DRAFT 11/7/2016
Substance Use and Societal Consequences (HS 412b)
Fall 2016
Mondays, 9:00 am – 11:50 pm
Heller RoomG53
Professor: Constance Horgan, Sc.D.
Office: Heller 257
(781) 736-3916
Objectives:
This course provides an overview of the use and abuse of alcohol, tobacco, and illicit drugs, the consequences of abuse from a societal perspective, and the various types of approaches used to prevent and reduce substance abuse. A historical perspective on shifting attitudes about these various substances is provided. The etiology of substance abuse is discussed from different theoretical orientations. The medical consequences of abuse are explored, as well as the broader implications for families, the workplace, and other systems, particularly criminal justice. Prevention and other demand reduction approaches, as well as supply side initiatives, are described and assessed in terms of effectiveness. Several sessions focus on issues and implications for specific population groups. The U.S. experience is discussed in the context of global drug and alcohol problems.
This course is designed as a companion to Issues in Substance Abuse Treatment (HS 568a) which provides an overview of the organization, delivery, and financing of substance abuse treatment in the United States. It focuses on the structure of the treatment system and access to services, the process of treatment, and the effectiveness, cost and quality of treatment delivery. These two courses have been planned together but are independent and may be taken in any order. Special behavioral health seminars are offered through the behavioral health doctoral seminar series on Mondays, 12:15 – 1:45 pm. All students are welcome to attend. Many seminars have guest speakers on topics complementary to course content.
Structure:
This course is organized around a series of topics, each of which is presented by individuals with specialized expertise and knowledge in the subject area. The course will consist of a weekly three-hour seminar focusing on a specific topic area. Dr. Horgan will coordinate the course, assure continuity, and teach several sessions. The syllabus is subject to change. Changes will be posted on the course website (LATTE).
Course Requirements:
- Readings: Complete assigned reading prior to the class session.
- Weekly Summaries: Prepare a one-page, double-spaced statement about the readings. Students will be expected to formulate a discussion question and summarize his/her perspective on how the readings inform the question. This summary should be posted on LATTE prior to the class with hard copy given to the instructor at the beginning of the session. Students should feel free to dialog on the postings. The summary will form the basis for introductory discussion in each class.
- Participation: Participate actively in class discussions.
- Presentation: Make a 15-minute presentation in class on his/her selected term paper topic.
- Paper: Prepare a double-spaced 15 – 20 page term paper due in three stages:
- September26One paragraph description for instructor approval
- October 31Detailed paper outline and preliminary bibliography
- December 12Completed paper
The paper should be on a policy or research issue related to substance abuse. It should synthesize the knowledge based on the selected topic, critique the research literature, and identify gaps in what is known.Doctoral students are strongly encouraged to use this paper to further explore dissertation topics.
If you are a student with a documented disability on record at Brandeis University and wish to have reasonable accommodations made for you in class, please see Dr. Horgan immediately.
Required Texts/Additional Readings:
- Heyman, Gene (2010). Addiction: A Disorder of Choice. Harvard University Press, Cambridge, MA (paperback).
- Center for Behavioral Health Statistics and Quality. (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health: National Findings. Substance Abuse and Mental Health Services Administration, Rockville, MD.
- Office of National Drug Policy (2015). The President’s National Drug Control Strategy. Washington, DC: Office of National Drug Control Policy.
- United Nations Office on Drugs and Crime (2016). World Drug Report 2016. United Nations, NY.
In addition, selected articles will be assigned for most sessions. These articles will be available through LATTE.
Class Session Schedule:
Session 1, August 29: Introduction and Overview of Substance Abuse in the United States
(Constance Horgan)
An overview of the role of substance use in American society is provided. The evolving view of substance use as a health and social problem is discussed, as well as historical trends in consumption and policy. Key issues in patterns of use and consequences of use are highlighted. Various approaches that may exacerbate or combat the problematic use of substances are reviewed.
Session 2, September 8: The Psychology and Neuroscience of Addiction(Brandeis Monday)
(Sharon Reif)
The goal of this session is to introduce a “biopsych” framework for understanding drug use and abuse. The topics include the acute psychological effects of key drugs, how drugs get to their site of action, what happens at the site of action, tolerance, sensitization and withdrawal. This background sets the stage for a review of theories of addiction. The theories fall into three categories: those based on drug effects, those based on individual differences, and those based on environmental factors
Session 3, September 12: Historical Perspective
(Constance Horgan)
This session provides an historical overview of alcohol, drug and tobacco use and abuse and shifting social attitudes and public policies. The historical review reveals that for drugs that are currently illegal, such as stimulants and opiates, addiction and government prohibitions are relatively recent phenomena.
