Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are sometimes considered stigmatizing and to discourage seeking treatment, so diagnostic terms such as alcohol use disorder or alcohol dependence are often used instead in a clinical context.
Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug misuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.
Alcohol dependence is a previous psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol.
Commonly-cited arguments for and against the prohibition of drugs include the following:
The gateway drug effect is a comprehensive catchphrase for the often observed effect that the use of a psychoactive substance is coupled to an increased probability of the use of further substances. Possible reasons for the connection include environmental influence, impulsive people seeking both soft and hard drugs, alterations in the brain due to earlier substance exposure, as well as similar attitudes of people who use different substances, and therefore experience a "common liability to addiction". In 2020, the National Institute on Drug Abuse released a research report which supported allegations that marijuana is a "gateway" to more dangerous substance use; one of the peer-reviewed papers cited in the report claims that while "some studies have found that use of legal drugs or cannabis are not a requirement for the progression to other illicit drugs [...] most studies have supported the "gateway sequence"." However, a 2018 literature review conducted by the National Institute of Justice, which analyzed 23 peer-reviewed research studies, concluded "that existing statistical research and analysis relevant to the "gateway" hypothesis has produced mixed results", and that "no causal link between cannabis use and the use of other illicit drugs can be claimed at this time."
Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.
Nora D. Volkow is a Mexican-American psychiatrist. She is currently the director of the National Institute on Drug Abuse (NIDA), which is part of the National Institutes of Health (NIH).
David C. Lewis was Professor Emeritus of Medicine and Community Health and the Donald G. Millar Distinguished Professor of Alcohol and Addiction Studies at Brown University.
Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include substance use problems and problematic drug or alcohol use.
Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use can alter brain function in synapses similar to natural rewards like food or falling in love in ways that perpetuate craving and weakens self-control for people with pre-existing vulnerabilities. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in the development of addiction. While mice given cocaine showed the compulsive and involuntary nature of addiction, for humans this is more complex, related to behavior or personality traits.
Cannabis use disorder (CUD), also known as cannabis addiction or marijuana addiction, is a psychiatric disorder defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-10 as the continued use of cannabis despite clinically significant impairment.
Mark S. Gold is an American physician, academic, and researcher known for his work on the effects of opioids, cocaine, tobacco, and food on brain function and behavior. He has held academic positions as a professor of neuroscience and psychiatry and served as chair of the Department of Psychiatry at the University of Florida College of Medicine, where he established the Division of Addiction Medicine.
Michael P. Botticelli is an American public health official who served as the director of the White House Office of National Drug Control Policy (ONDCP) from March 2014 until the end of President Obama's term. He was named acting director after the resignation of Gil Kerlikowske, and received confirmation from the United States Senate in February 2015. Prior to joining ONDCP, he worked in the Massachusetts Department of Public Health. Following completion of his service as ONDCP Director, he became the executive director of the Grayken Center for Addiction Medicine at the Boston Medical Center.
Charles P. O'Brien is a research scientist, medical educator and a leading expert in the science and treatment of addiction. He is board certified in neurology, psychiatry and addiction psychiatry. He is currently the Kenneth E. Appel Professor of Psychiatry, and vice chair of psychiatry, in the Perelman School of Medicine at the University of Pennsylvania.
John R. Knight is an Associate Professor of Pediatrics at Harvard Medical School (HMS) and the Associate Director for Medical Education at the HMS Division on Addictions. In 1999, he founded the Center for Adolescent Substance Abuse Research (CeASAR) and its companion outpatient clinic, the Adolescent Substance Abuse Program (ASAP). CeASAR and ASAP were the first programs of their kind to be located at a children’s hospital. He is best known as the clinical scientist who developed and validated the CRAFFT substance abuse screen for adolescents. In 2008 he was named the inaugural incumbent of the Boston Children’s Hospital Endowed Chair in Developmental Medicine
Elinore F. McCance-Katz is an American physician, academic, and government official who served as Assistant Secretary of Health and Human Services for Mental Health and Substance Use from 2017 to 2021. Prior to assuming her current role, she was the chief medical officer for the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals and a professor at the Alpert Medical School at Brown University. Her nomination was supported by the American Psychiatric Association, which released a statement saying "Dr. McCance-Katz has a wealth of experience in academic and public sector settings in addressing mental health and substance use disorders."
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.
Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.
John F. Kelly is an American-based researcher and professor of addiction medicine at Harvard Medical School. He is the Founder and Director of the Massachusetts General Hospital Recovery Research Institute, Associate Director of the MGH Center for Addiction Medicine, and Program Director of the MGH Addiction Recovery Management Service.
Amy Janes is an American psychiatry researcher. She is chief of the Cognitive and Pharmacological Neuroimaging Unit at the National Institute on Drug Abuse's Intramural Research Program. She is known for her work using multimodal neuroimaging to examine individual differences and potential therapeutics in addictive and substance use disorders. Prior to joining NIDA, Janes was an associate professor at Harvard Medical School, working at McLean Hospital, where she founded the Functional Integration of Addiction Research Laboratory.
