Talk:Substance abuse

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Suggested Addition on Special Populations[edit]

I have come up with an addition for this section addressing substance abuse in older adults and how they tend to transition into alcohol and prescription drug abuse. It discusses how this group (65+) is responsible for one-third of prescription drug sales and how these drugs can be abused. In addition, this group can be more susceptible to withdrawal symptoms and additional side-effects due to the mixing of alcohol and drugs. Any suggestions or problems? — Preceding unsigned comment added by Sankaria14 (talkcontribs) 22:34, 7 December 2014 (UTC)


why does the first sentence in the signs and symptoms paragraph say drug misuse instead of drug abuse? Is it because the definition of drug misuse is above it? I'm going to change it, if you have any problem with it go ahead and change it back but tell me why here (talk) 16:13, 12 August 2010 (UTC)

Responsible drug use[edit]

I'd like to make the following notes, though not sure what if any additions I can personally make above and beyond. More secificaly, my notes may be jurisdiction dependant.

1: The Majority of chemical drugs are not 'illegal' they are prohibited. for instance: Heroin is actually proscribed to some people, and not just for people who are dependant on it. 2: The misuse of drugs act [UK] (which came out of an international treaty) is based on 'misuse' being not of medical use, and so defines 'recreational' as not of medical use. Legal cases in the UK have been based on the idea of medical necessity, that is there was no suitable alternative available. and that serious harm would otherwise be caused. 3: I don't know anyone who's been coded this way for nicotine dependence, nor food dependence / abuse. —Preceding unsigned comment added by (talk) 19:34, 22 November 2010 (UTC)


Substance abuse is simply another euphemism for addiction. Tobacco for example has an 85% acquire rate which means for every 100 who smoke 1 cigarette will become dependent on tobacco. Ethanol is the active ingredient in beer, wine and spirits and the cessation rate is dismal at about 1 in 36.

This article smacks of prohibition when addiction should be recognized as a medical problem. Addiction is hard to treat, a jail cell is not treatment. My IQ >> 160 (talk) 01:23, 21 March 2011 (UTC)

Please use Wikipedia talk pages to improve the article. Are there verifiable and reliable sources to improve the article to show various points of view, while maintaining a neutral point of view? tedder (talk) 01:28, 21 March 2011 (UTC)

‘Substance’ use[edit]

The article’s use of ‘substance’ strikes me as bizarre
Does it represent denial that ethanol and nicotine are drugs, and generally muddled thinking about drug use by supposed authorities?
Or am I a substance abuser, within the meaning intended by the article, because air and water are substances?
Laurel Bush (talk) 14:43, 16 August 2011 (UTC)

"Substance" is usually shorthand for "psychoactive substance" or "drug", but casts a broader net because there are many people who abuse non-psychoactive substances (e.g., performance enhancing drugs)...In addition, "substance" is preferred by some over "drug" because the latter is more of a loaded term. While I have no idea if you abuse air or water, there is some discussion of this nomenclature in the article (though it could use more clarity) that would strongly suggest your possible issues with air and water, short of hyponatraemia or psychogenic polydipsia, aren't in the category of disorders discussed in the present article. — Scientizzle 16:25, 16 August 2011 (UTC)

Seems to me:

  • The article is really about drug abuse, meaning reckless or pathological use of a substance as a drug, and includes such use of substances which may not be recognised as drugs by drug and medicines control legislation, or in common discourse (with alcohol as an example of a substance which may be abused without being recognised as a drug)
  • ’Drug substance abuse’ might be a better article title, but would create, in my mind, a quandary as to what Drug substance should be or point to
  • The title should be Drug abuse (except Drug misuse might be better)

Laurel Bush (talk) 11:36, 24 August 2011 (UTC)

Drug misuse is a different concept than drug abuse (though I'm sure one could easily ID a demarcation problem between misuse and abuse), and more commonly associated with prescription drugs rather than illegal narcotics[1], so that would not be a good title. Substance abuse or Substance abuse disorder are the only proper titles based on the family of psychiatric disorders found in the DSM IV, in my opinion, and the former is simpler. — Scientizzle 14:00, 24 August 2011 (UTC)

Laurel Bush (talk) 09:35, 25 August 2011 (UTC)

