Policy on Drug Use

Cleared personnel are held to a higher standard than other Americans who have not assumed the privileges and obligations of a security clearance. Persons who have used drugs in the past may be approved for access to classified information. In accepting a security clearance, however, government employees and contractors also accept an obligation to remain drug free in the future.

Unlike other personal problems, any confirmed use of an illegal drug is automatically a basis for appropriate administrative action, including mandatory counseling or treatment. Presidential Executive Order 12564 dated September 15, 1986, established the U.S. Government as a drug-free workplace. It declares that “persons who use illegal drugs are not suitable for Federal employment. . . . The use of illegal drugs, on or off duty, by Federal employees is inconsistent not only with the law-abiding behavior expected of all citizens, but also with the special trust placed in such employees as servants of the public.”

Similarly, current use of an illegal drug, while on or off duty, by a contractor with access to classified U.S. Government information is incompatible with the terms of the contractor’s security clearance.

Use, Abuse, and Dependence

When categorizing extent of drug involvement, medical personnel use three terms: drug use, abuse, and dependence.1 This medical usage differs substantially from the way the terms use and abuse are used by the U.S. Government. For the government, any use at all of an illegal drug or misuse of a legal drug is drug abuse.

Medical personnel generally define the terms as follows:

Use: Any taking in of a psychoactive substance. The term simple use is sometimes used to distinguish experimentation or occasional recreational use that does not reach the point of abuse or dependence. Note: The distinction between use and abuse is not meant to imply that simple use is benign or that there is any level of drug involvement that is not potentially dangerous.

Abuse: Use becomes abuse when it continues despite persistent or recurrent social, occupational, psychological or physical problems caused by or made worse by this use. Use before driving a car or engaging in other activities that are dangerous when under the influence of a psychoactive substance also qualifies as abuse. The transition from use to abuse is often gradual, and there is no clear threshold for defining the point at which use becomes abuse. Frequency and quantity of use are important considerations, as is the extent to which drug use has become a regular feature of one’s lifestyle.

Dependence: Habitual, compulsive use of a substance over a prolonged period of time. The substance may be taken in larger amounts or over a longer period than intended. Increased amounts of the substance may be needed to achieve the desired effect. There may have been unsuccessful efforts to cut down on the amount of use. A great deal of time may be spent in obtaining the substance or recovering from its effects. There may be a significant impact on one’s work, home or social life, or mental or physical health.

Drug Dangers

There are two aspects of a drug’s dangerousness — the risk of addiction and the adverse health and behavioral consequences. Both differ greatly from one drug to another. There is no illegal drug that does not have serious adverse consequences.

Drug dependence can develop through either psychological or physical processes.

• Psychological dependence is characterized by emotional and mental preoccupation with the drug’s pleasurable effects. One craves more to regain the stimulation, elation, sense of well-being, or other psychological pleasures from the drug. Psychological dependence also occurs when one develops a lifestyle that depends upon drug use.

• Physical dependence occurs when the body adjusts to the presence of a drug, so that physical symptoms usually involving discomfort and pain occur when the drug is withdrawn. The addict craves more drugs in order to avoid or alleviate the pain.

The development of psychological or physical dependency depends, in part, on frequency of use. Increasing the frequency or dosage over time suggests tolerance and physical dependence.

Indicators of Severity

The circumstances of an individual’s drug use provide indicators of the severity of a current problem or the likelihood that a past problem will recur in the future.2

Age: Early initiation of drug use is one of the best predictors of future drug abuse and dependence. Individuals whose drug use started before high school (age 14 or younger) are more vulnerable to drug problems later in life than those who started using drugs in high school or college. Initiation of drug use between age 15 and 18 is common. Drug use usually peaks during the senior year in high school or in college (age 17 to 23). Continuation of peak usage after college (or age 23) indicates potential for future problems. Initial experimentation with drugs after college (or age 23) is unusual and suggests future problems.

Increased maturity and lifestyle changes that usually accompany employment, marriage, or the birth of children often lead to reduction or cessation of drug use. Continuation of the same social environment in which past drug use occurred suggests that use may continue.

Solitary Drug Use: Solitary drug use is more indicative of future drug problems than is social use. Use of drugs to relax prior to a social event is more indicative of future drug problems than use at social events.

Means of Acquiring Drugs: Purchase of drugs from a stranger may indicate as much about an individual’s need for and dependence upon drugs as growing one’s own. Buying drugs from a friend is more predictive of future problems than being given drugs by a friend. Few drug users admit to buying or selling drugs; almost everyone says they share or split. Asking what was given or shared in return for the drug may help distinguish a purchase in kind from a true gift.

