• Substance use: America’s number one health behavior problem — ctd.

    The following is from a 2001 paper by Norman Miller and colleagues titled “Why Physicians are Unprepared to Treat Patients Who Have Alcohol- and Drug-Related Disorders“.

    In the Epidemiological Catchment Area (ECA) study, a survey of mental health and substance disorders in almost 20,000 adult Americans, the lifetime prevalence of alcohol abuse/dependence was 13.5% in the general U.S. population in the 1980s. [41] A decade ago, the Institute of Medicine reported that approximately 6.4% of the U.S. population over the age of 12 probably need treatment for alcohol-use disorders. [42] During the same period, the lifetime incidence of alcohol and comorbid drug disorders affected approximately 20% of the population. [43] We see no evidence that these percentages have improved. […]

    Surveys in the early 1990s showed that 5% of all deaths in the United States were directly attributable to alcohol-related problems. [44] Alcohol use and alcoholism also contributed to 60–90% of deaths from cirrhosis, [45] 40–50% of motor vehicle fatalities, [46–48] two million nonfatal motor vehicle injuries, [49] 16–67% of home and job injuries, drownings, and fire fatalities, [47,50,51] and 3–5% of deaths due to cancer. [50,52,53] One study estimates that alcohol use and alcoholism are responsible for 15% of the years of life lost before age 65. [54] In 1987, a total of 105,095 deaths were caused by alcohol, including 30,000 from unintentional injuries, 19,600 from digestive diseases (including cirrhosis), 17,700 from intentional injuries, and 16,000 from cancers. [55]

    Again, is there a more recent treatment of these issues?

    UPDATE: A follow-up is here.


    41. Swift RM, Miller NS, Lewis DC. Addictive disorders. In: Goldman LS, Wise TN, Brody DS (eds). Psychiatry for Primary Care Physicians. Chicago, IL: American Medical Association, 1998.

    42. Institute of Medicine. Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press, 1990.

    43. Institute of Medicine. A study of the evolution, effectiveness and financing of public and private drug treatment systems. In: Gerstein DR, Harwood HJ (eds). Treating Drug Problems. Vol 1. Washington, DC: National Academy Press, 1990.

    44. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207–12.

    45. Johannes RS, Kahane SN, Mendeloff AI, Kurata J, Roth HP. Digestive diseases. Am J Prev Med. 1987;3:83–8.

    46. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore, MD: Williams & Wilkins, 1989.

    47. West LJ, Maxwell DS, Noble EP, Solomon DH. Alcoholism. Ann Intern Med. 1984;100:405–16.

    48. McCoy GF, Johnstone RA, Nelson IW, Duthie RB. A review of fatal road accidents in Oxfordshire over a 2-year period. Injury. 1989;20: 65–8.

    49. Rouse BA. Substance Abuse and Mental Health Statistic Sourcebook. Washington, DC: U.S. Department of Health and Human Services, 1965.

    50. Milio N. Promoting health through public policy. Philadelphia, PA: F. A. Davis, 1981.

    51. Smith GS, Falk H. Unintentional injuries. Am J Prev Med. 1987;3: 143–63.

    52. Doll R, Peto R. The Causes of Cancer: Quantitative Estimates of Avoidable Risks of Cancer in the United States Today. New York: Oxford University Press, 1981.

    53. Higginson J, Muir CS. Environmental carcinogenesis: misconceptions and limitations to cancer control. J Nat Cancer Inst. 1979;63:1291–8.

    54. Amler RW, Eddins DL. Cross-sectional analysis: precursors of premature death in the United States. Am J Prev Med. 1987;3:181–7.

    55. Centers for Disease Control. Alcohol-related mortality and years of potential life lost—United States, 1987. MMWR. 1990;39:173–8.

    • I dont think you can treat addiction problems until addicts want to be treated. While addicted, these are often terrible patients to deal with. We get a lot at my trauma center. Once addicts decide to seek treatment, you have a chance, but they are still trying for us docs who are basically a bunch of science geeks. It is easy to grasp the pathophysiology, but the personalities are difficult.


      • Perfect segue to my next (scheduled) post in this area. Forthcoming Wednesday (I think).

        • I agree with Steve.

          I remember a mentor in a substance abuse clinic explaining how individuals ravaged by addiction were like humpty dumpty (“all thing kings horses, all the kings men….. couldn’t put H-D together again”). His years of experience told him, most of these folks are permanently damaged and scarred.

          I always ask their stories. More often than not, they are horrifying. Gets back to social determinants, what are they going back too, inability to untangle childhood trauma. Even that aside, treatment success in this venue is brutal; as a doc, you just get numb. Seeing the same person admitted 4-6x/year for the same thing; repetitive cries of, “this time its different, etc.” Indifference sets in, as you realize the cure is beyond anything you or a few others on your team can provide.

          Cliche as it sounds, it is a societal problem and solution.