The cost and consequences of alcoholism and drug dependence place an enormous burden on American society.  As the nation’s number one health problem, addiction strains the economy, the health care system, the criminal justice system, and threatens job security, public safety, marital and family life.

Addiction crosses all societal boundaries, affects every ethnic group, both genders, and people in every tax bracket.  Today, however, Americans increasingly recognize addiction as a disease -- a disease that can be treated.

The scope of the problem:

Alcoholism

• Alcohol is the most commonly used addictive substance in the U.S.  17.6 million people, or one in every 12 adults, suffer from alcohol abuse or dependence along with several million more who engage in risky drinking patterns that could lead to alcohol problems.  More than half of all adults have a family history of alcoholism or problem drinking, and more than seven million children live in a household where at least one parent is dependent or has abused alcohol.

Drug Dependence

• According to the National Survey on Drug Use and Health (NSDUH), an estimated 20 million Americans aged 12 or older used an illegal drug in the past 30 days.  This estimate represents 8% percent of the population aged 12 years old or older.  Additionally, the nonmedical use or abuse of prescription drugs--including painkillers, sedatives, and stimulants--is growing, with an estimated 48 million people ages 12 and older using prescription drugs for nonmedical reasons.  This represents approximately 20 percent of the U.S. population.

Alcoholism and drug dependence can affect all aspects of a person’s life.  Long-term use of alcohol and other drugs, both licit and illegal, can cause serious health complications affecting virtually every organ in the body, including the brain.  It can also damage emotional stability, finances, career, and impact family, friends and the entire community in which an alcoholic or drug abuser lives.

What is addiction?

Addiction is a primary, complex brain disorder.  It is characterized by compulsive drug seeking and use, despite harmful consequences, and by long-lasting chemical changes in the brain which interfere with a person’s ability to think clearly, exercise good judgment, control behavior, and feel normal without using drugs.  Addiction is often (but not always) accompanied by physical dependence, a withdrawal syndrome, and a need for increasing amounts of the substance to achieve the same effect.  For many people, addiction becomes chronic, with relapses possible even after long periods of abstinence.

For additional information about the disease of addiction, see Learn About Alcohol and Learn About Drugs.

For additional information about treatment for alcoholism and drug dependence, see Get Help and For Families and Friends.

Recently, Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA),  appeared on CBS’s 60 Minutes in a story titled "Hooked- Why Bad Habits Are Hard to Break."  Click here to read the full transcript of the show.

Today, millions of Americans, individuals and family members, from all walks of life--doctors, lawyers, housewives, teachers, pilots, nurses, etc., are living life in long-term recovery from addiction to alcohol and other drugs.  To learn more about recovery and the recovery community, see For People in Recovery and Hope, Help, and Healing.

Facts and FAQs About Alcoholism and Drug Dependence

• What does moderate drinking mean?  There is no one definition of moderate drinking, but generally the term is used to describe a lower-risk pattern of drinking.  According to the Dietary Guidelines for Americans from the U.S. Department of Health and Human Services (HHS), drinking in moderation is defined as having no more than 1 drink per day for women and no more than 2 drinks per day for men.  This definition refers to the amount consumed on any single day and is not intended as an average over several days.
• Why do some people react differently to alcohol than others?  Individual reactions to alcohol vary, and are influenced by many factors, such as: age, gender, race or ethnicity, physical condition (weight, fitness level, etc.), amount of food consumed before drinking, how quickly the alcohol was consumed, use of drugs or prescription medicines, family history of alcohol problems.
• Why can’t alcoholics or those who are drug dependent just stop?  While many who become addicted to alcohol and/or drugs would like to stop using, they can find it life-threatening, extremely difficult or impossible to do so.  Although the initial decision to use alcohol or drugs is voluntary for most people, the body and brain changes that occur over time with addiction take away a person’s self control and ability to resist intense impulses urging them to use alcohol and/or drugs.

When a person uses alcohol and/or drugs, the brain is flooded with dopamine.  Dopamine is a neurotransmitter that resides in the parts of the brain that control movement, emotion, cognition, motivation and feelings of pleasure.  When these systems are overloaded by substances, a person experiences euphoria--a feeling that many drug abusers attempt to recreate by repeatedly abusing a substance.  However, the brain of a substance abuser adjusts by producing less dopamine or reducing the number of receptors that can receive or transmit signals.  As long as people are addicted to or abusing substances, they cannot feel the joy and pleasure of everyday life.  Many drug abusers feel depressed or flat when they are not taking drugs and need to take drugs to get their dopamine levels back to normal.

Not everyone who uses alcohol or drugs is an addict or alcoholic.  A person becomes a substance abuser when the substance becomes so crucial that he or she is willing to risk other important aspects of life in order to have the substance.  This may be after the first time a substance is used, or it may take years.

• Is alcoholism genetically inherited?  Research shows that the risk for developing alcoholism runs in families.  But just because there is a genetic predisposition doesn't mean that the child of an alcoholic parent will automatically become an alcoholic.  Not all children of alcoholic families get into trouble with alcohol.  And some people develop alcoholism even though no one in their family has a drinking problem.

Lifestyle is a critical factor, as well.  Heavy drinking friends, elevated stress levels, and how readily alcohol is available are factors that may increase the risk for alcoholism.

• What are the most commonly used and abused drugs?  The most commonly used and abused drug, after alcohol, is marijuana.  Other common drugs of abuse include cocaine, heroin, inhalants, LSD (acid), MDMA (ecstasy), methamphetamine, phencyclidine (PCP), steroids (anabolic), Vicodin, OxyContin and other prescription drugs, including pain relievers, depressants and stimulants.
• Are prescription drugs dangerous?  Prescription drugs can be as dangerous as street drugs.  Prescription drugs require a prescription from a doctor because they are powerful substances, need to be regulated and taken under a physician's care.

Even if a person is prescribed a medication, taking more of that drug than the recommended dosage is dangerous, including accidental overdose.  Medical supervision is needed to avoid dangerous drug interactions, as well as potentially serious side effects.  And, prescription drugs can be addictive.  Between 1995 and 2005, treatment admissions for abuse of prescription pain relievers grew more than 300%.  Using prescription drugs without a prescription and medical supervision is unsafe and illegal.

• How quickly can a person get addicted to a drug?  There is no easy answer to this question.  If and how quickly one becomes addicted to a drug depends on many factors including biology.  All drugs are potentially harmful and may have life-threatening consequences associated with their use.  There are also vast differences among individuals in sensitivity to various drugs.

While one person may use a drug one or many times and suffer no ill effects, another person may be particularly vulnerable and overdose with first use.  There is no way of knowing in advance how someone may react.