Motivation for Drug Use: If drugs are used to reduce stress or build self-esteem, this suggests underlying psychological problems that may persist and cause continued drug use or problems with other addictions. Rebelliousness as a motivation for past drug use does not necessarily predict future drug use, but it may indicate other antisocial behavior. Among the various possible motivations for drug use, peer pressure and a desire to be sociable are the least suggestive of future drug problems.

Use of Multiple Drugs: Use of more than one drug at a time, such as both marijuana and cocaine, suggests that drug use is well advanced and may stem from underlying psychological problems.

Behavior While Under the Influence of Drugs: If drug use is associated with traffic violations, pranks, shoplifting, fights, etc., it may be part of a larger pattern of antisocial behavior that is itself a security concern.

Prevalence

Statistics on prevalence of drug use indicate that some experimentation with drugs, especially marijuana, cannot be considered abnormal behavior among younger Americans at this time. In 1996, 50.8% of high school seniors had used some illegal drug at some time during their life, 40.2% during the previous year, and 24.6% during the previous month.3

Why People Abuse Drugs

Initial low-level involvement with drugs may result from peer pressure, drug availability or other risk factors in an individual’s social or family environment. Subsequent escalation to and maintenance of higher levels of drug use is likely to result from biological, psychological or psychiatric characteristics of the individual user. In some cases, vulnerability may be inherited in the form of heightened susceptibility to a certain type of drug. In most cases, however, escalation will be caused by psychological traits or psychiatric conditions, some of which may also be inherited.

Recent scientific research shows that characteristics of the individual, rather than of the drug, play a dominant role in vulnerability to drug abuse. The social and psychological maladjustment that characterizes most frequent drug abusers precedes the first drug use.4 One study that tracked children from an early age to adulthood identified predictors of future serious drug use that could be identified in children’s behavior as early as age seven. 5

Although psychoactive drugs do have potent addictive properties, addiction does not follow automatically from their use. Most people who experiment with drugs or even use them regularly for a while do not become abusers or develop dependence. For psychologically healthy youths, some experimentation with drugs does not normally have adverse future consequences. For others who already have some emotional or psychological problem, drug use easily becomes part of a broad pattern of self-destructive behavior.6

Poorly adjusted individuals who do not become involved with illegal drugs will often become involved with some other non-drug addictive behavior that fills the same psychological void.

A study based on a sample of 20,291 individuals drawn from the community at large found that more than half of those who met the medical criteria for diagnosis as drug abusers also suffered from one or more mental disorders at some point during their lifetime. This included 28% with anxiety disorders, 26% with mood disorders (depression), 18% with antisocial personality disorder, and 7% with schizophrenia. Some had multiple disorders. The prevalence of mental disorders varied with the drug being abused, ranging from 50% of marijuana abusers to 76% of those who abused cocaine. Almost half of the drug abusers also suffered from alcohol abuse at some point during their lifetime.7

Security Concerns

Much evidence indicates that drug use or abuse is associated with degraded employee performance, greater absenteeism, more workplace accidents, increased health care costs, loss of trained personnel, and theft. Drug use or abuse also raises a number of specific security concerns.

• Use of an illegal drug indicates an unwillingness or inability to abide by the law. Cleared employees must respect regulations whether they agree with them or not. If they do not respect the rules on use of psychoactive substances, they may not respect the rules for protection of classified information. This was the reasoning used by U.S. Army Sgt. Roderick Ramsey to recruit co-workers to spy for Hungary during the Cold War. Drug use was the principal weakness he looked for in selecting co-workers to recruit as spies.

• Users of illegal drugs may be susceptible to blackmail, especially if exposure of drug use could cost them their job. Police and security services actively monitor drug distribution networks. Procurement of illegal drugs while traveling abroad or carrying drugs across national boundaries risks attracting the attention of foreign intelligence services or other individuals who may seek to exploit this vulnerability.

• The more dangerous the drug, the more the drug use indicates about propensity for irresponsible or high risk behavior, rebellion against social norms, alienation, or emotional maladjustment, all of which may be security concerns. These characteristics cast doubt upon an individual’s judgment and ability to protect classified information even when not under the influence of drugs.

• Drug abuse or dependence often indicates the presence of broad emotional or personality problems of security concern. It may also cause financial problems, leading to criminal activity to finance a drug habit.

