A young mother and her four children are being seen in a free clinic within a homeless shelter for various health reasons (Figure 229-1). The woman is currently clean and sober, but has a long history of cocaine use and addiction (Figure 229-2). Her children span the ages of 3 months to 5 years. She was recently living with her mother after the birth of her youngest child, but was kicked out of her mother’s home when she began to use cocaine once again. The patient gave written consent to the photograph and when she was shown the image on the digital camera she noted how depressed she looked. She asked for us to tell the viewers of this photograph that these can be the consequences of drug abuse—being depressed, homeless, and a single mom. Only time will reveal the effect of this situation on her four children. They are at risk for so many problems including neglect, abuse, behavioral issues and being placed in foster care. They are also at higher risk of developing substance abuse disorder. Being the health care provider for these children requires understanding the disease of addiction and the consequences of this on the family.

Addiction occurs when substance use has altered brain function to an extent that an individual loses a degree of control over his or her behaviors. Addiction is an epigenetic phenomenon. Many genes influence the brain functions that affect behavior and genetic variants. These genes differ in their susceptibility to environmental conditions, which trigger the changes in brain circuitry, and contribute to the development of addiction. Addiction must be recognized and treated as a chronic illness with an interprofessional team and social support.

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  An estimated 69.6 million Americans age 12 years or older were current users of a tobacco product in 2010. This represents 27.4 percent of the population in that age range. In addition, 58.3 million persons (23% of the population) were current cigarette smokers, 13.2 million (5.2%) smoked cigars, 8.9 million (3.5%) used smokeless tobacco, and 2.2 million (0.8%) smoked tobacco in pipes.¹

  
  
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  An estimated 22.6 million Americans age 12 years or older were current illicit drug users in 2010. This represents 8.9 percent of the population in that age range.¹

  
  
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  Marijuana was the most commonly used illicit drug (17.4 million users; Figures 229-3 and 229-4). It was used by 76.8 percent of current illicit drug users. Among current illicit drug users, 60.1 percent used only marijuana, 16.7 percent used marijuana and another illicit drug, and the remaining 23.2 percent used only an illicit drug other than marijuana.¹

  
  
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  There were 1.5 million persons who were current cocaine users in 2010.¹

  
  
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  There were 353,000 persons who were current methamphetamine users in 2010 (Figure 229-5).¹

  
  
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  Hallucinogens were used by 1.2 million persons (0.5%) in 2010, including 695,000 (0.3%) who had used ecstasy (Figure 229-6).¹

  
  
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  In 2010, 140,000 persons used heroin for the first time (Figure 229-7).¹

  
  
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  There were 9 million people age 12 years or older (3.6%) who were current users of illicit drugs other than marijuana in 2010. Most (7 million, 2.7%) used psychotherapeutic drugs nonmedically (including prescription drugs). Of these, 5.1 million used pain relievers, 2.2 million used tranquilizers, 1.1 million used stimulants, and 374,000 used sedatives.¹

  
  
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  Among persons who used pain relievers nonmedically in the past 12 months, 55 percent reported that the source of the drug was from a friend or relative for free. Another 17.3 percent reported that they got the drug from a physician. Only 4.4 percent obtained the pain relievers from a drug dealer or other stranger, and only 0.4 percent reported buying the drug on the Internet.¹

Association With Cigarette and Alcohol Use

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  In 2010, the rate of current illicit drug use was 8.5 times higher among youths age 12 to 17 years who smoked cigarettes in the past month (52.9%) than it was among youths who did not smoke cigarettes in the past month (6.2%).¹

  
  
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  Past month illicit drug use was also associated with the level of past month alcohol use. Among youths age 12 to 17 years in 2010 who were heavy drinkers (i.e., drank 5 or more drinks on the same occasion [i.e., at the same time or within a couple of hours] on each of 5 or more days in the past 30 days), 70.6 percent were also current illicit drug users, which was higher than among nondrinkers (5.1%).¹