The last 20 years have brought two major changes in the field of addiction. First, the US Institute of Medicine (IOM) encouraged recognition of a spectrum of alcohol and other drug use that affects health and is not limited to those with the highest severity . Unhealthy use (the spectrum from use that risks consequences through addiction ) among those without addiction is much more common than addiction itself. The second major shift also began in the 1990s with an emphasis on addiction as a chronic illness [3,4] and on unhealthy use as a health condition.
Although drug and excessive alcohol use clearly have social and other environmental determinants and consequences, there is little doubt that health care should play a major role in addressing them. In the health-care sector, attention to unhealthy substance use cannot be limited to highly specialized care settings; most patients with these conditions appear in general health settings where such problems are all too often ignored. In 2006, the IOM urged improvements in the quality of care for substance use conditions . Responding to that report is a major impetus for the establishment of Addiction Science & Clinical Practice (ASCP). We see this focus as unique among journals that address addictions.