This variation in the acceptability of drug-using behavior is regarded by many young people as hypocritical. The Commission recognizes that contemporary social attitudes are indeed inconsistent, reflecting the special status which this society accords its youth as well as the general confusion regarding what is a drug and what constitutes "drug abuse." For this reason, the first part of this Chapter is devoted to drug consumption within the total population, most of which is not ordinarily characterized as "drug abuse."

The most widely used mood-altering drug in America is alcohol. Retail sales of alcohol (wine, beer and hard liquor) in 1971 amounted to $24.2 billion and sales have increased nearly $7 billion in the fiveyear period from 1966 to 1971. Put another way, Americans consumed almost four and one-half billion gallons of beer, wine and distilled spirits in 1971, a record high for American alcohol consumption. Between 1947 and 1971, the per capita consumption in gallons of beer, wine and distilled spirits among persons of drinking age increased from 27.15 gallons to 30.6 gallons.

In 1970, barbiturates and barbiturate substitutes accounted for 28.6% of the 214 million prescriptions issued for psychoactive drugs. Anti-anxiety agents, the so-called "minor" transquilizers, accounted for almost 39%. Prescriptions for stimulants (13.2%), anti-psychotics (10.2%), and anti-depressants (9%) made up the rest of the total, which represented altogether an estimated $972 million in retail sales (Balter and Levine, 1971).

At the same time, Americans were also obtaining large quantities of over-the-counter (non-prescription) mood-altering agents. In 1970, proprietary sales totalled $28,320,000 worth of sleeping agents, $4,401,000 worth of tranquilizing agents and a substantial, though unknown amount of caffeine stimulants. (See Table II-1.)

who purchase either by prescription or over-the-counter, information presently available indicates that the greatest proportion of such items was purchased and consumed by persons over 21. The same is certainly true with respect to the sale and use of alcoholic beverages. In an effort to assess more precisely the nature and extent of drug use in the American population, the Commission sponsored a national household survey of youth (12 to 17 years) and adults (18 years and over). By means of self-administered questionnaires, respondents anonymously indicated the incidence (ever use), prevalence (current use) and patterns (frequency, intensity, duration and amount) of their drug-using behavior. The questionnaire elicited information on the use of the most common mood-altering substances (tobacco and alcohol), as well as to controlled pharmaceuticals (proprietary and ethical sedatives, tranquilizers and stimulants), and a number of illict mood-altering drugs such as marihuana, LSD, cocaine and heroin.

The Survey findings indicate that substantial segments of our youth and adult population have had some experience with mood-changing drugs but that the incidence, prevalence and patterns of use vary significantly according to a number of important individual and social factors. Before discussing the characteristics of individuals who use drugs of different types and the individual, social and cultural influences which bear upon drug use, it is appropriate to describe the nature and patterns of drug use which emerged from our survey data.

TOBACCO AND ALCOHOL

The Commission's National Survey data show that 38% of the adults and 17% of the youth in this nation currently smoke cigarettes and that about half of the adults (53%) and one-fourth of the youth (24%) had consumed either beer, wine or liquor within the week prior to the Survey.

Although, as indicated earlier, the vast majority of respondents did not regard either tobacco or alcohol as drugs, a significant relationship was found to exist between the consumption of these substances and the use of other types of drugs. About one-half of the adults who admitted to having used "medical" drugs for non-medical reasons (53%), to having consumed alcohol (47%), and to having had some experience with marihuana (56%) were current smokers. Similarly, 86% of the adults and 63% of the youth who had tried marihuana reported consuming alcohol within the seven days prior to the Survey. Both tobacco and alcohol provide striking contrasts to most other forms of drug-using behavior, relative to the frequency, intensity, duration and amount of use. In brief, cigarette smoking and alcohol consumption are significantly more likely to start earlier and last

longer than other types of drug use; and a significantly greater percentage of those who have experience with these drugs progress or escalate to more frequent, more intense and heavier tobacco and alcohol use patterns as they grow from pre-adolescence to adulthood.

