Choose your poison
                   Jul 26th 2001
                   From The Economist print edition

                   Who uses drugs, and why

                   MOST drug users live in the poor world, not the rich. Countries
                   such as China and Pakistan in the case of heroin, and Colombia
                   (South America's second most populous country) in the case of
                   cocaine, have local traditions of drug use and vast uprooted urban
                   populations to provide expanding markets. In future, growth will be
                   concentrated in developing countries and the former Soviet Union.

                   At present, the markets with the big money are in the rich world,
                   where the mark-ups between import and sales prices are highest.
                   Here, not surprisingly, most people buy the drugs that have the
                   fewest side-effects and are least likely to cause addiction. In that
                   respect, drug users seem to behave as rationally as other
                   consumers.

                   Everywhere, the most
                   widely used drug by far
                   is cannabis. At some
                   point or another, about
                   half the people under 40
                   in America have probably
                   tried it. In time, as many
                   adults in the rich world
                   may have sampled
                   cannabis as have tried
                   alcohol. In many social
                   groupings, especially in
                   large cities, using
                   cannabis has already
                   become more or less
                   normal behaviour. “The
                   last time anyone offered
                   it to me,” recalls Paul
                   Hayes, a senior British
                   probation officer who has
                   just become head of a
                   new drug-treatment
                   agency, “was after a
                   primary school
                   parent-teacher
                   association disco, in the
                   home of a Rotary Club
                   member, and the person
                   was a
                   detective-sergeant in
                   the Metropolitan Police.
                   If that's not
                   normalisation, I don't
                   know what is.”
                   Prudently, Mr Hayes
                   refused.

                   Other drugs are
                   becoming part of the
                   normal weekly pattern of
                   life in some social circles. Amphetamines and cocaine, like
                   cannabis, are mostly taken sporadically, and are used far more
                   heavily by the young than by the middle-aged. Simon Jenkins, a
                   former editor of the Times and member of an inquiry into drugs and
                   the law under Lady Runciman, argues that London's vibrant
                   clubbing scene is clear testament to the profusion of drugs
                   available there: how else would people have the energy to dance
                   all night?

                   Most drug users, like those clubbers, are occasional dabblers. A
                   1997 survey of western German drug users sets the tone: just
                   under 80% of cannabis users take the drug no more than once a
                   week, and almost half take it fewer than ten times a year (see
                   chart). With ecstasy and cocaine, users indulge even less often.

                   With drugs, as with alcohol, a minority of users tends to account
                   for the bulk of consumption. In America, for instance, 22% of
                   users account for 70% of use. Heroin use is probably even more
                   dominated by frequent or dependent users. Most drug users, it
                   seems, understand the risks they are taking, and approach them
                   rationally. Of Europe's adults, at most 3% are likely to have tried
                   cocaine; fewer than 1% have ever sampled heroin.

                   Most drugs do not appear to be physically addictive. Views on this
                   may eventually change: in laboratories all over the United States,
                   unfortunate rats are being put into drug-induced hazes as the
                   National Institute on Drug Abuse (NIDA) spends its hefty budget
                   on a mass of research on the impact of drugs on the brain. Recent
                   work on people who give up a heavy marijuana habit seems to
                   show that they suffer anxiety and loss of appetite.

                   However, for the moment, the evidence suggests that neither
                   marijuana nor amphetamines are physiologically addictive. Many
                   people find it hard to abandon crack cocaine once they have tried
                   it a few times, but when they do, they do not appear to become
                   physically ill, as they would with heroin—or indeed nicotine or
                   caffeine. “Heroin is a true addiction, with a recovery rate of
                   40-50%,” explains Giel van Brussel, who has been head of
                   Amsterdam's addiction care department for many years. “With
                   cocaine, the recovery rate is around 90%, so we don't see it as
                   such an enormous problem.” That is rare sanity from a
                   policymaker, but then Dutch policymakers are saner than most.

                   Even with the most addictive illegal drugs, only a minority of users
                   seems to get hooked. With heroin, according to figures from
                   America's National Household Survey on Drug Abuse, one user in
                   three is dependent. Alarming—but not compared with nicotine,
                   which appears to be the most addictive drug of all: one study
                   quoted by America's Food and Drug Administration found that 80%
                   of cigarette smokers were addicted (see chart 2, previous page).
                   David Lewis, professor of alcohol and addiction studies at Brown
                   University in Rhode Island, reckons that the relapse rates for those
                   who try to give up are higher than those for heroin or crack
                   cocaine. If the aim of drugs policy were to prevent harmful
                   addiction, the main target of drugs enforcement agents would
                   clearly be tobacco smokers and their dealers.

                   Studies of the routes by which people come to take up drugs have
                   had a huge impact on policy. Most influential has been the
                   “gateway” theory, suggesting that soft drugs lead on to hard
                   drugs: if cannabis is the path to crack cocaine, then clearly the
                   sooner that path is blocked, the better.
 

                   Guesswork about gateways

                   In fact, this turns out to be nonsense. Certainly, most people who
                   take “hard” drugs have usually first smoked marijuana. But, as
                   Lady Runciman's excellent report on the misuse of drugs in Britain
                   argued last year, for the “gateway” theory to be proved correct
                   requires not just that cocaine and heroin users are highly likely to
                   have taken cannabis; it also requires that cannabis users are
                   highly likely to move on to cocaine or heroin. Yet the vast majority
                   of cannabis users do not graduate to these more dangerous drugs.

                   Moreover, there is no reliable evidence indicating that taking
                   marijuana pharmacologically disposes people to later use of heroin.
                   But work at Johns Hopkins University shows that children who drink
                   and smoke in their early teens are disproportionately likely to
                   progress later to marijuana. And a study in Britain found that the
                   probability of 11-to-15-year-olds using an illicit drug is strongly
                   related to under-age smoking and drinking. Beer and cigarettes
                   seem to be gateways to marijuana, but marijuana does not seem
                   to be a gateway to other drugs.

                   Whether somebody becomes a heavy drug user seems to depend
                   on other factors. Heredity may play some part, and so may social
                   conditions: recent American research has found that drug use is
                   50% more common in households that are welfare recipients than
                   in those that are not. And family circumstances may interact with
                   personality. Mr Hayes, after a long career in the London probation
                   service, sees a typical user as “someone who is a
                   risk-taker—whose lifestyle involves bending rules.” Part of the lure
                   of drug-taking seems to be the sense of danger. The question is
                   how far people should decide for themselves whether to take such
                   risks, and how far the government should make that decision for
                   them.