Addiction and risky use constitute the largest
preventable and most costly health problems
facing the U.S. today.^5 It is estimated that more
than 20 percent of deaths in the U.S. are
attributable to tobacco, alcohol and other drug
use.^6 Addiction and risky use cause or
contribute to more than 70 other conditions
requiring medical care, including cancer,
respiratory disease, cardiovascular disease,
HIV/AIDS, pregnancy complications, cirrhosis,
ulcers and trauma.^7 They also drive and
contribute to a wide range of costly social
consequences, including crime, accidents,
suicide, child neglect and abuse, family
dysfunction, unplanned pregnancies and lost
productivity.^8 Costs of addiction and risky
substance use to government alone total at least
$468 billion each year.^9
While both addiction and risky use of addictive
substances contribute to these consequences,
they are very different conditions. Addiction is
a disease and, like other diseases, it can and
should be diagnosed and treated in the context of
the medical system,* using available evidence-
based practices. Risky use of addictive
substances is a public health problem and tools
are available for a wide range of professionals in
the health, social services, education, criminal
justice and other sectors to screen for it and
intervene to reduce it and its consequences,
including the potential development of
addiction.
Despite the prevalence of these conditions, the
enormity of the consequences that result from
them and the availability of effective solutions,
screening and early intervention for risky
substance use is rare and the vast majority of
people in need of addiction treatment do not
receive anything that approximates evidence-
based care. Nine out of 10 people (89.1 percent)
who meet diagnostic criteria for addiction
- Involving interdisciplinary teams of physicians (of
multiple medical specialties and subspecialties),
nurses, physician assistants, nurses and nurse
practitioners and graduate-level clinical mental health
professionals (psychologists, social workers,
counselors), working collaboratively with auxiliary
and support personnel.
involving alcohol and drugs other than nicotine
report receiving no treatment† at all;^10 as a
society, we do not even collect information on
the number of people receiving treatment for
addiction involving nicotine. There is no other
disease that affects so many people, has such
far-reaching consequences and for which there is
such a broad range of effective interventions and
treatments that is as neglected as the disease of
addiction.This report documents the significant body of
evidence defining and describing the disease of
addiction and the risky use of addictive
substances. It reveals the size and shape of the
populations in need of screening, intervention
and treatment. It reviews the evidence of
effective screening, intervention, diagnostic,
treatment and disease management tools and
therapies. It outlines the consequences and costs
of our failure to prevent risky substance use and
treat addiction effectively. Finally, it examines
the profound gaps between those who need
treatment and those who receive it, and between
the services they receive and what constitutes
quality care.Key factors driving these gaps include: Inadequate Integration of Addiction Care
into Mainstream Medical Practice:
Addiction prevention and treatment are for
the most part removed from routine medical
practice.^11 In spite of the fact that about 80
percent of Americans‡ visited at least one
physician or other health care professional in† Treatment is defined in this report as psychosocial
and pharmaceutical therapies. Detoxification, mutual
support programs, peer counseling, other support
services (including religious-based counseling) and
services received in an emergency department are
excluded from the definition. Services provided in
prison or jail settings also are excluded since they
cannot be identified in the data sources used for this
analysis; furthermore, in CASA Columbia’s 2010
report (Behind Bars Update: Substance Abuse and
America’s Prison Population), more than 70 percent
of those receiving addiction-related services in
prisons and jails received support services rather than
any form of professional treatment.
‡ Ages 18 and older.