Although 5% of the youth reported smoking at least one pack of cigarettes a day, five times as many adults (25%) said they did so. Similarly, with respect to alcohol, one-fifth (20%) of the adults remember having first tried an alcoholic beverage at age ten or younger. Among today's youth, twice that proportion (40%) reported consuming alcohol prior to their eleventh birthday; however, awareness of the mood-changing properties of alcohol and the adoption of "social drinking" patterns do not generally occur until the teen years.

Beer is the type of alcoholic beverage currently consumed with greatest frequency by both youth and adults (17% and 38%, respectively). The consumption of hard liquor, however, reveals a different picture. One-half of all adults who reported consumption of alcohol within the week prior to the Survey consumed liquor (as opposed to beer or wine), but only one-fourth of the alcohol-using young people drank hard liquor.

Although most adults report light to moderate consumption of liquor and wine (up to five glasses a week), a considerable segment of the adult drinking population, roughly one-fourth, are heavier drinkers (more than six drinks in seven days). Among young people, use of wine and liquor tends to be rather light while the frequency of beer drinking is rather evenly distributed.

In terms of the quantity of alcohol consumed at any given time, the data show that on any one day, "light drinking" (one or two drinks on any one day) is the modal behavior pattern for use of the three types of alcoholic beverages in both age groups.

We have already noted the significant relationship between the consumption of alcohol and the use of other classes of drugs. The Survey data further show that the use of alcohol does not always occur by itself; a considerable segment of our population, particularly our young adults (18 to 25 years), use alcohol in combination with other drugs such as stimulants or sedatives, thereby potentiating the effects of both and significantly increasing the risk of individual and social harm. While the use of tobacco and alcohol cannot be said to lead to other types of drug use, this behavior can be viewed as a precursor to and a fairly accurate predictor of other types of drug-using behavior. With respect to cigarette consumption, the most substantial differences in smoking incidence among both youth and adults are found not in demographic attributes, but in other kinds of drug consumption.

is more frequently associated with the reported use of alcoholic bev erages, marihuana or prescription drugs than it is with any one of the social or demographic characteristics of the users. (See Table II-2.)

TABLE 11-2.-SMOKING INCIDENCE RELATED TO DEMOGRAPHIC CHARACTER. ISTICS AND EXPERIENCE WITH OTHER SUBSTANCES 1

1 Figures are not additive; thus, they do not total 100 percent.

Note: Example of how to read table: 42 percent of adult men are current cigarette smokers; 53 percent of adults who have used drugs for nonmedical purposes are current cigarette

smokers.

As Table II-2 shows, cigarette smoking increases with age until it reaches a peak of nearly half the population in the 26-34 age bracket and decreases after that time. Although there are no differences by sex among young smokers, higher proportions of men than women are current cigarette smokers. The data also reveal a somewhat higher percentage of cigarette consumption among the non-white than the white population. Observable, too, among adults is a greater reported incidence of cigarette smoking among people who live in the South or in metropolitan areas than among those residing in other geographic sectors or in rural areas. In sum, the Commission's National Survey data show that 53,114,000 adults and 4,234,000 youth currently smoke cigarettes.1

As shown in Table II-3, 53% or 74,080,000 adults 18 years and over, and 24% or 5,977,000 youth 12 to 17 years of age had consumed some type of alcoholic beverage within the week prior to the survey.2

Numerous social and demographic differences exist with respect to alcohol consumption. On the variable of sex, males, both adult and youth, are considerably more likely than females to be alcohol consumers. With regard to age, use begins its steep climb during the middle teens, reaches its high point (66%) in the 22-25-year age group and gradually levels off thereafter to about 39% of the 50 years and over age group.

Alcohol consumption also increases with years of formal education; only 38% of adults with some high school education as compared with more than 71% of those with some college education had consumed alcohol within the past week.

The highest proportion of adult consumers resides in the Northeast (65%) and the lowest proportion (37%) live in the South. Among youth, consumers are more equally distributed throughout the country, but again the smallest proportion is found in the South (15%). In both age groups, consumption is more prevalent in metropolitan than rural areas but the differences according to community type are not as pronounced among youth as they are for the adult population. (See Table II-3.)

2

1 Based upon U.S. Census data projections as of July 1, 1972.

The "past seven days" was arbitrarily established to define "use" because it provides more reliable data on consumption of beer, wine and liquor than does a longer reporting period.

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