May 31, 2024 - Health

The addiction crisis is even worse than headlines can convey

Illustration of a cityscape made of alcohol and drugs with a pill as a moon.

Illustration: Shoshana Gordon/Axios

Everyone knows the country's addiction crisis is bad, but even the direst headlines just barely scratch the surface.

Why it matters: We spend a lot of time talking about drug overdose deaths, which each year are nearly double the number of Americans killed in the Vietnam War. But overdose deaths are only one measure of the drug epidemic's severity — and even the formal toll doesn't capture the true extent of drugs' lethal power, experts say.

  • "That overdose number is only looking at overdoses. It's not looking at the person who dies of bacterial endocarditis related to their drug and alcohol use," said Cara Poland, an addiction medicine doctor at the Michigan State University College of Human Medicine.

The big picture: The evolving opioid epidemic has morphed again into a multi-drug crisis centered on fentanyl, which is often paired — knowingly or unknowingly — with other illicit drugs.

  • While more than 100,000 people are dying from drug overdoses every year — and alcohol regularly kills more — tens of millions misuse or are addicted to drugs. That also levies an emotional and financial toll on tens of millions more loved ones.

By the numbers: Nearly 49 million Americans 12 and older had a substance use disorder in 2022, including 30 million with an alcohol use disorder and more than 27 million with a drug use disorder, according to the most recent federal survey on drug use.

  • Put another way, that's more than 17% of that population. Among young adults ages 18-25, the share jumps to 28%.
  • More than 6 million people had an opioid use disorder, and another 1.8 million had a methamphetamine use disorder.

When put together with the mental health crisis — which I wrote about in depth last week — the behavioral health burden is enormous. And keep in mind, substance abuse and mental illness often feed off of one another.

  • In 2022, a third of adults had either a mental illness or a substance use disorder within the last year, including nearly 22 million people who had both.
  • Nearly half of young adults ages 18-25 had either a mental illness or a substance use disorder.

That's a lot of hard-to-fathom numbers, but bear with me for one more: An estimated 321,566 children lost a parent to drug overdose between 2011 and 2021, according to a JAMA Psychiatry study this month.

  • That's a tragedy, but it's also a mass trauma. And childhood trauma is one of the main risk factors for addiction later on.
  • "Not only does that have a direct economic impact on that family, but it's profoundly scarring," said Brendan Saloner, director of practice for Johns Hopkins' Center for Mental Health and Addiction Policy.
  • Millions of children live with parents who misuse substances or have a substance use disorder.

The bottom line: The addiction crisis obviously has huge implications for the health care system and the U.S. economy. But it also places enormous burdens on individuals, families and communities.

  • "I think there's a very narrow clinical way of thinking about it, in terms of thinking about the reality that there's all these people who have this sort of physical impairment," Saloner said.
  • "But I think there's another way of thinking about it in terms of lost potential; [people] who are not able to be their best self because of their substance abuse issue."
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