Addiction Medicine: Closing the Gap between Science and Practice

12.7 25.2 14.5 31.7 15.9

• 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 3.A

Continuum of Substance Use

Percent of Population Age 12+

by Level of Sustance Use*

Never
Used

No

Current

Use

Non-

Risky Use

Risky

Use

Addiction

consequences including crime, lost productivity,

child neglect and abuse, family dysfunction and

developmental disabilities.

Certain populations--including pregnant women,

adolescents and young adults and the elderly--

are more vulnerable to the damaging effects of

addictive substances. Other populations--

including those with co-occurring disorders,

members of the military exposed to combat and

those in the justice system--are more likely to

engage in risky use or have addiction.

Defining the Problem .........................................................................................................

Substance use can be understood as a continuum

ranging from having never smoked or used

alcohol or another drug* at one end to having an

unmanaged chronic, relapsing disease† at the

other. (Figure 3.A)

Most people (87.3 percent) ages 12 and older in

the U.S. have used one or more addictive

* Including any use of illicit drugs or the misuse of

controlled prescription drugs.

† This continuum focuses on substance use; the

category labeled addiction includes those individuals

whose substance use meets current clinical criteria

for this disease but does not include all individuals

with addiction. There are some individuals with the

disease of addiction who do not currently use any

addictive substances and others who currently may fit

into other use categories along the continuum.

substances at some point in their lives, and 62.1

percent are current users.‡ 7 Those who have

never used an addictive substance, are not

current users§ or do not engage in risky

substance use are appropriate targets for public

health efforts aimed at preventing risky use and

addiction; however, these individuals are not the

focus of this report.

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 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.

 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,** 8

‡ Current substance use among the entire U.S.

population ages 12 and older: 51.7 percent drink

alcohol; 27.6 percent use tobacco products; 7.5

percent use illicit drugs; and 2.8 percent misuse

controlled prescription drugs.

§ Having used the substance in the past 30 days.

** 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.