Substance abuse

See also: Substance use disorder

This article is about drug abuse. For the Dice album, see Drug Abuse (album).

Substance abuse
A 2007 assessment of harm from recreational drug use (mean physical harm and mean dependence liability)[1]
Specialty	Psychiatry
Frequency	27 million[2][3]
Deaths	307,400 (2015)[4]

Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder. Widely differing definitions of drug abuse are used in public health, medical and criminal justice contexts. In some cases criminal or anti-social behavior occurs when the person is under the influence of a drug, and long term personality changes in individuals may occur as well.^[5] In addition to possible physical, social, and psychological harm, use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.^[6]

Drugs most often associated with this term include: alcohol, cannabis, barbiturates, benzodiazepines, cocaine, methaqualone, opioids and some substituted amphetamines. The exact cause of substance abuse is not clear, with the two predominant theories being: either a genetic disposition which is learned from others, or a habit which if addiction develops, manifests itself as a chronic debilitating disease.^[7]

In 2010 about 5% of people (230 million) used an illicit substance.^[2] Of these 27 million have high-risk drug use otherwise known as recurrent drug use causing harm to their health, psychological problems, or social problems that put them at risk of those dangers.^[2][3] In 2015 substance use disorders resulted in 307,400 deaths, up from 165,000 deaths in 1990.^[4][8] Of these, the highest numbers are from alcohol use disorders at 137,500, opioid use disorders at 122,100 deaths, amphetamine use disorders at 12,200 deaths, and cocaine use disorders at 11,100.^[4]

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Contents

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  1 Classification
  
  
  
  • 
    1.1 Public health definitions
    
  
  
  • 
    1.2 Medical definitions
    
  
  
  • 
    1.3 Value judgment
    
  
  
  • 
    1.4 Drug misuse
    
  
  
  
  


• 
  2 Signs and symptoms
  
  
  
  • 
    2.1 Impulsivity
    
  
  
  • 
    2.2 Screening and assessment
    
  
  
  
  


• 
  3 Treatment
  
  
  
  • 
    3.1 Psychological
    
  
  
  • 
    3.2 Medication
    
  
  
  • 
    3.3 Dual diagnosis
    
  
  
  
  


• 
  4 Epidemiology
  


• 
  5 History
  
  
  
  • 
    5.1 APA, AMA, and NCDA
    
  
  
  • 
    5.2 DSM
    
  
  
  
  


• 
  6 Society and culture
  
  
  
  • 
    6.1 Legal approaches
    
  
  
  • 
    6.2 Cost
    
    
    
    • 
      6.2.1 Europe
      
    
    
    • 
      6.2.2 UK
      
    
    
    • 
      6.2.3 United States
      
    
    
    
    
  
  
  
  


• 
  7 Special populations
  
  
  
  • 
    7.1 Immigrants and refugees
    
  
  
  • 
    7.2 Street children
    
  
  
  • 
    7.3 Musicians
    
  
  
  • 
    7.4 Veterans
    
  
  
  
  


• 
  8 See also
  


• 
  9 References
  


• 
  10 External links
  

Classification

Public health definitions

A drug user receiving an injection of the opiate, heroin

Public health practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture, and availability. Some health professionals choose to avoid the terms alcohol or drug "abuse" in favor of language they consider more objective, such as "substance and alcohol type problems" or "harmful/problematic use" of drugs. The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada] — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse".^[9] This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence.

Medical definitions

A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Alcohol was found to be the overall most dangerous drug.^[10]

'Drug abuse' is no longer a current medical diagnosis in either of the most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organization's International Statistical Classification of Diseases (ICD).

Value judgment

This diagram depicts the correlations among the usage of 18 legal and illegal drugs: alcohol, amphetamines, amyl nitrite, benzodiazepine, cannabis, chocolate, cocaine, caffeine, crack, ecstasy, heroin, ketamine, legal highs, LSD, methadone, magic mushrooms (MMushrooms), nicotine and volatile substance abuse (VSA). Usage is defined as having used the drug at least once during years 2005–2015. The colored links between drugs indicate the correlations with |r|>0.4, where |r| is the absolute value of the Pearson correlation coefficient.^[11]

Philip Jenkins suggests that there are two issues with the term "drug abuse". First, what constitutes a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries.

Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in most Western countries, while drinking several bottles is seen as an abuse. Strict temperance advocates, who may or may not be religiously motivated, would see drinking even one glass as an abuse. Some groups even condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use of cannabis or substituted amphetamines constitutes drug abuse implies a decision made that the substance is harmful, even in minute quantities.^[12] In the U.S., drugs have been legally classified into five categories, schedule I, II, III, IV, or V in the Controlled Substances Act. The drugs are classified on their deemed potential for abuse. Usage of some drugs is strongly correlated.^[11] For example, the consumption of seven illicit drugs (amphetamines, cannabis, cocaine, ecstasy, legal highs, LSD, and magic mushrooms) is correlated and the Pearson correlation coefficient r>0.4 in every pair of them; consumption of cannabis is strongly correlated (r>0.5) with usage of nicotine (tobacco), heroin is correlated with cocaine (r>0.4), methadone (r>0.45), and strongly correlated with crack (r>0.5)^[11]

Drug misuse

Drug misuse is a term used commonly when prescription medication with sedative, anxiolytic, analgesic, or stimulant properties are used for mood alteration or intoxication ignoring the fact that overdose of such medicines can sometimes have serious adverse effects. It sometimes involves drug diversion from the individual for whom it was prescribed.

Prescription misuse has been defined differently and rather inconsistently based on status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of dependence symptoms.^[13][14] Chronic use of certain substances leads to a change in the central nervous system known as a 'tolerance' to the medicine such that more of the substance is needed in order to produce desired effects. With some substances, stopping or reducing use can cause withdrawal symptoms to occur,^[15] but this is highly dependent on the specific substance in question.

