The impact of alcohol, tobacco, and other drug use and abuse in the emergency department

Substance abuse is a major preventable public health problem affecting all racial, cultural, and socioeconomic groups with the total annual economic costs to the United States currently estimated at over $414 billion [1]. Over 500,000 deaths annually are attributable to alcohol, tobacco, or illicit drug use: 107,000 related to alcohol [2], 25,000 to illicit drugs [2], and 435,000 to tobacco [3]. Substance abuse is a risk factor for multiple diseases and a major risk factor for injury [4]. Tobacco use, especially cigarette smoking, is the leading cause of preventable disease and a major risk factor for heart disease, stroke, lung cancer, and chronic lung diseases [5]. It is responsible for more than 30% of all cancer deaths each year [6]. An estimated 18 million people have alcohol abuse problems, whereas an additional 5 million abuse other drugs [7]. Less than 3% of people with alcohol problems and fewer than 10% with drug problems receive treatment, despite the fact that substance abuse treatment has been demonstrated to be effective in reducing use and costs associated with substance abuse [8]. The consequences of substance abuse affect not only individuals, but also families, workplaces, and communities.