New data to support much needed policy change
Authors: Shekhar Saxena
Journal: The Lancet Psychiatry (2018)

The systematic analysis of the global burden of disease attributable to alcohol and drug use from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 20161GBD 2016 Alcohol and Drug Use CollaboratorsThe global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Psychiatry. 2018; (published online Nov 1.)http://dx.doi.org/10.1016/S2215-0366(18)30337-7Google Scholar published in The Lancet Psychiatry, is the most comprehensive and systematic global estimate to date of the adverse health effects of substance use. The GBD 2016 Alcohol and Drug Use Collaborators systematically analysed data on the epidemiology of alcohol and drug use and prevalence of these use disorders, and used disability weights to estimate disability-adjusted life-years. The estimates include the burden attributable to alcohol and drug use as risk factors for a variety of health conditions. The data are new, but the messages are not. Globally, alcohol remained the most prevalent of all substance use disorders with the highest disease burden (100·4 million estimated cases in 2016; age-standardised prevalence 1320·8 cases per 100 000 people, 95% uncertainty interval [95% UI] 1181·2–1468·0) and was attributed to 2·8 million deaths (95% UI 2·4–3·3) every year. Disease burden attributable to alcohol was often higher in low-income countries than high-income countries. Alcohol use disorders contribute to a minority of all alcohol-related harms. Globally, the most common drug use disorders were cannabis dependence (22·1 million cases; age-standardised prevalence 289·7 cases per 100 000 people, 95% UI 248·9–339·1) and opioid dependence (26·8 million cases; age-standardised prevalence 353·0 cases per 100 000 people, 309·9–405·9). More data on the global disease burden attributable to alcohol and drug use are welcome, but scarcity of data and evidence are not the main factors limiting action. Political determination is required to drive public health action to reduce the burden caused by substance use. In 2010, the World Health Assembly established the Global Strategy to Reduce the Harmful Use of Alcohol.2WHOGlobal Strategy to Reduce the Harmful Use of Alcohol. World Health Organization, Geneva2010Google Scholar The strategy contains ten effective policy options, of which three (increasing excise duty, restricting advertising, and restricting availability) were later deemed the most cost-effective.3WHOTackling NCDs: 'best buys' and other recommended interventions for the prevention and control of noncommunicable diseases. World Health Organization, Geneva2017Google Scholar However, the implementation of these policies has been far from satisfactory. The global commitments made for non-communicable diseases,4United Nations General AssemblyPolitical declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases.http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdfDate: 2012Date accessed: October 23, 2018Google Scholar for which alcohol is a major risk factor, present another opportunity for policy change. Despite several high-level declarations, progress within countries has been slow and inconsistent. The WHO non-communicable disease progress monitor5WHONoncommunicable diseases progress monitor 2017. World Health Organization, Geneva2017Google Scholar showed that in 2017, most countries had not made adequate progress with regard to alcohol related indicators; the report suggested the need for "bolder political action" on "safeguarding communities from interference by powerful economic operators". An analysis by an independent group6NCD Countdown 2030 collaboratorsNCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4.Lancet. 2018; 392: 1072-1088Summary Full Text Full Text PDF PubMed Scopus (458) Google Scholar has shown that the commitment made in the UN Sustainable Goal target 3.4 related to non-communicable diseases is likely to be achieved only in a minority of countries at the current rate of progress. Government leaders had another opportunity at the UN General Assembly in September, 2018, to finalise their commitments and more importantly, to put them in to action. The systematic analysis1GBD 2016 Alcohol and Drug Use CollaboratorsThe global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Psychiatry. 2018; (published online Nov 1.)http://dx.doi.org/10.1016/S2215-0366(18)30337-7Google Scholar by the GBD 2016 Alcohol and Drug Use Collaborators suggests efforts should be made to develop a framework convention for alcohol control, similar to that of the Framework Convention on Tobacco Control.7WHOWHO framework convention on tobacco control. World Health Organization, Geneva2005Google Scholar Although reaching a consensus on the need for a framework convention and establishing this agreement in action is time-consuming and burdensome, the extent of alcohol related problems and the current inaction of countries to prevent them might justify the consideration of a legally binding treaty. The need for such an agreement is all the more urgent since strong evidence suggests that the level of alcohol consumption that minimises harm across health outcomes is zero.8GBD 2016 Alcohol CollaboratorsAlcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2018; 392: 1015-1035Summary Full Text Full Text PDF PubMed Scopus (1477) Google Scholar Many governments derive a substantial proportion of their income from taxes levied on alcoholic beverages and are targeted by the alcohol industry, which considers legal regulation a serious threat to their interests. Governments will need to keep the health of the population and the long-term economic interests of the country and communities high on the agenda to counter these threats. Public health action on alcohol must be more vigorous, more comprehensive, and more immediate. Similarly for drugs, in 2016, the UN General Assembly agreed to commit to effectively addressing and countering the world drug problem9United Nations Office on Drugs and CrimeOutcome document of the 2016 United Nations General Assembly special session on the world drug problem. Our joint commitment to effectively addressing and countering the world drug problem. United Nations, New York2016Google Scholar and all members of the UN agreed to adhere to specific operational recommendations on demand reduction and related measures, including prevention and treatment, and other health-related issues. However, the World Drug Report 2018,10United Nations Office on Drugs and CrimeWorld drug report 2018. Executive summary: conclusions and policy implications. United Nations, New York2018Crossref Google Scholar published 2 years after the UN General Assembly declaration reported that "both the range of drugs and drug markets are expanding and diversifying as never before", "non-medical use of prescription drugs has reached epidemic proportions in parts of the world", and "drug treatment and health services continue to fall short." The methods used in the GBD studies aggregate mortality and disability, and thus remain the best available estimates for comparing the impact of diseases and risks to human health. However, the methods have several limitations, especially with regard to the use of alcohol and drugs. Data on the use of these substances are often unavailable or unreliable with substantial variations across countries and communities, which limits the accuracy of assumptions and extrapolations. For example, a range of potential health outcomes of drug use were not considered in the study, such as unintentional injuries and mental disorders. Furthermore, the methods used do not take into account harms to others or the social and economic impact of substance use, which have the largest impact in low-resource settings. Alcohol and illicit drugs are among the most salient threats to human health. The substantial effort of the GBD 2016 Alcohol and Drug Use Collaborators will be well rewarded if the estimates reported facilitate stronger public health action at the national and global level to decrease the burden caused by alcohol and drugs. I declare no competing interests. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016Alcohol and drug use are important contributors to global disease burden. Effective interventions should be scaled up to prevent and reduce substance use disease burden. Full-Text PDF Open Access