Examining Illicit Drug Production, Distribution, and Impact on Society and Environment., Exams of Latin language

Download Examining Illicit Drug Production, Distribution, and Impact on Society and Environment. and more Exams Latin language in PDF only on Docsity! Num ber 2 THE SOCIAL IMPACT OF DRUG ABUSE This study was originally prepared by UNDCP as a position paper for the World Summit for Social Development (Copenhagen, 6-12 March 1995) Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter Part one: background I. The drug problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. The global context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 B. Growing plants to produce drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 C. Distribution and illicit trafficking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 D. Consumption of drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 E. Overview of opium/heroin and coca/cocaine . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Part two: impact of drug abuse II. Social implications of drug abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 A. Family and community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 B. Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 C. Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 D. Crime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 E. Work and employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Part three III. Drugs and the environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 IV. Drugs and development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 V. Alternative development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 A. What is alternative development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 B. How can alternative development be characterized? . . . . . . . . . . . . . . . . . . . 38 C. Necessary components and implementation . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Part four VI. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 A. Drug abuse problems: losing ground . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 B. Lack of productive employment and impact on the workplace . . . . . . . . . . . 42 C. Implications of rural and urban poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 D. Marginalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 E. Future challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 VII. Recommendations addressed to the World Summit for Social Development . 45 3 Part one I. The drug problem A. The global context Global increases in problems Of illicit drugs both reflect and contribute to international tensions. The origins of some of these tensions are clear: rapid changes in political alignment, reduced family and community cohesiveness, increased unemployment and underemployment, economic and social marginalization and increased crime. At a time when dramatic improvements are taking place in some sectors, e.g. communications and technology, improvement of the quality of life for many people has fallen far short of the potential that exists and the rising expectation of people who know life can be better. At a time of rising social and Political tensions, the macroeconomic environment has fundamentally changed. World trade and investment have expanded and brought to some areas of the developed and developing world substantial economic benefits. Capital, goods and people move much more frequently and freely across national borders than was the case previously. In many industries, multinational enterprises operate on a world scale by allocating production according to the comparative advantage of individual countries or regions, by selling in diverse geographical markets and by undertaking financial operations where it is most advantageous. One of the consequences of these developments is that financial markets have become more transparent, with massive daily transfers of money around the world. Judging that the benefits of increased trade and investment outweigh a certain loss of sovereignty in controlling the entry and exit of people, goods and money, nation States seem to have made their fundamental choice in favour of economic liberalization because of the expected material benefits to be gained. The same macroeconomic environment which has facilitated the growth and development of global legitimate businesses has also provided the opportunity for drug producers and traffickers to organize themselves on a global scale, to produce in developing countries, to distribute and sell in all parts of the world, to move drug cartel members easily from country to country and to place and invest their drug profits in financial centres offering secrecy and attractive investment returns. The same deregulation that has allowed legitimate businesses to move money around the world electronically with few national controls has also permitted drug producers and traffickers to launder illicit drug profits so that these funds appear to be legitimate. The global changes which have allowed people, goods and money to move from one country to, other cheaply and easily have also had other consequences. They have made the differences and inequalities around the world more apparent and more unacceptable. In many cases, the differences between rich and poor grow wider. Moreover, a number of developing countries, especially those in Africa and selected countries in Latin America and Asia, have largely missed out on the benefits of increases in world trade and investment and consequent economic growth. In some cases, this has been the result of political instability, ethnic conflict, natural disasters or mismanagement of the economy. Whatever the reason in a given country, the lack of economic progress has put such countries in a financial bind and frequently placed severe restrictions on government services available to the most vulnerable segments of the population. In this context, both the nation State and its individual citizens have become more vulnerable to the temptations of money from illicit drug production and trafficking and to the acceptance of illicit drug profits by financial institutions or as direct investment. Today there is more awareness of the problems of illicit drugs and drug trafficking than ever 4 before. How to translate that awareness into constructive action is a major challenge. The term "illicit drugs" is used in this paper to include the narcotic drugs and psychotropic substances listed in the schedules of the Single Convention on Narcotic Drugs of 1961, and that Convention as amended by the 1972 Protocol and the Convention on Psychotropic Substances of 1971. Of the more than 200 controlled substances listed, UNDCP emphasizes opium-heroin, coca-cocaine, cannabis and arnphetamine-type stimulants due to their importance for both developing and industrialized countries. To prepare for the review of the social impact of drug abuse, the section which follows first examines the production, distribution and consumption of illicit drugs and other addictive substances. B. Growing plants to produce drugs The production of drugs may be divided into three categories: (a) those processes which require only plant products, (b) those involving a semi-synthetic process where natural materials are partly changed by synthetic substances to produce the final product and (c) processes which use only manmade chemicals to produce consumable drugs. Examples of these three are (a) opium gathered in the fields for home use, (b) coca bush leaves processed to make cocaine and (c) narcotic or psychotropic drugs made entirely in the laboratory or factory. Long before the world economy felt the impact of globalization of money, markets and products, illicit drugs moved internationally from producer countries in less developed areas of the world to consumer countries that were usually more developed. Production in rural areas was transported to and sold in other continents after enormous price increases along the way, providing high profit and risk incentive to traffickers. The end user has often been a poor person who buys drugs before the necessities of life. Estimates of illicit drug production come from several sources. Systematic attempts to provide information about the amount of opiates or coca produced may employ high technology satellite mapping, ground surveys, agronomic characteristics or consumption figures. Political factors may also affect the process of preparing estimates. Experts have called the production estimate process one of making "best guesses" (1, chap. 1). Many experts think that the first stage, when plants are grown in the fields or consumable drugs are produced in the laboratory, is the most vulnerable point in the chain of illicit production, distribution and consumption. The second major stage, the distribution phase, is also considered by some as an equally good intervention point for drug control purposes. However, the potential for easy movement, disguise and diversion of drug shipments and the vast numbers of shipments of small quantities of drugs decrease the yield of enforcement for each unit of intervention effort. The third stage of possible intervention is at the time of consumption. Here, a particularly vulnerable point is when drugs pass from dealers to consumers. This stage is often a target of law enforcement, especially if a strategy of "buy and bust" is followed. Recently, emphasis has been placed on drug demand, mostly in public statements and commentary in the media. Whereas the obligations of parties to the conventions on drug control concerning reductions in illicit supply are clearly defined, implementation of demand-side obligations of States parties are not specified in the conventions and depend on the ability of States parties to carry out education, information, treatment and rehabilitation. To some observers, this emphasis in the treaty system gives it the appearance of favouring supply-side mechanisms. The consequences of this apparent supply-demand imbalance for bringing drug control into closer collaboration with human and social development programmes are not known. 