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Tobacco and alcohol – the largest substance abuse health burdens

The largest health burden from substance use was attributable to tobacco smoking and the smallest was attributable to illicit drugs, according to a global review.

The review compiled the most recent and reliable information on alcohol, tobacco, and illicit drug use and the burden of death and disease. It shows that in 2015 alcohol and tobacco use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing a further tens of millions.

The largest health burden from substance use was attributable to tobacco smoking and the smallest was attributable to illicit drugs. Global estimates suggest that nearly one in seven adults (15.2%) smoke tobacco and one in five adults report at least one occasion of heavy alcohol use in the past month.

Compared with the rest of the world, Central, Eastern, and Western Europe recorded consistently higher alcohol consumption per capita (11.61, 11.98 and 11.09 litres, respectively) and a higher percentage of heavy consumption amongst drinkers (50.5%, 48.2%, and 40.2%, respectively). The same European regions also recorded the highest prevalence of tobacco smoking (Eastern Europe 24.2%, Central Europe 23.7%, and Western Europe 20.9%).

In contrast, use of illicit drugs was far less common. Fewer than one in twenty people were estimated to use cannabis in the past year, and much lower estimates were observed for amphetamines, opioids and cocaine. Hotspots included the US, Canada, and Australasia. The US and Canada had one of the highest rates of cannabis, opioid, and cocaine dependence (748.7 [694.8, 812.3], 650.0 [574.5, 727.3], and 301.2 [269.3, 333.7] per 100,000 people, respectively). Australasia (Australia and New Zealand) had the highest prevalence of amphetamine dependence (491.5 per 100,000 people [441.4, 545.5]), as well as high rates of cannabis, opioid and cocaine use dependence (693.7 [648.1, 744.4], 509.9 [453.7, 577.8], and 160.5 [136.4, 187.1] per 100,000 people, respectively).

Some countries and regions (Africa, Caribbean and Latin America, Asia regions) have little or no data on substance use and associated health burden. These are typically low or middle-income countries that frequently have punitive drug policies, and may experience serious political and social unrest. These countries need enhanced monitoring because they are at risk of rapid escalation in substance use and related health burden.

The report, 'Global Statistics on Alcohol, Tobacco, and Illicit Drug Use: 2017 Status Report', uses data mainly obtained from the World Health Organisation, UN Office on Drugs and Crime, and Institute for Health Metrics and Evaluation. The authors note that there are important limitations to the data, especially for illicit drugs, but believe that putting all this information in one place will make it easier for governments and international agencies to develop policies to combat substance use.

Abstract
Aims: This review provides an up‐to‐date curated source of information on alcohol, tobacco, and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future.
Methods: Online data sources were identified through expert review. Data were mainly obtained from the World Health Organization, United Nations Office on Drugs and Crime, and Institute for Health Metrics and Evaluation.
Results: In 2015, the estimated prevalence among the adult population was 18.3% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8%, 0.77%, 0.37%, and 0.35% for past‐year cannabis, amphetamine, opioid, and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardised prevalence of alcohol dependence was 843.2 per 100,000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100,000 people, respectively. High‐Income North America region had among the highest rates of cannabis, opioid, and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco (110.7 deaths per 100,000 people), followed by alcohol and illicit drugs (33.0, and 6.9 deaths per 100,000 people, respectively). Attributable age‐standardised mortality rates and DALYs for alcohol and illicit drugs were highest in Eastern Europe; attributable age‐standardised tobacco mortality rates and DALYs were highest in Oceania.
Conclusions: In 2015 alcohol and tobacco use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing a further tens of millions. Europeans proportionately suffered more but in absolute terms the mortality rate was greatest in low and middle income countries with large populations and where the quality of data was more limited. Better standardised and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.

Authors
Amy Peacock, Janni Leung, Sarah Larney, Samantha Colledge, Matthew Hickman, Jürgen Rehm, Gary A Giovino, Robert West, Wayne Hall, Paul Griffiths, Robert Ali, Linda Gowing, John Marsden, Alize J Ferrari, Jason Grebely, Michael Farrell, Louisa Degenhard

[link url="https://www.sciencedaily.com/releases/2018/05/180511081729.htm"]Society for the Study of Addiction material[/link]
[link url="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14234"]Addiction abstract[/link]

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