D rug-Related Deaths up 59%.” “Driving-and-Drinking Accident Claims 5 Lives.” “Teen Drug Abuse-The News Is Bad.”

The headlines tell a story with a moral, or lesson. The lesson is that the United States has a major health and social problem. Once called by a number of names, including alcoholism , drug addiction , and drug abuse , the problem today goes by the designation substance abuse . In this usage, the phrase applies to all forms of addiction or abuse, whether the substance is alcohol or such vegetation-derived drugs as marijuana, cocaine, and heroin.

In a broad sense, substances include any material aside from food that can be imbibed, injected, or taken into the body in any way and that changes or affects the body or mind. This definition covers aspirin, many medications, tobacco, and a broad range of other substances. But substance abuse refers to unhealthy or excessive use of any material, alcohol, or addictive drugs at an individual's discretion and not according to a physician's prescription.

The dimensions of the substance-abuse problem are almost incalculable. Americans in 1986 spent an estimated $110 billion on addictive drugs alone. At least 40 percent of all Americans between the ages of 18 and 25 had experimented with one or more illegal substances. As one authority wrote,

Not only the poor, the uneducated, the deprived, or the shadow types are being destroyed. We're dealing with the privileged, the successful, the professional.

Alcohol Abuse

A lcohol abuse is not unique to the United States or to the twentieth century. Alcoholic beverages, and their use or abuse, have an ancient history. Long before humans began to keep records of any kind, these beverages were valued as food, medicine, and ceremonial drinks. When people today have a beer with dinner, or toast newly weds with champagne, or share wine at a religious ritual or festival, they are continuing traditions that have deep roots in the past.

The consumption of alcoholic beverages has always been a fact of life. So has, in a sense, alcohol abuse. The immigrants who came to the United States brought their ethnic ceremonies and drinking habits with them. The frontiersmen who moved continually west found liquor to be a source of release and comfort. Inevitably, alcohol use and abuse occurred.

Most drinkers have been, and are, able to control what they are doing and are none the worse for the habit. However, of the estimated 100 million drinkers in the United States, about 10 million have some kind of problem with alcohol: they are alcohol abusers . The 10 million alcoholics cost the economy some $60 billion annually. Drunken drivers are implicated in about half of the nearly 50,000 traffic deaths occurring yearly.

Scientists have come to believe that habitual alcohol abuse is a disease and should be treated as such. In 1956, the American Medical Association officially termed alcoholism an illness and a medical responsibility.