This article is by Dr. Ahmed Kazaqza, a member of the Smiling Horizon Group.
Throughout history, people with substance use disorders have been viewed as individuals with character flaws or moral deficiencies, stigmatized with labels such as “addict” or worse. Advances in neuroscience have expanded our understanding of the brain changes responsible for this condition and provided the basis for recognizing substance use disorders as a chronic, progressive, and relapsing disorder that is treatable and recoverable.
The prevalence of substance use disorders is high and varies across countries and the type of drug used (the highest rates are in tobacco and alcohol use disorders), as well as by demographic and socioeconomic characteristics of the population. Rates of substance use disorders are higher in males than in females, and higher in young adults, with rates declining as both men and women reach one year of age. The impact of substance use disorders on societies, in terms of health, mortality, the economy, and crime, is profound and appears to be worsening. In fact, of all risk factors associated with premature death, tobacco and alcohol use rank second and seventh, respectively. The significant contribution to premature deaths reflects both the direct effects of drugs resulting from overdose, as well as their long-term negative health consequences.
In 2019, an estimated 7.7 million premature deaths were attributed to smoking, 2.4 million to alcohol use, and 550,700 to other drug use. Unfortunately, these negative trends have accelerated in some countries. Perhaps most notable are increases in drug-related overdose deaths in the United States, which have risen dramatically over the past decade and further accelerated during the COVID-19 pandemic. Annual deaths in the United States in 2021 were estimated at more than 107,000, mostly from opioids and exacerbated by the expansion of fentanyl in the illicit drug market. Similar trends (albeit not as severe) have been reported in Canada and the United Kingdom.
Drugs contribute to and exacerbate the outcomes of many acute and chronic diseases—including infectious, pulmonary, metabolic, cardiovascular, psychiatric, and oncological diseases. The Global Burden of Disease Study, which takes into account years lived with disability in addition to deaths, estimated that 30 million years lived with disability due to substance use disorders were estimated in 2017. Early onset, chronic or relapsing course, association with reduced quality of life, and prolonged remission all contribute to the significant impact of substance use disorders. Social stigma and discrimination against individuals with substance use disorders, criminalization of substance use, and severely inadequate responses from healthcare systems in all countries, particularly in low- and middle-income countries, further exacerbate the negative consequences of these conditions.
Significant economic costs accrue from the production, distribution, and use of illicit drugs, and these costs impact families, consumers, industries, and governments. For example, individuals with substance use disorders are less likely to be employed and more likely to experience the consequences of financial crisis, while resources allocated to drug production or distribution, law enforcement, or the treatment of substance use disorders cannot be allocated to other goals. The interplay of a host of interacting variables, including social and biological factors and the type of drug used, determines how easily or quickly drug use transitions into mild and then severe substance use disorders. Individual factors that influence susceptibility to substance use disorders include genetics, exposure to adverse childhood experiences, the stage of life development at which drug exposure first occurred, personality traits, and comorbid psychiatric disorders. These factors are, in turn, influenced by general social factors, including the amount of family and community support, social disorganization and inequality, normative drug behaviors, drug availability, and legal status, among others. The complexity of interactions between individual and social factors explains why not everyone exposed to drugs develops addiction, and why some individuals recover while others develop a more severe chronic condition and its associated negative outcomes. Pharmacological differences between drugs and their availability also play an important role in addiction risk, including the time it takes to transition from drug use to addiction.
Fortunately, effective treatments and preventive interventions exist for substance use disorders. Challenges for future research include deepening our understanding of the neurobiology of substance use disorders, applying this knowledge to develop more effective and sustainable prevention and treatment interventions, and developing and scaling service models to reach a larger segment of individuals with these disorders. There is also a pressing need for interventions targeting specific populations.
Scientific reference:
Volkow N. and Blanco C. (2023). Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment, and prevention. World Psychiatry 2023; 22:203–229.
