the most common substance abuse disorders
What are the most common types of substance use disorders?
Substance use is widespread in the United States, and a large number of Americans suffer from substance use disorders. Each year, the Substance Abuse and Mental Health Services Administration sponsors a national survey which examines the prevalence of substance use disorders during the previous year. In 2015, the survey showed that 8% of individuals age 12 and older met the diagnostic criteria for at least one substance use disorder in the past year, representing 21 million people.
Young adults between the ages of 18 and 25 had the highest rate of substance use disorders at 15%, followed by adults at 7% and adolescents at 5%. These percentages represented about 1 in 7 young adults, 1 in 15 adults, and 1 in 20 adolescents.
Alcohol Use Disorder
Alcohol Use Disorder is the most common type of substance use disorder in the United States. Eleven percent of young adults between the ages of 18 and 25 met the diagnostic criteria for an Alcohol Use Disorder in 2015, followed by 5% of adults and 3% of adolescents. Males have a higher rate of the disorder than females, with a ratio of about 2.5 to 1.0.
Among those who develop an Alcohol Use Disorder, the first use of the substance is usually in the mid-teens. Diagnostic criteria for the disorder are usually met between the ages of 18 and 25, with relatively few people developing the disorder after the age of 40. Genetics pose the greatest risk for an Alcohol Use Disorder, with 40% to 60% of the vulnerability to the disease being attributable to genetic factors. Children of alcoholics are four times more likely to become alcoholic than children of non-alcoholic parents. Other risk factors include childhood mental disorders (e.g., anxiety disorders, attention deficit hyperactivity disorder), early exposure to alcohol use (e.g., introduction by a parent or older sibling, involvement with a using peer group), and chronic childhood stressors or trauma (e.g., parental mental illness or addiction, child abuse or neglect, parental abandonment or divorce).
Even before the development of an Alcohol Use Disorder, excessive alcohol use can pose serious risks to the user as well as others. The Center for Disease Control reports that excessive alcohol use contributes to the death of about 88,000 Americans each year, making it the fourth leading preventable cause of death in the nation. Additionally, the lives of those lost are shortened by an average of 30 years, indicating the frequency with which young people lose their lives as the result of alcohol use.
In 2014, alcohol impairment resulted in 9,967 motor vehicle fatalities, representing 31% of all motor vehicle fatalities. Sixty-four percent of the fatalities were the impaired driver, and 15% were passengers with a blood alcohol concentration of .08 g/dL or higher. Included in the total number of motor vehicle fatalities were 1,070 children between the ages of 0 and 14, with 209 of these deaths involving an alcohol-impaired driver. Furthermore, over half of these children were riding in the vehicle with the impaired driver.
Other causes of alcohol-related injuries and deaths include falls, drownings, and burns, as well as suicide, homicide, sexual assault, physical assault, and intimate partner violence. Research has shown that the risk of injury increases with relatively low amounts of alcohol, and that even moderate amounts of alcohol have notable effects on cognitive processing, reaction time, and coordination. Nevertheless, there is a dose-response relationship, with a higher blood alcohol level increasing the risk for injury.
Long-term health risks associated with alcohol use include a number of chronic diseases, as well as other serious medical conditions. These include high blood pressure, coronary heart disease, stroke, cirrhosis of the liver, and pancreatitis, as well as cancer of the mouth, throat, esophagus, stomach, liver, and colon. The risk for female breast cancer is increased by 14% to 59% compared to abstainers, depending on the amount of alcohol consumed. Learning and memory problems, including dementia, are associated with excessive alcohol use, as are anxiety and depressive disorders. Additionally, alcohol withdrawal is the most dangerous form of withdrawal among all substances of abuse.
Cannabis Use Disorder
Marijuana is the most commonly used illicit drug in the U.S., and Cannabis Use Disorder was the second most common type of substance use disorder in 2015. Five percent of young adults met the diagnostic criteria for a Cannabis Use Disorder, followed by 1% of adults and 3% of adolescents. Adult males have a higher rate of the disorder than females with a ratio of 2.8 to 1.0, but the difference is nominal among adolescents with a ratio of 1.3 to 1.0.
Individuals who develop a Cannabis Use Disorder usually use the substance for the first time in their mid-teens. Diagnostic criteria for the disorder are usually met during adolescence or young adulthood. Similar to alcoholism, genetics pose a significant risk for Cannabis Use Disorder, with 30% to 80% of the vulnerability to the disorder being attributable to genetic factors. In addition to the sensitivity of the brain's reward system, susceptible individuals tend to have inherited tendencies toward novelty seeking and risk taking. Other risk factors for the disorder include academic problems, conduct problems, tobacco use, and an unstable or abusive home environment.
Although marijuana has long been regarded as a non-addictive substance, recent research has shown that it is both physically and psychologically addictive. Among regular users and those participating in treatment programs, between 30% and 95% report the experience of withdrawal. Furthermore, as the potency of cannabis has increased substantially in the past two decades, it is likely that its addictive properties have increased, as well.
With the publication of its most recent diagnostic manual, the American Psychiatric Association has introduced its first set of diagnostic criteria for cannabis withdrawal. Included in these withdrawal symptoms are irritability, anger, aggression, anxiety, restlessness, sleep disturbances, depressed mood, and decreased appetite or weight loss. Although cannabis withdrawal is not as debilitating as alcohol withdrawal, it can cause significant distress and contribute to the risk for relapse.