I can certainly admit that my perspective of this topic has been formed in the United States and specifically influenced by NIDA. "Drug misuse" appears to have a different usage and meaning in the UK--completely synonymous with "drug abuse" rather than slightly I said above, the terms are unfortunately somewhat ambiguous. However, the title of this article should come from an evaluation of the most prominent and relevant sources. There are two distinct questions here: "substance" vs. "drug" and "abuse" vs. "misuse" vs. "use". The article presently uses "substance abuse" as the preferred term, but synonymizes (is this even a word?) it with "drug abuse" right in the opening sentence. To determine what the reliable, authoritative sources currently use as terminology. Here's what I've found thus far...
  • DSM[2]-"Substance-Related Disorders" and specific DSM coding for "abuse"
  • MeSH[3][4]-Synonymous use of "substance abuse" and "drug abuse"
  • ICD[5]-"Mental and behavioural disorders due to psychoactive substance use"
  • NICE[6]-"Drug Misuse"
  • Australian National Drug Strategy seems to prefer "abuse"[7] over "misuse"[8] and "drug abuse" generally
  • Royal College of General Practitioners[9]-"Substance misuse" & "drug misuse"(see also doi:10.1093/innovait/inq113 in which almosst every variation of "substance/drug misuse/abuse" is used almost interchangeably)
  • There's some good discussion of terminology by the WHO[10]

    misuse, drug or alcohol Use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. The term is preferred by some to abuse in the belief that it is less judgmental.


    abuse (drug, alcohol, chemical, substance, or psychoactive substance) A group of terms in wide use but of varying meaning. In DSM-IIIR, "psychoactive substance abuse" is defined as "a maladaptive pattern of use indicated by ...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physical1y hazardous". It is a residual category, with dependence taking precedence when applicable. The term "abuse" is sometimes used disapprovingly to refer to any use at all, particularly of illicit drugs. Because of its ambiguity, the term is not used in ICD-10 (except in the case of non-dependence-producing substances- see below); harmful use and hazardous use are the equivalent terms In WHO usage, although they usually relate only to effects on health and not to social consequences. " Abuse" is also discouraged by the Office of Substance Abuse Prevention (OSAP, now CSAP - Center for Substance Abuse Prevention) in the USA, although terms such as "substance abuse" remain in wide use in North America to refer generally to problems of psychoactive substance use.

    In other contexts, abuse has referred to non-medical or unsanctioned patterns of use, irrespective of consequences. Thus the definition published in 1969 by the WHO Expert Committee on Drug Dependence was "persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical practice"

If anyone else wants to find more sources, I'd love to see them...
My take on what I've seen thus far is that "substance" & "drug" are widely and presently treated as synonymous and interchangeable, but the DSM & ICD use of substance over drug probably justifies substance being the preferred term over drug. That is, the way the opening sentence is structured right now is perfectly fine.
The question of "abuse" vs. "misuse" vs. "use" is a little trickier. It looks to me like there's a general abandonment of any distinction between misuse and abuse and the winds may be favoring the politically correct adoption of misuse over abuse. I think there's probably enough sourcing presented right here to adequately discuss the variations in terminology. Redirects for every major term, and bolded acknowledgment in the lede is probably warranted. — Scientizzle 15:02, 26 August 2011 (UTC)

I have read through some but not yet all of the material you have presented
It looks interesting

You say the winds may be favouring ‘misuse’ over ‘abuse’
I feel it blowing somewhat the other way in UK mass media, although my personal sense of English as a language is more comfortable with ‘misuse’ (with ‘abuse’ perhaps meaning deliberate or culpable misuse, and thus a category of misuse) Still, my local NHS board does continue to employ ‘substance misuse practitioners’, and has not rebranded them as ‘abuse practitioners’
Re ‘substance’ and ‘abuse’, I guess current DSM and ICD fashion must be respected, although I see use of ‘substance’ instead of ‘drug’ as denial, or pandering to denial, that ethyl alcohol and prescribed medicines are drugs
Or perhaps it is just that we are in an area littered with semantic traps (and perhaps the article should carry a warning to this effect)

I listed ‘Drug’ in Substance a while back

Laurel Bush (talk) 10:04, 29 August 2011 (UTC)

I have twigged
since writing the above
that substance abuse is usually code
or a morally prejudiced label
for intoxication
and that drug abuse is usally code for intoxication with 'drug'-stigmatised intoxicants
of which most are easily recognised as 'abuse'-stigmatised medicines
Reminds me of homosexuality used as a diagnosis
Laurel Bush (talk) 09:53, 27 October 2012 (UTC)