5 Since some drugs are more available and used more often than others, the questions that arise are the following: what pharmacological properties of specific drugs, what personal characteristics of the users and what social or cultural factors in a given country influence the attractiveness of a drug? Or, asked another way, why do users want certain drugs as opposed to others and how does this influence their willingness to pay for them? Studies suggest that production and distribution of illicit drugs follow supply-demand principles with some allowance for the illegal nature of the product. In terms of their impact on global drug problems and their large-scale financial implications, opium-heroin and coca- cocaine are the primary drugs of current interest. How much opium-heroin and coca-cocaine are produced and where? Illicit production figures are not precise, but gross amounts produced in various countries have been estimated. Based on the integration of information from nine country studies, an expert (1, p. 12) has noted that many variables detract from the precision of any attempt at assessment. Nevertheless, that study provides gross estimates of illicit drug production for coca, cocaine, opium, heroin and cannabis for major supplier countries. Adding the gross estimates for these nine countries results in estimated opium production of 3,045 tonnes. This is not considered an estimate of world production, for two reasons: (a) some countries have not been included in these estimates (Afghanistan, for example, had an estimated cultivation of 19,470 hectares in 1992 and produced 640 tonnes of opium that year according to the United States Department of State (2)); and (b) many unexamined assumptions have been made in preparing these estimates. For heroin, the comparable gross estimate for the nine-country production is 246 tonnes. In contrast to opium production, coca leaf and cocaine production take place in relatively few countries. The estimates made by the above-cited commentator are not highly divergent from those provided for coca and cocaine by the Department of State. The approximate total for the three producer countries (Peru, Bolivia and Colombia) are coca leaf, 330,000 tonnes, and cocaine, 322 tonnes. Several features of this picture are noteworthy: (a) the major production sources of drugs are quite varied, not limited to one or two producer countries or simply one region of the world; (b) according to 1992 GNP per capita data (3, p. 18ff.), major production of opium and coca takes place in less developed countries, many of which have considerable economic, agricultural, political and social problems; and (c) according to all estimates, the total amount of production is extremely high. If alcohol and tobacco production amounts were added to those of opium, cocaine, cannabis and psychotropic drugs to form an aggregated estimate of addictive substances production, the picture that emerges is one of enormous supply of these substances. One commentator has described the illicit drug industry during the production phase, as "labor intensive, decentralized, growth-pole oriented, cottage-industry promoting, and foreign exchange earning - desirable features of rural development in economically stagnating areas" (4, p. 57). He has found agreement on the following points: 1) the production of marijuana, heroin, and cocaine/crack is increasing, especially cocaine/crack; 2) cocaine traffickers, now finding their supply substantially exceeding current market demand in the United States, are vigorously opening new markets in Canada, Great Britain, Western and Eastern Europe (with Spain and Italy as principal ports of entry for Europe); 3) the increasing supply of illicit drugs relative to current demand contributes to additional violence as international cartels and domestic gangs war over market turf, and 4) the policy instruments designed so far to curtail the demand for, suppress the traffic in, and control the supply of illicit drugs have not produced satisfactory results (1, pp. 2-3). 8 Several States reported overall decreasing patterns: Bahrain, Iran (Islamic Republic of), Kuwait, Qatar and Saudi Arabia. E. Overview of opium/heroin and coca/cocaine Most of the world's opium is grown in Afghanistan, the Lao People's Democratic Republic and Myanmar. Several other countries also produce opium but in lesser volume. The development of significant populations of users and addicts in these countries indicates serious social changes that make it even more difficult to reduce drug production. While any social problem may be highly resistant to change, drug use exerts powerful effects, influencing not only the brain processes that influence or control individual behavior but also, ultimately, the social milieu. A portion of the illicit drug production that originates in remote areas of developing countries is invariably diverted along the way from the intended consumer to local individuals. In many cases, the local population provides a stable consumer base for illicit production. The distinction between producer and consumer country is not a rigid one, and the traditional categories of producer and consumer countries is being replaced by the recognition that consumption is a major problem in producer countries as well. For example, in Myanmar, which is one of the largest producers of opium, officials have reported a steady increase in the abuse of opium and heroin since 1970. In Afghanistan, another large producer, the areas of opium poppy cultivation increased in 1992 although the extent of consumption and addiction is unknown. In Pakistan, there were an estimated 650,000 heroin abusers with no end in sight for the increases (1, p. 42). The coca leaf has been chewed by indigenous people in the Andes for centuries. The plant is grown primarily in Bolivia, Colombia and Peru, with Peru having the largest plant production. Smoking of coca paste, often mixed with tobacco or cannabis (basuco, pitillo etc.) is now frequent among the youth of Bolivia, Colombia and Peru. Cocaine is the principal active ingredient of the coca leaf, extracted from leaves and used to make other forms of the drug such as coca paste or crack. The largest single market for cocaine is the United States, which saw sharp increases in the 1980s. Deaths and injuries related to cocaine received widespread publicity, and high percentages of individuals arrested by the police tested positive for cocaine use. The enormous profits in the cocaine trade have fueled the creation of new production centres and expansion into new markets as well as infiltration into legitimate businesses and political parties in a number of countries. The addictive nature of cocaine can lead to rapid escalation in frequency of use, amounts taken or use in combination with other drugs. Cocaine abuse has put a heavy burden on communities in many countries, frequently overloading welfare, treatment and law enforcement agencies. 9 Notes 1. LaMond Tullis, Illegal Drugs in Nine Countries: Socioeconomic and Political Consequences, Draft report prepared for UNRISD at Geneva and the United Nations University at Tokyo, 23 December 1993. 2. United States Department of State, Bureau of International Narcotics Matters, International Narcotics Control Strategy Report, Executive Summary, April 1994. 3. World Bank, The World Bank Atlas 1994, Washington, D.C., 1994. 4. LaMond Tullis, Handbook of Research on the Illicit Drug Traffic: Socioeconomic and Political Consequences (New York, N.Y., Greenwood Press, 1991). 5. United Nations, "Women and drug abuse: a position paper by the United Nations", 11 February 1994. 6. Peter Reuter, "Can the borders be sealed?", article from Peter Reuter, Gordon Crawford and Jonathan Cave, Sealing the Border (Santa Monica, California, the Rand Corporation, 1988). 7. United Nations, "Report of the United Nations Secretariat. Drug abuse: extent, patterns and trends", Prepared for the Commission on Narcotic Drugs, thirty-seventh session, Vienna, 13-22 April 1994. (E/CN.7/1994/4, 21) 8. "Report of the United Nations Secretariat. Drug abuse: extent, patterns and trends", Prepared for the Commission on Narcotic Drugs, Thirty-sixth Session, Vienna, 29 March-7 April 1993 (E/CN 7/1993/4). 10 Part two II. The impact of drug abuse A. Family and community Fast-paced social, economic and technological changes present a challenge to the stability and influence of the family. The family is often viewed as the basic source of strength, providing nurturance and support for its individual members as well as ensuring stability and generational continuity for the community and culture (1). In reality, the family is far more complex. At least four conceptual views of the family have been identified. First, it may be seen as protecting and sustaining both strong and weak members, helping them to deal with stress and pathology while nurturing younger and more vulnerable members. Secondly, the family may be a source of tension, problems and pathology, influencing weaker members in harmful ways, including destructive drug or alcohol use. Thirdly, it may be viewed as a mechanism for family members to interact with broader social and community groups, such as peer groups, schools, work colleagues and supervisors and persons associated with religious institutions. Fourthly, the family may be seen as an important point of intervention - a natural organizational unit for transferring and building social and community values. Rapid social, economic and technological change may, under certain circumstances, weaken the sense of family and reduce the sense of belonging to other people, groups and places. Stability of relationships, environment and expectations is a powerful force in helping people manage their lives, especially important for children and young adults. In some societies, the classical problem of balancing discipline and control of children with nurturing support to encourage their exploration, understanding of the world and self-realization may be complicated by substance abuse problems as well as a wide range of other conditions. Families can have a powerful influence on shaping the attitudes, values and behaviour of children, but how do they compare with peers in terms of influence on drug taking? The influence of peer groups, which is usually strong during formative years of youth, may be stronger than that of parents in some cases. One researcher (2) has found that friends are more similar in their use of marijuana than in any other activity or attitude. In this situation, drug use by peers may exert a greater influence than the attitudes of parents. This researcher observed that peer and parental influences are synergistic, with the highest rates of marijuana use being observed among adolescents whose parents and friends were drug users. Other investigators, however, have found that peers have a high degree of influence only when the parents have abdicated their traditional supervisory roles (3). Hence, parents exercising traditional family roles may be able to limit the influence of peer groups on children's attitudes towards drug use and therefore have a crucial influence on children's behaviour. Prevention of drug problems can employ knowledge about family dynamics to address personal and social concerns of family members that otherwise would lead to drug abuse, both with respect to dysfunctional as well as intact families. In this regard, it is important to avoid assuming "... either that parents are invariably responsible for the problems experienced by their children or that substance users can be blamed for all the problems experienced by the families in which they live" (4, p. 2). Family factors that may lead to or intensify drug use are thought to include prolonged or traumatic parental absence, harsh discipline, failure to communicate on an emotional level, chaotic or disturbed members and parental use of drugs, which provides a negative role model for children (5). Lack of household stability, income or employment for a parent may increase stress on the family and its vulnerability, pushing 13 9. World Bank, The World Bank Atlas 1994, Washington, D.C.. 1994, p. 18. 