Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
ILLICIT DRUG USE Past year illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, as well as the misuse of prescription pain relievers, tranquilizers, stimulants, and sedatives. Substance use disorders affect individuals, families, communities, and society as a whole and cause more deaths, illnesses, accidents, and disabilities than any other preventable health problem today. It is estimated that more than 20% of deaths in the United States are attributable to tobacco, alcohol, and other drug use (National Center on Addiction and Substance Abuse at Columbia University [CASA Columbia], 2012). According to the National Center for Drug Abuse Statistics (NCDAS, 2023), accidental drug overdose is a leading cause of death among persons under the age of 45 (NIDA, 2021j), while tobacco is linked to an estimated 480,000 deaths per year (Centers for Disease Control and Prevention [CDC], 2017). Over 70,000 drug overdose deaths occur in the United States annually and increase at an annual rate of 4.0% (NCDAS, 2023). In addition, the use of these substances contributes to more than 70 other conditions requiring medical care, including cancer, cardiovascular disease, HIV/AIDS, respira- tory disease, cirrhosis, ulcers, pregnancy complications, and trauma (CASA Columbia, 2012). Other substance use-related social consequences include crime, incarceration, accidents, suicide, child neglect and abuse, domestic violence, unplanned pregnancies, and lost productivity—all of which cost the U.S. government at least $600 billion each year (SAMHSA, 2015a). The Executive Office of the President of the United States, Office of National Drug Control Policy [ONDCP], 2022, coordinates across 19 federal agencies and oversees a $41 billion budget as part of a whole-of-government approach to addressing addiction (ONDCP, 2022). Despite the high rates of alcohol and drug use disorders, most individuals do not receive treatment. Of the more than 20 million persons need- ing treatment for drug or alcohol use-related problems, fewer than 20% were receiving clinical help (Grant et al., 2015). In 2009, the U.S. government estimated that only 15.8% of people who needed treatment for substance abuse received it at a specialty facility (NIDA, 2021c). Therefore, it is impera- tive to screen individuals for potential problems and provide them with evidence-based treatment for alcohol and drug use disorders when possible. SCOPE OF ALCOHOL USE-RELATED PROBLEMS As indicated previously, despite the U.S. government and media focus on users of illicit drugs, clinically it is important to note that there are approximately 17 million individuals manifesting an alcohol use disorder, approximately 10 million more than those manifesting a drug use disorder (SAMHSA, 2015a). Thus, it is much more likely that a clinician in a non- addiction setting will encounter someone with an alcohol use-related problem—or one of their family members—than problematic users of any other substance.
Alcohol abuse can result in significant social, mental health, and physical health problems. The most serious physical health problems include stroke and liver problems (CDC, n.d.; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2023). Other associated medical conditions include increased risk of cancer of the liver, breast, mouth, throat, esophagus, and colon (National Cancer Institute, 2021); furthermore, heavy use of alcohol is believed to contribute to the physiological process that causes cancer cells to metastasize (CASA Columbia, 2012). An epidemiological study found significant associations between 12-month and lifetime alcohol use disorder (AUD) and major depressive and bipolar disorders, as well as antiso- cial and borderline personality disorders across all levels of AUD severity (Grant et al., 2015). Past studies have indicated that nearly half of all violent deaths (accidents, suicides, and homicides), particularly of men younger than age 34, were alcohol use-related, and alcohol use is a consistent factor in sexual assault perpetration (Abbey et al., 2014). Up to 60% of sexual offenders were drinking at the time of the offense, and more than 75% of female victims of nonfatal domestic violence reported that the assailant was drinking or using drugs. Alcohol use also accounts for roughly one third of all automobile accident deaths each year (National Council on Alcoholism and Drug Dependence, 2021; CDC, 2020). Alcohol use disorder varies according to age and gender, as well as ethnic and racial factors. Although men consume and misuse alcohol at significantly higher rates than women, this gender gap has decreased, partly due to women’s earlier initiation into drinking in recent times (Grant et al., 2015). Compared with men, women experience significantly shorter time intervals between the initiation of alcohol use and the onset of significant alcohol-related problems and treatment entry; this difference has been attributed to a variety of bio- logical, socioeconomic, psychological, and cultural factors that affect women (Pape & Sarabia, 2014). Further, for several reasons—including differences in weight and amount of water in the body—women who engage in problematic drinking are at higher risk of experiencing health problems resulting from alcohol use compared with men who engage in problematic drinking (NIAAA, 2023). Several key racial/ethnic differences can be seen when examin- ing alcohol use patterns. White populations engage in current alcohol use at higher rates than other racial/ethnic groups. In 2015, among persons aged 18 or older, current alcohol use rates (i.e., use within the past month), based on race and ethnicity characteristics, show the following: • Whites, 60.9%
• Two or more races, 49.6% • Hispanics or Latinos, 47.5 • Blacks or African Americans, 48.3%
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