistics demonstrating the dangers of smoking are a. distorted by sampling errors, bias, and compounding variables. b. accurate, but the government uses terms that make the dangers seem worse than they are. c. simply made up. d. based on data going back to the 1950s. 2. The World Health Organization (WHO), which does not believe that the adverse effects of smoking are exaggerated, estimates that the number of people in the world who will die from smoking by 2030 is a. 500,000. b. 1,000,000. c. 5,000,000. d. 10,000,000. Multiple-Choice Questions 3. The most common cause of cancer death among women is a. breast cancer. b. lung cancer. c. cervical cancer. d. brain cancer. 4. The country with the highest number of tobacco deaths is a. the United States. b. France. c. China. d. Colombia. 5. Goode contends that smokers have a higher mortality than nonsmokers because smokers a. drink more coffee than nonsmokers. b. tend to have a lower socioeconomic status. c. are more genetically exposed to cancer than nonsmokers. d. care less about living longer lives than nonsmokers. 6. The relative risk of smoking for many types of heart disease, states Goode, is less than a. 2 to 1. b. 4 to 1. c. 8 to 1. d. 10 to 1. 7. Goode cites the average age of death for smokers as a. 59. b. 62. c. 65. d. 72. 8. The WHO states that ______ percent of lung cancer deaths can be attributed to smoking. a. 25 b. 50 c. 75 d. 90 Essay Questions 9. Do you feel that tobacco products should be limited? If so, what types of limits would you implement? If not, why not? 10. Do you think that people should be free to choose whatever behaviors they wish to indulge in even if those behaviors are harmful? Explain your answer. 11. Should the federal government deny people the right to smoke or simply educate people about tobacco's effects? Use arguments made by Goode and the WHO to support your response. Answers 1.a 2.d 3.b 4.c 5.b 6.a 7.d 8.d ISSUE 9 Should Marijuana Be Legal for Medicinal Purposes? YES: Lester Grinspoon, from "Whither Medical Marijuana?" Contemporary Drug Problems (Spring 2000) NO: James R. McDonough, from "Marijuana on the Ballot," Policy Review (April/May 2000) Synopsis Professor of psychiatry Lester Grinspoon argues that anecdotal evidence indicates that marijuana has medical benefits for patients suffering from chemotherapy nausea, AIDS, glaucoma, chronic pain, epilepsy, and migraine headaches. He asserts that the federal government is prohibiting its use without justification. James R. McDonough, director of the Florida Office of Drug Control, agrees that compounds in marijuana, such as THC, may have the potential to be medically valuable. However, smoked marijuana has not been proven to be of medicinal value. In addition, states McDonough, there are existing, approved drugs that are more effective for conditions that may be helped by marijuana use. Discussing the Issue The debate over whether or not marijuana should be legalized for medical purposes raises numerous questions. Should physicians who advocate the use of marijuana for their patients be held responsible for promoting an illegal activity? Should physicians promote a medical treatment that they feel will alleviate pain and suffering in patients, even though such treatment violates the law? Should legislators (most of whom do not practice medicine) be allowed to enact legislation that determines what physicians can and cannot do when treating patients? The majority of voters in several states, including the District of Columbia, have passed referenda supporting the medical use of marijuana. Despite these referenda, federal laws take precedence over state laws. Therefore, laws against the medical use of marijuana can be enforced. Should the dictates of voters be ignored? The so-called scheduling of drugs is a key component in this issue. Marijuana is a Schedule I drug. A Schedule I drug is considered to be highly dangerous without any medical value. A Schedule II drug is viewed as a highly dangerous drug, but a drug that has legitimate medical value. The Drug Enforcement Administration's (DEA's) concern is that if marijuana is approved for medical use, and its scheduling changed, it may become more acceptable for nonmedical use. A discussion of Western medicine's practice of scientifically "proving" a substance's medical values should be pursued, especially with regard to the fact that many of the drugs that are currently legal for medical use do not have definitive proof of their curative powers. Do legislators have the best interest of constituents in mind when passing drug scheduling laws, or are they driven by a political agenda? Moreover, do patients have a right to choose treatments that they think will best suit their needs? Another consideration in the debate on legalizing marijuana for medical purposes is determining what is a valid medical application. Anecdotal evidence suggests that marijuana may help numerous conditions ranging from nausea and vomiting, to glaucoma, to migraine headaches. However, one concern is that many people may seek medicinal marijuana for lesser problems. Finally, another point that needs to be examined is the credentials of medical experts. Researchers who receive funds from pharmaceutical companies for research studies of marijuana, for example, may be less than forthcoming when reporting results. Testing on the Issue Web Questions 1. Lester Grinspoon, who believes that marijuana should be legal for medicinal purposes, argues that marijuana a. has very little toxicity. b. should be prescribed only for people with life-threatening illnesses. c. works as effectively as placebos. d. has not been proven safe or dangerous. 2. James R. McDonough, who does not believe that marijuana should be legal for medicinal purposes, opposes the medical use of marijuana because a. the evidence supporting its use is not scientific. b. he tried it and found the drug harmful. c. people may like the effects of the drug and use it for nonmedical purposes. d. it is addicting. Multiple-Choice Questions 3. At the current time, marijuana is listed as a a. Schedule I drug (no medical use and a high potential for abuse). b. Schedule II drug (high potential for abuse but has medical use). c. Schedule III drug (potential for abuse and has medical value). d. Schedule IV drug (low potential for abuse and has medical value). 4. Currently, federal marijuana laws state that the drug can be used legally to treat a. nausea and vomiting related to chemotherapy. b. glaucoma. c. multiple sclerosis. d. nothing. 5. Grinspoon reports that marijuana is useful for treating all of the following except a. osteoarthritis. b. glaucoma. c. leprosy. d. nausea and vomiting induced by chemotherapy. 6. If patients were to use marijuana for medical purposes, McDonough recommends that they use it a. in tobacco form. b. in pill form. c. while heavily sedated to prevent psychosis. d. only if they are terminally ill. 7. According to McDonough, support for the medical use of marijuana comes from the a. Food and Drug Administration (FDA). b. National Institutes of Health (NIH). c. National Institute on Drug Abuse (NIDA). d. none of the above 8. McDonough feels that legalizing marijuana for medical purposes is a bad idea because a. it is harmful. b. too many people would use it in place of more effective medicines. c. the government would not know how to regulate its sale and distribution. d. people would then ask to legalize LSD and other currently illegal drugs. Essay Questions 9. Many physicians recommend marijuana to chemotherapy patients to relieve nausea and vomiting. Yet patients cannot legally obtain marijuana. Should physicians be held responsible (and prosecuted) for promoting this type of illegal activity? 10. McDonough contends that much of the research with regard to the effectiveness of marijuana is anecdotal. How would you set up research to establish whether or not marijuana is effective for remedying various medical conditions? 