The Social Epidemiology of Substance Use

Tobacco, alcohol, and illicit substance use continue to result in substantial morbidity and mortality and significant societal economic costs despite considerable efforts to minimize use of licit substances and prevent use of illicit substances. Each year, more than 400, 000 Americans die from cigarette smoking, and one in every five deaths in the United States is believed to be smoking related (1). Consequences of alcohol and illicit substance abuse include, among others, cirrhosis, job loss, and criminal behavior related to the acquisition and sale of illicit drugs. The economic costs of addiction were estimated as 400 billion yearly in the United States in 1999 (2). Substance use is associated with a wide range of risk behaviors. For the more commonly used substances, risk behavior includes symptoms of both dependence (e. g. , reducing important activities because of use of the substance) and abuse (e. g. , driving a car more than once while intoxicated, getting into trouble with superiors or co-workers because of intoxication). For example, in 2002, 4. 7 percent of the population reported driving under the influence of an illicit drug and 14. 2 percent reported driving under the influence of alcohol at least once during the past year (3).