Substance Abuse Disorders E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 690

Veröffentlichungsjahr: 2011

Beschreibung

Substance abuse disorders are among the most prevalent psychiatric disorders and are frequently comorbid with other psychiatric and health conditions and accompanied by social problems; however, they remain under-recognized and under-treated. Many physicians and mental health practitioners receive little-to-no training in the identification and treatment of these disorders.  Approaches to their prevention include some of the major success stories in modern public health as well as some of the deepest controversies in public life. This new title in the WPA series Evidence and Experience in Psychiatry informs psychiatrists and a wide range of professional groups from health and social services about these disorders and their treatment and control. 

'Highly Commended' in the Psychiatry section of the 2012 BMA Book Awards

Leseprobe

Contents

Cover

Series

Title Page

Copyright

List of Contributors

Preface

Section 1: Drugs

Chapter 1: Epidemiology of Drug Abuse: A Global Overview

1.1 INTRODUCTION

1.2 THE CASE OF VULNERABILITY POPULATIONS

1.3 DISCUSSION AND CONCLUSIONS

Chapter 2: Drug Abuse: Prevention

2.1 INTRODUCTION

2.2 HEALTH AND SOCIAL CONSEQUENCES OF DRUG USE AND DRUG-ATTRIBUTABLE BURDEN

2.3 TARGETS FOR PREVENTION

2.4 REDUCING THE BURDEN ATTRIBUTABLE TO DRUG USE

2.5 TRAJECTORIES OF DRUG USE: PRIMARY, SECONDARY AND TERTIARY PREVENTION

2.6 PREVENTIVE INTERVENTIONS: UNIVERSAL, SELECTIVE AND INDICATED

2.7 LEVELS OF INTERVENTIONS

2.8 PRINCIPLES FOR DRUG PREVENTION

2.9 EVIDENCE ON EFFECTIVENESS OF PREVENTION INTERVENTIONS

2.10 CONTROL OF AVAILABILITY OF DRUGS AND JUDICIAL PROCEDURES

2.11 MASS MEDIA INTERVENTIONS

2.12 PREVENTION PROGRAMS WITH SHORT-TERM AND LONG-TERM EFFECTS ON DRUG USE

2.13 INTERVENTIONS WITH SHORT-TERM FOLLOW-UP (UP TO 1 YEAR)

2.14 INTERVENTIONS WITH MEDIUM-TERM FOLLOW-UP (FROM 1 TO 3 YEARS)

2.15 INTERVENTIONS WITH LONG-TERM FOLLOW-UP (3+ YEARS)

2.16 INTERVENTIONS WITH EVIDENCE OF LITTLE OR NO EFFECTIVENESS

2.17 CONTENT AND DESIGN OF PROGRAMS WITH EVIDENCE OF EFFECTIVENESS

2.18 EXPERIMENTAL TECHNIQUES

2.19 ROLE OF HEALTH-CARE PROFESSIONALS IN PREVENTION OF DRUG USE AND DRUG-USE DISORDERS

Chapter 3: Drug Abuse: Treatment and Management

3.1 INTRODUCTION

3.2 PHARMACOLOGICAL MANAGEMENT OF OPIATE MISUSE; METHADONE

3.3 PHARMACOLOGICAL MANAGEMENT OF OPIATE MISUSE; BUPRENORPHINE

3.4 PHARMACOLOGICAL MANAGEMENT OF OPIATE MISUSE; NALTREXONE

3.5 STIMULANTS (COCAINE; AMPHETAMINE AND METHAMPHETAMINE; ECSTASY AND ECSTASY-LIKE DRUGS)

3.6 PHARMACOLOGICAL MANAGEMENT OF BENZODIAZEPINE MISUSE

3.7 REVIEW OF MOST RECENT LITERATURE ON THE ROLE OF PSYCHOSOCIAL INTERVENTION IN THE TREATMENT AND MANAGEMENT OF SUBSTANCE MISUSE

