The Various Theories Behind Drug and Alcohol Policy
The following is a paper I wrote for one of my classes in my PhD program:
Ever since the 1800’s, several states have banned certain drugs and our nation first placed federal restrictions on drugs like opium in the 1890’s (Kleiman et al., 2011). Drug prohibition and restrictions have been a prominent component of our criminal justice system for a long time, and it looks like they are here to stay. However, our country has varied in its approaches to the problems that arise from drug and alcohol consumption. This paper attempts to describe those different approaches and the theories that inspired them.
Legislative approaches have ranged from prohibiting the sale, manufacturing, distribution (but not the consumption), of a drug to complete criminalization (including the consumption). Other recent approaches have included complete legalization -- accompanied by excise taxes and regulations on where, when, and to whom the product can be sold (in the case of alcohol and cannabis) (Cook, 2007; Kleiman et al., 2011; Latzer, 2017, 2021). Approaches from law enforcement have ranged from vigorous enforcement(with harsh correctional penalties) to moderate enforcement (accompanied by some form of therapy or drug treatment) (Kleiman et al., 2011;Latzer, 2017,2021; Pfaff, 2015, 2017).
While there have been bans on drugs since the late 1800’s, our country’s first vigorous attempt to crack down on drugs actually began with alcohol prohibition starting in 1917 (Cook, 2007; Latzer, 2021). Prohibition started during WWI due to the federal government’s desire to conserve alcohol for the war effort, since military medical staff would be needing it to treat wounded soldiers. It then morphed into the Volstead Act, which was ratified as the 18th amendment to the constitution in 1920 (Cook, 2007; Latzer, 2021). The Act criminalized the making, selling, and distribution (but not the consumption) of alcohol. It was repealed in 1933 with the passing of the 21st amendment due to lax and sporadic enforcement, along with it being politically unpopular (Cook, 2007; Latzer, 2021).
After the repeal, our country’s alcohol laws morphed into more of a federalist approach, with some states keeping prohibition, while others allowing the sale of alcohol, but with a highly-regulated state monopoly (Cook, 2007); another approach was to allow private companies to sell alcohol, but with excise taxes and regulations that limited where, when, and to whom alcohol could be sold -- along with restrictions on how many alcohol-selling establishments there could be within a given geographical area (Cook, 2007; Payne et al., 2013). Once the 1960’s and 70’s hit, many states began to repeal these restrictions, with only seven states currently keeping these restrictions (Cook, 2007; Cook et al., 2021; Naimi et al., 2017; Payne et al., 2013; Xuan et al., 2015). However, even though our country as whole has become more lax regarding alcohol policy, the federal government did pass a law in 1984 making 21 the minimum drinking age (Cook, 2007).
The tale of drugs is a slightly different story. For most of the 20th century and all of the 21st, the possession, making, selling, and distribution of almost all drugs has been criminalized in the US (although the effort to enforce these laws have varied throughout our history) (Pfaff, 2015, 2017). Drugs such as marijuana, opioids, hallucinogens, methamphetamines, and cocaine have been the main focus of these policies, and different approaches have been emphasized to combat them. Many of these drugs started out as recreational drugs, or widely-used medications, and were even ingredients in popular food and drinks -- but they were eventually banned when their harmful and addictive properties were discovered (Kleiman et al., 2011).
These drug restrictions also had some culture-war aspects to them since many of these drugs were introduced to the U.S. by immigrants (e.g. Chinese and opium, Mexicans and cannabis), and there were also some culture-war aspects to alcohol prohibition since the U.S. Protestant population felt threatened by the newly-arrived alcohol-drinking Irish and Italian Catholics (Latzer, 2017, 2021). Petty culture-war disputes aside, the harmful effects of all these drugs were real and there were many progressive politicians, academics, and thought leaders who wished to stop the increased consumption of these drugs because of their very real criminogenic and addictive properties (Cook, 2007; Kleiman et al., 2011; Latzer, 2017, 2021; Pfaff, 2017).
