This Report reviews what we know about substance use and health and how we can use that knowledge to address substance misuse and related health consequences. First, a general Introduction and Overview of the Report (PDF | 1.5 MB) describes the extent of the substance use problem in the United States. Then it lays a foundation for readers by explaining what happens in the brain of a person with an addiction to these substances. Chapter 2 - The Neurobiology of Substance Use, Misuse, and Addiction (PDF | 6.0 MB) describes the three main circuits in the brain involved in addiction, and how substance use can “hijack” the normal function of these circuits. Understanding this transformation in the brain is critical to understanding why addiction is a health condition, not a moral failing or character flaw.
Few would disagree with the notion that preventing substance use disorders from developing in the first place is ideal. Prevention programs and policies are available that have been proven to do just that. Chapter 3 - Prevention Programs and Policies (PDF | 1.5 MB) describes a range of programs focused on preventing substance misuse including universal prevention programs that target the whole community as well as programs that are tailored to high-risk populations. It also describes population-level policies that are effective for reducing underage drinking, drinking and driving, spread of infectious disease, and other consequences of alcohol and drug misuse.
If a person does develop a substance use disorder, treatment is critical. Substance use disorders share some important characteristics with other chronic illnesses, like diabetes. Both are chronic conditions that can be effectively managed with medications and other treatments that focus on behavior and lifestyle. Chapter 4 - Early Intervention, Treatment, and Management of Substance Use Disorders (PDF | 629 KB) describes the clinical activities that are used to identify people who have a substance use disorder and engage them in treatment. It also describes the range of medications and behavioral treatments that can help people successfully address their substance use disorder.
As with other chronic conditions, people with substance use disorders need support through the long and often difficult process of returning to a healthy and productive life. Chapter 5 - Recovery: The Many Paths to Wellness (PDF | 335 KB) describes the growing array of services and systems that provide this essential function and the many pathways that make recovery possible.
Responsive and coordinated systems are needed to provide prevention, treatment, and recovery services. Traditionally, general health care and substance use disorder treatment have been provided through distinct and separate systems, but that is now changing. Chapter 6 - Health Care Systems and Substance Use Disorders (PDF | 1.3 MB) explains why integrating general health care and substance use services can result in better outcomes and describes policies and activities underway to achieve that goal. The final chapter, Chapter 7 - Vision for the Future: A Public Health Approach (PDF | 255 KB), provides concrete recommendations on how to reduce substance misuse and related harms in communities across the United States.
The following sections provide more detailed summaries of each of the chapters in the Report.