3.8 DISCUSSION AND CONCLUSIONS

Chapter : 4.1 Measuring, Preventing and Treating Global Drug Abuse

CULTURAL DIVERSITY AND ECONOMIC DISPARITY

REDUCING SUPPLY, DEMAND AND HARM

TREATMENT AND MANAGEMENT STRATEGIES

CHANGING TRENDS IN DRUG MISUSE AND IN TREATMENT

SUMMARY

Chapter : 4.2 Epidemiology, Treatment and Prevention of Addictive Disorders

Chapter : 4.3 The Global Challenge of Illegal Drugs

INTRODUCTION

Chapter : 4.4 Drug Misuse – Lessons Learned Through the Modern Science

Chapter : 4.5 An Integrated Approach to Drug-Abuse Treatment: The Role of Prevention

Chapter : 4.6 Informing the Field of Substance Misuse: Progress and Challenges

Section 2: Alcohol

Chapter 5: Epidemiology of Alcohol Abuse: Extent and Nature of the Problem

5.1 INTRODUCTION

5.2 METHODS

5.3 RESULTS

5.4 DISCUSSION

5.5 ACKNOWLEDGEMENTS

Chapter 6: The Prevention of Alcohol Problems

6.1 INTRODUCTION

6.2 THE IMPACT OF ALCOHOL ON HEALTH

6.3 ALCOHOL CONSUMPTION IN THE COMMUNITY

6.4 APPROACHES TO PREVENTION

6.5 PRACTICAL COMPONENTS OF PREVENTION

6.6 OTHER POTENTIAL APPROACHES

Chapter 7: Alcohol-Use Disorders – Treatment and Management

7.1 INTRODUCTION

7.2 PRINCIPLES OF TREATMENT AND MANAGEMENT

7.3 THE TREATMENT OF HAZARDOUS/HARMFUL DRINKERS

7.4 THE TREATMENT OF ALCOHOL DEPENDENCE

7.5 PREVENTING RELAPSE – PSYCHOLOGICAL INTERVENTIONS

7.6 SERVICE ORGANIZATION

Chapter: 8.1 Perverse Interpretation of Evidence in Alcohol Policy

Chapter: 8.2 Implementing the Evidence Base

Chapter : 8.3 Further Insights into the Burden of Alcohol Use on Mental Illness

DEFINITIONS

AETIOLOGICAL MODELS

THE EPIDEMIOLOGY OF AUD AND MENTAL ILLNESS

THE PREVENTION OF AUD AND MENTAL ILLNESS

THE TREATMENT OF AUD AND MENTAL ILLNESS

Chapter : 8.4 Alcohol Issues – What Next?

WHAT FUTURE FOR TAKING ALCOHOL PROBLEMS SERIOUSLY?

ALCOHOL PROBLEMS: THINKING ONE WORLD

INTERNATIONAL ORGANIZATIONS AND THE WORLD RESPONSE TO DRINKING PROBLEMS

ACKNOWLEDGEMENTS

Chapter : 8.5 The Evolving Global Burden of Disease from Alcohol

THE EVOLVING GLOBAL BURDEN OF DISEASE FROM ALCOHOL

PREVENTION IN DEVELOPED NATIONS

ALCOHOL USE AND AUDS IN DEVELOPING NATIONS

CONCLUDING REMARKS

Chapter : 8.6 A Timely Review of Alcohol Related Disorders

Section 3: Tobacco

Chapter 9: Epidemiology of Tobacco Use

9.1 HISTORICAL OVERVIEW

9.2 TOBACCO PRODUCTS

9.3 CURRENT PATTERNS OF TOBACCO USE

9.4 MORTALITY AND MORBIDITY

9.5 SPECIAL POPULATIONS

9.6 RACE AND ETHNICITY

9.7 CO-MORBID CONDITIONS

9.8 PROFESSIONAL GROUPS

9.9 METHODOLOGICAL ISSUES – CONSIDERATIONS FOR FUTURE RESEARCH

Chapter 10: Tobacco Use: Prevention

10.1 INTRODUCTION

10.2 YOUTH AND TOBACCO USE

10.3 TOBACCO-INDUSTRY STRATEGIES

10.4 A COMPREHENSIVE APPROACH FOR TOBACCO PREVENTION

10.5 CONCLUSION

Chapter 11: Tobacco Abuse: Treatment and Management

11.1 INTRODUCTION

11.2 INDIVIDUAL-BASED TREATMENT AND MANAGEMENT APPROACHES

11.3 POPULATION-LEVEL TREATMENT AND MANAGEMENT OPTIONS

11.4 CONCLUSION

Chapter : 12.1 Challenges in Reducing the Disease Burden of Tobacco Smoking

THE FUTURE OF TOBACCO CONTROL IN DEVELOPED COUNTRIES

Chapter : 12.2 Public Health and Tobacco Use

Chapter : 12.3 Decreasing the Health Hazards of Tobacco: Necessary and Possible, But not Easy