This article and the one on substance use disorder should not be merged. Substance use and substance use disorder are two different issues. Also, there are further differences between substance use, substance abuse, substance dependence, and substance withdrawal. So, again, these two are separate issues and the articles should not be merged. Daniellagreen (talk) 02:41, 20 February 2014 (UTC)

What about the third one, substance-related disorder? All seems the same to me. InedibleHulk (talk) 23:14, August 16, 2014 (UTC)

Less words please[edit]

I've just trimmed quite a bit, but this article still looks very much as if someone was paid "by the word" to pad it out. Keep it tight and on track people! Snori (talk) 18:25, 4 February 2015 (UTC)

DSM Updates[edit]

The DSM section of this article needs to be updated in that substance abuse is no longer a diagnosis according to DSM-5. Abuse and dependence have been merged as 'Substance Use Disorder.' The introduction should probably mention this with a wikilink to the Substance Use Disorder page. To the first paragraph a sentence such as:

According to the recently published DSM-5 substance abuse is no longer a specific diagnosis but under the category of Substance Use Disorder, combined with Substance Dependence.

I also suggest updating the DSM criteria for diagnosis. I do not have access to that information at the time of this edit. Ktwagner (talk) 12:57, 13 October 2015 (UTC)

@Ktwagner: Just came across your comment from 2 months ago. I agree. I'm going to post about it on WP:PSYCH first to see if there's already a general consensus about updating articles to the DSM-5 in a consistent way. If anyone sees message and wants to weigh in, I just posted about it on the talk page to the psych project. Permstrump (talk) 16:26, 15 December 2015 (UTC)


The last paragraph/phrase in that subsection (about risk for lungs when inhaling) looks odd. It is not in the same style than the rest. The whole section is not about harm but about special populations. The harm to lungs from aspiration/inhalation should IMHO be mentioned elsewhere. — MFH:Talk 00:43, 13 January 2016 (UTC)


Ref does not appear to support

Extended content

Scientist's began to study addiction in 1930, and concluded that addiction was a moral shortcoming and lack of willpower, developing a strong stigma towards what caused the addiction in the first place. Those conclusions influenced society’s view on addiction, but those conclusions are no longer valid because of groundbreaking information found by scientists in the past ten years that indicate addiction is a brain disease that affects both the brain and behavior.[1]

Doc James (talk · contribs · email) 07:13, 2 December 2015 (UTC)

what do you mean by "support"? what effect is opposed to what you expected/wanted? — MFH:Talk 00:43, 13 January 2016 (UTC)


I'm concerned about the following statement in the article as of 2016-05-24: "In 2013 drug use disorders resulted in 127,000 deaths up from 53,000 in 1990." I'm concerned about the following:
  1. Do these numbers refer to the entire world? I assume so, but it wasn't clear to me.
  2. I could not find those numbers in the article cited: GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.. I checked the article and could not find 127 (as in 127,000) nor 53 (as in 53,000) nor anything else quickly scanning that supported this statement. It may be there, but I didn't find it in the 5-10 minutes I spent skimming and searching.
Could someone please fix this verbiage and the citation?
Thanks, DavidMCEddy (talk) 18:44, 24 May 2016 (UTC)
I'm not seeing the numbers in the article or the figures either. Sizeofint (talk) 21:09, 24 May 2016 (UTC)

First graph is retarded[edit]

Most addictive drug is agreed by pharmacology authorities to be tobacco. Cannabis is not physically harmful at all. LSD is probably the least addictive substance that ever existed; it's practically impossible to form dependence even if one tries (due to tolerance etc). Amphetamine is infinitely more harmful than heroin. It's like it was randomly made by an idiot who has no knowledge at all about pharmacology. I won't remove it right now because I don't have the time to add the references to support my edit, but someone who has the time and the knowledge please look into this. — Preceding unsigned comment added by (talk) 07:53, 12 February 2016 (UTC)

I don't think we say LSD is addictive anywhere in this article. I agree this article needs improvement with reliable medical sources. Sizeofint (talk) 09:01, 12 February 2016 (UTC)
Thanks for the reply. I should clarify, I was only talking about the first graph. It seems completely full of errors — Preceding unsigned comment added by (talk) 12:57, 12 February 2016 (UTC)

Adding a section on Comorbidity[edit]

It is common for individuals that abuse or misuse drugs to have other psychological diagnoses. Depression, anxiety, and psychosis are all common comorbidities. However, it is difficult to determine if the substance abuse is a primary disorder or a result of the comorbid psychological disorder. Looking at family history, onset of the substance abuse and psychological disorder symptoms, and previous treatment, can all aid in determining the primary disorder.

