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Addiction & Recovery

Substance Abuse

Although progress has been made in substantially lowering rates of substance abuse in the United States, the use of mind- and behavior-altering substances continues to take a major toll on the health of individuals, families, and communities nationwide. In 2005, an estimated 22 million Americans struggled with a drug or alcohol problem.

Substance abuse—involving drugs, alcohol, or both—is associated with a range of destructive social conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child abuse, and crime. Moreover, both social attitudes and legal responses to the consumption of alcohol and illicit drugs make substance abuse one of the most complex public health issues. Estimates of the total overall costs of substance abuse in the United States, including lost productivity and health- and crime-related costs, exceed $600 billion annually.1

Learn more about Tackling the Opioid Crisis in Waterbury, CT

Determinants of Substance Abuse

Several biological, social, environmental, psychological, and genetic factors are associated with substance abuse. These factors can include gender, race and ethnicity, age, income level, educational attainment, and sexual orientation.2 Substance abuse is also strongly influenced by interpersonal, household, and community dynamics.

Family, social networks, and peer pressure are key influencers of substance abuse among adolescents. For example, research suggests that marijuana exposure through friends and siblings was a primary determinant of adolescents’ current marijuana use.3 Understanding these factors is key to reducing the number of people who abuse drugs and alcohol and improving the health and safety of all Americans.

Health Impact of Substance Abuse

Substance abuse contributes to a number of negative health outcomes and public health problems, including:

  • Cardiovascular conditions
  • Pregnancy complications
  • Teenage pregnancy
  • Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
  • Sexually transmitted diseases (STDs)
  • Domestic violence
  • Child abuse
  • Motor vehicle crashes
  • Homicide
  • Suicide


1) National Institute on Drug Abuse, National Institutes of Health. Understanding drug abuse and addiction. NIDA InfoFacts. Bethesda, MD; 2011. p.1. Available from…

2) Centers for Disease Control and Prevention. CDC health disparities and inequalities report: United States, 2011. MMWR. 2011;60(suppl). Available from [PDF – 3MB]

3) Galea S, Nandi A, Vlahov D. The social epidemiology of substance use. Epidemiol Rev. 2004;26(1):36–52.


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