____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
• American Indians and Alaska Natives, 41.2% • Asians, 42.9% • Native Hawaiians and Other Pacific Islanders, 37.6% (Center for Behavioral Health Statistics and Quality, 2016; Table 2.43B) Binge drinking and heavy alcohol use patterns among persons aged 12 or older are similar and highest among White people and lowest among Asian people (Grant et al., 2015; Center for Behavioral Health Statistics and Quality, 2016). SCOPE OF PROBLEMS RELATED TO OTHER DRUG USE Government-sponsored studies based on the 2021 National Survey on Drug Use and Health (NSDUH) indicate that an estimated 161 million Americans (more than 50% of the population) are current users of illicit drugs, tobacco, and/or alcohol in the past month (SAMHSA, 2021a). However, as pointed out previously, not all drug use is problematic, and only a small proportion of individuals who use a drug are addicted to it. Nonetheless, drug use often results in increas- ing serious individual and social problems. According to the ONDCP (2010, p. v), “Drug overdose deaths surpass gunshot deaths in our country, and in 16 states, overdose deaths are a more common cause of accidental death than car crashes. Drugged driving has now been identified at higher levels than alcohol-impaired driving, [while] prescription drug abuse is at record levels.” The 2021 NSDUH found that among people aged 12 or older, 57.8% (or 161.8 million people) used tobacco, alcohol, or an illicit drug in the past month (also defined as “current use”), including 47.5% (or 133.1 million people) who drank alcohol, 19.5% (or 54.7 million people) who used a tobacco product and 14.3% (or 40.0 million people) who used an illicit drug (NSDUH, 2021). In 2021, marijuana was the most commonly used illicit drug, with 18.7% of people aged 12 or older (or 52.5 million people) using it in the past year (NSDUH, 2021). Among people aged 12 or older in 2021, 3.3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescrip- tion pain relievers compared with 1.1 million people who used heroin (NSDUH, 2021). As in the past, recent national survey data indicate that men have a higher rate of current illicit drug use than women (22% vs. 17%), and they are more likely to use marijuana, cocaine, and hallucinogens. In 2021, 35% of college students indicated they used illegal drugs instead of prescription drugs, with 93% indicating they used marijuana, while 37% used cocaine and 36% used hallucinogens (NCDAS, 2021).
According to government data, individuals in the criminal justice system have a particularly high rate of substance use problems; approximately 53% of state and 45% of federal prisoners surveyed in 2004 met the criteria for SUD (U.S. Bureau of Justice Statistics, 2016). According to Carson and Sabol (2012; p. 9), “The most serious offense for 59.4% of women in federal prisons and 25.1% of women in state pris- ons is violation of drug laws.” Another group with a growing substance abuse problem is older adults. Among individuals older than age 65, alcohol, tobacco, cannabis, and prescrip- tion medications are the most commonly used substances (Kuerbis et al., 2014). It is essential to screen for potential SUDs among this age group because they account for 30% of the U.S. population, and substance use after age 65 can pose unique problems. Nevertheless, this population is less likely to be screened compared with other age groups (Kuerbis et al., 2014). A recent study found that the general risk for having a lifelong drug use disorder was highest among Whites, Native Ameri- cans, men, single people, individuals between the ages of 18 and 44, and those with lower incomes and educational back- grounds. The study also found that people with mental health conditions, such as depression, bipolar disorder, posttraumatic stress disorder (PTSD), personality disorders, anxiety, and panic and social disorders were more likely to have a lifelong drug use disorder (Grant et al., 2016). IMPACT ON THE FAMILY Life with a substance-abusing family member is typically full of inconsistency and unpredictability, resulting in a chronic state of crisis. Legal and financial problems, serious illnesses, and various accidents are common occurrences that intrude on family life. When the substance abuser is a parent, dysfunc- tional cross-generational alliance and role reversal (i.e., children assume parental roles and responsibilities) are frequently seen (Straussner, 2011). Child neglect, violence between parents, child abuse, and incest are some of the consequences and cor- relates of substance abuse (Staton-Tindall et al., 2013). Studies highlight the need to address the intergenerational cycle of substance abuse and child abuse if effective progress is to be made on either problem. The impact of substance abuse on the family has additional intergenerational repercussions: The sons of alcoholic fathers are four times more likely to become alcoholics, and the daughters of alcoholic parents are three times more likely to become alcoholics. Moreover, the daughters of alcoholic fathers are also more likely to marry alcoholic men. Intergenerational repercussions also exist for families with parental opiate and other drug addiction (CASA Columbia, 2012).
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