Individuals who have a comorbid psychological disorder often have a poor prognosis.

Additionally, substance abuse may produce symptoms that lead to a false diagnosis. For this reason, it is important that an individual maintain abstinence for 2 weeks before a psychiatric diagnosis is made.


Good idea, Mattmcgarr, and thanks for getting something started! My suggestions are below. I tried to make it how it would look in article. I took out a lot of the stuff about the primary diagnosis because I think you misinterpreted the authors’ meaning. Let me know if you want me to expand on that. Permstrump (talk) 11:18, 9 March 2016 (UTC)

Dual diagnosis[edit]

It is common for individuals that abuse or misuse drugs to have other psychological problems.[2] The terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), “symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol.”[3]

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated.[2] Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they didn’t receive any treatment all. However since the 1980’s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider.[3] Permstrump (talk) 11:18, 9 March 2016 (UTC)

Doc James, re: your recent edit, what do you think about "It is common for individuals that misuse drugs... or It is common for individuals with substance use disorders... to have other psychological problems."? The original wording was probably clunky, but the source is talking specifically about people with disordered use. I don't believe the statement applies to everyone who uses drugs/alcohol in general. PermStrump(talk) 04:11, 15 March 2016 (UTC)
I prefer "use". It is more factual. "Misuse" implies a judgement by someone. Many people who use drugs state they do so volitionally and can stop any time they wish. They deny they misuse them. Doc James (talk · contribs · email) 04:26, 15 March 2016 (UTC)
Even if the exact quote is, "symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol."? It's not that I'm so attached to the wording of that part of that one sentence, but I would have worried that it was misrepresentation of the source. If you think still think "use" is close enough compared to the direct quote, then I'll trust your opinion. I used that quote later in the same paragraph, so maybe that's qualification enough. PermStrump(talk) 04:32, 15 March 2016 (UTC)
Yes looking at sources such as this one [11] they do use "substance use disorder" so I guess we should stick with that. Doc James (talk · contribs · email) 04:37, 15 March 2016 (UTC)


  1. ^ "Drugs, Brains, and Behavior: The Science of Addiction." National Institute of Drug Abuse (NHI). 1 July 2014. Web. 10 Nov. 2015.
  2. ^ a b c Lingford-Hughes, A. R., Welch, S., Peters, L., & Nutt, D. J. (2012). BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. Journal of Psychopharmacology, 26(7), 899-952.
  3. ^ a b Ashley L. Peterson, BSN, BScPharm, RN. Integrating Mental Health and Addictions Services to Improve Client Outcomes. Issues in Mental Health Nursing, 34:752–756, 2013.

Relevance of current epidemiology statistic regarding "illicit substances"[edit]

I'm working on an Esperanto translation of this article and find it important to raise this issue without getting into any sort of debate about drug abuse: I am unable to understand the relevance of the statistic about the number of people who use illicit substances. The diagnosis of substance abuse is independent of legality, and can include legal drugs like alcohol. If someone can justify the statistic, please feel free to. Jan sewi (talk) 18:07, 10 January 2017 (UTC)

