Last Updated on May 1, 2021 by Morris Green

Alcohol and marijuana: highest rate of drug abuse

Alcohol and marijuana have the highest rate of abuse among all drugs.

In the 2019 National Survey on Drug Use and Health (NSDUH), the Substance Abuse and Mental Health Services Administration (SAMHSA) reported:

• 14.5 million Americans aged 12 or older had experienced alcohol dependence or abuse.
• 12 million Americans aged 12 or older used marijuana.
• It is a common misconception that marijuana is not addictive. 4.8 million Americans aged 12 or older met the criteria for dependence or abuse.
• The number of Americans with a marijuana use disorder was more than three times the number for dependence/abuse of prescription pain relievers (1.4 million) and nearly five times times the number for dependence/abuse of cocaine (1 million).
• Marijuana also comprises nearly half of all cases of Illicit Drug Use Disorder (8.3 million people).

The reasons alcohol and marijuana (though still illegal in most states) are so much more likely to be misused and abused are two-fold:

• Both are easier to access, despite the age limitation for purchasing alcohol and the fact that marijuana is illegal in 20 states (and decriminalized in another 13 states)
• Both are cheaper to come by. Even in a recession, alcohol, tobacco, and marijuana are purchased in high numbers because of the low price compared to other “more expensive” habits.

Drug use, drug abuse, and substance abuse disorder

It’s important to differentiate between using drugs, abusing drugs, and being addicted to drugs.

Drug use

Any kind of drug use is heavily stigmatized in the United States, despite the fact that almost every American adult is a drug user. You read that right: between 85 and 90 percent of Americans take the stimulant caffeine every day when they pour their morning cup of coffee or order a soda with their lunch. Millions more Americans take prescribed medication from their doctor, whether those are prescribed opioids to help with chronic pain, chronic physical illness, or mental illness. And while alcohol is the most commonly abused drug in the United States, many Americans still drink it regularly.

Drug misuse

Drug use–particularly using any drug recommended by your doctor–is not a problem so long as you use drugs responsibly. That means using only the recommended amount, only when/if you need them, and only for their intended purpose.

When you start to break or bend these rules, you may be lapsing into drug misuse (otherwise known as drug abuse). Drug misuse can include:

• Taking higher dose than directed or prescribed (overdose)
• Inhaling, “huffing”, or snorting drugs
• Taking a drug for a purpose other than prescribed or directed
• Taking another person’s prescribed drugs

Taking any substance not prescribed for you by your doctor is drug abuse or misuse.

Click here to learn more about the difference between drug use and abuse.

Substance use disorder

While any amount of drug abuse can become dangerous, drug abuse does not always lead to a substance abuse disorder (nor an addiction, which describes the most serious cases of substance use disorder). The NSDUH report found that in 2019, 20.4 million Americans aged 12 or older had a substance use disorder (an alcohol use disorder, illicit drug use disorder, or both). That’s 7.4% of that population!

You can find the official DSM 5 criteria for a substance abuse disorder here.

Understanding the 10 most commonly abused drugs

Though alcohol and marijuana are the top 2 most commonly abused drugs, they are not the only type of drug that people abuse or misuse. In addition to these, people also abuse pain relievers, hallucinogens, depressants, cocaine, inhalants, methamphetamine, and heroin. 

The infographic here highlights the 10 most commonly abused drugs in the United States. Were you aware of these numbers?

(Note: unless otherwise specified, all statistics below come from the 2019 NSDUH report, which examined Americans aged 12 years and older.)

1. Alcohol

Preventing alcohol abuse starts young. North Carolina has a zero tolerance policy for underage drinking. Despite this, the 2019 Youth Risk Behavior Survey done by the North Carolina Department of Public Instruction found that by middle school, 20.4% of students had already tried alcohol. By high school, 24.2% of North Carolina students are actively drinking alcohol. Unfortunately, studies show that young people who start drinking early are more likely to have an unhealthy relationship with alcohol as adults.

Alcohol consumption can damage the brain and most body organs–especially in young people. Areas of the brain that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our higher brain functions, including problem solving and decision making), the hippocampus (important for memory and learning), and the cerebellum (important for movement coordination).

