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By David Nutt & Liam J. Nestor & Liam Nestor

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The OFC is also involved in the attribution of salience to reinforcing stimuli. e. there is increased incentive salience for substance rewards). The enhanced motivation to procure substances becomes a hallmark of addiction. e. stimuli associated with the substance). Substance abusers show hyperactivity in the OFC during cue-induced craving. During protracted withdrawal, substance abusers demonstrate hypoactivity in the OFC. Following chronic substance use, dysfunction of the striato-thalamo-orbitofrontal circuit is thought to inappropriately intensify the motivation to procure and self-administer substances.

AFR=African region. AMR=American region. EMR=eastern Mediterranean region. EUR=European region. SEAR=South East Asian region. WPR=western Pacific region. , et al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders, 2223–2233. Copyright (2009), with permission from Elsevier. 6 One-year prevalence of alcohol-use disorders (AUDs) in people aged 15–64 years by sex and WHO region in 2004. AFR = African region. AMR = American region. EMR = eastern Mediterranean region.

Estimates for the cost of substance use to society in economic terms are limited. These include costs to the individual, such as the costs related to premature death, drug-related illness and the loss of earnings through criminality/imprisonment, sickness, temporary or permanent unemployment, and reduced educational attainment. The costs to society can usually be divided into four broad categories: Healthcare service costs—this includes costs to primary care and hospital services (A&E, medical and surgical inpatient services, paediatric services, psychiatric services, and outpatient departments).

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