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Substance use disorders involve a pattern of using drugs more extensively than intended and continuing use despite harmful consequences. This includes legal substances like alcohol and nicotine, as well as illegal drugs. These disorders often involve both physical and psychological dependence, reflecting compulsive use of substances that significantly alter thoughts, feelings, and behaviors, contributing to a major public health issue.
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Updated: May 12, 2026

Chronic Intermittent Ethanol Vapor Exposure Paired with Two-Bottle Choice to Model Alcohol Use Disorder
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Physical harm due to chronic substance use.

Jan van Amsterdam1, Ed Pennings, Tibor Brunt

  • 1National Institute of Public Health and the Environment (RIVM), Centre for Health Protection, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. Jan.van.amsterdam@rivm.nl

Regulatory Toxicology and Pharmacology : RTP
|April 2, 2013
PubMed
Summary

This study ranks the physical harm of 19 addictive substances. Heroin, crack, alcohol, and tobacco pose the highest physical risks, guiding public health policy for substance control.

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High Content Screening Analysis to Evaluate the Toxicological Effects of Harmful and Potentially Harmful Constituents (HPHC)
11:38

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Published on: May 10, 2016

Area of Science:

  • Addiction research
  • Public health policy
  • Toxicology

Background:

  • Chronic high-dose use of illicit drugs, alcohol, and tobacco is linked to physical diseases.
  • Quantifying the relative physical harm of these substances is crucial for informing policy.
  • Previous research has not comprehensively described the physical harm spectrum of addictive substances.

Purpose of the Study:

  • To assess and rank the physical harm of 19 addictive substances.
  • To provide data for guiding policy measures concerning licit and illicit substances.
  • To differentiate physical harm from psychiatric effects.

Main Methods:

  • Literature review and expert opinion were used to score physical harm (0-3 scale).
  • Assessment focused on toxicity and the risk/severity of somatic diseases.
  • 19 addictive substances, including alcohol and tobacco, were evaluated.

Main Results:

  • Heroin (2.09), crack (2.32), alcohol (2.13), and tobacco (2.10) received high physical harm scores.
  • Magic mushrooms, LSD, and methylphenidate had lower scores (0.45-0.65).
  • Societal disease burden for cannabis, tobacco, and alcohol exceeded individual-level impact.

Conclusions:

  • A clear ranking of physical harm for 19 addictive substances was established.
  • The findings support policy development for substance control based on physical harm.
  • The physical harm ranking closely aligns with previous multi-factor assessments.