The rate of prescription drug use is fast overtaking illegal drug use in the United States. According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th graders, nonmedical prescription drug use is now second only to cannabis.^[16] In 2011, "Nearly 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported such use of OxyContin."^[17] Both of these drugs contain opioids.

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying medications at school or work, and often "doctor shopping" to find multiple physicians to prescribe the same medication, without knowledge of other prescribers.

Increasingly, law enforcement is holding physicians responsible for prescribing controlled substances without fully establishing patient controls, such as a patient "drug contract." Concerned physicians are educating themselves on how to identify medication-seeking behavior in their patients, and are becoming familiar with "red flags" that would alert them to potential prescription drug abuse.^[18]

Signs and symptoms

Rational scale to assess the harm of recreational drug use^[1]

Drug	Drug class	Physical harm	Dependence liability	Social harm	Total harm
Heroin	Opioid	2.78	3.00	2.54	2.77
Cocaine	CNS stimulant	2.33	2.39	2.17	2.30
Barbiturates	CNS depressant	2.23	2.01	2.00	2.08
Methadone	Opioid	1.86	2.08	1.87	1.94
Alcohol	CNS depressant	1.40	1.93	2.21	1.85
Ketamine	Dissociative anesthetic	2.00	1.54	1.69	1.74
Benzodiazepines	Benzodiazepine	1.63	1.83	1.65	1.70
Amphetamine	CNS stimulant	1.81	1.67	1.50	1.66
Tobacco	Tobacco	1.24	2.21	1.42	1.62
Buprenorphine	Opioid	1.60	1.64	1.49	1.58
Cannabis	Cannabinoid	0.99	1.51	1.50	1.33
Solvent drugs	Inhalant	1.28	1.01	1.52	1.27
4-MTA	Designer SSRA	1.44	1.30	1.06	1.27
LSD	Psychedelic	1.13	1.23	1.32	1.23
Methylphenidate	CNS stimulant	1.32	1.25	0.97	1.18
Anabolic steroids	Anabolic steroid	1.45	0.88	1.13	1.15
GHB	Neurotransmitter	0.86	1.19	1.30	1.12
Ecstasy	Empathogenic stimulant	1.05	1.13	1.09	1.09
Alkyl nitrites	Inhalant	0.93	0.87	0.97	0.92
Khat	CNS stimulant	0.50	1.04	0.85	0.80
Notes about the harm ratings .mw-parser-output .nobold{font-weight:normal} The Physical harm, Dependence liability, and Social harm scores were each computed from the average of three distinct ratings.[1] The highest possible harm rating for each rating scale is 3.0.[1] Physical harm is the average rating of the scores for acute binge use, chronic use, and intravenous use.[1] Dependence liability is the average rating of the scores for intensity of pleasure, psychological dependence, and physical dependence.[1] Social harm is the average rating of the scores for drug intoxication, health-care costs, and other social harms.[1] Total harm was computed as the average of the Physical harm, Dependence liability, and Social harm scores.

Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.^[19]

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.^[20] In the US, approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.^[21]

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Both alcohol, barbiturate as well as benzodiazepine withdrawal can potentially be fatal. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use.

Cannabis may trigger panic attacks during intoxication and with continued use, it may cause a state similar to dysthymia.^[22] Researchers have found that daily cannabis use and the use of high-potency cannabis are independently associated with a higher chance of developing schizophrenia and other psychotic disorders.^[23][24]

Severe anxiety and depression are commonly induced by sustained alcohol abuse, which in most cases abates with prolonged abstinence. Even sustained moderate alcohol use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.^[25]

Impulsivity

Impulsivity is characterized by actions based on sudden desires, whims, or inclinations rather than careful thought.^[26] Individuals with substance abuse have higher levels of impulsivity,^[27] and individuals who use multiple drugs tend to be more impulsive.^[27] A number of studies using the Iowa gambling task as a measure for impulsive behavior found that drug using populations made more risky choices compared to healthy controls.^[28] There is a hypothesis that the loss of impulse control may be due to impaired inhibitory control resulting from drug induced changes that take place in the frontal cortex.^[29] The neurodevelopmental and hormonal changes that happen during adolescence may modulate impulse control that could possibly lead to the experimentation with drugs and may lead to the road of addiction.^[30] Impulsivity is thought to be a facet trait in the neuroticism personality domain (overindulgence/negative urgency) which is prospectively associated with the development of substance abuse.^[31]

Screening and assessment

There are several different screening tools that have been validated for use with adolescents such as the CRAFFT Screening Test and in adults the CAGE questionnaire.

Some recommendations for screening tools for substance misuse in pregnancy include that they take less than 10 minutes, should be used routinely, include an educational component. Tools suitable for pregnant women include i.a. 4Ps, T-ACE, TWEAK, TQDH (Ten-Question Drinking History), and AUDIT.^[32]

Treatment

Psychological

From the applied behavior analysis literature, behavioral psychology, and from randomized clinical trials, several evidenced based interventions have emerged: behavioral marital therapy, motivational Interviewing, community reinforcement approach, exposure therapy, contingency management^[33][34] They help suppress cravings and mental anxiety, improve focus on treatment and new learning behavioral skills, ease withdrawal symptoms and reduce the chances of relapse.^[35]

In children and adolescents, cognitive behavioral therapy (CBT)^[36] and family therapy^[37] currently has the most research evidence for the treatment of substance abuse problems. Well-established studies also include ecological family-based treatment and group CBT.^[38] These treatments can be administered in a variety of different formats, each of which has varying levels of research support^[39] Research has shown that what makes group CBT most effective is that it promotes the development of social skills, developmentally appropriate emotional regulatory skills and other interpersonal skills.^[40] A few integrated^[41] treatment models, which combines parts from various types of treatment, have also been seen as both well-established or probably effective.^[38] A study on maternal alcohol and drug use has shown that integrated treatment programs have produced significant results, resulting in higher negative results on toxicology screens.^[41] Additionally, brief school-based interventions have been found to be effective in reducing adolescent alcohol and cannabis use and abuse.^[42]Motivational interviewing can also be effective in treating substance use disorder in adolescents.^[43][44]

Alcoholics Anonymous and Narcotics Anonymous are one of the most widely known self-help organizations in which members support each other not to use alcohol.^[45]Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain.^[46] It has been suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious,^[47] including managing the social environment.

