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A person using an inhalant

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

Drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, hallucinogens, methaqualone, and opioids. The exact cause of substance abuse is not clear, but there are two predominant theories: either a genetic predisposition or a habit learned from others, which, if addiction develops, manifests itself as a chronic debilitating disease.

In 2010, about 5% of people (230 million) used an illicit substance. Of these, 27 million have high-risk drug use-otherwise known as recurrent drug use-causing harm to their health, causing psychological problems, and or causing social problems that put them at risk of those dangers. In 2015, substance use disorders resulted in 307,400 deaths, up from 165,000 deaths in 1990. Of these, the highest numbers are from alcohol use disorders at 137,500, opioid use disorders at 122,100 deaths, amphetamine use disorders at 12,200 deaths, and cocaine use disorders at 11,100.

A drug user receiving an injection of the opiate heroin

Public health practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture, and availability. Some health professionals choose to avoid the terms alcohol or drug "abuse" in favor of language considered more objective, such as "substance and alcohol type problems" or "harmful/problematic use" of drugs. The Health Officers Council of British Columbia - in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada - has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence.

A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was found to be the overall most dangerous drug.[10]

'Drug abuse' is no longer a current medical diagnosis in either of the most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organization's International Classification of Diseases (ICD).

This diagram depicts the correlations among the usage of 18 legal and illegal drugs: alcohol, amphetamines, amyl nitrite, benzodiazepines, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal highs, LSD, methadone, magic mushrooms (MMushrooms), nicotine and volatile substance abuse (VSA). Usage is defined as having used the drug at least once during years 2005-2015. The colored links between drugs indicate the correlations with ||r|>0.4, where r| is the absolute value of the Pearson correlation coefficient.[11]

Philip Jenkins suggests that there are two issues with the term "drug abuse". First, what constitutes a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries.

Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in most Western countries, while drinking several bottles is seen as abuse. Strict temperance advocates, who may or may not be religiously motivated, would see drinking even one glass as abuse. Some groups (Mormons, as prescribed in "the Word of Wisdom") even condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use of cannabis or substituted amphetamines constitutes drug abuse implies a decision made that the substance is harmful, even in minute quantities. In the U.S., drugs have been legally classified into five categories, schedule I, II, III, IV, or V in the Controlled Substances Act. The drugs are classified on their deemed potential for abuse. The usage of some drugs is strongly correlated. For example, the consumption of seven illicit drugs (amphetamines, cannabis, cocaine, ecstasy, legal highs, LSD, and magic mushrooms) is correlated and the Pearson correlation coefficient r>0.4 in every pair of them; consumption of cannabis is strongly correlated ( r>0.5) with the usage of nicotine (tobacco), heroin is correlated with cocaine ( r>0.4) and methadone ( r>0.45), and is strongly correlated with crack ( r>0.5)

Drug misuse is a term used commonly when prescription medication with sedative, anxiolytic, analgesic, or stimulant properties is used for mood alteration or intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse effects. It sometimes involves drug diversion from the individual for whom it was prescribed.

Prescription misuse has been defined differently and rather inconsistently based on the status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of dependence symptoms. Chronic use of certain substances leads to a change in the central nervous system known as a "tolerance" to the medicine such that more of the substance is needed in order to produce desired effects. With some substances, stopping or reducing use can cause withdrawal symptoms to occur, but this is highly dependent on the specific substance in question.

The rate of prescription drug use is fast overtaking illegal drug use in the United States. According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th graders, nonmedical prescription drug use is now second only to cannabis. In 2011, "Nearly 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported such use of OxyContin." Both of these drugs contain opioids. Fentanyl is an opioid that is 100 times more potent than morphine, and 50 times more potent than heroin. A 2017 survey of 12th graders in the United States, found misuse of OxyContin of 2.7 percent, compared to 5.5 percent at its peak in 2005. Misuse of the combination hydrocodone/paracetamol was at its lowest since a peak of 10.5 percent in 2003. This decrease may be related to public health initiatives and decreased availability.

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying medications at school or work, and often " doctor shopping" to find multiple physicians to prescribe the same medication, without the knowledge of other prescribers.

Increasingly, law enforcement is holding physicians responsible for prescribing controlled substances without fully establishing patient controls, such as a patient "drug contract". Concerned physicians are educating themselves on how to identify medication-seeking behavior in their patients, and are becoming familiar with "red flags" that would alert them to potential prescription drug abuse.

Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse. In the US, approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during withdrawal. In some cases, substance-induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Both alcohol, barbiturate as well as benzodiazepine withdrawal can potentially be fatal. Abuse of hallucinogens, although extremely unlikely, may in some individuals trigger delusional and other psychotic phenomena long after cessation of use. This is mainly a risk with deliriants, and most unlikely with psychedelics and dissociatives.

Cannabis may trigger panic attacks during intoxication and with continued use, it may cause a state similar to dysthymia. Researchers have found that daily cannabis use and the use of high-potency cannabis are independently associated with a higher chance of developing schizophrenia and other psychotic disorders.

Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather than careful thought. Individuals with substance abuse have higher levels of impulsivity, and individuals who use multiple drugs tend to be more impulsive. A number of studies using the Iowa gambling task as a measure for impulsive behavior found that drug using populations made more risky choices compared to healthy controls. There is a hypothesis that the loss of impulse control may be due to impaired inhibitory control resulting from drug induced changes that take place in the frontal cortex. The neurodevelopmental and hormonal changes that happen during adolescence may modulate impulse control that could possibly lead to the experimentation with drugs and may lead to addiction. Impulsivity is thought to be a facet trait in the neuroticism personality domain (overindulgence/negative urgency) which is prospectively associated with the development of substance abuse.

The screening and assessment process of substance use behavior is important for the diagnosis and treatment of substance use disorders. Screeners is the process of identifying individuals who have or may be at risk for a substance use disorder and are usually brief to administer. Assessments are used to clarify the nature of the substance use behavior to help determine appropriate treatment. Assessments usually require specialized skills, and are longer to administer than screeners.

Given that addiction manifests in structural changes to the brain, it is possible that non-invasive magnetic resonance imaging could help diagnose addiction in the future.

There are several different screening tools that have been validated for use with adolescents such as the CRAFFT Screening Test and in adults the CAGE questionnaire. Some recommendations for screening tools for substance misuse in pregnancy include that they take less than 10 minutes, should be used routinely, include an educational component. Tools suitable for pregnant women include i.a. 4Ps, T-ACE, TWEAK, TQDH (Ten-Question Drinking History), and AUDIT.

From the applied behavior analysis literature, behavioral psychology, and from randomized clinical trials, several evidenced based interventions have emerged: behavioral marital therapy, motivational Interviewing, community reinforcement approach, exposure therapy, contingency management They help suppress cravings and mental anxiety, improve focus on treatment and new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.

In children and adolescents, cognitive behavioral therapy (CBT) and family therapy currently has the most research evidence for the treatment of substance abuse problems. Well-established studies also include ecological family-based treatment and group CBT. These treatments can be administered in a variety of different formats, each of which has varying levels of research support Research has shown that what makes group CBT most effective is that it promotes the development of social skills, developmentally appropriate emotional regulatory skills and other interpersonal skills. A few integrated treatment models, which combines parts from various types of treatment, have also been seen as both well-established or probably effective. A study on maternal alcohol and other drug use has shown that integrated treatment programs have produced significant results, resulting in higher negative results on toxicology screens. Additionally, brief school-based interventions have been found to be effective in reducing adolescent alcohol and cannabis use and abuse. Motivational interviewing can also be effective in treating substance use disorder in adolescents.

Alcoholics Anonymous and Narcotics Anonymous are widely known self-help organizations in which members support each other abstain from substances. Social skills are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. It has been suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious, including managing the social environment.

A number of medications have been approved for the treatment of substance abuse. These include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and naltrexone in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including bupropion and modafinil. Methadone and buprenorphine are sometimes used to treat opiate addiction. These drugs are used as substitutes for other opioids and still cause withdrawal symptoms but they facilitate the tapering off process in a controlled fashion. When a person goes from using fentanyl every day, to not using it at all, they will experience a point where they need to get used to not using the substance. This is called withdrawal.[citation needed ]

Opiates v opioids illustrated with diagrams and sub-classifications

Three countries in Europe have active HAT programs, namely England, the Netherlands and Switzerland. Despite critical voices by conservative think-tanks with regard to these harm-reduction strategies, significant progress in the reduction of drug-related deaths has been achieved in those countries. For example, the US, devoid of such measures, has seen large increases in drug-related deaths since 2000 (mostly related to heroin use), while Switzerland has seen large decreases. In 2018, approximately 60,000 people have died of drug overdoses in America, while in the same time period, Switzerland's drug deaths were at 260. Relative to the population of these countries, the US has 10 times more drug-related deaths compared to the Swiss Confederation, which in effect illustrates the efficacy of HAT to reduce fatal outcomes in opiate/opioid addiction.

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2004.

The initiation of drug use including alcohol is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from 2010 Monitoring the Future survey, a nationwide study on rates of substance use in the United States, show that 48.2% of 12th graders report having used an illicit drug at some point in their lives. In the 30 days prior to the survey, 41.2% of 12th graders had consumed alcohol and 19.2% of 12th graders had smoked tobacco cigarettes. In 2009 in the United States about 21% of high school students have taken prescription drugs without a prescription. And earlier in 2002, the World Health Organization estimated that around 140 million people were alcohol dependent and another 400 million with alcohol-related problems.

More than 70,200 Americans died from drug overdoses in 2017. Among these, the sharpest increase occurred among deaths related to fentanyl and synthetic opioids (28,466 deaths). See charts below.

Drug use is higher in countries with high economic inequality

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol[71]

Total yearly U.S. drug deaths.[63]

US yearly overdose deaths, and the drugs involved.[63]

APA, AMA, and NCDA

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision':

...'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.

