Substance Use Disorders

Impact of Substance Use Disorders

The total costs of abuse of alcohol and abuse of other drugs including tobacco to the American economy has been estimated by the federal government to be more than $400 billion annually. The two most common substances of abuse are tobacco and alcohol. Conservative estimates indicate that about 20% of the population in the United States abuses tobacco, and between 8% and 13% of the population abuses alcohol. Men are more likely to abuse substances than women. Treatment often results in positive outcomes.

Substance abuse has been associated with the five leading causes of death in the United States in 2004: heart disease, cancers, strokes, chronic lower respiratory illnesses, and unintentional injuries. Some ethnic minority groups may be at high risk for substance use problems. For example, liver diseases often associated with alcohol abuse were the sixth leading cause of death for Hispanics and Native Americans. In contrast, liver diseases are not in the 10 leading causes of death for either Whites or Blacks. However, it is also worth noting that there is often wide variation in substance use within demographic groups. Interestingly, Native Americans also have the highest abstention rate from alcohol when compared with any other ethnic group.

In the United States, the recent trend is greater abuse of prescription medications and methamphetamines. Abuse of substances not traditionally classified as psychoactive, such as steroids and erectile dysfunction medications, has been commonly seen over the recent years. Although these substances often are not listed among traditional drugs of abuse, they can become problematic for users.

Substance abuse is strongly associated with legal consequences. In addition to violation of controlled substance statutes, substance abuse has been associated with domestic violence and other violent crimes such as suicide, property damage, vehicular offenses, and sexual perpetration. In the United States, crime-related costs of substance abuse have been projected to be around $100 billion annually, and conservative estimates have indicated that at least 1 million people have substance abuse problems. Substance abuse is also a major contributing factor to traffic and workplace accidents. Extreme substance-related toxicity can contribute to psychotic symptoms, although sometimes those symptoms preceded the substance use and were masked.

Biopsychosocial Model

Researchers use a biopsychosocial model to understand addictive processes. Biological processes that have been identified include physiological reactivity to the [Page 779]ingestion of substances, physiological changes due to acute or chronic use of substances, and physiological adaptations to the level of exposure to the substances. Physiological reactivity occurs in response to the substance and results in metabolic changes in the body. Substances activate the pleasure-reward system in the brain, which often results in euphoria. Acute or chronic substance abuse can cause neurotoxicity and damage to vital organs. Commonly experienced cognitive impairments include difficulties with short-term and working memory; problems with executive cognitive functions related to decision making, problem solving, impulse control, and abstraction; and, in some cases, difficulties with balance and motor functions. Existing evidence suggests that some physiological changes are reversible, including cognitive impairment, after a period of abstinence.

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