Substance Misuse and Addictions in Context

The world has been afflicted by substance misuse and addiction since the beginning of time. Yet, despite being recognized for millennia, substance misuse still causes stigma in the twenty-first century. Determining the prevalence of addiction and substance misuse, the attributable harm is fundamental to acknowledging the scale of the problem. The Global Burden of Disease study highlights the significant morbidity and mortality associated with substance misuse. On a global basis, disability-adjusted life years (DALYs) caused by substance misuse is high. The present chapter briefly reviews the prevalence and burden of disease caused by substance misuse. However, it must be recognized that studies of addiction are likely to underestimate the true scale of the disease burden due to the stigma associated with substance misuse and/or, its underreporting. Furthermore, while global and holistic data presents a quasi-overview, consideration must be given to the fact that within each area of substance misuse there is a considerable variation in the tissues and organs affected as well as their public health implications. Furthermore, addictions also be placed in the context of their impact on individual quality-of-life measures. Even then, consideration must also be given to the fact that the family unit is also affected. This is particularly evident from the point of view of physicians who may encounter the wide-ranging consequences of substance misuse. Thus, there is a transition from the molecular and cellular effects of a particular substance to its public health impact. However, not all addictions are related to chemical substances and the impact of behavioral addictions is receiving increasing attention.