Chapter I
Introduction and Executive Summary
A large and growing body of scientific research
has demonstrated clearly that addiction
involving nicotine, alcohol, illicit drugs and
controlled prescription drugs* is a complex brain
disease.^1 It affects 15.9 percent of the United
States population ages 12 and older (40.
million)† 2 --more than the share of the
population with heart disease,‡ diabetes or
cancer.^3 Another 31.7 percent of the population
(80.4 million), while not addicted, engages in
risky use§ of addictive substances in ways thatthreaten health and safety.^4
* In this report, we have used the general term
addiction to apply to those who meet criteria for past-
month nicotine dependence based on the Nicotine
Dependence Syndrome Scale (NDSS) and those who
meet diagnostic criteria for past year alcohol and/or
other drug abuse or dependence (excluding nicotine)
in accordance with the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV). (The DSM,
the most widely accepted diagnostic system in the
U.S. for such conditions, refers to substance abuse
and substance dependence collectively as substance
use disorders. The diagnostic criteria for nicotine
dependence in the NDSS parallel those of the DSM-
IV). This definition is consistent with the current
move to combine abuse and dependence into an
overarching diagnosis of addiction in the upcoming
DSM-V. The term addiction also has been used in
reference to compulsive behaviors involving eating,
gambling and other activities that affect the brain’s
reward system and which may develop independent
of or in combination with other manifestations of
addiction. This report, however, focuses only on
addiction involving nicotine, alcohol and other drugs.
† This estimate excludes the institutionalized
population, for which rates of addiction are higher.
‡ Includes coronary heart disease, angina pectoris,
heart attack or any other heart condition or disease,
excluding hypertension and stroke.
§ Risky users of addictive substances are defined in
this report as those who currently use tobacco
products, exceed the U.S. Department of Agriculture
(USDA) Dietary Guidelines for safe alcohol use,
misuse controlled prescription drugs, use illicit drugs,
or engage in some combination of these forms of
substance use, but do not meet clinical diagnostic
criteria for addiction. (See page 5.)