Concepts of Chemical Dependency

• Why Worry about Recreational Chemical Use In the U.S.

The abuse of drugs and alcohol is intermixed with every other problem
society faces today. The challenge of finding effective health care has
been compounded by alcohol and drugs
• Approximately 21% of patients admitted to a hospital Intensive Care
Unit are there because of alcohol use.
• The medical treatment of alcoholism and drug addiction, in
combination with the various psychiatric consequences of these
disorders, accounts for up to 60% of hospital usage in the United
States.
Why Worry?
• Either directly or indirectly, substance abuse is the most
common “disease” encountered by the modern physician, but
often not recognized.
• The abuse of illicit drugs is a major cause of ischemic stroke in
adults, increasing the individual’s risk of such and event.
• The most common cause of psychotic conditions in young
adults is alcohol/drug abuse.
• Alcohol use is a known risk factor in suicide attempts. (In one
study, 62% of suicide attempters were found to have
consumed alcohol prior to their suicide attempt.
Why Worry?
• Suicide is 30 times as common among alcoholics as among
the general population. In one study, 33% of completed
suicides were found to have alcohol in their bodies.
• Suicide is the cause of death in 35% of all intravenous drug
abusers.
• Fully 56% of all assaults are alcohol-related, and 60% of men
with a history of domestic assault are intoxicated on alcohol
when they attack their partner.
Why Worry?
• Substance abuse disorders are involved in 89% of
substantiated cases of child abuse involving a child under the
age of 12 months.
• There is a known relationship between substance abuse and
homicide. Researchers have found that there is 28-fold of a
woman’s chances of being murdered by a significant other,
even when she herself was not using drugs. Alcohol alone is
implicated in half of all homicides committed in the United
States.
Why Worry..
• The role of alcohol/drugs in victimization has been
underscored in many studies. Sexual abuse of both men and
woman have been documented.
Who “Treats” Those Who Abuse or are
Addicted to Chemicals
• Physicians most often fail to attribute the causes of illnesses
in their patients to the use of drugs/alcohol. Very few
medical schools or residency programs have an adequate
required course in addictions, and most physicians fail to
screen for alcohol or drug dependence during routine exams.
• In spite of the known relationship between alcohol use and
traumatic injury, almost three-quarters of the trauma centers
reviewed do not screen for alcohol abuse/addiction.
Treatment..
• Many physicians continue to feel that illicit drug use to
untreatable. Only 40% of general practice physicians are
motivated to work with the alcoholic patient.
• Nurses, psychologists and relationship counselors have
similar problems dealing with the chemically dependent
person and their family. Therapy continues in a very
haphazard fashion when a substance abuse problem is not
acknowledged or uncovered. Vital clues to the very real
illness within the family are missed; treatment is ineffective.
Scope of the Problem
• 1. People tend to hide evidence that they abuse recreational
chemicals. Because the typical abusers are not poor and
have full time jobs it is difficult for researchers or the general
public to comprehend the trends of abuse as it evolves.
• 2. The news media often concentrates on “breaking news”,
and not long-term problems.
• 3. Often scientists might reach different conclusions
regarding the problem, based on the sample they are
reviewing.
Scope of the Problem
• Finally, the public has been increasingly skeptical, convinced
that many problems outlined in the media are just “fake
news” items.
• At least half of the world’s population has used at least one
psychoactive substance at least once with alcohol being the
most commonly used psychoactive chemical. However, only
about 200 million people, or about 5% of the entire
population of the world, has abused an illicit substance.
Scope
• Illicit drug use might be considered an “American way of
life”. Sixteen percent of the entire population over the age of
12 is addicted to nicotine, alcohol, or illegal drugs. This figure
is deceptive however since it is possible for a person who is
addicted to nicotine to be addicted to another compound
such as alcohol. With just 5% of the world’s total population
the United States consumes 60% of the illicit drugs
produced. Each day in the U.S. 8,000 people try an illicit drug
for the first time.
Scope
• Many of these individual probably only experiment with illicit
drugs out of curiosity for less then 12 months and then
discontinue or curtail further use. The most commonly used illicit
substance is marijuana with 75.5% of illicit drug abusers using
only marijuana. This figure still means that 8.6 million people
over the age of 12 abused an illicit drug other than marijuana
proceeding the survey. Research studies reveal that waste water
from both rural and urban areas contained measurable amounts
of cocaine and methamphetamine metabolites, underscoring the
widespread abuse of these compounds in this country.
Substance Use Disorders
• The majority of those who use a psychoactive substance do so on
a short-term experimental basis and rarely present problems to
society seen in cases of substance addiction. Addiction develops
only in a minority of persons who abuse a compound(s). However
a thriving “black market” has evolved to meet the demand for
illicit drugs created by the curious user, the infrequent abuser,
the heavy abuser, or the person who is addicted to a chemical(s).
The worldwide illicit drug trade is estimated to be an $800
billion/year industry, making it larger than the annual gross
domestic product of 90% of the world’s countries.
Alcohol Use, Abuse and Addiction
• An estimated 119 million people in the U.S. ingest alcohol at
least once each year. Between 8 and 16 million persons will
become physically dependent and 5.6 million are believed to
abuse it on a regular basis. This underestimate the total
number of persons with an alcohol use disorder, since many
are high functioning, and are able to hide this fact from
friends, family, and coworkers for decades. Ten percent of
drinkers consume 60% of the alcohol consumed in the United
States, whereas the top 30% of drinkers consume 90% of the
alcohol consumed in this country.
Alcohol Use, Use and Addiction.
• If the persons drinking has resulted in their suffering, social,
physical, emotional, or vocational consequences, then it is
said that they have a AUD (alcohol use disorder). The
majority of those who do develop an AUD are men by a ratio
of 2-3 to every woman. This underscores the danger of
alcohol use and abuse in spite of its legal status as a socially
acceptable recreational compound for adults.
