Abuse of Dextromethorphan-Based Cough Syrup as a Substitute for Licit and Illicit Drugs: A Theoretical Framework

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INTRODUCTION

Drug abuse, both illicit and licit, is an ongoing serious national problem. To date, neither prevailing social policies, law enforcement apparatus (national and local) nor community efforts have been able to contain the problem and its devastating consequences. Like a multi-headed hydra, it regenerates itself in new forms. The abuse of dextromethorphan-based cough syrup could become a new national problem with profound implications if teenage experimentation with the drug becomes part of the search for substitutes for some better-known substances in order to get "high."

The improper use of drugs for nonmedical purposes not only is damaging to health, but is harmful to society in many profound ways. The drugs in question, as noted, may be classified in two broad categories: (1) licit psychoactive drugs such as caffeine, alcohol, and nicotine, as well as over-the-counter preparations, including pain killers and cold medications; and (2) the illicit psychoactive drugs such as cocaine, heroin, and marijuana. The forms of abuse include experimental use (a short-term trial); social recreational use (occasional indulgence among friends to share an experience); circumstantial (situational use in specific stressful circumstances); intensified use (long-term, regular, and habitual use); and compulsive use (frequent use of the drug to the point where an individual becomes physiologically and/or psychologically dependent) (Jones, Gallagher, & McFalls, 1988). The primary focus of this paper is to construct a theoretical framework with regard to the factors that make dextromethorphan-based cough syrup an attractive choice for experimental abuse or misuse.

Background

A recent study conducted by the University of Michigan's Institute for Social Research reported a significant drop in illegal drug abuse among high school seniors (U.S. Alcohol, Drug Abuse, and Mental Health Administration, 1991) However, a national poll of U.S. citizens reported ". . . drug abuse in general and teenagers' drug use in particular [as being] this nation's number one problem" (Eggert & Herting, 1991, p. 482). The National Institute on Drug Abuse also has reported only a modest decline in drug usage. Further, ". . . health officials see a new and terrifying danger--teenagers who regularly abuse and combine many different drugs end up with shattered and impotent lives" (Downey, 1991/1992, p. 264).

A wide range of drugs are being used by teenagers. Among students studied by Miller and Gold (1991), 10 to 13% reported use of inhalants. According to Eggert and Herting (1991), over 55% of high school students used illicit drugs, mostly those that are easily obtained, typically from their own homes. They may include alcohol, codeine, marijuana, or paint. "Hard" drugs, such as heroin, crack, and PCP were rarely used by teenagers according to Lewandowski and Westman (1991).

Drugs are used (experimentally or habitually) for many reasons, the most common of which is to produce an immediate euphoric effect. Other reasons frequently reported by students include ". . . to make me more popular with my friends; so people would like me; because my parents used them; because someone else wanted me to; to make me feel more like an adult; because my friends use drugs; because it was a habit, and because I could make extra money selling them" (Novacek, Raskin, & Hogan, 1991, p. 483). Novacek also discovered that ". . . the more reasons people have for using drugs and alcohol, the more frequently they use them." p. 476).

Other studies show abuse of licit drugs to be a precursor of illicit drug use. "History of solvent use may indicate individuals at high risk for intravenous drug abuse and youths who have used solvents should be considered at high risk for severe drug abuse, including IVDA [intravenous drug abusers]" (Dinwiddie, Ruch, & Cloninger, 1991.)

An important consequence of teenage drug abuse appears to be the increase in suicide rates: 28,100 suicides are reported per year among 15- to 24-year-olds (Downey, 1990/91). …