Many people are confused about substance use and misuse. While many adults legally use alcohol, tobacco, and in some places marijuana, even a small amount of use can lead to issues.The US Surgeon General has released a report entitled Facing Addiction in America. This report has been compared to the 1964 Surgeon General’s report on tobacco, in the breadth and depth of discussion on the topics. The report begins with a discussion about substance misuse.

Substance Misuse

Substance misuse is a very serious problem in the United States. Alcohol and other drug (AOD) misuse and related substance use disorders affect millions of Americans and cost our country a great deal. Despite evidence of harm, people continue to be affected by misuse.

Substance misuse is the use of alcohol or drugs in a manner, situation, amount, or frequency that could cause harm to the user or to those around them.

Facing Addiction in America, Chapter 1

Some of the effects (direct and indirect) of substance misuse include:

• compromised physical health
• mental health issues
• increased spread of infectious diseases (including HIV/AIDS)
• loss of productivity
• reduced quality of life
• increased crime and violence
• increased motor vehicle crashes
• abuse and neglect of children
• increased health care costs

Misuse Affects Many People

Many people are surprised to find out that binge drinking is defined as 4-5 drinks in 2 hours. More than 38 million U.S. adults report binge drinking an average of four times per month and consume an average of eight drinks per occurrence. In 2014, there were 47,055 drug overdose deaths. 28,647 of those deaths were from an overdose of some type of opioid.

Economic Consequences

AOD misuse and Substance Use Disorders (SUDs) cost more than $400 billion each year in increased crime, health problems, and lost productivity. Alcohol misuse and alcohol use disorders cost an estimated $245 billion each year in the United States in lost productivity, health care expenses, law enforcement, and other criminal justice costs. The costs associated with drug use disorders and use of illegal drugs and non-prescribed medications were estimated at $193 billion in 2007.

These costs can be compared to those associated with other serious health problems like diabetes, which is estimated to cost $245 billion each year and affects 29.1 million Americans.

A Public Health Model

The surgeon general’s report suggests using a public health model for addressing substance misuse and related consequences. The US currently and primarily uses a criminal justice model for dealing with substance misuse and abuse. A public health systems approach to substance misuse and its consequences, including substance use disorders, aims to:

• Define the problem through the systematic collection of data exploring the scope, characteristics, and consequences of the issue
• Identify the factors that are likely to lead to more or less risk of substance misuse
• Determine those factors that can be changed through interventions
• Work across sectors to develop and test these interventions (specifically those that address social, environmental, or economic factors of substance misuse and related health consequences)
• Support widespread implementation of effective strategies for prevention and treatment and recovery supports in a wide range of settings
• Monitor the impact of these strategies to determine effectiveness