In 1972, the American Psychiatric Association created a definition that used legality, social acceptability, and cultural familiarity as qualifying factors:

...as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien.

In 1973, the National Commission on Marijuana and Drug Abuse stated:

...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong.

The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (published in 1952) grouped alcohol and other drug abuse under "sociopathic personality disturbances", which were thought to be symptoms of deeper psychological disorders or moral weakness. The third edition, published in 1980, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance.

In 1987, the DSM-IIIR category "psychoactive substance abuse", which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous". It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis. By 1988, the DSM-IV defined substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal". Substance abuse can be harmful to health and may even be deadly in certain scenarios. By 1994, the fourth edition of the DSM issued by the American Psychiatric Association, the DSM-IV-TR, defined substance dependence as "when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed", along with criteria for the diagnosis.

The DSM-IV-TR defines substance abuse as:

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)

Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

the symptoms have never met the criteria for substance dependence for this class of substance

The fifth edition of the DSM ( DSM-5), was released in 2013, and it revisited this terminology. The principal change was a transition from the abuse-dependence terminology. In the DSM-IV era, abuse was seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's dependence term does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requested input as to how the terminology of this illness should be altered as it moves forward with DSM-5 discussions. In the DSM-5, substance abuse and substance dependence have been merged into the category of substance use disorders and they no longer exist as individual concepts. While substance abuse and dependence were either present or not, substance use disorder has three levels of severity: mild, moderate and severe.

Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug prohibition, Harm reduction

Most governments have designed legislation to criminalize certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history.

1991 Indian postage stamp bearing the slogan - Beware of drugs

Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all-time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health. In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens.

Despite drug legislation (or perhaps because of it), large, organized criminal drug cartels operate worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

Some states in the U.S., as of late, have focused on facilitating safe use as opposed to eradicating it. For example, as of 2022, New Jersey has made the effort to expand needle exchange programs throughout the state, passing a bill through legislature that gives control over decisions regarding these types of programs to the state's department of health. This state level bill is not only significant for New Jersey, as it could be used as a model for other states to possibly follow as well. This bill is partly a reaction to the issues occurring at local level city governments within the state of New Jersey as of late. One example of this is in the Atlantic City Government which came under lawsuit after they halted the enactment of said programs within their city. This suit came a year before the passing of this bill, stemming from a local level decision to shut down related operations in Atlantic City made in July that same year. This lawsuit highlights the feelings of New Jersey residents, who had a great influence on this bill passing the legislature. These feelings were demonstrated in front of Atlantic City City hall, where residents exclaimed their desire for these programs. All in all, the aforementioned bill was signed effectively into law just days after it passed legislature, by New Jersey Governor Phil Murphy.

Policymakers try to understand the relative costs of drug-related interventions. An appropriate drug policy relies on the assessment of drug-related public expenditure based on a classification system where costs are properly identified.

Labelled drug-related expenditures are defined as the direct planned spending that reflects the voluntary engagement of the state in the field of illicit drugs. Direct public expenditures explicitly labeled as drug-related can be easily traced back by exhaustively reviewing official accountancy documents such as national budgets and year-end reports. Unlabelled expenditure refers to unplanned spending and is estimated through modeling techniques, based on a top-down budgetary procedure. Starting from overall aggregated expenditures, this procedure estimates the proportion causally attributable to substance abuse (Unlabelled Drug-related Expenditure = Overall Expenditure × Attributable Proportion). For example, to estimate the prison drug-related expenditures in a given country, two elements would be necessary: the overall prison expenditures in the country for a given period, and the attributable proportion of inmates due to drug-related issues. The product of the two will give a rough estimate that can be compared across different countries.

As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) the member states, Norway, and the candidates' countries to the EU, were requested to identify labeled drug-related public expenditure, at the national level.

This was reported by 10 countries categorized according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of health (66%) (e.g. medical services), and public order and safety (POS) (20%) (e.g. police services, law courts, prisons). By country, the average share of GDP was 0.023% for health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for health, and a six-fold difference for POS.

To respond to these findings and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared health and POS spending and GDP in the 10 reporting countries. Results suggest GDP to be a major determinant of the health and POS drug-related public expenditures of a country. Labeled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of health, and r = 0.91 for POS. The percentage change in health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively.

Being highly income elastic, health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions.

United Kingdom

The UK Home Office estimated that the social and economic cost of drug abuse to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year. However, the UK Home Office does not estimate what portion of those crimes are unintended consequences of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition.

United States

These figures represent overall economic costs, which can be divided in three major components: health costs, productivity losses and non-health direct expenditures.

Health-related costs were projected to total $16 billion in 2002.

Productivity losses were estimated at $128.6 billion. In contrast to the other costs of drug abuse (which involve direct expenditures for goods and services), this value reflects a loss of potential resources: work in the labor market and in household production that was never performed, but could reasonably be expected to have been performed absent the impact of drug abuse.

Included are estimated productivity losses due to premature death ($24.6 billion), drug abuse-related illness ($33.4 billion), incarceration ($39.0 billion), crime careers ($27.6 billion) and productivity losses of victims of crime ($1.8 billion).