10. Market children are those boys and girls who are sent to work in the markets, usually selling something. These children retain some contact with family members. In contrast, street children are primarily abandoned and without families. 11. James D. Wright, Donald Karninsky and Martha Wittig, "Health and social conditions of street children in Honduras", American Journal of Diseases of Children, March 1993, vol. 147, p. 282. 12. LaMond Tullis, Illegal Drugs in Nine Countries: Socioeconomic and Political Consequences, Draft report prepared for UNRISD at Geneva and the United Nations University at Tokyo, 23 December 1993. 14 B. Health Health problems impair family life and productive employment, diminish the quality of life and may threaten survival. A comprehensive picture of worldwide health implications of drug abuse is not available. Significant country and international data, however, are available and the impact of addictive substances on health in both industrialized and developing countries is discussed below. The broader context of addictive substances includes tobacco, alcohol and solvents (including glues, thinners and gasoline). All of these substances have several important characteristics in common. They alter the function of the human brain and have an impact on behaviour; they are widely used throughout the world; and they burden society by increasing social and economic costs for productive enterprises and by drawing upon limited government services. The most widely used addictive substances, alcohol and tobacco, are harmful with extensive damage to the individual, family and the community. Disease, disability and dysfunction were obviously not included in the estimate in the box but would certainly increase significantly any estimate of human costs due to substance abuse. Deaths as a result of drug abuse are a major source of concern. Recent informal estimates are that perhaps 200,000 drug-injecting-related deaths may occur per annum based on the estimated size of the current world population of injecting drug abusers of approximately 5.3 million (2, p. 4). WHO has reported as follows: "Existing data indicated a several-fold increase in drug-related deaths over the past decade ... . The yearly mortality rates (or "lethality") among intravenous drug users or drug addicts on treatment programmes ranged between one and two percent in Europe and the United States" (3, p. 1). WHO's examination found that, during the period of 1980 to 1988, mortality related to drugs increased in some countries and decreased in others. It decreased in Japan and Thailand and showed little change in Austria, New Zealand and former Yugoslavia. Slight increases were seen in the former Czechoslovakia, the predecessor States of Germany, the Netherlands and Spain. Steeper increases in mortality were noted in Australia, Canada, France, Italy, Poland, the United Kingdom of Great Britain and Northern Ireland and the United States. High variability in mortality rates, however, was found within countries and from year to year. Substances commonly associated with drug abuse-related deaths are cocaine, heroin (and other opiates), barbiturates and amphetamines (and amphetamine derivatives). Benzodiazepines, hallucinogens, cannabis and other substances are less frequently implicated. Combinations of drugs and alcohol were frequently noted. Although commonly used, the term "overdose" is misleading since different reactions, such as hypersensitivity, may be the real mechanism of death in some cases rather than an acute intoxication effect due to excessive amounts of the drugs. Availability, cost, chemical contents of the drugs (e.g. adulterants), preexisting and potentially life-threatening health problems and patterns of use are all factors that may play key roles in determining whether harmful effects occur in any individual case. The most widely used controlled drug, cannabis, could be associated with some fatal accidents despite its low acute toxicity. Concerning chronic use, there may be greater risks of damaging the lungs by smoking cannabis than tobacco (4). Commenting on the public implications of the use of addictive substances, a Tobacco and alcohol consumption account for nearly 5 million deaths annually worldwide. As levels of GNP per capita rise, third world populations age, and noxious substances are more widely marketed and distributed in developing countries, the number of deaths can only be expected to increase (1, p. 5). 15 major health report states: "Decisions about the control of tobacco and other addictive substances are among the most important health-related choices that societies can make collectively. In many populations, prolonged cigarette smoking is already the greatest single cause of premature death. Alcohol and other drugs also contribute to disease and disability. The damage from substance abuse is not limited to the individuals involved; others also suffer indirectly because of drunk driving, fires, passive smoking, and drug related crime and violence" (5, pp. 86 and 87). The proportion of all drug users and abusers who end up with serious health and social problems is not known. Whatever that proportion, illicit drug use more frequently results in problems or disease rather than death. Since substance abuse is not evenly spread throughout the population, it is advisable to determine the characteristics of the specific groups involved in order to plan interventions. Drug abuse may be influenced by the social-cultural milieu, the degree to which a person is part of a structured environment, his or her personal characteristics, the specific drugs involved and the circumstances of use. The earliest stages of life are a particularly vulnerable time. Reporting on the effects of alcohol and drug abuse on foetuses in a study carried out in four Danish cities, one researcher has found (6) that the extent of maternal drug abuse is correlated with obstetric complications and developmental characteristics of the foetus. The effects of an unstable foetal life carry over into childhood. However, with care, many of these effects can be overcome. One of the most visible impacts of harmful drug use is seen in the consequences of cocaine use on newborn infants. Experts (7) have found that cocaine-using pregnant women have a higher rate of spontaneous abortion. Also, mothers who carried their foetus to full gestational term had infants with depressed behaviour and poor responses to stimuli. Other studies indicate that infants exposed to sedatives, stimulants or pentachlorophenol (PCP) may have marked deficits. PCP and cocaine used by mothers also may interfere with the essential bonding that occurs between mother and child at birth (8). Other investigators have findings supporting these views. In discussing the victims of drug abuse, a commentator (9, p. 52) notes that "maternal drug use is a substantial and apparently growing part of the problems of unhealthy newborns. The direct victim of such passive drug taking is the child, but there are indirect victims too. Drug-damaged children put burdens on already strained systems of pediatric health care and public education. Some of the forms of damage, particularly to cognitive function and impulse control, will tend to increase crime rates when the children become adolescents and young adults. The damaged child's future schoolmates, workmates, and neighbors will all bear some of the cost". Quite apart from the direct consequences, the care of children abandoned by, or taken away from, addicted parents again implies a considerable social cost. Probably the most widely occurring substance abuse pattern in this context is the foetal alcohol syndrome, which involves both physical and mental deficiencies that are costly to treat, often requiring both intensive initial and long- term care. The human immunodeficiency virus (HIV) causes the clinical disease acquired immunodeficiency syndrome (AIDS). Unknown before the 1980s, it now is an epidemic for which there is no known cure and no vaccine. The virus is spread by sexual intercourse, contaminated blood (e.g. during transfusions), mother-to-child transmission during the perinatal period and use of contaminated syringes and injection equipment. The importance of each of these means of spread varies from one region of the world to another. The devastating effects of AIDS are seen most clearly in the developing world. 18 benefit which could result from effective intervention programmes. Clearly, the preparation of social and economic cost estimates is becoming a priority. No comparative national estimates for the cost of care and treatment of substance abuse problems have been prepared. Most policy officials have little idea what the addictive disorders cost their countries or what they are spending on this group of problems. In the United States, a study of hospital records shows a surprisingly high number of admissions and costs for substance-abuse-related treatment. This study found that in 1991, "there were 2.2 million tobacco, alcohol or drug-related Medicare admissions, which accounted for 20 per cent of all Medicare hospitalizations (21). Because these substance abuse- related cases tend to be more expensive to treat than the average hospital case, the amount actually paid by Medicare for substance abuse-related care was even higher, accounting for 23 per cent or nearly one- fourth of the total Medicare payments for hospital care. Substance abuse-related cases cost more to treat because they required almost 26 per cent more hospital staff and other resources than Medicare discharges that are unrelated to substance abuse" (22, p. 4). Furthermore, "Medicare spent over $13 billion of its $57 billion inpatient short-stay hospital expenditures on substance-abuse-related care. These amounts exceed the 1 out of 5 dollars spent in the Medicaid programme for substance abuse-related conditions" (22, p. 4). Although the magnitude of these figures is not typical of other countries, this same study found that "relying solely on diagnoses that explicitly mention alcohol or drugs on the medical record in order to