introduction on substance abuse essay

Essay on Drug Abuse

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Essay on Drug Abuse in 150 words

Essay on drug abuse in 250-300 words, essay on drug abuse in 500-1000 words.

Drug abuse is a global issue that poses serious risks to individuals and society. It involves the harmful and excessive use of drugs, leading to physical and mental health problems. Drug abuse can result in addiction, organ damage, cognitive impairment, and social and economic difficulties. Prevention efforts should focus on education, raising awareness about the dangers of drug abuse, and promoting healthy lifestyles. Access to quality healthcare and addiction treatment services is crucial for recovery. Strengthening law enforcement measures against drug trafficking is necessary to address the supply side of the problem. Creating supportive environments and opportunities for positive engagement can help prevent drug abuse. By taking collective action, we can combat drug abuse and build healthier communities.

Drug abuse is a growing global concern that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have negative effects on physical and mental health.

Drug abuse has severe consequences for individuals and society. Physically, drug abuse can lead to addiction, damage vital organs, and increase the risk of overdose. Mentally, it can cause cognitive impairment, and psychological disorders, and deteriorate overall well-being. Additionally, drug abuse often leads to social and economic problems, such as strained relationships, loss of employment, and criminal activities.

Preventing drug abuse requires a multi-faceted approach. Education and awareness programs play a crucial role in informing individuals about the dangers of drug abuse and promoting healthy lifestyle choices. Access to quality healthcare and addiction treatment services is vital to help individuals recover from substance abuse. Strengthening law enforcement efforts to curb drug trafficking and promoting international cooperation is also essential to address the supply side of the issue.

Community support and a nurturing environment are critical in preventing drug abuse. Creating opportunities for individuals, especially young people, to engage in positive activities and providing social support systems can serve as protective factors against drug abuse.

In conclusion, drug abuse is a significant societal problem with detrimental effects on individuals and communities. It requires a comprehensive approach involving education, prevention, treatment, and enforcement. By addressing the root causes, raising awareness, and providing support to those affected, we can combat drug abuse and create a healthier and safer society for all.

Title: Drug Abuse – A Global Crisis Demanding Urgent Action

Introduction :

Drug abuse is a pressing global issue that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have detrimental effects on physical and mental health. This essay explores the causes and consequences of drug abuse, the social and economic impact, prevention and treatment strategies, and the importance of raising awareness and fostering supportive communities in addressing this crisis.

Causes and Factors Contributing to Drug Abuse

Several factors contribute to drug abuse. Genetic predisposition, peer pressure, stress, trauma, and environmental influences play a role in initiating substance use. The availability and accessibility of drugs, as well as societal norms and cultural acceptance, also influence drug abuse patterns. Additionally, underlying mental health issues and co-occurring disorders can drive individuals to self-medicate with drugs.

Consequences of Drug Abuse

Drug abuse has devastating consequences on individuals and society. Physically, drug abuse can lead to addiction, tolerance, and withdrawal symptoms. Substance abuse affects vital organs, impairs cognitive function, and increases the risk of accidents and injuries. Mental health disorders, such as depression, anxiety, and psychosis, are often associated with drug abuse. Substance abuse also takes a toll on relationships, leading to strained family dynamics, social isolation, and financial instability. The social and economic costs of drug abuse include increased healthcare expenses, decreased productivity, and the burden on criminal justice systems.

Prevention and Education

Preventing drug abuse requires a comprehensive and multi-faceted approach. Education and awareness programs are essential in schools, communities, and the media to inform individuals about the risks and consequences of drug abuse. Promoting healthy coping mechanisms, stress management skills, and decision-making abilities can empower individuals to resist peer pressure and make informed choices. Early intervention programs that identify at-risk individuals and provide support and resources are crucial in preventing substance abuse.

Treatment and Recovery

Access to quality healthcare and evidence-based addiction treatment is vital in addressing drug abuse. Treatment options include detoxification, counseling, behavioral therapies, and medication-assisted treatments. Rehabilitation centers, support groups, and outpatient programs provide a continuum of care for individuals seeking recovery. Holistic approaches, such as addressing co-occurring mental health disorders and promoting healthy lifestyles, contribute to successful long-term recovery. Support from family, friends, and communities plays a significant role in sustaining recovery and preventing relapse.

Law Enforcement and Drug Policies

Effective law enforcement efforts are necessary to disrupt drug trafficking and dismantle illicit drug networks. International cooperation and collaboration are crucial in combating the global drug trade. Additionally, drug policies should focus on a balanced approach that combines law enforcement with prevention, treatment, and harm reduction strategies. Shifting the emphasis from punitive measures toward prevention and rehabilitation can lead to more effective outcomes.

Creating Supportive Communities:

Fostering supportive communities is vital in addressing drug abuse. Communities should provide resources, social support networks, and opportunities for positive engagement. This includes promoting healthy recreational activities, providing vocational training, and creating safe spaces for individuals in recovery. Reducing the stigma associated with drug abuse and encouraging empathy and understanding are crucial to building a compassionate and supportive environment.

Conclusion :

Drug abuse remains a complex and multifaceted issue with far-reaching consequences. By addressing the causes, raising awareness, implementing preventive measures, providing quality treatment and support services, and fostering supportive communities, we can combat drug abuse and alleviate its impact. It requires collaboration and a collective effort from individuals, communities, governments, and organizations to build a society that is resilient against the scourge of drug abuse. Through education, prevention, treatment, and compassion, we can pave the way toward a healthier and drug-free future.

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Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov.

Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet].

Chapter 1 introduction and overview of the report.

• Chapter 1 Preview

The United States has a serious substance misuse problem. Substance misuse is the use of alcohol or drugs in a manner, situation, amount, or frequency that could cause harm to the user or to those around them. Alcohol and drug misuse and related substance use disorders affect millions of Americans and impose enormous costs on our society. In 2015, 66.7 million people in the United States reported binge drinking in the past month and 27.1 million people were current users of illicit drugs or misused prescription drugs. 3 The accumulated costs to the individual, the family, and the community are staggering and arise as a consequence of many direct and indirect effects, including compromised physical and mental health, increased spread of infectious disease, loss of productivity, reduced quality of life, increased crime and violence, increased motor vehicle crashes, abuse and neglect of children, and health care costs.

The most devastating consequences are seen in the tens of thousands of lives that are lost each year as a result of substance misuse. Alcohol misuse contributes to 88,000 deaths in the United States each year; 1 in 10 deaths among working adults are due to alcohol misuse. 6 In addition, in 2014 there were 47,055 drug overdose deaths including 28,647 people who died from a drug overdose involving some type of opioid, including prescription pain relievers and heroin—more than in any previous year on record. 7

Even though the United States spends more than any other country on health care, it ranks 27 th in life expectancy, which has plateaued or decreased for some segments of the population at a time when life expectancy continues to increase in other developed countries—and the difference is largely due to substance misuse and associated physical and mental health problems. For example, recent research has shown an unprecedented increase in mortality among middle-aged White Americans between 1999 and 2014 that was largely driven by alcohol and drug misuse and suicides, although this trend was not seen within other racial and ethnic populations such as Blacks and Hispanics. 8 An analysis from the Centers for Disease Control and Prevention (CDC) demonstrated that alcohol and drug misuse accounted for a roughly 4-month decline in life expectancy among White Americans; no other cause of death had a larger negative impact in this population. 9

Substance misuse and substance use disorders also have serious economic consequences, costing more than $400 billion annually in crime, health, and lost productivity. 10 , 11 These costs are of a similar order of magnitude to those associated with other serious health problems such as diabetes, which is estimated to cost the United States $245 billion each year. 12 Alcohol misuse and alcohol use disorders alone costs the United States approximately $249 billion in lost productivity, health care expenses, law enforcement, and other criminal justice costs. 10 The costs associated with drug use disorders and use of illegal drugs and non-prescribed medications were estimated to be more than $193 billion in 2007. 11

Despite decades of expense and effort focused on a criminal justice-based model for addressing substance use-related problems, substance misuse remains a national public health crisis that continues to rob the United States of its most valuable asset: its people. In fact, high annual rates of past-month illicit drug use and binge drinking among people aged 12 years and older from 2002 through 2014 ( Figure 1.1 ) emphasize the importance of implementing evidence-based public-health-focused strategies to prevent and treat alcohol and drug problems in the United States. 13 A public health approach seeks to improve the health and safety of the population by addressing underlying social, environmental, and economic determinants of substance misuse and its consequences, to improve the health, safety, and well-being of the entire population.

Past Month Rates of Substance Use Among People Aged 12 or Older: Percentages, 2002-2014, 2014 National Survey on Drug Use and Health (NSDUH). Notes: The National Survey on Drug Use and Health (NSDUH) obtains information on nine categories of illicit drugs: (more...)

This Surgeon General's Report has been created because of the important health and social problems associated with alcohol and drug misuse in America. As described in this Report , a comprehensive approach is needed to address substance use problems in the United States that includes several key components:

• Enhanced public education to improve awareness about substance use problems and demand for more effective policies and practices to address them;
• Widespread implementation of evidence-based prevention policies and programs to prevent substance misuse and related harms;
• Improved access to evidence-based treatment services, integrated with mainstream health care, for those at risk for or affected by substance use disorders;
• Recovery support services (RSS) to assist individuals in maintaining remission and preventing relapse; and
• Research-informed public policies and financing strategies to ensure that substance misuse and use disorder services are accessible, compassionate, efficient, and sustainable.

The Public Health System . The Public Health System is defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction” and includes state and local public health agencies, public safety agencies, health care providers, human service and charity organizations, recreation and arts-related organizations, economic and philanthropic organizations, and education and youth development organizations. 2

The Health Care System . The World Health Organization defines a health care system as (1) all the activities whose primary purpose is to promote, restore, and/or maintain health, and (2) the people, institutions, and resources, arranged together in accordance with established policies, to improve the health of the population they serve. The health care system is made up of diverse health care organizations ranging from primary care, specialty substance use disorder treatment (including residential and outpatient settings), mental health care, infectious disease clinics, school clinics, community health centers, hospitals, emergency departments, and others. 5

Recognizing these needs, the Report explains the neurobiological basis for substance use disorders and provides the biological, psychological, and social frameworks for improving diagnosis, prevention, and treatment of alcohol and drug misuse. It also describes evidence-based prevention strategies, such as public policies that can reduce substance misuse problems (e.g., driving under the influence [DUI]); effective treatment strategies, including medications and behavioral therapies for treating substance use disorders; and RSS for people who have completed treatment. Additionally, the Report describes recent changes in health care financing, including changes in health insurance regulations, which support the integration of clinical prevention and treatment services for substance use disorders into mainstream health care practice, and defines a research agenda for addressing alcohol and drug misuse as medical conditions.

Thus, this first Surgeon General's Report on Alcohol, Drugs, and Health is not issued simply because of the prevalence of substance misuse or even the related devastating harms and costs, but also to help inform policymakers, health care professionals, and the general public about effective, practical, and sustainable strategies to address these problems. These strategies have the potential to substantially reduce substance misuse and related problems; promote early intervention for substance misuse and substance use disorders; and improve the availability of high-quality treatment and RSS for persons with substance use disorders.

A Public Health Model for Addressing Substance Misuse and Related Consequences

A public health systems approach to substance misuse and its consequences, including substance use disorders, aims to:

• Define the problem through the systematic collection of data on the scope, characteristics, and consequences of substance misuse;
• Identify the risk and protective factors that increase or decrease the risk for substance misuse and its consequences, and the factors that could be modified through interventions;
• Work across the public and private sector to develop and test interventions that address social, environmental, or economic determinants of substance misuse and related health consequences;
• Support broad implementation of effective prevention and treatment interventions and recovery supports in a wide range of settings; and
• Monitor the impact of these interventions on substance misuse and related problems as well as on risk and protective factors.

A healthy community is one with not just a strong health care system but also a strong public health educational system, safe streets, effective public transportation and affordable, high quality food and housing -where all individuals have opportunities to thrive. Thus, community leaders should work together to mobilize the capacities of health care organizations, social service organizations, educational systems, community-based organizations, government health agencies, religious institutions, law enforcement, local businesses, researchers, and other public, private, and voluntary entities that can contribute to the above aims. Everyone has a role to play in addressing substance misuse and its consequences and thereby improving the public health.

