Module 1: Putting Drugs of Abuse and Clients in Perspective Chapter 1: Why Worry About Substance Abuse?

Ongoing Issues Substance use disorders are collectively still the most prevalent mental health problem facing the United States Approximately 25% of patients seen by primary care physicians have an alcohol or drug problem. Excessive alcohol use was a factor in 50% of all deaths from acute traumatic injuries.

Ongoing issues Approximately 25 percent of those individuals on Medicaid have a substance use disorder. As this group ages, their medical costs increases at a higher rate than for age matched individuals without a SUD. Substance abuse is the number one cause of preventable death in the United States, killing more people each year than any other preventable cause of death.

Ongoing Issues Alcohol use disorders are the third leading cause of premature death in the United States. Tobacco use is the leading cause of premature death in this country. Alcohol dependence is the second most common psychiatric disorder in the United States. Between 40% and 60% of those who commit suicide were intoxicated at the time.

Significant contributing Factors Approximately 10% of those individuals with a substance use disorder eventually commit suicide. Alcohol or illicit drug abuse is a factor in 50% - 75% of all psychiatric admissions. Adults with a substance use disorder were 2.7 times as likely to report having engaged in the physical abuse of a child and 4.2 times as likely to report child neglect as non-using control substance.

Significant contributing factors 50% of perpetrators of violent crimes in the US were using alcohol at the time of offense. Illicit drug use in home increase a woman’s chances of being murdered by a significant other by 28-fold even if she was not herself using drugs. Globally, about 200 million people (5% of the world’s population) have abused illicit substance at least once.

The scope of the problem The retail cost is estimated at $800 billion (a figure larger than the gross domestic product figures of 90% of the world’s countries). Although the population of the USA makes up under 5% of the world’s population, we consume 60% of the world’s illicit drugs.

Alcohol Use in the USA Alcohol is the most popular licit psychoactive drug after caffeine. Its estimated that there are 119 million alcohol users: Between 8 to 16 million drinkers are physically dependent 5.6 million abuse it on a regular basis For most people alcohol will not become a problem. Majority of alcohol use disorders in the USA are male in a ratio of between 2:1 and 3:1. Drinking by men is a stronger predictor of intimate partner violence (IPV) than drinking by women.

Alcohol Costs Thought to be a direct factor in 10-11% of all deaths each year. Cost financially at least $185 billion a year. 15-30% of those in nursing homes are there as a direct or indirect result of an alcohol use disorder

Opioids/Narcotics Globally around 15.6 million people abuse or are addicted to heroin. In the USA, approximately 3 million have used heroin at some point. Cost to our society exceed $21 billion annually. Fully 76% of illicit users are employed. Narcotics include a wide range of drugs including: opium, heroin, morphine, hydromorphone, methadone, fentanyl, codeine, and oxycodone just to name a few.

Central Nervous System Stimulants Globally estimated 14 million people abuse or are addicted to cocaine. 2.5 million cocaine addicts in the United States. Cocaine accounts for twice as many emergency room visits as heroin. The most common drug used to treat ADHD is a highly addictive amphetamine. Methamphetamines are the fastest growing illicit drug used in the U.S.

Marijuana Most commonly abused illicit drug in the United States and Canada. 25% of the entire population of the US (70 million) have abused marijuana at least once. Of this, approximately 3 million are addicted. 20% of high school seniors report abusing marijuana in the past thirty days. The federal government grows marijuana on a well-guard farm in Mississippi.

Hallucinogenic 10% of the entire population of the United States has abused hallucinogens at least once. Over 6,000 plants are capable of altering consciousness some are still used in spirit quests. LSD waxes and wanes in popularity. PCP and Ketamine are pharmaceutically animal tranquilizers. Ecstasy has been linked to long-term changes in brain chemistry.

Tobacco 25% of Americans are current smokers 25% of Americans are former smokers 50% of Americans never smoked Globally more than 3 million people a year die as a direct result of their tobacco consumption. Tobacco-related illness in the US accounts for 60% or more of the annual expenditure for health care

Who Treats a Person with a SUD? Physicians have a negative view of those with an SUD because of their training. They don’t screen well for SUD in their patients. Nurses are also ill prepared to work with SUD patients Marriage and Family Therapists see some but it is rarely disclosed

Who Treats a Person with a SUD? “Most clinical psychologists are not well prepared to deal with issues involving substance use or abuse” . Most rated their graduate school training as “inadequate” in this area. The front line workers in drug and alcohol programs are often the least trained and most highly overworked counseling professionals.