A lot of the content in the epidemiology section seems more appropriate for recreational drug use. For the lead I think it is necessary since the source is discussing the proportion of illicit drug users that have substance-related problems. Sizeofint (talk) 18:15, 10 January 2017 (UTC)
This puts the condition into perspective. Doc James (talk · contribs · email) 10:37, 11 January 2017 (UTC)
It would be nice if it did put the condition into perspective, but it doesn't. Putting the condition into perspective would require statistics about the number of people who use both licit and illicit drugs. As it stands the number is arbitrary, because "licit" varies by jurisdiction. Jan sewi (talk) 13:00, 11 January 2017 (UTC)
Did you read the ref? It is by the UN. There are international agreements. Doc James (talk · contribs · email) 13:04, 11 January 2017 (UTC)
The ref does not include alcohol as an illicit substance, which makes it irrelevant to an article about substance abuse:
Annual prevalence of the use of alcohol is 42 per cent (the use of alcohol being legal in most countries), which is eight times higher than annual prevalence of illicit drug use (5.0 per cent).
So it's irrelevant according to the lead itself, which says alcohol is associated with substance abuse. It's also an atrocious underestimation of substance abuse according to the cited report. A relevant statistic is needed. Jan sewi (talk) 13:10, 11 January 2017 (UTC)
Adding further: in the body of the article, in the Classification section, it points out that the DSM-V even includes caffeine as a drug of abuse, which is not regulated in any way in most countries. I'm not claiming I agree with the inclusion of caffeine in this category, only that the topic of the article includes caffeine by definition, so illicit drug use statistics are not relevant to the topic.
If my objection is confusing to anyone, the issue is that "illicit" is a synonym of "illegal" or "prohibited," which has nothing to do with any medical concept of substance abuse. I should add also that my criticism does not involve the validity or invalidity of drug laws, it's only pointing out that statistics about the use of illicit drugs have nothing to do with substance abuse, which, according to current standard definitions, may include the abuse of alcohol or even caffeine. Does this make sense? Am I over-explaining myself? It's just hard for me to translate an article that gives conflicting messages. Jan sewi (talk) 10:59, 12 January 2017 (UTC)
If you have refs for use of legal substances and the frequency with which they result in substance abuse lets add them. This does not make the number who illegally use substances undue. Doc James (talk · contribs · email) 16:38, 12 January 2017 (UTC)

Possible Additions to the Society and Culture Section[edit]

Perhaps something could be said about how the cultural patterns of drug use are associated with the values, beliefs, and norms that a society assigns a drug. For example, the attitudes towards alcohol in the U.S., where the drinking age is 21, may influence behaviors of binge drinking in adolescence where as in some southern European countries, rates of binge drinking may be lower. Perhaps a different Wikipedia article altogether for this topic would be best. Courtlee214 (talk) —Preceding undated comment added 20:48, 26 January 2017 (UTC)

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The photo[edit]

Dear @Doc James:, thanks for reaching out.

I think that photo has potential to mislead patients about the efficacy of psycho-stimulants which could hold back patients like ADHD to take medications they need. --It's gonna be awesome!Talk♬ 03:04, 5 October 2017 (UTC)

Yes psychostimulants work for ADHD but they are also drugs of abuse. Ketamine is also used for a lot of medication uses as are barbiturates and even cocaine occasionally.
Not seeing that as justification to remove the image. Doc James (talk · contribs · email) 03:08, 5 October 2017 (UTC)
However, if you're a patient or patient's parent seeing the picture saying either methylphenidate or amphetamine are rated close to other commonly-abused drugs that cause troubles in the society, would you still dare to or allow your child to take those drugs at a daily basis for treating ADHD or other medical indications such as narcolepsy, depression chronic pain, and obesity? At least, I think it's required to add more information along with the current photo description. Thanks! : ) --It's gonna be awesome!Talk♬ 03:38, 5 October 2017 (UTC)
And what about ketamine? I give it to kids all the time. Hopefully this will help parents keep better controls over their kids methylphenidate and realize that they could be selling it at school. Doc James (talk · contribs · email) 03:42, 5 October 2017 (UTC)
Perhaps cultures vary between countries to countries. My assumed context is very likely to show up in my country. Adapting this article to better reflect global views and culture is preferable to continuing the present version because it has been translated to other languages and caused unnecessary panic among parents here. By the way, are you a pediatric psychiatrist? : ) --It's gonna be awesome!Talk♬ 03:53, 5 October 2017 (UTC)
I found the recent photo update is more appropriate. I appreciate you all. : ) --It's gonna be awesome!Talk♬ 10:49, 5 October 2017 (UTC)
Have moved the other one to the body of the text. Doc James (talk · contribs · email) 18:04, 5 October 2017 (UTC)
Sure, maybe you've your reason. Have a nice day buddy. --It's gonna be awesome!Talk♬ 02:26, 7 October 2017 (UTC)
You too. Doc James (talk · contribs · email) 09:03, 7 October 2017 (UTC)

Comparison of risks[edit]

The consensus is to use the second image, File:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg.

