Addiction Medicine: Closing the Gap between Science and Practice

substance use because of state laws that exclude
alcohol and other drug-related injuries from
medical insurance coverage.* 143

Risky alcohol use and addiction involving
alcohol are associated with neurological
problems including dementia, stroke and
neuropathy;^144 cardiovascular problems
including myocardial infarction,
cardiomyopathy, atrial fibrillation and
hypertension;^145 psychiatric problems including
depression, anxiety and suicide;^146 liver diseases
including hepatitis and cirrhosis;^147 and
gastrointestinal problems including pancreatitis
and gastritis.^148 Other associated conditions
include increased risk of cancer of the liver,
breast, mouth, throat, esophagus and colon,^149
and recent research suggests that risky alcohol
use may contribute to the physiological process
that causes cancer cells to metastasize.^150

Heavy alcohol use during pregnancy is
associated with miscarriage and stillbirth and is
one of the primary causes of severe mental and
developmental delays in infants.^151 Fetal alcohol
syndrome (FAS) is the leading known cause of
preventable mental retardation.^152

Illicit Drugs ..................................................................................................................

In 2008,† there were an estimated 16,044 deaths
attributed to the use of illicit drugs.^153 Of the
13,555 substance-related traffic fatalities in
2009, 5,938 involved drivers impaired either by
illicit drugs alone (3,146 deaths) or illicit drugs
in combination with alcohol (2,792 deaths).^154

In 2009, illicit drugs were involved in an
estimated 973,591 emergency department
visits;‡ accounting for 35.9 percent of substance-
related ED visits;^155 cocaine, marijuana and

• In 25 states, Uniform Accident and Sickness Policy

Provision Laws (UPPL) exclude alcohol and other
drug-related injuries from medical insurance
coverage, creating a barrier to conducting screening
for risky substance use (see Chapters IV and X).
† Most recent available data that distinguishes

between illicit and controlled prescription drugs.
‡ Measured in terms of patient visits, not individual

drug reports.

heroin were the most frequently mentioned illicit

drugs.^156

Injection drug use behavior--including sharing

needles and other injection paraphernalia--is

associated with the spread of HIV/AIDS.^157 It is

estimated that more than one-third of all AIDS-

related deaths in the U.S. have occurred among

illicit drug users and their sexual partners.^158

Morbidity (secondary illness) and mortality

(death) data related to illicit drug use may

represent the direct pathological effects or

medical toxicities from the drug (e.g., cocaine

producing seizures or strokes or inhalants

producing cardiac arrhythmias that can lead to

sudden cardiac deaths), but also the infections

transmitted via drug self-administration (e.g.,

intravenous or intramuscular self-

administration).^159

Marijuana use is associated with sexually

transmitted disease due to unsafe sexual

behaviors engaged in while under the influence

of the drug, bronchitis and lung cancer; cocaine

use is associated with pancreatitis; heroin use is

associated with hepatitis and tuberculosis;

hallucinogen use is associated with tinnitus and

sexually transmitted disease; and inhalant use is

associated with HIV/AIDS, sexually transmitted

disease, tuberculosis, bronchitis, asthma,

sinusitis and tinnitus.§ 160

Illicit drug use also is linked to mental health

problems. Marijuana use is associated with the

onset of psychotic disorders, particularly in

individuals with an underlying vulnerability to

the illness;^161 several longitudinal studies have

linked marijuana use with the subsequent onset

of schizophrenia, and case studies have linked

synthetic cannabinoids with psychosis.^162

Marijuana and inhalant use are associated with

§ These health consequences are associated primarily

with long-term use of illicit drugs. The analyses

adjusted for potentially confounding factors such as

the duration of controlled prescription drug misuse,

alcohol use, tobacco use, daily cigarette smoking

history and demographic variables (age, gender,

race/ethnicity, educational attainment, health

insurance status and family income).