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Chapter 2: Epidemiology of Substance Use and Abuse
At the conclusion of the chapter, students will be able to:
1. Outline the overarching goals of healthy people 2020
2. Explain the public health significance of substance use and abuse.
3. Define the goal of Healthy People 2020 with regard to substance use and abuse.
4. Describe the physical and mental health and social and legal consequences of driving under the influences.
5. Describe the trends in the consumption of major substances of abuse by America’s youth.
Traditionally, the health care system is mainly concerned with medical or surgical treatment of diseases. However, over the years, the Surgeon General has increasingly placed priority on public health issues, including preventive medicine, and health education/health promotion. The year 1979 marked a milestone in the history of US public health. This was the year the Surgeon General issued a landmark report on disease prevention and health promotion. The report was a culmination of the U.S. Federal Government’s Healthy People Initiative.1 Healthy People Initiative was a program of nationwide health promotion and disease prevention goals set by US Department of Health and Human Services (DHHS). The goals of Healthy People have been updated in the years 2000, 2010, and 2020.. The vision of Healthy People 2020 is to have a society in which all people live long, healthy lives. The framework for the upcoming Health People 2030 states the following overarching goals.2, 3
Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death.
Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.
Create social, physical, and economic environments that promote attaining full potential for health and well-being for all.
Promote healthy development, healthy behaviors, and well-being across all life stages.
Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.2
The DHHS has set the goal of reducing substance abuse to protect the health, safety, and quality of life for all people, especially children. A great deal of information needs to be gathered continuously and/or periodically to understand the state of health, and the trend in morbidity and mortality related to substance use and abuse so that appropriate preventive, treatment, care and interventions for recovery from addiction can be planned and implemented. For example, the National Survey on Drug Use and Health4, a comprehensive household survey of substance use, substance use disorders, mental health, and use of mental health and substance abuse treatment services, report key findings about the state of substance use and mental health issues in the US. Here are some of the key findings:
There was a significant reduction in prescription opioid misuse across all age groups
Heroin use declined overall from 2016-2018 and especially in ages 18-25
The total number of individuals with opioid use disorder decreased from 2.1M in 2017 to 2.0M in 2018
Use of medication-assisted treatment increased
Past month substance use among pregnant women decreased compared to 2017. However, there was an overall increase over the prior 3 years, particularly with use of marijuana
Marijuana use among young people increased year-over-year
Prevalence of marijuana use disorder in 18-25-year-old persons increased from 5.1% in 2015 to 5.9% in 2018
There was a significant increase in methamphetamine use among adults > 26 years old
Serious mental illness is rising among adolescents and adults
These estimates highlight the importance of the continuing need to address the rising rates of marijuana and methamphetamine use in adults. Equally important is the declining mental health in adolescents. The need for increasing prevention efforts and improving access to treatment for substance abuse and co-morbid disorders is an important public health priority.4
Why is Drug Abuse and Addiction Important?
Drug abuse has been defined as the “persistent or sporadic excessive use of a drug inconsistent with or unrelated to acceptable medical practice." 5
Substance-related and addictive disorders in America results in
More deaths and hospitalizations than any other public health threat (Mortality/Morbidity)
More incarceration and criminal justice intervention
Greater financial costs than all other expenses.
In any case, addiction is the most preventable of chronic medical disorders. Annually, 480,000 US deaths are caused by nicotine use. Excessive alcohol consumption causes 130,000 deaths annually. Illicit Drugs (heroin, cocaine, methamphetamine, Ecstasy etc.) cause 20,000, whereas prescription Drugs (opioids, benzos, antidepressants, sedatives, etc. cause 36,000 - 38,000 per year. Thus addiction and abuse of drugs result in some 668,000 deaths per year, 94% of which is from legal drugs.
Substance abuse and addiction have a major impact on individuals, families, and communities. The effects of substance abuse are cumulative, contributing to costly social, physical, mental, and public health consequences.2 These include teenage pregnancy, miscarriage, premature birth; Hepatitis C, HIV/AIDS, and other infectious diseases; intimate partner violence; adverse childhood experiences; injury and death from motor vehicle accidents; and mental health consequences, including depression and suicide. Survey findings indicate that past year use of illicit drugs among 12th graders remained steady at 38% , whereas illicit drugs not including marijuana was 11.5%. 6
Chapter Review and Discussion Questions
Outline the overarching goals of Healthy People 2020.
Describe the morbidity and mortality associated with drug abuse.
Define drug abuse and describe the social, physical, mental, and public health consequences of drug abuse.
Why is the impact of drug abuse especially important in the youth?