Substance abuse and control in the United States: ethical and legal issues

In 1986, the United States began to wage its most recent War on Drugs. This has involved establishing various policies and making investments to implement these policies and approaches. In general, the U.S. has taken a tough-guy stand to drug abuse and control that emphasizes punishment, restriction, and 'social warfare', as opposed to a public health oriented position. Current policy reflects a 'quick fix' solution to a complex problem, which may partially explain its failure and why we appear to be losing the War on Drugs. In this review I summarize the current debates and controversies surrounding drug abuse in the U.S. regarding the extent of the drug problem, the need for drug control, prevention efforts, legalization controversy, workplace strategies, treatment dilemmas, and maternal drug abuse. I argue that a radically different approach must be taken that is grounded in public health methods and an appreciation of the larger social context in which drug abuse occurs. We must look for a long-term solution to this complex problem that is integrated into society, and which is certainly resistant to the current quick fix approaches.