This illness is called a substance use disorder. Disorders can range from mild and temporary to severe and chronic. Severe and chronic substance use disorders ...NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutJournalListTransAmClinClimatolAssocv.128;2017PMC5525418TransAmClinClimatolAssoc.2017;128:112–130.PMCID:PMC5525418PMID:28790493SubstanceMisuseandSubstanceuseDisorders:WhydotheyMatterinHealthcare?A.THOMASMCLELLAN,PhDA.THOMASMCLELLANSARASOTA,FLORIDAFindarticlesbyA.THOMASMCLELLANAuthorinformationCopyrightandLicenseinformationDisclaimerA.THOMASMCLELLAN,SARASOTA,FLORIDA;Correspondenceandreprintrequests:A.ThomasMcLellan,PhD,2833BayShoreCircle,Sarasota,Florida34234,Phone:347-828-0704,gro.hcraesert@nallelcmtCopyright©2017TheAmericanClinicalandClimatologicalAssociationThisarticlehasbeencitedbyotherarticlesinPMC.Thispaperfirstintroducesimportantconceptualandpracticaldistinctionsamongthreekeyterms:substance“use,”“misuse,”and“disorders”(includingaddiction),andgoesontodescribeandquantifytheimportanthealthandsocialproblemsassociatedwiththeseterms.Nationalsurveydataarepresentedtosummarizetheprevalenceandvariedcostsassociatedwithmisuseofalcohol,illegaldrugs,andprescribedmedicationsintheUnitedStates.Withthisasbackground,thepaperthendescribeshistoricalviews,perspectives,andeffortstodealwithsubstancemisuseproblemsintheUnitedStatesanddiscusseshowbasic,clinical,andhealthserviceresearch,combinedwithrecentchangesinhealthcarelegislationandfinancing,havesetthestageforamoreeffective,comprehensivepublichealthapproach.Asacountry,wehaveaserioussubstancemisuseproblem—useofalcohol,illegaldrugs,and/orprescribedmedicationsinwaysthatproduceharmstoourselvesandthosearoundus.Theseharmsaresignificantfinanciallywithtotalcostsofmorethan$420billionannuallyandmorethan$120billioninhealthcare(1,2).Buttheseproblemsarenotsimplyfinancialburdens—theydeterioratethequalityofourhealth,educational,andsocialsystems,andtheyaredebilitatingandkillingus—particularlyouryo