Heroin and powder cocaine were the main drugs of focus during the 60’s and 70’s, and it was during this time that a more rehabilitative approach (with moderate enforcement) was taken to combat it (Pfaff, 2015, 2017). However, it was in the mid 70’s that some scholars and criminal justice professionals began to believe that “nothing works” when it came to programs intended to reform criminals and drug users. It was shortly thereafter that more punitive drug policy measures began to be implemented in the mid 80’s and 90’s (Paff, 2015, 2017; Weisburd et al., 2016, 2017)
In the mid 1980’s, crack cocaine hit the scene and -- next to alcohol -- it proved to be one of the most criminogenic drugs in our nation’s history (Cork, 1999; Grogger & Willis, 2000; Kennedy, 1993; Latzer, 2017; Pacula et al., 2013). Given crack’s propensity to foment violence -- coupled with the tough-on-crime atmosphere of the time -- there was a concerted effort by police departments to crack down on the people making and distributing crack (Latzer, 2017). The penalty for possession of 5 grams of crack became equivalent to the penalty for 500 grams of powder cocaine at the federal level -- and many states followed suit (Kennedy, 1993; Kleiman et al., 2011). The crack epidemic has been partly credited with creating the highest levels of crime this country saw in the mid 80’s and early 90’s, which is partly why there was such a severe reaction to it from the criminal justice system (Latzer, 2017). Likewise, the end of the crack epidemic has been partly credited for the crime drop beginning in 1992 and continuing to the present day (Latzer, 2017; Levitt, 2004; Zimring, 2008, 2011).
After the crack epidemic began to subside, methamphetamine began to take its place, and the illegal markets associated with meth are still prevalent in the U.S. today. The U.S. has made concerted efforts to crack down on meth markets and distribution (Pacula et al., 2013). Opioids have also made a comeback in recent years with problems that start with addictions to prescriptions eventually morphing into heroin and fentanyl use (Pacula et al., 2013).
Throughout all the time periods mentioned above, marijuana was also being used frequently by the populace. While it has been illegal in the U.S. since the 1930’s, it has not received the harsh blowback from our criminal justice system like crack, meth, and heroin have -- given that it is not nearly as criminogenic as these drugs are (Kleiman et al., 2011; Pacula et al., 2013). However, given that many states have recently legalized marijuana for medical or recreational use, there are merited concerns that increased marijuana use will increase deaths due to impaired driving (Alexander et al., 2017).
What Theories Have Inspired These Policies?
There are certain theory families that I believe influence current and past drug and alcohol policies. These are as follows: classical criminology theories, biological theories, and social learning/social contagion theories. I will discuss the various theories that fall under each family and how they influence current and past drug and alcohol policies. For convenience, I will not be citing the original creators of these theories, nor will I go into an exhaustive discussion on their origin. When referring to any specific theories I will cite Snipes et al. (2019) and Robinson & Beaver (2020), where a detailed description of all these theories can be found.
Classical Criminology Theories
Within the family of classical criminology, there is routine activities theory (Snipes et al., 2019; Robinson & Beaver, 2020). Purveyors of this theory assert that differences in risks of victimization and offending are associated with the varying routines of different lifestyles, which include vocational activities and leisure activities (Snipes et al., 2019). For example, people who are younger, male, unmarried, poor, and from a disadvantaged ethnic minority group have higher risks of offending and victimization than people who are older, female, married, wealthy, and from the privileged ethnic majority. The theory holds that the first group engages in routine activities that are more likely to result in criminal victimization and offending (e.g. being away from home with groups of people from similar demographics, especially at night) (Snipes et al., 2019). In order for a person to have criminogenic routine activities, there must be a convergence of these three factors: a motivated offender, a suitable target, and an absence of a capable guardian (e.g. police) (Snipes et al., 2019).
One drug policy that would fit within this theory is alcohol prohibition from 1917 to 1933. One of the main proponents of prohibition during that time was the Anti-Saloon League, which was a group that recognized that the disinhibiting effects of alcohol combined with large groups of young men coming from the criminogenic demographics mentioned above were a toxic combination. And they were right (Cook, 2007; Latzer, 2021). Assaults and murders were all-too-common in saloons, and they became a part of the “routine activities” of young men with criminogenic backgrounds, making saloons crime hotspots (Cook, 2007; Latzer, 2021). One of the goals of prohibition was to kill the saloon thereby changing the routine activities of these young men. In this effort, prohibition was successful. According to Blocker (2006):
By the end of the 20th century, two thirds of the alcohol consumed by Americans was drunk in the home or at private parties. In other words, the model of drinking within a framework of domestic sociability, which had been shaped by women, had largely superseded the style of public drinking men had created in their saloons and clubs. Prohibition helped to bring about this major change in American drinking patterns by killing the saloon, but it also had an indirect influence in the same direction, by way of the state...Some states retained their prohibition laws—the last repeal occurring only in 1966—but most created pervasive systems of liquor control that affected drinking in every aspect... With the invention of the aluminum beer can and the spread of home refrigeration after the 1930s, the way was cleared for the home to become the prime drinking site.