CONCLUSION

Chapter : 12.4 Overcoming State Addiction to Tobacco Industry

Chapter : 12.5 The Framework Convention on Tobacco Control: The Importance of Article 14

IMPORTANCE OF HEALTH PROFESSIONALS IN THE TREATMENT OF SMOKERS

CLINICAL PRACTICE GUIDELINES

HIGH-RISK POPULATIONS WHO USE TOBACCO

Chapter : 12.6 Comments Regarding Epidemiology of Tobacco Use, Tobacco Use: Prevention and Tobacco Abuse: Treatment and Management

Index

World Psychiatric Association Evidence and Experience in Psychiatry Series

Series Editor: Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

Depressive Disorders, 3eEdited by Helen Herrman, Mario Maj and Norman Sartorius ISBN: 9780470987209

Substance Abuse DisordersEdited by Hamid Ghodse, Helen Herrman, Mario Maj and Norman Sartorius ISBN: 9780470745106

Trauma and Mental Health: Resilience and Post-Traumatic Stress DisordersEdited by Dan J Stein, Matthew J Friedman and Carlos Blanco ISBN: 9780470688977

Schizophrenia 2eEdited by Mario Maj, Norman Sartorius ISBN: 9780470849644

Dementia 2eEdited by Mario Maj, Norman Sartorius ISBN: 9780470849637

Obsessive-Compulsive Disorders 2eEdited by Mario Maj, Norman Sartorius, Ahmed Okasha, Joseph Zohar ISBN: 9780470849668

Bipolar DisordersEdited by Mario Maj, Hagop S Akiskal, Juan José López-Ibor, Norman Sartorius ISBN: 9780471560371

Eating DisordersEdited by Mario Maj, Kathrine Halmi, Juan José López-Ibor, Norman Sartorius ISBN: 9780470848654

PhobiasEdited by Mario Maj, Hagop S Akiskal, Juan José López-Ibor, Ahmed Okasha ISBN: 9780470858332

Personality DisordersEdited by Mario Maj, Hagop S Akiskal, Juan E Mezzich ISBN: 9780470090367

Somatoform DisordersEdited by Mario Maj, Hagop S Akiskal, Juan E Mezzich, Ahmed Okasha ISBN: 9780470016121

Current Science and Clinical Practice Series

Series Editor: Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

SchizophreniaEdited by Wolfgang Gaebell ISBN: 9780470710548

Obsessive Compulsive DisorderEdited by Joseph Zohar ISBN: 9780470711255

Other World Psychiatric Association titles

Series Editor (2005– ): Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

Special Populations

The Mental Health of Children and Adolescents: an area of global neglectEdited by Helmut Remschmidt, Barry Nurcombe, Myron L. Belfer, Norman Sartorius and Ahmed Okasha ISBN: 9780470512456

Contemporary Topics in Women's Mental Health: global perspectives in a changing societyEdited by Prabha S. Chandra, Helen Herrman, Marianne Kastrup, Marta Rondon, Unaiza Niaz, Ahmed Okasha, Jane Fisher ISBN: 9780470754115

Families and Mental DisordersEdited by Norman Sartorius, Julian Leff, Juan José López-Ibor, Mario Maj, Ahmed Okasha ISBN: 9780470023822

Disasters and Mental HealthEdited by Juan José López-Ibor, George Christodoulou, Mario Maj, Norman Sartorius, Ahmed Okasha ISBN: 9780470021231

Parenthood and Mental Health: A bridge between infant and adult psychiatryEdited by Sam Tyano, Miri Keren, Helen Herrman and John Cox ISBN: 9780470747223

Approaches to Practice and Research

Religion and Psychiatry: beyond boundariesEdited by Peter J Verhagen, Herman M van Praag, Juan José López-Ibor, John Cox, Driss Moussaoui ISBN: 9780470694718

Psychiatric Diagnosis: challenges and prospectsEdited by Ihsan M. Salloum and Juan E. Mezzich ISBN: 9780470725696

Recovery in Mental Health: reshaping scientific and clinical responsibilitiesBy Michaela Amering and Margit Schmolke ISBN: 9780470997963

