Substance Use Disorders

Understand the Problem

Coast to Forest Web Library

This page defines substance use and gives a brief overview of the state of substance use in the United States and Oregon.

Defining Substance Use Disorders

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorders (SUDs) occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. The most common substance use disorders include alcohol use disorder, cocaine use disorder, hallucinogen use disorder, heroin use disorder, inhalant use disorder, marijuana use disorder, nicotine use disorder, opioid use disorder, and stimulant use disorder.

Risk factors for substance use disorders include biological/genetic predisposition, having a co-occurring mental health condition, family members or peers modeling substance use, neighborhood poverty and/or violence, stigma, discrimination, and trauma. Trauma can occur when a person experiences an event, a series of events, or a long-standing condition that overwhelms their ability to cope. To learn more about trauma and substance use, please visit Substance Use Disorders 101, a free course provided by Oregon State University's Professional and Continuing Education.

Substance use disorders can have a variety of negative health effects including lung disease, heart disease, liver disease, stroke, cancer, and death.

Talking about substance use disorders is important because it sheds light on the harm these substances can cause when using them improperly.

Language to Combat Stigma

Stigma is a negative social attitude toward a group of people or ideas based on a specific characteristic. In this web library, we are using the term “substance use disorders” instead of “substance abuse” wherever possible because it is a more person-centered and less stigmatizing approach to talking about this disease. In some cases this isn’t possible because literature may use stigmatizing words and organization names may include such language.

Additionally, it is important to acknowledge the differences between person-first and identity-first language when discussing substance use. Person-first language emphasizes the person as an individual before a diagnosis (e.g., person with a substance use disorder) while identity-first language places the diagnosis before the person (e.g., substance user or addict).

When talking about substance use the current standard is to use person-first language to help combat stigma. To learn more about best practices, please refer to Reporting on Addiction's Language Style Guide and Visual Style Guide

Substance Misuse vs. Substance Use Disorders

Substance misuse

Substance misuse is defined as the use of a substance for a purpose that does not align with legal or medical guidelines. A common type of substance misuse is prescription and over-the-counter medication misuse which is defined as taking medication prescribed for someone else, taking extra doses or more than the recommended dose, or taking medication for non-medical reasons. Common prescriptions to misuse include opioids, anxiety or sleep medications, and hyperactivity disorder medications.


Substance use disorders

Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

Alcohol use disorder

The most common substance use disorder in the United States is alcohol use disorder. Alcohol use disorder is a type of substance use disorder where the consumption of alcohol and the inability to limit and/or stop drinking has significant negative impacts on a person’s daily life.

Other substance use disorders

Other common substance use disorders are opioid use disorder (OUD) and stimulant use disorder (StUD).

Opioid use disorder

Opioid use disorder involves a pattern of opioid use that results in significant impairment and distress. Examples of opioids include oxycodone (e.g., OxyContin), hydrocodone-acetaminophen (e.g. Vicodin), morphine, fentanyl, and heroin.

Stimulant use disorder

Stimulant use disorder is a type of substance use disorder characterized by a pattern of stimulant use that has a significant impact on a person’s everyday life. Stimulants are a class of drugs that increase central nervous system activity. Examples of stimulants include amphetamines (e.g., Adderall), cocaine, khat, methamphetamine, and nicotine.


Learn more

To learn more about specific substance use disorders, please visit our Fact Sheets.

The Opioid Crisis in the United States

Opioids, also known as narcotics, are a class of drugs that provide pain relief and cause the body to feel relaxed. Opioids may be prescribed by a healthcare provider to manage moderate to severe pain after surgery or for chronic diseases like cancer. While opioids are mostly taken in pill form, they can also be prescribed as liquid or lozenges.

Beginning in the late 1990s, opioid prescriptions became widespread when the Food and Drug Administration (FDA) approved Vicodin, OxyContin, and Percocet to treat chronic pain. These drugs were similar to Morphine, but pharmaceutical companies advertised them to the medical community as a safer and non-addictive alternative, despite evidence to the contrary. Between 1997 and 2002, opioid prescriptions including Morphine, Fentanyl, and Oxycodone increased by 73%, 226%, and 402%, respectively. This spike in prescriptions caused the first wave of the opioid crisis to begin.