measure the prevalence and cost of drugs and/or alcohol problems in hospitals grossly underestimates the full impact of substance abuse" (22, p. 5). Cases where alcohol and drug treatment were the primary diagnoses represented less than 3 per cent of the substance-abuse total costs. The conclusion is that substance-abuse-related costs may be a serious but unrecognized drain on national income; it is often unrecognized because drugs or alcohol may not appear directly in diagnoses and classifications but may be major risk factors contributing to other diseases and costly social disorders. Paying for the costs of assistance to persons with drug problems raises many questions, including that of the role of the public and private sectors. Many drug abusers are unable to pay the costs of care by themselves and have no insurance or other means to pay when health care is primarily provided by the private sector. Public policy should take into consideration two points. First, priority should be given to the most important aspects of the drug abuse problem, such as compulsive heroin or cocaine users' inability to pay for treatment. Involving them in public treatment programmes would reduce the demand for these drugs and allow supply reduction efforts to be more successful since the compulsive drug users consume far more drugs than experimenters. Secondly, the issue of preventive care needs to be addressed. If preventive care systematically loses out to market forces, which are politically or commercially stronger, a government may need to intervene to ensure adequate support for prevention. The cost picture is made more complex by the nature of the existing health care system. Does a national or comprehensive health care system exist? If it does, are drug treatment services covered? A major policy issue is whether information on costs of the problem is sufficient to draw conclusions about resource allocation. In addition, estimates are needed about the costs of various alternative policy responses, including what the consequences would be if limited or no intervention takes place by authorities. Allocation of scarce resources may be determined not only by costs associated with morbidity, mortality and associated social problems but also by other factors such as public perceptions of safety and security. Although this discussion concerns the impact of illicit drugs, it should be borne in mind that many parts of the world lack adequate supplies of licit drugs, with neither essential medications nor access to basic health care. Highlighting the abuse of dependence-producing drugs does not, however, diminish the magnitude of problems related to the unavailability of licit narcotics or psychotropics needed for treatment of health problems. Programmes to control the illicit use of drugs may be designed which support 19 pharmaceutical control measures essential for distribution of licit drugs. Notes 1. James A. Cercone, Alcohol-Related Problems as an Obstacle to the Development of Human Capital: Issues and Policy Options, World Bank Technical Paper No. 219, Washington, D.C.,World Bank, 1994. 2. M. Frischer, S. T. Green and D. Goldberg, Substance Abuse Related Mortality: A Worldwide Review, Compiled for UNDCP, March 1994. 3. WHO, Programme on Substance Abuse, Deaths Related to Drug Abuse, Report on a WHO consultation, Geneva, 22-25 November 1993. 4. "Marijuana more harmful than tobacco", New Scientist, 17 December 1987, p. 15. 5. World Bank, World Development Report, 1993: Investing in Health (Oxford University Press, 1993). 6. Joav Merrick, "Addicted mothers and their children: research results from Denmark", International Journal of Rehabilitation 8 (I): 79-84, 1985. 7. Ira J. Chasnoff et al., "Cocaine use in pregnancy", New England Journal of Medicine 313 (1 I): 666-669, 1985. 8. Charles P. O'Hara, "Behavioral effects of phencyclidine and cocaine on infants exposed in utero, as measured by the Neonatal Behavioral Assessment Scale". Ph.D. Dissertation, California School of Professional Psychology, 1987. 9. Mark A. R. Kleiman, Against Excess: Drug Policyfor Results (New York, Basic Books, 1992). 10. WHO, "The current global situation of the HIV/AIDS pandemic", Geneva, 1994. 11. World Bank, Combatting AIDS and other Sexually Transmitted Diseases in Africa: A Review of the World Bank's Agenda for Action, World Bank Discussion Papers, No. 181, Washington, D.C. 12. Gerry V. Stimson, "The global diffusion of injecting drug use: implications for HIV infection", Presentation for VIII International Conference on AIDS/III-STD World Congress, 22 July 1992, London. 13. INCB, Report of the INCB for 1992, Vienna, 1992. 14. Don Des Girls, and Samuel Friedman, "AIDS and the use of injected drugs", Scientific American, February 1994. 15. WHO, Programme on Substance Abuse, Strategy Document, Geneva, 1990. 20 16. James O. Prochaska, Carlo C. DiClemente and John C. Norcross, "In search of how people change: Applications to addictive behaviors", American Psychologist, September 1992. 17. S. W. Acuda, "Community participation and the role of primary health care in treatment and rehabilitation of drug dependent persons", unpublished paper, Harare, Zimbabwe. 18. D. P. Rice, S. Kelman, L. S. Miller and S. Dunmeyer, The Economic Costs ofalcohol and Drug Abuse and Mental Illness: 1985 (Washington, D.C., Government Printing Office, 1990). 19. C.S.J. Fazey, and R.C. Stevenson, The Social and Economic Costs of Drug Abuse in the UK. and the Netherlands, Commission of the European Communities, London. 20. D. J. Collins and H. M. Lapsley, "Issues and alternatives in the development of a drug abuse estimation model", Paper presented at the International Symposium on the Economic and Social Costs of Substance Abuse organized by the Canadian Centre on Substance Abuse, Banff, Canada, May 1994. 21. IntheUnitedStates,theMedicareprogrammeissimilartoasocialinsuranceprogrammefunded through payroll taxes, premiums and Federal revenues. Medicaid, on the other hand, is a welfare programme to cover the medical costs of low-income and needy persons. 22. Centeron Addictionand Substance Abuseat Columbia University, TheCostofSubstanceAbuse to American's Health Care System. Report2: Medicare Hospital Costs, Mayl994. 23 Notes 1. UNDP, Human Development Report 1993 (New York, Oxford University Press, 1993). 2. UNESCO, "Prevention of drug abuse through education and information: An interdisciplinary responsibility within the context of human development", Paris, 1993. 3. K. E. Thomas, "Drugs and human development", in The International Encyclopedia of education Research and Studies, vol. 3, T. Husen and T. Postlethwaite, eds. (Oxford, Pergarnon Press). 4. UNESCO, "Education for development: responding to new challenges" (ED- 93/CONF.202/LD. 12). 5. LaMond Tullis, Handbook of Research on the Illicit Drug Traffic: Socioeconomic and Political Consequences (New York, Greenwood Press, 1991). 6. Patricia Bandy and Patricia A. President, "Recent literature on drug abuse prevention and mass media: Focusing on youth, parents, women and the elderly", Journal of Drug Education, 1983. 7. Colin Fraser, "Communication and social mobilization for drug abuse control - What Prospects?" Paper for presentation to the senior management of UNDCP@ Vienna, 16 March 1994. 24 D. Crime Countries vary in the way they define crime. In the drug abuse field, however, a common conceptual structure is provided by international drug treaties. Several of the treaties have obligations which require penal provisions in national law for illicit traffic offences (1, p. 4). Requirements concerning illicit demand are more complicated. Countries implement both supply and demand obligations in enormously varied ways. Crime and drugs may be related in several ways, none of them simple. First, illicit production, manufacture, distribution or possession of drugs may constitute a crime. Secondly, drugs may increase the likelihood of other, non-drug crimes occurring. Thirdly, drugs may be used to make money, with subsequent money-laundering. And fourthly, drugs may be closely linked to other major problems, such as the illegal use of guns, various forms of violence and terrorism. Whether illicit drug use should be considered a crime, a disease, a social disorder or some mixture of these is debated in many countries. Often, public policy is ambivalent about the nature of addiction, with social attitudes towards drug abuse reflecting uncertainty about what causes abuse and who is ultimately responsible. A continuum exists in relation to accepted social status and crime. At one end is law-abiding behaviour and at the other, criminal activity. Between these two extremes are found deviant behaviour and delinquency. Many marginal persons who use drugs do not go on to become delinquents or criminals. If progression along this continuum does not take place within a country, the concept of progression is even less applicable across cultures. What is marginal or deviant in one culture may be tolerated or even considered to be part of the mainstream in another. Information collected by police or other authorities varies from country to country. The amount of unreported crime depends on many variables. States parties to the international drug control treaties have an obligation to report on drug abuse to the United Nations. Reports on the illicit traffic and drug abuse are presented to sessions of the Commission on Narcotic Drugs, which meets regularly in Vienna. Whatever the limitations are of reports to the United Nations as estimates of the illicit traffic, these reports do shed light on how serious the situation is. Using these various sources of information, UNDCP has recently reported the spread of illicit opium poppy cultivation in Latin America, increased heroin abuse in parts of Africa and Asia and increased cocaine abuse in Latin America and the Caribbean. These increases, along with other information about current trends, reflect a bleak picture (2, p. 2). The United Nations conducts and publishes a series of surveys of crime trends, operations of criminal justice systems and crime prevention strategies in Member States. Reports on crime-related matters, including the impact of organized criminal activities on society at large and control of the proceeds of crime, are presented to the Commission on Crime Prevention and Criminal Justice. The sharpest increase in crime. recorded in both the 1980-1985 period and the 1975-1989 period was in drug- related crime and robbery. The rate of increase in drug crimes was greater than for all other types of crime, except kidnapping, for which the base figures were low (3, chap. 11) The complex connection between drug use, delinquency and crime has been discussed by experts for decades. Substance use and delinquent behaviour are often related, especially as either drug use or delinquency become more serious. Early sexual activity is strongly related to delinquency and drug abuse. Girls who have been pregnant report increased prior use of alcohol and other drugs. Youth who do not feel a strong attachment to their parents are more likely than others to use drugs and become delinquent, consistent with the findings cited earlier in the section on the family. 