Source: National Library of Medicine

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well‐being, and social functioning. Long‐lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self‐awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD.

Consequently, prevention strategies targeting social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk of these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine, and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions.

Involvement of health care providers in the detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.

For most of history, persons suffering from a substance use disorder (SUD) have been viewed as individuals with a character flaw or a moral deficiency, and stigmatized with labels such as “addict” or worse.

Advances in neuroscience have expanded our understanding of the brain changes responsible for this condition and have provided the basis for recognizing SUD as a progressive, chronic, relapsing disorder that is amenable to treatment and recovery.

The prevalence of SUDs is high and varies across countries and the type of drugs used (highest for tobacco and alcohol use disorders) as well as by demographic and socioeconomic characteristics of the populations. The rates of SUDs are higher for males than females and higher for younger people, with rates decreasing as both men and women age.

The impact of SUDs on societies as it relates to health and mortality, economics, and crime is profound, and it appears to be worsening. Indeed, among all of the risk factors associated with premature death, tobacco and alcohol use rank second and seventh, respectively. The high contribution to premature mortality reflects direct effects of drugs from overdoses as well as their longer‐lasting negative effects on health.

In 2019, the number of premature deaths attributed to smoking was estimated at 7.7 million, to alcohol use at 2.4 million , and to use of other drugs at 550,700. Click here to keep reading.