It's no secret that I'm outspoken about drug and alcohol use among young people. Being passionate about this issue can be tough. It would probably be easier to concern myself with a more universally appealing subject -- helping sick kittens or providing meals to the homeless.
A friend recently posed an interesting question to me: "Why do you care?" she said. "Can't you just let go of substance use issues and worry about something else?"
It had been a long time since anyone had asked me that question, and I had to really think about it. Here is the best answer I can muster:
I am concerned with drug and alcohol issues because substance use targets a weak and vulnerable population and because most people are dangerously misinformed about the costs of substance use. Further, substance use is one of the most important public health issues of our time, and yet stigmatization impedes progress at every turn.
Still don't believe drug and alcohol issues are worth worrying about? Allow me to explain.
1. Substance use targets a weak and vulnerable population.
I first became interested in drug and alcohol issues from personal experience. Between ninth and tenth grade, many of my friends started to experiment with drugs and alcohol. I was shocked -- these were the good old kids I had grown up with, not the juvenile delinquents we had learned about in D.A.R.E.
I realized quickly that many of these kids didn't even want to try drinking -- they felt compelled to. They didn't have a non-drinking support structure to lean on, and so even the mildest nudges to drink or try drugs felt overwhelming to them.
As an economically-minded individual, I support people making their own decisions and living with them. But I don't like to see people treated unfairly. Teenagers are vulnerable and often fail to think through the long-term consequences of their actions. Even if teens make the ultimate decision on whether to drink or not, I think it's our responsibility to (at least) create a support structure for those who want to make healthy decisions.
Speaking of economics, economists agree that free-market decisions fundamentally don't work in certain cases, and I'll use the next two points to argue that substance use is one of those cases.
2. Most people are dangerously misinformed about the consequences of substance use.
The economics of decisions depends on people being able to weigh the costs and benefits of options. When most teens pick up a beer for the first time, I'd argue they probably don't understand the full costs. Sure, teens may understand that there's a potential for being caught (either by parents or by the police) and that there's probably some vomiting and hangovers at the end of the road.
But what about addiction? Nearly 10 percent of the adult American population struggles with addiction, and 90 percent of people struggling with addiction started using before they turned 18. Overdose? 38,000 people died of an overdose in 2010, and the proportion of young people overdosing is growing exponentially due to the opioid epidemic. And these are just a few of the worst costs of drug and alcohol use.
3. Drinking and drug use causes problems for your friends, family, co-workers, and people you don't even know.
Another rule of free-market decisions is that the decision-maker needs to feel the full consequences and benefits. Again, substance use doesn't fit into this model. People drink and use drugs more often than they should because they're not feeling all the consequences of their actions.
The obvious example is driving under the influence. In 2010, over 10,000 people died from DUI incidents - many of whom were completely innocent. That doesn't include thousands of life-limiting injuries and trauma caused from DUI crashes.
But driving drunk isn't the only negative externality. Substance use contributes significantly to increased health care costs, increased crime, and lost productivity. When addiction affects nearly one in ten adults, it's a safe bet that many families are torn apart by substance use.
4. Substance use is one of the most important public health concerns in America.
The leading preventable cause of death? Tobacco addiction.
The leading cause of accidental death? Overdose.
The NIH's estimated annual economic cost of substance use is $559 billion/year. (That's about $1,700 for every American man, woman, and child, every single year.)
5. The only thing preventing us from making progress in substance use issues is stigma.
Think of both a drug addict and someone else with another chronic condition -- say diabetes. Who is more likely to be cured?
The answer is neither -- both addiction and diabetes are incurable. But both are maintainable chronic diseases. Here's the difference: the stigma behind substance use disorders makes people think that prevention and treatment programs are worthless.
I care about substance use not because it's a sad story -- instead, substance use is a world full of opportunities. If people could see that prevention and treatment programs work -- which they quantifiably do -- we could easily change the course of millions of lives.
When my friend asked me why I cared about substance use, it's clear she thought substance use issues were a lost cause. She thought it was inevitable. Kids will drink or use drugs, some will become addicted, and lives will be damaged.
I care about substance use to show her and others like her the truth: substance use problems can change. And who is better equipped to change the way substance use is addressed than us, the young people?