By Carol Watwood, MLS, MPH (Health Sciences Librarian/Assoc. Professor, Western Kentucky University Libraries)
Column Editor: Jack Montgomery (Library Technical Assistant, Government Documents, Georgia Southern University Libraries)
Editor’s Note: Carol Watwood, the author of this issue’s column, is an Associate Professor and Health Services Librarian as well as a certified medical librarian. Carol has served as Health Sciences Librarian since August 2004. Prior to that time, she was the Law Librarian at WKU. Carol was also a Medical Librarian at the Vanderbilt University Medical Center Library from 1979 to 1989.
Carol serves as liaison librarian to the College of Health and Human Services, and helps staff the Information Desk in the Reference Center. She maintains several library research guides at http://libguides.wku.edu/profile.php?uid=34334.
Carol’s research interests include collections development, e-resources, and information literacy skills in the health sciences. Over the years, she has gained a reputation and an excellent librarian and teacher on the campus and in the community. — JM
Drug abuse and addiction, now often termed drug or substance or use disorder (SUD), involves “a self-destructive pattern of using a substance that leads to significant problems and distress, which may include tolerance to or withdrawal from the substance.” SUDs usually involve ten classes of drugs that activate the brain’s reward system (Merck Manual). These drugs (or substances) can “hijack” the brain’s reward system to create intense cravings. Some are legal; some are illegal; and others are prescription-only.
SUD is a public health crisis that claims 400 lives a day in the U.S. alone (drugabuse.org). In recent years, a trend toward over-prescribing of powerful opioid pain relievers added to the toll of SUDs. Currently in the U.S., opioids are the main driver of drug overdose deaths. Indeed, the number of opioid overdose deaths increased fivefold between 1999 and 2016. Nearly 841,000 people in the U.S. have died of drug overdoses since 1999 (CDC). Besides the high death toll, SUDs are a large financial burden to U.S. families and institutions. The abuse of alcohol, tobacco, and illegal drugs are estimated to cost the U.S. more than $740 billion a year in lost productivity, medical costs, and other expenses (NIDA). The numbers of people involved are staggering as well. Substance use disorders (SUDs) affect nearly every household in America, either directly or indirectly. In 2017, 21 million people in the U.S. had an SUD involving alcohol or other drugs, but only 4 million received treatment. It is estimated that one in seven Americans will develop an SUD during their lifetime (https://www.hhs.gov/surgeongeneral/priorities/opioids-and-addiction/index.html). All age groups are affected.
Educational, policy, and public health efforts to reverse these trends are being made. Primary prevention must target young people since more than 70% of people admitted to treatment facilities began substance use before age 17 (SAMHSA). Fortunately, there are science-based ways to prevent and treat SUDs, and rehabilitate people with SUDs. Many people can and do recover. Public policy efforts can strive to change prescribing practices, educate the public about SUDs, and change the social conditions associated with SUDs. Many high-quality, free online web resources are available to educate ourselves about SUDs, and to see how we are doing at preventing initiation of substance misuse and helping ourselves and others living with SUDs. Here is a selection, listed alphabetically.
Alcoholics Anonymous World Services — https://www.aa.org/ — Alcoholics Anonymous (AA) is an international mutual aid fellowship that began in 1935 in Akron, OH to help people stop drinking. Groups are autonomous, self-supporting, and do not affiliate with outside groups or publicize members’ names. There are more than 118,000 groups in 180 countries with an estimated 2 million members. AA has no specific religious affiliation, but its principles have strong roots in faith-based traditions. The 12 steps mention “a Power greater than ourselves” and “God as we understood him.” The Twelve Traditions offer guidance for groups. AA has a rich heritage and a number of publications available in print and online.
Blueprints for Healthy Youth Development — https://www.blueprintsprograms.org/program-search/ — Based at University of Colorado, Blueprints is currently funded by Arnold Ventures and historically has had public and private funding. Since the 1990s, this organization, using a team of expert advisers, has certified effective programs that prevent violence, crime, substance abuse, and delinquency, and promote prosocial behavior, academic success, emotional, and physical health among the nation’s youth. This site includes a finding tool that locates, describes, and rates available interventions.
FindTreatment.gov — https://findtreatment.gov/ — SAMHSA-sponsored locator service for state-licensed treatment providers for substance use disorders and mental illness.
Healthy People 2020. Substance Abuse. — https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse — Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. This initiative began with the Surgeon General’s 1979 report, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. This document was followed by Healthy People 1990, 2000, 2010, and 2020. Healthy People 2030 is now in the initial stages. Involving a number of Federal agencies, Healthy People is one of the most influential and widely-cited public health initiatives. The site is arranged by leading health indicators, topics, and objectives. Substance abuse, as a leading health indicator, is extensively covered. Interventions, resources, and data are incorporated. Also, each specific objective links to a preformulated PubMed search to locate additional references. The site lends itself well to lesson plans and classroom use.
