Academic journal article Public Health Reviews; Rennes

Editorial: A New Public Understanding about Addiction

Academic journal article Public Health Reviews; Rennes

Editorial: A New Public Understanding about Addiction

Article excerpt


Substance Use Disorders' Effects on Mainstream Healthcare

Substance use disorders-defined here as harmful use of cigarettes, alcohol, illicit and non-prescribed licit drugs-affect approximately 20 percent of adult populations in most western countries.1 In the United States, approximately eight to ten percent of the adult population2 have the most serious form of this disorder-"addiction". An additional 40 million adults use substances in a manner that significantly interferes with their health and healthcare.3 Yet screening, intervening and treating substance use disorders have not been embraced within mainstream healthcare or by most public health initiatives.

The impact of the US Surgeon General's 1964 report on smoking is a case in point.4 This report was an important impetus, eventually demonstrating that multiple modes of prevention and treatment intervention resulted in dramatic reduction in smoking in the US and elsewhere, which in turn contributed to reduced death rates from cardiovascular diseases and lung cancer especially.5,6

As regards other substance abuse, especially illegal drugs, it may be thought that the inattention from public health and healthcare providers results from a lack of effective medications, therapies or interventions to address substance use problems. This is not the case. If we accept the US Food and Drug Administration standards for judging effectiveness (effectiveness in two randomized controlled trials or one large-scale field trial) there are at least three screening instruments, five prevention inter- ventions, five medications and over a dozen behavioral therapies that can be called effective in identifying, intervening early and treating/managing substance use disorders.7

Whether benign inattention or wilful neglect, failure to address substance use problems as a public health issue has been an expensive mistake. In the US, these disorders produce annual costs of over USD $120 billion in unnecessary or inappropriate healthcare procedures, inaccurate diagnoses, poor treatment adherence and rapid re-hospitalizations.8-10

Internationally, although there is great variation in the types and quantities of substances consumed, the problems are overwhelming. Notwithstanding the considerable difficulties in generating reliably comparable estimates worldwide, approximately one in three adults use tobacco, equating to one billion people.11 Despite reduction in smoking in high income countries, tobacco and alcohol consumption are the fourth and fifth most important risk factors respectively for global burden of disease.12 If current trends continue, tobacco use will kill 100 million people prematurely during this century.13 The United Nations estimated that in 2007 between 172-250 million people took drugs at least once in the previous 12 months and that five percent of the population between the age of 15-64 years had used drugs at least once in the previous 12 months.14,15

Responses to these harrowing conditions are diverse and imaginative, despite the limitations of covert obstacles and overt lack of resources, and this might explain why only a small proportion of cases have contact with treatment services within the first year of onset of a substance misuse disorder; the proportion in the developing world is lower than that in the developed world.16 As will be described, much of the exciting and rapidly accumulating translational research has been generated in the developed world. In order to minimise the gap between need, demand and availability, we recognize the pressing need to cautiously and humbly examine whether the impact could be transferable, or whether other models may be more appropriate at this point in time.17

Change is Imminent

Among the many reasons explaining the lack of attention to substance misuse within the healthcare field is the longstanding public conception that addiction is a sin, a sign of weak character, or a bad habit-not a health condition. …

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