Health Care System and Substance Abuse

Alcohol and Drug Prevalence Rates and Disease Burden

According to a 2005 to 2006 U.S. survey of states from the Substance Abuse and Mental Health [Page 450]Services Administration, the rate of alcohol use during a 1-month period ranged from a low of 32.4% in Utah to a high of 63.1% in Wisconsin. These statistics were further broken down into rates of dependence or abuse, binge drinking, perception of risk of binge drinking, and underage drinking. The national rate of alcohol dependence or abuse for individuals 12 years and older was 9.2%. In the area of binge drinking, the rate for 12- to 17-year-olds was 10.1%, slightly lower than the 10.5% recorded the year before. The highest rates of binge drinking occurred in the 18- to 25-year-old age group with figures of 56.5% in North Dakota, about twice the rate for individuals ages 26 or older (Wisconsin at 27.4%) and almost 4 times the highest rate among youths ages 12 to 17 (Montana at 15.3%).

Alcohol consumption has health as well as social consequences due to intoxication, dependence, and other biochemical effects. Although evidence suggests that intoxication contributes to car crashes and domestic violence, it has also been shown to cause chronic health and social problems. According to the WHO, there are causal relationships between average amount of alcohol consumption and over 60 types of disease and injury. Most of these relationships are detrimental, although there are some beneficial relationships in terms of coronary heart disease, stroke, and diabetes mellitus if consumption is low to moderate and is combined with nonbinge patterns of drinking.

Alcohol use has major implications for disease burden and mortality rates. Worldwide, alcohol causes 3.2% of deaths (1.8 million) with 16% of the global burden occurring in the Americas, according to WHO. The proportion is much higher in males (5.6% of deaths) than females (0.6% of deaths). In addition, the proportion of disease burden within subregions of the world attributable to alcohol is greatest in the Americas and in Europe, where it ranges from 8% to 18% for males and 2% to 4% for females. Besides the direct effects of intoxication and addiction, alcohol is estimated to cause about 20% to 30% of each of the following worldwide: esophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle accidents.

The WHO believes that illicit drug use is on the rise worldwide, causing significant disease burden, even though there is a paucity of research quantifying the risks. Available prevalence rates for opioid use in the past year among people over the age of 15 vary from 0.02% to 0.04% in the Western Pacific region to 0.4% to 0.6% in the Eastern Mediterranean region. Cocaine use also varies in a similar way. The prevalence rate of amphetamine use is estimated to be 0.1% to 0.3% in most regions. Available data for stimulants and opioids, including cocaine and heroin, indicate that 0.4% of deaths (0.2 million) worldwide are caused by illicit drug use. There is higher risk among men than among women with the most at-risk patterns found among dependent users who frequently inject drugs and have done so over periods of years. Illicit drugs account for the highest percentage of disease burden among low mortality, industrialized countries in the Americas, Eastern Mediterranean, and European regions. Studies of treated injecting opioid users show this pattern is associated with increased overall mortality, including deaths caused by HIV/AIDS, overdose, suicide, and trauma. Several other adverse health and social effects that are more difficult to measure are important to note including other blood borne diseases such as hepatitis B and hepatitis C and criminal activity associated with drug abuse and addiction.

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