Medication

A number of medications have been approved for the treatment of substance abuse.^[48] These include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and naltrexone in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including bupropion and modafinil. Methadone and buprenorphine are sometimes used to treat opiate addiction.^[49] These drugs are used as substitutes for other opioids and still cause withdrawal symptoms.

Antipsychotic medications have not been found to be useful.^[50] Acamprostate^[51] is a glutamatergic NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is associated with a hyperglutamatergic system.

Dual diagnosis

Main article: Dual diagnosis

It is common for individuals with drugs use disorder to have other psychological problems.^[52] The terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), “symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol.”^[53]

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated.^[52] Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they didn’t receive any treatment all. However, since the 1980s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider.^[53]

Epidemiology

Disability-adjusted life year for drug use disorders per 100,000 inhabitants in 2004..mw-parser-output .refbegin{font-size:90%;margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{list-style-type:none;margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li,.mw-parser-output .refbegin-hanging-indents>dl>dd{margin-left:0;padding-left:3.2em;text-indent:-3.2em;list-style:none}.mw-parser-output .refbegin-100{font-size:100%}

  no data

  <40

  40–80

  80–120

  120–160

  160–200

  200–240

  240–280

  280–320

  320–360

  360–400

  400–440

  >440

Total recorded alcohol per capita consumption (15+), in litres of pure alcohol^[54]

The initiation of drug and alcohol use is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from 2010 Monitoring the Future survey, a nationwide study on rates of substance use in the United States, show that 48.2% of 12th graders report having used an illicit drug at some point in their lives.^[55] In the 30 days prior to the survey, 41.2% of 12th graders had consumed alcohol and 19.2% of 12th graders had smoked tobacco cigarettes.^[55] In 2009 in the United States about 21% of high school students have taken prescription drugs without a prescription.^[56] And earlier in 2002, the World Health Organization estimated that around 140 million people were alcohol dependent and another 400 million with alcohol-related problems.^[57]

Studies have shown that the large majority of adolescents will phase out of drug use before it becomes problematic. Thus, although rates of overall use are high, the percentage of adolescents who meet criteria for substance abuse is significantly lower (close to 5%).^[58] According to BBC, "Worldwide, the UN estimates there are more than 50 million regular users of morphine diacetate (heroin), cocaine and synthetic drugs."^[59]

More than 72,000 Americans died from drug overdoses in 2017.^[60] Among these, the sharpest increase occurred among deaths related to fentanyl and synthetic opioids (> 29,000 deaths).^[60] See charts below.

• 
  

  

  
  

  
  

  Total yearly U.S. drug deaths.^[60]

  
  

  
  


• 
  

  

  
  

  
  

  US yearly overdose deaths, and the drugs involved.^[60]

  
  

  
  

History

APA, AMA, and NCDA

In 1932, the American Psychiatric Association created a definition that used legality, social acceptability, and cultural familiarity as qualifying factors:

.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 40px}.mw-parser-output .templatequote .templatequotecite{line-height:1.5em;text-align:left;padding-left:1.6em;margin-top:0}

…as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien."^[61]

In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision':

…'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.

In 1973, the National Commission on Marijuana and Drug Abuse stated:

...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong.^[62]

DSM

The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (published in 1952) grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness.^[63] The third edition, published in 1980, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance.

In 1987, the DSM-IIIR category "psychoactive substance abuse," which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous." It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis. By 1988, the DSM-IV defines substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal." Substance abuse can be harmful to your health and may even be deadly in certain scenarios. By 1994, The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association, the DSM-IV-TR, defines substance dependence as "when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed." followed by criteria for the diagnose^[64]

DSM-IV-TR defines substance abuse as:^[65]

• A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)


2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)


3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)


4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

• B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

The fifth edition of the DSM (DSM-5), planned for release in 2013, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-5 discussion.^[66]

Society and culture

Legal approaches

Related articles: Drug control law, Prohibition (drugs), Arguments for and against drug prohibition, Harm reduction

Most governments have designed legislation to criminalize certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their unlicensed production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history.

Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful.
In spite of the huge efforts by the U.S., drug supply and purity has reached an all-time high, with the vast majority of resources spent on interdiction and law enforcement instead of public health.^[67][68] In the United States, the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the EU, despite the fact that the EU has 100 million more citizens.^[69]

Despite drug legislation (or perhaps because of it), large, organized criminal drug cartels operate worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

Cost

Policymakers try to understand the relative costs of drug-related interventions. An appropriate drug policy relies on the assessment of drug-related public expenditure based on a classification system where costs are properly identified.

Labelled drug-related expenditures are defined as the direct planned spending that reflects the voluntary engagement of the state in the field of illicit drugs. Direct public expenditures explicitly labeled as drug-related can be easily traced back by exhaustively reviewing official accountancy documents such as national budgets and year-end reports. Unlabelled expenditure refers to unplanned spending and is estimated through modeling techniques, based on a top-down budgetary procedure. Starting from overall aggregated expenditures, this procedure estimates the proportion causally attributable to substance abuse (Unlabelled Drug-related Expenditure = Overall Expenditure × Attributable Proportion). For example, to estimate the prison drug-related expenditures in a given country, two elements would be necessary: the overall prison expenditures in the country for a given period, and the attributable proportion of inmates due to drug-related issues. The product of the two will give a rough estimate that can be compared across different countries.^[70]

Europe

As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labeled drug-related public expenditure, at the country level.^[70]

This was reported by 10 countries categorized according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%) (e.g. medical services), and Public Order and Safety (POS) (20%) (e.g. police services, law courts, prisons). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms?