• Misuse: 65 million people participated in binge drinking in the month prior to the NSDUH report. In addition, 16 million people reported heavy alcohol use.
• Alcohol Use Disorder: 14.5 million people experienced alcohol dependence or abuse.

2. Marijuana

Marijuana is a mixture of the dried and shredded leaves, stems, seeds, and flowers of the Cannabis plant intended for use as a psychoactive drug and as medicine. The intoxicating effect of marijuana comes from the amount of delta-9-tetrahydrocannabinol (or THC) content found in the drug. 

Common street names for marijuana are: “pot,” “grass,” “herb,” “weed,” “Mary Jane,” “reefer,” “skunk,” “boom,” “gangster,” “kif,” “chronic,” and “ganja.”

Marijuana is decriminalized in North Carolina–but this does not make it legal. Even possessing half an ounce of marijuana is a class 3 misdemeanor that can result in a fine and a mark on your permanent record. Possessing anything more than 1.5 oz is a felony. In addition, because there is no safe, regulated way to purchase marijuana in North Carolina, it may be laced with other, more addictive substances.

If you require assistance related to licensing and regulatory compliance, a cannabis law firm may be able to help.

• Misuse: 12 million people used marijuana in 2019.
• Marijuana Use Disorder: 4.8 million people (over one third of all marijuana users) met the criteria for dependence or abuse.

3. Pain relievers (other than heroin)

Prescription drugs are the #1 most abused drug in this category. Whether obtained from a friend or family member or prescribed by their own doctor, people often misuse or abuse pain relievers such as morphine, codeine, methadone, oxycodone and hydrocodone to experience euphoria or intense excitement.

That said, there are also many people who are taking pain relievers prescribed by their doctors correctly and safely. Not everyone who takes a pain reliever will become addicted; it depends on your own personal risk for addiction.

• Misuse: 9.7 million people misused pain relievers in 2019.
• This number has decreased in recent years, from 12.5 million in 2015.
• Prescription Pain Reliever Use Disorder: 1.4 million of those abusing prescription pain relievers (14%) met the criteria for a prescription pain reliever use disorder.
• This number has also decreased from 2 million in 2015.

(Note: Opioid Use Disorder, of which 1.6 million people meet the clinical criteria, is a combination of those abusing prescription pain relievers and those abusing heroin.)

4. Hallucinogens

Hallucinogens are mind or perception-altering drugs that cause a state of euphoria in the brain. LSD and Ecstasy are the most abused drugs in this category, but it also includes psilocybin mushrooms, MDMA, DMT, and ketamine. 

Use of these drugs may cause abusers to see vivid colors and images, hear sounds, and feel sensations that seem real but do not exist. Abusers also may have traumatic experiences and emotions that can last for many hours. Some short-term effects can include increased body temperature, heart rate, and blood pressure; sweating; loss of appetite; sleeplessness; dry mouth; and tremors.

• Misuse: 6 million people misused hallucinogens in 2019.
• This number has increased from 4.7 million users in 2015.
• The NSDUH report did not include statistics for hallucinogen use disorder.

5. Depressants (tranquilizers & sedatives)

Depressants are usually prescribed to promote sleep or to reduce anxiety. As measured by national surveys, depressants are often categorized as sedatives or tranquilizers. Sedatives primarily include barbiturates (e.g., phenobarbitol) but also comprise sleep medications such as Ambien and Lunesta. Tranquilizers primarily include benzodiazepines such as lorazepam and clonazepam, but also include muscle relaxants and other anti-anxiety medications.

As with pain relievers, there are many Americans that take these medications as-needed for relief from muscle pain and anxiety who do not become addicted. 

• Misuse: 5.9 million people misused depressants in 2019.
• This number decreased from 7 million people in 2015.
• Prescription Tranquilizer or Sedative Use Disorder: 681,000 depressant abusers met the criteria for prescription tranquilizer or sedative use disorder.

