Alcohol and drug misuse can have a wide range of effects; a single instance of alcohol or drug misuse can have profound negative consequences. The specific effects associated with substance misuse depend on the substances used, how much and how often they are used, how they are taken (e.g., orally vs. injected), and other factors. Some of these effects include:
- Immediate, direct consequences: Substance misuse can have immediate, direct consequences for health ranging from effects on heart rate and regulation of body temperature to psychotic episodes, overdose, and death. Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents.4 The opioid crisis is fueling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014.5 An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine, or non-opioid prescription drugs.6-8
- Indirect consequences related to risky behaviors that often accompany alcohol and drug misuse: Alcohol and drug misuse can impair judgment, leading to risky behaviors including driving under the influence (DUI), unprotected sex, and needle/syringe sharing. Driving under the influence of alcohol or drugs contributes to thousands of deaths annually, and 10.6 percent of drivers report engaging in this hazardous behavior each year.1 As misuse of some drugs such as prescription opioids progresses, many people seek to intensify the high by injecting them, and sharing of needles among users can result in outbreaks of HIV and hepatitis.
- Longer-term health effects on a person’s physical and mental health: For example, heavy drinkingii can lead to hypertension, liver disease, and cancer; regular marijuana use is associated with chronic bronchitis; and use of stimulants such as cocaine can lead to heart disease.11-13 In addition, substance misuse during pregnancy can result in long lasting health effects for the baby including fetal alcohol spectrum disorders (FASDs), which are estimated to affect as many as 2 to 5 percent of the population,14,15 and neonatal abstinence syndrome (NAS); the ongoing opioid crisis has resulted in a five-fold increase in the number of babies who are dependent on opioids at birth.14
- Longer-term societal consequences: These can include reduced productivity, higher health care costs, unintended pregnancies, spread of infectious disease, drug-related crime, interpersonal violence, stress within families, and many other direct and indirect effects on communities, the economy, and society as a whole.
Some of these consequences result from substance use disorders, which occur when a person uses alcohol or drugs to such an extent that it causes clinically significant impairments in health, social functioning, and voluntary control over substance useiii. The majority of individuals who misuse substances do not develop a substance use disorder. However, roughly one in seven people in the United States (14.6 percent of the population) are expected to develop a substance use disorder at some point in their lives.15 A substance use disorder can be diagnosed as mild, moderate, or severe depending on the extent of a person’s symptoms. In this Report, addiction is used to refer to substance use disorders that can be categorized as severe and are associated with compulsive or uncontrolled use of one or more substances. Addiction is a chronic brain disease that, like milder substance use disorders, has the potential for both recurrence and recovery.
In 2015, substance use disorders affected 20.8 million Americans—almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes,16 and more than 1.5 times the annual prevalence of all cancers combined (14 million).17 Of the 20.8 million people with a substance use disorder in 2015, 15.7 million were in need of treatment for an alcohol problem in 2015 and nearly 7.7 million needed treatment for an illicit drug problem.1
1. Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
6. Rudd, R. A., Aleshire, N., Zibbel, J. E., & Gladden, R. M. (2016). Increases in drug and opioid overdose deaths — United States, 2000–2014. MMWR, 64(50), 1378-1382.
7. Centers for Disease Control and Prevention. (2015). Alcohol poisoning deaths. Vital signs: Alcohol poisoning kills six people each day. Accessed on April 6, 2016.
10. Tashkin, D. P. (2013). Effects of marijuana smoking on the lung. Annals of the American Thoracic Society, 10(3), 239-247.
11. Kloner, R. A., Hale, S., Alker, K., & Rezkalla, S. (1992). The effects of acute and chronic cocaine use on the heart. Circulation, 85(2), 407-419.
13. May, P. A., Baete, A., Russo, J., Elliott, A. J., Blankenship, J., Kalberg, W. O., . . . Hoyme, H. E. (2014). Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics, 134(5), 855-866.
14. Roussos-Ross, K., Reisfield, G., Elliot, I., Dalton, S., & Gold, M. (2015). Opioid use in pregnant women and the increase in neonatal abstinence syndrome: What is the cost? Journal of Addiction Medicine, 9(3), 222-225.
15. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
16. Centers for Disease Control and Prevention. (2015). Number (in millions) of civilian, non-institutionalized persons with diagnosed diabetes, United States, 1980-2014. Accessed on May 17, 2016.
18. Anthony, J. C., Warner, L. A., & Kessler, R. C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2(3), 244-268.
19. Goldman, D., Oroszi, G., & Ducci, F. (2005). The genetics of addictions: Uncovering the genes. Nature Reviews Genetics, 6(7), 521-532.
ii. Defined by the Centers for Disease Control and Prevention (CDC) as consuming 8 or more drinks per week for women, and 15 or more drinks per week for men, and by the Substance Abuse and Mental Health Services Administration (SAMHSA), for research purposes, as binge drinking on 5 or more days in the past 30 days.
iii. This Report follows the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, which defines substance use disorders as “clinically and functionally significant impairments caused by substance use, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”