Drug Abuse Treatment

Drug abuse treatment includes detoxification, management of drug dependence, and prevention of relapse. Since drug abuse is a complex disorder with multiple causes, there are multiple treatment methods that are more or less effective with, or acceptable to, different patients. Unfortunately, the present state of knowledge does not permit matching an individual patient’s drug abuse history and personal characteristics with the treatment method most likely to be successful for that person. As a result, treatment programs are varied and usually multifaceted. Treatment methods are of two general types:

• Drugs that Affect Physiological Processes: Prescribed medications may provide a substitute drug that has similar physiological effects (i.e., methadone treatment of heroin addiction and nicotine chewing gum for treatment of tobacco dependence); may block the physiological effects of the abused drug; or may treat the symptoms of the abused drug (i.e., reduce the craving or treat the insomnia and anxiety often associated with withdrawal from drug use).
• Therapies that Aim to Modify Behavior: Treatments that aim to change behavior include a variety of counseling and psychotherapy approaches based primarily on talking: peer support self-help groups modeled after Alcoholics Anonymous; behavioral conditioning to alter one’s response to drug stimuli; skill development (i.e., teaching job or social skills, assertiveness, or relaxation/stress management); or relatively long term (typically 6 months or longer) treatment in a closed residential setting emphasizing drug abstinence and learning of new attitudes and behaviors.8

Many studies show that treatment is effective, but that relapse remains common and repeated treatments are often required. Successful treatment depends in part upon the amount of time spent in the treatment program. Six to 12 months of treatment is often needed. Those who remain in a program for one year are less likely to return to regular drug use than those in treatment less than one year.9

In addition to length of the treatment program, chances of relapse are influenced by the severity of the problem and by the same biological, psychological, behavioral, social and environmental risk factors that influence the onset of drug use and the escalation to drug abuse in the first place. If a person returns to a drug-taking environment, there is a strong likelihood of relapse. The longer someone has abstained from drug use, the greater the chances of continued abstinence in the future.

Alternative Names

Heroin abuse; Substance abuse; Marijuana abuse; Illicit drug abuse; Narcotic abuse; Cocaine abuse; Hallucinogen abuse; PCP abuse; LSD abuse

Marijuana

About 2 in 5 Americans have used marijuana (also called “grass,” “pot,” “reefer,” “joint,” “hashish,” “cannabis,” “weed,” and “Mary Jane”) at least once. Approximately 10% of the population uses it on a regular basis. Next to tobacco, and alcohol in some areas, marijuana is the most popular substance young people use regularly.

The source of marijuana is the hemp plant (cannabis sativa). The active ingredients are THC (delta-9-tetrahydrocannabinol) and other cannabinoids, which are found in the leaves and flowering shoots of the plant.

Hashish is a resinous substance, taken from the tops of female plants. It contains the highest concentration of THC.

The drug dose delivered from any particular preparation of marijuana varies greatly. The concentration of THC may vary as much as a hundred fold, due to diluting or contaminating materials.

The effects of marijuana may be felt from seconds to several minutes after inhaling the smoke (from a joint or a pipe), or within 30 – 60 minutes after ingestion (eating foods containing marijuana, such as “hash brownies”).

Because the effects are felt almost immediately by the smoker, further inhalation can be stopped at any time to regulate the effect. In contrast, those eating marijuana experience effects that are slower to develop, cumulative (they add up), longer-lasting, and more variable, making unpleasant reactions more likely.

The primary effects of marijuana are behavioral, because the drug affects the central nervous system (CNS). Popular use of marijuana started because of its effects of euphoria (feeling of joy), relaxation, and increased visual, auditory (hearing), and taste perceptions that may occur with low-to-moderate doses. Most users also report an increase in their appetite (”the munchies”).

Unpleasant effects that may occur include depersonalization (inability to distinguish oneself from others), changed body image, disorientation, andacute panic reactions or severe paranoia.

Some cases of severe delirium, hallucinations, and violence have also been reported. Such cases should raise suspicion that the marijuana may have been laced with another agent, such as PCP.

Marijuana has specific effects that may decrease one’s ability to perform tasks requiring a great deal of coordination (such as driving a car). Visual tracking is impaired, and the sense of time is typically prolonged.

Learning may be greatly affected because the drug reduces one’s ability to concentrate and pay attention. Studies have shown that learning may become “state-dependent,” meaning that information acquired or learned while under the influence of marijuana is best recalled in the same state of drug influence.