11. One of the questions raised in the debate over legalizing marijuana for medicinal purposes is whether physicians should be driven by ethical/moral views or by the legal views of the state. How do you think Grinspoon and McDonough would respond to this question? Answers 1.a 2.a 3.a 4.d 5.c 6.b 7.d 8.a ISSUE 10 Should Doctors Promote Alcohol for Their Patients? YES: Stanton Peele, from "Should Physicians Recommend Alcohol to Their Patients? Yes," Priorities (vol. 8, no. 1, 1996) NO: Albert B. Lowenfels, from "Should Physicians Recommend Alcohol to Their Patients? No," Priorities (vol. 8, no. 1, 1996) Synopsis Psychologist Stanton Peele, an expert on alcoholism and addiction, asserts that physicians should recommend that their patients drink alcohol in moderate amounts. He maintains that numerous studies demonstrate the benefits of moderate alcohol use in reducing the risk of coronary heart disease, the leading cause of death in the United States. Albert B. Lowenfels, a professor at New York Medical College, contends that recommending moderate alcohol consumption is not prudent, especially since many people come from families with histories of alcohol abuse. He argues that it is inappropriate to extol the merits of moderate alcohol use to people who have abstained throughout their lives. Discussing the Issue Cardiovascular disease is the leading cause of death in the United States. There are many studies that describe how to limit the risk of heart disease. One area of concern is the role of alcohol in heart disease. Is it feasible that the likelihood of heart disease could be reduced through moderate alcohol consumption? The significance that alcohol plays in reducing the probability of heart disease and whether or not physicians should promote its use is the focus of this issue. Debates regarding alcohol's effects typically concern the consequences of heavy alcohol use for their patients. Alcoholism affects an estimated 10 to 20 million people. Alcohol abuse is often described as a national epidemic, posing a threat to all people in society. Thus, is it wise for physicians to promote moderate alcohol consumption even though such behavior may lessen the risk of heart disease? What is meant by moderate use of alcohol? To a social drinker, it may entail a few drinks per week. Moderation may be defined more broadly by an alcoholic. Moreover, how much alcohol is necessary to reduce the risk of heart disease? A number of studies indicate that two drinks per day for men and one drink per day for women are beneficial. Lowenfels raises doubts about the merit of promoting moderate alcohol consumption for people who have maintained a lifetime of sobriety. He agrees that the research extolling the benefits of moderate alcohol use is favorable for people who drink, but Lowenfels argues that no research supports the benefits of moderate alcohol use for abstainers. Some experts feel that the evidence showing the benefits of moderate alcohol use over abstinence is misleading because these studies are based on self-reports. Peele agrees that excessive alcohol use is potentially harmful, but he argues that it is reasonable for physicians to advocate moderate alcohol consumption. Peele contends that educators and public health officials are preoccupied with the detrimental effects of alcohol and that researchers downplay the positive effects of alcohol because they fear that people would drink more than a moderate amount if they were told of alcohol's benefits. Peele argues that there is no basis for this fear. Another argument against promoting moderate alcohol use is that studies indicate that some people are genetically predisposed to becoming alcoholic and that moderate use may become excessive and unhealthy. Another concern opposing the promotion of moderate alcohol consumption is that some people may misconstrue the information. Heavy drinkers may justify their behavior by saying that they drink for health purposes. If moderate alcohol use protects against heart disease, then one may ignore other risk factors that are clearly harmful, like hypertension, smoking, inadequate exercise, and poor nutrition. Also, moderate alcohol use may be detrimental while driving, taking medicine, operating dangerous equipment, and while pregnant. What impact might a moderate alcohol use message have on the general public? Testing on the Issue Web Questions 1. According to Stanton Peele, who believes that doctors should promote alcohol for their patients, moderate drinkers have a. the same mortality rate as heavy drinkers. b. the same mortality rate as nondrinkers. c. a higher mortality rate than nondrinkers. d. a lower mortality rate than nondrinkers. 2. According to Albert B. Lowenfels, who does not believe that doctors should promote alcohol for their patients, alcohol consumers have an increased risk for a. cirrhosis of the liver. b. digestive-tract diseases. c. throat cancer. d. all of the above Multiple-Choice Questions 3. Which one of the following statements is true? a. In France and Italy, where alcohol use is greater than in the United States, rates of heart disease are higher. b. Most Americans drink less alcohol, not more, than would be the most beneficial to their health. c. Studies on the benefits of alcohol only show that men benefit from moderate alcohol use. d. Alcohol decreases the risk of breast cancer. 4. The number of alcoholic drinks per day that are recommended for men to reduce the risk of cardiovascular disease is a. zero. b. one. c. two. d. four. 5. Peele suggests that women who may not benefit from drinking alcohol are those who a. are under age 50 and are at a high risk for getting breast cancer. b. are under age 40 and who exercise very little. c. are over age 75. d. have a family history of heart disease. 6. Lowenfels estimates that the number of Americans who die each year from alcohol-related deaths is a. 100,000. b. 50,000. c. 10,000. d. 5,000. 7. According to Lowenfels, the survival rate of Seventh Day Adventists and Mormons, groups that abstain from alcohol, is a. lower than the average American. b. higher than the average American. c. about the same as the average American. d. irrelevant to this debate. 8. Lowenfels contends that research showing the cardiovascular benefits of alcohol a. misrepresents the findings. b. is inconclusive. c. is funded by the wine industry and is therefore biased. d. includes too few subjects to be of value. Essay Questions 9. Lowenfels argues against promoting moderate alcohol use. He believes that the consequences outweigh the benefits. List and discuss his arguments against advocating the moderate use of alcohol. 10. Peele asserts that U.S. officials try to be paternalistic regarding alcohol consumption. Are Americans capable of deciding for themselves whether or not they should drink alcohol for health purposes? Explain your answer. 11. Some people view alcoholism as a disease, and others view it as a behavioral disorder. In what ways, if any, would these two viewpoints influence whether or not physicians recommend moderate alcohol use for their patients? Answers 1.d 2.d 3.b 4.c 5.a 6.a 7.b 8.b ISSUE 11 Do the Consequences of Caffeine Outweigh the Benefits? YES: Nell Boyce, from "Storm in a Coffee Cup," New Scientist (January 29, 2000) NO: Editors of Choice, from "Caffeine Fix?" Choice (June 2000) Synopsis Writer Nell Boyce states that caffeine is more addictive than most people realize. Boyce maintains that caffeine not only causes dependency but also has a myriad of other effects. Caffeine raises blood pressure, a factor leading to heart disease, and there is also evidence that caffeine consumption during pregnancy involves some risk for the fetus. The editors of Choice magazine argue that many of the risks associated with moderate amounts of caffeine are exaggerated. They admit that caffeine produces some mild effects, such as dependence and high blood pressure. However, they maintain that the research showing that moderate caffeine use causes heart disease, osteoporosis, and cancer is inconclusive. Discussing the Issue Caffeine is the most widely consumed legal drug in the world. In the United States more than nine out of every ten people drink some type of caffeinated beverage. Most people consume caffeinated drinks for their stimulating effects. Caffeine often provides people the "lift" they need to start their day. Although many people associate caffeine with coffee, caffeine is also found in numerous soft drinks, over-the-counter medications (such as antihistamines and diet pills), chocolate, and tea. Since caffeinated drinks are so common in society and there are very few legal controls with regard to the use of caffeine, caffeine's physical and psychological effects are frequently overlooked, ignored, or minimized. One change in recent years is the decline in coffee consumption--although the amount of caffeine being consumed has not declined appreciably because of the increase in soft drinks. To reduce their level of caffeine intake, many people have switched to decaffeinated soft drinks and coffee. People may be taking in less caffeine, but decaffeinated coffee does contain small amounts of caffeine. Decaffeinated coffee is not without its risks. The decaffeination process involves solvents that have been shown to cause cancer in laboratory animals. Research studies evaluating the effects of caffeine consumption on personal health date back to the 1960s. In particular, the medical community has conducted numerous studies to determine whether or not there is a relationship between caffeine consumption and cardiovascular disease since heart disease is the leading cause of death in many countries, including the United States. Studies have yielded conflicting results. Rather than clarifying the debate with regard to the consequences of caffeine, the research only adds to the confusion. A serious limitation of previous research on caffeine's deleterious effects is that the research looked primarily at coffee use. There may be other ingredients in coffee that produce harmful effects besides caffeine. Also, the fact that there is an increasing percentage of caffeine being consumed from other sources affects the data. Therefore, studies involving caffeine are not truly representative of the amount of caffeine that people are ingesting. Studies that demonstrate a relationship between caffeine and heart disease need to ask a fundamental question: how much caffeine is too much? It is unclear what a safe level of caffeine is. Also, critics contend that it is difficult to establish a definitive relationship between caffeine and heart disease due to a myriad of confounding factors, such as family history, a sedentary lifestyle, cigarette smoking, obesity, fat intake, and stress. Individuals who consume large amounts of coffee are more likely to smoke cigarettes, drink alcohol, and be hard-driving people. Several factors affect caffeine's excretion from the body. Cigarette smoking increases caffeine metabolization, while the use of oral contraceptives and pregnancy slow down the rate at which caffeine is metabolized. Therefore, determining the extent to which caffeine use causes heart disease while adjusting for the influence of these other factors is difficult. Testing on the Issue Web Questions 1. Nell Boyce, who believes that the consequences of caffeine outweigh the benefits, argues that caffeine withdrawal can occur after regularly consuming a. one cup of coffee. b. two cups of coffee. c. four cups of coffee. d. six cups of coffee. 2. The editors of Choice, who do not believe that the consequences of caffeine outweigh the benefits, indicate that caffeine is metabolized more slowly by people who a. exercise a great deal. b. are sedentary. c. smoke. d. take their coffee with cream. Multiple-Choice Questions 3. Caffeine is present in a. coffee. b. decaffeinated coffee. c. some medications. d. all of the above 4. With regard to its safety, coffee a. can be deadly if one consumes 50 to 100 cups at one time. b. is not fatal regardless of how much one consumes. c. is only fatal if one drinks alcohol at the same time. d. is deadly only if one has a heart condition. 5. The effects of caffeine include a. sleep difficulties. b. irritability. c. anxiety. d. all of the above 6. Coffee raises one's blood pressure if it is a. instant coffee. b. drip-filtered coffee. c. in the form of espresso. d. decaffeinated. 7. Boyce contends that children who drink caffeinated beverages a. are able to run faster. b. have slower reactions in various tests. c. are more likely to develop diarrhea. d. are more likely to drop out of high school. 8. The editors of Choice state that caffeine a. increases the risk for heart disease. b. improves alertness and concentration. c. is associated with liver cancer. d. increases the likelihood of developing kidney stones. Essay Questions 9. What are some of the reported adverse effects of caffeine? Are these supported by the research? Do you find the research convincing enough to lead you to believe that caffeine can be harmful to your health? Explain. 10. Based on the evidence in the selections by Boyce and the Choice editors, do you feel that caffeine should be regulated like other drugs? Why, or why not? Answers 1.a 2.c 3.d 4.a 5.d 6.c 7.b 8.d ISSUE 12 Are Too Many Children Receiving Ritalin? YES: Richard Bromfield, from "Is Ritalin Overprescribed? Yes," Priorities (vol. 8, no. 3, 1996) NO: Jerry Wiener, from "Is Ritalin Overprescribed? No," Priorities (vol. 8, no. 3, 1996) Synopsis Harvard Medical School professor Richard Bromfield contends that physicians are often too eager to prescribe Ritalin for children with attention deficit/hyperactivity disorder (ADHD). Bromfield is concerned that Ritalin's long-term effects have not been adequately researched and that its overuse may be masking other childhood disorders. George Washington Medical School professor Jerry Wiener maintains that Ritalin has been proven to be safe and effective. Wiener argues that attention deficit/hyperactivity disorder is underdiagnosed in many instances and that children who could benefit from the use of Ritalin often do not receive it. Discussing the Issue Ritalin is the most commonly prescribed drug for attention deficit/hyperactivity disorder (ADHD). Over 2 million children in the United States, primarily boys between the ages of 5 and 12, receive prescriptions of Ritalin for ADHD. Rates of Ritalin use are greater in the United States than in Europe, where only 1 in 200 children are diagnosed with ADHD. This raises the question of whether or not too many U.S. children are receiving Ritalin. It seems peculiar to prescribe a stimulant like Ritalin for a behavioral disorder like ADHD. However, Ritalin appears to be effective with many children, as well as with adults, suffering from ADHD. From a broader perspective, should behavioral problems be treated as a disease? Does Ritalin address a problem, or does it merely cover up other problems children may be having? Ritalin helps one to focus attention and filter out extraneous stimuli. The drug has been proven to improve short-term learning, although it produces adverse side effects, such as insomnia, headaches, irritability, nausea, dizziness, weight loss, and growth retardation. Physical dependence is not likely to develop, although psychological dependence may occur. In the 1990s the number of children receiving Ritalin rose two and one-half times. This tremendous increase may be attributed to a broader application of the criteria for diagnosing ADHD, heightened public awareness, and changes in educational policy, which require American schools to identify children with the disorder. Some people feel that the increase in prescriptions for Ritalin is to satisfy the needs of parents whose children exhibit behavioral problems. Frequently, parents will pressure their pediatrician into writing a prescription for Ritalin. Despite the reasons for the increase, many people question whether Ritalin is overprescribed or whether Ritalin is a miracle drug. With the increased prevalence of Ritalin prescriptions, its illegal use has risen. There are reports of students on college campuses using Ritalin to get high or to stay awake in order to study. Illegal Ritalin use has been minimal, although the Drug Enforcement Agency is concerned that its illegal use will increase. Testing on the Issue Web Questions 1. Richard Bromfield, who believes that too many children are receiving Ritalin, says that one problem is that a. there are no guidelines for physicians to follow before prescribing Ritalin. b. physicians are not following the guidelines for prescribing Ritalin. c. each state has its own guidlines for prescribing Ritalin. d. no one knows exactly what attention deficit/ hyperactivity disorder (ADHD) is. 2. Jerry Wiener, who does not believe that too many children are receiving Ritalin, asserts that children who are diagnosed with ADHD a. have subtle but significant anatomical differences in their brains. b. received poor prenatal care. c. have bedrooms near utility power lines. d. were exposed to highly sweetened foods as infants. Multiple-Choice Questions 3. Bromfield estimates that the percentage of people who are vulnerable to distraction or impulsive behavior is a. 1-2 percent. b. 10 percent. c. 25 percent. d. 40 percent. 