25 One aspect of this connection between drugs and crime is temporal causation: which is cause and which is effect? In the case of individual addicts, drug use may precede crime or the reverse. After examination of groups, researchers in the United States have concluded that many variations exist but that some delinquency or crime often precedes addiction. They have found that involvement in property crime generally precedes the addiction career. After addiction occurs, property crime increases and narcotic use is further increased. One expert found that during "... periods of curtailed narcotics use produced by treatment, property crime levels are significantly reduced and become extremely low after termination of the addiction career" (4, p. 197). Researchers have found a close connection between drug abuse, criminal behaviour and social attitudes. Review of the crime/drugs literature (5, p. 270) supports three notions: heroin addicts are usually deeply involved in crime; daily opiate use increases criminality several fold; and many heroin abusers are not interested in obtaining treatment although drug treatment programmes do reduce the criminality of addicts while they are in treatment. Whether causality is involved in these relationships is not clear. Illicit drug use, delinquency and crime are best seen as closely interrelated behaviours, especially when they occur in contact with the supply of illicit drugs. Drugs and crime cannot be considered separately, in isolation from each other, especially if they emerge from a common set of circumstances. The close connection between drug use and criminal behaviour is supported by many studies. A national survey in the United States examined the relationship between drug use and criminal behaviour. Results show that "drug use is a strong correlate of being booked for a criminal offence, but age is the more important correlate of criminal involvement. There were few differences in models predicting violent as opposed to property crime, although minority status was a more important predictor of violent crime, and poverty was a more important predictor of property crime" (6). The close connection between crime and drug use is seen in studies of arrestees. The Drug Use Forecasting Program of the United States National Institute of Justice monitors drug use among recently arrested persons in selected cities. Periodically, examinations are conducted on a sample of arrestees in booking facilities. A study of findings on males in 14 United States cities in 1989 used urine screening and selective confirmation tests for 10 drugs (7). Preference for selection into the testing programme was given to persons charged with serious non-drug-related offences. With a total of nearly 3,000 tests, results were drug positive for cocaine for a high percentage of persons in New York (76%), Philadelphia (74%) and the District of Columbia (65%). Smaller cities had lower percentages of positive test results: Indianapolis (26%) and San Antonio (24%). The test method used detects only drugs used 2-3 days prior to arrest so that actual drug use by arrestees was probably higher than the results obtained. Upon interview, arrestees revealed a surprisingly high percentage of needle sharing, with the lowest percentages found in Detroit (10%) and San Antonio (48%). In sum, from one-fourth to three-fourths of the serious non-drug offenders tested positive for cocaine, many tested positive for other drugs, and a substantial portion of these arrestees are at significant risk of acquiring HIV and other blood-borne infections. When drug problems in a community are perceived as serious, people must face unpleasant alternatives. They can accept the reality of drugs in their neighbourhood, adapting to a situation that they cannot hope to change immediately; they can change their lifestyle to reduce the threat of drug dealing and violence in their streets and buildings; they can change the environment by some form of community action either with or without the support of the police; or they can flee to safer housing if possible. Many of these alternatives are not available to persons living in poverty or with limited means. Thus, with fewer choices, the poor pay a greater personal price for drug problems than others. Another implication of crime is that the political agenda becomes filled with drug abuse issues and 28 Notes 1. United Nations, United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988 (United Nations publication, Sales No. E.91.XI.6) and Report of the International Narcotics Control Board for 1992, United Nations, New York, 1992. 2. United Nations, "Report of the Executive Director: Activities of the United Nations International Drug Control Programme", Prepared for the Commission on Narcotic Drugs, Thirty-sixth session (E/CN.7/1992/3). 3. UnitedNations,CrimeTrendsandCriminalJusticeOperationsattheRegionalandInterregional Levels: Results of the Third United Nations Survey of Crime Trends, Operations of Criminal Justice Systems and Crime Prevention Strategies (United Nations publication, Sales No. E.94.1V.2 4. M. Douglas Anglin and George Speckard, "Narcotics use and crime: A multi sample, multimethod analysis", Criminology, vol. 26, No. 2, 1988. 5. LaMond Tullis, Handbook of Research on the Illicit Drug Traffic: Socioeconomic and Political Consequences (New York, Greenwood Press, 1991). 6. Lana Harrison, and Joseph Gfroerer, "The intersection of drug use and criminal behavior: Results from the National Household Survey on Drug Abuse", Crime and Delinquency, vol. 38 (4) 422- 443. 7. United States Government, Morbidity and Mortality Weekly Report, vol. 3 8, No. 45, pp. 780-783. 8. Bruce M. Bagley, "Colombia and the war on drugs", Foreign Affairs 67 (I): 71-92. 9. Pino Arlacchi, "Effects of the new anti-Mafia law on the proceeds of crime and on the Italian economy", Bulletin on Narcotics 36.4 (October-December): 91-100, 1984. 10. Richard Clutterbuck, Terrorism, Drugs and Crime in Europe after 1992 (London, Routledge, 1990). 11 "The high price of freeing markets", The Economist, 19 February 1994. 12. OECD, Report of the Financial Action Task Force on Money Laundering, Paris, 7 February 1990. 13. Bonnie Wilford, "Abuse of prescription drugs", The Western Journal of Medicine, vol. 152, No. 5, May 1990. 14. I. Bayer, "The monitoring of trade in and control of psychotropic substances to guard against their diversion", Bulletin on Narcotics 35 (4): 3-13, 1983. 15. Robert Maccan and Peter Reuter, "Are the wages of sin $30 an hour? Economic aspects of street- level drug dealing", Crime & Delinquency, vol. 38, No. 4, October 1992. 29 E. Work and employment Work status includes more than being either employed or unemployed. Also to be considered are the rate of underemployment and the extent of work in the informal sector. What is perceived as an employment problem also varies according to the views of society. For example, if youth have low status in a particular culture, the fact that they are disproportionately unemployed, not to mention underemployed, may be of little interest to decision makers. If a society places youth in a marginal status until some distant adulthood, it is even more difficult for young people who have been associated with drugs to obtain productive employment. These adverse effects on youth may also appear for female youth, who in some cultures do not normally have prospects for occupational roles outside the home. According to "an estimated 30 per cent of the world's labour force are not productively employed. More than 120 million people are registered as unemployed; some 700 million are underemployed" (1, p. 89). Further, the disparity between the income levels of people in rich and poor countries is growing larger, and even when there has been a drop in poverty levels in some countries, the distribution of income has not correspondingly improved (1, p. 19). Employment has constantly lagged behind economic growth for both developing and industrialized countries. The situation in both is similar in one respect: substantial increases in capital investment or productivity have not always created a corresponding number of jobs. One study terms this phenomenon "jobless growth" (2, p. 36). Policy makers are searching for ways to increase the number of jobs along with economic growth. The number of young people is expanding faster than available jobs. The disparity between the size of the labour force and the number of persons employed is projected to worsen throughout the 1990s. ILO estimates, for example, that "the labour force for sub-Saharan Africa will grow 3.3% a year in the 1990s, while productive employment will increase by only 2.4% a year. Even this employment growth assumes an acceleration of GDP growth from 3.7% to around 5%. This situation is unlikely to be any better in Latin America or South Asia" (reported in 2, p. 37). Increased rates of unemployment are projected to occur in the same age group as those persons most likely to use drugs and have drug problems. Add to this the fact that many of the jobs that are available are separated from the community and the family support network necessary to sustain workers, and the ingredients for intensification of social problems are clear. Education and training, often mentioned as solutions to unemployment, may be part of the problem rather than the solution since the existing supply of educated and trained persons frequently exceeds the demand in many countries. Competition for jobs will likely increase and employers may become even more selective in hiring young people. Drug abuse occurs more frequently in young people than in other age groups. The risk factors for drug use often occur before entry into the workforce. The drug abuse problems of the community are, therefore, brought into the workplace. The age group with the highest frequency of drug use is often 18- 35 years, although wide variation exists between countries. Thus the point of maximum benefit of prevention programmes may occur before or at the point of entry into the labour market. Employers can make major contributions to the prevention of drug abuse, helping themselves and the community in the process. Effective workplace initiatives to prevent drug abuse should begin in the community and be directed at young persons who are potential workers. In many parts of the world, the workplace and living areas are not separate. Even if