Other marijuana effects may include:

• Blood-shot eyes
• Increased heart rate and blood pressure
• Bronchodilatation (widening of the airways)
• In some users, bronchial (airway) irritation leading to bronchoconstriction (narrowing of the airways) or bronchospasm (airway spasms, leading to narrowing of the airways)
• Pharyngitis, sinusitis, bronchitis, and asthma in heavy users
• Possible serious effects on the immune system

Regular users, upon stopping marijuana use, may experience withdrawal effects. These may include agitation, insomnia, irritability, and anxiety. Because the metabolite (the substance formed when the body breaks down the drug) of marijuana may be stored in the body’s fat tissue, evidence of marijuana may be found in heavy users through urine testing up to 1 month after discontinuing the drug.

The active component in cannabis is believed to have medical properties. Many people maintain that it is effective in the treatment of nausea caused by chemotherapy in cancer patients.

Others claim that cannabis stimulates appetite in patients with AIDS, or is useful in the treatment of glaucoma. While the active ingredient in marijuana has been approved as a synthetic medication by the Food and Drug Administration (dronabinol) for these purposes, use of whole marijuana remains hugely controversial. Currently, cannabis is illegal even for medical use under federal law.

Heroin, or diacetylmorphine (INN), also known as diamorphine (BAN), is a semi-synthetic opioid drug synthesized from morphine, a derivative of the opium poppy. It is the 3,6-diacetyl ester of morphine (di(two)-acetyl-morphine). The white crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride, though often adulterated thus dulling the sheen and consistency from that to a matte white powder, which however heroin freebase typically is.^[1]

As with other opioids, heroin is used as both a pain-killer and a recreational drug and has an extremely high potential for abuse. Frequent and regular administration is associated with tolerance, moderate physical dependence, and severe psychological dependence which develops into addiction.

Internationally, heroin is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs.^[2] It is illegal to manufacture, possess, or sell diacetylmorphine without a licence in Belgium, Denmark,Germany, Iran, India, the Netherlands, the United States, Australia, Canada, Ireland, Pakistan, the United Kingdom and Swaziland.

Under the name diamorphine, it is a legally prescribed controlled drug in the United Kingdom. It is available for prescription to long-term addicts in the Netherlands, the United Kingdom, Switzerland, Germany andDenmark.^[3][4]

The opium poppy was cultivated in lower Mesopotamia as long ago as 3400 BC.^[8] The chemical analysis of opium in the 19th century revealed that most of its activity could be ascribed to two alkaloids, codeine and morphine.

Diacetylmorphine was first synthesized in 1874 by C. R. Alder Wright, an English chemist working at St. Mary’s Hospital Medical School in London. He had been experimenting with combining morphine with various acids. He boiled anhydrous morphine alkaloid with acetic anhydride for several hours and produced a more potent, acetylated form of morphine, now called diacetylmorphine. The compound was sent to F. M. Pierce of Owens College in Manchester for analysis. Owens told Wright:

Wright’s invention did not lead to any further developments, and diacetylmorphine only became popular after it was independently re-synthesized 23 years later by another chemist, Felix Hoffmann. Hoffmann, working at the Aktiengesellschaft Farbenfabriken (today the Bayer pharmaceutical company) in Elberfeld, Germany, was instructed by his supervisor Heinrich Dreser to acetylate morphine with the objective of producing codeine, a constituent of the opium poppy, pharmacologically similar to morphine but less potent and less addictive. Instead the experiment produced an acetylated form of morphine one and a half to two times more potent than morphine itself.

From 1898 through to 1910 diacetylmorphine was marketed under the name heroin as a non-addictive morphine substitute and cough suppressant. Bayer marketed heroin as a cure for morphine addiction before it was discovered that it rapidly metabolizes into morphine. As such, heroin is essentially a quicker acting form of morphine. The company was embarrassed by the new finding, which became a historic blunder for Bayer.^[10]

In the U.S.A. the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of “heroin” and other opioids, which allowed the drug to be prescribed and sold for medical purposes. In 1924 the United States Congress banned its sale, importation or manufacture. It is now a Schedule I substance, which makes it illegal for non-medical use in signatory nations of the Single Convention on Narcotic Drugs treaty, including the United States.

