ABSTRACT
Of the major public health concerns of the 20th century, alcoholism and drug addiction certainly are among the most insidious and devastating. However defined, excessive use of alcohol and other drugs is an all-too-common problem, not only in the United States, but across the globe. A large national survey sponsored by the National Institute on Alcohol Abuse and Alcoholism found the lifetime prevalence of alcoholism in the U.S. population to be 13.4%; thus, one in seven people have had a problem with alcohol use in their lifetimes (Grant, 1997). Although the prevalences of other drug use disorders are much lower than for alcohol, they are sizable by nearly any standard. For illicit psychoactive substances, the lifetime prevalence of drug abuse or dependence is roughly 6% in the United States, with lifetime cannabis abuse (i.e., 4.6%) being the most common after alcohol (Grant, Peterson, Dawson, & Chou, 1994). The World Health Organization (1997) estimates that 28 million people worldwide incur significant health risks by using psychoactive substances other than alcohol. Annually, substance use in the United States claims 600,000 lives, including 440,000 attributable to nicotine use, 125,000 from alcohol use, and 10,000 from heroin and cocaine (exclusive of deaths from HIV; McCrady & Epstein, 1999).
