ADDICTION, DRUG ADDICTION
Statistics suggest that substance abuse has become a critical public health problem in the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 61.9 million people (21.9% of the population) used illicit drugs during the past year.
There are a number of factors related to substance used that may be little known, misunderstood, or misconceptions about substance abuse issues. A few of those topics are discussed below.
Substance Use Disorders Are as Prevalent as Diabetes
In 2016, almost 21 million people age 12 and older in the U.S. met the criteria for a substance use disorder diagnosis. That is approximately 8% of the entire adolescent and adult population and is comparable to the number of people with diabetes.
People with substance use disorders outnumber those with thyroid conditions. They are equal to 1.5 times the number of people diagnosed with all types of cancers combined—breast, lung, prostate, colon, liver, and all other cancers combined.
This number appears to have grown in recent years. The 2021 National Survey of Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 46.3 million people (16.5% of the population) met the criteria for a substance use disorder.
Substance use disorders do not include the millions of people who have engaged in harmful drinking (binge drinking and heavy drinking) or have used illegal drugs in the past 12 months but do not meet the criteria for a diagnosable substance use disorder.
According to a report Surgeon General, of the 265 million Americans over the age of 12:2
175 million (65.7%) drank alcohol
66.7 million (24.9%) reported binge drinking
17.3 million (6.5%) were heavy drinkers
36 million (13.5%) used marijuana
18.9 million (7.1%) misused prescription drugs
300,000 used heroin
The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as consuming five (men) or four (women) or more drinks within a two-hour period.4 Heavy drinking for men and women involves binge drinking at least five times in the past 30 days.
Opioid Overdose Deaths Have Increased
A trend of over-prescribing opioid pain pills, which began in the 1990s, resulted in a rapid increase in the use and misuse of these pain relievers. The escalation of opioid use soared throughout all regions of the country and across demographic lines.
Opioid overdose deaths rose throughout the U.S., increasing nearly four-fold between 1999 and 2014.
This trend has continued despite efforts to curb the opioid epidemic. According to the Centers for Disease Control and Prevention (CDC), opioid overdose deaths rose between 2020 and 2021.5 Provisional data from the CDC suggests that approximately 82,998 people died from opioid overdoses in 2022.
Stigma Around Substance Use Can Affect Treatment Rates
Only about 10% of the people who need treatment for substance abuse in the U.S. receive treatment in any given year.2 According to the 2021 NSDUH report, 94% of people over age 12 with a substance use disorder did not receive any type of treatment for their condition. Almost all of these individuals reported that they did not believe they needed treatment for their substance use.
One reason for this lack of treatment stems from the stigma that still exists in society concerning substance use and addiction.
There is, therefore, a trend among professional treatment providers to use the term "substance misuse" because it feels less shaming than "substance abuse."
Substance use disorders are treatable conditions. Effective treatments are available that can help people recover from addiction.
Confrontational Interventions Are Rarely Effective
Although surprise confrontational family interventions to try to get loved ones to enter into treatment for alcohol and drug problems have gained notoriety due to their portrayal on television programs, in reality, they are not very effective.
Confrontational interventions, sometimes called the "Johnson Intervention," have been around since the 1960s, but have not been found in scientific studies to be very effective in getting people into treatment and, in fact, can actually backfire—making the targeted person even more resistant to seeking treatment.
One study found that people with substance use problems perceived confrontational interventions as unhelpful.
When mental health professionals use the term "intervention," they are not referring to these types of confrontations. Instead, the term is used to refer to treatment programs delivered by mental health professionals to help prevent or treat substance use disorders.
Medical Treatments Are Not Substitute Addictions
One long-held misconception about the use of pharmaceutical treatments to help people who have alcohol and substance use disorders is that using medications to treat craving and withdrawal is substituting one addiction for another.
The use of methadone and buprenorphine to control opioid craving and withdrawal has been found in scientific studies to reduce substance misuse, reduce the risk of relapse and overdose, reduce criminal behavior, and reduce the transmission of infectious diseases. These treatments also help people return to a healthy and functional lifestyle.8
According to a report by the U.S. Surgeon General, the stance by many abstinence-based treatment approaches that the use of these medications is substituting one addiction for another is scientifically unsound and severely limits their use by people who could benefit from them.
Restrictions on how methadone and buprenorphine can be prescribed and dispensed have also reduced their availability.
It Doesn't Have to Be Severe to Be Treated
Traditionally, alcohol and drug problems were not treated until a person "hit bottom" after substance misuse became a crisis. When treatment was sought, it was usually provided by specialty addiction treatment programs that were separate and isolated from the mainstream healthcare system.
A report by the Surgeon General's suggested that:
Mild substance use disorders can also be treated
Any harmful misuse should receive intervention
Early intervention can prevent later severe disorders
Substance misuse screening should be a part of primary healthcare
Intervention and monitoring should be handled in the mainstream healthcare system
The report also emphasized that not everyone with a substance use disorder needs ongoing treatment; many only require brief intervention and monitoring. Many people could receive treatment from general primary care providers.
If substance misuse screening and brief intervention and monitoring were conducted as a routine part of primary health care, it could significantly reduce the development of more severe substance use disorders.
Peer Recovery Coaches Can Be Effective
A recent trend in substance use disorder treatment is the use of peer recovery coaches, who are people who are in recovery themselves who use their knowledge and life experiences to help others who are new to recovery.
Sometimes called sober coaches, peer recovery coaches provide others in recovery with emotional, informational, and practical support to help them maintain recovery.
Although you may have heard of celebrities hiring private recovery coaches, the peer coaches can also be associated with recovery community organizations, clinics, sober living homes, and recovery high schools.
They can also be employees in primary care settings, emergency departments, mental health clinics, criminal justice systems, child welfare, and homeless agencies.
Peer recovery coaches are not substance use disorder treatment counselors or treatment case managers. They are also not 12-step program sponsors, because they do not promote any specific recovery pathway, but facilitate all pathways.
There are very few research studies on the effectiveness of peer recovery coaches, but that which has been conducted is promising.2
Recovery Houses Are Very Effective
Recovery houses, traditionally known as halfway houses or sober living residences, have been found to be very effective in helping those who have completed alcohol and drug detox or treatment to remain abstinent.
Sober Living Residences provide cost-efficient and substance-free housing to individuals in recovery.
A study of sober living residents found the following outcomes:
• 87% of residents were abstinent after two years
• Abstinent rates were 4-5 higher than typical outcomes
• Higher, more positive rates of self-efficacy and self-mastery
• Higher monthly incomes
• Lower incarceration rates
Research has found that going to a recovery house after detox or residential treatment results in generally better outcomes than going directly back into society.
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
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By Buddy T Updated on June 01, 2023
Medically reviewed by Steven Gans, MD