The non-health direct expenditures primarily concern costs associated with the criminal justice system and crime victim costs, but also include a modest level of expenses for administration of the social welfare system. The total for 2002 was estimated at $36.4 billion. The largest detailed component of these costs is for state and federal corrections at $14.2 billion, which is primarily for the operation of prisons. Another $9.8 billion was spent on state and local police protection, followed by $6.2 billion for federal supply reduction initiatives.

According to a report from the Agency for Healthcare Research and Quality (AHRQ), Medicaid was billed for a significantly higher number of hospitals stays for opioid drug overuse than Medicare or private insurance in 1993. By 2012, the differences were diminished. Over the same time, Medicare had the most rapid growth in number of hospital stays.

Canada

Substance abuse takes a financial toll on Canada's hospitals and the country as a whole. In the year 2011, around $267 million of hospital services were attributed to dealing with substance abuse problems. The majority of these hospital costs in 2011 were related to issues with alcohol. Additionally, in 2014, Canada also allocated almost $45 million towards battling prescription drug abuse, extending into the year 2019. Most of the financial decisions made on substance abuse in Canada can be attributed to the research conducted by the Canadian Centre on Substance Abuse (CCSA) which conduct both extensive and specific reports. In fact, the CCSA is heavily responsible for identifying Canada's heavy issues with substance abuse. Some examples of reports by the CCSA include a 2013 report on drug use during pregnancy and a 2015 report on adolescents' use of cannabis.

Immigrant and refugees have often been under great stress, physical trauma and depression and anxiety due to separation from loved ones often characterize the pre-migration and transit phases, followed by "cultural dissonance", language barriers, racism, discrimination, economic adversity, overcrowding, social isolation, and loss of status and difficulty obtaining work and fears of deportation are common. Refugees frequently experience concerns about the health and safety of loved ones left behind and uncertainty regarding the possibility of returning to their country of origin. For some, substance abuse functions as a coping mechanism to attempt to deal with these stressors.

Immigrants and refugees may bring the substance use and abuse patterns and behaviors of their country of origin, or adopt the attitudes, behaviors, and norms regarding substance use and abuse that exist within the dominant culture into which they are entering.

Street children in many developing countries are a high-risk group for substance misuse, in particular solvent abuse. Drawing on research in Kenya, Cottrell-Boyce argues that "drug use amongst street children is primarily functional-dulling the senses against the hardships of life on the street-but can also provide a link to the support structure of the 'street family' peer group as a potent symbol of shared experience."

In order to maintain high-quality performance, some musicians take chemical substances. Some musicians take drugs such as alcohol to deal with the stress of performing. As a group they have a higher rate of substance abuse. The most common chemical substance which is abused by pop musicians is cocaine, because of its neurological effects. Stimulants like cocaine increase alertness and cause feelings of euphoria, and can therefore make the performer feel as though they in some ways 'own the stage'. One way in which substance abuse is harmful for a performer (musicians especially) is if the substance being abused is aspirated. The lungs are an important organ used by singers, and addiction to cigarettes may seriously harm the quality of their performance. Smoking harms the alveoli, which are responsible for absorbing oxygen.

Substance abuse can be a factor that affects the physical and mental health of veterans. Substance abuse may also harm personal and familial relationships, leading to financial difficulty. There is evidence to suggest that substance abuse disproportionately affects the homeless veteran population. A 2015 Florida study, which compared causes of homelessness between veterans and non-veteran populations in a self-reporting questionnaire, found that 17.8% of the homeless veteran participants attributed their homelessness to alcohol and other drug-related problems compared to just 3.7% of the non-veteran homeless group.

There are many sex differences in substance abuse. Men and women express differences in the short- and long-term effects of substance abuse. These differences can be credited to sexual dimorphisms in the brain, endocrine and metabolic systems. Social and environmental factors that tend to disproportionately affect women, such as child and elder care and the risk of exposure to violence, are also factors in the gender differences in substance abuse. Women report having greater impairment in areas such as employment, family and social functioning when abusing substances but have a similar response to treatment. Co-occurring psychiatric disorders are more common among women than men who abuse substances; women more frequently use substances to reduce the negative effects of these co-occurring disorders. Substance abuse puts both men and women at higher risk for perpetration and victimization of sexual violence. Men tend to take drugs for the first time to be part of a group and fit in more so than women. At first interaction, women may experience more pleasure from drugs than men do. Women tend to progress more rapidly from first experience to addiction than men. Physicians, psychiatrists and social workers have believed for decades that women escalate alcohol use more rapidly once they start. Once the addictive behavior is established for women they stabilize at higher doses of drugs than males do. When withdrawing from smoking women experience greater stress response. Males experience greater symptoms when withdrawing from alcohol. There are gender differences when it comes to rehabilitation and relapse rates. For alcohol, relapse rates were very similar for men and women. For women, marriage and marital stress were risk factors for alcohol relapse. For men, being married lowered the risk of relapse. This difference may be a result of gendered differences in excessive drinking. Alcoholic women are much more likely to be married to partners that drink excessively than are alcoholic men. As a result of this, men may be protected from relapse by marriage while women are at higher risk when married. However, women are less likely than men to experience relapse to substance use. When men experience a relapse to substance use, they more than likely had a positive experience prior to the relapse. On the other hand, when women relapse to substance use, they were more than likely affected by negative circumstances or interpersonal problems.