4. Ritalin is a a. depressant. b. narcotic. c. stimulant. d. hallucinogen. 5. A side effect of Ritalin is a. difficulty getting to sleep. b. abnormal growth spurts. c. bodily hair growth. d. increased nervousness. 6. According to Wiener, Ritalin is effective for _______ percent of children with ADHD. a. 5-10 b. 25-30 c. 50-60 d. 75-80 7. Which one of the following does Wiener propose as an alternative to Ritalin? a. minor tranquilizers b. antidepressants c. marijuana d. nitrous oxide 8. According to Wiener, Ritalin's safety and effectiveness a. are unknown. b. have never been studied. c. are well documented. d. depend on who is conducting the research. Essay Questions 9. Do you think that the increase in Ritalin use is due to improved diagnosis of ADHD, greater reliance on drugs to solve personal problems, or parents' being too eager to have their children labeled in order to receive extra benefits from schools? Explain. 10. Considering the evidence from the selections by Bromfield and Wiener, would you conclude that Ritalin is overprescribed, underprescribed, or neither? Explain. 11. Children labeled with ADHD receive extra services from their school districts. However, labels can also have adverse effects. What are the advantages and disadvantages of being labeled with ADHD? Answers 1.b 2.a 3.a 4.c 5.d 6.d 7.b 8.c ISSUE 13 Should Advertisements for Prescription Drugs Be Regulated? YES: Matthew F. Hollon, from "Direct-to-Consumer Marketing of Prescription Drugs: Creating Consumer Demand," JAMA, The Journal of the American Medical Association (January 27, 1999) NO: Alan F. Holmer, from "Direct-to-Consumer Prescription Drug Advertising Builds Bridges Between Patients and Physicians," JAMA, The Journal of the American Medical Association (January 27, 1999) Synopsis Matthew F. Hollon, a physician, maintains that doctors may compromise their judgment when patients insist on being given drugs that they see advertised in the media. He asserts that pharmaceutical manufacturers advertise directly to consumers to increase their profits, not to help patients. Alan F. Holmer, president of Pharmaceutical Research and Manufacturers of America, contends that advertisements for prescription drugs serve to educate the consumer, that such advertisements provide a benefit to the public's health, and that patients are more likely to comply with treatment if they request it. Discussing the Issue One of the most lucrative businesses in the world today is the prescription drug business. Billions of dollars are spent every year in the United States alone for prescription drugs. The only way for consumers to obtain a prescribed drug is through a physician; despite this, drug companies have begun advertising their products directly to consumers. It is logical for drug companies to advertise to physicians because they are responsible for writing prescriptions. However, is it logical for pharmaceutical manufacturers to advertise their drugs directly to consumers? Are most consumers capable of making informed, rational decisions regarding their health care needs? An increasing number of individuals are assuming more responsibility for their own health care. In the United States, it is estimated that up to one-third of all prescriptions are written at the request of patients. One may wonder whether or not most consumers are adequately educated to make decisions pertaining to their health care needs or to assess the risks associated with prescription drugs. Critics argue that one advantage of direct advertising is that it makes consumers better informed about the benefits and risks of certain drugs. It is not unusual for a person to experience side effects from a drug without knowing that the drug was responsible for the side effects. Another advantage for consumers is that they may learn about a medication that they may not have known existed. Holmer argues that advertising lowers the cost of prescription drugs because consumers are able to ask physicians about less expensive drugs that may be available. Finally, prescription drug advertising allows consumers to become more involved in choosing the medications that they need or want. Critics argue that one risk associated with the direct advertising of prescription drugs is that consumers are not always told of the adverse effects of the drugs being advertised. Critics also charge that the drugs' benefits are frequently exaggerated. Hollon maintains that promotions for drugs often appear as objective reports but are actually slick publicity material. The cost of the drugs advertised are seldom mentioned in the advertisements. David A. Kessler, the former director of the Food and Drug Administration (FDA), argues that more restrictions should be placed on how drug manufacturers promote their products because these companies make false or misleading claims. Holmer contends that advertisements for prescription drugs are beneficial to consumers because they lower the cost of drugs and make consumers better informed about the benefits of new drugs. An important issue is whether or not the average consumer is capable of discerning information distributed by pharmaceutical companies. Are people without a background in medicine or research sufficiently knowledgeable to understand literature disseminated by drug companies? If patients receive prescriptions that are not appropriate for their needs, is that the responsibility of the patient, the physician, or the drug manufacturer? Another point on which both selections clearly disagree is whether the promotion of new drugs reduces or increases health care costs. In the final analysis, does the average consumer profit when pharmaceutical companies are allowed to advertise their products directly to consumers? Testing on the Issue Web Questions 1. Matthew F. Hollon, who believes that advertisements for prescription drugs should be regulated, feels that the motive of the pharmaceutical industry is to a. make consumers better informed about drugs. b. ease the burden of physicians. c. make more money. d. lower the costs of prescription drugs. 2. Alan F. Holmer, who does not believe that advertisements for prescription drugs should be regulated, supports direct-to-consumer advertising because a. physicians are not always aware of patients' needs. b. patients will take more responsibility for their own health care needs. c. the United States is built on giving people choices. d. there are already too many government regulations. Multiple-Choice Questions 3. In the late 1990s pharmaceutical companies annually spent ______ on advertising prescription drugs directly to consumers. a. $10 million b. $50 million c. $100 million d. $900 million 4. According to a study based on a national survey conducted in the spring of 1998, the number of consumers who received a prescription drug as a direct result of seeing a direct-to-consumer advertisement was approximately a. 3 million. b. 12 million. c. 50 million. d. 100 million. 5. Hollon asserts that prescription drug advertisements a. provide a beneficial service to consumers. b. will increase the cost of prescription drugs. c. are never misleading. d. are overregulated. 6. Hollon asserts that the information in prescription drug advertisements a. has very little educational value. b. serves the same purpose as public service announcements. c. helps physicians explain the benefits of various drugs. d. is closely monitored by the Food and Drug Administration (FDA). 