Handbook of Service User Involvement in Mental Health ResearchEdited by Jan Wallcraft, Beate Schrank and Michaela Amering ISBN: 9780470997956

Psychiatrists and Traditional Healers: unwitting partners in global mental healthEdited by Mario Incayawar, Ronald Wintrob and Lise Bouchard, ISBN: 9780470516836

Psychiatric Diagnosis and ClassificationEdited by Mario Maj, Wolfgang Gaebel, Juan José López-Ibor, Norman Sartorius ISBN: 9780471496816

Psychiatry in SocietyEdited by Norman Sartorius, Wolfgang Gaebel, Juan José López-Ibor, Mario Maj ISBN: 9780471496823

Psychiatry as a NeuroscienceEdited by Juan José López-Ibor, Wolfgang Gaebel, Mario Maj, Norman Sartorius ISBN: 9780471496564

Early Detection and Management of Mental DisordersEdited by Mario Maj, Juan José López-Ibor, Norman Sartorius, Mitsumoto Sato, Ahmed Okasha ISBN: 9780470010839

World Psychiatric Association titles in the `Depression' series

In recent years, there has been a growing awareness of the multiple interrelationships between depression and various physical diseases. This series of three short volumes dealing with the comorbidity of depression with diabetes, heart disease and cancer provides an update of currently available evidence on these interrelationships.

Depression and DiabetesEdited by Wayne Katon, Mario Maj and Norman Sartorius ISBN: 9780470688380

Depression and Heart DiseaseEdited by Alexander Glassman, Mario Maj and Norman Sartorius ISBN: 9780470710579

Depression and CancerEdited by David W. Kissane, Mario Maj and Norman Sartorius ISBN: 9780470689660

Related WPA title on depression:

Depressive Disorders, 3eEdited by Helen Herrman, Mario Maj and Norman Sartorius ISBN: 9780470987209

For all other WPA titles published by John Wiley & Sons Ltd, please visit the following website pages:

http://eu.wiley.com/WileyCDA/Section/id-305609.html

http://eu.wiley.com/WileyCDA/Section/id-303180.html

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Library of Congress Cataloging-in-Publication Data

Substance abuse disorders : evidence and experience / editors, Hamid Ghodse … [et al.]. p. cm. Includes index. ISBN 978-0-470-74510-6 (cloth) 1. Substance abuse. 2. Substance abuse–Etiology. 3. Substance abuse–Treatment. I. Ghodse, Hamid. RC564.S83155 2011 616.86–dc22 2010033338

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF: 978-0-470-97507-7; Wiley Online Library: 978-0-470-97508-4; ePub: 978-0-470-97594-7

List of Contributors

Steve Allsop National Drug Research Institute, Curtin University of Technology, GPO Box U1987, Perth WA 6845, Australia

Adriana Blanco Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, USA

Helen Fung-Kum Chiu Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), China

Nicolas Clark Institute for Health Services Research, Monash University, Melbourne, Australia

Ilana B. Crome Academic Psychiatry Unit, Keele University Medical School, St George's Hospital, Corporation Road, Stafford ST16 3SR, UK

Vera da Costa e Silva Rua Pinheiro Guimares, 149 casa 145, 22281-080 Rio de Janeiro, Brazil

Pim Cuijpers Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands

David A. Deitch University of California, San Diego, CA, USA

Colin Drummond National Addiction Centre, Institute of Psychiatry, King's College London, London SE5 8BB, UK

Griffith Edwards National Addiction Centre, Institute of Psychiatry, King's College London, London SE5 8BB, UK

Nady el-Guebaly Addiction Division, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada

Waleed Fawzi Ministry of Health, Egypt

Susanna Galea Community Alcohol & Drug Services, Auckland, Pitman House, 50 Carrington Road, Point Chevalier, Auckland, New Zealand

Coral Gartner School of Population Health, University of Queensland, Brisbane, Queensland, Australia

Abdu'l-Missagh Ghadirian McGill University, Faculty of Medicine, Montreal, Quebec, Canada

Wayne Hall School of Population Health, University of Queensland, Brisbane, Queensland, Australia

Igor Koutsenok Department of Psychiatry, University of California San Diego School of Medicine, 5060 Shoreham Place, Suite 200, San Diego, CA 92122, USA

