History of Substance Abuse and Addiction

Substance misuse and addiction constitute a complex issue that impacts millions of Americans and costs the country’s economy hundreds of billions each year. How bad is the country’s addiction crisis? And how did the U.S. get here?

To learn more, check out the infographic below, created by Counseling Degrees Online.

The Extent of the United States’ Substance Misuse Problem

Addiction is a chronic disorder that a person will live with for the rest of their life. While addiction is the more recognizable word, experts recognize substance use disorder as a spectrum. Roughly 20 million Americans live with a substance use disorder.

The Costs of Addiction

Alcohol, nicotine, and illicit drugs cost the U.S. upward of $750 billion annually in healthcare and criminal justice costs, as well as in lost productivity. Alcohol alone kills roughly 88,000 Americans annually, while opioid overdoses claim the lives of roughly 47,000 Americans each year. Addiction can be responsible for serious health issues, such as cancer, mental health problems, high blood pressure, heart disease, strokes, and memory and learning problems. The damage is far-reaching, including problems at work, as well as financial and legal woes.

Who Is Most at Risk?

The people most at risk of developing a substance use disorder include those who use drugs, as well as those who experience mental health disorders, such as depression, bipolar disorder, and PTSD. Anyone with a parent or grandparent who had a substance use disorder and members of the LGBTQ2+ community may also be at heightened risk.

Signs of an Addiction

A person may struggle with a substance use disorder if they exhibit a lack of control — they can’t stop using even if they want to. Other signs include displaying a higher tolerance for a substance than before, fixating on the substance or their behavior around the substance, and using the substance to deal with withdrawal from using that substance previously.

What Help Is Available?

There are many ways to help a person with a substance use disorder, including detox, medication, and rehabilitation. Therapy and support groups such as Alcoholics Anonymous and Narcotics Anonymous can also help.

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Our Evolving Understanding of Addiction

The history of substance abuse treatment in the U.S. reflects a growing understanding that substance use disorder is a disease. Sobriety circles and mutual aid societies first emerged in the 1750s, and by 1784, Dr. Benjamin Rush had identified alcoholism as a disease that needed to be treated. His work helped launch the temperance movement. By the early 1900s, Church-led healing and spiritual and psychological responses to alcoholism emerged, and in 1935, Alcoholics Anonymous was created.
By the 1950s, AA membership approached 100,000. The American Medical Association defined alcoholism for the first time in 1952, describing it as a chronic disease impacted by genetic, psychosocial, and environmental factors. During the 1970s and 1980s, the U.S. government increased funding for research on drug use and abuse.

The United States’ 21st-Century Addiction Crisis

A relentless opioid epidemic has killed thousands of people in the U.S. In 2020 alone, nearly 70,000 people died from overdoses involving opioids. The number of babies born in withdrawal jumped more than 80% from 2010 to 2017.

Toxic Fentanyl

The U.S. is paying increasing attention to a relatively new synthetic opioid called fentanyl. The CDC is particularly concerned about the speed at which fentanyl has exacerbated the opioid crisis.

Fentanyl is 50 to 100 times more potent than morphine. It enters brain tissue more quickly, making it potentially deadly to touch a surface that has had fentanyl on it or breathe in air with atomized fentanyl in it. It’s high potency and low production costs make it highly profitable for traffickers.

And while some users seek it out, many people often don’t know they’ve ingested it because it’s commonly mixed with heroin, cocaine, sedatives, and other drugs.

How Do We Fix the Problem?

Drug threats change and evolve. The better the data, the more quickly new drug threats can be detected. Pharmaceutical companies have had to pay millions for overstating the benefits of opioids and minimizing their risks, and doctors are now being advised against using opioids as a first measure.
In 2021, Oregon decriminalized possession of small amounts of drugs — an American first. Decriminalization removes fear about criminal records and legality. It also paves the way for fearful people to reach out for support and treatment.

A Complex Disease

Substance use disorder is a complex disease that impacts millions of Americans. It also requires continual intervention and support to treat properly. As the opioid epidemic continues to claim tens of thousands of lives annually, health experts call for more comprehensive public health approaches.

Addiction Center, “Statistics on Addiction in America”
American Addiction Centers, “Timeline: History of Addiction Treatment”
CDC, “Alcohol Use and Your Health”
CDC, “Excessive Drinking Is Draining the U.S. Economy”
CDC, “Overdose Deaths Accelerating During COVID-19”
Cleveland Clinic, “Addictions: An Overview”
Council on Foreign Relations, “The U.S. Opioid Epidemic”
Drug Policy Alliance, “Drug Decriminalization in Oregon Officially Begins Today”
National Institute on Drug Abuse, “Opioid Overdose Crisis”
National Institute on Drug Abuse, “Overdose Death Rates”
National Institute on Drug Abuse, “The Science of Drug Use and Addiction: The Basics”
National Institute on Drug Abuse, “The True, Deadly Scope of America’s Fentanyl Problem”
NCBI, “Drug Abuse Research in Historical Perspective”
NCBI, “Historical and Cultural Aspects of Man’s Relationship With Addictive Drugs”
The New York Times, “Pointers From Portugal on Addiction and the Drug War”
PEW, “The High Price of the Opioid Crisis, 2021”
Quit Genius, “Understanding the Employer-Facing Cost Burdens of Addiction”
Verywellmind, “How Drug Use Affects Our Society”

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