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October 25, 1985

Substance Abuse

JAMA. 1985;254(16):2335-2337. doi:10.1001/jama.1985.03360160167050

Significant developments in research, epidemiology, and clinical practice have in recent years moved problems of substance abuse into the mainstream of medicine. At the same time that the use of dependence-producing drugs poses a major threat to the health of Americans, the understanding, prevention, and treatment of substance abuse offer useful insights for general clinical medicine and the public at large.

A new understanding of substance abuse focuses on aspects of behavior and life-style, identified by the Surgeon General as contributing significantly to seven of the ten leading causes of death in the United States.1 This same report showed that about 30% of all deaths in the United States are premature because of the use of just two dependence-producing drugs, tobacco and alcohol.

The most remarkable aspect of substance abuse is the biologic process of dependence—how it happens and what can be done to stop it, particularly during the