The safety risks posed by marijuana use are not as easily determined as the risks posed by alcohol use. Since tetrahydrocannabinol (THC), the active ingredient in marijuana, remains in the user's system for several weeks after their last use, it is usually not possible to assess the effect of the drug on the user's functioning at the time of an accident or injury. Additionally, since marijuana users often use marijuana along with alcohol or other drugs, it is usually not feasible to determine that marijuana alone had caused the user's impairment.
Nevertheless, THC is known to impair cognitive functioning, as it affects regions of the brain involved with attention, perception, judgment, reaction time, balance, coordination, problem solving, and decision making. Therefore, it is reasonable to conclude that marijuana use could pose a significant risk in numerous situations, such as operating a vehicle, participating in sports or recreational activities, or performing hazardous job duties.
Other cognitive effects associated with marijuana use include reduced goal-directed behavior, sometimes called amotivational syndrome. This condition often results in diminished performance at work or school, as well as a notably changed attitude toward previously held values and goals. Relationships with others can also become strained, as family members, teachers, and friends strive to understand the user's loss of initiative.
Perhaps the most serious cognitive effect posed by marijuana is the user's increased risk for mental illness. Research has shown that marijuana users are significantly more likely than non-users to develop chronic mental disorders, such as schizophrenia spectrum disorders. Additionally, among those suffering from a psychotic disorder, cannabis use can trigger acute psychotic episodes, as well as impede the treatment of the disorder. Cannabis Use Disorder is also associated with anxiety, depression, and bipolar disorders, as well as antisocial, obsessive-compulsive, and paranoid personality disorders. Studies also show lower levels of life satisfaction, increased mental health care and hospitalizations, and increased suicide attempts.
Physical health risks posed by marijuana use continue to be explored, but there is evidence that it is damaging to both the cardiovascular and respiratory systems. Research has shown a notable effect on heart rate and blood pressure, and there is a significant risk for heart attack in the hours following marijuana use. Research regarding lung cancer is inconclusive since most marijuana users are also tobacco users, and tobacco smoke is a known cause of lung cancer. Nevertheless, marijuana smoke contains many of the same toxins and carcinogens as tobacco smoke, so it is likely that marijuana use also contributes to the development of lung cancer. Marijuana users are also known to suffer from bronchitis, shortness of breath, and excessive phlegm production.
Opioid Use Disorder
Opioid use is the second most common type of illicit drug use in the United States. Within the context of substance misuse, opioid use refers to heroin use and the non-medical use of prescription pain relievers. In 2015, the rate of Opioid Use Disorder was 1% among young adults, 0.5% among adults, and 0.3% among adolescents. Males have a higher rate of the disorder than females, with a ratio of 3.0 to 1.0 for heroin use, and a ratio of 1.5 to 1.0 for prescription pain reliever use.
Opioid Use Disorder is most likely to occur during adolescence or early adulthood. Similar to other substance use disorders, genetic factors play a significant role in the development of an Opioid Use Disorder. In addition to the inherited susceptibility of the brain's reward system, vulnerable individuals are likely to have genetic tendencies toward impulsivity and novelty seeking. Additional risk factors for an Opioid Use Disorder include an injury or medical procedure leading to the initiation of prescription pain relievers, as well as family and peer environmental influences.
Compared to the rates of Alcohol or Cannabis Use Disorders, the rates of Opioid Use Disorder may seem insignificant at 1% or less. However, these seemingly small rates represent about 2.6 million people in our nation, and there has been a significant loss of life related to the disorder. The Center for Disease Control reports that the rate of overdose deaths from prescribed opioids nearly quadrupled between 1999 and 2008, and that the states with the highest rates of prescribing opioids had the highest rates of overdose deaths. Similarly the rate of overdose deaths from heroin quadrupled between 2002 and 2013, and then increased by 29% in just one year from 2013 to 2014.
While prescribed opioid-related deaths continue to exceed heroin-related deaths on an annual basis, they are not increasing at the same rate as heroin-related deaths. In 2014, the number of prescribed opioid-related deaths increased by 9%, whereas the number of heroin-related deaths increased by 29%. This difference is due to the fact that many prescribed opioid users switch to heroin, as it is more readily available and considerably less expensive than prescribed opioids. Still, the increasing number of deaths from both causes is causing widespread alarm, and the CDC is striving to enact measures among legislators, prescribers, and consumers to curb the trend.
Clearly, the risk of an overdose is the most serious health risk associated with opioid use. However, there are a number of other risks associated with an Opioid Use Disorder, particularly when the user administers the drug intravenously. Endocharditis, a condition in which a bacterial infection lodges in one of the heart valves, poses a serious risk to the life of an opioid user. Still other bacterial and viral infections include Hepatitis and HIV/AIDS. Chronic constipation, sclerosed veins or "tracks," cellulitis, abscesses, and tuberculosis also pose a risk to the health of an opioid user.
Many Americans meet the diagnostic criteria for a substance use disorder or otherwise suffer the effects of their substance use during any given year. Additionally, the 2015 SAMHSA study showed that 41% of individuals who met the criteria for a substance use disorder also met the criteria for a mental disorder. Given the complications posed by co-occurring mental disorders and substance use disorders, it is essential for both disorders to be treated at the same time. This provides the affected individual with the best chance for long-term recovery from both conditions.