Reframing the science and policy of nicotine, illegal drugs and alcohol – conclusions of the ALICE RAP Project

Abstract

In 2013, illegal drug use was responsible for 1.8% of years of life lost in the European Union, alcohol was responsible for 8.2% and tobacco for 18.2%, imposing economic burdens in excess of 2.5% of GDP. No single European country has optimal governance structures for reducing the harm done by nicotine, illegal drugs and alcohol, and existing ones are poorly designed, fragmented, and sometimes cause harm. Reporting the main science and policy conclusions of a transdisciplinary five-year analysis of the place of addictions in Europe, researchers from 67 scientific institutions addressed these problems by reframing an understanding of addictions. A new paradigm needs to account for evolutionary evidence which suggests that humans are biologically predisposed to seek out drugs, and that, today, individuals face availability of high drug doses, consequently increasing the risk of harm. New definitions need to acknowledge that the defining element of addictive drugs is ‘heavy use over time’, a concept that could replace the diagnostic artefact captured by the clinical term ‘substance use disorder’, thus opening the door for new substances to be considered such as sugar. Tools of quantitative risk assessment that recognize drugs as toxins could be further deployed to assess regulatory approaches to reducing harm. Re-designed governance of drugs requires embedding policy within a comprehensive societal well-being frame that encompasses a range of domains of well-being, including quality of life, material living conditions and sustainability over time; such a frame adds arguments to the inappropriateness of policies that criminalize individuals for using drugs and that continue to categorize certain drugs as illegal. A health footprint, modelled on the carbon footprint, and using quantitative measures such as years of life lost due to death or disability, could serve as the accountability tool that apportions responsibility for who and what causes drug-related harm.

Impulsivities and addictions: a multidimensional integrative framework informing assessment and interventions for substance use disorders

“…The ANA framework posits that in order to better understand the different aetiological mechanisms implicated in various forms of addictions, their assessment should be multidimensional and combine clinical, personality, neurocognitive, neuroimaging and genetic approaches that focus on three key neurofunctional domains associated with impulsivity and compulsivity: executive function, incentive salience, and negative emotionality. Another recent conceptual framework that derived from the European context focuses on variance that is unique to SUDs (chronic and elevated patterns of consumption) in an attempt to steer clear of psychopathological constructs and potentially stigmatizing terms when addressing harm from substances, but recommends a similar framework when referring to risk for SUDs [148]. Nevertheless, there is a consensus across neuropsychiatric conceptualizations of addition (e.g.…”

Relación entre las motivaciones para consumir y el consumo problemático de cannabis

“…Sin embargo, este tipo de medidas de salud pública se centran ante todo en las sustancias, y menos en las conductas individuales. El abordaje de la problemática del consumo se beneficiaría de incluir ambos focos: el más general -la propia sustancia-y el individual-conocer las motivaciones que llevan a las personas a poner en riesgo su salud (Anderson et al, 2017;Barrio y Gual, 2016).…”

Estimación del coste social del consumo de drogas ilegales en Catalunya

“…En la actualidad coexisten en Europa varios tipos de governanza en el ámbito de las addicciones. Algunos países introducen estrategias innovadoras para disminuir los efectos negativos; otros aún dependen de enfoques más tradicionales (Anderson et al, 2017). Independientemente del enfoque de la administración pública, cuantificar la prevalencia del uso y la carga asociada a la enfermedad y mortalidad a nivel de país, junto con un análisis de los costes económicos directos e indirectos de las drogas ilegales para la sociedad, es clave y debe informar la planificación de políticas y la evaluación de la provisión de servicios (Degenhardt et al, 2012).…”