To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively.

Being highly income elastic, Health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions.^[70]

UK

The UK Home Office estimated that the social and economic cost of drug abuse^[71] to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year.^[72]
However, the UK Home Office does not estimate what portion of those crimes are unintended consequences of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition.^[73]

United States

Year	Cost (billions of dollars)[74]
1992	107
1993	111
1994	117
1995	125
1996	130
1997	134
1998	140
1999	151
2000	161
2001	170
2002	181

These figures represent overall economic costs, which can be divided in three major components: health costs, productivity losses and non-health direct expenditures.

• Health-related costs were projected to total $16 billion in 2002.


• Productivity losses were estimated at $128.6 billion. In contrast to the other costs of drug abuse (which involve direct expenditures for goods and services), this value reflects a loss of potential resources: work in the labor market and in household production that was never performed, but could reasonably be expected to have been performed absent the impact of drug abuse.

Included are estimated productivity losses due to premature death ($24.6 billion), drug abuse-related illness ($33.4 billion), incarceration ($39.0 billion), crime careers ($27.6 billion) and productivity losses of victims of crime ($1.8 billion).

• The non-health direct expenditures primarily concern costs associated with the criminal justice system and crime victim costs, but also include a modest level of expenses for administration of the social welfare system. The total for 2002 was estimated at $36.4 billion. The largest detailed component of these costs is for state and federal corrections at $14.2 billion, which is primarily for the operation of prisons. Another $9.8 billion was spent on state and local police protection, followed by $6.2 billion for federal supply reduction initiatives.

According to a report from the Agency for Healthcare Research and Quality (AHRQ), Medicaid was billed for a significantly higher number of hospitals stays for Opioid drug overuse than Medicare or private insurance in 1993. By 2012, the differences were diminished. Over the same time, Medicare had the most rapid growth in number of hospital stays.^[75]

Special populations

Immigrants and refugees

Immigrant and refugees have often been under great stress,^[76] physical trauma and depression and anxiety due to separation from loved ones often characterize the pre-migration and transit phases, followed by "cultural dissonance," language barriers, racism, discrimination, economic adversity, overcrowding, social isolation, and loss of status and difficulty obtaining work and fears of deportation are common. Refugees frequently experience concerns about the health and safety of loved ones left behind and uncertainty regarding the possibility of returning to their country of origin.^[77][78] For some, substance abuse functions as a coping mechanism to attempt to deal with these stressors.^[78]

Immigrants and refugees may bring the substance use and abuse patterns and behaviors of their country of origin,^[78] or adopt the attitudes, behaviors, and norms regarding substance use and abuse that exist within the dominant culture into which they are entering.^[78][79]

Street children

Street children in many developing countries are a high risk group for substance misuse, in particular solvent abuse.^[80] Drawing on research in Kenya, Cottrell-Boyce argues that "drug use amongst street children is primarily functional – dulling the senses against the hardships of life on the street – but can also provide a link to the support structure of the ‘street family’ peer group as a potent symbol of shared experience."^[81]

Musicians

In order to maintain high-quality performance, some musicians take chemical substances.^[82] Some musicians take drugs or alcohol to deal with the stress of performing. As a group they have a higher rate of substance abuse.^[82] The most common chemical substance which is abused by pop musicians is cocaine,^[82] because of its neurological effects. Stimulants like cocaine increase alertness and cause feelings of euphoria, and can therefore make the performer feel as though they in some ways ‘own the stage’. One way in which substance abuse is harmful for a performer (musicians especially) is if the substance being abused is aspirated. The lungs are an important organ used by singers, and addiction to cigarettes may seriously harm the quality of their performance.^[82] Smoking causes harm to alveoli, which are responsible for absorbing oxygen.

Veterans

Substance abuse can be another contributing factor that affects physical and mental health of veterans. Substance abuse may also damage personal relationships families and lead to financial difficulty. There is evidence to suggest that substance abuse disproportionately affects the homeless veteran population. A 2015 Florida study compared causes of homelessness between veterans and non veteran populations in a self reporting questionnaire. The results from the study found that 17.8% of the homeless veteran participants attributed their homelessness to alcohol and drug related problems compared to just 3.7% of the non-veteran homeless group.^[83]

A 2003 study found that homelessness was associated with access to support from family/friends and services. However, this relationship was not true when comparing homeless participants who had a current substance-use disorders.^[84] The U.S. Department of Veterans Affairs provide a summary of treatment options for veterans with substance use disorder. For treatments that do not involve medication, they offer a therapeutic options that focused on finding outside support groups and “looking at how substance use problems may relate to other problems such as PTSD and depression”.^[85]

See also

• ΔFosB


• Addictive personality


• Alcohol abuse


• Combined drug intoxication


• Controlled Substances Act


• Drug addiction


• Drug overdose


• List of controlled drugs in the United Kingdom


• List of deaths from drug overdose and intoxication


• Harm reduction


• Low-threshold treatment programs


• Needle-exchange programme


• Poly drug use


• Polysubstance abuse


• Substance use disorder

References

1. 
   ^ ^abcdefg Nutt, D.; King, L. A.; Saulsbury, W.; Blakemore, C. (2007). "Development of a rational scale to assess the harm of drugs of potential misuse". The Lancet. 369 (9566): 1047–1053. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"""""""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/6/65/Lock-green.svg/9px-Lock-green.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/Lock-gray-alt-2.svg/9px-Lock-gray-alt-2.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Lock-red-alt-2.svg/9px-Lock-red-alt-2.svg.png")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
   


2. 
   ^ ^abc "World Drug Report 2012" (PDF). UNITED NATIONS. Retrieved 27 September 2016.
   