Later, as with Aspirin, Bayer lost some of its trademark rights to “heroin” under the 1919 Treaty of Versailles following the German defeat in World War I.^[11]

Pharmacology

When taken orally, diacetylmorphine undergoes extensive first-pass metabolism via deacetylation, making it a prodrug for the systemic delivery of morphine.^[12] When the drug is injected, however, it avoids this first-pass effect, very rapidly crossing the blood-brain barrier due to the presence of the acetyl groups, which render it much more lipid-soluble than morphine itself.^[13] Once in the brain, it then is deacetylated into 6-monoacetylmorphine (6-MAM) and morphine which bind to μ-opioid receptors, resulting in the drug’s euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects; diacetylmorphine itself exhibits relatively low affinity for the μ receptor.^[14] Unlike hydromorphone and oxymorphone, however, administered intravenously, diacetylmorphine creates a larger histamine release, similar to morphine, resulting in the feeling of a greater subjective “body high” to some, but also instances of pruritus (itching) when they first start using.^[15]

Both morphine and 6-MAM are μ-opioid agonists which bind to receptors present throughout the brain, spinal cord and gut of all mammals. The μ-opioid receptor also binds endogenous opioid peptides such as β-endorphin, Leu-enkephalin, and Met-enkephalin. Repeated use of diacetylmorphine results in a number of physiological changes, including decreases in the number of μ-opioid receptors.^{[citation needed]} These physiological alterations lead to tolerance and dependence, so that cessation of diacetylmorphine use results in a set of extremely uncomfortable symptoms including pain, anxiety, muscle spasms, and insomnia called the opioidwithdrawal syndrome. Depending on usage it has an onset 4 to 24 hours after the last dose of diacetylmorphine. Morphine also binds to δ- and κ-opioid receptors.

There is also evidence that 6-MAM binds to a subtype of μ-opioid receptors which are also activated by the morphine metabolite morphine-6β-glucuronide but not morphine itself.^[16] The contribution of these receptors to the overall pharmacology of heroin remains unknown.

A subclass of morphine derivatives, namely the 3,6 esters of morphine, with similar effects and uses includes the clinically-used strong analgesics nicomorphine (Vilan), and dipropanoylmorphine; there is also the latter’s dihydromorphine analogue,diacetyldihydromorphine (Paralaudin).

Teens at risk of developing a substance abuse disorder have deficits in frontal brain activation, a U.S. study concludes.

The researchers used functional MRI to study brain activity in 25 participants, ages 12 to 19, as they did an eye movement test. The scientists found a link between increased risk for a substance abuse disorder and shortfalls in executive cognitive function (ECF).

“ECF is basically the control center for governing other cognitive processes,” corresponding author Rebecca Landes McNamee, assistant research professor of radiology and bioengineering at the University of Pittsburgh, said in a prepared statement.

“For example, in school, ECF would be engaged in the planning and control process required in answering a question, formulating your…

Stimulants have long been prescribed to children diagnosed with attention-deficit hyperactivity disorder, or ADHD. Over the past decade, child psychiatrists have debated the long-term potential for these medications to trigger drug abuse. Two new studies indicate that the stimulants do not increase children’s risk of abusing cocaine, nicotine, and other drugs as adults.

Although these findings come as a relief to child psychiatrists, not all the news is good. The new investigations, already published online and slated to appear in the May American Journal of Psychiatry, underscore earlier evidence that youngsters with ADHD frequently become drug abusers, whether or not they take prescribed stimulants.

As more and more prescriptions are being written for medications to treat attention-deficit hyperactivity disorder (ADHD), more and more children are abusing these drugs.

That’s the conclusion of new research in the September issue of Pediatrics that found the rate of ADHD medication abuse was up 76 percent from 1998 to 2005, and at the same time, the rates of prescriptions for these medications rose about 80 percent.

Start Your Journey to Long-Term Recovery

Lakeview Health Systems is an elite, nationally recognized drug abuse clinic created to help individuals overcome drug abuse and addiction as well as alcoholism and dual diagnosis. We have helped hundreds of people achieve long-term recovery and we can do the same for you or your loved one.

To learn more about drug abuse, treatment options and how Lakeview can help, call us at1-800-708-4156 or fill out the contact form. Our counselors are standing by 24/7 to offer confidential assistance.

Smoking

Smoking leads to the greatest number of problems of any drug in use in the world today. Smoking contributes to more than 400,000 deaths each year in the United States. These deaths are mainly the result of increased numbers of lung cancers as well as increased numbers of cases of atherosclerotic heart disease and emphysema of the lung. Smoking increases the risk for cancers of the bladder, pancreas, kidney, and cervix. There is an increased risk for gastritis and gastric ulceration in persons who smoke. Cataracts of the crystalline lens of the eye occur with increased frequency in smokers.

Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

• Biology. The genes that people are born with—in combination with environmental influences—account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.
• Environment. A person’s environment includes many different influences—from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.
• Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decisionmaking, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.

Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives. What is drug addiction? Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual that is addicted and to those around them.