The Ground Truth on Substance Use: Risk, Cost, and the Reality We Ignore

Michael Diggs
Mar 15
5 min read

M. Diggs | The Ground Truth

Let's get one thing straight right up front.

Substance use disorder isn't just a health issue.

It's a leadership issue.

It's a readiness issue.

And in too many cases, it becomes a life-or-death issue.

I spent years working inside the Marine Corps Drug Demand Reduction program. I watched Marines lose careers, families, and futures over substances that started as "no big deal." A few beers after work. A prescription after surgery. A way to take the edge off when life gets heavy.

Nobody starts with addiction.

They drift there.

And if leaders, families, or communities don't recognize that drift early, the consequences stack fast.

Science now backs what many of us saw on the ground: addiction doesn't flip on like a light switch. It develops over time, and once it takes hold, it rewires the brain systems responsible for impulse control, reward, and decision-making (Volkow & Blanco, 2023).

That's why prevention matters. Not after the damage is done. Before it.

Addiction Doesn't Appear Overnight

For years, people treated substance use like a simple on-off problem: either you were fine, or you were addicted.

Modern science says that's wrong.

The DSM-5 replaced the old abuse-versus-dependence labels with a single diagnosis called Substance Use Disorder, measured by severity: mild, moderate, or severe. That shift matters because it reflects reality. Substance use moves along a continuum.

It usually looks something like this:

Abstinence
Experimentation
Social or recreational use
Risky use
Misuse
Substance use disorder

Most individuals who develop serious substance-related problems begin somewhere in the middle of the use spectrum. Substance use exists along a continuum of severity, and biological, psychological, and environmental factors interact to influence where an individual falls along that continuum (Saunders & Latt, 2020; Belfiore et al., 2024).

From a leadership perspective, this model is gold.

Because if you understand the continuum, you understand that intervention doesn't have to wait until disaster strikes.

In the military, we saw it all the time. Social drinking becomes routine binge drinking. A legitimate pain prescription slowly becomes misuse. Stress without healthy outlets becomes dependency.

By the time someone reaches severe addiction, the damage has already been done.

That's why prevention has to happen early.

The Cost of Waiting

Substance use disorder isn't just a personal struggle. It's a massive societal burden.

Opioid use disorder and fatal overdoses were estimated to cost the United States more than one trillion dollars in a single year (Florence et al., 2021). Alcohol alone costs societies roughly 1.5–2.6 percent of total economic output in many countries (Manthey et al., 2021).

Those numbers are staggering, but the financial cost is only part of the damage.

Substance misuse contributes to:

family breakdown
domestic violence
child neglect
lost productivity
homelessness
community instability

Nearly seventeen million children in the United States are estimated to live in homes affected by parental substance use disorder (Schepis et al., 2025). That means millions of kids growing up in environments shaped by instability and trauma.

In military communities, the impact is even more direct. Substance misuse erodes discipline, weakens cohesion, increases risk-taking behavior, and compounds mental health struggles tied to PTSD, injury, and operational stress (Bennett et al., 2022).

The mission suffers. The people suffer.

And the cost keeps climbing.

Why the Problem Gets Worse

Addiction doesn't happen in isolation.

Several factors increase the likelihood that someone moves from casual use into disorder.

One of the biggest problems is early exposure. Research shows that the earlier someone begins using substances, the greater the long-term risk for developing severe addiction (Stewart et al., 2022).

Another factor is the environment people grow up in. Poverty, unstable housing, untreated trauma, lack of access to healthcare, and social isolation all increase vulnerability (Mulhern & Mulhern, 2022).

When those factors stack together, the odds get worse.

And when treatment or prevention programs aren't available early, problems escalate until the system only responds at a crisis level.

Ironically, prevention and treatment are far cheaper than the alternatives. Substance use treatment programs often generate substantial economic returns by reducing both criminal activity and healthcare costs (Fardone et al., 2023).

In other words, prevention isn't just compassionate.

It's strategic.

The Media Problem

Another issue that doesn't get talked about enough is how addiction is portrayed in the media.

Most people learn about substance use through headlines and news coverage. The problem is that those stories tend to focus on the worst possible outcomes:

overdoses, crime, and destruction.

Those things exist. But when that's all people see, the public gets a distorted picture.

Research shows this clearly. Nearly three-quarters of drug-related media coverage carries a negative tone and focuses primarily on criminal activity and death rather than prevention or recovery (Bouzoubaa et al., 2025).

Similar patterns have been identified in broader media portrayals, which frequently depict individuals with substance use disorders as dangerous or criminal (Bosworth et al., 2024).

That framing fuels stigma.

And stigma does real damage. Negative portrayals of substance use can discourage individuals from seeking treatment and reduce public support for effective prevention programs (Baumann et al., 2022).

Even articles that support harm reduction sometimes fall into the same trap. Many pro-reform opinion pieces still contain stigmatizing language, contributing to a public conversation that is often driven more by fear than by science (Carlon et al., 2025).

The result is a public conversation driven more by fear than by science.

And fear rarely produces good policy.

What Changed My Thinking

Working in prevention programs taught me a lot about the reality of substance misuse, but this research reinforced something important.

The fight against addiction isn't won at rock bottom.

It's won earlier.

It's won when leaders notice risky behavior before it escalates. It's won when communities invest in prevention programs. It's won when stigma is replaced with education and access to help.

The biopsychosocial model of addiction makes that clear. Addiction isn't simply a moral failing. It's the intersection of biology, psychology, and environment working together to shape behavior (Duncan, 2020).

That perspective changes how leaders respond.

Instead of waiting for collapse, you focus on reducing risk and increasing resilience.

That's the mindset shift.

Final Word

Substance use disorder is complex. It is influenced by biology, shaped by environment, and reinforced by social conditions.

But one thing is clear.

Addiction rarely begins at the bottom. It begins somewhere along a continuum.

If we want better outcomes—for families, communities, or military units—then the focus must shift from reaction to prevention.

Early intervention. Evidence-based education. Reduced stigma. Strong leadership.

Those are the tools that actually work.

Everything else is just waiting for the damage report.

That's the ground truth.

Gunny's Ground Truth Quote

"Addiction doesn't start at rock bottom. It starts with drift, and prevention is about stopping the drift early."

References and Research Sources

Baumann, E., Horsfield, P., Freytag, A., & Schomerus, G. (2022).The role of media reporting for substance use stigma. Cambridge University Press.

Belfiore, C. I., Galofaro, V., Cotroneo, D., Lopis, A., & Tringali, I. (2024).Biological, social, and psychological determinants of substance use disorder. Psychoactives.

Bennett, A. S., Guarino, H., & Britton, P. C. (2022).US military veterans and the opioid overdose crisis. Annals of Medicine.

Bosworth, K. T., Massey, Z. B., Boyle, M., Henry, N., & McGough, K. G. (2024).Media portrayals of people with substance use disorder. Cultures of Science.

Florence, C., Luo, F., & Rice, K. (2021).The economic burden of opioid use disorder in the United States. Drug and Alcohol Dependence.

Manthey, J., et al. (2021).Economic costs attributable to alcohol use. PharmacoEconomics.

Schepis, T. S., Veliz, P. T., West, B. T., McCabe, V. V., & Hulsey, E. G. (2025).Youth exposure to parental substance use disorder. Journal of Addiction Medicine.

Stewart, S. A., Copeland, A. L., & Cherry, K. E. (2022).Risk factors for substance use across the lifespan. The Journal of Genetic Psychology.

Volkow, N. D., & Blanco, C. (2023).Substance use disorders: A comprehensive update. World Psychiatry.