The Burden of Addiction

In this series of public health articles, you will be able to learn about the fundamentals of public health which will serve you well for your medical school interviews. These principles will help you to understand how medicine and public health are intertwined especially as a result of the Coronavirus pandemic.

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The burden of addiction relates to substance use, most commonly consisting of smoking, alcohol and drug use. Illicit drugs are substances that have been prohibited under international control systems for extra-medical use, i.e. use for any other purpose that is not medical and given by qualified healthcare professionals. These illicit drugs include drugs such as heroin, morphine, cannabis, amphetamines and cocaine among many others. However, substance abuse can also happen with prescription drugs. Therefore, drug use often includes all drugs, not just illicit drugs. Dependence upon such substances develops among individuals who use them regularly over a sustained period of time, this is what leads to the burden of addiction as this dependence leads to serious health issues.

Substance use has direct impacts on health. Smoking is not just a risk factor but has been shown to cause lung diseases such as COPD and chronic bronchitis. Alcohol is a risk factor for many diseases such as cancers of the mouth, throat, liver, colon and breast (in women). Drugs such as heroin and morphine can lead to permanent brain damage, and cocaine can cause cardiovascular diseases, along with many more health impacts. Substance abuse also has indirect health impacts which account for many deaths related to substance use. Injection of drugs using non-sterile needles can increase the risk of HIV and other viral infections exposure. Alcohol impairs cognitive function resulting in unintentional and intentional injuries and infections. Therefore, substance abuse carries a huge burden of disease.

According to the Lancet Global Burden of Disease attributable to alcohol and drug use analysis, alcohol use disorders are the most prevalent of all substance use disorders, followed by cannabis and opioid dependence. In 2019, the second leading risk factor globally for attributable deaths was tobacco which accounted for 8.71 million deaths. Collectively, smoking, illicit drug, and alcohol use kill 11.8 million people each year. Around 1.5% of the global disease burden results from alcohol and illicit drug addiction, with some countries showing around 5%. These statistics highlight the huge burden of addiction globally, leading to millions of mortalities and morbidities.

This calls for the global health community and healthcare professionals to act and respond adequately to tackle the issue of alcohol and drug use. There have been big interventions to tackle tobacco use such as - plain advertising policies, which restrict the amount of advertising on cigarette packets, and increasing tobacco tax, which can make cigarette packs four times more costly in countries globally by 2025. However, much more is needed for alcohol and drug use, along with stronger actions on tobacco. Many of the alcohol and drug use related disorders can be prevented with improved public health and policy interventions. Taxation and regulation of availability can drastically reduce the intake of alcohol, along with reducing the alcohol strength of beverages and minimum pricing. Further interventions should be introduced and be made readily accessible for patients with alcohol dependence. Along with this, it should be ensured that healthcare professionals are regularly monitoring their patients for such issues. Better accessibility for psychosocial interventions can also assist people with alcohol and drug dependence. However, these interventions need to be made more available and culturally appropriate to increase uptake.

Overall, the burden of addiction is a huge public health issue with smoking, alcohol and drug use being among the top risk factors for many diseases and infections. Policy changes and tax increases are essential to tackle this issue, however, at a more proximal level healthcare professionals need to take further action in identifying and managing patients with drug or alcohol dependence. We need to also tackle some of the underlying mechanisms which can lead to addiction such as lower socioeconomic deprivation which has been associated with increased alcohol and drug intake and mental health conditions which can lead to many people resorting to drugs. Such multilevel approaches will enable prevention and adequate management of addiction.

Key Points

• Substance use has direct impacts on health such as lung disease, many cancers and cardiovascular disease. It also has many indirect impacts such as injection-related infections and impaired cognition.

• Collectively, smoking, illicit drug, and alcohol use kills 11.8 million people each year.

• Around 1.5% of the global disease burden results from alcohol and illicit drug addiction, with some countries showing around 5%.

• There have been big interventions to tackle tobacco use such as plain advertising policies, which restricts the amount of advertising on cigarette packets, and increasing tobacco tax.

• Taxation and regulation of availability can drastically reduce intake of alcohol, along with reducing the alcohol strength of beverages and minimum pricing.

• These interventions need to be made more available and culturally appropriate to increase uptake.

Further Reading

• Global Burden of Disease attributable to alcohol and drug use in 195 countries - The Lancet

• Drug use - Our World in Data

• Global burden of 87 risk factors in 204 countries - The Lancet

• Drug and alcohol use - Statpearls

• Management of substance abuse - WHO

• Alcohol and drug use disorders - WHO

By Nafisa Insan BSc MPH

PhD Student in Population Health Sciences