Alcohol, Tobacco Take Heavy Toll, Get Little Notice

The national fervor to stamp out drug addiction, from Nancy Reagan’s “Just Say No” campaign to the federal war on domestic marijuana growers, has stifled concern about “legal drugs” that do the most serious damage to society, some addiction experts say.

Alcohol and tobacco cause many times the number of deaths attributed to illegal drugs and are far more costly in terms of time lost from work and medical bills, according to federal and private statistics.

“In reality, if you look at historical drug use, our worst drugs are basically our legal ones,” said Daryl Inaba, an expert in biochemical addictions at San Francisco’s Haight-Ashbury Medical Clinic. “There’s no greater problems from a health perspective than those posed by alcohol, nicotine and caffeine.”

Drug treatment experts also believe that addictions to alcohol and tobacco are stronger--and in many cases more dangerous to kick--than even addiction to heroin. They fear that the increased funds and publicity aimed at drug enforcement will reduce efforts at drug treatment and prevention.

The American Cancer Society predicts that more than 320,000 Americans will die this year of diseases linked to smoking. The National Council on Alcoholism says 98,000 Americans will die from alcohol abuse, a figure that encompasses medical problems, automobile crashes, homicides, suicides and accidents.

National figures on drug deaths are wildly variant, with a high of about 30,000 in published but unattributed reports in news magazines.

About 4,200 deaths annually are attributed to illegal drug use, about one-third of these from heroin, in a survey of 26 metropolitan areas by the National Institute on Drug Abuse plus separate New York City figures. Fewer than 800 of the listed deaths were from cocaine, a current prime target of federal enforcement efforts, although drug experts caution that such deaths are often listed as natural and not recorded.

Inaba said the current high profile on illegal drug use is part of a recurring historical cycle, but “it’s kind of hypocritical as a society to continue to concentrate or react to cocaine, heroin or marijuana. We’re almost all drug abusers, and the drugs we use have an impact on our lives.”

The latest upswing in the war on drugs was partially triggered by this summer’s cocaine-related deaths of Maryland basketball star Len Bias and Cleveland Browns defensive back Don Rogers. The deaths coincided with, and encouraged, massive publicity on the dangers of crack, a smokeable form of cocaine available in small quantities at $10 a vial and far more powerful and frightening than powdered cocaine.

President Reagan in August called for a national crusade against drugs and suggested that federal employees in sensitive jobs such as air traffic control undergo drug testing. Atty. Gen. Edwin Meese III suggested that employers not only test for drugs, but also monitor employees as far as the local tavern for evidence of drug use.

At the same time, the Administration’s new anti-drug initiative has earmarked $262 million in federal funds in 1987 for research, prevention and treatment of alcohol and drug abuse, a slight increase from $200 million in 1982. An additional $672 million is budgeted in 1987 for block grants to states for substance-abuse treatment programs, an increase of $163 million over this year.

The drug-enforcement budget, aimed at importers and growers, has gone from $853 million in 1982 to $1.8 billion this year.

Confiscations of illegal drugs are at an all-time high (an Oct. 29 cocaine bust in Florida yielded a record 4,620 pounds), but the number of overall users has not declined. There has been a slight downturn in the number of regular marijuana smokers from 20 million in 1982 to 18.2 million currently, but cocaine use in the same period has risen from 4.2 million people to 5.8 million.

In all other illegal-drug categories, where current use is defined as having tried the substance in the last 30 days, a recent household survey by the National Institute on Drug Abuse found about 12.5 million people, some of whom may be counted more than once for different drugs:uppers, downers, hallucinogens.

An estimated 500,000 of these are hard-core heroin users, a figure that has remained level for about 15 years.

Users of alcohol, on the other hand, number 113.1 million Americans, with 12.1 million having symptoms of alcoholism--an 8.5%increase since 1980, according to drug institute figures. There are 60.3 million cigarette smokers.

The economic cost to employers from alcohol abuse is estimated at $116.7 billion--compared to $33 billion from drug abuse--due to absenteeism, lost productivity and higher accident rates, according to government figures.

Heroin Withdrawal Easier

Medically, alcohol and cigarette addictions are the hardest habits to break. Dr. William Brostoff, director of chemical dependency at Marin County’s Ross Valley Medical Clinic, said it is easier to withdraw or undergo detoxification from cocaine or even heroin.