Noeline C. Latt Area Drug and Alcohol Service, Herbert Street Clinic, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia

Nasser Loza Ministry of Health, Egypt

Neil McKeganey University of Glasgow, Glasgow, UK

Maria-Elena Medina Mora Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muiz, Calzada México Xochimilco 101, Tlalpan, México D.F. 14370, Mexico

Ahmad Mohit Department of Psychiatry, Iran University of Medical Science, Tehran, Iran

Maristela Monteiro Pan American Health Organization, 525 23rd St NW, Washington DC 20037, USA

Marcus R. Munafó School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK

Filippo Passetti Division of Mental Health, St George's University of London, London SW17 0RE, UK

Jayadeep Patra Centre for Addiction and Mental Health, 33 Russell Street, Room T-508, Toronto, Ontario, M5S 2S1 Canada

Vladimir B. Pozynak Training and Research Centre, Belarussian Psychiatric Association, Minsk, Belarus

Mark Prunty Respond (Community Substance Misuse Service), Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, UK

Rebeca Robles Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muiz, Calzada México Xochimilco 101, Tlalpan, México D.F. 14370, Mexico

Duncan Raistrick Leeds Addiction Unit, 2150 Century Way, Thorpe Park, Leeds LS15 8ZB, UK

Tania Real Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muiz, Calzada México Xochimilco 101, Tlalpan, México D.F. 14370, Mexico

Kylie D. Reed National Addiction Centre, Institute of Psychiatry, King's College London, London SE5 8BB, UK

Jürgen Rehm Centre for Addiction and Mental Health, 33 Russell Street, Room T-508, Toronto, Ontario, M5S 2S1 Canada

Robyn Richmond School of Public Health and Community Medicine, University of New South Wales, Kensington NSW 2052, Australia

Pedro Ruiz Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA

Andriy V. Samokhvalov Centre for Addiction and Mental Health, 33 Russell Street, Room T-508, Toronto, Ontario, M5S 2S1 Canada

John B. Saunders Centre for Youth Substance Abuse Research, Faculty of Health Sciences, University of Queensland, Herston Qld 4029, Australia

Fabrizio Schifano University of Hertfordshire, School of Pharmacy, College Lane Campus, Hatfield AL10 9AB, UK

John Strang National Addiction Centre, Institute of Psychiatry, King's College London, London SE5 8BB, UK

Joshua Tsoh Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), China

Robert West Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, UK

James White Department of Primary Care and Public Health, School of Medicine, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK

Yu Xin Institute of Mental Health, Peking University, Beijing, China

Preface

This book offers a comprehensive review of substance abuse disorders that, it is generally recognized, have proved to be very difficult problems for medical and psychiatric practice over the last century. It has three sections, one each for tobacco, alcohol and `drugs'. Each section contains three reviews: epidemiology, treatment and management and prevention. Whole books have previously been dedicated to the subject of each section and indeed to each chapter within each section. This book does not seek to achieve that level of detail; instead, by standing back and taking a broader perspective, it highlights the differences and the similarities between the areas of study and emphasizes the importance of prevention, health-care delivery, policy formation and academic research. The authors of each chapter are internationally renowned in their respective fields and their chapters are complemented by commentaries from world-class authorities in research, teaching and clinical practice.

The misuse of tobacco, alcohol and of licit and illicit drugs is one of the greatest health challenges in the world today. It affects not just the health of those using these substances, but also all other aspects of their life as well as their families, their colleagues and the wider society. It lies behind a high proportion of all crime, costing nations billions of dollars each year in prevention and treatment programmes, in law enforcement and other economic costs. This imposes a heavy burden on the social infrastructure of developed and developing countries. Valuable human and financial resources have to be diverted away from productive activities contributing to development and prosperity, while drug trafficking foments corruption that is one of the most formidable obstacles to good governance.

The young people of today live in a world that is very complex. It provides them with tremendous opportunities as well as difficult challenges, with many benefits and many risks. The influence of their peers and their surroundings upon them and their behaviour, their life style and their health is greater than ever before. Peer influences no longer emanate solely from school or the local neighbourhood but can come from thousands of miles away. Indeed, adolescents' ideals and role models may be in another continent; their problems may start from under the same roof or from far away. The provision of a healthy environment has thus become more difficult and the sociocultural control of behaviour less predictable. These complex societal changes might have contributed to the increase of mental and behavioural problems of children and adolescents. Indeed, the scale of misuse of tobacco, alcohol and drugs is such that practioners are likely to see its impact on patients on most days. In comparison, the control of traditional diseases now appears relatively simple.

