Legal and Illegal Drugs of Abuse:
Both are Hurting Our Country
Eugene H. Rubin, MD, PhD is Professor and Vice-Chair for Education in the Department of Psychiatry at Washington University in St. Louis – School of Medicine. Charles F. Zorumski MD is the Samuel B. Guze Professor and Head of the Department of Psychiatry at Washington University in St. Louis – School of Medicine, where he is also Professor of Neurobiology. In addition, he is Psychiatrist-in-Chief at Barnes-Jewish Hospital and Director of the Washington University McDonnell Center for Cellular and Molecular Neurobiology. Together they wrote, Demystifying Psychiatry: A Resource for Patients and Families, which offers a straightforward description of the specialty and the work of its practitioners. In the excerpt below we learn about the prevalence of psychiatric disorders. In the original article below they argue for funds to support drug prevention rather than for research for the resulting medical problems.
Heart disease, cancer, and stroke are the leading causes of death in the US. This is well known. What is less well known is that cigarette smoking (nicotine dependence) is the most important preventable contributor to these causes of death and alcohol abuse is the third most important contributor. These two legal substances have substantial addiction potential and together account for more than 400,000 deaths per year in the US. Once a young person smokes more than about 100 cigarettes, his or her chances of becoming addicted are substantial. Long term risky drinking predisposes a person to many health consequences in addition to enhancing the risk of becoming alcohol dependent. Risky alcohol use is defined as drinking 5 or more alcoholic beverages (12 oz beer equivalents) over a few hours on repeated occasions (actually, it is 5 drinks for men and 4 for women).
When misused, alcohol can lead to job loss, destruction of relationships, and a myriad of physical ailments not to mention its contribution to increased rates of traffic accidents, violence, and suicides. Alcohol-related disorders are major reasons why our emergency rooms (ERs) are so busy.
Cocaine, methamphetamine, and heroin are illegal drugs that with repeated use can take over a person’s ability to behave rationally. These addictive drugs have severe physical and psychiatric consequences. They destroy relationships as well and harm society in obvious ways. They also increase our health care costs and tie up our ERs.
All of these drugs, including nicotine and alcohol, hijack the brain’s motivational system and hamper its executive system (the part of the brain that helps us think, plan, and learn). Each drug interacts with the “wiring” of these brain systems in different, but related, ways. The cigarette smoker who reaches for a smoke before getting out of bed in the morning, the alcoholic who needs an eye-opener to start the day, and the woman who prostitutes herself in order to get her next injection of heroin – all are responding to the control of an abused substance.
Although the use and trafficking of illegal drugs grab the majority of headlines, cigarettes and alcohol actually have more dramatic effects on our country’s overall health. Because they are abused by so many people, they contribute much more to the burden on our healthcare system than the relatively lesser used illegal drugs. Our point is not to minimize how bad illegal drugs are for individuals and society but to sensitize all of us to the much larger health problems related to the legal use of cigarettes and alcohol. This also raises an important point when considering whether it is wise to legalize other abused drugs, including marijuana.
Treatments for nicotine and alcohol dependence exist but are only modestly effective. Clinical and basic science research which could lead to more effective treatments is underway. This work is aided by neuroscience research investigating how these drugs exert their controlling effects on our brains. Research and clinical efforts in this area are grossly underfunded compared to what is spent on cancer and heart disease, end-stage illnesses that are associated with cigarette and alcohol dependence. We would argue that efforts aimed at prevention and more effective early interventions for addictive disorders could have much greater impact on our country and health care economics than new treatments for the medical problems that result from these addictions.