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Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts.

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drug abuse is no longer considered a medical diagnosis, which doesn't seem correct. everything we know about addiction points to it being a mentally lacking disorder that can be cured through treatment like any other physiatric disorder. also the substances that fall under the category of "drug abuse" are very debatable and blurry. Nicotine isn't considered to be a drug but GHB is, which occurs naturally in the body's central nervous system.

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Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease-people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn't work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient's changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.

Environment. A person's environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction.

Development. Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn't a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient's drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.

Brain changes that occur over time with drug use challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.

Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.

Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.

Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.

No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.

Drug addiction is treatable and can be successfully managed.

More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Learn more

For information about understanding drug use and addiction, visit:

For more information about the costs of drug abuse to the United States, visit:

For more information about prevention, visit:

For more information about treatment, visit:

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

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Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse

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Provides an overview of drug use and addiction, including what happens in the brain during drug use, why some people become addicted while others don't, and the importance of prevention.

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It says that addiction is a chronic disease that laches itself to the brains "reward circuit" and gives off large amounts of dopamine, making the drug use seem very good and putting towards the top of peoples priority list.
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As a response to the floods of dopamine the brain reduces the number of cells in the reward circuit. making it harder for them to get high and even feel happiness doing anything.
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people who seek treatment are at risk of relapsing for many years after being sober, maybe even their whole life for some people.

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It should be noted that these Indiana drug use statistics are not intended as an academic reference. The data collected is from State and Federal sources.

Indiana Addiction Treatment Statistics

The Substance Abuse and Mental Health Services Administration reported that 24,054 people were admitted for alcohol and drug addiction treatment in 2010.

There were approximately 290 treatment facilities in Indiana during 2009. 156 facilities provided a mix of mental health and substance abuse treatment services.

Of all those admitted for drug or alcohol abuse in Indiana during 2010, men comprised 64.5 % of the total, while women comprised 35.5%.

Alcohol Addiction in Indiana

In 2010, there were 4,064 people admitted to treatment for alcohol abuse as the primary drug and 4,931 people admitted with alcohol addiction combined with a secondary substance.

Commonly Abused Drugs in Indiana

The Office of National Drug Control Policy's 2008 report indicated that prescription drugs are the second most commonly abused substance following marijuana.

A new 2011 study conducted by Indiana Prevention Resource Center found that alcohol abuse among teens was declining

A new 2011 study conducted by Indiana Prevention Resource Center at IU Bloomington found that alcohol abuse among teens was declining but that marijuana and smokeless cigarette use was on the increase.

This shift seems to be a result of a false perception that marijuana use is harmless. This perception is closely aligned with the move to legalize its use for medical purposes.

Marijuana
Marijuana was most commonly cited as the primary drug of choice for those entering drug treatment facilities in Indiana. In 2010, there were 5,121 people admitted for treatment of marijuana addiction. Marijuana was ranked first in the state for the most available and most abused substance in 2010.

Heroin
Heroin use has been steadily increasing for the past decade. In 2010, 1,276 people went to drug rehab for heroin addiction. The number of people using heroin in certain cities in the state has increased 300% in the last three years according to a 2011 news report.

Cocaine
Among those who were admitted for cocaine dependence, the largest demographic was between ages 41-45 years of age, with a fairly equal split between men and women using cocaine.

Prescription Drugs
There were 2,183 individuals who entered treatment for opiates other than heroin, the majority or 50.7% of prescription drug admissions were women. Prescription drug abuse is on the rise. In 2007, a report by SAMHSA illustrated that the largest group of abusers for nonmedical use of pain relievers was among the 18-25 year olds followed by 26-30 year olds. Use of OxyContin rose from 29 million dosages in 2002 to 54 million in 2007.

Indiana Drug and Alcohol Fatalities, Injuries and Drug Court Statistics

Drug related deaths were higher in Indiana than the national average. The number of people who died from drug use in 2007-2008 was 827 compared to those who died in motor vehicle accidents which was 942. There were 28 drug courts in Indiana as of 2007, 25 adult drug courts and 3 courts for juveniles. The national average age, and indeed the average age for Indiana participants in adult drug court is between the ages of 31-33 years.

The number of people who died from drug use in 2007-2008 was 827

Methamphetamine lab seizures by law enforcement agencies recorded an increase of incidents from 803 incidents in 2007 to 1,231 incidents in 2009. The number of arrests for possession of Barbiturates, Benzedrine and other drugs rose from 1,688 in 2003 to 2,720 in 2007.

Alcohol impaired driving fatalities number 210 in 2009. However, there were 22,618 people arrested in Indiana for driving while intoxicated and an additional 16,936 people arrested for drunkenness.

