10.5: Drug Abuse, Addiction, and Co-Occurring Disorders
Drugs can include any substance that is psychoactive or mind/mood altering. This would include nicotine (found in tobacco products), caffeine, alcohol, marijuana, and all other illicit (illegal) drugs along with any psychoactive pharmaceutical medicines. Abuse of a substance is defined as either using an excessive amount of a recreational substance, or using a prescription medication for a purpose other than it was intended for (for example, taking someone else’s ADHD pills in order to stay up late and study for a test). Sometimes people develop a substance use disorder (SUD) , which according to the APA definition, is a “cluster of physiological, behavioral, and cognitive symptoms associated with the continued use of substances despite substance-related problems, distress, and/or impairment, such as impaired control and risky use” (APA, 2008). There is likely a continuum of symptoms ranging from recreational use, to binging, to daily use, which may become an addiction. Addiction is differentiated from other use disorders as being in a state of dependence - psychological and often physiological dependence - on a substance (like alcohol, methamphetamines, or prescription painkillers), or a behavior (such as gambling, shopping, sex, or exercise) (APA, 2008).
According to the 2022 National Survey on Drug Use and Health, over 168 million people, or 59.8% of the population over the age of 12 used some sort of drug in the year prior. Their survey categorized a drug as including alcohol, tobacco, vaping, and illicit drugs (including marijuana, and prescription drug abuse). The majority of that use came from alcohol consumption: 48.7% (or 137.4 million people) drank alcohol, whereas only 18.1% used tobacco products, 16.5% used an illicit drug, and 8.3% vaped nicotine. Alcohol consumption becomes particularly concerning based on the dose. Binge drinking is defined as having 4 or more drinks for a woman or 5 or more drinks for a man on the same occasion. Heavy alcohol use is this type of drinking behavior on 5 or more separate occasions in the past month (SAMHSA, 2023). See Fig. \(\PageIndex{1}\) below for more on alcohol consumption.
The same report notes that marijuana is the most commonly used illicit drug, and in several states it has become legal for medicinal and/or recreational use, but typically only for those over the age of 21. About 22% of people over the age of 12 have used marijuana in the past year, and almost a quarter of those between the ages of 12-20 reported using it (SAMHSA, 2023). Use at young ages has been associated with declines in cognitive functioning and academic performance, as well as amplified behavioral issues. Teens who use marijuana seem to be at a higher risk of developing an addiction to marijuana or other substances later in life. Additionally, marijuana use is associated with poorer mental health: teens experiencing depression or suicidal thoughts may be more likely to use marijuana as a coping mechanism, but marijuana use also increases symptoms of depression and suicidality (Sultan et al., 2023). On a positive note, according to the YRBSS, the use of alcohol, marijuana, and any illicit drugs among high school students has declined since 2011 (CDC/DASH, 2023).
Although presumably in possession of more developed brains than their highschool selves, college students are not immune to SUDs. Many college students have the perception that using stimulants will improve their academic performance, although science provides evidence to the contrary. The misuse of prescription amphetamines (a type of stimulant used to treat ADHD) is particularly common among college students, who may use it to help them study, or along with other drugs like marijuana or alcohol (Butler et al., 2021).
Whether from prescription medications to treat pain, or street drugs (like heroin), opioids are particularly addictive and carry a high potential for drug overdoses due to the fact that they depress (slow down) the function of the central nervous system (CNS). According to the SAMHSA report, 8.9 million Americans or 3.2% misused prescription opioids, and only 991,000 misused fentanyl - including illegally manufactured fentanyl. This might be a significant underestimation however, since illegally manufactured fentanyl is often present in other drugs like heroin and cocaine without the user’s knowledge (SAMHSA, 2023). In 2022, the drug overdose death rate was 32.6 per 100,000 population, an increase from 8.2 per 100,000 population just two decades prior. Although there was no significant change between 2021 and 2022, the last few years have seen an increase in drug overdoses from fentanyl and stimulants (like cocaine and methamphetamines). Drug overdose deaths affect men at over twice the rate of women (Spencer et al., 2023).
Substance use disorders (SUD) and mental illness are often co-occurring disorders. People often use alcohol or drugs to alleviate symptoms of anxiety, depression, sadness, or thoughts of suicide. About half of those living with a serious mental illness (such as major depression or bipolar disorder, among others) also had an SUD - yet only 70% of these folks with co-occurring disorders actually received treatment for it. Mental illness can lead to the desire for self-medicating or using drugs to reduce negative side-effects from psychiatric medication. The link between SUD and mental illness is complex, and often treatment models and providers are separated. Additionally, nicotine dependence and tobacco use problems are commonly overlooked in mental health treatment and addiction recovery (Abrams, 2024). See Fig. \(\PageIndex{2}\) below.