Cunard (talk) 00:22, 4 December 2017 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

(first image) Rational harm assessment of drugs radar plot
(second image) Rational scale to assess the harm of drugs (mean physical harm and mean dependence)

Which of the two images should we use? Doc James (talk · contribs · email) 01:19, 30 October 2017 (UTC)

Support use of 1st[edit]

Support use of 2nd[edit]

  • Support second one With respect to these two graphs I find the second one much clearer. A few items: The second one has bigger words, The second one is intuitively laid out (more right and higher means more significant), The second one makes good use of color. Doc James (talk · contribs · email) 01:23, 30 October 2017 (UTC)
  • support the second graph seems better overall--Ozzie10aaaa (talk) 11:17, 30 October 2017 (UTC)
  • support Seems the clearer of the two. Attic Salt (talk) 15:19, 30 October 2017 (UTC)
  • support This is better because it is a true 2D plot. The other is actually a pair of 1D plots in polar coordinates, and a sortable Wikitable would not be any sort of plot at all. Looie496 (talk) 20:45, 30 October 2017 (UTC)
  • Support. I can actually read the words in the second one shown here, at the scale given, and interpret which substances are where on the scale. The first one is just some starry shapes with what look like words around them but are too small to be legible. Also, from a more technical point of view, the ordering around the star chart, and the line segments connecting one substance to the next one in the ordering, appears to convey very little useful information. So you're wasting bandwidth by not making the spatial information (positions of substances on the chart) tell the reader something. The second chart makes better use of its information channels, although its choice of colors could be better explained. —David Eppstein (talk) 06:20, 31 October 2017 (UTC)
  • Support using this image provided that the table is also included since this image doesn't contain all the data from the source (social harm), a drug class comparison, or the aggregated harm rating. Seppi333 (Insert ) 22:07, 31 October 2017 (UTC)
  • Support. This is a much clearer representation at a glance in my opinion. Also, the first graph is an example of using a line graph when not appropriate - only the points are relevant, the line segments between them are not and only serve to clutter the graph.

Ashcanpete (talk) 17:47, 2 November 2017 (UTC)

  • Second one - just more clearly understandable a format to me. Markbassett (talk) 20:12, 2 November 2017 (UTC)
  • Support. Easier to interpret for me, and I suspect for almost all readers. (The reason's it's easier to interpret are explained above. It uses two dimensions to show two things, and does not clog the bandwidth with its near-meaningless ordering of the substances and totally meaningless line segments.) Maproom (talk) 08:02, 4 November 2017 (UTC)


Why can't we keep using both? They're both in the article right now. WhatamIdoing (talk) 02:36, 30 October 2017 (UTC)

True. And which one do you think should go first? Doc James (talk · contribs · email) 02:40, 30 October 2017 (UTC)
I'm fine with keeping both. Sizeofint (talk) 03:18, 30 October 2017 (UTC)
Using both is okay. First No.2 (easier to read), then No.1, (more detailed). --A D Monroe III(talk) 17:18, 30 October 2017 (UTC)
Yes so maybe 2 first and 1 second than? Doc James (talk · contribs · email) 19:06, 30 October 2017 (UTC)
Yeah, that's what I meant. Sorry. Amended my comment. --A D Monroe III(talk) 19:26, 30 October 2017 (UTC)
The radar plot is just bizarre. There's nothing circular about the data. Maybe convert all pages using the radar plot to either the second graph or the table, then delete File:Rational_harm_assessment_of_drugs_radar_plot.svg and File:Rational_harm_assessment_of_drugs_radar_plot.png? Alsee (talk) 14:36, 25 November 2017 (UTC)

Table alternative[edit]

@Doc James and Sizeofint: See below. I've left-aligned the table on this page since the images take up too much space on the right at the moment. In the article, this table should be right-aligned.

Also, can someone please check to make sure that I didn't make a clerical error while copying the table values? I had to do this manually. Seppi333 (Insert ) 19:56, 30 October 2017 (UTC)