Thus, prohibition succeeded in changing the routine activities of young men from criminogenic backgrounds which limited their opportunities to commit violence. But did this succeed in reducing violence overall? The 1920’s saw a major violent crime wave, and some have attributed that wave to prohibition (Jensen, 2000). However, most serious analyses have found that, while violent crime did go up in the 20’s, prohibition was not the cause of it. One exception was gang crime: prohibition appears to have increased violent crime associated with alcohol gangs and smugglers (Cook, 2007; Latzer, 2021). Most studies have found that the overall crime wave was due to a rise in urbanization and a dramatic change in the demographic composition of the U.S. population (Asbridge & Weerasinghe, 2009; Owens, 2011). A more recent analysis shows that state and federal level prohibition during that era did reduce homicides at the beginning of its enforcement, but did not have any effects afterwards (Livingstone, 2016).
Therefore, during the era of prohibition, studies have shown that the law either had no effect on overall violent crime or a negative relationship with it (Asbridge & Weerasinghe, 2009; Cook, 2007; Livingstone, 2016; Latzer, 202; Owens, 2011). The main effects of prohibition were not felt until after the law was repealed. As Blocker (2006) stated earlier, the killing of the saloon changed the country’s routine activities associated with alcohol. This had a lag effect, which contributed not only to much lower overall alcohol consumption from 1925 to 1965, but one of the lowest levels of violent crime this country has ever seen from 1935 to 1965 (Latzer, 2017, 2021).
A more recent example of routine activities theory seen in practice is how the police have dealt with drugs, especially crack in the late 1980’s and early 1990’s along with meth and opioids today. It has long been observed by researchers that flagrant drug markets tend to be much more violent than discrete markets (Kleiman et al., 2011). Flagrant markets are characterized by dealers selling their drugs out in the open streets or in designated drug houses; whereas discrete markets are characterized by dealers selling their drugs within the confines of their home or apartment (Kleiman et al., 2011).
Dealers on street corners and in drug houses are attractive targets for robbery and therefore need to be armed. And the buyers in those markets are both targets of robbery and likely perpetrators of property crime to feed their habits. Flagrant markets only emerge when there is a sufficient density of customers, making it extremely difficult for the police to arrest all of them (Kleiman et al., 2011).
Certain proactive policing strategies (like hot spot policing and focused-deterrence policing) have been used to disrupt the routine activities of the dealers and buyers within these flagrant markets (Snipes et al., 2019). Several systematic reviews have shown that these strategies are very effective in diffusing these crime hotspots associated with flagrant markets and specifically target the gang members who are most responsible for the violent crime (Weisburd et al., 2016, 2017). Specific cases of their effectiveness would be Operation Ceasefire in Boston and the hot-spot policing in New York City that took place under Rudy Guliana and William Bratton, which were extremely successful (Snipes et al., 2019; Zimring, 2011). Even if these strategies do not succeed in decreasing overall drug consumption and dealing, they can reduce the violence associated with flagrant markets by forcing the dealers and buyers into more discreet markets (Kleiman et al., 2011).
This strategy was exemplified best during the crack epidemic of the 80’s and 90’s. Crack during this time period was renowned for being the most criminogenic drug next to alcohol; the high-to-price ratio of crack led to high demand and therefore high rates of market-based crime along with numerous property crimes and robberies in inner cities. (Friedman, 1998; Latzer, 2017; Pacula et al., 2013; Parker & Auerhahn; 1998). Several studies showed a connection between the emergence of crack in various cities to an increase in homicides, robberies, and other severe violent crimes that wreaked havoc in poor urban communities (Baumer et al., 1998; Cork, 1999; Grogger & Willis, 2000; Kennedy, 1993).
In fact the crime drop that happened after 1992 (which is still ongoing) is partially due to the end of the crack epidemic (which accounts for 15% of the crime drop) (Levitt, 2004; Zimring, 2008), and the epidemic (along with violent crime in general) ended partly due to the following following reasons: an increase in the number of police in the U.S. by the tens of thousands (which explains 5-6% of the crime drop), an increased utilization of proactive policing like focused-deterrence policing and hot-spot policing, incarcerating more offenders and adding harsher sentences (which explains 10-27% of the crime drop) (Latzer, 2017; Levitt, 2004; Zimring, 2008). All of these tactics served to disrupt the routine activities of those in the crack trade by removing them completely from their neighborhoods, by diffusing them away from crime hot-spots and forcing them into more discreet markets, or by deterring them from committing crime due to promises of swift and certain punishment (Latzer, 2017; Levitt, 2004; Zimring, 2008, 2011).