• Substances Discussed in this Report

This Report defines a substance as a psychoactive compound with the potential to cause health and social problems, including substance use disorders (and their most severe manifestation, addiction). These substances can be divided into three major categories: Alcohol, Illicit Drugs (a category that includes prescription drugs used nonmedically), and Over-the-Counter Drugs. Some specific examples of the substances included in each of these categories are included in Table 1.1 . Over-the-Counter Drugs are not discussed in this Report , but are included in Appendix D - Important Facts about Alcohol and Drugs.

Categories and Examples of Substances.

Although different in many respects, the substances discussed in this Report share three features that make them important to public health and safety. First, many people use and misuse these substances: 66.7 million individuals in the United States aged 12 or older admitted to binge drinking in the past month and 27.1 million people aged 12 or older used an illicit drug in the past month 3

Second, individuals can use these substances in a manner that causes harm to the user or those around them . This is called substance misuse and often results in health or social problems, referred to in this Report as substance misuse problems. Misuse can be of low severity and temporary, but it can also result in serious, enduring, and costly consequences due to motor vehicle crashes, 18 , 19 intimate partner and sexual violence, 20 child abuse and neglect, 21 suicide attempts and fatalities, 22 overdose deaths, 23 various forms of cancer 24 (e.g., breast cancer in women), 25 heart and liver diseases, 26 HIV/AIDS, 27 and problems related to drinking or using drugs during pregnancy, such as fetal alcohol spectrum disorders (FASDs) or neonatal abstinence syndrome (NAS). 28

Third, prolonged, repeated misuse of any of these substances can produce changes to the brain that can lead to a substance use disorder , an independent illness that significantly impairs health and function and may require specialty treatment Disorders can range from mild to severe. Severe and chronic substance use disorders are commonly referred to as addictions.

FOR MORE ON THIS TOPIC

See the section on Diagnosing a Substance Use Disorder later in this chapter.

Key Terms Used in the Report

Addiction : The most severe form of substance use disorder, associated with compulsive or uncontrolled use of one or more substances. Addiction is a chronic brain disease that has the potential for both recurrence (relapse) and recovery.

Substance : A psychoactive compound with the potential to cause health and social problems, including substance use disorders (and their most severe manifestation, addiction). For a list of substance categories included in this Report see Table 1.1 . Note: Cigarettes and other tobacco products are only briefly discussed here due to extensive coverage in prior Surgeon General's Reports. 14 - 17

Substance Use : The use—even one time—of any of the substances in this Report .

Substance Misuse : The use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them. For some substances or individuals, any use would constitute misuse (e.g., underage drinking, injection drug use).

Binge Drinking : Binge drinking for men is drinking 5 or more standard alcoholic drinks, and for women, 4 or more standard alcoholic drinks on the same occasion on at least 1 day in the past 30 days.

Heavy Drinking : Defined by the CDC as consuming 8 or more drinks per week for women, and 15 or more drinks per week for men, and by the Substance Abuse and Mental Health Services Administration (SAMHSA), for research purposes, as binge drinking on 5 or more days in the past 30 days.

Standard Drink : Based on the 2015-2020 Dietary Guidelines for Americans , a standard drink is defined as shown in the graphic below. All of these drinks contain 14 grams (0.6 ounces) of pure alcohol.

Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture, (2015). 29

Substance Misuse Problems or Consequences : Any health or social problem that results from substance misuse. Substance misuse problems or consequences may affect the substance user or those around them, and they may be acute (e.g., an argument or fight, a motor vehicle crash, an overdose) or chronic (e.g., a long-term substance-related medical, family, or employment problem, or chronic medical condition, such as various cancers, heart disease, and liver disease). These problems may occur at any age and are more likely to occur with greater frequency of substance misuse.

Substance Use Disorder: A medical illness caused by repeated misuse of a substance or substances. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 30 substance use disorders are characterized by clinically significant impairments in health, social function, and impaired control over substance use and are diagnosed through assessing cognitive, behavioral, and psychological symptoms. Substance use disorders range from mild to severe and from temporary to chronic. They typically develop gradually over time with repeated misuse, leading to changes in brain circuits governing incentive salience (the ability of substance-associated cues to trigger substance seeking), reward, stress, and executive functions like decision making and self-control. Multiple factors influence whether and how rapidly a person will develop a substance use disorder. These factors include the substance itself; the genetic vulnerability of the user; and the amount, frequency, and duration of the misuse. Note: A severe substance use disorder is commonly called an addiction.

Relapse : The return to drug use after a significant period of abstinence.

Recovery : A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Even individuals with severe and chronic substance use disorders can, with help, overcome their substance use disorder and regain health and social function. This is called remission. When those positive changes and values become part of a voluntarily adopted lifestyle, that is called “being in recovery.” Although abstinence from all substance misuse is a cardinal feature of a recovery lifestyle, it is not the only healthy, pro-social feature.

• Prevalence of Substance Use, Misuse Problems, and Disorders

How widespread are substance use, misuse, and substance use disorders in the United States? The annual National Survey on Drug Use and Health (NSDUH) gathers data on the scope and prevalence of substance use, misuse, and related disorders, as well as utilization of substance use disorder treatment, among Americans aged 12 and older, representing more than 265 million people. Table 1.2 provides selected findings from the 2015 NSDUH. The table provides only general statistics for the United States as a whole; readers are urged to consult NSDUH's detailed tables 3 for subpopulation estimates.

Past Year Substance Use, Past Year Initiation of Substance Use, and Met Diagnostic Criteria for a Substance Use Disorder in the Past Year Among Persons Aged 12 Years or Older for Specific Substances: Numbers in Millions and Percentages, 2015 National (more...)

Over 175 million persons aged 12 and older (65.7 percent of this population) reported alcohol use in the past year, with over 66 million (24.9 percent) reporting binge drinking in the past month ( Table 1.2 ). More than 36 million (13.5 percent) reported using marijuana in the past year, 12.5 million reported misusing prescription pain relievers, and over 300,000 reported using heroin in the past year. Almost 8 percent of the population met diagnostic criteria for a substance use disorder for alcohol or illicit drugs, and another 1 percent met diagnostic criteria for both an alcohol and illicit drug use disorder. Although 20.8 million people (7.8 percent of the population) met the diagnostic criteria for a substance use disorder in 2015, only 2.2 million individuals (10.4 percent) received any type of treatment. Of those treated, 63.7 percent received treatment in specialty substance use disorder treatment programs. 3

Prevalence . The proportion of a population who have (or had) a specific characteristic—for example, an illness, condition, behavior, or risk factor— in a given time period.

Several specific findings shown in Table 1.2 bear emphasis. Past year misuse of prescription psychotherapeutic drugs was reported by 18.9 million individuals in 2015 (7.1 percent of the population). 3 Within this category, prescribed opioid pain relievers (e.g., OxyContin®, Vicodin®, Lortab®) accounted for 12.5 million people, followed by tranquilizers, such as Xanax®, reported by 6.1 million people; stimulants, such as Adderall® or Ritalin®, reported by 5.3 million people; and sedatives, such as Valium®, reported by 1.5 million people. 3

Substance Use Disorder Treatment Programs

Historically, treatment services were designed for people with severe substance use disorders (addictions), and programs were generally referred to as “specialty addiction treatment programs.” Today, individuals with mild to severe substance use disorders may receive treatment. These treatments are delivered by specialty programs, as well as by more generalist providers (e.g., primary care and general mental health providers). Not everyone with a substance use disorder will need ongoing treatment; many will require only a brief intervention and monitoring. Because treatments vary substantially in level of specialization, content, duration, and setting, and because those receiving services may differ substantially in the severity, duration, and complexity of their substance use disorder, this Report uses the phrase “substance use disorder treatment” as the generic term to capture the broad spectrum of advice, therapies, services, and monitoring provided to the group of individuals with mild to severe substance use disorders. The programs and services that provide specialty treatment are referred to as “substance use disorder treatment programs or services.”

The prevalence of past 30-day use of “any illicit drugs” (a broad category including marijuana/hashish, cocaine/crack, heroin, hallucinogens, inhalants, and prescription psychotherapeutic medications used nonmedically) rose from 9.4 percent in 2013 to 10.2 percent in 2014 among persons aged 12 and older ( Figure 1.2 ). This 2014 prevalence rate for illicit drugs is significantly higher than it was in any year from 2002 to 2013. However, no significant changes were observed that year specifically in the use of prescription psychotherapeutic drugs, cocaine, or hallucinogens, suggesting that the observed increase was primarily related to increased use of marijuana. Marijuana was the most frequently used illicit drug (35.1 million past year users). 31 The rate for past month marijuana use in 2014 was significantly higher than it was in any year from 2002 to 2013, with the prevalence of past 30-day marijuana use rising from 7.5 percent in 2013 to 8.4 percent in 2014. 13 (Note: In 2015, changes were made to the NSDUH questionnaire and data collection procedures that do not allow for the presentation of trend data beyond 2014. For more information, see Summary of the Effects of the 2015 NSDUH Questionnaire Redesign: Implications for Data Users . 32 )

Trends in Binge Drinking and Past 30-Day Use of Illicit Drugs among Persons Aged 12 Years or Older, 2014 National Survey on Drug Use and Health (NSDUH). Notes: * Difference between this estimate and the 2014 estimate is statistically significant at the (more...)

Demographics of Substance Use

Table 1.3 and Table 1.4 show substance use by demographic characteristics. Prevalence of substance misuse and substance use disorders differs by race and ethnicity and gender, and these factors can also influence access to health care and substance use disorder treatment. Past year alcohol use for men was 68.6 percent and for women it was 62.9 percent. Past month binge alcohol use was 29.6 percent for men and 20.5 percent for women. The prevalence of past month binge alcohol use was 24.1 percent for American Indians or Alaska Natives, 25.7 percent for Hispanics or Latinos, and 26.0 for Whites. Prevalence of an alcohol use disorder was 7.8 percent for men and 4.1 percent for women. The prevalence of an illicit drug use disorder was 3.8 percent for men and 2.0 percent for women.

Past Year Alcohol Use, Past Month Binge Alcohol Use, and Met Diagnostic Criteria for a Substance Use Disorder in the Past Year Among Persons Aged 12 Years or Older: Numbers in Millions and Percentages, 2015 National Survey on Drug Use and Health (NSDUH). (more...)

Past Year Substance Use, Past 30-Day Illicit Drug Use, and Met Diagnostic Criteria for a Substance Use Disorder in the Past Year Among Persons Aged 12 Years or Older: Numbers in Millions and Percentages, 2015 National Survey on Drug Use and Health (NSDUH). (more...)

Relevance of Substance Use and Misuse

It is sometimes thought that concern over substance use and misuse should be secondary to the real issue of substance use disorders and especially their severest manifestation, addiction, which has captured media headlines and has been linked to many health and social problems. This is an important misconception. Individuals with substance use disorders have elevated rates of substance misuse–related health and social problems and costs, but as shown in the last columns of Table 1.2 , Table 1.3 , and Table 1.4 , many people who misuse substances do not meet the diagnostic criteria for a substance use disorder. For example, binge drinking at least once during the past month was self-reported by over 66 million individuals. By definition, those episodes have the potential for producing harm to the user and/or to those around them, through increases in motor vehicle crashes, violence, and alcohol-poisonings. 33 Similarly, in 2015, 12.5 million individuals misused a pain reliever in the past year—setting the stage for a potential overdose—but only 2.9 million met diagnostic criteria for a prescription medication disorder. 3

The clear implications of these data are that a comprehensive approach to reducing the misuse of alcohol and drugs—one that includes the implementation of effective prevention programs and policy strategies as well as high-quality treatment services—is needed to reduce the problems and costs of substance misuse in the United States. In fact, greater impact is likely to be achieved by reducing substance misuse in the general population—that is, among people who are not addicted—than among those with severe substance use problems. Of course, efforts to reduce general population rates of substance use and misuse are also likely to reduce rates of substance use disorders, because substance use disorders typically develop over time following repeated episodes of misuse (often at escalating rates) that result in the progressive changes to brain circuitry that underlie addiction.