Opiate Abuse and Addiction
• Current estimates indicate that 3million people have abused
heroin at some point in their lives and that there are
between 810,000 and 1 million people currently dependent
on it. The states with the largest number of opioid abusers
are thought to be California, New York, Massachusetts and
New Jersey; although heroin use disorders are found in every
state. In the U.S. is a growing number of people who are
addicted to prescription narcotic analgesics either prescribed
for the user or obtained from illicit sources. An estimated 33
million person have used a narcotic analgesic not prescribed
to them at some point in their lives.
Estimates of the Problem of Stimulant
Abusers and Addiction
• Globally, the problem of central nervous system (CNS)
stimulant abuse has apparently reached a plateau with
approximately 25 million people around the world abusing a
CNS stimulant at least once each year. In North America, the
demand for the most potent of the CNS stimulants, the
amphetamines (especially methamphetamine), has been
stable, with about 3.8 million people in North America
abusing these compounds at least once each year. Much of
the methamphetamine in the U.S. enters the country from
other countries, although there are still “local” labs.
Estimates of the Problem of Cocaine Abuse
and Addiction
• The number of cocaine abusers/addicts has remained
relatively stable around the globe over the past decade. 14
million people are cocaine abusers or addicts, most living in
living in north America. In the U.S. there are perhaps 2.5
million people who are addicted to cocaine; an unknown
number who have tried it, or abused it in their life time. The
true scope of the problem is confused by the fact that
researchers estimate that only 2-3% of people who abuse
will become addicted.
Marijuana Use, Abuse and Addiction
• Estimated 160 million people have used marijuana in the last
month. Just under 30 million in North America are current
users. 25% of the entire population in the U.S. is thought to
have abused marijuana at least once with 3million people
being addicted.
Hallucinogen Abuse
• Researchers question if one can be addicted to hallucinogens, but it is
thought that perhaps 10% of the population have abused at least
once in the U.S. It is estimated that 1.1 million people in the U.S. have
abused and hallucinogenic compound in the last month.
Tobacco
• Legal but destructive and addictive. 20.8% of the entire
population of the U.S. smoke cigarettes; 25% are former
smokers and 50% have never smoked.
The Cost…
• Drug use disorders are the sixth leading cause of disease in
adults in the world. Illicit drug use costs the global economy
$800 billion/year, with AUDs costing the world economy
another $880 billion/year. In the U.S., the alcohol and drug
use disorders are thought to drain at least 375 billion/year
from the economy. The annual toll from the various diseases
associated with illicit drug use in the United States, combined
with the number of drug related infant deaths, suicides,
homicides, and motor vehicle accidents, is estimated at
12,000-17,000 people a year.
Cost….
• 440,000 persons are thought to die each year from smoking
related illnesses brought on by their own tobacco use, and an
additional 35,000 to 56,000 persons each year in the United
States who die from the effect of second hand or
environmental tobacco smoke. 100,000 people die each year
in the Untied States as a direct result of the individual alcohol
use. The alcohol use disorders contribute to or exacerbate 60
disorders. If one was to include all the “indirect” alcohol-
related deaths, it becomes clear that alcohol indirectly or
directly causes as many deaths in the U.S.as tobacco.
Cost of Alcohol Use/Abuse/Addiction
• Globally, alcohol use is thought to be a direct factor in 10-
11% of all deaths each year. In the U.S., alcohol dependence
ranks third as the most common cause of preventable death.
• The annual economic impact of alcohol/abuse/addiction in
the U.S. is thought to be at least $185 billion/year, of which
$26 billion is for direct health care costs, and 37 billion as a
result of lost productivity brought on by alcohol-related
premature deaths. The alcohol use disorders cost every man,
woman and child in the U.S. in the U.S. $638 per year.
The Cost…
• It has been estimated that the complications brought on by the
use of alcohol can account for 15-25% of the annual total
expenditure for health care each year in the U.S. Although only
5-10% of the population of this country has an AUD, they
consume a disproportionate amount of the yearly health care
cost; 15-30% of those individuals in nursing homes are thought
to be there either as a direct or indirect result of their AUD.
Alcohol is thought to be involved in approximately 40% of all
motor vehicle accidents and 40-60% of all traumatic injury cases
involve patient with an SUD. Alcohol abuse and motor accidents
cost $24/7 billion a year.
Costs….Tobacco
• Globally, more than 3 million people/year die around the
world as a direct result of their use of tobacco
products;442,000 live in the U.S. Economic cost in the U.S.
alone is $157 billion. One of every five deaths can be traced
to smoking related illness in the U.S., not counting exposure
second-hand smoke.
Costs… Substance Use Disorders
• Cost of premature death and illness, lost wages, financial
losses by victims of substance-related crime, who were hurt
by others combined with the cost of law enforcement
activities directly aimed at the problem of SUDs, illicit
substance use costs at least $900 for every person over 18yrs
old in the U.S. each year. When the cost of disability,
accidental injuries, health care and absenteeism from work
are added together, the total economic impact of SUDs on the
U.S. economy each year is estimated to be $428 billion dollars.
Costs…
• Average cost of hospitalization of alcohol abusers was 120%
higher than non-abusers. Opioid abusers 482% higher than
non-users.
Who Treats
• Various government spend only 4cents of every dollar on
programs devoted to the treatment or prevention for
persons with SUD. Most health care professionals are under
trained and ill prepared to work with substance abusers.
• Marriage therapists and psychologists have little background
in the area of substance abuse treatment. Professional abuse
substance counselors make up a small percentage of the
number of health care workers generally who will work with
this population.