Smoking remains the single biggest preventable cause of ill health – and the smoking epidemic has yet to peak in low- and middle-income countries where the majority of the world's smokers now live. Tobacco use is strongly correlated with and can be a substantial contributor to social disadvantage. If current trends continue, it will kill 1000 million people prematurely during this century. According to the World Health Organization, three out of every five young people who experiment with tobacco will become dependent smokers into adulthood and half of them will die prematurely. However, studies demonstrate that no single youth-focused intervention will be effective if society as a whole does not address tobacco use as a social problem. Therefore, the main recommendation for public-health decision makers and activists is to concentrate efforts on changing the environment in parallel with any youth-orientated strategy in order to ensure adherence of this population to the concept that the best life option is to be or become a nonsmoker.

An instructive comparison can be made between the control regimes for illicit drugs and tobacco. Although it is both psychoactive and addictive, nicotine was never put under a drug-control regime like those of the International Conventions for the control of narcotic and psychotropic drugs. The recent World Health Organization Framework Convention on Tobacco Control adopts a very different approach. It emphasizes interlinked strategies for harm reduction, demand reduction, denormalization of tobacco use and regulation of the tobacco industry. Tobacco markets are relatively unregulated, relying on taxation, advertising and age-related controls on consumption. In this context, it is interesting that the annual prevalence of tobacco use is about one quarter of the world population (age 15+) – some 1.7 billion people – while the annual prevalence of use of any illicit drug is only 5% of the world population (age 15–64) – some 200 million people. The prevalence of tobacco consumption is thus eight times that for illicit drugs. Tobacco also claims 25 times as many lives as illicit drug abuse. In the early twentieth century and prior to any international drug control, the prevalence of drug dependence in many parts of the world was very high indeed. In China alone there were 10 million opium addicts out of a total estimated population of 450 million and in the United States according to a government report 90% of narcotics were used for nonmedical purposes.

Had there been no drug-control system, the size of the drug-using population, as well as the burden of disease associated with it, would have been much greater – perhaps even at levels close to tobacco. It can be argued therefore that the multilateral drug-control system has helped to contain the problem at 5% of the world population (age 15–64) or < 1% if only problem drug use is considered. This is an achievement that should not be underrated and provides a useful perspective within which more recent developments can be analysed.

It is evident from the chapter on the epidemiology of drug abuse that in some parts of the world the abuse of prescription drugs has already surpassed the abuse of traditional illicit drugs such as heroin and cocaine. For example, in the United States, the abuse of prescription drugs, including pain killers, stimulants, sedatives and tranquillizers, exceeds that of practically all illicit drugs, with the exception of cannabis. The unregulated market for pharmaceuticals, particularly through the internet, exposes people to serious health risks through the delivery of often poorly documented, unsafe, ineffective or low-quality medicines. An additional concern is that the gains of the past years in international drug control may be seriously undermined by this ominous development, if it remains unchecked.

The epidemiological data that have been reviewed show that the most salient issue is the global nature of drug abuse, including the changing geographical location of crops and drug production, and the density and malleability of trafficking routes. Changes in drug use or policies within one country inevitably impact on others, emphasizing the need for international collaboration on a problem that knows no borders. A global view of the problem shows that knowledge of changes in the prevalence rates in one country or modification of the trafficking routes or oversupply of drugs in the illicit market allows some prediction of potential problems in other countries. This global view also facilitates international collaboration in relation to the interchange of information, evidence of best practice, coordination of activities and mutual support.

The importance of this type and level of collaboration is emphasized when it is realized that hundreds of preventive programmes were implemented around the world at various times without any attempt to evaluate their effectiveness or cost effectiveness. Under increasing pressure from governments and funding agencies to demonstrate the effectiveness of drug prevention interventions, several reviews have been undertaken during the past decade and the number of methodologically sound studies is now growing. Similarly, with regard to treatment, currently available evidence does not support any single treatment approach as yielding better outcomes for the chronic, relapsing nature of addiction, with all its correlates and consequences. Indeed, it seems likely that the most promising results come from a combination of pharmacotherapeutic and psychosocial treatment approaches that take account of the local sociocultural environment.