Indiana Drug and Alcohol Addiction Resources

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Indiana Drug Use Statistics, Indiana Drug Abuse Statistics

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It should be noted that these Indiana drug use statistics are not intended as an academic reference. The data collected is from State and Federal sources. The Substance Abuse and Mental Health Services Administration reported that 24,054 people were admitted for alcohol and drug addiction treatment in 2010.

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Prevention and early intervention strategies can reduce the impact of substance use and mental disorders in America's communities.

Prevention activities work to educate and support individuals and communities to prevent the use and misuse of drugs and the development of substance use disorders. Substance use and mental disorders can make daily activities difficult and impair a person's ability to work, interact with family, and fulfill other major life functions. Mental and substance use disorders are among the top conditions that cause disability in the United States. Preventing mental and/or substance use disorders or co-occurring disorders and related problems is critical to behavioral and physical health.

Overview

SAMHSA's Center for Mental Health Services (CMHS) leads federal efforts to promote the prevention and treatment of mental disorders. SAMHSA's Center for Substance Abuse Prevention (CSAP) aims to develop comprehensive systems through providing national leadership in the development of policies, programs, and services to prevent the onset of substance misuse.

SAMHSA'S Evidence-Based Practices Resource Center works to provide communities, clinicians, policymakers, and others in the field with the information they need to incorporate evidence-based practices in their communities for prevention, treatment, and recovery services.

SAMHSA's prevention and early intervention efforts promote evidence-based decision-making. Some of SAMHSA's prevention campaigns and initiatives include:

Substance Use Disorder Prevention

Talk. They Hear You. Campaign-Aims to reduce underage drinking and substance use among youths under the age of 21 by providing parents and caregivers with resources to discuss substance use with their children.

Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD)-Coordinates federal efforts to reduce underage drinking and served as a resource for the development of A Comprehensive Plan for Preventing and Reducing Underage Drinking. This committee is comprised of 15 federal agencies and is led by SAMHSA.

STOP Underage Drinking -This interagency website portal of the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) provides research, federal and state resources, and funding opportunities to reduce and prevent underage drinking and its consequences.

National Prevention Week-Held in May, NPW promotes community involvement, resource sharing, and partnership engagement to increase public awareness of substance use and mental disorders. In addition, NPW provides resources to communities so they can highlight their prevention successes throughout the year.

Communities Talk to Prevent Alcohol and Other Drug Misuse-This nationwide initiative provides community-based organizations, institutions of higher education, and statewide or state-based organizations resources and planning stipends to organize activities that raise awareness and educate youth, families, and communities about the potentially harmful consequences of alcohol and other drug misuse among youth and young adults 12 to 25 years old. Held every year, Communities Talk events and activities mobilize communities to take action around underage drinking and substance use prevention and strengthen existing prevention programs.

Mental Disorder Prevention

National Children's Mental Health Awareness Day-Held in May, Awareness Day works to increase public awareness about the needs of children with serious mental illness and severe emotional disturbance. The day also demonstrates how children's mental health initiatives promote positive youth development, recovery, and resilience.

Federal Commission on School Safety-This federal commission, established in 2018, works to address school safety by recommending policy and best practices for school violence prevention. It includes various federal cabinet members, including current Assistant Secretary for Mental Health and Substance Use.

National Child Traumatic Stress Initiative (NCTSI)-This initiative raises awareness about the impact of trauma on children and adolescents as a behavioral health concern. NCTSI develops and implements evidence-based interventions to reduce the mental health impact of traumatic experiences on children and adolescents.

Workforce/Practitioner Training and Education

Prevention Technology Transfer Center (PTTC) Network - Provides training and technical assistance to the substance use prevention field through 10 regional centers, 2 National focus area centers, and a Network Coordinating Office.

Mental Health Technology Transfer Centers (MHTTC) Network- Provides training and technical assistance to organizations and behavioral health treatment providers to deliver evidence-based practices in mental illness prevention, treatment, and recovery support.

SAMHSA's Suicide Prevention Resource Center - This web portal, supported by a SAMHSA CMHS grant, provides resources, programs, training, and research on suicide prevention best practices.

Center of Excellence for Infant and Early Childhood Mental Health Consultation (IECMHC)-Helps communities support the success of the next generation by increasing access to evidence-based infant and early childhood mental health consultation.

National Training and Technical Assistance Center for Child, Youth, and Family Mental Health (NTTAC)-Provides states, tribes, and communities with training and technical assistance on children's behavioral health, with a focus on systems of care.

Resources and Publications

Related SAMHSA Grant Programs

Substance Use Prevention, Treatment, and Recovery Services Block Grant-Provides funding to states, territories, and tribal entities for efforts in prevention and treatment of substance misuse.

Community Mental Health Services Block Grant-Supports grantees in carrying out plans for providing comprehensive community mental health services.

Synar Amendment-As part of the Substance Use Prevention, Treatment, and Recovery Services Block Grant, SAMHSA's Center for Substance Abuse Prevention oversees the implementation of the Synar Amendment, which requires states to have laws prohibiting the sale and distribution of tobacco products to minors.