property lines set these two areas apart, people pass back and forth frequently between the two. The close connection between the family and the work setting make it more difficult to use formally organized welfare services or assistance programmes to assist with workers' problems. Moreover, community or 30 government agencies, such as occupational safety and health departments, are less able to assist workers in informal or in home work settings. The relationship between drug and alcohol abuse and the workplace is significantly influenced by national, social, cultural, ethnic, religious and gender issues. Cultural or group practices may also facilitate drug or alcohol abuse. Drinking or drug abuse cultures exist in some workplaces and some of them set a standard that may be imposed on the non-user. In addition, conditions in some workplaces involve exposure to harmful or dependence-producing substances, such as glue in shoe factories. Employees may follow fads or local customs and accept substance abuse, holding views that are clearly inconsistent with known facts about their physical effects. A recent study in Portugal found that there are "still some workers who believe they can work with more precision if they drink a certain amount of wine and there are some employers, both in the building and agricultural sector, who offer free wine to get some work done" (3, p. 17). While the consequences of unemployment vary, it usually reduces the ability of the person to participate in the social, economic and political life of the community (4, p. 127). Unemployment is itself a marginal status so long as employment is the norm. With increased migration from rural areas to cities, more competition exists for jobs. Without training and employment, young people may find themselves on the fringes of an urban society. Since the expectation exists for most people to engage in productive work of some kind, unemployment may become a state of idleness. When employment means separation from the family and friends, social relationships may deteriorate. If living at home, the unemployed person may feel that the lack of work places an undue burden on the family that may already have difficulty meeting the needs of its members. The workplace reflects the strengths and weaknesses of the community. To assess the scope of drug and alcohol problems, a Canadian study (5) carried out three surveys of more than 2,000 persons in the Alberta workforce, including both the current workforce and those actively seeking work (6, p. 24). Less than 1 in 16 persons reported using illicit drugs, mainly marijuana, in the past 12 months. Among current drug users, 18 per cent reported at least two personal problems associated with their drug use. Alcohol was the most frequently used substance. In research carried out more than 10 years ago (7), disruptive drug use was examined in an extensive study of 468 young adults in Los Angeles, one-third of whom were minorities (black, Hispanic or Asian). Thirty-one per cent admitted to being drunk, stoned or high on at least one psychoactive substance while at work or school during the past six months. Less than 13 per cent of these young adults had sold any illicit drug during the past six months. Disruptive drug use was not limited to a single substance and characteristically involved multiple substances. Alcohol was the most prevalent class of substance used, and marijuana was the most prevalent individual substance used at work or school. The magnitude of the relationship of disruptive drug use and work-related variables was small to moderate. However, "disruptive use of all drugs was significantly correlated with the more times that one lost a job during the past four years, losing a job in the past six months, increased trouble with job, increased vandalism at work, and increased seeking of support and advice from family and friends for a work problem" (7, p. 85). A recent study carried out by ILO and the Commission of the European Communities examined drugs and alcohol in the European workplace. A total of 237 respondents from employers', enterprises' and workers' organizations provided information on drug and alcohol uses of nearly 1.5 million workers in Europe (8). The frequency of drug- and alcohol-related problems during the last three years was obtained for 13 different problems. As indicated in the table below, more than half of the sample reported specific performance impairments and absences from work as a result of drug-related problems. In about two out 33 4. Le Thanh Khoi, "For or with young people: the Asian perspective", in Facing the Future: Young People and Unemployment Around the World (Paris, UNESCO, 199 1). 5. Alberta Alcohol and Drug Abuse Commission, Substance Use and the Alberta Workplace: Summary Report, Edmonton, 1992. 6. Barbara Butler, Alcohol and Drugs and the Workplace (Toronto, Butterworths, 1993). 7. Michael D. Newcomb, Drug Use in the Workplace: Risk Factors for Disruptive Substance Use Among Young Adults (Dover, Massachusetts, Auburn House). 8. Jean Paul Smith, Alcohol and Drugs in the Workplace: Attitudes, Policies and Programmes in the European Community, Report of ILO in collaboration with the Health and Safety Directorate, Commission of the European Communities, Geneva, 1993. 9. Jacques Normand, Richard 0. Lempert and Charles P. O'Brien, eds., Under the Inj7uence? Drugs and the American Work Force, Committee on Drug Use in the Workplace, National Research Council/Institute of Medicine (Washington, D.C., National Academy Press, 1994). 10. United States Postal Service, Personnel Research and Development Branch, Office of Selection and Evaluation, Utility Analysis of premployment Drug Testing As a Selection Device, June 199 1. 11. Craig Zwerling, "Current practice and experience on drug and alcohol testing in the workplace", in Drug and Alcohol Testing in the Workplace: Report of the Interregional Tripartite Experts Meeting, 10-14 May 1993, Oslo (Geneva, ILO, 1994). 34 Part three In Part three, several broad development issues will be examined, including the harmful environmental impacts of drug abuse, issues related to economic and social development, and alternative development. Conceptually and practically, alternative development provides a means to combine general economic and social development with the specific aims of drug abuse prevention and control. This section supports three points of view: one, illicit drug manufacture causes serious environmental damage; two, drug abuse prevention supports broad economic and social development; and three, for some countries, broad economic and social development efforts should include prevention of drug abuse. III. Drugs and the environment Environmental degradation in developing countries is due principally to population pressures, shifting cultivation patterns and the extraction of resources from the earth. In developing countries in the tropics, damage is also inflicted on rain forests, which are cleared for new farms, roads, ranches, dams, factories and other buildings. Environmental damage related to drugs can be caused in essentially three ways: clearing of forests or land, growth and cultivation of plants and processing of harvested plants into drugs. The type of environmental damage found in any country will depend on whether drug producers grow plants, process plants or chemical substances into drugs, or do both. Since coca growers want to avoid police and military detection, they select remote and difficult terrain to clear. According to a recent report, "coca farmers cut down forests on steep hillsides subject to erosion, instead of expanding cultivation of rich alluvial soil on the valley floors" (1, p. 16). An expert from Peru's National Agrarian University (2), states that coca cultivation may have resulted in deforestation of 700,000 hectares in the Amazon region. The situation in Bolivia has similarities to that in Peru. In reviewing the impact of coca growth on the environment in Bolivia, a country expert found that "farmers in the Chapare are estimated to clear between 2 and 6 hectares of land for every one in production. Assuming a (low) peak figure of 52,000 hectares of coca under cultivation in the Chapare ... and an average 2.5 hectares under cultivation with coca and other crops, this would mean that between 260,000 and 780,000 hectares have been cleared as a result of the boom in coca production. This would represent a significant chunk of the 250,000 hectares of forest estimated to be lost annually in recent years due to timber extraction, colonization, and cattle ranching" (3, p. 66ff.). Opium poppy cultivation has historically taken place in South-East Asia, where hill tribe farmers have cleared enormous amounts of rain forest to support their slash-and-bum agricultural system, using the new land for poppy growth and then subsequently moving to find more fertile land. More recently, significant poppy growth has taken place outside South-East and South-West Asia. In the tropical and high mountain forest regions of Latin America, opium poppy cultivators are planting crops on fragile land that is isolated from population centres, thereby reducing visibility and possibility of detection. Cannabis is even more widely grown than either opium or coca. Cannabis growers typically try to use the most fertile soils to produce the biggest crop, often abandoning fields after runoff and erosion have taken place. In an effort to examine the linkage between illicit drug cultivation and harmful environmental impacts, one expert has noted that, unlike indigenous farmers, cultivators of drug crops have fewer ties to the land and are less respectful of it (4, p. 10). As a consequence, their practices are far more wasteful, depleting the soil without allowing an opportunity for it to restore itself. In the effort to produce more plants, growers frequently use herbicides and insecticides, often in large amounts without following the prescribed procedures. 