Dorota Jagus Department of Clinical Medicine Dorota943@wp.

pl

Alcohol and substance abuse as a global problem Introduction Alcohol and drug abuse are problems that exist in every country, regardless of geographical, cultural, and economic background. However, the production, consumption and patterns of use differ from country to country as well as within regions of countries. The understanding of characteristics of each region together with reliable assessment of undertaken actions are fundamentals for establishing policy on reducing alcohol and drug abuse. The effects of the policies are depicted not only by estimated consumption but mostly by the decrease in negative results of alcohol and drug abuse. This essay is to outline some of the aspects of alcohol and substance abuse policies both in global and regional means. Alcohols impact on public health According to WHO alcohol intake is the third largest risk factor for disease and disability, accounting for 3,6% deaths worldwide and 4,4% disability-adjusted life year (DALY). It is directly responsible for 60 diseases and 200 conditions as a component cause. The most significant impact concerns liver cirrhosis (50% of deaths) esophageal cancer (30%), liver cancer, epilepsy and homicide. 20% of deaths due to traffic accidents were connected with alcohol intake. Also social and economical issues such as violence, child neglect and abuse, absenteeism in work are significantly related to alcohol abuse. The impact of harmful alcohol intake is also noticeable in family members, friends, neighbors and strangers who may experience physical and psychological trauma falling victims to violence and accidents also by pure witnessing. (1) Consumption and consequences of alcohol intake The global average consumption of alcohol is estimated for 6,13 l of pure alcohol per person aged 15 years and older. However this value varies largely from less than 2,5 l in regions inhabited by Muslim majority, where the abstention rate is high to more than 12,5 in high and middle income countries of Northern Hemisphere, Australia and Argentina. Middle levels of consumption are in Southern Africa and both Americas. That data does not always correspond with the harmful impact
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on health, which is due to different patterns of drinking. The least risky patterns of regular but moderate drinking dominate in Southern and Western Europe, where despite high consumption the percentage of alcohol-attributable deaths is relatively low. On the other hand high risk drinking patterns especially heavy episodic drinking, common in Russian Federation and neighboring countries, Malawi and South America correspond with high alcohol related mortality in these countries. A significant disproportion between sexes exists in this factor, counting for almost 6 times higher mortality rate in men than in women. (1) Policy responses Regarding the impact of alcohol abuse on public health it is one of the crucial global challenge to reduce harmful effect of alcohol. Since 1979 WHO has been developing policies aimed at global tackling of the problem. The recent initiative is the Global Strategy to Reduce the Harmful Use of Alcohol, that supplies the evidence for the most effective policies. These include awareness campaigns, controlling the availability and price of beverages, drink-driving and health service policies. According to WHO the most cost effective policies include rising tax and setting legal drinking age for purchasing alcohol, which was confirmed by numerous studies carried in the USA and Northern Europe throughout last 50 years. The studies are based not only on reduction of consumption but also decrease in health problems and violence acts.(2) However it might not be applicable globally because of disproportions in unrecorded consumption of homemade and illegal alcohol, that differ from 22% in Europe up to 70% in South-East Asia Region(1). Another effective policy is implementing blood alcohol concentration limits for drivers and checkpoints of sobriety(3) and restrictions on advertising and sponsoring by alcohol producers(1). Although the studies and reports show evidence of effective policies, most of the studies were carried in modern, high income counties. Therefore they might not be beneficial in countries with different consumption patterns. Also the long-term effects could be noticeable only through further studies regarding numerous geographical, cultural and economical factors and long lasting followup. This relates mostly to social campaigns and health service changes. Finally, it is important to carry out careful research on consumption, consequences and effectiveness of undertaken actions to be able adjust policies and measurements to various backgrounds. Drug abuse impact on public health According to WHO statistics every year from 3 to 6% of population of 15-64 years old uses illicit substances. The number of so called problem drug users is between 15-39 million, but the estimations are uncertain because of inadequate data from China, India and Africa. Drug abuse is a
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reason for 245 000 deaths every year which makes 0,4% of deaths globally and 0,9% of DALYs. A serious problem among people addicted to drugs is high prevalence of infectious diseases reaching 18% (2,8 million) and 50% (8 million) regarding HIV and HCV respectively. Apart from individual harm, drug abuse involves social and economic effects especially connected with crime consequences. (4) Trends and patterns of drug abuse When tackling problem of drug abuse globally it is crucial to consider geographical mismatch between production, trafficking and consumption. For instance amphetamine group substances consumption dominates in America, Africa and Asia, the cultivations are spread worldwide while manufactures of precursors are highly concentrated in South Asia and trafficking is mostly significant in Africa.(4) According to WHO reports of recent decade the production of opioids, ecstasy, cocaine and cannabis declined during recent decade, while traffic seizures increased and the amphetaminegroup substances production is increasing. When it comes to use of above drugs, most governments report stabilization. (4) At the same time new problems are arising: new synthetic drugs, that are not under national control, especially included in groups of piperazines, mephedrone and synthetic cannabinoids. Every year tens of new substances are synthesized that have psychoactive effect but differ slightly from substances registered as illegal and therefore escape control and prohibition. Also non-medical use of prescribed medicines is becoming significant problem especially among young adults, females, old people and health service workers. The wide access to the drugs through illegal internet sale highly comprises to the problem.(4) Policy responses The actions aimed at decreasing drug abuse problem aim at detecting and punishing subjects responsible for production and traffic as well as treatment of addicts and prophylaxis in high risk groups as well as widespread, addressing both demand and supply. An example of action decreasing harmful effects of drugs are needle exchange services that play significant role in limiting spread of HIV and HCV and HBV without reducing drug abuse itself.(5) In order to increase the effectiveness of these actions a reliable data about prevalence, trends and effect of implemented policies is needed. One of initiatives undertaken by WHO is establishing

evidence-based recommendations for management of substance use disorders that would be helpful in effective management of patients with any drug connected problems.(5) Summary Alcohol and drug abuse problems are undoubtedly problems that need global attention and action. However, they should be addressed both locally and globally. A vivid action is necessary not only to reducing consumption rates but paralelly it should be aimed at reducing harmful effects of consumption. To make it possible, reliable databases of reported trends, action and changes are needed. A deep analysis of local, regional and finally global data would unable subjects responsible for managing above problems to adjust the most beneficial policies to unique conditions of particular region or country and evaluate effects of the implemented actions.

References:
1. Global Status Report On Alcohol And Health. World Health Organization 2011 2. Chaloupka FJ, Grossman M, Saffer H. The Effects Of Price On Alcohol Consumption And Alcohol-Related Problems. Alcohol Research & Health Vol. 26, No. 1, 2002 3. Global Status Report: Alcohol Policy 2004. World Health Organization. 4. World Drug Report 2011. United Nations Office On Drugs And Crime 5. Roberts M, Bewley-Taylor D, Trace M. Monitoring Drug Policy Outcomes: The Measurement Of Drug-Related Harm. The Beckley Foundation. Drug Policy Programme. Report Nine. July 2006