Strategic Prevention Framework - Partnerships for Success grants-Provides funding to prevent the onset and reduce the progression of substance abuse and its related problems while strengthening prevention capacity at the community level. This grant is targeted for interventions to prevent underage drinking among persons age 9 to 20.

First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) Grants-Provides funding to train and provide resources to first responders on carrying and administering naloxone, an opioid overdose reversal drug.

Sober Truth on Preventing Underage Drinking Act grants- Aims to prevent and reduce alcohol use among youth and young adults ages 12-20 in communities.

Tribal Behavioral Health Grant Program-Aims to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health among American Indian/Alaska Native youth through age of 24.

Project AWARE (Advancing Wellness and Resiliency in Education) State Education Agency Grants-Aims to build the capacity of state education agencies to increase awareness of mental health issues among school-aged youth; provide training for school personnel to detect and respond to mental health issues; and connect school-aged youth and families to needed services.

Garrett Lee Smith (GLS) Campus Suicide Prevention Grant-Aims to develop a coordinated approach to enhance behavioral health services for all college students, prevent mental and substance use disorders, promote help-seeking behaviors, and improve the identification and treatment of college students at-risk for suicide.

Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Grant Program-Supports states and tribes with implementing youth suicide prevention and early intervention strategies in schools, youth-serving organizations, and health care settings.

National Center of Excellence for Infant and Early Childhood Mental Health Consultation-Works to promote the healthy social and emotional development of infants and young children and to prevent the onset of serious emotional disturbance through funding of public and private nonprofit entities.

Linking Actions for Unmet Needs in Children's Health Grant Program (Project LAUNCH)-Aims to promote the wellness of young children, from birth to age 8, by addressing the social, emotional, cognitive, physical and behavioral aspects of their development and prevent the development of serious emotional disturbances.

Learn more about SAMHSA grants and how to apply.

Related Organizations

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Prevention of Substance Use and Mental Disorders

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Prevention and early intervention strategies can reduce the impact of substance use and mental disorders in America's communities. Prevention activities work to educate and support individuals and communities to prevent the use and misuse of drugs and the development of substance use disorders.

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this shows that there is a direct correlation between substance abuse and heart disease/diabetes.
they have a recovery program which is purely helpful and safe with no intervention of the law. it gives links to the bases of their plan to stop substance abuse. they have a plan to teach teachers and other adults that are around children to be able to notice changes in mental health and how to help those dealing with these kinds of problems.

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Definition of Addiction - What is Addiction? The American Society of Addiction Medicine defines addiction as....

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Johann Hari: Everything you think you know about addiction is wrong

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What really causes addiction -- to everything from cocaine to smart-phones? And how can we overcome it? Johann Hari has seen our current methods fail firsthand, as he has watched loved ones struggle to manage their addictions. He started to wonder why we treat addicts the way we do -- and if there might be a better way.

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Addiction is an often chronic disease that affects the structure & function of the brain. It can be effectively treated & managed by medical professionals.

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For too long our country felt like we could arrest our way out of this problem.But we know that we can't.
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Generally, people with other diseases get care and treatment. If you have cancer, you get treatment, if you have diabetes, you get treatment. If you have a heart attack, you get emergency services, and you get referred to care. But somehow people with addiction have to wait for treatment or often can't get when they need it.
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My story is not unique. Like millions of Americans, my disease progressed undiagnosed. It took me to people and places and things that I never would have chosen. It wasn't until an intersection with the law gave me an "opportunity" to get care, that I began my journey of recovery.

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Chapter 2 Impact of Substance Abuse on Families

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Family structures in America have become more complex-growing from the traditional nuclear family to single‐parent families, stepfamilies, foster families, and multigenerational families. Therefore, when a family member abuses substances, the effect on the family may differ according to family structure. This chapter discusses treatment issues likely to arise in different family structures that include a person abusing substances.

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he talks about how the entirety of how the American legal system deals with addiction, how we don't actually try to help people we just throw them in jail hoping that they will be different when they come out.
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he also talks about how challenging it is to actually seek and receive treatment and that most people don't even seek help with their addictions.

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almost everything we think we know about addiction is wrong, and if we start to absorb the new evidence about addiction, I think we're going to have to change a lot more than our drug policies.
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I'll be taken to the hospital and I'll be given loads of diamorphine. Diamorphine is heroin.--- And you'll be given it for quite a long period of time. There are loads of people in this room, you may not realize it, you've taken quite a lot of heroin.
--- And if what we believe about addiction is right -- those people are exposed to all those chemical hooks -- What should happen? They should become addicts. This has been studied really carefully. It doesn't happen

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he says that addiction is purely habitual and not mental or physically binding. our ideas about addiction are completely false and the way we are attacking it are even more wrong.
I agree with his idea that the way we view and try to "treat" addiction are heavily flawed and need to be corrected into more of a retribution/therapy way of doing things instead of correction by law and forced rehab.