See Chapter 2 - The Neurobiology of Substance Use , Misuse, and Addiction .

• Costs and Impact of Substance Use and Misuse

Alcohol misuse, illicit drug use, misuse of medications, and substance use disorders are estimated to cost the United States more than $400 billion in lost workplace productivity (in part, due to premature mortality), health care expenses, law enforcement and other criminal justice costs (e.g., drug-related crimes), and losses from motor vehicle crashes. 10 , 11 Furthermore, about three quarters of the costs associated with alcohol use were due to binge drinking, and about 40 percent of those costs were paid by government, emphasizing the huge cost of alcohol misuse to taxpayers. 34

These costs are not unique to the United States. A 2010 study examined the global burden of disability attributable to substance misuse problems and disorders, focusing particularly on lost ability to work and years of life lost to premature mortality. Costs were calculated for 20 age groups and both sexes in 187 countries. 35 Mental and substance use disorders were the leading causes of years lived with disability worldwide, largely because these problems strike individuals early in their lives and can continue—especially if untreated—for long periods.

In addition to the costs to society, substance misuse can have many direct and indirect health and personal consequences for individuals. The direct effects on the user depend on the specific substances used, how much and how often they are used, how they are taken (e.g., orally vs. injected), and other factors. Acute effects can range from changes in mood and basic body functions, such as heart rate or blood pressure, to overdose and death. Alcohol misuse and drug use can also have long-term effects on physical and mental health and can lead to substance use disorders. For example, drug use is associated with chronic pain conditions and cardiovascular and cardiopulmonary diseases. 36 , 37 Alcohol misuse is associated with liver and pancreatic diseases, hypertension, reproductive system disorders, trauma, stroke, FASD, and cancers of the oral cavity, esophagus, larynx, pharynx, liver, colon, and rectum. 26 , 28 For breast cancer, studies have shown that even moderate drinking may increase the risk. 25 Although alcohol consumption is associated with adverse health effects as noted above, the 2015-2020 Dietary Guidelines for Americans indicate that moderate alcohol use can be part of a healthy diet, but only when used by adults of legal drinking age. i

In addition, alcohol and drug use by pregnant women can have profound effects on the developing fetus. Alcohol use during pregnancy can lead to a wide range of disabilities in children, the most severe of which is FASD, characterized by intellectual disabilities, speech and language delays, poor social skills, and sometimes facial deformities. Use of drugs, such as opioids during pregnancy, can result in NAS, a drug-withdrawal syndrome requiring medical intervention and extended hospital stay for newborns. Use of some drugs, such as cocaine, during pregnancy may also lead to premature birth or miscarriage. In addition, substance use during pregnancy may interfere with a child's brain development and result in later consequences for mental functioning and behavior.

Substance misuse also can affect a user's nutrition and sleep, as well as increase the risk for trauma, violence, injury, and contraction of communicable diseases, such as HIV/AIDS and Hepatitis C. These consequences can all contribute to the spectrum of public health consequences of substance misuse and need to be considered both independently and collectively when developing and implementing clinical and public health interventions.

Substance misuse problems can also result in other serious and sometimes fatal health problems and extraordinary costs; they may also lead to unexpected death from other causes. Three examples of these serious, sometimes lethal, problems related to substance misuse are highlighted below.

Driving Under the Influence

In 2014, 9,967 people were killed in motor vehicle crashes while driving under the influence of alcohol, representing nearly one third (31 percent) of all traffic-related fatalities in the United States. 38 DUI continues to be among the most frequent causes for arrests every year. 39 But at approximately 1.3 million per year, these arrests represent only about 1 percent of the actual alcohol-impaired driving incidents reported in national surveys, suggesting that there are many more people who drive while impaired that have not been arrested, putting themselves and others at high risk of being harmed. 18 , 40 In addition to the deaths that result from DUI, the National Highway Traffic Safety Administration (NHTSA) estimates that DUI costs the United States more than $44 billion each year in prosecution, higher insurance rates, higher taxes, medical claims, and property damage. 41

As important as they are, these statistics account for only alcohol-related driving impairment and fail to measure other impairing substances. A study by NHTSA tested oral fluid and blood specimens from a random sample of drivers at the roadside (during daytime on Friday or nighttime Friday to Sunday) and found 12 to 15 percent had used one or more illegal substances. 42 Drivers tested positive for drugs in approximately 16 percent of all motor vehicle crashes. 43

Overdose Deaths

Overdose deaths are typically caused by consuming substances at high intensity and/or by consuming combinations of substances such as alcohol, sedatives, tranquilizers, and opioid pain relievers to the point where critical areas in the brain that control breathing, heart rate, and body temperature stop functioning.

Alcohol Overdose (Alcohol Poisoning)

The CDC reports more than 2,200 alcohol overdose deaths in the United States each year—an average of six deaths every day 44 More than three quarters (76 percent) of alcohol overdose deaths occur among adults between ages 35 and 64, and 76 percent of those who die from alcohol overdose are men.

Drug Overdose (Illicit and Prescription Drugs)

Opioid analgesic pain relievers are now the most prescribed class of medications in the United States, with more than 289 million prescriptions written each year. 45 , 46 The increase in prescriptions of opioid pain relievers has been accompanied by dramatic increases in misuse ( Table 1.1 ) and by a more than 200 percent increase in the number of emergency department visits from 2005 to 2011. 47 In 2014, 47,055 drug overdose deaths occurred in the United States, and 61 percent of these deaths were the result of opioid use, including prescription opioids and heroin. 7 Heroin overdoses have more than tripled from 2010 to 2014. 7 Heroin overdoses were more than five times higher in 2014 (10,574) then ten years before in 2004 (1,878). Additionally, rates of cocaine overdose were higher in 2014 than in the previous six years (5,415 deaths from cocaine overdose). In 2014, there were 17,465 overdoses from illicit drugs and 25,760 overdoses from prescription drugs. 48 Drug overdose deaths also occur as a result of the illicit manufacturing and distribution of synthetic opioids, such as fentanyl, and the illegal diversion of prescription opioids. Illicit fentanyl, for example, is often combined with heroin or counterfeit prescription drugs or sold as heroin, and may be contributing to recent increases in drug overdose deaths. 7 , 49

KEY CONCEPT

The Opioid Crisis. Over-prescription of powerful opioid pain relievers beginning in the 1990s led to a rapid escalation of use and misuse of these substances by a broad demographic of men and women across the country. 1 This led to a resurgence of heroin use, as some users transitioned to using this cheaper street cousin of expensive prescription opioids. As a result, the number of people dying from opioid overdoses soared—increasing nearly four-fold between 1999 and 2014. 4

Intimate Partner Violence, Sexual Assault, and Rape

Intimate partner violence, sexual assault, and rape are crimes with long-lasting effects on victims and great cost to society. 50 , 51 These crimes happen to both women and men and are often associated with substance use. A recent national survey found that 22 percent of women and 14 percent of men reported experiencing severe physical violence from an intimate partner in their lifetimes. 52 In this survey, 19.3 percent of women and 1.7 percent of men reported being raped in their lifetimes, while 43.9 percent of women and 23.4 percent of men reported some other form of sexual violence in their lifetimes. 52 Substance misuse is often related to these crimes.

Numerous studies have found a high correlation between substance use and intimate partner violence, 53 - 56 although this does not mean that substance use causes intimate partner violence. In addition to evidence from the criminal justice arena, recent systematic reviews have found that substance use is both a risk factor for and a consequence of intimate partner violence. 57 - 59

A recent survey of sexual assault and sexual misconduct on college campuses found that use of alcohol and drugs are important risk factors for nonconsensual sexual contact among undergraduate, graduate, and professional students. 20 It is clear that substance use and intimate partner violence and sexual assault are closely linked; however, more research is needed on the nature of the relationship between substance use and these forms of violence to determine how substance use contributes to the perpetration of violence and victimization and how violence contributes to subsequent substance use among both perpetrators and victims.

• Vulnerability to Substance Misuse Problems and Disorders

Risk and Protective Factors: Keys to Vulnerability

Substance misuse problems and substance use disorders are not inevitable. An individual's vulnerability may be partly predicted by assessing the nature and number of their community, caregiver/family, and individual-level risk and protective factors.

Significant community-level risk factors for substance misuse and use disorders include easy access to inexpensive alcohol and other substances. Caregiver/family-level risk factors include low parental monitoring, a family history of substance use or mental disorders, and high levels of family conflict or violence. At the individual level, major risk factors include current mental disorders, low involvement in school, a history of abuse and neglect, and a history of substance use during adolescence, among others. 60

See Chapter 3 - Prevention Programs and Policies .

Community-level protective factors include higher cost for alcohol and other drugs (often achieved by increasing taxes on these products); regulating the number and concentration of retailers selling various substances (e.g., density of alcohol outlets or marijuana dispensaries); preventing illegal alcohol and other drug sales by enforcing existing laws and holding retailers accountable for harms caused by illegal sales (e.g., commercial host [dram shop] liability); availability of healthy recreational and social activities; and other population-level policies and their enforcement. 61 Caregiver/family-level protective factors include support and regular monitoring by parents. 60 Some important individual-level protective factors include involvement in school, engagement in healthy recreational and social activities, and good coping skills. 60

Three important points about vulnerability should be highlighted. First, no single individual or community-level factor determines whether an individual will develop a substance misuse problem or disorder. Second, most risk and protective factors can be modified through preventive programs and policies to reduce vulnerability. Third, although substance misuse problems and disorders may occur at any age, adolescence and young adulthood are particularly critical at-risk periods. Research now indicates that the majority of those who meet criteria for a substance use disorder in their lifetime started using substances during adolescence and met the criteria by age 20 to 25. 62 - 64 One likely reason for this vulnerability in adolescence and young adulthood is that alcohol and other substances have particularly potent effects on developing brain circuits, and recent scientific findings indicate that brain development is not complete until approximately age 21 to 23 in women and 23 to 25 in men. 65 - 67 Among the last brain regions to reach maturity is the prefrontal cortex, the brain region primarily responsible for “adult” abilities, such as delay of reward, extended reasoning, and impulse control. This area of the brain is one of the most affected regions in a substance use disorder.

Substance misuse can begin at any age. Therefore, it is important to focus on prevention of substance misuse across the lifespan as well as the prevention of substance use disorders.

• Diagnosing a Substance Use Disorder

Changes in Understanding and Diagnosis of Substance Use Disorders

Repeated, regular misuse of any of the substances listed in Figure 1.2 may lead to the development of a substance use disorder. Severe substance use disorders are characterized by compulsive use of substance(s) and impaired control of substance use. Substance use disorder diagnoses are based on criteria specified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). Much of the substance use disorder data included in this Report is based on definitions included in the DSM-IV, which described two distinct disorders: substance abuse and substance dependence, with specific diagnostic criteria for each. Anyone meeting one or more of the abuse criteria—which focused largely on the negative consequences associated with substance misuse, such as being unable to fulfill family or work obligations, experiencing legal trouble, or engaging in hazardous behavior as a result of drug use—would receive the “abuse” diagnosis. Anyone with three or more of the dependence criteria, which included symptoms of drug tolerance, withdrawal, escalating and uncontrolled substance use, and the use of the substance to the exclusion of other activities, would receive the “dependence” diagnosis. Notably, addiction is not listed as a formal diagnosis in the DSM. However, substance dependence was often used interchangeably with addiction, and tolerance and withdrawal were considered, by many, cardinal features of addiction.

Misuse versus Abuse. This Report uses the term substance misuse, a term that is roughly equivalent to substance abuse. Substance abuse, an older diagnostic term, was defined as use that is unsafe (e.g., drunk or drugged driving), use that leads a person to fail to fulfill responsibilities or gets them in legal trouble, or use that continues despite causing persistent interpersonal problems like fights with a spouse.

However, “substance abuse” is increasingly avoided by professionals because it can be shaming. Instead, substance misuse is now the preferred term. Although misuse is not a diagnostic term, it generally suggests use in a manner that could cause harm to the user or those around them.

