Substance Misuse


Substance misuse is defined as the use of alcohol or drugs in a manner, situation, amount, or frequency that could cause harm to the user or to those around them. Substance misuse is a national concern as millions of Americans are affected by alcohol or drug misuse incurring a financial and emotional burden on the society at large. The burden of substance misuse extends beyond the person using substances to their families and their community. 

Substance misuse is a public health issue as it's consequences can include compromised physical and mental health, increased spread of infectious disease, loss of productivity, reduced quality of life, increased crime and violence, increased motor vehicle crashes, abuse and neglect of children, and increased health care costs. As draining as these consequences can be to a community, the most devastating consequence of substance misuse is death. 

Key Terms

Substance Use

The use, even one time, of any substance discussed within this chapter.

Substance Misuse

The use of any substance in a manner, situation, amount or frequency that could cause harm to the user or to those around them.

Illicit Drug

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine.

Substance Misuse Data Overview

Check out the points below for the main takeaways from this page. 

• In Hillsborough County, 30% of all alcohol-impaired automobile accidents in 2018 resulted in death, a rate that has gone down by 6% since 2014.

• In Nashua, the number of drug offenses decreased from 485 in 2017 to 483 in 2018, according to the Nashua Police Department.

The majority of students that use substances in 2019 first started using substances at age 15 and 16 (Alcohol 41.4%, Marijuana 30.4%, Cigarettes 5%).

• The most popular illicit drugs with students in 2019 were synthetic marijuana (9% of students have tried synthetic marijuana at least once) and ecstasy (2% of students have tried ecstasy at least once). 

• In 2020, the Syringe Service Alliance of the Nashua Area (SSANA) distributed 350 Naloxone kits which were able to reverse 115 overdoses. A total of 84,560 syringes were distributed to clients, with a 53% return rate. 

Substance Use

Substance Use Disorder (SUD) is a medical illness caused by repeated misuse of a substance or substances. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), SUDs are characterized by clinically significant impairments in health, social function, and impaired control over substance use and are diagnosed through assessing cognitive, behavioral, and psychological symptoms. SUDs affect a person's brain and behavior, leading to the inability to control the use of substances including alcohol, marijuana, tobacco, or illicit drugs.

Alcohol Use

Excessive alcohol consumption can directly harm your health. According to the CDC, excessive drinking led to approximately 88,000 deaths and 2.5 million years of potential life lost each year in the United States (U.S.) from 2006-2010. Further, excessive drinking was also responsible for 1 in 10 deaths among working-age adults aged 20 to 64 years. The economic costs of excessive alcohol consumption in 2010 were estimated at $249 billion, or $2.05 a drink. 

Key Terms 

Excessive Drinking: Percentage of adults who reported either binge drinking or chronic drinking.

Binge Drinking: Defined as drinking five or more drinks for males and four or more drinks for females on one occasion. 

Chronic Drinking: Defined as drinking 15 or more drinks for males and eight or more drinks for females per week. 

Heavy Drinking: Defined as binge drinking on five or more days in the in past 30 days. 

Underage Drinking: All 50 states and the District of Columbia currently prohibit possession of alcoholic beverages by individuals under the age of 21 and most prohibit underage consumption. 

Alcohol Use and Driving

Excessive alcohol use can increase the risk of immediate harmful health conditions including injuries, violence, alcohol poisoning, risky sexual behaviors, and adverse birth outcomes. According to the CDC, 29 people in the U.S. die every day in automobile crashes involving an alcohol-impaired driver, equivalent to one death every 50 minute. The annual cost of alcohol-impaired automobile crashes is over $44 billion. In Hillsborough County, 30% of all alcohol-impaired automobile crashes in 2018 resulted in death, a rate that has gone down by 6% since 2014.

Illicit Drug Use

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. According to the CDC, in 2017, 11.2% of the U.S. population over the age of 12 reported using illicit drugs within the past month, an increase of 0.6% in one year.

Opioid Use

Many experts trace the roots of the opioid crisis to the over-prescription of opioid pain relievers, beginning in the late 1990’s. Health experts now recognize that prescription opioids are dangerously addictive. Many doctors have taken steps to limit opioid prescriptions, and prescription rates have decreased every year since 2010. 

