12.7 25.2 14.5 31.7 15.
- Includes tobacco, alcohol, illicit drugs and misuse of
controlled prescription drugs.
Source: CASA Columbia analysis of The National Survey on
Drug Use and Health(NSDUH), 2010.
Figure 1.A
Continuum of Substance Use
Percent of Population Age 12+
by Level of Substance Use*
Never
Used
No
Current
Use
Non-
Risky Use
Risky
Use
Addiction
While this report focuses primarily on those with
the disease of addiction, it makes an important
distinction between addiction and risky use of
addictive substances:
Those with the active disease of addiction*
are defined in this report as meeting the
clinical diagnostic criteria for past month
nicotine dependence or past year alcohol
and/or other drug abuse or dependence.
Individuals who meet diagnostic criteria for
addiction are targets for appropriate,
evidence-based clinical interventions by
physicians and other health professionals.
Addiction afflicts 15.9 percent of the U.S.
population ages 12 and older (40.3 million
people).^19
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
* Available data allow us to include only those who
meet behavioral criteria in accordance with the
diagnostic standards, meaning in most cases that their
disease is not currently being managed. Individuals
who have the disease of addiction but do not meet
diagnostic criteria for past month (nicotine) or past
year (alcohol and other drug) addiction are not
included.
† In the past 30 days.
Guidelines for safe alcohol use,‡ 20 misuse
controlled prescription drugs,§ use illicit
drugs** 21 or engage in some combination of
these forms of substance use but do not
meet clinical diagnostic criteria for
addiction. Risky use can result in
devastating and costly health and social
consequences including the disease of
addiction. Risky users are targets for public
health efforts aimed at reducing risky use
and for health professionals’ efforts to
prevent risky use from progressing to the
disease of addiction. Approximately one-
third (31.7 percent) of the U.S. population
ages 12 and older (80.4 million people) are
risky substance users.^22
‡ The U.S. Department of Agriculture Dietary
Guidelines for safe alcohol use are no more than one
drink a day for women, no more than two drinks a
day for men and no alcohol consumption for:
(1) persons under the age of 21; (2) pregnant women;
(3) individuals who cannot restrict their drinking to
moderate levels; (4) individuals taking prescription or
over-the-counter medications that can interact with
alcohol; (5) individuals with certain specific medical
conditions (e.g., liver disease, hypertriglyceridemia,
pancreatitis); and (6) individuals who plan to drive,
operate machinery, or take part in other activities that
require attention, skill or coordination or in situations
where impaired judgment could cause injury or death
(e.g., swimming). Due to data limitations, we were
unable to include categories 4-6 in our calculation of
risky drinkers.
§ For data analysis purposes, the national survey
examined for this report defines misuse of controlled
prescription medications more generally as “taking a
controlled prescription drug not prescribed for you or
taking it in a manner not prescribed for the
experience or feeling it causes.” The misuse of over-
the-counter medications also constitutes risky use;
however, rates of risky use in this report do not
include the misuse of these medications since they
are not directly measured in the national surveys that
were analyzed for this study.
** Substances controlled (either through prohibited or
restricted use) through the federal Controlled
Substances Act of 1970, which created a system for
classifying illicit and prescription drugs according to
their medical value and their potential for misuse. In
this analysis, illicit drugs include marijuana/hashish,
cocaine/crack, heroin, hallucinogens, Ecstasy,
methamphetamine and inhalants.