I copy/pasted the data table below and the data table from File:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg#Data into excel and computed the difference between the column values to double check the data I copied. There was only 1 erroneous value in the table (Heroin's social harm score - I copied its "other social harms" score instead of the "mean social harm" score). The rest of the data was likely copied correctly from the source, unless I and the person who created that data table made the same clerical error in the same cell under one of the three mean harm columns; that's rather unlikely. Seppi333 (Insert ) 23:18, 31 October 2017 (UTC)
This could be good in addition to the images. Would a column for "total" be useful? Doc James (talk · contribs · email) 20:09, 30 October 2017 (UTC)
By total, do you mean the average of the of the 3 column values, or something else (e.g., the sum of those values)? Either would be fine I suppose. Seppi333 (Insert ) 20:15, 30 October 2017 (UTC)
Yes one can either add the three or add the three and divide by three. More or less the same. Doc James (talk · contribs · email) 20:39, 30 October 2017 (UTC)
@Doc James: Alright. Should the table footer (the text beneath "Notes about the harm ratings") be collapsed or should the formatting be left as is? Seppi333 (Insert ) 21:03, 30 October 2017 (UTC)
No strong feeling. Collapsed will be smaller. Doc James (talk · contribs · email) 21:07, 30 October 2017 (UTC)
Ok. I had to add another table around the wikitable since sorting a column when the footer is placed inside the wikitable sorts the footer along with the values under each heading (i.e., it looked pretty bad when it was sorted by any column). Seppi333 (Insert ) 21:15, 30 October 2017 (UTC)

─────────────────────────@Doc James: I've finished reformatting the table. I managed to get the footer to function correctly (i.e., not be sorted when sorting the columns) using only 1 wikitable, so there's no weird outside border in the current version. The table should be ready for the article now. Seppi333 (Insert ) 21:55, 30 October 2017 (UTC)

Looks like a good addition to the images Doc James (talk · contribs · email) 22:40, 30 October 2017 (UTC)
Much more readable, and... well, visually dull? I think we can bring it back by adding color to each cell, yellow for under 1.00, orange for under 2.00, and (pale-ish) red for under 3.00, and maybe violet for (the single) 3.00 and above. I'm very tempted to immediately put it in myself so I can see it, but I thought I'd better ask first. --A D Monroe III(talk) 00:27, 31 October 2017 (UTC)
I don't see any harm in adding it to see how it looks, especially since it can always be undone later. I think the sorting feature makes it a bit unnecessary to color code it though. Seppi333 (Insert ) 00:42, 31 October 2017 (UTC)
Done. I kept the colors pale to maintain text contrast. --A D Monroe III(talk) 04:14, 31 October 2017 (UTC)
That coloring scheme actually seems rather useful. Thanks for adding that. Seppi333 (Insert ) 21:47, 31 October 2017 (UTC)
Rational scale to assess the harm of recreational drug use[1]
Drug Drug class Physical
Heroin Opioid 2.78 3.00 2.54 2.77
Cocaine CNS stimulant 2.33 2.39 2.17 2.30
Barbiturates CNS depressant 2.23 2.01 2.00 2.08
Methadone Opioid 1.86 2.08 1.87 1.94
Alcohol CNS depressant 1.40 1.93 2.21 1.85
Ketamine Dissociative anesthetic 2.00 1.54 1.69 1.74
Benzodiazepines Benzodiazepine 1.63 1.83 1.65 1.70
Amphetamine CNS stimulant 1.81 1.67 1.50 1.66
Tobacco Tobacco 1.24 2.21 1.42 1.62
Buprenorphine Opioid 1.60 1.64 1.49 1.58
Cannabis Cannabinoid 0.99 1.51 1.50 1.33
Solvent drugs Inhalant 1.28 1.01 1.52 1.27
4-MTA Designer SSRA 1.44 1.30 1.06 1.27
LSD Psychedelic 1.13 1.23 1.32 1.23
Methylphenidate CNS stimulant 1.32 1.25 0.97 1.18
Anabolic steroids Anabolic steroid 1.45 0.88 1.13 1.15
GHB Neurotransmitter 0.86 1.19 1.30 1.12
Ecstasy Empathogenic stimulant 1.05 1.13 1.09 1.09
Alkyl nitrites Inhalant 0.93 0.87 0.97 0.92
Khat CNS stimulant 0.50 1.04 0.85 0.80
Notes about the harm ratings
The Physical harm, Dependence liability, and Social harm scores were each computed from the average of three distinct ratings.[1] The highest possible harm rating for each rating scale is 3.0.[1]
Physical harm is the average rating of the scores for acute binge use, chronic use, and intravenous use.[1]
Dependence liability is the average rating of the scores for intensity of pleasure, psychological dependence, and physical dependence.[1]
Social harm is the average rating of the scores for drug intoxication, health-care costs, and other social harms.[1]
Total harm was computed as the average of the Physical harm, Dependence liability, and Social harm scores.

Section reflist[edit]


  1. ^ a b c d e f Nutt, D.; King, L. A.; Saulsbury, W.; Blakemore, C. (2007). "Development of a rational scale to assess the harm of drugs of potential misuse". The Lancet. 369 (9566): 1047–1053. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831.