7. Holmer argues that patients who request prescriptions a. are more likely to comply with the treatment. b. feel empowered with regard to their health care needs. c. learn about the various drugs through the media. d. all of the above 8. Holmer asserts that one public health benefit of direct-to-consumer advertising is that a. many consumers will be encouraged to receive prescriptions for underdiagnosed conditions. b. consumers will be able to purchase prescription drugs without a physician's approval. c. pharmaceutical companies will be encouraged to develop more new drugs. d. consumers will not waste their time buying worthless over-the-counter medicines. Essay Questions 9. Are consumers able to understand drug advertisements and make reasonable decisions with regard to their own health care? Explain. 10. Do you feel that prescription drugs should be advertised directly to consumers? Why, or why not? What are the advantages and disadvantages of this policy? 11. What restrictions, if any, would you place on prescription drug advertising that is directed toward consumers? Answers 1.c 2.b 3.d 4.b 5.b 6.a 7.d 8.a CBEL.com: Secondhand Smoke http://www.cbel.com/Secondhand_Smoke/ This site features over 200 links to sites on secondhand smoke. Categories include effects on children, industry actions, organizations, restaurants, and health risks. DARE.com http://www.dare.com/index_3.htm This is the official Web site of Drug Abuse Resistance Education (DARE). Drug Testing News.com http://www.drugtestingnews.com The purpose of Drug Testing News.com is to provide the most comprehensive source for up-to-date news and information on the drug and alcohol testing industry, including legislation, legal issues, business, technology, prevention, and treatment. Treatment Improvement Exchange (TIE) http://www.treatment.org The Treatment Improvement Exchange (TIE) is a resource sponsored by the Division of State and Community Assistance of the Center for Substance Abuse Treatment (CSAT) to provide information exchange between CSAT staff and state and local alcohol and substance abuse agencies. National Youth Anti-Drug Media Campaign http://www.mediacampaign.org The Office of National Drug Control Policy's National Youth Anti-Drug Media Campaign is a multidimensional effort designed to educate and empower youth to reject illicit drugs. This Web site features progress reports on the campaign's performance, campaign publications, television and print antidrug advertisements, up-to-date news stories, and more. ISSUE 14 Should Nonsmokers Be Concerned About the Effects of Secondhand Smoke? YES: John R. Garrison, from "Scientific Research Shows Overwhelmingly That Other People's Smoke Can Hurt You," Insight on the News (June 16, 1997) NO: J. B. Copas and J. Q. Shi, from "Reanalysis of Epidemiological Evidence on Lung Cancer and Passive Smoking," British Medical Journal (February 12, 2000) Synopsis John R. Garrison, CEO of the American Lung Association, contends that evidence of adverse effects of secondhand smoke on nonsmokers is strong. He asserts that years of research clearly show that secondhand smoke is a factor in the development of lung cancer, heart disease, asthma, and respiratory infections. Statisticians J. B. Copas and J. Q. Shi argue that research demonstrating that passive smoking is harmful is biased. They argue that many journals are more likely to publish articles if passive smoking is shown to be deleterious and that the findings of many studies exaggerate the adverse effects of passive smoking. Discussing the Issue The issue of secondhand smoke is extremely divisive. Many smokers feel that their right to smoke is jeopardized, while many nonsmokers feel equally adamant about their right not to jeopardize their health due to the effects of secondhand smoke. Many smokers believe that they are targets of discrimination, that they are constantly made to feel as social outcasts. Yet nonsmokers feel they are the unwilling targets of unthinking, insensitive smokers. Can smokers light up without infringing on the rights of nonsmokers? The movement to restrict secondhand smoke is growing. Smoking is banned on all commercial airplane flights within the continental United States. Canada and Australia have enacted similar bans. Railroads restrict smoking to certain passenger cars. Smoking is prohibited or restricted in all federal public areas and workplaces. The right to smoke in public places is quickly being eliminated. Is this fair, considering tobacco's addictive hold over smokers? Nonsmokers strongly believe that their rights to clean air are being violated by smokers. Their objections are based on concerns about the health effects of smoke. Smokers argue that many of the restrictions on them are unreasonable. The tobacco industry has allocated vast sums of money to conduct research studies on the effects of secondhand smoke. Based on the results of these studies, smoking rights groups contend that the health concerns related to secondhand smoke are based on emotion, not scientific evidence. They argue that too many variables interfere with knowing the exact impact of secondhand smoke. In today's health-conscious society, many people seem to be more aware of what they eat, whether or not they get enough exercise, and how much stress they experience. People are also concerned about possible environmental threats to their health, such as secondhand smoke. Whether or not secondhand smoke is injurious is relevant since many businesses have adopted policies and states have passed laws based on the premise that secondhand smoke causes bodily harm. A number of states restrict smoking in the workplace; most shopping malls prohibit smoking; the military has banned or restricted smoking in many of its facilities; and numerous restaurants forbid smoking in their establishments. The issue of smoking has become a point of contention in child custody cases, too. It has been argued that parents who smoke around their children are unfit parents. How does one balance the rights of smokers against those of nonsmokers? Testing on the Issue Web Questions 1. John R. Garrison, who believes that nonsmokers should be concerned about the effects of secondhand smoke, states that secondhand smoke is responsible for ______ deaths each year. a. 16,000 b. 29,000 c. 41,000 d. 53,000 2. J. B. Copas and J. Q. Shi, who do not believe that nonsmokers should be concerned about the effects of secondhand smoke, indicate that publications a. are more likely to publish research showing that secondhand smoke is harmful. b. are unbiased in which research they publish. c. include antismoking critics on their editorial boards. d. are paid by antismoking forces to publish only certain research. Multiple-Choice Questions 3. A Harvard University study found that secondhand smoke a. is unrelated to heart disease. b. doubles the risk of heart disease. c. and its relationship to heart disease cannot be determined. d. only slightly increases the risk of heart disease. 4. According to the Centers for Disease Control and Prevention (CDC), mothers who smoke 10 or more cigarettes a day can cause as many as ______ new cases of asthma among their children each year. a. 3,000 b. 8,000 c. 13,000 d. 26,000 5. Garrison indicates that secondhand smoke is related to a. lung cancer. b. asthma. c. heart disease. d. all of the above 6. Copas and Shi estimate that passive smoking increases the risk of lung cancer by a. 12 percent. b. 18 percent. c. 24 percent. d. 36 percent. 7. Copas and Shi state that many studies linking secondhand smoke to lung cancer are a. conducted by smokers. b. designed to prove that secondhand smoke is harmful. c. objective. d. paid for by the American Lung Association. 8. Copas and Shi assert that research demonstrating that the relationship between secondhand smoke and lung cancer is not as great as believed is a. less likely to be published. b. widely publicized by the tobacco industry. c. paid for by the tobacco industry. d. nonexistent. Essay Questions 9. What are the limitations of the research in which secondhand smoke is linked to various health problems? 10. What do you think will be the implications if subsequent research proves that the dangers of secondhand smoke are exaggerated? 