Alcohol and tobacco are by far the biggest threat to human welfare of all addictive drugs

May 11, 2018

A new review published online today in the journal Addiction has compiled the best, most up-to-date source of 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 (e.g., 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 Organization, United Nations 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.
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For editors:

This paper is free to download from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14234 (after the embargo has lifted) or by contacting Jean O'Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Tables of particular note:

Table 2: Modelled regional estimates of prevalence of alcohol use and tobacco smoking, 2015.
Table 3: Past 12 month prevalence of any drug use among the population aged 15-64 years, by region and globally, 2015.
Table 4: Modelled estimates of cases and age-standardised rates of past year substance dependence by GBD region, 2015.
Table 5: Crude attributable DALYs and deaths (in 1000s) and age-standardised attributable DALYs and death rate (per 100,000) for alcohol, tobacco and illicit drugs as risk factors for disease burden by GBD region, 2015.
Appendix B: Crude attributable DALYs and deaths (in thousands) and age-standardised attributable DALYs and death rate (per 100,000) for tobacco smoking and second-hand smoking by GBD region, 2015

Interviews with co-author and Addiction Editor-in-Chief Professor Robert West: contact him at UCL (University College London) by email (robert.west@ucl.ac.uk) or telephone (+44 (0)7813916681).

Full citation for article: Peacock A, J Leung, S Larney, S Colledge, M Hickman, J Rehm, GA Giovino, R West, W Hall, P Griffiths, R Ali, L Gowing, J Marsden, AJ Ferrari, J Grebely, M Farrell, and L Degenhardt (2018) Global statistics on alcohol, tobacco, and illicit drug use: 2017 status report. Addiction 110: doi: 10.1111/add.14234

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

Society for the Study of Addiction

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