Rather, the major message from this paper is that science now offers a public health-oriented approach to translate the available science into effective, practical, and sustainable policies and practices to prevent substance “use” before it starts identify and intervene early with emerging cases of substance “misuse” and effectively treat serious substance use disorders.

Thus, the first and perhaps most important message from this paper is NOT that that substance misuse and disorders cause immensely expensive and socially devastating harms and costs.

Also, recent changes in healthcare insurance regulation and financing now open the door to integration of prevention and treatment of substance use disorders into mainstream medicine in ways that were previously not possible. In this regard, science has already produced a range of effective interventions, treatment medications, behavioral therapies, and recovery support services that make full recovery from even serious addictions an expectable result of professional, continuing, evidenced-based care. Genetic, brain imaging, and neurobiological science suggests that “addiction” is qualitatively different from substance use and is now best understood as an acquired chronic illness, similar in many respects to type 2 diabetes - illnesses that can be managed but not yet cured. As will be discussed, substance misuse can reasonably be considered a lifestyle problem, but there are effective prevention policies and practices that could significantly reduce the harms and costs of these problems. However, a review of the available science offers a much more optimistic projection for our efforts to reduce these problems. Many Americans believe that there are no viable solutions to what they think of as these unfortunate “lifestyle problems” - that they are as intractable as poverty and ignorance.

Most Americans are already painfully aware of the size and cost of substance misuse problems. But these problems are not simply financial burdens - they deteriorate the quality of our health, educational, and social systems, and they are debilitating and killing us - particularly our young through alcohol-related car crashes, drug related violence, and medication overdoses. These harms are significant financially with total costs of more than $420 billion annually and more than $120 billion in healthcare (1,2). As a country, we have a serious substance misuse problem - use of alcohol, illegal drugs, and/or prescribed medications in ways that produce harms to ourselves and those around us.

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