11. Do you feel that parents who smoke around their children are engaging in child abuse? Should parental smoking be a factor in child custody cases? Explain. Answers 1.d 2.a 3.b 4.d 5.d 6.c 7.b 8.a ISSUE 15 Is Total Abstinence the Only Choice for Alcoholics? YES: Thomas Byrd, from Lives Written in Sand: Addiction Awareness and Recovery Strategies (Hallum, 1997) NO: Joseph Volpicelli and Maia Szalavitz, from Recovery Options: The Complete Guide (John Wiley, 2000) Synopsis Professor of health Thomas Byrd maintains that Alcoholics Anonymous (AA) provides more effective treatment for alcoholics than psychiatrists, members of the clergy, or hospital treatment centers. Byrd contends that AA is the most powerful and scientific program, in contrast to all other therapies. Addiction treatment specialist Joseph Volpicelli and journalist Maia Szalavitz advocate a moderate drinking approach for individuals with drinking problems. They support alcohol treatment programs that are tailored to meet the different needs of problem drinkers. Volpicelli and Szalavitz argue that abstinence may be counterproductive for many problem drinkers. Discussing the Issue There are an estimated 10 to 20 million alcoholics in the United States. One way to counter addictive behavior such as alcoholism is to abstain from the behavior. However, is total abstention the best or only viable treatment goal? Some critics believe that addiction occurs when people lose control over their addiction and when there is some type of benefit derived from the addiction. As long as addicts receive some reward from their addictive behavior, they will not be able to stop their behavior. Opposing critics feel that not everybody needs to abstain from unhealthy behaviors. With some addictive behaviors--such as eating disorders or work--it is impossible to abstain, they say. Yet with behaviors that are not necessary for survival, like alcohol consumption, some people feel that abstention is the only choice. The most popular approach for treating addiction is the abstinence model, which is included in the 12-step model promoted by Alcoholics Anonymous (AA) and other self-help groups. The 12-step model includes admitting to being powerless over one's addiction, accepting a higher power, and restructuring one's life. Opponents of the 12-step approach say that it is not appropriate for everyone nor has it been proven effective. Having faith in a higher power is not consistent with the values of many people, especially with those who do not believe in a higher power. The effectiveness of AA is based on testimonies of people who participate in it, but because of the anonymity and confidentiality of people who attend or attended AA meetings, follow-up studies are negligible. Many studies show that most people who stop addictive behaviors do so through their own efforts. For example, many heroin addicts quit using heroin without going through any formal treatment. Most people who quit smoking stop without an organized program. It is unlikely that heroin or tobacco users stopped because they suddenly developed a belief in a higher power. Factors contributing to spontaneous remission are not well understood. A criticism of the abstinence approach is that it stigmatizes people. The label "alcoholic" may dissuade people from getting help because it has the connotation of being socially deviant. Also, if people admit to not having control over their behavior, then they are implying that they lack the strength to manage their behavior. This stigma may impede some people from receiving help. Alternative self-help groups like Moderation Management (MM) and the Secular Organization for Society (SOS) have appeared. MM and SOS do not emphasize a belief in a higher power. There is also Women for Sobriety/Men for Sobriety. These groups do not accept AA's disease model of addiction. Abstinence is viewed as important, but self-acceptance and the role of love in relationships are stressed. A third program, Rational Recovery (RR), accepts moderate alcohol use and tries to get people to exert control over their cognitive processes. Testing on the Issue Web Questions 1. According to Thomas Byrd, who believes that total abstinence is the only choice for alcoholics, Alcoholics Anonymous (AA) is more effective in treating alcoholism than a. psychiatrists. b. the clergy. c. hospitals. d. all of the above 2. Joseph Volpicelli and Maia Szalavitz, who do not believe that total abstinence is the only choice for alcoholics, found that people who would not be good candidates for this approach are those who a. are long-term heavy drinkers. b. are under 50 years of age. c. have spouses who are alcoholics also. d. were raised in dysfunctional families. Multiple-Choice Questions 3. In the moderate drinking approach, moderate drinking is defined for women as no more than ______ drinks per week and for men as no more than ______ drinks per week. a. 1; 2 b. 4; 5 c. 7; 9 d. 9; 14 4. As Byrd relates, the first step of AA begins with a. paying a small membership fee. b. bringing family members to AA meetings. c. admitting being powerless over alcohol. d. giving away worldly possessions. 5. According to Byrd, AA believes that alcoholism is a. symptomatic of other problems. b. due to personality defects. c. best treated by improving one's self-concept. d. due to job-related stress. 6. Byrd states that an important component of AA is a. giving up one's old friends. b. group fellowship. c. rejecting religion. d. trying to correct past mistakes. 7. According to Volpicelli and Szalavitz, Canadian researcher Martha Sanchez-Craig found that after a two-year follow-up, a. those who participated in a moderate drinking program did as well as those in an abstinence-only program. b. almost all participants in moderate drinking programs relapsed. c. no type of alcoholism treatment was effective. d. the abstinence-only approach was superior to the moderate drinking approach. 8. Volpicelli and Szalavitz indicate that the success rate for the moderate drinking approach at any one time is a. 3-5 percent. b. 15-20 percent. c. 30-35 percent. d. 75-80 percent. Essay Questions 9. Describe the major differences between AA and other forms of alcohol treatment. 10. Some critics assert that the label "alcoholic" discourages people from receiving help. Do you agree or disagree with this statement? Explain. 11. Which approach do you support: an alcohol treatment based on abstinence or moderate drinking? Explain your reasons. Answers 1.d 2.a 3.d 4.c 5.a 6.b 7.a 8.b ISSUE 16 Is Drug Abuse Resistance Education (DARE) an Effective Program? YES: Michele Alicia Harmon, from "Reducing the Risk of Drug Involvement Among Early Adolescents: An Evaluation of Drug Abuse Resistance Education (DARE)," Evaluation Review (April 1993) NO: Richard R. Clayton et al., from "DARE (Drug Abuse Resistance Education): Very Popular but Not Very Effective," in Clyde B. McCoy, Lisa R. Metsch, and James A. Inciardi, eds., Intervening With Drug-Involved Youth (Sage, 1996) Synopsis Researcher Michele Alicia Harmon reports that Drug Abuse Resistance Education (DARE) had a positive impact on fifth-grade students in terms of attitudes against substance abuse, assertiveness, positive peer association, association with drug-using peers, alcohol use within the previous year, and prosocial norms. Drug researchers Richard R. Clayton et al. maintain that despite DARE's popularity, it does not produce less drug use among its participants. They argue that the money that is spent by the federal government to fund DARE could be used for more effective drug prevention programs. Discussing the Issue People's use of drugs has not significantly changed, even though their availability has been limited. Drug prohibition, as in the case of alcohol, has not been successful. One option for curtailing drug abuse is drug education. Cigarette smoking among adults, for example, has gone down dramatically, but it took more than three decades of public health efforts to accomplish this. Many schools have organized programs to increase drug awareness in which former drug abusers describe how their personal lives and families were ruined by drugs, pharmacologists conduct demonstrations showing drugs' physical effects, and films depict the horrors of drug use. It is not unusual for drug use to increase after a week of these sensationalized programs because students' curiosities