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The editors of this section wished to explore psychoanalytic approaches to addiction and substance abuse; though not sub-specializing in that domain, in our own practices, we found we were both treating several patients with opiate, alcohol, and marijuana dependence.
As of 2014, one in four young adults aged 18–25 reported misuse of prescription or illicit substances, which include marijuana, stimulants, and heroin. The National Survey on Drug Use and Health (NSDUH) is a nationwide survey of 70,000 people aged 12 and older on tobacco, alcohol, and drug use and mental health in the United States. It has been conducted yearly since 1971. Results from the most recent survey, in 2019, give us cause for both hope and concern. Opiate use has diminished, now affecting about 2 million people. Marijuana was the most frequently used illicit substance, and its use is increasing; 17% of those over 12 years old had used it in the past year. In youth 12 to 25 years old, marijuana smoking is associated with depression and concurrent opioid and alcohol abuse.
Adolescents and adults with substance use disorders rarely receive treatment. Approximately 20 million people in the United States have substance abuse disorders and 9 million have co-occurring mental illness and substance disorders; less than 1 in 10 in either of those groups obtain treatment. Most substance abusers have problems with alcohol, with or without the addition of other drugs.
According to one recent review, a third of adolescents with a substance use disorder also had a co-occurring mental illness (Robinson and Riggs 2016). This finding seems less than clinical experience would suggest. Among adolescents referred for treatment psychiatric co-morbidity was higher, with diagnoses of: conduct disorder (60–80%); attention deficit hyperactivity disorder (ADHD; 30–50%); and major depressive disorder (MDD; 24–50%). Substance abuse and psycholog