8 Common Misconceptions About Substance Abuse

With an increase in the number of people using marijuana and the epidemic level of prescription drug misuse, substance abuse has become a critical public health problem in the United States.

In response to the growing substance abuse problems facing the country, in 2016 the former U.S. Surgeon General Vivek H. Murthy issued a historic report, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health," in hopes of ending the public health crisis of addiction.

Throughout the exhaustive 428-page report, which takes a comprehensive look at all facets of the substance abuse problem, featured sections are dedicated to explaining factors involved that may be little known, misunderstood or misconceptions about substance abuse issues. A few of those topics are discussed below.


Substance Use Disorders Are as Prevalent as Diabetes

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Almost 21 million people age 12 and older in the U.S. meet the criteria for a diagnosis of having a substance use disorder. That is approximately 8 percent of the entire adolescent and adult population and is comparable to the number of people who have diabetes.

People with a substance use disorder outnumber those who have thyroid conditions and are equal to 1.5 times the number of people who have been diagnosed with all types of cancers combined—breast cancer, lung cancer, prostate cancer, colon cancer, liver cancer, and all other cancers combined.

The 21 million Americans with substance use disorders do not include the millions of people who have engaged in harmful drinking (binge drinking and heavy drinking) or who have used illegal drugs in the past 12 months but do not meet the criteria for a diagnosable substance use disorder.

According to the Surgeon General's report, of the 265 million Americans over the age of 12:

  • 175 million (65.7%) drank alcohol
  • 66.7 million (24.9%) reported binge drinking
  • 17.3 million (6.5%) were heavy drinkers
  • 36 million (13.5%) used marijuana
  • 18.9 million (7.1%) misused prescription drugs
  • 300,000 used heroin

Binge drinking, according to the report, is "drinking five (males)/four (females) or more drinks on the same occasion on at least one day in the past 30 days" and heavy drinking for both men and women is binge drinking at least five times in the past 30 days.


Opioid Overdose Deaths Have Increased Four-Fold

A trend of over-prescribing opioid pain pills which began in the 1990s resulted in a rapid increase in the use and misuse of these pain relievers. The escalation of opioid use soared throughout all regions of the country and across demographic lines.

When authorities cracked down on "pill mills" and "doctor shopping" across the nation, pain pills became more difficult to obtain and more expensive. As a result, many users ​began using heroin which was cheaper and more available.​​

This trend was evidenced in the steep rise in opioid overdose deaths throughout the U.S., increasing nearly four-fold between 1999 and 2014, according to the report.


The Difference Between Misuse and Abuse

You may not know the difference between the terms "substance misuse" and "substance abuse" because, well, there really isn't a difference. It's just a matter of semantics.

The Surgeon General's report on alcohol, drugs, and health points out that only about 10 percent of the people who need treatment for substance abuse in the U.S. actually receive treatment in any given year. One reason for that is the stigma that still exists in society concerning alcoholism and addiction.

There is, therefore, a trend among professional treatment providers to refer use the term "substance misuse" because it seems to be less shaming than "substance abuse." The Surgeon General's 2016 report refers to substance misuse throughout the document.


Confrontational Interventions Are Rarely Effective

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Although surprise confrontational family interventions to try to get loved ones to enter into treatment for alcohol and drug problems have gained notoriety due to their portrayal on television programs, in reality, they are not very effective.

Confrontational interventions, sometimes called the "Johnson Intervention," have been around since the 1960s, but have not been found in scientific studies to be very effective in getting people into treatment and, in fact, can actually backfire—making the targeted person even more resistant to seeking treatment.

Throughout the Surgeon General's report, "intervention" does not refer to these types of confrontations, but to "a professionally delivered program, service, or policy designed to prevent substance misuse or treat an individual’s substance use disorder."


Medical Treatments Are Not Substitute Addictions

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One long-held misconception about the use of pharmaceutical treatments to help people who have alcohol and substance use disorders is that using medications to treat craving and withdrawal is substituting one addiction for another.

The use of methadone and buprenorphine to control opioid craving and withdrawal has been found in scientific studies to reduce substance misuse, reduce the risk of relapse and overdose, reduce criminal behavior, reduce the transmission of infectious diseases, and helps addicts return to a healthy and functional lifestyle.

The stance by many abstinence-based treatment approaches that use of these medications is substituting one addiction for another is scientifically unsound and severely limited their use by people who could benefit from them, the Surgeon General reports said.

Restrictions on how methadone and buprenorphine can be prescribed and dispensed have also reduced their availability, the report said.


It Doesn't Have to Be Severe to Be Treated

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Traditionally, alcohol and drug problems were not treated until the addict "hit bottom" after their substance misuse became a crisis. When treatment was sought, it was usually provided by specialty addiction treatment programs that were separate and isolated from the mainstream healthcare system.

The Surgeon General's 2016 report hopes to establish new trends in substance use disorder treatment such as:

  • Mild substance use disorders can also be treated
  • Any harmful misuse should receive intervention
  • Early intervention can prevent later severe disorders
  • Substance misuse screening should be a part of primary health care
  • Intervention and monitoring should be handled in the mainstream healthcare system

The report emphasizes not everyone with a substance use disorder needs ongoing treatment and many only require brief intervention and monitoring, so therefore many patients could receive treatment from general primary care providers.

If substance misuse screening and brief intervention and monitoring were conducted as a routine part of primary health care it could significantly reduce the development of more severe substance use disorders, the report said.


Peer Recovery Coaches Can Be Effective

A recent trend in substance use disorder treatment is the use of peer recovery coaches, who are people who are in recovery themselves who use their knowledge and life experiences to help others who are new to recovery.

Sometimes called sober coaches, peer recovery coaches provide others in recovery with emotional, informational, and practical support to help them maintain recovery.

Although you may have heard of celebrities hiring private recovery coaches, the peer coaches can also be associated with recovery community organizations, clinics, sober living homes, and recovery high schools.

They can also be employees in primary care settings, emergency departments, mental health clinics, criminal justice systems, child welfare, and homeless agencies.

Peer recovery coaches are not substance use disorder treatment counselors or treatment case managers. They are also not 12-step program sponsors, because they do not promote any specific recovery pathway, but facilitate all pathways.

There are very few research studies on the effectiveness of peer recovery coaches, but that which has been conducted is promising, according to the Surgeon General's report.


Recovery Houses Are Very Effective

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Recovery houses, traditionally known as halfway houses, have been found to be very effective in helping those who have completed alcohol and drug detox or treatment to remain abstinent.

One particular model of this cited in the report, Oxford House, Inc. is an oversight network connecting Oxford Houses in 43 states and the District of Columbia. Oxford Houses provide cost-efficient and substance-free housing to individuals in recovery.

A study of Oxford House residents found the following outcomes:

  • 87% of residents were abstinent after two years
  • Abstinent rates were 4-5 higher than typical outcomes
  • Higher, more positive rates of self-efficacy and self-mastery
  • Higher monthly incomes
  • Lower incarceration rates

Going to a recovery house after detox or residential treatment results in generally better outcomes than going directly back into society, research has found.

A Word From ​Verywell

If you or someone you know is drinking or using drugs in a way that is harmful to themselves or others around them, they do not have to wait until it becomes a crisis to receive help. There are substance use treatments that are designed specifically for those who are not yet addicted.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, Executive Summary." Washington, DC: HHS, November 2016.

By Buddy T
Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.