3. 
   ^ ^ab "EMCDDA | Information on the high-risk drug use (HRDU) (formerly 'problem drug use' (PDU)) key indicator". www.emcdda.europa.eu. Retrieved 2016-09-27.
   


4. 
   ^ ^abc GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
   


5. 
   ^ Ksir, Oakley Ray; Charles (2002). Drugs, society, and human behavior (9th ed.). Boston [u.a.]: McGraw-Hill. ISBN 0072319631.
   


6. 
   ^ (2002). Mosby's Medical, Nursing & Allied Health Dictionary. Sixth Edition. Drug abuse definition, p. 552. Nursing diagnoses, p. 2109.
   ISBN 0-323-01430-5.
   


7. 
   ^ "Addiction is a Chronic Disease". Archived from the original on 24 June 2014. Retrieved 2 July 2014.
   


8. 
   ^ GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
   


9. 
   ^ "A Public Health Approach" (PDF). Retrieved 1 April 2017.
   


10. 
    ^ Nutt, David J; King, Leslie A; Phillips, Lawrence D (November 2010). "Drug harms in the UK: a multicriteria decision analysis". The Lancet. 376 (9752): 1558–1565. doi:10.1016/S0140-6736(10)61462-6.
    


11. 
    ^ ^abc E. Fehrman, A. K. Muhammad, E. M. Mirkes, V. Egan, A. N. Gorban,The Five Factor Model of personality and evaluation of drug consumption risk, arXiv:1506.06297 [stat.AP], 2015
    


12. 
    ^ Philip Jenkins, Synthetic panics: the symbolic politics of designer drugs, NYU Press, 1999,
    ISBN 0-8147-4244-0, pp. ix–x
    


13. 
    ^ Barrett SP, Meisner JR, Stewart SH (November 2008). "What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations" (PDF). Curr Drug Abuse Rev. 1 (3): 255–62. doi:10.2174/1874473710801030255. PMID 19630724. Archived from the original (PDF) on 2010-06-15.
    


14. 
    ^ McCabe SE, Boyd CJ, Teter CJ (June 2009). "Subtypes of nonmedical prescription drug misuse". Drug Alcohol Depend. 102 (1–3): 63–70. doi:10.1016/j.drugalcdep.2009.01.007. PMC 2975029. PMID 19278795.
    


15. 
    ^ Antai-Otong, D. 2008. Psychiatric Nursing: Biological and Behavioral Concepts. 2nd edition. Canada: Thompson Delmar Learning
    


16. 
    ^ "The Prescription Drug Abuse Epidemic". PDMP Center of Excellence. 2010–2013.
    


17. 
    ^ "Topics in Brief: Prescription Drug Abuse" NIDA, December 2011.
    


18. 
    ^ "Combating Prescription Drug Abuse in Your Practice" Archived 2012-06-18 at the Wayback Machine. Aubrey Westgate, Physicians Practice, June 2012.
    


19. 
    ^ Burke PJ, O'Sullivan J, Vaughan BL (November 2005). "Adolescent substance use: brief interventions by emergency care providers". Pediatr Emerg Care. 21 (11): 770–6. doi:10.1097/01.pec.0000186435.66838.b3. PMID 16280955.
    


20. 
    ^ O'Connor, Rory; Sheehy, Noel (29 January 2000). Understanding suicidal behaviour. Leicester: BPS Books. pp. 33–36. ISBN 978-1-85433-290-5.
    


21. 
    ^ Isralowitz, Richard (2004). Drug use: a reference handbook. Santa Barbara, Calif.: ABC-CLIO. pp. 122–123. ISBN 978-1-57607-708-5.
    


22. 
    ^ University of Miami: Substance Abuse, Substance Abuse and Health Risks
    


23. 
    ^ Di Forti M, Marconi A, Carra E, Fraietta S, Trotta A, Bonomo M, Bianconi F, Gardner-Sood P, O'Connor J, Russo M, Stilo SA, Marques TR, Mondelli V, Dazzan P, Pariante C, David AS, Gaughran F, Atakan Z, Iyegbe C, Powell J, Morgan C, Lynskey M, Murray RM (2015). "Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study" (PDF). Lancet Psychiatry. 2 (3): 233–8. doi:10.1016/S2215-0366(14)00117-5. PMID 26359901.
    


24. 
    ^ Marta Di Forti (17 December 2013). "Daily Use, Especially of High-Potency Cannabis, Drives the Earlier Onset of Psychosis in Cannabis Users". Schizophrenia Bulletin. 40: 1509–1517. doi:10.1093/schbul/sbt181.
    


25. 
    ^ Evans, Katie; Sullivan, Michael J. (1 March 2001). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). Guilford Press. pp. 75–76. ISBN 978-1-57230-446-8.
    


26. 
    ^ "Impulsivity". The Free Dictionary.
    


27. 
    ^ ^ab Gerard Moeller M.D., Barratt Ernest S., Ph, Dougherty Donald M., Ph, Schmitz Joy M., Ph, Swann Alan C. (2001). "Psychiatric Aspects of Impulsivity". The American Journal of Psychiatry. 158 (11): 1783–93. doi:10.1176/appi.ajp.158.11.1783. PMID 11691682. Archived from the original on |archive-url= requires |archive-date= (help).CS1 maint: Multiple names: authors list (link)
    


28. 
    ^ Bishara AJ, Pleskac TJ, Fridberg DJ, Yechiam E, Lucas J, Busemeyer JR, Finn PR, Stout JC (2009). "Similar Processes Despite Divergent Behavior in Two Commonly Used Measures of Risky Decision Making". J Behav Decis Mak. 22 (4): 435–454. doi:10.1002/bdm.641. PMC 3152830. PMID 21836771.
    


