Substance Use Disorder

Substance Use Disorder
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Substance abuse, such as alcohol or drug abuse, can impact individuals, families, and communities. Its effects can significantly contribute to social, physical, mental, and public health problems. [ Reference 1 ] According to the Centers for Disease Control and Prevention (CDC), there are approximately 88,000 deaths attributable to excessive alcohol use each year in the United States (U.S.). Excessive alcohol use is a leading lifestyle-related cause of death in the nation. [ Reference 2 ] In 2005, there were over 1.6 million hospitalizations and over four million emergency room visits for alcohol-related conditions. [ Reference 3 ] The detrimental effects of excessive alcohol consumption can lead to medical issues with organs including the liver, pancreas, heart or brain, increased risk for certain cancers (mouth, esophagus, throat, liver, or breast), a weakened immune system, fetal alcohol exposure, and increased risk for suicide and other injuries. [ Reference 4 ]

Results from the U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) 2013 National Survey on Drug Use and Health indicate that in 2013, slightly more than half of Americans age 12 or older reported being current drinkers of alcohol with almost 38 percent of 18 to 25 year olds binging on alcohol in the last 30 days (binge drinking is defined as having five or more drinks on the same occasion on at least one day in the 30 days prior to the survey).

The financial costs of excessive drinking are enormous and represent a drain on the American economy. It is estimated that excessive drinking cost the U.S. $249 billion in 2010. Most of that figure ($191 billion) was accounted for by binge drinking (five or more drinks per occasion for men; four or more drinks per occasion for women). [ Reference 5 ]

The 2013 National Survey on Drug Use and Health also indicated that an estimated 24.6 million Americans age 12 or older were current illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 9.4 percent of the population age 12 or older. Illicit drugs include: marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used non-medically. Among young adults ages 18 to 25, the rate of current nonmedical use of prescription-type drugs in 2013 was 4.8 percent. Illicit drug use and addiction costs the United States more than $193 billion in crime, health, and productivity each year, including criminal justice, crime victim, hospital and emergency department, insurance administration, labor participation, specialty treatment, incarceration, premature mortality, and other costs [ Reference 6 ]

Military Substance Use

Alcohol and substance misuse are areas of concern for the military given their potential impacts to mission readiness, productivity, personal health, and mental health. Of particular concern are binge drinking and heavy drinking and their connection to combat exposure and deployment-related psychological stress. The Department of Defense (DoD) regularly tracks alcohol and illicit drug use in the military. The most recent survey, the 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel (HRB), indicated that among current alcohol drinkers, approximately 40 percent of active-duty service members reported binge drinking in the past 30 days, with the Marine Corps reporting the highest rate of binge drinking (56.7 percent) and the Air Force reporting the lowest rate (28.1 percent). Findings indicate that 11.3 percent of active-duty personnel were classified as problem drinkers (Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8).

According to the HRB, almost 90 percent of active-duty service members reported having received drug testing in the past year. Aggressive testing, along with several policies, may contribute to the low illicit drug use (1.4 percent) of active-duty service members in comparison to civilians (9.4 percent [ Reference 7 ]Active-duty service members who responded to the HRB also reported low prescription drug misuse (1.3 percent) with the most popular misused prescription drugs being steroids (16.6 percent) and stimulants (11.6 percent).

Alcohol dependence was one of the top four mental health conditions represented in outpatient clinical encounters for male service members, from 2004 to 2013 [ Reference 8 ]In 2013, Alcohol dependence was one of the top five diagnoses for hospitalizations for male service members, accounting for more than 1,700 hospitalizations [ Reference 9 ]Substance abuse was among the top 10 conditions for overall medical encounters in 2013, accounting for 373,515 medical encounters and 51,130 hospital bed days (the second most of any diagnostic category) [ Reference 10 ]Clearly, alcohol and substance use disorders represent significant health care burdens and associated decrements to military readiness among U.S. service members.

The 2011 HRB also specifically examined mental health in relation to substance use. Heavy drinkers, defined as those who reported consuming five or more drinks per typical drinking occasion at least once a week, reported greater psychological and general distress compared to other respondents. Heavy drinkers reported higher levels of:

  • Overall stress
  • Relationship difficulties
  • Financial problems
  • Symptoms of anxiety
  • Symptoms of depression
  • Symptoms of post-traumatic stress
  • Suicidal ideation
  • History of abuse 

VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders (SUD)

In September 2001, DoD and the Department of Veterans Affairs (VA) released the VA/DoD Management of Substance Use Disorders in Primary and Specialty Care Clinical Practice Guideline. It was designed to assist clinicians in evaluating and managing adult patients with substance use disorders (SUD). In 2009, the guideline was revised and renamed the VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders. This guideline was most recently updated in 2015.

The 2015 guideline consists of two modules:

  1. Module A - Screening and Treatment
  2. Module B - Stabilization

For further information on this VA/DoD CPG for substance use disorders and other CPGs, as well as related provider and patient/family support tools, visit the Clinical Guidance section.