There have been three major waves of opioid-related deaths in the United States, with recent data suggesting that we may be entering a new, fourth wave.

  • The first wave began in the 1990s as prescription opioid deaths started rising.
  • The second wave started in 2010 when overdose deaths involving heroin sharply increased.
  • The third wave began in 2013 with a rise in synthetic opioid overdose deaths, mostly attributable to Fentanyl (pdf). The word synthetic means that opioids like Fentanyl are made from start to finish in a lab. Fentanyl is particularly dangerous because a very small amount can be deadly and it can be used to cut other substances, meaning that people may be unaware they are consuming Fentanyl.

Current data is suggesting that we are now in a new wave, characterized by polysubstance use, with a noted increase in stimulant and/or opioid use. Research is underway to better understand this new wave and pinpoint when it began.


Timeline of the Opioid Epidemic

(A timeline spanning from 1990 to 2017 that shows each of the four waves of the opioid epidemic as well as the launch of the American Pain Association campaign “pain as the fifth vital sign”.)


In 2017, the US Department of Health & Human Services (HHS) declared a public health emergency and created a five-point strategy to combat the opioid crisis. This strategy emphasized better research, better data, better pain management, better targeting of overdose reversal drugs, and better addiction prevention, treatment, and recovery services. More recently in President Biden’s State of the Union Address, the President called for reducing barriers to medication for opioid use disorder, increasing funding for public health efforts, and emphasizing harm reduction services.

Continued efforts to address the opioid epidemic are vital, as overdose deaths continue to rise.

Substance Use Disorders in the United States

  • In 2019, 165.4 million people had used a substance within the last month and 20.4 million people had a substance use disorder.
  • In 2021, nearly 107,000 people died from a substance overdose, with synthetic opioids being involved in 66,889 deaths.
  • Substance use costs the United States approximately $1 trillion annually.
  • But, for every $1 spent on substance use prevention, communities can save $4-5 on treatment and counseling services

Substance Use Disorders in Oregon

  • In 2018, 339 deaths were caused by opioid drug overdoses and 57.3 prescriptions for opioids were written for every 100 people in Oregon.
  • From 2019 to 2020, the number of fentanyl related deaths increased from 75 to 298.
  • Between September 2020 and September 2021 drug overdose deaths rose by 40.7%.
  • Only 5.8% of Oregonians who died from an unintentional drug overdose in 2021 were receiving current treatment for mental health and substance use.
  • Oregon’s substance use disorder rate is 27.6% higher than the national average.

Number of Fentanyl Related Deaths in Oregon

This graphic is based on the Opioid Overdose Public Health Surveillance Updates.

Risks of Substance Use Disorders

General risks

General risks of substance use disorders include overdose, accidental injury, and mental health conditions.


Risks of alcohol use disorder include heart disease, depression, infertility, erectile dysfunction, and/or liver damage.


Risks of cannabis use disorder include short-term memory loss, accelerated heartbeat, increased blood pressure, difficulty concentrating, and/or lapses in judgment.


Risk of stimulant use disorder include heart attacks, seizures, strokes, and/or anxious or paranoid behavior.


Risk of heroin use disorder includes chills, sweating, runny nose, muscle pains, and/or insomnia.


Risks of nicotine use disorder include lung cancer, heart attacks, emphysema (a lung condition that makes it harder to breathe over time), and/or high blood pressure.

COVID-19 and Substance Use

The COVID- 19 pandemic has caused significant stress for many through various restrictions including lockdowns and isolation, social distancing, closures of business, and transitions to remote work and learning, among others. These stressors were often made worse through confusing, unclear, or inaccessible communication methods.

These measures have impacted those using substances by disrupting current services and access to services as well as affecting initiation or increase of substance use to cope with stress. Additionally, those with substance use disorders are at an increased risk of contracting COVID-19 and are more likely to experience severe outcomes.

It is important to note, that while telehealth services for substance use have expanded during the pandemic, access to such services is not yet equitable. This is because services require access to a computer and internet, which is not universal. For example, in rural communities limited access to high-speed broadband services is a major barrier to telehealth services. Services can also be expensive, meaning that people experiencing financial difficulties or those without insurance may not be able to afford such services.