This collection of statements provides you with CASAColumbia’s stance on pressing addiction issues.
Position statements Accordion
CASAColumbia recommends that the U.S. Food and Drug Administration (FDA) take immediate action to assert the regulatory authority granted in the Tobacco Control Act and regulate e-cigarettes as cigarettes, and that the federal and state governments tax them accordingly.
As is the case with conventional cigarettes, e-cigarettes deliver nicotine, an addictive drug. A growing body of evidence suggests that early use of nicotine increases the risk of addiction involving not only nicotine but also other drugs. In fact, 95% of cases of addiction involving nicotine originate with substance use before age 21. High school students who have ever smoked cigarettes are 9 times likelier to develop addiction involving alcohol or other drugs than those who have never smoked. Tobacco, alcohol and other substance use and addiction is the largest preventable and most costly health problem in the U.S.
As the tobacco industry knows only too well, the best way to get a lifetime user is to start them early. This explains current e-cigarette marketing tactics that revive the glamorous promotional cues which for decades have attracted young people to the deadly habit of cigarette smoking. E-cigarettes are designed to look like cigarettes, are often flavored in ways that appeal directly to children and adolescents, including candy and menthol, and may be used as a bridge to other addictive substances, including conventional cigarettes.
While e-cigarettes probably are less toxic than conventional cigarettes, there is no evidence to assure their safety and some evidence to suggest they may carry negative health effects that should not be ignored. If e-cigarettes were used only as replacement products for smokers who have been unable to quit smoking, they appear to be harm reduction products; however, research on how these products are used is very scarce and some suggests that e-cigarettes are being used to supplement rather than replace other tobacco use. E-cigarettes also are promoted as safer than combustible tobacco products because of the lack of secondhand smoke. While it is true that e-cigarettes do not produce carcinogenic smoke, there is not sufficient evidence to prove they have no secondhand effects.
Given the history of cigarette marketing in this country and the horrific health consequences and costs that resulted, we should be very careful about endorsing this new product without first developing a solid understanding of its impact on health, public safety and the anticipated market for new users.
There may be therapeutic value in a vaporized nicotine delivery system for the purpose of tobacco use cessation. Companies interested in developing such products should use the established FDA process for bringing drugs to market while assuring their safety and efficacy.
Research documented in CASAColumbia’s two recent reports, Adolescent Substance Use: America’s #1 Public Health Problem (2011) and Addiction Medicine: Closing the Gap between Science and Practice (2012), affirms that addiction is a brain disease that typically originates with substance use in adolescence.
In the U.S., 9 out of 10 people who meet clinical criteria for addiction started smoking, drinking or using other drugs before age 18. The earlier substance use begins, the greater the likelihood of developing addiction. Individuals who first use any addictive substance before age 15 are 6 1/2 times as likely to develop addiction as those who delay first use until age 21 or older; yet the average age that high school students report starting to use an addictive substance is between 13 and 14 years.
Given that three-fourths (76%) of all high school students report having used an addictive substance in their lifetime and almost half (46%) have done so in the past month, it is critical to understand the link between adolescent substance use and addiction and address it accordingly. 1 in 8 high school students meets clinical criteria for addiction and, among those who have used an addictive substance in the past month, 1 in 3 already is addicted.
The combination of several factors makes adolescence the critical period of vulnerability for beginning to use addictive substances and for developing the disease of addiction:
- Because the parts of the brain responsible for judgment, decision-making, emotion and impulse control are not fully developed until early adulthood, adolescents are more likely than adults to take risks, including experimenting with addictive substances
- Because these regions of the brain are still developing, they appear to be more vulnerable to the negative impact of addictive substances, further interfering with brain development and increasing the risk of addiction
- Compounding these biological vulnerabilities is the fact that adolescents are exposed to a constant stream of messages from friends, family, advertising and the entertainment media promoting and glamorizing substance use at a time of peak susceptibility to social influences. Some teens may also have genetic or biological conditions or personal experiences such as abuse or other trauma that when combined with these factors further increase their risk of substance use and addiction
Adolescent substance use not only increases the risk of addiction, it also has profound social and financial costs. It is directly linked to the three leading causes of death among adolescents—accidents, homicides and suicides—and is implicated in poor academic performance, cognitive impairment and school dropout; unprotected sex and unintended pregnancies; mental health problems; violence and criminal involvement; and numerous potentially fatal medical conditions.
Adolescent substance use is our country’s largest preventable and ultimately most costly health problem. To address it, the public, health professionals and policymakers must recognize it as a health problem rather than a normal rite of passage, help young people delay substance use for as long as possible, be vigilant for signs of risk and intervene appropriately as we do for any other health condition.
In order to reduce crime and save taxpayer dollars, the U.S. justice system must address risky substance use and addiction as health problems and provide effective intervention and treatment. While individuals who commit crimes as a result of their substance use must be held accountable, incarceration alone cannot prevent or treat a disease.
As of 2005, 1.5 million (66%) of the 2.3 million inmates incarcerated in the U.S. met the clinical criteria for addiction. An additional 458,000 inmates had histories of substance use; were under the influence of alcohol or other drugs at the time of their crime; committed their offense to get money to buy drugs; were incarcerated for an alcohol or other drug law violation; or shared some combination of these characteristics. In total, 85% of America’s prison and jail inmates are substance-involved.
Crime related to risky substance use and addiction is not limited to adults in the justice system. 78% of 10- to 17-year olds in the juvenile justice system are substance-involved. Among juvenile offenders, 44% meet clinical criteria for addiction involving alcohol and drugs other than nicotine as do more than half of juvenile offenders incarcerated in state prisons and local jails.
People entering the justice system as juveniles or adults who are risky users but not addicted do not routinely receive any interventions to help them reduce their risky use, and despite these high rates of addiction among both adult and juvenile offenders, few in need of treatment receive it. CASAColumbia found that less than 4% of juvenile offenders and only 11% of all prison and jail inmates with addiction receive any treatment. Most of those who do receive treatment do not receive evidence-based care.
CASAColumbia has documented the profound link between substance use and crime in 3 national research studies of America’s justice system: Behind Bars; Behind Bars II: Substance Abuse and America’s Prison Population; and Criminal Neglect: Substance Abuse, Juvenile Justice and the Children Left Behind, and has documented the enormous return on investment possible from providing addiction treatment. If all inmates who needed treatment and disease management received such services and a mere 10% remained substance free, crime free and employed, our nation would reap an economic benefit of more than $90,000 per year for each of these inmates.
To reduce the number of substance-involved offenders, the justice systems must employ trained health care professionals to screen, assess, intervene and treat these offenders using evidence-based pharmaceutical and psychosocial therapies and provide care for co-occurring health (including psychiatric) conditions. Addiction treatment for inmates must be medically managed, and corrections-based treatment programs and providers should be required to be accredited. We must also expand the use of treatment-based alternatives to incarceration and assure that individuals with addiction facing release and re-entry receive appropriate post-release treatment, disease management and support services.