Substance misuse, and in particular, use of Illicit drugs, to include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used non-medically, and related addiction costs the U.S. more than $193 billion per year in crime, health, and productivity, spanning criminal justice, crime victim, hospital and emergency department, insurance administration, labor participation, specialty treatment, incarceration, premature mortality, and other costs.[ Reference 1 ]; Per the 2013 National Survey on Drug Use and Health, an estimated 24.6 million or 9.4 percent of Americans age 12 or older were current illicit drug users, meaning they had used an illicit drug during the prior month.[ Reference 2 ]
According to the 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel (HRB), almost 90 percent of active-duty service members reported having received drug testing in the past year. Aggressive testing, along with DoD policies, may contribute to the low illicit drug use (1.4 percent) of active-duty service members in comparison to civilians (9.4 percent).[ Reference 3 ] Active-duty service members who responded to the HRB also reported low prescription drug misuse (1.3 percent) with the most popular misused prescription drugs being steroids (16.6 percent) and stimulants (11.6 percent).The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues using a substance despite significant substance-related problems.
Impaired control
- Individual may take the substance in larger amounts or over a longer period than was originally intended
- Individual may express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use
- Individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects
- Craving manifested by an intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug previously was obtained or used
Social impairment
- Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home
- Individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
- Important social, occupational, or recreational activities may be given up or reduced because of substance use
Risky use
- Recurrent substance use in situations in which it is physically hazardous
- Individual may continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
Pharmacological criteria
- Tolerance signaled by requiring more of a substance to achieve a desired effect or experiencing a reduced effect when the usual amount is consumed
- Withdrawal is a syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of a substance