are stimulated. For this and other reasons, some drug prevention experts say that drug awareness programs are ineffective. The current emphasis in drug education is on primary prevention. The idea is to prevent young people from using drugs in the first place rather than to get them to stop after they have already started. Drug Abuse Resistance Education (DARE) tries to persuade fifth- and sixth-grade students to pledge not to use drugs. Elementary students are the focus rather than high school students because high school students may already have begun engaging in drug use. Drugs most likely to be addressed are tobacco, alcohol, and marijuana, because they are considered "gateway drugs." Studies show that the longer students postpone their use of tobacco, alcohol, and marijuana, the less likely they will be to use other drugs. Ask students if they have ever experienced a drug education program. If so, what effect did it have on their attitudes toward drugs? Do students see the components of DARE as beneficial? Discuss students' perceptions of why people use drugs. Testing on the Issue Web Questions 1. Michele Alicia Harmon, who believes that Drug Abuse Resistance Education (DARE) is an effective program, states that the purposes of DARE include all of the following except a. increasing self-esteem. b. reducing actual drug use. c. treating students who are abusing drugs. d. helping students to develop coping skills. 2. According to Richard R. Clayton et al., who do not believe that DARE is an effective program, the DARE program is taught in a. one-tenth of all school districts in the United States. b. one-fourth of all school districts in the United States. c. one-third of all school districts in the United States. d. one-half of all school districts in the United States. Multiple-Choice Questions 3. According to Harmon, the best way to reduce adolescent drug use is by a. reducing the supply of drugs. b. drug prevention efforts. c. offering more drug treatment. d. having dogs sniff school lockers for drugs. 4. DARE programs, Harmon says, are designed for students in the a. first and second grades. b. fifth and sixth grades. c. eighth and ninth grades. d. eleventh and twelfth grades. 5. Harmon reports that the people who conduct DARE programs are a. clergy. b. former drug addicts. c. peer counselors. d. police officers. 6. According to Harmon, the DARE program was started in a. Los Angeles. b. Chicago. c. New York. d. Miami. 7. Clayton et al. maintain that DARE has been shown to affect a. knowledge and attitudes about drugs for a short time but that drug-taking behavior is not affected. b. neither knowledge, attitudes, nor behavior about drugs. c. drug-related knowledge, attitudes, and behavior. d. nothing because the effects of DARE have never been determined. 8. Clayton et al. contend that improving a child's self-esteem a. reduces the likelihood of drug use. b. increases the likelihood of drug use. c. has no effect on drug use. d. may or may not affect drug use; the relationship is unclear. Essay Questions 9. Describe some of the problems in evaluating the effectiveness of DARE. 10. Discuss the advantages and disadvantages of DARE. 11. Describe the many goals that DARE programs try to achieve. Do you believe a different approach would work better? If so, what is it? If not, why not? Answers 1.c 2.d 3.b 4.b 5.d 6.a 7.a 8.c ISSUE 17 Should Employees Be Required to Participate in Drug Testing? YES: Gillian Flynn, from "How to Prescribe Drug Testing," Workforce (January 1999) NO: Leslie Kean and Dennis Bernstein, from "More Than a Hair Off," The Progressive (May 1999) Synopsis Gillian Flynn, a contributing editor to Workforce, argues that workplace drug testing has proven to be beneficial to companies with such a policy because the number of workers who test positive for drug use has declined. She also maintains that many accidents that occur at the workplace can be prevented if drug testing is implemented. Authors Leslie Kean and Dennis Bernstein oppose drug testing because many employees, especially African Americans, falsely test positive for drugs. As a result, too many employees with false positive findings are unfairly discharged. Discussing the Issue Today, an overwhelming majority of major corporations in the United States require drug testing as a condition of employment. Government agencies, including the military, adopted the practice of random drug testing to screen its personnel for illicit drugs. Many critics feel that random drug testing is unreasonable because it involves testing even those employees who are not drug users and who have shown no cause to be tested. In addition, drug tests may not clearly differentiate between on-the-job drug use or off-duty drug use. Drug-testing proponents believe that all people suffer from individuals' use of illicit drugs. For example, the public pays higher prices due to lost productivity from work-related accidents and job absenteeism caused by drug use. Also, innocent people are often directly victimized by people on drugs who inadvertently make dangerous mistakes. Flynn writes that the benefits of drug testing outweigh their drawbacks. She feels that discouraging drug use and making the workplace safe takes precedence over the concern of whether or not someone's right to privacy has been violated. Logically, if one does not engage in illegal drugs, then drug testing should not be a concern to that individual. Also, drug testing improves safety for all employees. Others argue that drug testing does not prove that one is under the influence of an illegal substance while at work. A person using marijuana, the most commonly used illegal drug, can test positive for the drug up to 30 days after it was last used. The evidence suggesting a correlation between drug use and job performance is unconvincing to many. Drug use is a problem in society, but is drug testing the fairest and most efficient way of dealing with this problem? An important question is what should be done with people who test positive for drugs? Should they be fired, put on leave until they test negative, or sent for rehabilitation? Is the purpose of drug testing to eliminate workers who use drugs or to help workers who use drugs? Do companies have the right to punish workers for their activities away from the job? Aside from the legal issues, how reliable are drug tests? Far more accidents are attributed to alcohol than illegal drugs. Should drug tests apply to illegal drugs only? Proponents of drug testing argue that anyone concerned with job welfare should be in favor of drug testing in the workplace. When the safety of the general public is at risk, which is often the case in certain safety and security jobs, succumbing to a drug test at work may indeed be appropriate and warranted. Furthermore, nonusing employees should invite drug testing because the only way those employees who are using drugs will get tested is if all employees are tested. Advocates of company drug testing argue that it is fair and effective. Testing at the workplace will prevent illicit drug use and those problems associated with drug use, they say. Proponents believe that it is not a violation of civil rights when the government acts to protect all citizens from the problems of illicit drug use. But drug tests are not always accurate, and they sometimes indicate drug use when there has been none. Drug testing raises other questions: How should drug test results be recorded at work? Should testing be implemented at the worksite or at a "neutral" location? Who should have access to employees' files regarding test results? How could employees be assured of their privacy? Will employees be discriminated against or stigmatized if they test positive? A larger question concerns the role that employers should have in regulating their employees' actions. Testing on the Issue Web Questions 1. Gillian Flynn, who believes that employees should be required to participate in drug testing, states that such programs a. reduce drug use among employees. b. should be conducted on every employee from the chief executive officer to the factory worker. c. should only be performed on people applying for a job. d. should be conducted on employees as well as their spouses. 