HelpGuide: Drug Abuse and Addiction — https://www.helpguide.org/articles/addictions/drug-abuse-and-addiction.htm — HelpGuide, founded in 1999, is a nonprofit mental health self-help website for people with mental health issues, including drug abuse and addiction. It describes causes, symptoms, coping skills, and finding sources of professional help for oneself, family members, and friends.
MedlinePlus. Drug Use and Addiction. — https://medlineplus.gov/druguseandaddiction.html — See also Substance Abuse Problems — https://medlineplus.gov/substanceabuseproblems.html — MedlinePlus is an online medical information website sponsored by the U.S. National Library of Medicine. Content is reviewed by expert editors. The centerpiece of MedlinePlus is an online A-Z medical encyclopedia with extensive information on more than 1000 conditions. The article on drug abuse links to other reliable online resources on all aspects of drug abuse. A special feature of MedlinePlus is health information in multiple languages: https://medlineplus.gov/languages/all_healthtopics.html For example, information on opioid overdose is available in thirteen languages. MedlinePlus is a good one-stop shop for consumer health information. It also leads the user to other reliable, free online sources of drug information.
Merck Manual Professional Version: Substance-Related Disorders. — https://www.merckmanuals.com/professional/psychiatric-disorders/substance-related-disorders — Published since 1899, this free, signed online medical encyclopedia has articles written by expert subject specialists and frequently updated. The section on substance-related disorders is thorough, detailed, and accessible to educated laypersons. With the click of a button, the reader can switch to the “consumer” version for easier reading if desired.
Monitoring the Future: A Continuing Study of American Youth (MTF) — http://www.monitoringthefuture.org/ — MTF began in 1975. It is funded by NIDA and is conducted at the University of Michigan’s Institute for Social Research. It explores the attitudes, behaviors, and values of a sample of 8th, 10th, and 12th grade students in the U.S., with annual follow-up surveys. Although MTF also covers other topics, it has become a key source of information on attitudes about and use of alcohol, tobacco, and illicit drugs in adolescents and young adults. Separate reports on adolescent drug use, taken from MTF surveys, are freely available on this site.
Narcotics Anonymous World Services — https://www.na.org/meetingsearch/ — Growing out of Alcoholics Anonymous, Narcotics Anonymous World Services began in the Los Angeles area in 1953. It is the largest organization of its kind and holds nearly 76,000 meetings weekly in 143 countries. It is an independent, nonprofit fellowship of recovering addicts and has no religious or other affiliation, although its site does mention “a loving higher power.” There are no fees or membership dues. The only membership requirement is the desire to stop using, with a goal of abstinence from all drugs. NA’s purpose is “communication, coordination, information, and guidance.” It sponsors a variety of publications and outreach efforts.
National Drug Early Warning System (N-DEWS) — https://ndews.org/ — Currently funded by NIDA to the University of Florida, N-DEWS uses 18 sentinel sites to identify emerging drug trends. Data are collected directly from nontraditional sources such as dance parties and nightclubs, as well as more traditional “time-lagged” resources such as drug overdose deaths. A weekly newsletter describes emerging trends.
National Survey of Drug Use and Health — https://nsduhweb.rti.org/respweb/homepage.cfm — Begun in 1971, this nationwide annual survey investigates tobacco, drug, and alcohol use, mental health, and other health issues in the U.S. It is sponsored by SAMHSA, and includes 70,000 Individuals aged 12 and older. The alcohol and drug portion of the survey aims to track data on misuse of alcohol, tobacco, and other drugs; describe trends and consequences; and identify groups most at risk.
Opioid Overdose: Worsening Epidemic — https://www.cdc.gov/drugoverdose/index.html — This CDC page offers facts and resources about the surge in drug overdose deaths in the U.S. In 2019, more than 70% of the 71,000 drug overdose deaths involved an opioid. Nearly 73% of opioid overdose deaths involve synthetic opioids other than methadone. Especially problematic is the illicit manufacture and distribution of fentanyl and fentanyl analogs. Many Americans affected by opioid abuse also have other coexisting SUDS or mental health issues.
Besides describing and quantifying the problem, this page describes evidence-based prevention, treatment, and public policy initiatives to combat drug overdoses.
