Traditional patterns of psychoactive substance use in most societies were episodic, coming at times of personal celebrations (e.g., birth and marriage), rituals (e.g., arrivals, departures, and changes in status), and seasonal celebrations (e.g., harvest and New Year). Exceptions to this pattern were daily or at least occasional use of alcohol as a foodstuff and use of various stimulants (e.g., betel-areca, tea and coffee, and coca leaf) in association with long, hard labor (e.g., paddy rice or taro farming and silver mining). Daily beer or wine drinking was limited to Europe, especially the para-Mediterranean wine countries and central grain-beer countries. Such daily or "titer" use is not without its problems, even when socially sanctioned. Hepatic cirrhosis and other organ damage (e.g., to brain, bone marrow, neuromuscular system, and pancreas) may result from long-term, daily use of more than 2-4 ounces of alcohol, depending on body weight (Baldwin, 1977). Daily use of stimulants, especially if heavy or addictive, can lead to biomedical or psychosocial problems, such as oral cancers in the case of betel-areca chewing (Ahluwalia & Ponnampalam, 1968) or psycho-behavioral changes in the case of coca leaf chewing (Negrete, 1978).
Socially sanctioned, episodic psychoactive substance use may involve heavy use, with marked intoxication or drunkenness (Bunzel, 1940). In a low-technology environment, this pattern may cause few problems, although psychotomimetic drugs such as cannabis can cause toxic psychosis (Chopra & Smith, 1974). In a high-technology environment, with modern methods of transportation and industrial machinery, intoxication even at mild traditional levels may be life threatening (Stull, 1972). Binge-type alcohol problems include delirium tremens, fights, sexually transmitted disease, and falls.
Among other consequence of technology and advanced civilization are widespread substance abuse epidemics, or long-lasting endemics. In the pre-
Columbian era, sporadic cases of acute and chronic substance abuse problems had been known for at least a millennium, and probably longer. However, relatively sudden, massive substance abuse increases appeared early in the post-Columbian era. One of these was the English gin epidemic or gin plague (Thurn, 1978), which began in the late 1600s and continued for several decades. Transatlantic intercontinental trade and the beginnings of the Industrial Revolution were the immediate causes. At about the same time, opium epidemics broke out in several Asian countries. The origins of these epidemics were somewhat different. The post-Columbian spread of tobacco smoking to Asia introduced the inhabitants to inhalation as a new mode of drug administration. This new route of administration applied to an old drug, opium, produced a combination more addictive than the old opium-eating tradition. Governmental pressures against tobacco smoking (which was viewed as wasteful and associated with seditious elements) probably accelerated the popularity of opium smoking. Subsequently, European colonialism and international trade contributed to the import of Indian opium to several East Asian countries. Opium epidemics also occurred somewhat later in Europe and North America (Kramer, 1979). Although East Asian countries have largely controlled their opium problems, opiate endemics continue in Southeast and South Asia, the Middle East, parts of Europe, and North America.
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