Biological Theories
One of the most obvious connections between alcohol and drugs and behavior are their disinhibiting effects (Vohs & Baumeister, 2016). While the biological mechanisms by which this happens are under dispute, nevertheless, the disinhibiting effects are real and these effects increase the likelihood that a person will commit a crime; this is true especially with alcohol, but it is true with other drugs, as well (Exum, 2006; Friedman, 1998; Pacula et al., 2013; Parker & Auerhahn, 1998). The violence associated with drug and alcohol consumption usually falls under three categories: the violence that results from disinhibition, the violence that results from a person's desire to feed their addiction, and market-based violence (Kleiman et al., 2011). This section mainly deals with the first two.
Contrary to popular belief, alcohol does not increase a person’s impulse to do stupid or destructive things; instead it simply removes restraints. It lessens self control in two ways: by lowering blood glucose and by reducing self awareness. Therefore, it mainly affects behaviors marked by inner conflicts, such as when one part of the psyche wants to do something and another part does not -- like having sex with the wrong person, spending too much money, getting into a fight, or committing a violent crime (Vohs & Baumeister, 2016). Alcohol increases aggressive behavior at lower doses and temporarily decreases it at higher doses (Friedman, 1998). Cook (2007) showed a strong correlation between levels of alcohol consumption in an area and sexual assault, drunk driving, and violent crime.
Regarding the specific biological mechanisms that connect alcohol to violent behavior, the conclusions are still unclear, but possible mediators are that alcohol lowers serotonin levels and blood glucose levels, and genetic predispositions (Snipes et al., 2019; Vohs & Baumeister, 2016). Whatever the biological mechanisms are, the relationship between alcohol and violent crime in experimental studies, macro-level studies, and numerous meta-analyses is very strong -- especially for men (Cook, 2007; Exum, 2006; Friedman, 1998; Parker & Auerhahn, 1998; Duke et al., 2018; White & Hansel, 1996). The relationship between the simultaneous consumption of alcohol and drugs and violent behavior is especially strong (Duke et al., 2018).
Regarding various illegal drugs, the biological explanation for the crime associated with those drugs is not as strong as it is with alcohol, but the link is still there. For crack, the combination of cheap prices and the intense, but short-lasting, high proved to be devastating to urban communities (Latzer, 2017). The crack-based violence that was not market related was mostly related to people committing property crimes and robberies (which often resulted in homicides) in order to feed their addictions (Friedman, 1998; Parker & Auerhahn, 1998; Duke et al., 2018; Pacula et al., 2013; White & Hansel, 1996). Females would often turn to prostitution to feed their addiction, and there were myriads of violent crimes associated with prostitution rings (Latzer, 2017). Unlike alcohol, I have not been able to find evidence of crime related to the disinhibiting effects of crack.
Opiate withdrawal and meth use have been connected to aggressive behavior and crime (Duke et al., 2018; Snipes et al., 2019). Heroin addiction (but not heroin markets) have been shown to be most strongly causally related to property crimes (Pacula et al., 2013). While there has been no evidence for marijuana use being a catalyst for criminal behavior by itself, there is concern that it may be a gateway drug to other drugs that are criminogenic (Kleiman et al., 2011). There is also concern that the legalization of it in certain states has increased accidents due to impaired driving (Alexander et al., 2017).
One of the central premises of biological theories is that if there are biological causes to criminal behavior then there must be biological solutions (Weisburd et al., 2016, 2017). In the case of drug and alcohol policies that are based on biological theories, several treatments have been devised to help people with addiction. Such treatments include taking drugs like methadone, buprenorphine, and naltrexone (Kleiman et al., 2011).
Methadone is a synthetic chemical that binds to the same chemical receptors as heroin and other opiates. It is longer-lasting than heroin, meaning that someone using methadone does not experience the same levels of euphoria and craving that is common with heroin use (Kleiman et al., 2011). Buprenorphine is a semi-synthetic opioid partial agonist, which means that it is less powerful than the full agonists like heroin or methadone. Both of these drugs are meant to make the withdrawal period more comfortable for the addict without quitting opiates “cold turkey,” which can be very unpleasant (Kleiman et al., 2011). Several systematic reviews have found these treatments to be very effective in treating opiate addiction and lowering the crime that is associated with the addiction (Kleiman et al., 2011; Weisburd et al., 2016, 2017).
Naltrexone, one the other hand, is not meant to simulate the effects of opiates, but block the euphoric and sedative effects of opiates and alcohol (Kleiman et al., 2011). Several systematic reviews have found it to be extremely effective in treating heroin addiction (even more effective than methadone and buprenorphine), and it has had moderate success with alcohol addiction as well (Weisburd et al., 2016, 2017). The most important part about all of these drug treatments is that they not only help with addiction, but they also help reduce property and violent crime that is often associated with drug addiction; this finding is indirect evidence that these drugs do cause crime (Weisburd et al., 2016, 2017).
