Alcohol and Substance Use Disorders in Veterinary Medicine: Part 1

This article is part one of a three-part series that addresses the subject of alcohol and substance use disorders and its impact on veterinary medicine. Today, we’ll discuss the diagnostic criteria for alcohol and substance use disorders; its impact on veterinary medicine; and the prevalence and costs associated with alcohol and substance use disorders. 

What is an alcohol or substance use disorder? 

When we hear the words alcohol and substance use disorder, we have our own ideas of what this means. But having a standardized definition and appropriate language helps behavioral health professionals understand the severity of as well as the appropriate intervention for the person suffering with an addiction.

So, what does it mean to have a diagnosis of either alcohol or substance use disorder? In the U.S., a diagnosis is based on criteria from either the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR, 2022) or the International Classification of Diseases, 11th Revision (ICD-11, 2019).   

Both the DSM 5-TR and the ICD-11 use diagnostic criteria outlining specific clinical impairment occurring within a 12-month period.  In the DSM 5-TR, as the number of diagnostic criteria increases, the level of impairment increases as well (mild, moderate, or severe) and may indicate a level of intervention that includes inpatient hospitalization, withdrawal management (formerly detoxification), or outpatient treatment, followed by the implementation of a Recovery Plan. 

A substance use disorder (SUD) is a set of disorders that also includes within each category a separate diagnosis for intoxication and withdrawal. The following are the primary SUD diagnoses used in the DSM-5-TR: [i]

• Alcohol use disorder

• Cannabis use disorder

• Phencyclidine (PCP) use disorder

• Other hallucination use disorder (LSD, mescaline, etc.)

• Inhalant use disorder (aerosols, gasoline, etc.)

• Opioid use disorder

• Sedative, hypnotic, or anxiolytic use disorder

• Stimulant use disorder (amphetamine, methamphetamine, cocaine, etc.)

• Tobacco use disorder

• Other substance use disorder

Prevalence of alcohol and substance use disorders in the U.S.

Some mental health practitioners, researchers, and others will use the term substance use disorder to include alcohol. In this article, we will separate them in order to provide a more robust description of their costs to the U.S. economy and healthcare system.

Overall, for all groups of adults in the U.S., approximately 10% have either an alcohol and/or substance use disorder.[ii]

Alcohol use disorder is the more prevalent diagnosis (16.3 million) followed by all substance use disorders (6.2 million) in the U.S.[iii]  Similarly, alcohol is also the more prevalent (100 million) of all substance use disorders throughout the world.[iv]

For the purposes of this article, substance use disorder also includes designer drugs (MDMA or ecstasy, etc.), synthetic drugs (synthetic cannabinoids, synthetic phenethylamines, etc.), herbal extracts (kratom, khat, etc.), and the misuse of prescription medicine.

Prevalence of alcohol and substance use disorders in veterinary medicine

A search of the literature for the prevalence rates for alcohol and substance use disorders in veterinary medicine does not yield many recent studies since 2010 or many studies of veterinarians in the U.S. However, a 2006 cross-sectional study in Germany of over 550 veterinarians by Harling and colleagues[v] found intense psychosocial stress as a risk factor for binge drinking and drug use. 

The Merck Animal Health Veterinary Wellbeing Study in 2020 found that overall, alcohol and substance use was not significantly different than the general population except cannabis use was slightly lower compared to the general population. [vi]

A recent U.S. study of veterinary students, Diulio and colleagues[vii] looked for an association between depressive symptoms and drinking motives (emotional regulation) among veterinary students. The results suggest harmful drinking patterns may be related to depressive symptoms.

While there are a limited number of recent studies on alcohol and substance use among veterinarians, prior research has also documented mental health problems such as anxiety, depression, and moral distress among veterinarians, which are also risk factors for AUD and SUD.

Costs associated with alcohol and substance use disorders in the U.S.

In the U.S., excessive alcohol use costs (e.g., crime, lost work productivity, and healthcare) exceeded $249 billion in 2010,[viii] an increase from $223 billion in 2006.[ix] Using the Alcohol-Related Disease Impact (ARDI) tool, the CDC[x] found 140,000 deaths from excessive alcohol use in the U.S. for each year since 2014 through 2019, with binge drinking accounting for 40% of those deaths. 

