Substance Abuse, The Nation's Number One Health Problem

Prepared by the Schneider Institute for Health Policy, Brandeis University, for the Robert Wood Johnson Foundation

Reviewed by Marty N.


More deaths, illnesses and disabilities in the U.S. result from the use of tobacco, alcohol and illicit drugs than from any other preventable health condition. Together these drugs account for about one in every four deaths from all causes. The legal drugs are by far the worst killers. Tobacco alone accounts for more than 430,000 deaths per year. Alcohol is a distant second with about 100,000. The illegal drugs, all together, bring up the rear in this morbid race, with 16,000 estimated fatalities per year.

Alcohol consumption rises during wars and falls during recessions. It was at an all-time low during Prohibition. Federal legislation in 1984 raising the minimum drinking age to 21 in all states may be partly accountable for the gradual decline in drinking since 1980, but consumption remains more than 2.18 gallons per capita per year, higher than any time since the opening decade of the 20th century.

The per capita numbers, however, mask important differences. About 48 per cent of American households report using no alcohol at all, and this percentage has been rising. The hardest-drinking ten per cent of all drinkers drink half of all the alcohol sold. Two thirds of the heaviest drinkers also smoke cigarettes, compared to 18 per cent of nondrinkers. A quarter of the heaviest drinkers also smoke marijuana, compared to less than one per cent of nondrinkers. About one seventh of the heaviest drinkers also use illicit drugs, compared to less than one per cent of nondrinkers.

People who use alcohol and/or tobacco in their early teens are by far the most likely to develop long-term problems with those or other drugs. Tobacco and alcohol are the most common gateways to use of illicit drugs. White males in their 20s in blue collar occupations living in small towns of the Midwest or South are the most likely to be heavy drinkers, smokers and users of illicit drugs. Although whites are more likely to drink, blacks are more likely to die from alcohol use. Slightly more than half of current drinkers report having relatives who are alcoholics.

Alcohol and drugs are closely associated with crime, or at least with getting caught; from a third to two thirds of prisoners of various categories were under the influence at the time of their offense. The number of prisoners serving time for drug offenses increased five-fold between 1985 and 1995. Drug offenders make up more than 80 per cent of the growth in the federal prison population during that time.

Nearly three fourths of illicit drug users have jobs, but they tend to miss more work and change jobs more often, as do heavy drinkers.

Most Americans view alcohol, tobacco and illicit drug use as risky and endorse restrictive legislation; but a large majority favors treatment rather than incarceration. The tobacco industry spends more than $6 billion a year advertising and promoting cigarettes, and the alcohol industry spends about $3 billion for this purpose. Television viewers see about six acts of drinking alcohol per hour, on the average. About 93 per cent of the most popular video rentals show alcohol being used, 89 per cent show people smoking, and 22 per cent show people using illicit drugs.

Although federal drug control spending has multiplied by a factor of 12 since 1981, two thirds goes for "supply reduction," without noticeable impact on the availability of illicit drugs. Police make more than 1.5 million drug arrests per year, 80 per cent of them for possession.

Only 18 per cent of the federal drug control dollar goes for treatment. These public moneys account for about half of all funding for addiction treatment in the U.S., and Medicaid/Medicare account for another 21 per cent. No other area of medical treatment shows such a large proportion of public funding. The effectiveness of self-help groups such as AA and NA is unknown because their philosophy of anonymity prevents accurate counts. Treatment appears cost-effective by comparison with the cost of untreated addiction. The best treatment programs combine behavioral and pharmacological treatments with other social services designed to address individual needs.

The above is a brief sampler and partial synopsis of material contained in Substance Abuse, The Nation's Number One Health Problem, a glossy spiral-bound reference work of 128 pages with multi-color graphs and charts, available free from the Robert Wood Johnson Foundation. A concise text provides continuity for dozens of illustrations based on an overview of a large array of research data, current and retrospective. Those seeking a grounding in the available "hard" data about the parameters of alcohol and other drug use in the United States will want to have this well-done annotated compendium in their libraries. The presentation is professional throughout, and the price is right. For a copy, go to http://www.rwjf.org/files/publications/other/SubstanceAbuseChartbook.pdf
~ Marty N. 5/16/01