29. 
    ^ Genetic influences on impulsivity, risk taking, stress responsivity and vulnerability to drug abuse and addiction^{[dead link]}
    


30. 
    ^ Chambers RA, Taylor JR, Potenza MN (2003). "Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability". Am J Psychiatry. 160 (6): 1041–52. doi:10.1176/appi.ajp.160.6.1041. PMC 2919168. PMID 12777258.
    


31. 
    ^ Jeronimus B.F.; Kotov, R.; Riese, H.; Ormel, J. (2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506.
    


32. 
    ^ Morse, Barbara (1997). Screening for Substance Abuse During Pregnancy: Improving Care, Improving Health (PDF). pp. 4–5. ISBN 1-57285-042-6.
    


33. 
    ^ O'Donohue, W; K.E. Ferguson (2006). "Evidence-Based Practice in Psychology and Behavior Analysis". The Behavior Analyst Today. 7 (3): 335–350. doi:10.1037/h0100155. Retrieved 2008-03-24.
    


34. 
    ^ Chambless, D.L.; et al. (1998). "An update on empirically validated therapies" (PDF). Clinical Psychology. 49: 5–14. Retrieved 2008-03-24.
    


35. 
    ^ "NIH Senior Health "Build With You in Mind": Survey". nihseniorhealth.gov. Archived from the original on 2015-08-11. Retrieved 29 July 2015.
    


36. 
    ^ "Association for Behavioral and Cognitive Therapies – What is CBT?". Archived from the original on 2010-04-21.
    


37. 
    ^ "Association for Behavioral and Cognitive Therapies – What is Family Therapy?". Archived from the original on 2010-06-13.
    


38. 
    ^ ^ab Hogue, A; Henderson, CE; Ozechowski, TJ; Robbins, MS (2014). "Evidence base on outpatient behavioral treatments for adolescent substance use: updates and recommendations 2007–2013". Journal of Clinical Child and Adolescent Psychology. 43 (5): 695–720. doi:10.1080/15374416.2014.915550. PMID 24926870.
    


39. 
    ^ "Association for Behavioral and Cognitive Therapies – Treatment for Substance Use Disorders". Archived from the original on 2010-04-21.
    


40. 
    ^ Engle, Bretton; Macgowan, Mark J. (2009-08-05). "A Critical Review of Adolescent Substance Abuse Group Treatments". Journal of Evidence-Based Social Work. 6 (3): 217–243. doi:10.1080/15433710802686971. ISSN 1543-3714. PMID 20183675.
    


41. 
    ^ ^ab "Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: a meta-analysis". www.crd.york.ac.uk. Retrieved 2016-03-09.
    


42. 
    ^ Carney, Tara; Myers, Bronwyn J; Louw, Johann; Okwundu, Charles I (2016-01-20). "Brief school-based interventions and behavioural outcomes for substance-using adolescents". Cochrane Database of Systematic Reviews (1): CD008969. doi:10.1002/14651858.cd008969.pub3. PMID 26787125.
    


43. 
    ^ Jensen, Chad D.; Cushing, Christopher C.; Aylward, Brandon S.; Craig, James T.; Sorell, Danielle M.; Steele, Ric G. (2011). "Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review". Journal of Consulting and Clinical Psychology. 79 (4): 433–440. doi:10.1037/a0023992. PMID 21728400.
    


44. 
    ^ Barnett, Elizabeth; Sussman, Steve; Smith, Caitlin; Rohrbach, Louise A.; Spruijt-Metz, Donna (2012). "Motivational Interviewing for adolescent substance use: A review of the literature". Addictive Behaviors. 37 (12): 1325–1334. doi:10.1016/j.addbeh.2012.07.001. PMC 3496394. PMID 22958865.
    


45. 
    ^ "Self-Help Groups Article". Retrieved May 27, 2015.
    


46. 
    ^ Uekermann J, Daum I (May 2008). "Social cognition in alcoholism: a link to prefrontal cortex dysfunction?". Addiction. 103 (5): 726–35. doi:10.1111/j.1360-0443.2008.02157.x. PMID 18412750.
    


47. 
    ^ Purvis G.; MacInnis D. M. (2009). "Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic" (PDF). Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine. 2: 133–44. Archived from the original (PDF) on 2010-12-29.
    


48. 
    ^ "Current Pharmacological Treatment Available for Alchhol Abuse". The California Evidence-Based Clearinghouse. 2006–2013.
    


49. 
    ^ James W. Kalat Biological psychology 11th edition pg.78
    


50. 
    ^ Maglione, M; Maher, AR; Hu, J; Wang, Z; Shanman, R; Shekelle, PG; Roth, B; Hilton, L; Suttorp, MJ; Ewing, BA; Motala, A; Perry, T (September 2011). "Off-Label Use of Atypical Antipsychotics: An Update [Internet]". Agency for Healthcare Research and Quality (US). PMID 22132426. Report No.: 11-EHC087-EF.
    


51. 
    ^ Lingford-Hughes AR, Welch S, Peters L, Nutt DJ, British Association for Psychopharmacology, Expert Reviewers Group (2012-07-01). "BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP". Journal of Psychopharmacology. 26 (7): 899–952. doi:10.1177/0269881112444324. ISSN 0269-8811. PMID 22628390.
    


52. 
    ^ ^ab Lingford-Hughes A. R.; Welch S.; Peters L.; Nutt D. J. (2012). "BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP" (PDF). Journal of Psychopharmacology. 26 (7): 899–952. doi:10.1177/0269881112444324. PMID 22628390. Archived from the original (PDF) on 2012-12-03.
    


53. 
    ^ ^ab Peterson Ashley L (2013). "Integrating Mental Health and Addictions Services to Improve Client Outcomes". Issues in Mental Health Nursing. 34: 752–756. doi:10.3109/01612840.2013.809830. PMID 24066651.
    