In 2007, hospitalization costs for illicit drug use in the U.S. were estimated at $13 billion per year,[xi] and overall healthcare costs are $193 billion.[xii],[xiii] Prescription opioid healthcare costs are $26 billon per year and overall costs are $78.5 billion per year in 2013.[xiii] Lives lost to overdose deaths in the U.S. exceeded 107,000 in 2021.[xiv] Since 2014, the result of both AUD and SUD has been a decrease in life expectancy in the U.S. of three years.[xv]

Conclusion

We’ve discussed the diagnostic criteria for AUD and SUD, its prevalence, including the economic and healthcare costs to the U.S., as well as the impact on veterinary medicine. In the next article, Alcohol and Substance Use Disorders in Veterinary Medicine Part 2, we’ll discuss:

• The history of addiction treatment in the U.S.

• Advancements in the neurobiology of addiction

• The Americans with Disability Act of 1990 and its relevance to substance and alcohol use disorders

References

[i] American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR.  5th ed., Text Revision.  Arlington, VA,  American Psychiatric Association, 2022.

[ii] U.S. Department of Health and Human Services, National Institute of Health, National Institute of Alcohol Abuse and Alcoholism.  10 percent of US adults have drug use disorder at some point in their lives.  https://www.nih.gov/news-events/news-releases/10-percent-us-adults-have-drug-use-disorder-some-point-their-lives.  Accessed May 11, 2022.   

[iii] Lipari RN, Van Horn, SL.  Trends in substance use disorders among adults aged 18 or older.  The CBHSQ Report: June 29, 2017.  Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.  https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html.  Accessed May 25, 2022. 

[iv] Alcohol and Drug Use Collaborators.  The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016.  Lancet Psychiatry.  2018;5:987-1012.  http://dx.doi.org/10.1016/S2215-0366(18)30337-7

[v] Harling M, Strehmel P, Schablon A, Nienhaus A.  Psychosocial stress, demoralization and the consumption of tobacco, alcohol and medical drugs by veterinarians.  Journal of Occupational Medicine and Toxicology.  2009;4(4).  doi:10.1186/1745-6673-4-4

[vi] Merck Animal Health Veterinary Wellbeing Study.  2020. https://www.merck-animal-health-usa.com/offload-downloads/veterinary-wellbeing-study.  Accessed May 20, 2022. 

[vii] Diulio AR, Dutta NM, Gauthier JM, Witte TK, Correia CJ, Angarano, D.   Associations among depressive symptoms, drinking motives, and risk for alcohol-related problems in veterinary students.  Journal of Veterinary Medical Education.  2015;42(1):11-17.  doi: 10.3138/jvme.0914-093R 

[viii] Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD.  2010 national and state costs of excessive alcohol consumption.  American Journal of Preventive Medicine.  2015;49(5):e73-e79.  http://dx.doi.org/10.1016/j.amepre.2015.05.031 

[ix] Bouchery EE, Harwood HJ, Saks JJ, Simon CJ, Brewer RD.  Economic costs of excessive alcohol consumption in the U.S., 2006.  American Journal of Preventive Medicine.  2011;41(5):516-524.  doi: 10.1016/j.amepre.2011.06.045

[x] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,

National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Alcohol and Public Health, Data and Surveillance.  Data on excessive drinking.  https://www.cdc.gov/alcohol/data-stats.htm.  Accessed May11, 2022.   

[xi] Peterson C, Li M, Xu L, Mikosz CA, Luo F.  Assessment of Annual Cost of Substance Use Disorder in U.S. Hospitals.  JAMA Network Open.  2021;4(3):e210242.  doi:10.1001/jamanetworkopen.2021.0242 

[xii] U.S. Department of Justice, National Drug Intelligence Center  (2011).  The economic impact of illicit drug use on American society.  Product No. 2011-Q0317-002.  https://www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf.  Accessed May 12, 2022.   

[xiii] U.S. Department of Health and Human Services, National Institute of Health, National Institute on Drug Abuse.  Cost of substance abuse.  https://archives.drugabuse.gov/trends-statistics/costs-substance-abuse.  Accessed May 12, 2022. 

[xiv] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.  U.S. overdose deaths in 2021 increased half as much as in 2020–but are still up 15%.  https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm.  Accessed May 12, 2022. 

[xv] Woolf SH, Schoomaker H.  Life expectancy and mortality in the United States, 1959-2017.  Journal of the American Medical Association.  2019;322(20):1996-2016.  doi:10.1001/jama.2019.16932