The DSM-5, which is the fifth and current version of the DSM, integrates the two DSM-IV disorders, substance abuse and substance dependence, into a single disorder called substance use disorder with mild, moderate , and severe sub-classifications. Individuals are evaluated for a substance use disorder based on 10 or 11 (depending on the substance) equally weighted diagnostic criteria ( Table 1.5 ). Most of these overlap with those used to diagnose DSM-IV dependence and abuse. Individuals exhibiting fewer than two of the symptoms are not considered to have a substance use disorder. Those exhibiting two or three symptoms are considered to have a “mild” disorder, four or five symptoms constitutes a “moderate” disorder, and six or more symptoms is considered a “severe” substance use disorder. 30 In this Report , addiction is used to refer to substance use disorders at the severe end of the spectrum and are characterized by compulsive substance use and impaired control over use.

Criteria for Diagnosing Substance Use Disorders.

Tolerance . Alteration of the body's responsiveness to alcohol or a drug such that higher doses are required to produce the same effect achieved during initial use.

Withdrawal . A set of symptoms that are experienced when discontinuing use of a substance to which a person has become dependent or addicted, which can include negative emotions such as stress, anxiety, or depression, as well as physical effects such as nausea, vomiting, muscle aches, and cramping, among others. Withdrawal symptoms often lead a person to use the substance again.

Implications of the New Diagnostic Criteria

The new diagnostic criteria are likely to reduce the “all or nothing” thinking that has characterized the substance use field. Tolerance and withdrawal remain major clinical symptoms, but they are no longer the deciding factor in whether an individual “has an addiction.” Substance use disorders, including addiction, can occur with all substances listed in Table 1.1 , not just those that are able to produce tolerance and withdrawal. It is also important to understand that substance use disorders do not occur immediately but over time, with repeated misuse and development of more symptoms. This means that it is both possible and highly advisable to identify emerging substance use disorders, and to use evidence-based early interventions to stop the addiction process before the disorder becomes more chronic, complex, and difficult to treat.

What is an Intervention?

Intervention here and throughout this Report means a professionally delivered program, service, or policy designed to prevent substance misuse or treat an individual's substance use disorder. It does not refer to an arranged meeting or confrontation intended to persuade a friend or loved one to quit their substance misuse or enter treatment—the type of “intervention” sometimes depicted on television. Planned surprise confrontations of the latter variety—a model developed in the 1960s, sometimes called the “Johnson Intervention”—have not been demonstrated to be an effective way to engage people in treatment. 68 Confrontational approaches in general, though once the norm even in many behavioral treatment settings, have not been found effective and may backfire by heightening resistance and diminishing self-esteem on the part of the targeted individual. 69

This type of proactive clinical monitoring and management is already done within general health care settings to address other potentially progressive illnesses that are brought about by unhealthy behaviors. 70 For example, patients with high blood pressure may be told to adjust their activity and stress in order to reduce the progression of hypertension. Typically, these individuals are also clinically monitored for key symptoms to ensure that symptoms do not worsen.

See Chapter 6 - Health Care Systems and Substance Use Disorders .

There are compelling reasons to apply similar procedures in emerging cases of substance misuse. Routine screening for alcohol and other substance use should be conducted in primary care settings to identify early symptoms of a substance use disorder (especially among those with known risk and few protective factors). This should be followed by informed clinical guidance on reducing the frequency and amount of substance use, family education to support lifestyle changes, and regular monitoring.

Research has shown that substance use disorders are similar in course, management, and outcome to other chronic illnesses, such as hypertension, diabetes, and asthma. 71 Unfortunately, substance use disorders have not been treated, monitored, or managed like other chronic illnesses, nor has care for these conditions been covered by insurance to the same degree. Nonetheless, it is possible to adopt the same type of chronic care management approach to the treatment of substance use disorders as is now used to manage most other chronic illnesses. 70 - 72 Evidence-based behavioral interventions, medications, social support services, clinical monitoring, and RSS make this type of chronic care management possible, often by the same health care teams that currently treat other chronic illnesses.

See Chapter 4 - Early Intervention , Treatment, and Management of Substance Use Disorders and Chapter 6 - Health Care Systems and Substance Use Disorders .

Evidence also shows that such an approach will improve the effectiveness of treatments for substance use disorders. Remission of substance use and even full recovery can now be achieved if evidence-based care is provided for adequate periods of time, by properly trained health care professionals, and augmented by supportive monitoring, RSS, and social services. This fact is supported by a national survey showing that there are more than 25 million individuals who once had a problem with alcohol or drugs who no longer do. 73

• The Separation of Substance Use Treatment and General Health Care

Until quite recently, substance misuse problems and substance use disorders were viewed as social problems, best managed at the individual and family levels, and sometimes through the existing social infrastructure—such as schools and places of worship, and, when necessary, through civil and criminal justice interventions. 74 In the 1970s, when rates of substance misuse increased, including by college students and Vietnam War veterans, most families and traditional social services were not prepared to handle this problem. 75 Despite a compelling national need for treatment, the existing health care system was neither trained to care for nor especially eager to accept patients with substance use disorders.

For these reasons, a new system of substance use disorder treatment programs was created, but with administration, regulation, and financing placed outside mainstream health care. 74 , 75 This meant that with the exception of detoxification in hospital-based settings, virtually all treatment was delivered by programs that were geographically, financially, culturally, and organizationally separate from mainstream health care. Of equal historical importance was the decision to focus treatment only on addiction. This left few provisions for detecting or intervening clinically with the far more prevalent cases of early-onset, mild, or moderate substance use disorders.

Creating this system of substance use disorder treatment programs was a critical element in addressing the burgeoning substance use disorder problems in our nation. However, that separation also created unintended and enduring impediments to the quality and range of care options. For example, separate systems for substance use disorder treatment and other health care needs may have exacerbated the negative public attitudes toward people with substance use disorders. Additionally, the pharmaceutical industry was hesitant to invest in the development of new medications for individuals with substance use disorders, because they were not convinced that a market for these medications existed. Consequently, until the 1990s, few U.S. Food and Drug Administration (FDA) approved medications were available to treat addictions. 76 , 77

Meanwhile, despite numerous research studies documenting high prevalence rates of substance use disorders among patients in emergency departments, hospitals, and general medical care settings, mainstream health care generally failed to recognize or address substance use disorders. 78 In fact, a recent study by the CDC found that in 2011, only 1 in 6 United States adults and 1 in 4 binge drinkers had ever been asked by a health professional about their drinking behavior. 79 Furthermore, the percent of adult binge drinkers who had been asked about their drinking had not changed since 1997, reflecting the challenges involved in fostering implementation of screening and counseling services for alcohol misuse in clinical settings. This has been a costly mistake, with often deadly consequences. A recent study showed that the presence of a substance use disorder often doubles the odds for the subsequent development of chronic and expensive medical illnesses, such as arthritis, chronic pain, heart disease, stroke, hypertension, diabetes, and asthma. 80

In this regard, fatal medication errors due to unforeseen interactions between a prescribed medication for a diagnosed medical condition and unscreened, unaddressed patient substance use increased ten-fold over the past 20 years. 81 To address this problem, researchers suggested “…(1) screening patients for use…of alcohol and/or street drugs; (2) taking extra precautions when prescribing medicines with known dangerous interactions with alcohol and/or street drugs; and (3) teaching the patient the risks of mixing medicines with alcohol and/or street drugs.” 81 Similar recommendations focusing on prescribed opioids have been issued by the CDC to curb the rise in opioid overdose deaths. 82 Again, screening for substance use and substance use disorders before and during the course of opioid prescribing, combined with patient education, are recommended. 82

Yet despite these and other indications of extreme threats to health care quality, safety, effectiveness, and cost containment, as of this writing, few general health care organizations screen for, or offer services for, the early identification and treatment of substance use disorders. Moreover, few medical, nursing, dental, or pharmacy schools teach their students about substance use disorders; 83 - 86 and, until recently, few insurers offered adequate reimbursement for treatment of substance use disorders. 87 , 88

• Recent Changes in Health Care Policy and Law

The longstanding separation of substance use disorders from the rest of health care began to change with enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Affordable Care Act in 2010. 89 , 90 MHPAEA requires that the financial requirements and treatment limitations imposed by health plans and insurers for substance use disorders be no more restrictive than the financial requirements and treatment limitations they impose for medical and surgical conditions. The Affordable Care Act requires the majority of United States health plans and insurers to offer prevention, screening, brief interventions, and other forms of treatment for substance use disorders. 89

It is difficult to overstate the importance of these two Acts for creating a public health-oriented approach to reducing substance misuse and related disorders. These laws and related changes in health care financing are creating incentives for health care organizations to integrate substance use disorder treatment with general health care. Many questions remain, but those questions are no longer whether but how this much-needed integration will occur. These changes combine to create a new, challenging but exceptionally promising era for the prevention and treatment of substance use disorders and set the context for this Report .

• Marijuana: A Changing Legal and Research Environment

Although this Report does not examine the issue of marijuana legalization, its continually evolving legal status is worth mentioning because of implications for both research and policy. As mentioned elsewhere, marijuana is the most commonly used illicit drug in the United States, with 22.2 million people aged 12 or older using it in the past month. 3 In recent years marijuana use has become more socially acceptable among both adults and youth, while perceptions of risk among adolescents of the drug's harms have been declining over the past 13 years. 91

As use of marijuana and its constituent components and derivatives becomes more widely accepted, it is critical to strengthen understanding of the effects and consequences for individual users and for public health and safety. Conducting such research can be complex as laws and policies vary significantly from state to state. For example, some states use a decriminalization model, which means production and sale of marijuana are still illegal and no legal marijuana farms, distributors, companies, stores, or advertising are permitted. Through ballot initiatives, other states have “legalized” marijuana use, which means they allow the production and sales of marijuana for personal use. Additionally, some states have legalized marijuana for medical purposes, and this group includes a wide variety of different models dictating how therapeutic marijuana is dispensed. The impacts of state laws regarding therapeutic and recreational marijuana are still being evaluated, although the differences make comparisons between states challenging. 92

As of June 2016, 25 states and the District of Columbia have legalized medical marijuana use. Four states have legalized retail sales; the District of Columbia has legalized personal use and home cultivation (both medical and recreational), with more states expecting to do so. None of the permitted uses under state laws alters the status of marijuana and its constituent compounds as illicit drugs under Schedule I of the federal Controlled Substances Act. 93 It should also be noted that use for recreational purposes has not been legalized by any jurisdiction for people under age 21, and few jurisdictions have legalized medical marijuana for young people. While laws are changing, so too is the drug itself with average potency more than doubling over the past decade (1998 to 2008). 94 The ways marijuana is used are also changing - in addition to smoking, consuming edible forms like baked goods and candies, using vaporizing devices, and using high-potency extracts and oils (e.g., “dabbing”) are becoming increasingly common. 95 Because these products and methods are unregulated even in states that have legalized marijuana use, users may not have accurate information about dosage or potency, which can lead and has led to serious consequences such as hospitalizations for psychosis and other overdose-related symptoms. 95 Marijuana use can also impair driving skills and, while estimates vary, is linked to a roughly two-fold increase in accident risk. 96 - 98 The risk is compounded when marijuana is used with alcohol. 96 , 99

There is a growing body of research suggesting the potential therapeutic value of marijuana's constituent cannabinoid chemicals in numerous health conditions including pain, nausea, epilepsy, obesity, wasting disease, addiction, autoimmune disorders, and other conditions. Given the possibilities around therapeutic use, it is necessary to continue to explore ways of easing existing barriers to research. Marijuana has more than 100 constituent cannabinoid compounds, with cannabidiol (CBD) and tetrahydrocannabinol (THC, the chemical responsible for most of marijuana's intoxicating effects) being the most well-studied. Evidence collected so far in clinical investigations of the marijuana plant is still insufficient to meet FDA standards for a finding of safety and efficacy for any therapeutic indications. However, the FDA has approved three medications containing synthetically derived cannabinoids: Marinol capsules and Syndros oral solution (both containing dronabinol, which is identical in chemical structure to THC), and Cesamet capsules (containing nabilone, which is similar in structure to THC) for severe nausea and wasting in certain circumstances, for instance in AIDS patients. Recognizing the potential therapeutic importance of compounds found in marijuana, the FDA has granted Fast Track designation to four development programs of products that contain marijuana constituents or their synthetic equivalents. The therapeutic areas in which products are being developed granted Fast Track by FDA include the treatment of pain in patients with advanced cancer; treatment of Dravet syndrome (two programs), a rare and catastrophic treatment-resistant form of childhood epilepsy; and treatment of neonatal hypoxic ischemic encephalopathy, brain injury resulting from oxygen deprivation during birth.

