Worldwide, someone dies from drug or alcohol addiction every 4 minutes.
Globally, 108 million people are estimated to be addicted to alcohol, and nearly 40 million are addicted to illicit drugs. In 2019, alcohol use disorder (AUD) killed 168,000 people worldwide and was a risk factor in an additional 2.44 million deaths. In the same year, substance use disorder (SUD)—partly defined by continued use of substances despite negative consequences—killed over 128,000 people worldwidei. And the numbers are getting worse.
The number of people with SUDs between 2009 and 2019 increased by 45%–from 27.3 million to 39.5 million globally. In the United States alone, an estimated 29.5 million people 12 years old or older met the criteria for having an AUD in 2021; 24 million for an SUD. Globally, AUD and SUD cause an estimated 131 million years lived with disability (YLDs), resulting in an annual cost of over $740 billion in healthcare, lost work productivity, and crime. No country or region is immune. The prevalence of AUDs is highest in Europe (14.8% of the population), followed by the Americas (10.6%) and Africa (5.1%), and the prevalence of illicit SUDs is highest in North America (2.7% of the population), followed by Oceania (2.3%) and Europe (1.5%)ii.
Addiction continues to rise despite increased expenditures.
Reliable values of global expenditures on drug abuse prevention and treatment are difficult to obtain. However, the US spent $24 billion to prevent and treat alcohol and drug abuse in 2009iii and $32.6 billion in 2019iv. These expenditures represent an increase of 35% over ten years. In that same period, the proportion of US adults who met the AUD and SUD criteria rose from 8.5% in 2013 to 12.5% in 2021. Efforts and resources devoted to addressing addiction have risen, but it’s not working.
“Most people with addictions try to quit. Most can’t quit.”
In 2021, in the US, fewer than 4 million of the more than 46 million people with an AUD or SUD received treatmentv. In total, that’s less than 9% of the US population with AUD or SUD having received treatment. Percentages in the UK are a bit better for SUD treatment, with 20% of people meeting the criteria of SUD receiving treatment. However, the numbers for AUD are comparable to those seen in the US, with only 5% of those meeting the criteria of AUD receiving treatmentvi.
“Drug Addiction is a chronic, relapsing brain disorder characterized by compulsive drug seeking and use despite harmful consequences.”
— National Institute on Drug Abuse (NIDA)
Among those treated, the statistics for relapse are equally alarming. For alcohol addiction, studies have shown relapse rates of approximately 50% within the first three months after completion of intensive inpatient programs. One study showed a 91% relapse rate for opiates, with 59% relapsing within the first week and 80% within a month.
This calls for a radical rethinking of our current approaches. A new approach that measures and characterizes the underlying neural and physiological factors that are affected and altered by addiction and incorporates that understanding into the treatment and tracking of recovery.
Why are we stuck?
Worldwide efforts at reducing and treating addiction have been ineffective primarily because (1) only a fraction of people with addictions get treatment; (2) treatment approaches are one-size-fits-all with minimal, if any, matching of treatment to the underlying physiology of the person with addiction; and (3) there are no standard relapse prevention programs with the result that more than half of those treated to achieve abstinence reverting to their addiction within 90 days. To make matters worse, potentially addictive substances are increasing in number and potency.
Prescription opiates: A new source of addiction.
‘Super meth’ and other mixed use of illicit drugs are on the rise, but perhaps most troubling has been the emergence of prescription opioids. Historically, most substance abuse stems from the recreational use of illicit drugs and alcohol. Nevertheless, in the past 20 years, the rise in the legitimate prescription of potent opioid pain relievers has spurred an alarming new wave of misuse and addiction. Naturally occurring opiates, like opium and morphine, have been used for medicinal purposes for millennia to relieve pain and induce sleep. More recently, synthetic opioids, like fentanyl and sufentanil, have become available that are 100x and 500x more potent, respectively, than morphine.
