Issue #27 September 2023
[This is a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”. NOW AVAILABLE AT https://blackrosebooks.com/products/buzz-kill-michael-r-devillaer] .
There is a long-gone era (late 1970s-early 1980s) when I worked for the Addiction Research Foundation of Ontario (ARF). It was not uncommon for generous amounts of free alcohol beverages to be available after educational events. Such a practice, at such an organization, seems bizarre by 2023 standards. But it was the norm of the time, and few questioned the practice. But a few did, and the discussions were fascinating. I was at a junior stage of my career and did not offer much input. But I listened carefully. One argument was that the educational events provided an opportunity to show that alcohol could be introduced into a social event in a civilized manner such that moderation and responsible use could be showcased for all to see. That sounded reasonable. The counterpoint was that a responsible attitude towards alcohol use also meant sending a message that alcohol need not be a part of every social event and should not be so elevated in its societal importance (i.e., normalized). Also, a reasonable point. It was not too many years before the counterpoint prevailed. However, I have always suspected that the move away from free alcohol also had something to do with budgetary constraints, and perhaps legal liability. Alcohol for sale remains common at many academic conference social events – including conferences on drug policy.
Drug use normalization typically refers to drug use becoming embedded within broader social norms – as alcohol has become a customary part of social events such as weddings, seasonal and anniversary celebrations, sports victory celebrations and, somewhat less frequently these days – workplace social events. Within the context of social normalization, some people’s use of a drug evolves from being an occasional activity to a more routine part of their lifestyle. Use is still very much aligned with social bonding but will also usually involve an increase in solitary use. Daily or near daily use of a drug by an individual can be referred to, without any stigma or judgement intended, as habitual use.
However, daily or almost daily drug use by an individual is recognized as the stage at which higher risk practices are more likely to be adopted, and in some cases can lead to harmful consequences. It can also be an indicator of drug dependence. I will write about higher risk practices, adverse consequences, and dependence in subsequent issues. This issue focuses on habitual use.
Drug use by an individual can be described along two dimensions. The first is how many days a person uses a drug over a period (week, month, or year). This is called frequency. A person’s drug use can also be measured in the amount used on a given occasion, usually referred to as quantity or dosage. Drug use, as defined by frequency and quantity, typically occurs along a spectrum, ranging from infrequent use of small quantities to frequent use of large quantities. As one moves from the former to the latter, there can be an increase in risk for problematic drug use. Of course, there are considerable individual differences in how people are affected by drugs and under what conditions. These individual differences can affect a person’s transition from occasional drug use to increased use, to higher risk use, and to harmful use.
There is also a less common variant in which a person uses a drug rarely, but in a high quantity when they do. This would include the binge drinker. I recall a former colleague who showed another variant. He was a non-smoker, except when he went to an out-of-town meeting for a couple days. He would buy a pack of cigarettes and smoke the entire pack over the two days he was away. He would then return home and not smoke at all – until the next out-of-town meeting, typically several weeks from then. I once asked him if he ever craved a cigarette when he returned home. He said he did not – also noting this was a good thing because his wife would not tolerate him smoking.
Surveys that measure use of major drug types find that most peoples’ use of drugs is at the low end of frequency and dosage – with little risk involved. But the surveys also identify a group that uses drugs such that it places them at increased risk for harm.
In the previous issue of this newsletter, I drew from two general population surveys of drug use to paint a statistical picture of how many non-institutionalized Canadians age 15+ had ever used various types of drugs. These were The Canadian Alcohol and Drugs Survey (CADS) and The Canadian Tobacco and Nicotine Survey (CTANS). I will draw upon these surveys again to explore how many people become habitual users – as defined by daily or near-daily use.
CTANS reported daily cigarette smoking at 9% in 2019 and 8% in 2020 and in 2021. These estimates do not include daily use of other forms of tobacco (cigars, chew) or other methods of use (vaping) in the absence of smoking cigarettes. Including them would increase these percentages.
CADS does not provide information on daily use of alcohol. For that estimate, we must access The Centre for Addiction and Mental Health’s CAMH Monitor. The Monitor reported daily drinking among Ontarians at 9.7% for 2020 and 9.2% for 2022.
What about cannabis? Drawing upon 2019 (post-legalization) data from CADS, I calculated that daily or almost daily cannabis use was reported by approximately 5% of survey respondents – placing cannabis third behind alcohol and tobacco. CADS does not provide data that allow a calculation of daily or near-daily use of illegal drugs or psychoactive pharmaceuticals.
It should be noted that the alcohol estimate from the CAMH Monitor is based upon Ontario adults aged eighteen and older in 2020. For these, and other reasons, the data are not optimally comparable to the CADS & CTANS estimates. Nonetheless, the results are consistent with a general pattern suggested in the previous issues of this newsletter – alcohol and tobacco are the drugs that people are most likely to begin using, continue using, and become habitual in their use. But facilitated by legalization, cannabis may be catching up.
Implications for Cannabis Legalization: Our long-term legal drug industries – alcohol and tobacco – have played a significant role in normalizing the use of their drug products. (They have had lots of help from pop culture.) Will legalization lead to the normalization of cannabis use such that habitual use will increase to that of our other two legal recreational drugs? Will cannabis use become normalized, as is alcohol, as a routine part of social events such as weddings, sports team celebrations, and seasonal or holiday festivities? What about social events at trade meetings or conferences that have an alcohol cash bar? Will cannabis edibles also be for sale someday? At drug policy conferences?
Hamilton Ontario Canada
September 23 2023