Additionally, there are clinical investigations for the treatment of refractory seizure syndromes, including Lennox Gastaut Syndrome, and for treatment of post-traumatic stress disorder (PTSD). However, further exploration of these issues always requires consideration of the serious health and safety risks associated with marijuana use. Research shows that risks can include respiratory illnesses, dependence, mental health-related problems, and other issues affecting public health such as impaired driving. Within this context of changing marijuana policies at the state level, research is needed on the impact of different models of legalization and how to minimize harm based on what has been learned from legal substances subject to misuse, such as alcohol and tobacco. Continued assessment of barriers to research and surveillance will help build the best scientific foundation to support good public policy while also protecting the public health.

• Purpose, Focus, and Format of the Report

The Audience

This Report is intended for individuals, families, community members, educators, health care professionals, public health practitioners, advocates, public policymakers, and researchers who are looking for effective, sustainable solutions to the problems created by alcohol and other substances. To meet those needs, the Report reviews and synthesizes the most important and reliable scientific findings in key topic areas and distills those findings into recommendations for:

• Improving public awareness of substance misuse and related problems;
• Reducing negative attitudes related to substance use disorders;
• Closing the gap between what is known to reduce substance misuse at the population level and within specific subgroups, and the implementation of these effective programs, policies, and environmental strategies at the federal, state, and community levels;
• Understanding the need for and effectiveness of programs for high-risk populations;
• Expanding the capacity of health care systems to deliver evidence-based substance use disorder treatment;
• Integrating financing and health care system models to facilitate access and affordability of care for substance use disorders;
• Continuing to build the science base of effective prevention, treatment, and recovery practices and policies; and
• Engaging stakeholders in reducing substance use and misuse problems and protecting the health of all individuals across the lifespan.

Because of the broad audience, the Report is purposely written in accessible language without excessive scientific jargon. The Report also focuses on current issues and practical questions that trouble so many people:

• What are the health and social impacts of alcohol and drug use and misuse in the United States? What key factors influence these behaviors?
• What are the major substance misuse problems facing the United States?
• What causes substance use disorders and why do they change people so dramatically?
• Can substance misuse problems and disorders be prevented? How?
• What constitutes effective treatment?
• Can addicted individuals recover? What will it take to manage their disorders and sustain recovery?

Topics Covered in the Report

Individual chapters in the Report review the science associated with the major substance use, misuse, and disorder issues for specific topics. Tobacco, also an addictive substance, is mentioned only briefly, because problems associated with tobacco use and nicotine addiction have been covered extensively in other Surgeon General's Reports. 14 - 16 , 100 - 103

Because of the broad audience and the practical emphasis, the Report is intentionally selective rather than exhaustive, emphasizing findings that have the potential for the greatest public health impact and the greatest potential for action. For readers wanting greater scientific detail or more specific information, detailed research reports, as well as supplemental resource materials, are supplied in references, in the Appendices, and in special emphasis boxes throughout the Report .

Scientific Standards Used to Develop the Report

Findings cited in all of the chapters came from electronic database searches of research articles published in English. Within those searches, priority was given to systematic literature reviews and to findings that were replicated by multiple controlled trials. However, many important issues in prevention, treatment, recovery, and health care systems have not yet been examined in rigorous controlled trials, or are not appropriate for such research designs. In these cases, the best available evidence was cited and labeled according to the reporting conventions published by the CDC: 104

• Well-supported: Evidence derived from multiple controlled trials or large-scale population studies.
• Supported: Evidence derived from rigorous but fewer or smaller trials or restricted samples.
• Promising: Findings that do not derive from rigorously controlled studies but that nonetheless make practical or clinical sense and are widely practiced.

In cases in which evidence was based on findings of neurobiological research, the CDC standards were adapted.

A summary of the key findings appears at the beginning of each chapter. The key findings highlight what is currently known from available research about the chapter topic, as well as the strength of the evidence. As with the rest of the Report , the key findings are not intended to be exhaustive, but are instead considered the important “take-aways” from each chapter. Readers interested in a fuller discussion of the topics are encouraged to read the chapters in their entirety.

Addressing Substance Use in Specific Populations

As indicated, the chapters are designed to prioritize best available research findings that apply most broadly across different substances and across various subgroups, while also identifying program and policy interventions that have strong evidence for particular substances (e.g., alcohol), when available. The rationale for this decision is that the available research suggests that the genetic, neurobiological, and environmental processes underlying substance use, misuse, and disorders are largely similar across most known substances and unrelated to the age, sex, race and ethnicity, gender identity, or culture of the individual. The available research also clearly indicates that many of the interventions, including population-level policies, focused programs, behavioral therapies, medications, and social services shown to be effective in one subgroup are generally effective for other subgroups. Put differently, it is reasonable to assume that the findings presented in this Report are relevant for many substance use types and patterns; for most age, gender, racial and ethnic, and cultural subgroups; and for many special needs subgroups (e.g., those with co-occurring mental or physical illnesses; those involved with the criminal justice system).

However, this general statement has some important caveats. First, the statement depends heavily on the phrase “available research.” There is insufficient research examining subgroup differences in the neurobiology of substance use disorders and in interventions aimed at preventing, treating, and promoting recovery from substance use disorders. Additional research designed to examine these differences and to test interventions in specific populations is needed.

A second caveat is that individual variability in response to standard prevention, treatment, and recovery support interventions is common throughout health care. Individuals with the same disease often react quite differently to the same medicine or behavioral intervention. Accordingly, general health care has moved toward “personalized medicine,” an individualized treatment regimen derived from specific information about the individual's genetics and stage of illness, as well as lifestyle, language, culture, and personal preferences. Personalized care is not common in the substance use disorder field because many prevention, treatment, and recovery regimens were created as standardized “programs” rather than individualized protocols.

The third caveat to the statement on general research findings is that even if research has shown that certain medications, therapies, or recovery support services are likely to be effective , this does not mean that they will be adequate , especially for groups with specific needs. For example, a medication that is effective in blocking the rewarding effects of opioid use will not fully address the multiple, complex problems of those with opioid use disorders, nor address any co-occurring health conditions such as depression or HIV/AIDS.

Recognizing these limitations to the generalizability of research findings, each chapter has a dedicated section on Specific Populations that focuses particularly on age, racial and ethnic subgroups, and individuals with co-occurring mental and physical illnesses. Findings relevant to other important groups (e.g., military veterans; lesbian, gay, bisexual, and transgender [LGBT] populations; those with criminal justice involvement; those in rural areas) are referred to throughout the Report when available.

The Organization of the Report

This Report is divided into Chapters, highlighting the key issues and most important research findings in those topics. The final chapter concludes with recommendations for key stakeholders, including implications for practice and policy.

This Chapter 1 - Introduction and Overview describes the overall rationale for the Report , defines key terms used throughout the Report , introduces the major issues covered in the topical chapters, and describes the organization, format, and the scientific standards that dictated content and emphasis within the Report .

Chapter 2 - The Neurobiology of Substance Use , Misuse, and Addiction reviews brain research on the neurobiological processes that turn casual substance use into a compulsive disorder.

Chapter 3 - Prevention Program and Policies reviews the scientific evidence on preventing substance misuse, substance use-related problems, and substance use disorders.

Chapter 4 - Early Intervention , Treatment, and Management of Substance Use Disorders describes the goals, settings, and stages of treatment, and reviews the effectiveness of the major components of early intervention and treatment approaches, including behavioral therapies, medications, and social services.

Chapter 5 - Recovery : The Many Paths to Wellness discusses perspectives on remission and recovery from substance use disorders and reviews the types and effectiveness of RSS.

Chapter 6 - Health Care Systems and Substance Use Disorders reviews ongoing changes in organization, delivery, and financing of care for substance use disorders in both specialty treatment programs and in mainstream health care settings.

Chapter 7 - Vision for the Future: A Public Health Approach presents a realistic vision for a comprehensive, effective, and humane public health approach to addressing substance misuse and substance use disorders in our country, including actionable recommendations for parents, families, communities, health care organizations, educators, researchers, and policymakers.

The Appendices provide additional detail about the topics covered in this Report . Appendix A - Review Process for Prevention Programs details the review process for the prevention programs included in Chapter 3 and the evidence on these programs; Appendix B - Evidence-Based Prevention Programs and Policies provides detail on scientific evidence grounding the programs and policies discussed in Chapter 3 ; Appendix C - Resource Guide provides resources specific to those seeking information on preventing and treating substance misuse or substance use disorders; and Appendix D - Important Facts about Alcohol and Drugs contains facts about alcohol and specific drugs, including descriptions, uses and possible health effects, treatment options, and statistics as of 2015.

Moderate alcohol use is defined by the 2015-2020 Dietary Guidelines for Americans as up to 1 drink per day for women and up to 2 drinks per day for men—and only by adults of legal drinking age. Many individuals should not consume alcohol, including individuals who are taking certain over-the-counter or prescription medications or who have certain medical conditions, those who are recovering from an alcohol use disorder or are unable to control the amount they drink, and anyone younger than age 21 years. In addition, drinking during pregnancy may result in negative behavioral or neurological consequences in the offspring.

• Cite this Page Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 1, INTRODUCTION AND OVERVIEW OF THE REPORT.
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One of the world’s largest and most dangerous epidemics is the raging addiction to illegal drugs and substance abuse. A 2014 study showed that more than 21 million American citizens 12 years of age and older struggle with a substance use disorder. There are many different conceptions of what it means to have an addiction, and while everyone has the right to their own opinion, the true scientific definition of addiction is: “Addiction is a complex disease of the brain […]

Substance Abuse and Family Struggles

People that suffer from substance abuse have a hard time going through rehab therapy due to the lack of support from family members. I believe that family members should join family therapy because there is always something new that a person can learn about themselves. Also, families can also learn something new about other family members. What are some of the issues surrounding substance abuse? Substance abuse affects the lively hood of a person, it also can affect a person's […]

Poverty and Drug Abuse Addiction

One popular stereotype associated with drug use is that it is rampant among the poor. However, this is not entirely true since insufficient money linked with the poor cannot probably sustain drug use. The link between the two factors is multifaceted, and the connectedness of poverty is complex. Poverty entails unstable family and interpersonal associations, low-skilled jobs and low status, high arrest degrees, illegitimacy, school dropping out, deprived physical health, high mental conditions, and high mortality rates. Such factors resemble […]

Alcohol and Substance Abuse

When adolescents begin experimenting with drugs and alcohol many parents believe their children are just going through a rebellious stage, but that is not always the case (11 Reasons Why Teenagers Experiment with Drugs, 2016). There are many reasons why adolescents begin experimenting with drugs and it may lead to a serious addiction. Boredom is the most common reason why adolescents begin experiment with drugs and alcohol. They have too much time on their hand, so they experiment as a […]

Depression and Substance Abuse

Depression is a very serious mood disorder that can affect and influence your mood, how you might feel and engage in certain activities that you may have once enjoyed before having some negative feelings and emotions that are significant factors when we think about depression. Depression and the co-morbidity of substance abuse is a rising epidemic that is becoming a more prevalent diagnosis in our society through the means of self-medication or abusing substances to cope with the anxiety or […]

Substance Abuse in American Culture

Substance abuse has always had a constant presence in American culture but was never seen in the limelight. The society has always talked down on its victims and tried to shield the youth away. According to research, throughout the past four generations, every generation had addiction problems and this shielding process hasn't helped. The youth and parents should be informed about the risks of substance abuse and schools should be taking on a larger role, instead of shying away from […]