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

The graph[edit]

This graph sould be removed from the lede, it just repeats the old anti-benzo prejudices. There's no evidence whagtsoever than benzos are at the same level of such extremely harmful drugs as alcohol, see also: [12].Miacek (talk) 21:31, 15 May 2018 (UTC)

What "anti benzo prejudice" do you speak about? Yah harm is definitely mid way on the spectrum in my experience. But we do not need my experience as we have a source. Doc James (talk · contribs · email) 23:41, 15 May 2018 (UTC)
As I pointed out, other estimates that put benzos' risk much lower do exist.Miacek (talk) 08:12, 16 May 2018 (UTC)
The graph came about from a large survey of a diverse range of experts. It is one of the most robust surveys done. That is why it is included in the article. There is no evidence of an "anti-benzo" bias. In fact, the lead author, Prof. David Nutt, is very much pro-benzos and closely tied with the manufacturers of benzodiazepine drugs.--Literaturegeek | T@1k? 14:29, 16 May 2018 (UTC)


This needs to be converted to inline references Doc James (talk · contribs · email) 00:00, 31 August 2018 (UTC)

"St Louis Epidemic The overdose rate has risen in St Louis by 79 percent from 2010 to 2016 (Saint Louis County Department of Public Health, 2018). This increase could be explained by number of opioid prescription and quantity of pills issued to patients. Prescription Drug Monitoring Programs (PDMP) could directly influence the number of prescriptions written. Analysis was performed and determined that PDMP’s are not effective in reducing prescription rates unless physicians were required to access the program prior to writing the prescription (Ayres & Jalal, 2018). Additionally, Research has shown that patients receiving opioids to relieve chronic pain are 77 percent more likely to abuse drugs than those who do not (Banerjee et al., 2016). Education programs could be implemented to combat the overdoses as well. Historically, overdoses have decreased nine to 11 percent due to the Good Samaritan Laws that grant immunity to users that try and prevent an overdose (Ayres & Jalal, 2018). If citizens and more importantly, users, knew about law and other like it, the overall overdose rate could be positively impacted. Lastly, Naloxone has been available for many years but only to first responders and EMTs. Overdoses cost Missouri $12.6 billion annually (Missouri Department of Health, 2018). Research has shown, through the use of naloxone, overdose death rates decreased by 50 percent (Frank, Mateu-Gelabert, Guarino, Bennett, Wendel, Jessell, & Teper, 2015). The overdoses in St Louis continue to rise. By implementing PDMPs to monitoring prescriptions, educating the population about laws in place to combat overdoses and a cheaper more effective Naloxone prescription could reduce the number of drug related overdoses in the St Louis Area. References:

Ayres, I. & Jalal, A. (2018). Opioids, law & ethics. The Journal of Law, Medicine & Ethics, 46(2018), 387-403. doi:10.1177/1073110518782948

Banerjee, G., Edelman, E.J., Barry, D.T, Becker, W.C, Cerda, M., Crystal, S., Gaither, J.R., … Marshall, B.D. (2016). Non-medical use of prescription opioids is associated with heroin initiation among U.S. veteran: A prospective cohort study. Society for the Study of Addiction, 111(11), 2021-2031. doi:10.1111/add.13491 Frank, D., Mateu-Gelabert, P., Guarino, H., Bennett, A., Wendel, T., Jessell, L., & Teper, A. (26, January 2018).

High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users. International Journal of Drug Policy., 26(1), 84-91. doi: 10.1016/j.drugpo.2014.07.013 Missouri Department of Health. (2018). Good Samaritan law. Official Missouri State Website. Retrieved from:

Saint Louis County Department of Public Health. (June, 2018). Drug overdose deaths St. Louis County, Missouri. Retrieved from: e_Adapted_from_Heroin_Deaths_profile_2017_Final.pdf"

Outdated statement on cause[edit]

The current lede reads "The exact cause of substance abuse is not clear, with the two predominant theories being: either a genetic disposition which is learned from others, or a habit which if addiction develops, manifests itself as a chronic debilitating disease." with a citation to an obsolete ref. I suggest that it would be clearer to acknowledge that there is complex causation, with many genetic, epigenetic, and developmental factors. See for instance LeadSongDog come howl! 18:02, 2 January 2019 (UTC)