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About the Survey

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts the annual National Survey on Drug Use and Health (NSDUH), a major source of information on substance use, abuse, and dependence among Americans 12 years and older. Survey respondents report whether they have used specific substances ever in their lives (lifetime), over the past year, and over the past month (also referred to as "current use"). Most analyses focus on past-month use.

The following are facts and statistics on substance use in the United States in 2013, the most recent year for NSDUH survey results. Approximately 67,800 people responded to the survey in 2013.

Illicit Drug Use*

Illicit drug use in the United States has been increasing. In 2013, an estimated 24.6 million Americans aged 12 or older-9.4 percent of the population-had used an illicit drug in the past month. This number is up from 8.3 percent in 2002. The increase mostly reflects a recent rise in use of marijuana, the most commonly used illicit drug.

Marijuana use has increased since 2007. In 2013, there were 19.8 million current users-about 7.5 percent of people aged 12 or older-up from 14.5 million (5.8 percent) in 2007.

Use of most drugs other than marijuana has stabilized over the past decade or has declined. In 2013, 6.5 million Americans aged 12 or older (or 2.5 percent) had used prescription drugs nonmedically in the past month. Prescription drugs include pain relievers, tranquilizers, stimulants, and sedatives. And 1.3 million Americans (0.5 percent) had used hallucinogens (a category that includes ecstasy and LSD) in the past month.

Cocaine use has gone down in the last few years. In 2013, the number of current users aged 12 or older was 1.5 million. This number is lower than in 2002 to 2007 (ranging from 2.0 million to 2.4 million).

Methamphetamine use was higher in 2013, with 595,000 current users, compared with 353,000 users in 2010.

Most people use drugs for the first time when they are teenagers. There were just over 2.8 million new users of illicit drugs in 2013, or about 7,800 new users per day. Over half (54.1 percent) were under 18 years of age.

More than half of new illicit drug users begin with marijuana. Next most common are prescription pain relievers, followed by inhalants (which is most common among younger teens).

Drug use is highest among people in their late teens and twenties. In 2013, 22.6 percent of 18- to 20-year-olds reported using an illicit drug in the past month.

Drug use is increasing among people in their fifties and early sixties. This increase is, in part, due to the aging of the baby boomers, whose rates of illicit drug use have historically been higher than those of previous generations.

Alcohol

Drinking by underage persons (ages 12 to 20) has declined. Current alcohol use by this age group declined from 28.8 to 22.7 percent between 2002 and 2013, while binge drinking declined from 19.3 to 14.2 percent and the rate of heavy drinking went from 6.2 to 3.7 percent.

Binge and heavy drinking are more widespread among men than women. In 2013, 30.2 percent of men and 16.0 percent of women 12 and older reported binge drinking in the past month. And 9.5 percent of men and 3.3 percent of women reported heavy alcohol use.

Driving under the influence of alcohol has also declined slightly. In 2013, an estimated 28.7 million people, or 10.9 percent of persons aged 12 or older, had driven under the influence of alcohol at least once in the past year, down from 14.2 percent in 2002. Although this decline is encouraging, any driving under the influence remains a cause for concern.

Tobacco

Fewer Americans are smoking. In 2013, an estimated 55.8 million Americans aged 12 or older, or 21.3 percent of the population, were current cigarette smokers. This reflects a continual but slow downward trend from 2002, when the rate was 26 percent.

Teen smoking is declining more rapidly. The rate of past-month cigarette use among 12- to 17-year-olds went from 13 percent in 2002 to 5.6 percent in 2013.

Substance Dependence/Abuse and Treatment

Rates of alcohol dependence/abuse declined from 2002 to 2013. In 2013, 17.3 million Americans (6.6 percent of the population) were dependent on alcohol or had problems related to their alcohol use (abuse). This is a decline from 18.1 million (or 7.7 percent) in 2002.

After alcohol, marijuana has the highest rate of dependence or abuse among all drugs. In 2013, 4.2 million Americans met clinical criteria for dependence or abuse of marijuana in the past year-more than twice the number for dependence/abuse of prescription pain relievers (1.9 million) and nearly five times the number for dependence/abuse of cocaine (855,000).

There continues to be a large "treatment gap" in this country. In 2013, an estimated 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (0.9 percent) received treatment at a specialty facility.

*Note that the terms dependence and abuse as used in the NSDUH are based on diagnostic categories used in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); in the newly published Fifth Edition (DSM-V), those categories have been replaced by a single Substance Use Disorder spectrum.

Learn More

For complete NSDUH findings, visit: www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.htm#3.1.2

For more information about drug use among adolescents, visit: www.drugabuse.gov/publications/drugfacts/high-school-youth-trends

This publication is available for your use and may be reproduced in its entirety without permission from the NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

* "Illicit" refers to use of illegal drugs, including marijuana according to federal law, and misuse of prescription drugs.

Binge drinking is five or more drinks on the same occasion. Heavy drinking is binge drinking on at least five separate days in the past month.

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About the Survey The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts the annual National Survey on Drug Use and Health (NSDUH), a major source of information on substance use, abuse, and dependence among Americans 12 years and older.