Use of any addictive substance by pregnant
women, for whom there is no known safe
level of use.
Use of any tobacco product; there is no
known safe level of use of tobacco products.
Alcohol use in excess of the established
dietary guidelines for safe alcohol use of no
more than one drink per day for women and
two drinks per day for men, as described by
the U.S. Departments of Agriculture
(USDA) Dietary Guidelines.* 162 This
includes the non-mutually exclusive
categories of binge drinking,† heavy
drinking‡ and heavy binge drinking.§
Misuse (non-medical use) of controlled
prescription drugs and over-the-counter
medications**--i.e., using them for purposes
- The guidelines also stipulate 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). Although drinking alcohol, as described
in (4) through (6) is considered risky substance use,
estimates of rates of risky substance use in this report
do not include these criteria since they are not
directly measured in the national surveys that were
analyzed for this study.
† Consuming five or more drinks on the same
occasion (within a few hours) on at least one day in
the past 30 days.
‡ When a woman consumes more than three drinks on
a given day or more than seven drinks during a given
week or when a man consumes more than four drinks
on a given day or more than 14 drinks during a given
week.
§ Binge drinking on at least five occasions in the past
30 days.
** In accordance with 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.
not prescribed or intended such as to get
high, feel stimulated or sedated; taking more
of the substance than prescribed or
recommended; or taking the substance too
often or for a longer period of time than was
prescribed or recommended.†† 163 Use of non-prescribed federally controlled
(illegal/illicit drugs) drugs;‡‡ there is no
known safe level of use of these drugs.Addiction: A Medical Disease. At the end of
the continuum of substance use are those who
meet clinical criteria for addiction. Yet even
among these individuals, there is tremendous
variation in the severity and course of the
disease. At the extreme end of the continuum is†† 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 substance 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) by 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 the
analyses presented in this report, illicit drugs include
marijuana/hashish, cocaine/crack, heroin,
hallucinogens, Ecstasy, methamphetamine and
inhalants. (See Chapter III.)The public, and treatment sources alike, often are
confused as to the distinction among use, heavy
use and addictive disease.^164--Stuart Gitlow, MD, MPH, MBA
Executive Director
Annenberg Physician Training Program in
Addictive Disease
Associate Clinical Professor
Mount Sinai School of Medicine
Acting President & AMA Delegate
American Society of Addiction Medicine