54. 
    ^ Global Status Report on Alcohol 2004
    


55. 
    ^ ^ab Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2011). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2010. Ann Arbor: Institute for Social Research, The University of Michigan.
    


56. 
    ^ "CDC Newsroom Press Release June 3, 2010".
    


57. 
    ^ Barker, P. ed. 2003. Psychiatric and mental health nursing: the craft and caring. London: Arnold. pp297
    


58. 
    ^ Effective Child Therapy: Substance Abuse and Dependence. Copyright 2012 Archived 2013-05-03 at the Wayback Machine.
    


59. 
    ^ "Drug Trade". BBC News.
    


60. 
    ^ ^abcd Overdose Death Rates. By National Institute on Drug Abuse (NIDA).
    


61. 
    ^ Glasscote, R.M., Sussex, J.N., Jaffe, J.H., Ball, J., Brill, L. (1932). The Treatment of Drug Abuse for people like you...: Programs, Problems, Prospects. Washington, D.C.: Joint Information Service of the American Psychiatric Association and the National Association for Mental Health.
    


62. 
    ^ Second Report of the National Commission on Marihuana and Drug Abuse; Drug Use In America: Problem In Perspective (March 1973), p.13
    


63. 
    ^ Transformations: Substance Drug Abuse
    


64. 
    ^ DSM-IV & DSM-IV-TR:Substance Dependence Archived 2011-09-27 at the Wayback Machine.
    


65. 
    ^ American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC.
    


66. 
    ^ Hasin, Deborah S.; O’Brien, Charles P.; Auriacombe, Marc; Borges, Guilherme; Bucholz, Kathleen; Budney, Alan; Compton, Wilson M.; Crowley, Thomas; Ling, Walter (2013-08-01). "DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale". American Journal of Psychiatry. 170 (8): 834–851. doi:10.1176/appi.ajp.2013.12060782. ISSN 0002-953X. PMC 3767415. PMID 23903334.
    


67. 
    ^ Copeman M (April 2003). "Drug supply and drug abuse". CMAJ. 168 (9): 1113, author reply 1113. PMC 153673. PMID 12719309. Archived from the original on 2009-09-06.
    


68. 
    ^ Wood E, Tyndall MW, Spittal PM, et al. (January 2003). "Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure". CMAJ. 168 (2): 165–9. PMC 140425. PMID 12538544.
    


69. 
    ^ Bewley-Taylor, Dave, Hallam, Chris, Allen Rob. The Beckley Foundation Drug Policy Programme: The Incarceration of Drug Offenders: An Overview. March 2009.
    


70. 
    ^ ^abc Prieto L (2010). "Labelled drug-related public expenditure in relation to gross domestic product (gdp) in Europe: A luxury good?". Substance Abuse Treatment, Prevention, and Policy. 5: 9. doi:10.1186/1747-597x-5-9.
    


71. 
    ^ "NHS and Drug Abuse". National Health Service (NHS). March 22, 2010. Retrieved March 22, 2010.
    


72. 
    ^ "Home Office | Tackling Drugs Changing Lives | Drugs in the workplace". 2007-06-09. Archived from the original on 2007-06-09. Retrieved 2016-09-19.
    


73. 
    ^ Thornton, Mark. "The Economics of Prohibition".
    


74. 
    ^ The economic costs of drug abuse in the United States
    


75. 
    ^ Owens PL, Barrett ML, Weiss AJ, Washington RE, Kronick R (August 2014). "Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993–2012". HCUP Statistical Brief #177. Rockville, MD: Agency for Healthcare Research and Quality.
    


76. 
    ^ Drachman, D. (1992). "A stage-of-migration framework for service to immigrant populations". Social Work. 37 (1): 68–72. doi:10.1093/sw/37.1.68.
    


77. 
    ^ Pumariega A. J.; Rothe E.; Pumariega J. B. (2005). "Mental health of immigrants and refugees". Community Mental Health Journal. 41 (5): 581–597. doi:10.1007/s10597-005-6363-1.
    


78. 
    ^ ^abcd National Institute on Alcohol Abuse and Alcoholism. (2005). Module 10F: Immigrants, refugees, and alcohol. In NIAAA: Social work education for the prevention and treatment of alcohol use disorders (NIH publication). Washington, D.C.
    


79. 
    ^ Caetano R.; Clark C. L.; Tam T. (1998). "Alcohol consumption among racial/ethnic minorities: Theory and research". Journal of Alcohol, Health, and Research. 22 (4): 233–241.
    


80. 
    ^ UNODC. "Understanding Substance Use Among Street Children" (PDF). Retrieved 30 January 2014.
    


81. 
    ^ Cottrell-Boyce, Joe (2010). "THE ROLE OF SOLVENTS IN THE LIVES OF STREET CHILDREN" (PDF). African Journal of Drug & Alcohol Studies. 9 (2): 93–102. doi:10.4314/ajdas.v9i2.64142. Retrieved 28 January 2014.
    


82. 
    ^ ^abcd Breitenfeld D.; Thaller V.; Perić B.; Jagetic N.; Hadžić D.; Breitenfeld T. (2008). "Substance abuse in performing musicians". Alcoholism: Journal on Alcoholism and Related Addictions. 44 (1): 37–42.
    


83. 
    ^ Dunne, E. M., Burrell, L. I., Diggins, A. D., Whitehead, N. E., & Latimer, W. W. (2015). "Increased risk for substance use and health‐related problems among homeless veterans". The American Journal On Addictions. 24 (7): 676–680. doi:10.1111/ajad.12289.CS1 maint: Multiple names: authors list (link)
    


84. 
    ^ Zlotnick, C., Tam, T., & Robertson, M. J. (2003). "Disaffiliation, substance use, and exiting homelessness". Substance Use & Misuse. 38 (3–6): 577–599. doi:10.1081/ja-120017386.CS1 maint: Multiple names: authors list (link)
    


85. 
    ^ "Treatment Programs for Substance Use Problems – Mental Health". www.mentalhealth.va.gov. Retrieved 2016-12-17.
    