For cocaine or meth, there is no biologically based treatment like the ones mentioned above. Successful treatments include therapeutic communities, drug courts, twelve step programs, and cognitive behavioral therapy (Kleiman et al., 2011; Vohs & Baumeister, 2016; Weisburd et al., 2016, 2017). Policy makers and medical professionals hope that biologically-based treatments for these drugs will be available in the future.
Social Contagion and Learning Theories
Purveyors of social learning theory believe that social behavior is learned by observing and imitating the behavior of others (Snipes et al., 2019). Pratt et al. (2010) conducted a meta-analysis of 133 studies asking if there was empirical support for social learning theory and deviant behavior in youth. They found strong effect sizes and that peer influence was stronger than parents’ influence (although parents influence was still fairly strong). So how does this apply to drug and alcohol policy?
The criminalization and regulation of these substances isn’t meant to just deter those who are already abusing them. They are meant to prevent people from abusing them in the first place. One observation that Cook (2007) made from his review of the literature is that the more casual drinkers a state has, the more binge drinkers they have, too. Said differently, the more “wet” an area is, the more binge drinking, teenage drinking, drunk driving, sexual assaults, and familial violence there will be in that area (Cook, 2007).
One quasi-experimental way to see if this is true is to look at various states before and after they enact an alcohol tax or regulation. After analyzing 30 years of research on state alcohol taxes, Cook (2007) estimated that a tripling of the alcohol excise tax reduced homicide and motor vehicle fatalities by six percent. Policies that enforce age limits on drinking and put restrictions on where, when, and how many alcohol selling establishments have also been shown to be very effective in reducing various violent crimes, drunk-driving fatalities, alcohol-related family problems, and youth binge drinking (Branas et al., 2020; Cook et al., 2021; Naimi et al., 2017; Payne et al., 2013; Xuan et al., 2015).
All of this evidence lends support to social learning theory because these policies incentivize the reduction of casual drinkers in a given area (Cook, 2007; Kleiman et al., 2011). People who become alcohol abusers - and therefore are more likely to commit the alcohol related crimes listed above - usually start drinking because they observe the examples of their peers or family members. Even if the peers and family members are not alcohol abusers, the chances of a person becoming an alcohol abuser rises if everyone around them are casual drinkers as opposed to alcohol abstainers (Cook, 2007).
A macro level version of social learning theory is social contagion theory (Latzer 2017). Once drinking becomes accepted all over the country and is depicted favorably by one’s friends and family and by the media, it then becomes more common and begins to spread and become “contagious” to the surrounding community (Kleiman et al., 2011; Latzer, 2017). Increased demand for an activity directly raises its popularity. This is especially true for teenagers where, even if the rewards for a certain destructive behavior is low, they will still engage in it because their peers are doing it and the behavior is depicted favorably in the media (Latzer, 2017). Increases in problematic drug use and drinking among youth can spread throughout an entire state or country due to social contagion (Latzer, 2017). The policies listed above are meant to limit the access of alcohol to casual drinkers, therefore making drinking less socially- and culturally -acceptable, and therefore limiting the amount of problematic drinkers in a given area (Cook, 2007; Payne et al., 2013; Kleiman et al., 2011).
Since alcohol is already an integral part of our culture, an outright ban would probably not be feasible. Therefore, raising prices through taxes and decreasing easy access to it through the regulations mentioned above are a much more logical path to take if one wants to make alcohol consumption less socially-acceptable (Branas et al., 2020; Cook et al., 2021; Naimi et al., 2017; Payne et al., 2013; Xuan et al., 2015). However, when it comes to drugs, outright prohibition is still a viable option. Since drugs are less socially-acceptable in our society than alcohol, it is much more feasible to increase prices and reduce access to them through criminalization; doing this increases the likelihood that they will stay socially-unacceptable and don’t become as widespread as alcohol (Kleiman et al., 2011).
However, when it comes to enforcement, extremely punitive policing measures need to be avoided as they tend to create extremely violent drug markets (Werb et al., 2011). And there is evidence that overly-punitive drug enforcement sees diminishing returns when it comes to raising drug prices (Kleiman et al., 2011). Criminalization, coupled with moderate enforcement and drug treatment, is enough to raise prices, decrease access, prevent social contagion, and also help rehabilitate those who exhibit problematic behavior related to drug use (Kleiman et al., 2011; Pfaff, 2017). This combination will keep the social acceptability of drug use low, while also helping those who chose to use drugs (despite it being illegal), thus reducing the likelihood of social contagion that has already happened with alcohol (Caulkins & Reuter, 2021).
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