Substance Abuse in Different Races

Have you ever wondered what types of drugs are common between races? Sociologist Collect data through surveys and test to figure out what type of drugs are used among different races and ethnicities. Substance abuse causes millions of illnesses and injuries among people who decide to use drugs. According to data collected African American teens are arrested at a rate 10 times more than of Caucasian teens. Research has also found that caucasians are more likely to develop substance abuse […]

Cause and Effect of Child Abuse

Cause and Effect of Child Abuse Abuse impacts an individual negatively and follows them the rest of their life. Child abuse is horrific as the abuse is often from the very person that is supposed to protect the child. The abuse isn't always physical but can be mental, sexual, and neglectful. Many factors can influence a child's reaction to the traumas that they experience such as age, how far developmentally they are, the type of abuse, how long the abuse […]

The Effects of Parental Substance Abuse on the Development of Children

Substance abuse has been a recurring theme of concern when considering the impact it can have on children in the environment in which they grow up in. When individuals become addicted, it can lead to neglect in childcare with the focus remaining on feeling the highs from the substance of choice. It also becomes difficult to prevent relapse if an individual is able to obtain sobriety. To begin, information will be reviewed on the effects of prenatal drug exposure and […]

Schizophrenia and Substance Abuse

Up to 60 percent of chronic schizophrenic patients have been reported to be substance abusers (Hambrecht 1). The comorbidity of drugs and alcohol asks the question if one disorder causes another disorder. From a collected sample of 232 schizophrenic patients, alcohol abuse prior to admission was found in 24 percent (Hambrecht 2). Whereas, drug abuse was found in 14 percent. These rates are two times higher than the rates in the general population (Hambrecht 2). Both alcohol and drug abused […]

Substance Abuse Related to Depression

Depression is a mental health disorder that affects the mental state wellbeing of a person. It is a mental illness very commonly found in an adult age groups. Whereas, excessive use or depending on addictive substances such as alcohol and drugs refers to Substance abuse (web). The statistics of people diagnosed with depression and substance abuse can be seen as a growing problem in the society. According to the government estimate, 20% of the American adult is diagnosed with a […]

Drug and Substance Abuse

One common disease that is prevalent throughout the country is drug and substance abuse. This particular impediment remains as difficult an issue to tackle as ever before with drug abuse statistics in Georgia increasing at a shocking rate. While these numbers alone are staggering, the issues that stem from drug abuse bring forward an increase in addiction to low-income communities making this an even more pressing issue to overcome. Drug abuse has unfortunately become normalized in today's society, and the […]

Background on Drug Abuse

Drug abuse has been around for as long as the world has been created. Drug abuse dates back to the early 5000 B.C. when the Sumerians used opium, suggested by the fact that they have an ideogram for it which has been translated as HUL, meaning joy or rejoicing (Lindesmith, 2008). It then occurred often later on because indigenous South Americans chewed on coca leaves in the rainforest as a type of ritual, giving them stimulation and energy. Since then, […]

“Teenage Substance Abuse and Impacts on Academic Performance and Relationships”

Introduction The unobserved complexity of an adolescent and his or her potential severity of substance abuse results in negative consequences. Substance abuse represents a dependence on addictive substances such as alcohol or drugs. The use of tobacco, nicotine, alcohol, and other drugs during adolescent years can interfere with the brain development, reduce academic performance and increases the risk of health complications and increase family issues (NIDA, 2014). In America today, family structures have become more complex than ever. They range […]

Reviewing the Impact of Informatics on Substance Abuse Disorders and the Opioid Epidemic

Objective Drug overdoses are now the top reason for unintentional mortality in the United States, and prescription opioid abuse is a major contributor to the public health crisis (Sun et al., 2018). This review explores the contributions of informatics in combating substance abuse disorders and the opioid epidemic. Substance abuse informatics incorporates the availability and implementation of educational and preventative resources, analyzes associations and trends, identifies predictors and treatment outcomes, and establishes prescription drug monitoring programs. Methods The review was […]

Substance Abuse Among Soldiers

Substance abuse among soldiers has increased drastically due to uninformed medical personnel on base, alcohol sales outlets are more prevalent, and soldiers are resorting to alcohol to deal with PTSD instead of seeking counseling. Individuals from the military are not invulnerable to the substance utilize issues that influence whatever remains of society. Albeit illegal medication utilize is bring down among U.S. military faculty than among regular citizens, overwhelming liquor and tobacco utilize, and particularly physician endorsed sedate manhandle, are substantially […]

Childhood Maltreatment and Substance Abuse

Including in the article of the topic and discerning the studies to steer readers to be educated on the broad input of childhood maltreatment possibly going hand and hand with abuse of substances. In surrounding this topic, you can pull out the gist of all the studies and background information to bring a responsible observation that is proven. That which is humans who are brought into or raised into a childhood maltreatment experience such as, emotional or physical neglect along […]

Homelessness Problem in LA

Homelessness in LA is not an isolated case in U.S but rather public issue from 1980s since represents a huge problem for several cities as well as for largely populated states. People are facing this problem in daily basis; every time we are waiting by the traffic lights on the street, homeless people approaches to us and ask us either for a food or a change. Homeless people are people who are without a home and therefore living on the […]

The Effect of Substance Abuse on the Family System

When someone decides to start a family, they have a certain picture in their head for how the future will plan out. Mom and dad will love their child and have their best interest at heart throughout their whole life. Most parents go into it, thinking nothing will break up their bond or make them less close to their son/daughter. They believe their child is to love, cherish, and respect their grandparents and elders. They will spend quality time with […]

Sexual Re-victimization and Increase in the Chance of Alcohol and Substance Abuse

Sexual re-victimization refers to a form of sexual abuse which is insensitive and causes fear for the victims of violence. Currently, there are many kinds of research concerning the female re-victimization of few sexual assaults, child sexual abuse, and adult sexual abuse survivors. Despite this, there is little research concerning male victimization and any form of service is available to them, this is because most attention has been shifted to females leaving men behind. Also, there is variance on the […]

The Effect of Substance Abuse on Depression

The Substance Abuse and Mental Health Services Administration (2016) state, "the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death (para. 2). One strategy to support the treatment of Rhonda is to provide help with regulating her emotions rather than how to cope with alcohol and nicotine cravings. In the study from Holzhauer & Gamble (2017), it was found that women with depression and […]

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Public Health Notes

Your partner for better health, substance abuse: introduction, prevention & treatment.

October 31, 2020 Kusum Wagle Global Health 0

Table of Contents

What is Substance Abuse?

• According to WHO, substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.
• Substance abuse means taking drugs that are illegal.
• Additionally, substance abuse also means taking alcohol, prescription medicine, and other legal substances too much or in the wrong way.
• Substance abuse refers to the conditions associated with the consumption of mind- and behavior-altering substances that have negative behavioral and health outcomes.
• Social, political and legal responses to substance abuse (consumption of alcohol and illicit drugs) make substance abuse one of the major problems of public health.

Global Facts on Substance Abuse (WHO, 2020):

• The harmful use of alcohol results in 3.3 million deaths each year.
• On average every person in the world aged 15 years or older drinks 6.2 litres of pure alcohol per year.
• Less than half the population (38.3%) actually drinks alcohol, this means that those who do drink consume on average 17 litres of pure alcohol annually.
• Some 31 million persons have drug use disorders.
• Almost 11 million people inject drugs, of which 1.3 million are living with HIV, 5.5 million with hepatitis C, and 1 million with both HIV and hepatitis C.

Additional Facts:

• According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 21.5 million Americans ages 12 and older were categorized with a substance use disorder in 2014. Of those, 2.6 million had complications with equally alcohol and drugs, 4.5 million had difficulties with drugs but not alcohol, and 14.4 million had problems with alcohol merely.

Problems Related to Substance Abuse:

Substance abuse creates adverse impact on individuals, families, and communities. The major problems related to substance abuse are:

• Teenage pregnancy
• Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
• Other sexually transmitted diseases (STDs)
• Domestic violence
• Child abuse
• Motor vehicle crashes
• Physical fights
• Suicide etc.

Relationship between Mental Health and Substance Abuse:

• Substance abuse and mental health disorders such as depression and anxiety are closely linked, although one doesn’t necessarily directly cause the other.
• Substance use illnesses arise when an individual recurrently uses alcohol or drugs. This recurrent use can lead to health complications, relationship suffering, injury, and ill health.
• For those who struggle with substance use, mental illness can also be an issue.
• Substance abuse can worsen the symptoms of mental health. It can sharply increase symptoms of mental illness or even trigger new symptoms.
• According to SAMHSA, in 2014, 7.9 million adults struggled with both substance use and mental illness. In some circumstances, side effects of drugs can cause mental illness symptoms.
• Let us say, alcohol itself is a drug and can worsen pre-existing depression or even permits symptoms for the first time.
• Additionally, alcohol and further drugs can lead an individual to do or say things they possibly will later regret, affecting stressed relationships, trouble at work, and health difficulties. The effects of these occurrences can promote anxiety, depression, and other mental diseases.
• In other cases, those who previously struggled with mental disease frequently attempt to self-medicate with alcohol and drugs.
• Substance use may shortly ease agony from mental illness. Nevertheless, lacking specialized treatment, self-medication can lead to additional problems and possible dependence.

What are the Preventive Measures for Substance Abuse?

• Medical prescription and the claim of specific regulations for the manufacture and circulation of medical drugs and their precursors.
• Medical training has a crucial role to play in reducing the availability of prescribed substances for abuse
• Demand reduction through special programs directed to transform those factors, which make individuals vulnerable to substance experimentation, constant use, and addiction, in addition to encourage protective factors in the individual and the surroundings.
• The Incorporated strategy of supply and demand reduction
• Early intermediation with individuals that have tested with substances but are not relentlessly reliant and may possibly thus be “reinstructed” through education intermediations, in addition to the treatment of dependency ,  relapse avoidance,  and  social rehabilitation .

What are the Treatment Measures for Substance Abuse?

Various treatment measures for substance abuse are:

• Behavior psychotherapy
• Detoxification
• Managing of withdrawal symptoms
• Medical devices and applications are used to treat withdrawal symptoms or deliver skills training
• Evaluation and cure for co-occurring mental health problems such as depression and anxiety
• Long-term follow-up to prevent relapse

Among these treatment measures, behavioral therapy deserves more attention and focus because of its high effectiveness and wide usefulness.

Importance of Behavioral therapies in Substance Abuse:

Behavioral therapy helps patients to:

• Modify their disobedience and conducts related to substance use
• Progress in healthy life skills
• Carry on with other procedures of treatment, such as medication
• Patients can take delivery of treatment in many different sceneries with several attitudes.

Types of Behavioral therapy/treatment:

1. the outpatient behavioral treatment:.

Outpatient behavioral therapy contains an extensive range of curriculums for patients who visit a behavioral health therapist on an ordered schedule. Various types of outpatient behavioral treatment includes:

• Cognitive-behavioral therapy:  which helps patients identify, evade, and handle the conditions in which they are most expected to use drugs
• Multidimensional family therapy : established for adolescents with drug abuse difficulties along with their families which addresses a variety of impacts on their drug abuse forms and is planned to recover generally family working
• Motivational interviewing :  which makes the most of people’s willingness to transform their behavior and go into treatment
• Motivational incentives  (contingency management): which uses optimistic corroboration to inspire self-restraint from drugs

2. Inpatient or residential treatment:

Inpatient therapy/treatment can also be very effective, especially for those with more severe problems (including co-occurring disorders). Various types of inpatient treatment includes:

• Therapeutic communities: which are highly arranged programs in which patients remain at a home, normally for 6 to 12 months. The entire community, counting treatment team and those in recovery act as key mediators of change, prompting the patient’s attitudes, understanding, and behaviors associated with drug use.
• Shorter-term residential treatment : which typically emphases on cleansing along with providing early concentrated counseling and training for treatment in a community-based setting.
• Recovery housing:  which delivers supervised, short-term accommodation for patients, often resulting in other types of inpatient or domestic treatment.

