Substance abuse and substance addiction are two separate but overlapping conditions that can occur in people who misuse alcohol or a broad spectrum of medications and illegal drugs. In mental health terms, the single diagnosis used to account for both of these conditions is substance use disorder. Every year, the Substance Abuse and Mental Health Services Administration uses a nationwide effort called the National Survey on Drug Use and Health to roughly determine how many U.S. teenagers and adults qualify as substance abusers or substance addicts.

The Basics

Substance abuse occurs whenever an individual participates in a pattern of alcohol, drug or medication use that can seriously damage his or her physical health and/or mental well-being. Some people begin a pattern of abuse through purely recreational substance involvement, while others begin such a pattern by misusing a properly prescribed medication or self-medicating without any form of guidance from a physician. As a rule, doctors consider officially diagnosing issues of substance abuse in non-addicted users whose patterns of substance intake clearly cause harm to self or others. A substance addict has undergone long-term changes in his or her brain function that trigger a physical dependence on the continued use of the substance in question. In addition, he or she experiences accompanying problems such as repeated cravings for more substance use, uncontrolled substance intake and a substance tolerance that leads to increasing levels of intake. Any affected person can simultaneously have symptoms related to both abuse and addiction.

The Overall Picture

The federal researchers behind the National Survey on Drug Use and Health (NSDUH) release their findings in the fall of each year. The most recent findings, released in the fall of 2013, cover the timespan between the tail end of 2011 and most of 2012. Altogether, approximately 22.2 million Americans age 12 or older had diagnosable cases of substance abuse or substance addiction during this period of time. Roughly 14.9 million of these affected individuals had problems that related only to the use of alcohol. Another 4.5 million people had problems that related only to the use of a drug or medication. In addition, about 2.8 million affected individuals had problems that stemmed from the use of both alcohol and some form of drug or medication.

Breakdown by Substance

In addition to tracking overall totals for substance abuse and addiction, the NSDUH tracks the number of people who have diagnosable problems related to the use of specific substances. In 2012, marijuana was by far the drug or medication most commonly associated with serious substance-related problems; roughly 4.3 million users of this substance were affected. In descending order, the other drugs and medications most likely to function as sources of abuse or addiction were opioid painkillers (approximately 2.1 million users affected), cocaine (approximately 1.1 million users affected), prescription tranquilizers (approximately 629,000 affected), stimulants other than cocaine (approximately 535,000 affected), heroin (approximately 467,000 affected), LSD and other hallucinogens (approximately 331,000 affected), inhalants (approximately 164,000 affected) and prescription sedatives (approximately 135,000 affected).

Additional Considerations

Doctors and public health officials know that, statistically speaking, a person’s age at the time he or she first tries alcohol has an important influence on his or her chances of developing symptoms of substance abuse or substance addiction in later life. They also know that a person’s age at his or her first exposure to marijuana has an impact on later substance-related risks. In 2012, the results from the National Study on Drug Use and Health show that people who first drank alcohol before age 15 developed serious problems with substance abuse or addiction at a rate of 16.1 percent during adulthood; conversely, only 3.6 percent of the people who first drank alcohol after reaching the age of 18 developed such problems. In addition, people who first used marijuana before the age of 15 developed problems with substance abuse or addiction during adulthood about 2.2 percent more often than people who used the drug for the first time after reaching the age of 18.

Overall, the rate for drug and medication abuse and addiction rose fairly sharply between 2011 and 2012. The single most notable spike occurred in people affected by cocaine abuse or addiction. Still, the combined, long-term rate for all forms of drug- and medication-related abuse and addiction rose only slightly in the decade between 2002 and 2012.