Tobacco Use

Tobacco use is a major threat to public health. Tobacco use remains the leading cause of preventable death in the U.S. and contributes to substantial health and financial costs. The use of tobacco has been associated with an increased risk of many adverse health outcomes, including heart disease, stroke, diabetes, asthma, and cancer. Although cigarette smoking has declined significantly since the 1960's due to public health efforts, disparities in tobacco use remain across groups defined by race, ethnicity, educational level, and socioeconomic status. In New Hampshire (NH) and the U.S., people living below the poverty level and people having lower levels of educational attainment have higher rates of cigarette smoking than the general population. 

Substance Use and Adolescents

Although substance misuse can occur at any age, the adolescent years are critical at-risk periods. Research shows that the majority of adults who experience SUD started using substances when they were in their youth. Adolescents who use substances are at increased risk for sexual behaviors such as having multiple sex partners, not using a condom, and becoming pregnant before 15 years of age.

E-Cigarettes (Vaping)

Although adolescent cigarette use has decreased, the world of smoking products is evolving. Adolescents are subject to marketing with pro-tobacco messages via movies, magazines, peers,  and social media. These products pose a set of new challenges, as their ingredients are known to be harmful, but their health impact is not yet fully understood.


Substance misuse can cause lifelong health effects and is mostly preventable. There is much work to be done in prevention, treatment, and recovery services in the GNPHR to lower the incidence SUDs. Through the work of local and regional substance misuse prevention coalitions, task forces, and regional partners in prevention efforts, we will continue to work towards the Healthy People national objectives, and New Hampshire State Health Improvement Plan (SHIP) goals of reducing substance misuse. Prevention involves everyone in the community to be effective. The community includes parents, businesses, schools, safety officials, government, and healthcare providers. No one group has sole responsibility for this problem. It is a community problem and as such needs the entire community’s participation in implementing effective interventions to decrease substance misuse. Treatment for addictions can lead to sustained recovery. Long term recovery is possible. People can recover from addiction and live productive lives. 

Prevention works, treatment is effective, and people recover!

Harm Reduction

Hepatitis C, HIV, Hepatitis A, and other infectious diseases can be transmitted when sharing syringes or substances with others. Harm reduction includes practical strategies aimed at reducing these negative consequences associated with drug use. There is no universal definition of or formula for implementing harm reduction as its interventions and policies are designed to reflect specific individual and community needs. The medication Naloxone, or Narcan, is a form of harm reduction that rapidly reverses the effects of opioid overdose and is the standard treatment for opioid overdose. 

To learn more about SSANA and the impact it has on our community, visit our website.

Access to Services

A community effort is needed to end stigma, and help those that are suffering find their unique path to recovery. We, as a community, acknowledge that recovery is an individualized concept that goes far beyond abstaining from substances or achieving a desired state of health. Connecting with friends, family, and the greater community is key to a successful recovery.

Access to services is paramount to being able to address substance use in the Greater Nashua Public Health Region. Points of access may change as time goes by but services will always be available. One way to access SUD services is to call 2-1-1 for entry into The Doorway program, the statewide initiative that provides comprehensive addiction services to residents experiencing substance use disorder. The program helps to facilitate access to treatment and offers ongoing monitoring as needed. The Nashua Doorway is located at 268 Main Street in Nashua and its hours of operation are Monday through Friday, 8 am to 5 pm.

Health Equity & Substance Misuse

A person's health can be seriously impacted by their race, ethnicity, gender, income level, education, and other socioeconomic factors. In regards to substance misuse...

• Blacks and Latinos have limited access to prevention, treatment, and recovery services for substance use disorders. While they have similar rates of opioid misuse as the general population, in recent years Blacks have experienced the greatest increase in rate for overdose deaths from non-methadone synthetic opioids (SAMHSA).

• Among women who reported using alcohol, being African American and less educated were associated with binge drinking, but race/ethnicity and educational level were not associated with binge drinking in men who reported using alcohol (NH DHHS).

• Among Asian Americans, chronic liver disease is a leading cause of death. While the cause is not always known, some cases can be initiated by conditions such as chronic alcoholism, obesity, and exposure to hepatitis B and C viruses (Office of Minority Health, HHS).

• Among Asian Americans, chronic liver disease is a leading cause of death. While the cause is not always known, some cases can be initiated by conditions such as chronic alcoholism, obesity, and exposure to hepatitis B and C viruses (Office of Minority Health, HHS).

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