Worldwide, of course, alcohol consumption is one of the most important risk factors in the global burden of disease, ranking fifth, behind underweight (from malnutrition and underfeeding), unsafe sex, high blood pressure and tobacco use. In addition, it is important to remember that alcohol abuse contributes to some of the other risk factors for disease – for example to the prevalence of unsafe sex. The prevalence and severity of alcohol-use disorders depend on many factors, such as the amount and quality of alcohol consumed on a daily basis and the frequency of drinking. This is reflected in the distribution of alcohol-use disorders in different world regions. Although aggregate alcohol consumption is escalating fast in the developing world, limited research data are available on the regional prevalence and patterns of alcohol use in a vast number of countries. Such data would aid in the formulation of cost-effective treatment strategies within the medical and social infrastructures of those countries because most of the currently recommended practices for prevention and treatment, together with the supporting evidence, are derived from developed Western healthcare settings. Here, research evidence about effective interventions has not uniquely influenced policy and clinical decisions about responses to alcohol-related problems. Instead, in shaping policy, research evidence competes with: vested interests, such as those of the alcohol manufacturers and retailers; the divergent views of government departments such as treasury, employment, industry and health; and, community and clinician perceptions about the nature and extent of alcohol-related harm. Community views in turn are influenced by an individual's perceived proximity to the adverse outcomes of alcohol consumption and popular perceptions that alcohol problems are resolutely an issue of personal responsibility/individual weakness.

Preventing substance abuse and treating those who suffer from substance abuse disorders is an investment in the health of nations just as much as the prevention and treatment of HIV infection, diabetes or tuberculosis. However, because substance-abuse problems often have associated social problems, the issues have to be addressed by the whole of society. The review carried out within this book will therefore be useful not only to psychiatrists and other medical practitioners, but also to a wide range of professional groups, from health and social services, behavioural and social scientists and practitioners in the judiciary and law enforcement. We hope that it will also contribute to the ongoing debate on some of the controversial issues discussed here.

Hamid Ghodse Helen Herrman Mario Maj Norman Sartorious

Section 1

Drugs

Chapter 1

Epidemiology of Drug Abuse: A Global Overview

Maria-Elena Medina-Mora, PhD, Tania Real, M.S. and Rebeca Robles, PhD

Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry, Ramón de la Fuente Muñiz, México, Mexico

1.1 INTRODUCTION

Public Health is interested in the health condition of the population and in the relation between the health status of groups and the environment. Epidemiology, through the differentiation of healthy individuals from those in poor health, and by the study of biological and social, individual and collective factors related to health and disease, estimates the extension and magnitude of a problem, subgroups of the population affected, trends over time, its determinants and consequences, the proportion of persons exposed to preventive interventions and the treatment demand covered. Its challenge is to describe the problem in a way that provides the evidence required to orientate policy.

Providing a comprehensive view of the drug problem across different cultures poses some difficulties, mainly derived from the availability of accurate information. On the one hand, illicit activities are difficult to evaluate, willingness to report might be affected by social tolerance toward drug use; persons conducting surveys in countries where drug use is defined as a felony and the police are active, might find more difficulties in obtaining an adequate rate of persons accepting to answer a questionnaire and an accurate self-report of use. Also, studies conducted in different countries might reflect differences in methods pursued, populations covered and conceptual definitions of behaviours and consequences, more than variations in rates of use. In spite of these limitations, data available show interesting global trends that can serve as an arena for the discussion of drug policies.

This chapter provides a view of the extension of the problem per type of substance and in different regions of the world; it is introduced by a discussion related to the different approaches epidemiology can follow, it provides evidence on the need to study dimensions of use and problems as separate interacting indicators and of considering the circular nature of the drug problem with epidemic rises, periods when drug use is stable or is reduced, followed by a new rise, that calls attention to the need to consider replicating studies with a periodicity that allows the description of trends.

Data included in the chapter are drawn from a literature review, from the reports of member countries to the United Nations, from the annual reports of the International Narcotics Control Board, the UNESCO and from statistics and other studies coordinated by the World Health Organization. Regional organizations such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the Inter-American Drug Abuse Control Commission CICAD, were also visited. This information is completed with data coming from epidemiological studies, household and student surveys, and surveillance systems, when available.