From the applied behavior analysis literature and the behavioral psychology literature, several evidence-based intervention programs have emerged, such as behavioral marital therapy, community reinforcement approach, cue exposure therapy, and contingency management strategies.[48][49] In addition, the same author suggests that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious.
Medication
[edit]
Medication-assisted treatment (MAT) refers to the combination of behavioral interventions and medications to treat substance use disorders.[50] Certain medications can be useful in treating severe substance use disorders. In the United States five medications are approved to treat alcohol and opioid use disorders.[51] There are no approved medications for cocaine, methamphetamine.[51][52]
Medications, such as methadone and disulfiram, can be used as part of broader treatment plans to help a patient function comfortably without illicit opioids or alcohol.[53] Medications can be used in treatment to lessen withdrawal symptoms. Evidence has demonstrated the efficacy of MAT at reducing illicit drug use and overdose deaths, improving retention in treatment, and reducing HIV transmission.[54][55][56]
Potential vaccines for addiction to substances
[edit]
Vaccines for addiction have been investigated as a possibility since the early 2000s.[57] The general theory of a vaccine intended to "immunize" against drug addiction or other substance abuse is that it would condition the immune system to attack and consume or otherwise disable the molecules of such substances that cause a reaction in the brain, thus preventing the addict from being able to realize the effect of the drug. Addictions that have been floated as targets for such treatment include nicotine, opioids, and fentanyl.[58][59][60][61] Vaccines have been identified as potentially being more effective than other anti-addiction treatments, due to "the long duration of action, the certainty of administration and a potential reduction of toxicity to important organs".[62]
Specific addiction vaccines in development include:
NicVAX, a conjugate vaccine intended to reduce or eliminate physical dependence on nicotine.[63] This proprietary vaccine is being developed by Nabi Biopharmaceuticals[64] of Rockville, MD. with the support from the U.S. National Institute on Drug Abuse. NicVAX consists of the hapten 3'-aminomethylnicotine which has been conjugated (attached) to Pseudomonas aeruginosa exotoxin A.[65]
TA-CD, an active vaccine[66] developed by the Xenova Group which is used to negate the effects of cocaine. It is created by combining norcocaine with inactivated cholera toxin. It works in much the same way as a regular vaccine. A large protein molecule attaches to cocaine, which stimulates response from antibodies, which destroy the molecule. This also prevents the cocaine from crossing the blood–brain barrier, negating the euphoric high and rewarding effect of cocaine caused from stimulation of dopamine release in the mesolimbic reward pathway. The vaccine does not affect the user's "desire" for cocaine—only the physical effects of the drug.[67]
TA-NIC, used to create human antibodies to destroy nicotine in the human body so that it is no longer effective.[68]
As of September 2023, it was further reported that a vaccine "has been tested against heroin and fentanyl and is on its way to being tested against oxycontin".[69]
Epidemiology
[edit]
The disability-adjusted life year, a measure of overall disease burden (number of years lost due to ill-health, disability or early death), from drug use disorders per 100,000 inhabitants in 2004
no data
<40
40-80
80-120
120-160
160-200
200-240
240-280
280-320
320-360
360-400
400–440
>440
Rates of substance use disorders vary by nation and by substance, but the overall prevalence is high.[70] On a global level, men are affected at a much higher rate than women.[70] Younger individuals are also more likely to be affected than older adults.[70]
United States
[edit]
In 2020, 14.5% of Americans aged 12 or older had a SUD in the past year.[71] Rates of alcohol use disorder in the past year were just over 5%. Approximately 3% of people aged 12 or older had an illicit drug use disorder.[71] The highest rates of illicit drug use disorder were among those aged 18 to 25 years old, at roughly 7%.[71][70]
There were over 72,000 deaths from drug overdose in the United States in 2017,[72] which is a threefold increase from 2002.[72] However the CDC calculates alcohol overdose deaths separately; thus, this 72,000 number does not include the 2,366 alcohol overdose deaths in 2017.[73] Overdose fatalities from synthetic opioids, which typically involve fentanyl, have risen sharply in the past several years to contribute to nearly 30,000 deaths per year.[72] Death rates from synthetic opioids like fentanyl have increased 22-fold in the period from 2002 to 2017.[72] Heroin and other natural and semi-synthetic opioids combined to contribute to roughly 31,000 overdose fatalities.[72] Cocaine contributed to roughly 15,000 overdose deaths, while methamphetamine and benzodiazepines each contributed to roughly 11,000 deaths.[72] Of note, the mortality from each individual drug listed above cannot be summed because many of these deaths involved combinations of drugs, such as overdosing on a combination of cocaine and an opioid.[72]
Deaths from alcohol consumption account for the loss of over 88,000 lives per year.[74] Tobacco remains the leading cause of preventable death, responsible for greater than 480,000 deaths in the United States each year.[75] These harms are significant financially with total costs of more than $420 billion annually and more than $120 billion in healthcare.[76]
Canada
[edit]
According to Statistics Canada (2018), approximately one in five Canadians aged 15 years and older experience a substance use disorder in their lifetime.[77] In Ontario specifically, the disease burden of mental illness and addiction is 1.5 times higher than all cancers together and over 7 times that of all infectious diseases.[78] Across the country, the ethnic group that is statistically the most impacted by substance use disorders compared to the general population are the Indigenous peoples of Canada. In a 2019 Canadian study, it was found that Indigenous participants experienced greater substance-related problems than non-Indigenous participants.[79]
Statistics Canada's Canadian Community Health Survey (2012) shows that alcohol was the most common substance for which Canadians met the criteria for abuse or dependence.[77] Surveys on Indigenous people in British Columbia show that around 75% of residents on reserve feel alcohol use is a problem in their community and 25% report they have a problem with alcohol use themselves. However, only 66% of First Nations adults living on reserve drink alcohol compared to 76% of the general population.[80] Further, in an Ontario study on mental health and substance use among Indigenous people, 19% reported the use of cocaine and opiates, higher than the 13% of Canadians in the general population that reported using opioids.[81][82]
Australia
[edit]
Historical and ongoing colonial practices continue to impact the health of Indigenous Australians, with Indigenous populations being more susceptible to substance use and related harms.[83] For example, alcohol and tobacco are the predominant substances used in Australia.[84] Although tobacco smoking is declining in Australia, it remains disproportionately high in Indigenous Australians with 45% aged 18 and over being smokers, compared to 16% among non-Indigenous Australians in 2014–2015.[85] As for alcohol, while proportionately more Indigenous people refrain from drinking than non-Indigenous people, Indigenous people who do consume alcohol are more likely to do so at high-risk levels.[86] About 19% of Indigenous Australians qualified for risky alcohol consumption (defined as 11 or more standard drinks at least once a month), which is 2.8 times the rate that their non-Indigenous counterparts consumed the same level of alcohol.[85]
However, while alcohol and tobacco usage are declining, use of other substances, such as cannabis and opiates, is increasing in Australia.[83] Cannabis is the most widely used illicit drug in Australia, with cannabis usage being 1.9 times higher than non-Indigenous Australians.[85] Prescription opioids have seen the greatest increase in usage in Australia, although use is still lower than in the US.[87] In 2016, Indigenous persons were 2.3 times more likely to misuse pharmaceutical drugs than non-Indigenous people.[85]