References and For More Information:

https://www.who.int/topics/substance_abuse/en/

https://www.who.int/substance_abuse/facts/en/

https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse

https://www.webmd.com/mental-health/addiction/substance-abuse#1

https://www.helpguide.org/articles/addictions/substance-abuse-and-mental-health.htm

https://www.helpguide.org/articles/healthy-living/the-mental-health-benefits-of-exercise.htm/

https://www.landmarkhealth.org/the-importance-of-mental-health-on-overall-health/

https://blog.doctorondemand.com/why-its-important-to-care-for-your-mental-health-834c8670b889

https://www.who.int/features/factfiles/mental_health/en/

https://www.mentalhealth.gov/basics/what-is-mental-health

https://www.mindwise.org/blog/awareness-days/the-connection-between-substance-use-and-mental-health/

https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414714/

https://www.mentalhealthtips.xyz/category/importance-mental-health/

• Global Facts on Substance Abuse
• how to prevent substance abuse
• importance of behavioral therapy
• Inpatient or residential treatment
• Outpatient behavioral treatment
• prevention for substance abuse
• Problems Related to Substance Abuse
• Relationship between Mental Health and Substance Abuse
• treatment of substance abuse
• types of behavioral therapy
• What are the Preventive Measures for Substance Abuse
• What are the Treatment Measures for Substance Abuse
• what is behavioral therapy
• what is substance abuse

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Essay on Drug/ Substance Abuse

Drug and substance abuse remains one of the most challenging and destructive problems facing societies worldwide. It refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. This essay aims to delve into the complexities of drug and substance abuse, examining its causes, effects, and the crucial steps needed to address this epidemic.

Drug and Substance Abuse

Drug and Substance Abuse involves the recurrent use of drugs or substances leading to significant impairment, including health problems, disability, and failure to meet responsibilities at work, school, or home. This includes the misuse of legal substances like alcohol and prescription medications, as well as illegal substances like heroin, cocaine, and methamphetamines.

Causes of Drug and Substance Abuse

The reasons behind drug and substance abuse are multifaceted and can vary from individual to individual:

• Genetic Predisposition : Research indicates a genetic component to the susceptibility to substance abuse.
• Mental Health Disorders : Many individuals with mental health disorders such as depression, anxiety, or PTSD turn to substances as a form of self-medication.
• Peer Pressure : Particularly among adolescents and young adults, peer pressure can significantly influence substance use.
• Stressful Life Events : Traumatic experiences, chronic stress, or life-changing events can lead to substance abuse as a coping mechanism.
• Curiosity and Experimentation : Often, particularly in young individuals, there’s a desire to experiment, which can lead to misuse and addiction.

Effects of Drug and Substance Abuse

Drug and substance abuse, a major public health challenge, affects individuals, families, and communities across the globe. This essay explores the multifaceted effects of drug and substance abuse, including physical health, mental well-being, social relationships, and broader societal impacts.

Physical Health Effects

Immediate physical effects.

• Altered State of Consciousness : Substances like alcohol, marijuana, and hallucinogens alter perception, mood, and consciousness.
• Overdose Risk : Excessive consumption of drugs can lead to overdose, potentially resulting in coma or death.
• Infectious Diseases : Intravenous drug use increases the risk of diseases like HIV and Hepatitis B and C due to needle sharing.

Long-Term Health Effects

• Organ Damage : Chronic substance abuse can lead to severe damage to vital organs like the liver (cirrhosis), heart, and brain.
• Neurological Impact : Long-term effects on the brain can include memory loss, cognitive decline, and mental health disorders.
• Physical Dependency : Prolonged use leads to dependency, where the body requires the substance to function normally.

Mental Health and Psychological Effects

• Mental Health Disorders : Substance abuse can trigger or exacerbate mental health conditions like depression, anxiety, and psychosis.
• Behavioral Changes : Changes in behavior, such as increased aggression or impulsivity, are common.
• Cognitive Impairments : Drugs can impair decision-making abilities, judgment, and other cognitive functions.

Social and Relationship Impacts

• Family Dynamics : Drug abuse can strain family relationships, leading to conflict, mistrust, and breakdown of family structures.
• Workplace Issues : It affects job performance, leading to decreased productivity, absenteeism, and higher risk of accidents.
• Legal Problems : Substance abuse can result in legal issues, including arrests for possession, driving under the influence, or engaging in illegal activities to support the addiction.

Societal and Economic Impacts

• Healthcare Costs : Treating drug-related health complications burdens healthcare systems.
• Crime and Safety : There’s a correlation between substance abuse and increased crime rates, impacting community safety.
• Economic Burden : The economic impact includes loss of productivity, healthcare expenses, and law enforcement costs.

Prevention and Treatment

• Education and Awareness : Programs aimed at educating individuals about the risks of drug use are crucial.
• Rehabilitation Programs : Effective treatment programs, including therapy and medication-assisted treatment, help individuals recover.
• Support Systems : Family, community, and peer support are vital in the recovery process.

Addressing Drug and Substance Abuse

• Prevention Programs : Education and awareness programs, particularly targeting young people, are crucial in preventing substance abuse.
• Treatment and Rehabilitation : Access to effective treatment, including counseling, medication, and support groups, is vital for recovery.
• Policy and Regulation : Government policies to regulate the availability of substances, and laws to address drug trafficking and misuse, play a critical role.
• Community Support : Community-based efforts, including support from families, schools, and religious organizations, are essential in supporting those affected.

The Role of Society and Individuals

• Destigmatization : Removing the stigma around substance abuse and addiction encourages individuals to seek help.
• Educational Initiatives : Schools and universities should have programs to educate students about the dangers of substance abuse.
• Role Models : Influential figures and celebrities should promote healthy lifestyles and speak out against substance abuse.
• Supportive Environment : Creating an environment that fosters open discussion and support for those struggling with substance abuse.

In conclusion, Drug and substance abuse is a complex issue requiring a multifaceted approach. It is not just a personal problem but a societal challenge that calls for comprehensive prevention strategies, effective treatment programs, supportive policies, and community involvement. Understanding and addressing the root causes, along with providing support and care for those affected, is crucial in mitigating the impact of this global issue. For students participating in essay competitions, exploring this topic provides an opportunity to contribute to a critical dialogue, advocating for change and supporting those in need.

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Essay On Substance Abuse

Type of paper: Essay

Topic: Drugs , Abuse , Bullying , Violence , Addiction , Substance , Drug Abuse , Alcohol

Words: 1650

Published: 2020/12/01

Substance abuse has become a major problem for society. Substance abuse crosses over ethnic, economic and cultural lines. Addiction to legal drugs, illegal drugs and alcohol affects millions of people in the United States. The costs of addiction are economic, psychological and physical, not only to the individual but to society as a whole. Substance abuse destroys individuals and their familial relationships. The dynamics of addiction on the individual are varied and complex. Many do recover from addiction with intense interventions and go on to live a normal life. Substance abuse is a set of behaviors that involve the use of drugs (legal and illegal) and/or alcohol. Substance abuse affects people of all ethnic, cultural and socioeconomic backgrounds. Substances that are abused include but are not limited to: alcohol, cocaine, marijuana, prescription drugs, crack and heroin. The signs of substance abuse include: Addiction affects people of all ethnic, cultural and socioeconomic backgrounds. The signs of a substance abuse problem include both physical, mental and emotional problems. Daily use of the substance and strong cravings for the substance occur. An abuser will spend all of their money on their drug of choice and will have an inability to meet work and personal obligations. An abuser will participate in behaviors that they normally would not participate in such as stealing and risky sexual behaviors. A person with a substance abuse problem will go to any lengths to obtain the drug they crave. Attempts to stop using the substance can result in physical withdrawal from the substance (Mayo Clinic). According to the National Institute for Drug Abuse, in 2012, 9.2% of Americans abuse an illegal drug. This is up from 8.3% in 2002. Marijuana has seen a steady increase in the number of users, cocaine use has dropped and methamphetamine has remained steady over this time period. Drug abuse is most popular in young adults ages 18-25. In an interesting statistic people in their fifties are abusing drugs at higher rates than ever. Approximately 19% of the population is considered alcoholic. Statistics demonstrate minor fluctuations in drug and alcohol abuse across races and ethnicities. Professionals in the medical, psychological and law enforcement communities argue on what constitutes a “substance abuser”. Research in the last twenty years has grown exponentially to study the causes of addiction. Attempts to define terms such as “addiction” and “substance abuse” are cause for argument and disagreement among professionals. It is generally agreed that if a substance interferes with one’s ability to live a healthy life, physically, mentally and emotionally, then there is a substance abuse problem. Generally statistics are very difficult to read when it comes to addiction. Many people in the general public simply don’t understand what addiction and abuse are. In general people perceive alcoholics as Skid Row bums and drug addicts as homeless people or criminals that live in the ghettos. Many people have multiple addictions or their habits may vary. Many people with an addiction or abuse problem simply are in denial or do not recognize their use as a problem. The definition “addiction” is still debated among doctors, psychologists and addiction counselors. Many who may have had an addiction at one time have recovered and are now living free from the addiction after intervention and treatment. The financial burden of substance abuse is great. It is estimated that substance abuse costs the government $484 billion dollars each year. Diabetes costs society only $131 billion and cancer, $171 billion. These figures include health care costs, accidents, crime and courts (National Institute on Drug Abuse). Financial costs to both employers and employees with a substance abuse problem are also great. People with addictions often call in sick to work because they are high or hung-over. If they do show up for work they are not as productive or effective as they would be if they were sober. On the job accidents from substance abuse cost employers millions every year through workers’ compensation claims. Health insurance rates are on the rise since most companies now offer coverage for the treatment of substance abuse. For those without health insurance coverage, the government also offers assistance to get treatment which costs taxpayers more money. The mortality rate of those with an addiction is astonishing. The rates for alcoholics who die from liver disease and related alcoholic diseases was 88,000 people in 2012. The number of alcohol related accidents that took a life was 31% of all fatalities. The hidden cause of death from alcoholism is harder to determine: heart attacks, murders and accidents in the home. Deaths from drug overdoses numbers over 40,000, this includes both prescription and illegal drugs. Again, deaths that occurred due to intoxication on drugs but not directly attributed, such as car accidents, murder and suicides is unaccounted (National Institute on Drug Abuse). Many addicts are abusing prescription drugs which are much easier to obtain than illegal drugs. Doctors are generally unaware of their patients who may have a prescription drug abuse problem and will continue to prescribe pain killers and benzodiazepines. Often prescription drugs are taken for bona fide reasons at first but for those with a predisposition to addiction abuse can occur quickly and unnoticed. Many with a prescription abuse problem rationalize the addiction because the drugs are legal and were prescribed for a physical ailment, so taking them, even excessively is alright. Prescription drug abuse is the fastest growing type of substance abuse in the United States (Simoni-Wastila & Strickler). Alcohol is a leading choice of addicts. Alcohol is socially accepted and completely legal. It is generally the first substance teenagers abuse when they embark on a career of substance abuse. Millions of adults who begin as social drinkers eventually begin to abuse alcohol and become full blown alcoholics (Moos, Finney & Cronkite). Much research has been done on this topic over the years. According to Alcoholics Anonymous, alcoholism is both a disease of the mind and body. They describe the alcoholic as suffering from a physical “allergy” to alcohol. Many researcher describe a similar phenomenon in that alcoholics simply cannot stop drinking once they begin. In recent years, the use of cocaine and crack are on the decline. The new drug of choice for many addicts is heroin and methamphetamine. Both have been on the rise over the last ten years. Heroin no longer has to be injected which is appealing to many drug abusers who refuse to use a needle. Meth can be smoked, sniffed or injected and provides an “up” for addicts. Addicts on meth could stay awake for days at a time (National Institute on Drug Abuse). According to the Justice Department, 18% of prisoners have been incarcerated because they committed crimes to obtain money for drugs. 5% of homicides were directly related to drugs. A survey of inmates found that 30% of them admitted to being under the influence of alcohol or drugs when they committed their crime. Sixty percent of children who experience abuse were victims of someone under the influence of drugs or alcohol. In domestic violence cases nearly 80% were preceded by alcohol or drug abuse. The war on drugs that the United States began in the 1980’s has been ineffective. Drugs are still coming across our borders, many are now produced within this country. Marijuana is now being grown internally and drugs such as methamphetamine is created within our borders. The $15 billion that has been spent in combatting the drug problem has not worked. There are many reasons for addiction. Many drug addicts and alcoholics have at least one person in their family that has also faced addiction Addiction occurs with any substance because of the way alcohol and drugs affect the production of dopamine in the brain. Drugs increase the production of this natural chemical. This is what produces the high effect of drugs. In order to achieve this high, an addict must consume more and more of their substance. Addiction is also coupled with mental disorders. Most abusers suffer from depression, bipolar disorder or anxiety. Addicts are generally devoted to a particular drug that seems to work best for them. Different people due to their personality and physical chemistry tend to prefer one type of drug over another. Once they have found their drug of choice, most addict remain faithful to that one. Addicts also tend to engage in specific behaviors or rituals when using their drug of choice, thus cementing the addiction (Sandra D., personal communication, 10 January 2015). Substance abuse in teenagers is at a record high. Causes for the use of alcohol and drugs are often identified as physical, emotional or sexual abuse and bullying. Teenagers use drugs and alcohol as a way to escape from the painful traumas. They often observe family members or friends that seem to successfully use substances to alter their moods. Peer pressure also ranks as a leading cause for substance abuse. Many adult addicts claim that their addictions began as teenagers and once they started abusing substances they simply could not stop (Whitesell, Bachand, Peel and Brown, 2-4). Substance abusers use complex psychological mechanisms to justify and defend their use of drugs or alcohol. They may deny that they have a problem altogether (denial). Often the abuser uses drugs and alcohol as an escape from life’s pressures and burdens and they give themselves permission to do so (rationalization). The prescription drug abuser may intellectualize the abuse by claiming that the drug is a legal prescription for a real medical problem. Family members may also be unaware of the severity of a substance abuse problem. Often spouses or other family members unwittingly cover up the problems of substance abuse by making excuses or covering up for the abuser. There is hope for those that are suffering with a substance abuse problem. Rehabilitation centers for those that suffer from addiction have sprung up all over the country in the last thirty years. Addicts and alcoholics have the options of admitting themselves into residential or outpatient facilities for treatment. Many companies offer employee assistance programs that can guide an employee to the right place for treatment. Alcoholics Anonymous has been instrumental in helping alcoholics to achieve recovery. This 12 step program has also given rise to similar programs such as Narcotics Anonymous that help those with drug problems. These programs have met tremendous success with long term sobriety for alcoholics and drug addicts alike. Substance abuse is a serious problem that was once hidden in the closet. It takes on many forms and levels of severity. In the last thirty years new light has been shed upon the subject. Research in the field to understand the physical, mental and emotional aspects of the disease has opened doors of opportunity for understanding and successful treatment of people who suffer from addiction. Substance abuse affects not only the individual, but their family and friends as well. There are financial implications for businesses who employ people with a substance abuse problem. The judicial system is overwhelmed with criminals who committed crimes to obtain money for drugs or directly acquiring the drugs. Domestic abuse and child abuse and neglect cases are often rooted in substance abuse problems. The important thing to understand that there is now hope for a person who suffers a substance abuse problem. Treatment centers and a better understanding by the public through education is slowly removing the stigma attached to addiction which can lead to treatment.

