Short answers, pulled from the story.
Substance use disorder is the persistent use of drugs or alcohol despite causing substantial harm to the individual and others. Diagnosis is made by a psychiatrist, psychologist, or drug and alcohol counselor using the 11 criteria in the DSM-5, which classify severity as mild (2-3 criteria met), moderate (4-5), or severe (6 or more).
In 2017, an estimated 35 million people globally had a substance use disorder tied to illicit drugs. An additional 237 million men and 46 million women had alcohol use disorder as of 2016.
In 2017, over 72,000 Americans died from drug overdoses, a threefold increase from 2002. Synthetic opioids including fentanyl contributed to nearly 30,000 deaths per year, with death rates from fentanyl rising 22-fold between 2002 and 2017.
Treatment options include cognitive behavioral therapy, motivational interviewing, and combined behavioral intervention. Five medications are approved in the United States for alcohol and opioid use disorders; no approved medications yet exist for cocaine or methamphetamine. Medication-assisted treatment has been shown to reduce illicit drug use and overdose deaths.
Several addiction vaccines are in development, including NicVAX for nicotine (developed by Nabi Biopharmaceuticals of Rockville, Maryland) and TA-CD for cocaine (developed by the Xenova Group). As of September 2023, a vaccine tested against heroin and fentanyl was reported to be on its way to being tested against oxycontin.
SUD treatment records have been protected under 42 CFR Part 2 since 1975, with stricter rules than ordinary medical records and a bar on their use in criminal proceedings without a court order. A 2024 rule from the U.S. Department of Health and Human Services aligned those protections more closely with HIPAA, effective April 2024, with full compliance required by February 2026.