35 Another form of damage to the environment caused by growers of coca and opium results from the improper disposal of toxic wastes created during the processing of the plant material into a consumable drug (1, p. 16, and 4, p. 67). Chemicals used to process plants are often simply thrown on the ground or into streams or rivers. In speaking of Bolivia, an expert has stated that "lime, sodium carbonate, sulfuric acid, kerosene, acetone and hydrochloric acid used in the processing range from being moderately toxic to extremely destructive of the environment. Around 30,000 tons of toxic chemicals are flushed down the waterways each year, and this does not count what the police confiscate and also characteristically discard in the country's waterways. Nor does it count the 200,000 tons of annually discarded contaminated coca leaves thrown about and left to leach into the soil" (5, p. 217). A Peruvian official (6) has concluded that the extensive use of chemicals to process drugs and the practice of disposing of them by the quickest means possible have been responsible for the killing off of species of fish and aquatic plants in the Huallaga River. Other experts, relying on United States government studies, have concluded that cocaine processors in the Andean region" dump each year 10 million liters of sulfuric acid, 16 million liters of ethyl ether, 8 million liters of acetone, and from 40 to 770 million liters of kerosene, depending on how much is recycled. The processors simply pour these dangerous chemicals on to the ground, and they quickly end up in the region's rivers" (1, p. 16). The chemical wastes alter water pH, reduce oxygen and lead to acute poisoning of fish and plants with possible genetic mutations in some species. These pieces of evidence, fragmentary as they are, point to a clear need for more quantitative studies to assess the precise environmental impact of illicit drug cultivation and processing. Notes 1. Patrick Clawson and Rensselaer Lee, Consequences of the Illegal Drug Trade.. the Negative Economic, Political and Social Effects of Cocaine on Latin America, Study for the Bureau of International Narcotics Matters of the United States Department of State. 2. M. Dourojeanni, "Environmental impact of coca cultivation and cocaine production in the Amazon region of Peru", Bulletin on Narcotics, vol. XLIV, No. 2, 1992. 3. Jaines Painter, Bolivia and coca: A study in dependency (Boulder, Colorado, Lynne Rienner Publishers, 1994). 4. L. Annstead, "Illicit narcotics cultivation and processing: the ignored environmental drama", Bulletin on Narcotics, vol. XLIV, No. 2, 1992. 5. LaMond Tullis, Illegal Drugs in Nine Countries.. Socio and Political Consequences, Report prepared for UNRISD at Geneva and the United Nations University at Tokyo, 23 December 1993. 6. T. Marcelo, Rios de la selva: Mas victimas del narcotrafico, Universidad Nacional Agraria, Peru, 1987. 38 V. Alternative development A. What is alternative development? Although the conceptual connection between drug abuse and development has been weak, an operational linkage between the two can be traced back to the early 1970s. At that time, crop substitution to provide sufficient income to replace opium poppies was carried out with pilot projects. Early experiences were frustrating. Each substitute crop brought new problems: selection of the substitutes; gaining experience in planting, care and harvesting; and other difficulties associated with processing, storage and marketing. Officials recognized that agricultural diversification was needed and commercial support was required for production. To survive, development projects had to become more diversified and regional in nature. Poppy-growing regions of Asia needed regional development programmes and the promotion of agroprocessing, the generation of new employment and the introduction of activities in entirely new economic sectors and services, as well as the development of basic infrastructure, especially in transport and communications. These programmes also sometimes required the creation of alternative living conditions acceptable to the local populations. The evolution of development and drug abuse is discussed in the UNDCP technical information paper". Alternative development as an instrument of drug abuse control" (1). What began as crop substitution broadened into integrated rural development and has now further evolved into alternative development as a means of drug abuse prevention and control. Evolution of these concepts has occurred on both the positive side (that is, what was supposed to be stimulated and increased), and on the negative side (what was intended to be given up or eliminated). How these two could be brought together has been a difficult issue. Aid and assistance to countries for specific projects often has conditions placed on it. In some cases, it requires countries to implement control or other measures to ensure the success of the project. The major sources of plant-derived illicit drugs are in developing countries. Opium poppies/heroin, coca/cocaine and cannabis are inextricably tied to problems of development in the countries where they are produced and used. Both development and drug prevention planning require an acceptable level of political stability and continuity of governance to be effective. B. How can alternative development be characterized? According to one commentator, "Alternative development is an approach to policy formulation and implementation that takes into account the economic and social structures that influence illicit drug supply. This approach recognizes that in order to achieve long-run success it is necessary to integrate into the social mainstream peasants, producers and traffickers" (2). The aim, therefore, is to combine development for drug abuse prevention and control with broader, mainstream development efforts. Alternative development programmes assist governments in finding alternative socioeconomic strategies and extending them to farmers engaged in the production of drug-producing crops that the governments want to eliminate. These programmes "may also serve to ease, and thus help encourage, the Based on experience in countries with serious drug problems, both economic and social development and drug abuse prevention and control must proceed together: progress in either area requires success in the other. 39 transition of an entire country from an economic dependency on narcotics production and/or trafficking to a non-narcotics based development strategy" (2). As broad as these programmes are, there is no single approach to alternative development suited to all countries where it may be used. Each country needs a carefully tailored strategy to fit its situation (3). Alternative development differs from mainstream development in that it not only indicates a process of change to strengthen the legal economy but also sets an additional goal, directing change so as to prevent or exclude illicit activities. As a response to rural poor people living in isolated areas producing plants for drugs, infrastructure development is necessary. By itself, however, increasing the infrastructure is not sufficient for successful alternative development. What happens after an area is opened by infrastructure development depends on measures designed to (a) suppress drug production and use and (b) enhance productivity and sustainable income for rural households. Access to productive resources means access to inputs, markets and services. These latter objectives are frequently accomplished with coordinated agricultural development, including sustainable production, marketing and social measures that respond to potential or actual drug problems. Also normally required are credit facilities, extension services, training and information provided to farmers and campesinos. Hence, infrastructure development should be followed up by comprehensive programmes that provide projects tailored to specific needs of communities. C. Necessary components and implementation Why would a farmer grow an alternative crop knowing he will be paid less than he can get for opium, coca or cannabis? Narco-traffickers have huge profits and the flexibility to pay much more than competing buyers can pay for licit crops. On purely economic grounds, it is possible that farmers cannot make as much money, crop for crop, for coffee, fruit, nuts or other commodities as they can from cannabis, opium or coca. The question turns on the issue of what the farmer wants and whether he sees the question solely in terms of immediate money. Hopes for realistic drug abuse control approaches to alternative development depend on the answers to this question. This recurring issue arises in rural development, where it is not always evident whether economic factors alone, or other social, moral or religious considerations, influence the behaviour of farmers, peasants and campesinos (4). The rationale for alternative development involves several considerations. The first is to see the financial side of crop production as involving more than single isolated payments for drug crops as opposed to the security and stability of potential non-drug crop income over several years. By experience, farmers have their own perceptions of the risks involved. They weigh intuitively the known and potential risks and gains of one course of action, growing poppies, coca or cannabis, against the known and potential risks and gains of growing alternative crops. What has been the experience of farmers with payments for drug crops over several seasons? How likely is it that zealous police will rip up plants or put natural predator insects in his fields to destroy crops? Non-economic concerns may also be relevant. Is the farmer afraid that his sons or daughters may become involved in the illicit drug trade or prostitution? Does he or his family have ethical or religious concerns about growing drug crops? Is he under pressure to grow these crops from criminal organizations? In some cases, realistic planning for alternative development needs information on the views of individual farmer and how they, in fact, weigh prospects for gain from legitimate crops promoted by alternative development strategies versus drug crops. The crucial issue is the motivation of farmers and community leaders, as well as civil and military figures and government authorities. If relatively modest income is enough for these persons and they can obtain it through alternative development programmes, then the higher income of poppies or coca may not be sufficiently attractive to offset additional risks. The closed and limited market for selling illicit drugs needs to be turned to the advantage of drug control 40 personnel and against dealers. It may be helpful to regard the farmer or campesino as a private investor who is probably risk-averse and whose primary concern is to have a decent life for himself and his family. The self-interest of all those concerned should be assessed as part of feasibility planning in alternative development programmes since it can bring valuable insights to understanding the process of change (5). Alternative development programmes in rural areas may also have literacy, vocational training and health components. The combined expertise of different national and international development assistance agencies should be used to plan and implement components of integrated programmes, capitalizing on the strengths of each organization. The combined efforts of these agencies, particularly at the international level, increase the likelihood that high-priority targets, such as women and children, will be reached. Alternative development as a strategy applies especially to producing areas where a government has access and influence, along with a political commitment, to make changes. Mobilization of resources is required and collaboration of provincial, national and international agencies is a prerequisite. Short-term aims must be distinguished from long-term goals. The outcome of such projects should be assessed in terms of measurable progress, not achievement of perfection or complete solutions. As described in the UNDCP technical information paper (1), recurrence of production in zones where it had been eliminated, emergence of illicit cultivation in neighbouring zones within or across national borders and opportunistic expansion of production in new areas by criminals-all of these are to be expected. Sustainability of progress in alternative development will increase with experience, given the necessary political, financial and organizational commitments. Drug risks will remain, however: "Experience shows that without the continuation of development activities, there is an increased risk of return to illicit crops as long as there remain disparities between the former drug areas and similar areas which are more developed" (1, p. 26). Notes 1. UNDCP, Alternative Development as an Instrument of Drug Abuse Control, Technical Information Paper 5, 4 November 1993, Vienna. 