6. Cocaine 

Cocaine is a powerful stimulant. Stimulants are a class of drugs that can elevate mood, increase feelings of well-being, and increase energy and alertness, but they also have dangerous effects like raising heart rate and blood pressure. Cocaine may also be called “coke,” “Coca,” “C,“ “snow,” “flake,“ “blow,” “bump,“ “candy,” “Charlie,” “rock,” and “toot.”

• Misuse: 5.5 million people misused cocaine in 2019.
• This number has decreased in the last two decades, from 5.9 million in 2002.
• Cocaine Use Disorder: 1 million cocaine users (18%) met the criteria for cocaine use disorder, also showing a decrease since 2002.

7. Prescription stimulants

The most commonly abused prescription stimulant is the ADHD medication Adderall. It can improve attention, executive function, and emotional regulation for people with ADHD. One of the primary components of Adderall is amphetamine, but this is not the same thing as methamphetamine (“meth”). While the two are chemically similar, methamphetamine is far more powerful than Adderall because of how it enters the brain, and meth has a higher chance of misuse and harmful side effects. 

That said, people without ADHD should never take Adderall, as it can have very serious side effects when misused. Other stimulants include methylphenidate products and some weight-loss stimulants.

• Misuse: 4.9 million people misused prescription stimulants in 2019.
• Prescription Stimulant Use Disorder: 558,000 prescription stimulant abusers met the clinical criteria for a substance use disorder.

8. Inhalants

Inhalants are volatile substances found in many household products that induce mind-altering effects. Commonly abused inhalants include solvents with loud fumes (paint thinner, nail polish remover, degreaser, dry-cleaning fluid, cement glue), aerosol sprays (deodorant spray, hair spray, air fresheners, spray paint), and gases (gasoline, kerosene, anesthesia, ether, chloroform, halothane, and nitrous oxide). Inhalants are extremely toxic and can damage the heart, kidneys, lungs, and brain.

• Misuse: 2.1 million people misused inhalants in 2019.
• This number has increased from 1.7 million people in 2016.
• The NSDUH report did not include statistics for inhalant use disorder.

9. Methamphetamine

Methamphetamine (commonly called “meth”) is a dangerous and highly addictive stimulant usually obtained illegally. Meth is commonly smoked, snorted, injected, or swallowed. It is also known as “crank”, “chalk”, “crystal”, “fire”, “glass”, “go fast”, “ice”, “speed”, or “Tina”.

• Misuse: 2 million people used meth in 2019.
• Methamphetamine Use Disorder: 1 million meth users (half of all meth users) met the criteria for a methamphetamine use disorder in 2019, an increase since 2016.

10. Heroin

Heroin is an opioid drug that is made from morphine, a naturally occurring substance taken from the seed pod of the Asian opium poppy plant. Opioids, also known as opiates, are known for their pain-relieving properties. Only licensed and authorized physicians may prescribe opiates for use to relieve pain. Street names for heroin: “Smack,” “Junk,” “H,” “Black tar,” “Ska,” and “Horse.”

• Misuse: 745,000 Americans used heroin in 2019.
• This number has unfortunately increased from 404,000 people in 2002.
• Heroin Use Disorder: 438,000 heroin users (more than half of all heroin users) met the criteria for heroin use disorder in 2019. This number has more than doubled since 2002.
• Over 14,000 Americans died of heroin overdose in 2019.

Some doctors and pain patients think that the climate around prescription opioids may be partially to blame for this increase; Dr. Gerald Harris II, an addiction treatment specialist from Arizona, said in a 2018 article about pain patients’ responses to the opioid prescription debate, “Unfortunately, a great many patients turn to street heroin and other drugs to self-medicate because they couldn’t get the medications they need.” Certain sociodemographic factors may also create a disparity in chronic pain treatment.

(Note: Opioid Use Disorder, of which 1.6 million people meet the clinical criteria, is a combination of those abusing prescription pain relievers and those abusing heroin.)

Drug abuse and COVID-19

When looking at these numbers, it’s important to remember that the 2019 NSDUH report does not include data from the COVID-19 pandemic. The CDC found that 13% of Americans started or increased their substance abuse during late June 2020. It will take time to fully evaluate the extent of the COVID-19 behavioral health crisis and to see how long these effects last.