External links

Classification	D ICD-10: F10.1-F19 ICD-9-CM: 305 MeSH: D019966 DiseasesDB: 3961
External resources	MedlinePlus: 001945

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• The National Institute on Drug Abuse

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v t e Mental and behavioral disorders (F00–F99 & 290–319)
Neurological/symptomatic Dementia Mild cognitive impairment Alzheimer's disease Vascular dementia Pick's disease Creutzfeldt–Jakob disease Huntington's disease Parkinson's disease AIDS dementia complex Frontotemporal dementia Sundowning Wandering Autism spectrum Autism Asperger syndrome Savant syndrome PDD-NOS High-functioning autism Other Delirium Post-concussion syndrome Organic brain syndrome
Psychoactive substances, substance abuse and substance-related disorders Intoxication/Drug overdose Physical dependence Substance dependence Rebound effect Double rebound Withdrawal Stimulant psychosis
Schizophrenia, schizotypal and delusional Psychosis and schizophrenia-like disorders Schizoaffective disorder Schizophreniform disorder Brief reactive psychosis Schizophrenia Disorganized (hebephrenic) schizophrenia Paranoid schizophrenia Simple-type schizophrenia Childhood schizophrenia Pseudoneurotic schizophrenia Delusional disorders Delusional disorder Folie à deux
Mood (affective) Mania Bipolar disorder Bipolar I Bipolar II Cyclothymia Bipolar NOS Depression Major depressive disorder Dysthymia Seasonal affective disorder Atypical depression Melancholic depression
Neurotic, stress-related and somatoform Anxiety disorder Phobia Agoraphobia Social anxiety Social phobia Anthropophobia Specific social phobia Specific phobia Claustrophobia Other Panic disorder Panic attack Generalized anxiety disorder OCD stress Acute stress reaction PTSD Adjustment disorder Adjustment disorder with depressed mood Somatic symptom disorder Somatization disorder Body dysmorphic disorder Hypochondriasis Nosophobia Da Costa's syndrome Psychalgia Conversion disorder Ganser syndrome Globus pharyngis Neurasthenia Mass psychogenic illness Dissociative disorder Dissociative identity disorder Psychogenic amnesia Fugue state Depersonalization disorder
Physiological/physical behavioral Eating disorder Anorexia nervosa Bulimia nervosa Rumination syndrome NOS Nonorganic sleep disorders Hypersomnia Insomnia Parasomnia REM sleep behavior disorder Night terror Nightmare Sexual dysfunction sexual desire Hypoactive sexual desire disorder Hypersexuality sexual arousal Female sexual arousal disorder Erectile dysfunction orgasm Anorgasmia Delayed ejaculation Premature ejaculation Sexual anhedonia pain Vaginismus Dyspareunia Postnatal Postpartum depression Postpartum psychosis
Adult personality and behavior Gender dysphoria Sexual maturation disorder Ego-dystonic sexual orientation Sexual relationship disorder Paraphilia Voyeurism Fetishism Other Personality disorder Impulse control disorder Kleptomania Trichotillomania Pyromania Dermatillomania Factitious disorder Munchausen syndrome
Disorders typically diagnosed in childhood Intellectual disability X-linked intellectual disability Lujan–Fryns syndrome Psychological development (developmental disabilities) Specific Pervasive Emotional and behavioral ADHD Conduct disorder ODD Emotional/behavioral disorder Separation anxiety disorder social functioning Selective mutism RAD DAD Tic disorder Tourette syndrome Speech Stuttering Cluttering Movement disorders Stereotypic
Symptoms and uncategorized Catatonia False pregnancy Intermittent explosive disorder Psychomotor agitation Stereotypy Psychogenic non-epileptic seizures Klüver–Bucy syndrome

v t e Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)
General	SID Substance intoxication / Drug overdose Withdrawal Substance-induced psychosis SUD Substance abuse / Substance use disorder / Substance-related disorders Physical dependence / Psychological dependence / Substance dependence
Alcohol	SID Neurological disorders Alcoholic hallucinosis Alcohol withdrawal Fetal alcohol spectrum disorder (FASD) Fetal alcohol syndrome (FAS) Korsakoff's syndrome Korsakoff's psychosis Wernicke–Korsakoff syndrome Wernicke's encephalopathy Digestive system Alcoholic hepatitis Alcoholic liver disease Auto-brewery syndrome Nervous system Alcohol-related dementia Alcoholic hallucinosis Hangover Cardiovascular system Alcoholic cardiomyopathy Alcohol flush reaction SUD Alcoholism (alcohol use disorder) Binge drinking
Caffeine	SID Effect of caffeine on memory Caffeine-induced sleep disorder SUD Caffeine dependence
Cannabis	SID Effects of cannabis Long-term effects of cannabis SUD Cannabis dependence
Cocaine	SID Cocaine intoxication SUD Cocaine dependence
Hallucinogen	SID Hallucinogen persisting perception disorder
Opioids	SID Opioid overdose SUD Opioid use disorder
Sedative / hypnotic	benzodiazepine: SID Benzodiazepine overdose Benzodiazepine withdrawal SUD Benzodiazepine use disorder Benzodiazepine dependence barbiturate: SID Barbiturate overdose SUD Barbiturate dependence
Stimulants	SID Stimulant psychosis SUD Amphetamine dependence
Tobacco	SID Nicotine poisoning Nicotine withdrawal SUD Nicotine dependence
Volatile solvent	Inhalant abuse: Toluene toxicity
Poly drug use	SID Combined drug intoxication SUD Polysubstance dependence

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