Partnership to End Addiction — https://drugfree.org/ — Formed by the merger of the Center on Addiction (CASA) and Partnership for Drug-Free Kids (formerly Partnership for Drug-Free America). The Center on Addiction began in 1992 as a research initiative started at Columbia University by former HEW Secretary Joseph J. Califano, Jr. The Partnership on Drug-Free America, on the other hand, was founded in 1986 by a group of advertising and media executives headed by the former CEO of Johnson and Johnson. It has used the power of advertising in anti-drug PSAs such as the iconic “fried egg” image. The resulting merger, the Partnership to End Addiction, is a broad-focused organization focusing on young adults that aims to empower families, advance effective care, shape public policy, and change culture. It provides customized assistance to families and helps them find treatment programs. It emphasizes a non-blaming approach to addiction. Their current “Start with Connection” PSA features music from the Lumineers and has been viewed over 4 million times. Current sponsors include the Screen Actors’ Guild-American Federation of Radio and Television Artists (SAG-AFTRA).
U.S. Department of Health and Human Services. — HHS.gov/opioids. Help and Resources: National Opioids Crisis. — https://www.hhs.gov/opioids/ — Portal and finder for a variety of HHS information about opioids. Includes a helpline number, treatment finder, statistics, grant opportunities, prevention, policy, legal issues, and more.
U.S. Drug Enforcement Administration (DEA) — https://www.dea.gov/ — The DEA enforces laws and regulations relating to controlled substances in the U.S. It helps to investigate, prosecute, and prevent illegal drug trafficking in cooperation with state, national, and international organizations such as Interpol and the United Nations. It sponsors preventive and educational programs such as Take Back Prescription Drugs Day and Get Smart About Drugs https://www.getsmartaboutdrugs.gov/ (has a drug identifier and facts about commonly-misused drugs). Site includes known drug labs and arrest statistics.
U.S. National Center for Health Statistics (NCHS). Illicit Drug Use. — https://www.cdc.gov/nchs/fastats/drug-use-illicit.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnchs%2Ffastats%2Fdrug-use-illegal.htm — The U.S. National Center for Health Statistics, since 1960, has been the principal U.S. health statistics agency. Data on drug use are obtained from birth and death records (National Vital Statistics System), medical records, interview surveys, physical examinations, and laboratory tests. In addition to NCHS’s four major data collection programs, information is obtained from other public and private sources.
U.S. National Institute on Drug Abuse (NIDA) — https://www.drugabuse.gov/ — NIDA, part of the U.S. National Institutes of Health, is the lead Federal agency sponsoring drug abuse research. Its mission also encompasses applying knowledge to improve individual and public health. This site includes drug topics and fact sheets, training and research grants, and a variety of clinical resources. There is some overlap with the SAMHSA site, but each has a distinct set of resources. The CTN Dissemination Initiative http://ctndisseminationlibrary.org/blending.htm (formerly called the NIDA/SAMHSA Blending Initiative) was begun it 2018 to enable the two agencies to work together to facilitate the adoption of research-based interventions in clinical settings.
U.S. Office of the Surgeon General. Surgeon General Priority: Opioids and Addiction. — https://www.hhs.gov/surgeongeneral/priorities/opioids-and-addiction/index.html — Opioids and Addiction are listed first among five urgent health priorities of the U.S. Office of the Surgeon General. The following two major reports have been published:
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Washington, DC: HHS, September 2018. https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf and Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf
U.S. SAMHSA. Substance Abuse and Mental Health Administration — https://www.samhsa.gov/ — SAMHSA is the agency within the U.S. Department of Health, Education, and Welfare that leads public health efforts to advance behavioral health in the U.S. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. SAMHSA is a broad-focused agency, begun in 1992. This site has a treatment finder, helplines, practitioner training, research grants, statistics, EBP resources, drug-free workplace information, and hundreds of publications and flyers. Its data reports include the recently-revived Drug Abuse Warning Network (DAWN) (monitors drug-related ER visits); the Behavioral Health Barometer (including both mental health and substance abuse); the National Survey on Drug Use and Health (NSDUH); and the National Survey of Substance Abuse Treatment Services, among others.
Youth Risk Behavior Surveillance System (YRBSS) — https://www.cdc.gov/healthyyouth/data/yrbs/index.htm — YBRSS was developed in 1990 to monitor risk behaviors among U.S. high school students that contribute markedly to leading causes of death, disability, and social problems among U.S. adolescents and adults. Surveys are carried out every 2 years and are voluntary, school-based, and rely on self-reported behavior. A number of questions address use of alcohol, tobacco, and other drugs, as well as how these items were obtained. As of 2019, data from more than 4.9 million high school students had been collected in 2100 separate surveys. Among other uses, the YBRSS data help assess progress toward Healthy People goals.