Session 4, September 19: The Nature of Addiction and Decision-Making
(Gene Heyman)
Addiction is commonly referred to as a “compulsive, relapsing, disease.” By this phrase clinicians and researchers often mean that an addict is someone for whom drug use has become involuntary. However, a number of recent choice theories predict “compulsive-like” patterns of voluntary behavior. The goals of this session are to introduce the new choice theories, to discuss whether it is possible to find useful (e.g., acceptable) definitions of “voluntary” and“involuntary,” and to test whether the choice or disease approach best describes addiction, using as criteria for the test the results fromepidemiological, clinical, and experimental research. The outcome is important. For example, the disease and choice models have led to different treatment programs, and, it can be argued that the two approaches suggest different drug control policies. The role of education level as a predictor is examined.
Session 5, September 26: General Epidemiology
(Constance Horgan)
Epidemiology is concerned with patterns of disorders in a population. This session provides a general overview of the epidemiology of substance use and abuse. Sources include national surveys, aggregate studies, and ethnographies. These research programs provide information on the correlates of drug use, such as age, gender, income, education, etc. The goal of this session is to characterize addiction in terms of these and other correlates. For example, is addiction a disorder of youth, or “once an addict, always an addict?”
Session 6, October 10: Medical and Health System Consequences of Substance Use and Abuse
(Constance Horgan)
The medical consequences of alcohol, drug and tobacco use will be reviewed, both in terms of morbidity and mortality. A substance-specific overview of the wide range of health consequences will be provided, focusing on the most serious illnesses, both acute and chronic, mainly by organ system or type of illness. The discussion will cover a wide range of topics including HIV/AIDS, fetal alcohol syndrome and other effects of prenatal exposure. Controversial areas such as beneficial effects of alcohol and long-term effects of drugs such as marijuana will be highlighted.
Session 7, October 25: Prevention and Demand Reduction Efforts(Brandeis Monday)
(Scott Formica)
Various approaches to prevention and demand reduction are described, including school-based programs, taxation, regulation, the media and community coalitions. The effectiveness of these prevention and demand reduction approaches are described, as well as the special challenges in evaluating prevention efforts. The expanding role of Prescription Drug Monitoring Programs will be discussed.
Session 8, October 31: Disparities and Substance Use Disorders
(Constance Horgan, Andrea Acevedo and Robert Dunigan)
This panel session examines the epidemiology of substance abuse for selected populations and focuses on special issues related to use, abuse, consequences and policy interventions. Disparities by race, ethnicity, gender, income and other priority population are discussed.
Session 9, November 7: Understanding Addiction Problems across the Age Span
(Constance Horgan and Maggie Giles)
This session will present the notion of “gateway” drug use in adolescents and its merits and controversy in the clinical field of addiction. Trends in adolescent use over the past three decades will be discussed. Developmental differences of drug use over a person’s lifetime will be examined. Finally, substance use and elders will be examined.
Session 10, November 14: Policy Approaches to Drug and Alcohol Abuse
(John Carnavale – Consultant and Former Director of Office of Program, Budget, Research and Evaluation in Office of National Drug Control Policy, The White House)
Approaches to the problems of substance abuse are discussed from the perspective of a federal policy maker. This will include demand vs. supply side approaches as well as the intersection of federal policy with state and local efforts. Recent initiatives regarding drug legalization and medical marijuana are discussed. The likely impact of these types of policy changes is examined.
Session 11, November 21: Substance Abuse and the Criminal Justice System
(William Brownsberger – Massachusetts State Senator, former Massachusetts Assistant
Attorney General and practicing criminal defense attorney)
This session will explore the causal and ecological relationships between sociopathy, substance abuse, poverty and crime. This exploration will include a discussion of the distributional politics of drug policy. We will also discuss policy issues related to the control of substance abuse among criminal offenders, especially focusing on cooperation between the treatment and the criminal justice systems. We will also consider the issue of treatment quality in the public treatment system.
Session 12, November 28: Social and Economic Consequences of Substance Abuse
(Constance Horgan)
The broader consequences of substance abuse on American society are discussed. The implications of substance abuse for the family and workplace are highlighted. The economic costs of alcohol, drug and tobacco use and abuse on American society are explored. The different pattern of societal costs for each substance is highlighted as background for a discussion in a later session regarding policy implications. There is also a discussion of how illicit transnational drug economies operate.
Session 13, December 5: Student Presentations and Wrap-Up
Each student will have 15 minutes to present an overview of his/her term paper and to engage the class in discussion on the topic. The purpose is: to impart new knowledge to the class; to gain experience in giving presentations; and to receive feedback on the topic which may lead to refinements in the final paper which is due on December 12.
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