Opioids are the most effective pain relievers available and have become indispensable to the practice of medicine, particularly for relieving severe pain, such as that caused by cancer, surgery, or trauma. However, opioids can also evoke feelings of intense euphoria and are highly addictive, such that about 10% of patients prescribed opioids for chronic pain begin to abuse themvii. In 2019, nearly 10 million Americans misused prescription opioids, and the number of overdose deaths directly resulting from prescription opioids was four times higher than a decade earliervi. In 2021, 9.2 million people in the US over the age of 12 misused opioidsv, and 8.7 million misused prescription opioid pain relieversv. Opioids currently contribute to over 70% of overdose deaths in both the USi and the EUii. Alarmingly, a 2014 study found that 75% of recent heroin users first abused prescription opioidsviii. Thus, opioids are not only a growing source of addiction but increasingly the dominant cause of death in addiction.
What needs to change?
We have a critical gap in our understanding and treatment of substance use disorders. Despite the myriad of factors that can influence treatment outcomes, it remains unclear which or even whether, any of these interventions can be considered universally effective, underscoring the need to consider personalized approaches to substance abuse treatmentixi. By applying knowledge gained from neuroscience, genetics, and pharmacology, we aim to set a new standard for patient outcomes in substance abuse. Indeed, if we are to make impactful change in how substance use disorders are prevented and treated, we need to re-envision two important paradigms.
The persistent opioid crisis, coupled with the emergence of new potentially addictive substances and the global resurgence of cocaine abusexvi, underscores the urgent need for innovative approaches to addiction prevention and treatment. Given that lives and communities are at stake, it is critical to adopt and integrate new technologies and methodologies. At this pivotal moment, the field of addiction research and treatment finds itself at a transformative juncture, shaped by recent advances in our understanding of the biological underpinnings of addiction and by novel technological breakthroughs.
The escalating rates of global substance use, addiction, and overdose-related deaths highlight an urgent need for innovative methods to prevent, diagnose, and treat substance use disorders (SUD) and alcohol use disorders (AUD). The myriad of biological factors that determine individual susceptibility to addiction and their responsiveness to intervention is poorly understood. A primary objective of this program is to identify biomarkers that can be detected through non-invasive or minimally invasive methods (e.g., blood tests, somatosensory evoked potentials, etc.) to facilitate quantitative assessment of the fundamental changes and neurobiological underpinnings of drug abuse and, ultimately, to demonstrate increased efficacy of prevention and treatment approaches using these quantitative methods.
To that end, our goals are to:
- Develop scalable measures to assess individual addiction susceptibility to a range of addictive and potentially addictive substances. Approaches may include, but are not limited to, analysis of longitudinal samples from existing biobanks, in vitro experiments with patient-derived hiPSCs, or computational methods such as predictive modeling and machine learning algorithms. Measures should demonstrate an accuracy of ≥ 80% in the prediction of progression to addiction.
- Quantify addiction risk and progression during prescription drug use. We are particularly focused on prescription opioids with a goal to demonstrate the ability to reduce misuse and subsequent addiction in patient populations by 50%, from an estimated 1 out of 10 patients to 1 out of 20.
- Develop innovative treatments and quantifiably assess recovery using new or existing treatments, on a personalized basis, such that the risk of relapse is reduced by a factor of 2 post treatment. Estimated abstinence rates for AUD is ~50% 90 days after treatment, and ~25% 1 year after treatmentxxxiii. The 90-day abstinence rate for SUD varies by drug but is estimated to be between 15-30% for opioids.
Call for abstracts and proposals.
We are soliciting abstracts and proposals for work over three (3) years in one or more of the following thrust areas (see Thrust areas in full program description). Proposers should clearly relate work in these thrust areas to one or more of the program goals.
It is not necessary to form a large consortium or teams to address all facets of the program. The strength of this approach will manifest through program-level integration of efforts from individuals and small agile teams with deep (and sometimes narrow) expertise. Across all projects, Wellcome Leap will facilitate iterative and collaborative integration of findings to refine models and improve and validate predictive measures and adapt approaches as teams make progress towards shared goals.
Kevin Jones, PhD is a practicing professor with expertise in neurophysiology and neuropharmacology of mental health disorders, including schizophrenia, post-traumatic stress disorder and depression. He uses a variety of technical approaches to identify cellular and molecular deficits that can be targeted with novel therapeutics. He earned his PhD in Neuropharmacology from Duke University.