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September 18, 2013

Managing Substance Dependence as a Chronic Disease: Is the Glass Half Full or Half Empty?

Author Affiliations
  • 1Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
JAMA. 2013;310(11):1132-1134. doi:10.1001/jama.2013.277610

Worldwide, alcohol use accounts for approximately 2.5 million deaths annually1 and in the United States is estimated to account for economic costs exceeding $200 billion per year.2 According to the 2011 National Survey on Drug Use Health, 52% of Americans aged 12 years or older reported alcohol use, nearly 25% reported binge drinking (≥5 drinks on 1 occasion), and 6% reported heavy drinking (binge drinking on ≥5 occasions) over the past 30 days.3 The harmful effects of alcohol on health involve nearly every organ system as well as psychiatric and social comorbidity. While less prevalent, illicit drug use is also associated with health problems (such as human immunodeficiency virus infection and overdose) and substantial health care expenditures. The 2011 National Survey on Drug Use Health estimates that approximately 9% of Americans aged 12 years or older—an estimated 22.5 million individuals—used illicit drugs during the past 30 days in the United States.3 Because individuals who use alcohol and other drugs may have substantial health problems, they interact frequently with primary care, emergency departments, and other health care settings.