2. Organization of American States, "Alternative development: A critical dimension of illicit international drug traffic", a Scope paper prepared by the Executive Secretariat of the InterAmerican Drug Abuse Control Commission (CICAD), Lima, 13 September 1993, p. 1. 3. Organization of American States, "Report by the Rapporteur of the Inter-American Meeting of Experts on Alternative Development", Inter-American Drug Abuse Control Commission, Lima, 17 September 1993, p. 2. 4. Edward Friedman, "Review article: What do peasants really want? An exploration of theoretical categories and action consequences", Economic Development and Cultural Change, vol. 4 1, No. 1 (October 1992), pp. 197-205. 5. "Mind over matter", The Economist, 23 April 1994, pp. 73-74. A unique aspect of alternative development is the inclusion of non-economic variables which may reflect farmers' motivations. 43 C. Implications of rural and urban poverty Although rural and urban poor are alike in that they must constantly seek the essentials of daily living, they have basically different kinds of involvement in drug problems. Rural poverty is more related to the supply of illicit drugs and urban poverty is more related to both dealing and demand. Illicit growth provides income for farmers willing to take risks for the higher gain than obtained from licit crops. Because of the size of the shadow economy created by illicit drug money, the absorption of drugs and drug money into the fabric of society and the degree of dependence of many social and economic sectors on this relatively new income, drugs have a social significance far beyond that reflected in statistics on production, consumption or impact. Persons with marginal incomes often spend money on drugs, alcohol or tobacco instead of food, clothes and shelter. With dependence-producing drugs, sporadic use may deteriorate into regular or compulsive use, reinforcing consumption and guaranteeing a market for the supplier. When suppliers become compulsive or regular abusers, illicit growth and supply-demand patterns are more difficult to change. Poverty may change perspective so that immediate money with a risk is preferable to stable but delayed income with less risk. Development programmes should examine the behaviour of farmers and peasants, however, to determine their economic motivations rather than make assumptions about their behaviour based on theory or impressions. Reasonable assurance of a modest income over a long time- span from licit crops may be sufficient to motivate farmers to participate in alternative development programmes. The urban poor do not have the opportunities for crop production as do the poor in remote rural areas. Urban dwellers are, however, exposed to more varieties of abuse and are more vulnerable to taking up jobs in the illicit distribution system. More negative role models and opportunities to make illicit money are found among urban than rural poor. D. Marginalization Due to its highly varied nature in different sociocultural contexts, drug abuse may be seen as normative, marginal, deviant or criminal behaviour. Processes of marginalization apply to the behaviour of governments and communities as well as people. Large numbers of people are migrating from rural poverty to urban squalor, creating shanty towns where serious housing, health, and education problems are bred. Young people especially are vulnerable to drug abuse, especially abuse of cheap solvents, volatile substances and marijuana. Drug subcultures rapidly develop, teaching young persons drug practices. Persons who are identified as drug abusers become more difficult to reintegrate back into the larger community. Indifference or denial to the plight of those with substance abuse disorders, whether practised by individuals, communities or governments, are common. How to avoid stereotyping and stigmatizing persons with drug problems is problematic. A start can be made by separating drug using behaviour from the person, rejecting the illegal behaviour but accepting the person for his or her human potential to follow a different path. In the remote areas of developing countries, no authority may be present to represent the rule of law. Tribal, religious, ethnic or other groups may control a region relatively independent of national policies. In many countries, social and political institutions appear weaker now than decades ago. In extreme cases, these institutions appear under siege, having lost legitimacy and stability. When governments lose contact with people and control of the economic process, civil society is weakened. Civil frustration, violence, terrorism and corruption create conditions ripe for illicit drug growth, production and abuse and vice versa. 44 Drugs, delinquency and crime are related in many ways. In some cases, drug abuse may lead to crime; in others, criminal behaviour precedes drug abuse. The broader impact of drug abuse and crime may increase tension and other deviance, placing additional burdens on institutions such as the family. Drug-related crimes and terrorism cause instability and overload police, courts and prisons. Given sufficient size, drug problems may marginalize governments and institutions as well as people. In extreme cases, these problems may lead to parallel governments, where drug czars exercise enormous personal and financial power. E. Future challenges With neither a single cause nor a simple cure, drug abuse and its many related problems continue to increase in many regions of the world. Problems related to the abuse of drugs are severe in some parts of both the developing and the industrialized world: disease, accidents, deaths, crime, lowered productivity and many other problems are frequently reported. Not adequately monitored, drug abuse acts as a brake on human and social development and cannot be separated from endemic problems of disease, poverty, joblessness and violence. Varying widely between countries, illicit drug use and related problems reflect several characteristics: sales of drugs are usually highly profitable and they are easily marketed commodities. Also, they have powerful effects on the brain and behaviour, influencing a wide range of human activities. Progress in the field of drug abuse prevention depends on several factors. First, our strategies to response to drug problems should begin with the people, communities and institutions involved. People should be considered as the heart of the problem and the beginning of any solution. This principle will obviously take different forms in rural and urban areas and also be influenced by class distinctions. Secondly, alternative development strategies for rural areas should respond to the conditions found in target areas, which will differ according to the communities involved. Thirdly, as in rural settings, urban drug problems also need an individualized assessment and response, building on the strengths found on site. To succeed, urban and rural interventions need a series of support mechanisms and long-term planning. To be effective, both need the support of the local community and a base in public policy. Profits from illicit drug sales are truly enormous, overshadowing major international development efforts in magnitude. The concentration of drug money in the hands of a small number of persons is as important as its size. Further, people who become rich from illicit drugs, however they spend money, are not publicly accountable. The accumulation of huge sums outside the official governmental and economic structures threatens the stability of government, economic institutions and civil society. Further, the illicit activity that produces these sums generates enormous social costs in governance, health care, crime control and integrity of public institutions and officials. Whether the resulting social costs of drug abuse and its problems are greater than any benefits of illicit funds, basic principles of social justice require that these funds not be considered the same as legitimately earned money. By any reasoning, such illicit funds cannot be considered simply another example of the redistribution of wealth by an unsanctioned, alternate market. In 1991, member countries of OECD provided $55.5 billion for official development assistance (4, p. 274). Profits from the illicit drug traffic in cocaine, heroin and cannabis have been estimated at $85 billion by the OECD Financial Action Task Force (5, p. 6). This estimated amount of laundered money is larger than the GNP of three-fourths of the world's economics. 45 AIDS has changed the nature and impact of drug abuse. In the illicit drug scene, the HIV virus is spread in two primary ways: first, contaminated needles or syringes are shared; secondly, infected injecting drug abusers may travel widely. Although heterosexual transmission is the major cause of AIDS in many countries, drug injection is widely practised and high concentrations of seropositive drug injectors exist in Africa, Asia and Latin America. Recent evidence shows that "in cities such as Bangkok and Edinburgh and in the Indian state of Manipur, HIV seroprevalence among drug users has risen from 0 to 40 percent within two years or less" (6, p. 84). Persons between 15 and 45 are frequently the victims of AIDS, with most deaths occurring so far, at least in Africa, among skilled workers. A growing population of young orphans and dependent, older family members will be severely affected socially and economically.