Substance Abuse

Many definitions of substance abuse exist. For example, legal statutes can be interpreted to support the position that the mere use of illegal substances is abuse, whereas adaptation perspectives may stipulate that substance abuse occurs only when the negative consequences of using outweigh the benefits. Over time, the establishment of a singular definition of substance abuse has been further confused by changes in social, legal, and cultural norms related to substance use. Nevertheless, substance abuse can generally be defined as the detrimental or risky use of legal or illegal substances or the use of legal substances in a manner or amount inconsistent with medical recommendations.

Because many definitions and methods for measuring substance abuse exist, agreement on the incidence and prevalence of substance abuse has proven difficult. Moreover, prevalence estimates vary greatly across countries, and there is some question as to how much of this variance can be attributed to incongru-ent definitions (some of which are rooted in cultural customs) rather than actual differences. According to the 2005 National Survey on Drug Use and Health, nearly 12 million Americans met the criteria for substance abuse (including abuse of alcohol); this figure represents more than 5% of the United States population over the age of 12. When including the more severe condition of substance dependence, it was estimated that a total of 22.2 million Americans over the age of 12 (about 9.1%) met the criteria for a substance use problem. In addition, males were about twice as likely as females to be diagnosable for substance abuse.

There are significant economic costs associated with the abuse of alcohol and other substances. According to the Office of National Drug Control Policy, in 2002, the overall cost of abuse of substances other than alcohol in the United States approximated $181 billion. More than 20% of these costs were related to incarceration, and nearly another 20% were related to drug-related illnesses. Furthermore, the National Institute on Alcohol Abuse and Alcoholism estimated that, in 1998, the costs related to alcohol abuse alone were nearly $185 billion. The majority of these costs (about 66%) were related to lost current or future earnings due to alcohol-related illness or premature death.