“Heroin withdrawal used to be considered most dreaded,” Brostoff, an internal medicine specialist, said. “But, under medical supervision, it is not a serious problem. In the most severe cases, it’s somewhat like a bad case of the flu. Medically, no one, except in rare cases, dies of heroin withdrawal.”

Cocaine withdrawal, he said, is also a relatively minor problem, with the main symptoms being depression and tiredness lasting a few days.

Withdrawal from an alcohol addiction, however, can be a medically significant problem, characterized by shaking, nausea and, in the worst extremes, delirium tremens--known as “DTs”--that bring high fever, hallucinations and even death.

Physical, Emotional Damage

“It’s clear that alcohol is the most commonly abused drug,” Brostoff said. “It causes the most physical and emotional damage, problems in the family, loss of income and decreased productivity.”

Jennifer Farr, executive director of the Marin Services for Women in Marin County, a model program for women who abuse alcohol, said President Reagan’s anti-drug campaign does not fully recognize the fact that alcohol is as much a drug as cocaine.

“Alcoholism is a much larger problem in this country than drug addiction and it’s not really being addressed by the Administration,” Farr said. “They’re dealing with drugs as a law issue rather than a health issue, and as long as they do it on that basis, they won’t get to the worst problem, which is alcohol abuse.”

She said one of the reasons alcohol abuse is not emphasized is that there is a general societal denial that heavy drinking is bad. “It’s easier for someone to point a finger at people who are using drugs, even if their own family is falling apart and they’re missing work because of alcohol.”

If the government wants to test for drug use, she said, “perhaps they should start with lawmakers after their three-martini lunches.”

Whatever the chemical dependency, Brostoff said, rehabilitation and long-term treatment emphasize education, group interaction, learning the nature of the disease, gaining the support of others and family involvement. Most programs, he said, emphasizes the importance of a 12-step program similar to that used by Alcoholics Anonymous.

“It’s a whole package approach that must begin by honestly facing the problems and seeing the addiction as a disease rather than a psychological or emotional disturbance,” Brostoff said. “It doesn’t matter whether the addiction is cocaine out of a gold spoon or Tokay from a paper bag, the feelings of helplessness and despair are similar.”

Brostoff said successful treatment occurs when patients accept their addiction--many of whom have more than one--and agree to completely quit substance abuse.

“I tell them the reason their use is out of control is because they have a nervous system such that they’re unable to control psychoactive substances,” Brostoff said. “The main thing to emphasize is (that)treatment is readily available and effective.”

Marijuana, the most widely used substance after alcohol, tobacco and cocaine, has long been considered a “gateway” drug and a major predictor of cocaine use as well as one widely used in combination with alcohol and tobacco.

“By reducing marijuana use, we reduce the number of people who are at risk of going on to use other drugs,” is the conclusion of a National Household Survey of Drug Abuse released in October by the U.S. Department of Health and Human Services.

“Among young adults, current marijuana users are 12 times more likely to be current users of cocaine than those who do not use marijuana,” the report said. “They are also more likely to use alcohol and cigarettes.”

The survey said overall marijuana use has decreased slightly since 1982, but there are still 18.2 million regular users, 6 million of whom reported using it almost daily, a statistic called “unacceptably high.”

Inaba said his Haight-Ashbury clinic currently treats 600 illegal drug abusers a month and has a waiting list of 450, some of whom are victims of synthetic “designer drugs,” which continue to hit the streets in increasing frequency. Because of altered molecular structures, these synthetics are not covered under most illegal-drug definitions.

Inaba said marijuana smokers are beginning to show up in small numbers for therapy, which is a new phenomenon. The reason, he said, is that street samples of marijuana are showing much stronger potencies of THC, the drug’s active ingredient.

“So, we’re dealing with a stronger drug, but what that means we don’t know. Based on the people who smoke it and develop psychosis, we’re still talking about a relatively safer form of drug than alcohol or nicotine and definitely (safer)than cocaine or heroin.”

A separate and new alcohol program, with limited funding and a staff of only two full-time counselors, sees more than 400 people a month at the Haight-Ashbury clinic.

“We can’t treat away substance abuse, no way,” Inaba said. “We can’t legislate it or enforce it away. The answer is putting more and more emphasis on preventive education.”