The Unmistakable Answer: What Drug Gets Abused the Most?
According to the World Health Organization (WHO) and other leading health institutions, alcohol is the most commonly abused drug in the world [1.2.1, 1.5.1]. In 2023, data from the National Survey on Drug Use and Health (NSDUH) indicated that 134.7 million Americans aged 12 or older were current alcohol users [1.3.2]. Globally, the harmful use of alcohol is responsible for 3.3 million deaths each year [1.2.3]. The legality and widespread social acceptance of alcohol contribute to its high rates of use and misuse [1.2.1]. Globally, an estimated 400 million people lived with alcohol and drug use disorders, with 209 million of those living with alcohol dependence [1.5.1]. The sheer scale of its consumption places it far ahead of all other substances, legal or illicit.
Following alcohol, nicotine (tobacco) and marijuana are the next most commonly used substances [1.2.2]. In 2023, 61.8 million Americans reported using marijuana in the past year [1.4.1]. While often perceived as less harmful, about 1 in 10 adult marijuana users may develop an addiction [1.2.2].
A Deeper Look at Other Commonly Abused Drugs
While alcohol holds the top spot, several other categories of drugs are abused at alarming rates, leading to significant public health crises.
Opioids: A Continuing Crisis
Opioids, a class of drugs prescribed for pain relief, are highly addictive and have been at the center of a devastating overdose epidemic [1.2.1, 1.8.3]. This category includes both prescription medications like oxycodone (OxyContin) and hydrocodone (Vicodin), as well as illicit drugs like heroin and illegally manufactured fentanyl [1.6.5, 1.2.2]. In 2023, 8.9 million people in the U.S. misused opioids [1.3.2]. The danger of opioids is magnified by their potent effect on the respiratory system; an overdose can slow or stop breathing, leading to death [1.8.3]. The proliferation of fentanyl, which is 50 to 100 times more potent than morphine, has dramatically increased overdose deaths, as it is often mixed into other illicit drugs without the user's knowledge [1.2.2, 1.8.4].
Prescription and Illicit Stimulants
Stimulants are drugs that increase activity in the body's central nervous system [1.9.1]. This class includes prescription drugs like Adderall and Ritalin, used to treat ADHD, and illicit drugs such as methamphetamine and cocaine [1.6.1, 1.9.1]. According to the 2022 NSDUH report, prescription stimulants are the most commonly abused prescription drugs in the U.S [1.2.2]. Cocaine is the second most trafficked illicit drug in the U.S. [1.2.4]. Chronic stimulant abuse can lead to severe health consequences, including heart attack, stroke, paranoia, psychosis, and severe dental problems ("meth mouth") [1.9.1, 1.9.3].
CNS Depressants (Benzodiazepines)
Central nervous system (CNS) depressants are prescribed to treat anxiety and sleep disorders [1.6.1]. This category is dominated by benzodiazepines, with brand names like Xanax, Valium, and Klonopin [1.6.1]. These drugs slow brain function, and when taken in high doses or combined with other substances like alcohol, they can lead to respiratory depression, coma, and death [1.6.3]. Long-term use can lead to physical dependence and addiction [1.6.3].
Comparison of Commonly Abused Drugs
| Substance Class | Common Examples | Primary Effects | Key Health Risks |
|---|---|---|---|
| Alcohol | Beer, Wine, Spirits | Sedation, euphoria, lowered inhibitions | Liver disease, cancer, heart problems, addiction, neurological damage [1.7.1, 1.7.3] |
| Opioids | Fentanyl, Heroin, OxyContin, Vicodin | Pain relief, euphoria, drowsiness | Respiratory depression, high addiction potential, overdose, constipation [1.8.2, 1.8.4] |
| Stimulants | Cocaine, Methamphetamine, Adderall | Increased energy, alertness, euphoria | Heart attack, stroke, psychosis, anxiety, addiction, severe weight loss [1.9.1, 1.9.3] |
| CNS Depressants | Xanax, Valium, Klonopin | Sedation, reduced anxiety, muscle relaxation | Respiratory depression (especially with alcohol), dependence, withdrawal seizures, memory problems [1.6.1, 1.6.3] |
| Cannabis | Marijuana, Hashish | Relaxation, altered perception, euphoria | Impaired memory, potential for addiction, cannabinoid hyperemesis syndrome (CHS), impaired coordination [1.4.1, 1.2.2] |
The Pharmacology of Abuse: Dependence vs. Addiction
It is crucial to understand the difference between substance abuse, dependence, and addiction.
- Substance Abuse: This refers to a pattern of using a substance in a way that is harmful, such as binge drinking or using illicit drugs. An individual engaging in substance abuse may still maintain control over their life and can often change their behavior when faced with negative consequences [1.10.1, 1.10.4].
- Dependence: Physical dependence occurs when the body adapts to the presence of a drug. If the person stops taking the drug abruptly, they experience withdrawal symptoms. Dependence can occur even when taking a medication as prescribed and is not the same as addiction [1.10.4].
- Addiction (Substance Use Disorder): The National Institute on Drug Abuse (NIDA) defines addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use, despite harmful consequences [1.10.3]. It involves changes in brain circuits related to reward, stress, and self-control [1.4.2]. A person with an addiction cannot simply stop using through willpower alone [1.10.1].
Conclusion
While the question "What drug gets abused the most?" has a clear answer—alcohol—the landscape of substance abuse is complex and multifaceted. From the opioid crisis fueled by prescription painkillers and illicit fentanyl to the widespread misuse of stimulants and sedatives, the impact on public health is profound. Understanding the prevalence, risks, and pharmacological nature of these substances is the first step toward addressing the challenges of abuse and addiction through prevention, effective treatment, and compassionate support.
For more information and resources on substance abuse and treatment, a valuable outbound link is the Substance Abuse and Mental Health Services Administration (SAMHSA).
