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ABOUT SUBSTANCE USE DISORDERS

• According to the Centers for Disease

Control and Prevention (CDC), SUDs are a 

leading cause of death in the United States. 

Excessive alcohol use alone leads to about 

88,000 premature deaths each year, and 

more than 480,000 deaths each year are 

caused by cigarette smoking.

• SUDs can develop in individuals who

use alcohol or other addicting drugs in 

harmful quantities. According to the VA/

DoD Clinical Practice Guideline for the 

Management of Substance Use Disorders,

about 9 percent of Americans over age 18 

have a non-tobacco SUD, and about 1 in 4 

Americans will develop a non-tobacco SUD 

over the course of a lifetime. 

• In service members and Veterans,

SUD commonly co-occurs with and 

complicates other conditions or issues. 

These conditions or issues may be healthrelated, such as other mental health 

conditions. They may also be societal, 

such as homelessness, criminal justice 

involvement, or unemployment.

• SUDs have substantial negative

consequences on Veterans’ mental and 

physical health, work performance, 

housing status, and social function. 

The department offers treatments for 

substance use problems throughout its 

health care system.

VA RESEARCH ON SUBSTANCE 

USE DISORDERS: OVERVIEW

• VA supports a broad portfolio of

research looking at substance abuse 

prevention, screening, and treatment. 

Some researchers are looking at treatmentseeking patterns: why and when Veterans 

ask for help—and why many don’t. 

Treatment strategies, including cognitive 

behavioral strategies and Web-based 

approaches, are also being studied.

• Other researchers are working to identify

the most effective therapies for co-morbid 

disorders, such as depression and PTSD, 

and attempting to determine if early 

intervention improves outcomes. Still 

others are focusing on how readjustment 

issues relate to substance abuse.

• A Collaborative Research to Enhance and

Advance Transformation and Excellence 

(CREATE) group is working to promote 

value and access in VA’s SUD services. 

The group is doing so by validating and 

refining quality metrics; evaluating and 

disseminating low-cost, high impact 

innovations; and promoting patient and 

provider knowledge about evidence-based 

treatment for SUDs.

SELECTED MILESTONES AND 

MAJOR EVENTS

1956 – Linked cigarette smoking with 

precancerous lesions

1976 – Completed a comparison trial of 

two different types of methadone

1984 – Developed the nicotine 

transdermal patch and other therapies to 

help smokers quit

1992 – Published a study in which the 

drug Naltrexone was shown to be effective 

in keeping alcoholics from relapsing into 

heavy drinking and reduced cravings for 

alcohol

2013 – Successfully tested a vaccine to 

treat methamphetamine addiction on mice

2016 – Developed, and tested on rats, a 

painkiller as strong as morphine that is 

unlikely to be addictive and has fewer side 

effects

RECENT STUDIES: SELECTED 

HIGHLIGHTS

• For treating alcohol dependence, a

26-week primary care intervention is 

just as effective as specialty outpatient 

treatment, according to VA researchers 

in Philadelphia. The study enrolled 163 

Veterans and randomly assigned them 

to primary care treatment or specialty 

treatment groups. Those receiving primary 

care treatment were offered medicine 

and psychosocial support, delivered in 

person and by phone. The researchers 

found that Veterans in the primary care 

treatment group were more than five 

VA research on 

SUBSTANCE USE DISORDERS

Substance use and abuse, with its associated health 

consequences, is a major public health problem. Substance use 

disorders (SUDs) include dependencies on alcohol, illicit and 

prescription drugs, and nicotine. 

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SUDs have major negative impacts on Veterans’ 

mental and physical health, work performance, 

housing status, and social function. 

times as likely to complete all 26 weeks. 

Overall abstinence rates were the same 

between groups, and the primary care 

group had a smaller percentage of days 

with heavy drinking. (Journal of General 

Internal Medicine, January 2014)

• Smoking marijuana is not as bad as 

smoking cigarettes when it comes to 

lung disease, according to researchers 

from the Central Arkansas Veterans 

Healthcare System in Little Rock and 

the University of Arkansas. They found 

a clear linkage between marijuana 

use and chronic bronchitis and large 

airway inflammation, conditions that 

make breathing difficult. However, 

they found no links to emphysema, a 

chronic disease in which the air sacs in 

the lungs are gradually damaged, and 

only weak, if any, links to lung cancer. 

The researchers concluded, however, 

that there is unequivocal evidence that 

habitual or regular marijuana use is 

not harmless, and that doctors should 

caution patients about possible lung 

damage from regular heavy marijuana 

use. (Current Opinion in Pulmonary 

Medicine, March 2014)

• Lung cancer screening can actually 

lower smokers’ motivation to quit 

smoking, according to investigators 

with the VA Puget Sound Health Care 

System and the University of Seattle. 

The team interviewed smokers who had 

just undergone lung cancer screening. 

Nearly half found some reason to 

believe that just being screened meant 

that they did not need to stop smoking. 

This assumption is false, as is the 

assumption many study participants 

had that lung cancer was the only 

potential lethal effect of smoking. (JAMA 

Internal Medicine, September 2015)

• Most prescriptions for opioid 

painkillers are made by the broad 

swath of U.S. general practitioners, 

not by a limited group of specialists, 

according to a study by researchers at 

the Palo Alto VA Health Care System and 

Stanford University School of Medicine. 

The research team examined Medicare 

prescription drug claim data, and found 

that while the top 10 percent of opioid 

prescribers account for 57 percent of 

all opioid prescriptions, this prescribing 

pattern is comparable to that found in the 

Medicare data for prescribers of all drugs. 

(JAMA Internal Medicine, February 2016)

• Scientists know that alcohol itself 

can directly damage liver cells. A 

2016 study by researchers at the VA 

San Diego Healthcare System and the 

University of California yielded evidence 

that alcohol is harmful to the liver for a 

second reason—it allows gut bacteria 

to migrate to the liver promoting 

alcohol-induced liver disease. According 

to the research team, alcohol appears 

to impair the body’s ability to keep 

microbes in check. When barriers break 

down, bacteria that don’t normally 

colonize the liver end up there—and 

this bacterial migration promotes 

alcohol liver disease. (Cell Host and 

Microbe, Feb. 10, 2016)

• Specialized counseling delivered 

by telephone may be more effective 

than state quit lines to help smokers 

in mental health care kick the habit. 

A team of researchers from the VA 

New York Harbor Health Care system 

and New York University found that 

specialized counseling yielded a quit 

rate of 26 percent at six months, versus 

18 percent for the state quit lines. 

(American Journal of Preventive Medicine, 

April 2016)

• Veterans receiving the highest 

doses of opioid painkillers are more 

than twice as likely to die by suicide, 

compared with those receiving the 

lowest doses. Investigators with the VA 

Ann Arbor Healthcare System and the 

University of Michigan looked at nearly 

124,000 Veterans who had non-cancer 

chronic pain and received prescriptions 

for opioids. They found that the 

suicide risk rose as dose increased. The 

researchers could not tell, however, 

whether there was a direct causal link 

between the pain medications and 

suicide risk. Instead, the high doses may 

be a marker for other factors that drive 

suicide, including unresolved severe 

chronic pain. (Pain, May 2016) 

For more information on VA studies 

on substance use disorders and 

other key topics relating to Veterans’ 

health, please visit 

www.research.va.gov/topics

SUBSTANCE USE DISORDERS

Updated September 2016 • For a digital version of this fact sheet with active links to sources, visit www.research.va.gov/topics