Addiction Medicine: Closing the Gap between Science and Practice

Chapter III

Prevalence and Consequences

More than one in seven (15.9 percent, 40.3

million) people in the United States ages 12 and

older currently meet clinical criteria for

addiction* 1 --more than the share of the

population with cancer, diabetes or heart

disease.† 2 An additional but unknown number

of people have the disease but are managing it

effectively and so do not meet these behavioral

criteria.‡ 3 Another third of the population (31.7

percent, 80.4 million), while not addicted,

currently§ use one or more addictive substances

in ways that threaten their own health and safety

or the health and safety of others.^4

Risky substance use and addiction are the largest

preventable and most costly public health and

medical problems in the U.S.^5 Together they are

the leading causes of preventable death and

cause or contribute to more than 70 other

conditions requiring medical care.^6 The

damaging effects of risky substance use and

addiction extend to a wide range of costly social

* Defined as meeting criteria for past-month nicotine

dependence based on the Nicotine Dependence

Syndrome Scale (NDSS) and meeting 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 refers to substance

abuse and substance dependence collectively as

substance use disorders. The criteria for nicotine

dependence in the NDSS parallel those of the DSM-

IV.) 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.

‡ There are no national data on the proportion of the

population that has been diagnosed with addiction

and is effectively managing the disease. Existing

national survey data indicate that 10 percent of adults

ages 18 and older report that they “once had a

problem with drugs or alcohol but no longer do”

(sometimes referred to as “sustained recovery”), but

it is not clear what proportion of this group ever was

diagnosed with addiction as distinguished from

“having a problem.”

§ In the past 30 days.