{'fraction_non_alphanumeric': 0.023523763802208355, 'fraction_numerical': 0.0, 'mean_word_length': 5.165680473372781, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is Substance Abuse a Medical Problem?

Abuse of psychoactive drugs for non-medicinal purposes—termed herein “substance abuse”—is a medical problem, a major one. Like many other major medical problems—heart disease, cancer, diabetes, obesity, sedentary lifestyle—it also has behavioral, social, economic, and political dimensions. However, any consideration of substance abuse differs significantly from the consideration of the problems in the list above, for the following reasons. First, national legal policy, beyond conventional health care system policy, has a singular role in determining how the United States deals with the problem. Therefore, virtually no consideration of any aspect of the substance abuse problem takes place in the absence of a consideration, stated or unstated, of national legal policy-making on the issue. Second, national legal policy is central to any consideration of how substance abuse is dealt with in the United States. This is due to the dominant role that the criminal justice system, operating separate and apart from the health care system in this instance, plays in dealing with one subset of it. The U.S. gives a central, independent, role to the criminal justice system in dealing with certain aspects of the substance abuse problem, especially in how those who use one particular subset of the substances of abuse are dealt with. The criminal justice system has no such role in dealing with any other medical problem. This phenomenon is a direct result of how the substance abuse problem and its several components are defined, politically and legislatively. Neither medicine nor other science underlie this peculiar definition. The centrality of definitions to the understanding of the substance abuse problem and how it is dealt with makes it unique among the major medical problems. The fact that substance abuse is the only medical problem defined primarily in the political and legislative arenas rather than the medical and scientific ones has an enormous impact on national policy-making. This paper briefly examines these issues.