Anonymous. Alcoholics Anonymous. New York: Alcoholics Anonymous World Services Inc. 2001. Print “Drug Crimes and Facts”. Bureau of Justice Statistics. Retrieved from: http://www.bjs.gov/content/dcf/contents.cfm Fleury, M, Grenier, G, Bamvita, J, Perrault, M & CarAn, J. (2014). Predictors of alcohol and drug dependence. Canadian Journal of Psychology, 59(4), 203-212. Grohol, J. (2007). 15 Common defense mechanisms. Psych Central. Retrieved on January 13, 2015, from http://psychcentral.com/lib/15-common-defense-mechanisms/0001251 Kreek, M.J., Nielsen, D., Butleman, E., Laforfge, K.S. (2005). Genetic influences on impulsivity, risk taking, stress responsivity and vulnerability to drug abuse and addiction. Nature Neuroscience 8,1450-1457. doi:10.1038/nn1583 Mackenzie Whitesell, Annette Bachand, Jennifer Peel, and Mark Brown (2013). Familial, social, and individual factors contributing to risk for adolescent substance use. doi:10.1155/2013/579310 Mayo Clinic. Drug addiction: Symptoms. Retrieved 28, Feb 2015. Retrieved from: http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/symptoms/con- 20020790. Moos, R., Finney, J., Cronkite, R. (1990). Alcohol Treatment: Context, Process and Outcome. New York: Oxford University Press, (1990). Print. National Institute on Drug Abuse. Retrieved from: http://archives.drugabuse.gov/about/welcome/aboutdrugabuse/magnitude/ Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Simoni-Wastila, L. and Strickler, G. (2004). Risk factors associated with the use of prescription drugs. American Journal of Public Health 94(2), 266-268. doi: 10.2105/AJPH.94.2.266 Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS

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Writing An Effective Drug Abuse Essay Introduction

Table of Contents

Drug abuse is the obsessive, compulsive, and excessive use of drugs over time. Regular use of drugs within a specific time frame results in addiction. A drug abuse essay discusses the concept of drug abuse, its effects, and ways to get rid of drug addiction. The  introduction to drug abuse essay  sets the tone for the rest of the paper. 

The introduction is the first thing a reader sees, so it should be gripping. Your introduction should be compelling; it needs to give the reader an overview of the topic and present the argument or thesis.

The introduction should immediately grab the reader’s attention so that he or she will want to read the rest of the piece.

What Is A Drug Abuse Essay?

Drug addiction is a huge problem all over the world. It is the continuous use of certain substances to excite the brain and derive pleasure. Drugs are self-destructive and lead to significant changes in one’s behavior, activities, brain functioning, and health. 

It is now more important than ever to educate others about the effects of drugs and their several harmful effects. Drug abuse essays aim to present an argumentative view on the problem of drug abuse. They also highlight possible solutions that may help eliminate drug addiction. 

Common drug abuse essays are as follows:

• Poverty and Drug Abuse Addiction
• Drug Abuse in the Community
• Teenage Drug Abuse
• Drugs – Escape from Reality
• The Truth About Drugs – Illegal Drugs
• Drug Abuse Among Students.
• Substance Abuse and Development.
• The Destructive Pattern of Drug Abuse
• Drug Testing
• Prescription Drug Abuse
• Background on Drug Abuse
• Effects of Parental Drug Abuse on Teens
• The Relationship Between Adult Drug Abusers and Children.
• Effects of Drug Abuse on Families
• Drug Abuse Prevention and Control.
• The Truth of Drug Abuse.
• Drug Abuse in Athletes

How To Write A Compelling Introduction to Drug Abuse Essay

The introduction sets up the main issue you want to address within the main body of the paper. It gives an overview of the topic , provides background information, and states the thesis.

The introduction must grab the reader’s attention instantly and keep them engaged. It should be clear, concise, and relevant to the topic. 

A good introduction consists of the following:

1.  The Hook. The opening paragraph should intensely appeal to the reader’s immediate attention. Begin with a bold statement, a shocking fact/statistic, an anecdote, or a thoughtful question that tells the reader what the paper is about.

2.  Background Information. Your introductory paragraph should provide the reader with background information about your topic, so they can grasp the significance of what you’re writing about. 

3.  The Thesis : Your paper’s thesis is what you will try to prove. It should be interesting enough to draw the reader’s immediate attention and let them know the main point you’re going to be arguing. 

Introduction to Drug Abuse Essay Example

Drug addiction has become a serious problem today. More than 19.7 million adults (aged 12 or older) were reported to use illicit drugs in America in 2015. And, the rate has been steady. America spent over 740 billion dollars on drug and alcohol problems. Drug use has crucial psychological, social, and health effects. There is a need to understand the ill effects of drug abuse and what can be done to curb the rising cases. 

The introduction to drug abuse essay sets the tone of the paper. Your introduction should grab the readers’ attention and help them decide whether or not to continue reading the piece.

Begin with an exciting opening statement; it could be a shocking fact or an interesting anecdote. Give the readers an overview of the topic and provide background information.

End the introduction with the thesis statement, a summary of the main points the body of the essay will focus on. 

Abir Ghenaiet

Abir is a data analyst and researcher. Among her interests are artificial intelligence, machine learning, and natural language processing. As a humanitarian and educator, she actively supports women in tech and promotes diversity.

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Substance Abuse in Teenagers Essay

Introduction, substance abuse issue, causes of substance abuse.

I picked this topic because teenage drug addiction has prevailed in society, making it a growing problem. Teenagers frequently experiment with various activities and substances that often result in abuse and addiction. Brain development in adolescents is more vulnerable to drug deficits, which concerns society. Substance abuse causes injury, sexually transmitted diseases, teenage pregnancies, poor mental health, and suicide. The essay presents the issues and the causes of substance abuse among adolescents.

The prevalence of drug use is higher in boys than in girls. For example, a survey conducted by Molinaro et al. (2011) presents cannabis as five times more prevalent than other drugs. Figure 1 below shows the rate of use of cannabis by male adolescents.

A comparison of the two figures shows more males using cannabis. The prevalence of cannabis in 2009 in females is 24.7, while in males, it is 33.8, which affirms that males are more subject to drug addiction than females (Molinaro et al., 2011). The results show men being the bigger addicts to heroin, cocaine, stimulants, and hallucinogens.

Drug consumption also exhibits a dynamic evolution over time influenced by cultural, political, and economic factors like changing laws and market price volatility (Molinaro et al., 2011). Despite significant legislative and social communication efforts in the field, the prevalence of drug use remained relatively unchanged for the commonly used drugs like cocaine and cannabis, with a decrease in heroin overbalanced by a significant increase in hallucinogen and stimulant use (Molinaro et al., 2011). Between 2005 and 2008, the trend for cannabis use and availability decreased while its price increased, whereas the prevalence of cocaine and stimulant use increased significantly (Molinaro et al., 2011). In spite of the various social communication and legislative initiatives to prevent substance misuse, the situation has not improved considerably.

There are various reasons why teenagers and young adults become involved with drugs. Regrettably, the root of substance abuse often goes deeper than experimentation. The availability of illegal drugs for adolescents predicts increased substance use as an adult. According to a survey conducted between 1999 and 2009, cannabis has been the most widely available illicit substance, with cocaine’s availability rising since 2006, where one out of every five students reported easy access to the drug (Molinaro et al., 2011). Substance availability influences the use of substances by adolescents as they can obtain them easily. Cannabis is a consistently available illicit drug that adolescents abuse.

An increase in the prices of illicit substances affects the rates of abuse. The cheaper the illegal drugs are, the easier it is for adolescents to access them. An example is from the survey conducted by Molinaro et al. (2011) on cannabis.

Cannabis use and availability decreased in 2006, and its price increased, although cocaine and stimulant use prevalence increased significantly from 2005 to 2006, and their price decreased (Molinaro et al., 2011). The prices set for drugs influence their abuse. The higher the set costs, the less their abuse and inversely.

Drug usage is common among high school students, with cannabis being the most common and heroin being the least. Girls are less susceptible to illicit substance use than boys. The root of substance abuse often goes deeper than experimentation. Substance availability influences the use of substances by adolescents as they can obtain them easily. In spite of the various social communication and legislative initiatives to prevent substance misuse, the situation has not improved considerably.

Molinaro, S., Siciliano, V., Curzio, O., Denoth, F., Salvadori, S., & Mariani, F. (2011). Illegal substance use among Italian high school students: Trends over 11 years (1999–2009) . PloS one , 6 (6), e20482. Web.

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"Substance Abuse in Teenagers." IvyPanda , 5 Jan. 2023, ivypanda.com/essays/substance-abuse-in-teenagers/.

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IvyPanda . 2023. "Substance Abuse in Teenagers." January 5, 2023. https://ivypanda.com/essays/substance-abuse-in-teenagers/.

1. IvyPanda . "Substance Abuse in Teenagers." January 5, 2023. https://ivypanda.com/essays/substance-abuse-in-teenagers/.

Bibliography

IvyPanda . "Substance Abuse in Teenagers." January 5, 2023. https://ivypanda.com/essays/substance-abuse-in-teenagers/.

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