2. Leslie Kean and Dennis Bernstein, who do not believe that employees should be required to participate in drug testing, argue that drug testing--especially hair testing--is more likely to record a false positive for a. Caucasians. b. Hispanics. c. African Americans. d. Asians. Multiple-Choice Questions 3. In the SmithKline Beecham Company example provided by Flynn, the most common illegal drug for which people tested positive was a. heroin. b. marijuana. c. cocaine. d. ecstasy. 4. If an employee tests positive for a legally prescribed drug, such as for depression, the employer a. can terminate that employee. b. can require that employee to go for rehabilitation. c. cannot discriminate against that employee. d. can force that employee to stop using the drug. 5. Which one of the following statements is true? a. An employer has the right to search one's home or locker. b. An employee who tests positive for an illegal drug is protected by the Americans with Disabilities Act (ADA). c. Employers can engage in random drug testing even if no reasonable suspicion exists. d. Employers have the right to not hire employees who have tested positive for drugs. 6. The Department of Health and Human Services a. does not approve of hair testing. b. supports hair testing if it is done properly. c. feels that hair testing is the most accurate method for detecting drug use. d. states that hair tests are more accurate if the sample is taken from one's leg rather than one's head. 7. Based on the Fourth Amendment, a. all drug searches are forbidden. b. drug searches are allowed if there is reasonable suspicion. c. only federal employees can be searched for drugs. d. a drug search is permissible if the person is a known drug user. 8. Flynn states that when the SmithKline Beecham Company initiated drug testing, the percentage of employees who tested positive went from 18 percent to ______ percent. a. 12 b. 10 c. 8 d. 5 Essay Questions 9. Some people believe that random drug tests are necessary for sensitive occupations (e.g., railroad workers, pilots) because innocent people are put in jeopardy when such an employee makes a mistake due to drug use. What jobs would you consider sensitive, and why? 10. What should happen to employees who test positive for drug use? Should they be fired? Suspended? Sent to rehabilitation? Why? 11. Many people use illegal drugs while not working. Should employers penalize workers for using drugs away from the job? Explain. Answers 1.a 2.c 3.b 4.c 5.d 6.a 7.b 8.d ISSUE 18 Does Drug Abuse Treatment Work? YES: John B. Murray, from "Effectiveness of Methadone Maintenance for Heroin Addiction," Psychological Reports (vol. 83, 1998) NO: Robert Apsler, from "Is Drug Abuse Treatment Effective?" The American Enterprise (March/April 1994) Synopsis Psychology professor John B. Murray contends that drug abuse treatment, especially methadone maintenance, has been shown to reduce illegal opiate use, curtail criminal activity, and lower rates of HIV infection. Assistant professor of psychology Robert Apsler questions the effectiveness of drug abuse treatment and whether or not drug addicts would go for treatment if services were expanded. Discussing the Issue The interdiction of illegal drugs and increased prosecution of drug users and dealers have not lessened the demand for drugs. Many critics contend that more funding should be directed to the prevention and treatment of drug abuse. Studies have found that treatment reduces illicit drug use and improves drug addicts' abilities to function in society and to maintain employment. Also, economic costs from criminal activity go down. Moreover, drug treatment may be helpful in stemming the spread of HIV. Drug abusers in treatment can be educated about the high-risk behaviors leading to HIV transmission. The cost of drug treatment is lower than those for hospitalization or imprisonment. Some critics dispute the effectiveness of drug abuse treatment because research on drug abuse has not been subjected to rigorous standards. What criteria should be used to determine effectiveness? For example, should treatment be deemed effective if a person relapses after a year? Is reduced use of illegal drugs, rather than abstention, an indication of effectiveness? Drug treatment programs vary greatly. Therapeutic communities, which are staffed by former drug addicts, entail assigning tasks to residents, group intervention techniques, vocational and educational counseling, and the development of personal skills. Inpatient treatment centers, the most costly type of treatment, include controlled schedules, demanding rules of conduct, and individual and group counseling. Outpatient treatment, usually used as a follow-up to other treatment, is less expensive. One growing trend is self-help groups, but their confidentiality rules hamper research to assess their effectiveness. Narcotics addicts are often sent to methadone maintenance programs. In addition to methadone, many clinics provide psychiatric, medical, and vocational services. Like other types of treatment, programs do not get at the roots of addiction--poverty, unemployment, and inadequate health care. Testing on the Issue Web Questions 1. John B. Murray, who believes that drug abuse treatment works, states that methadone will eliminate heroin withdrawal symptoms for a. 3 hours. b. 6 hours. c. 24 hours. d. 3 days. 2. According to Robert Apsler, who does not believe that drug abuse treatment works, under the Clinton administration, the antidrug strategy emphasized more funding for a. the military to intercept drug shipments. b. treatment and prevention. c. drug enforcement. d. drug testing of all government workers and students. Multiple-Choice Questions 3. Murray indicates that methadone maintenance programs reduce a. heroin use among heroin addicts. b. criminal activity by heroin addicts. c. the rate of HIV infection. d. all of the above 4. According to Murray, after addicts stop participating in methadone treatment, a. very few return to using drugs. b. most return to using drugs. c. most die from methadone withdrawal. d. most disappear; thus, it is hard to know what happens to them. 5. Murray reports that methadone treatment is most effective if a. it is accompanied by extensive counseling. b. addicts receive moderate amounts of counseling. c. addicts receive methadone without any counseling. d. addicts are taken off welfare when they receive methadone. 6. Apsler maintains that the most effective type of drug treatment appears to be a. residential therapeutic communities. b. inpatient/outpatient chemical dependency treatment. c. methadone maintenance. d. prison. 7. According to Apsler, most people who enter drug treatment do so because a. their physicians advised them to seek treatment. b. they almost fatally overdosed. c. they receive government funds for being in treatment. d. of a threat from a judge, employer, or spouse. Essay Questions 8. Determining the effectiveness of drug abuse treatment is difficult because different criteria are used to gauge effectiveness. What criteria would you use to determine whether or not drug treatment is effective? 9. Several ways to address drug abuse are treatment, enforcement, interdiction, and prevention. With a limited amount of funding, which of these four ways would you emphasize? Explain your answer. 10. Drug abuse treatment for employees is often paid for by employers, but for drug abusers who cannot afford treatment, the government often pays. Should employers pay for drug-abusing employees, and should taxpayers foot the bill for treating a behavior that is illegal in the first place? Why, or why not? Answers 1.c 2.b 3.d 4.b 5.a 6.c 7.d ISSUE 19 Are Antidrug Media Campaigns Effective? YES: Barry R. McCaffrey, from Investing in Our Nation's Youth: National Youth Anti-Drug Media Campaign: Phase II (Final Report) (U.S. Government Printing Office, 1999) NO: David R. Buchanan and Lawrence Wallack, from "This Is the Partnership for a Drug-Free America: Any Questions?" Journal of Drug Issues (Spring 1998) Synopsis Barry R. McCaffrey, former director of the Office of National Drug Control Policy (ONDCP), argues that the attitudes and behaviors of young people regarding drug use