Drug addiction: a public health perspective


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Brain Awareness Week, a global campaign aiming to raise awareness of brain research, takes place between 13th and 19th March 20171. One related topic, which I personally find interesting, is addiction, especially the addiction to psychoactive drugs (e.g. tobacco, alcohol, and illicit drugs). For a long time, the myth has been that addiction is a willpower, behavioural problem or a choice7. However, addiction is more like a chronic disease of the brain 23. As a part of the brain awareness week, I would like to shed some light on psychoactive drug addiction as a disease of the brain, but with a public health perspective. Although the prevalence of alcohol and tobacco use is greater compared to illicit drugs  45, the focus is on illicit drugs.

Addiction is a state in which a person engages in a compulsive behaviour, even when faced with adverse consequences. An addicted person loses the control over the use of the addictive substance. The initial decision to take drugs is voluntary. However, drug use affects the central nervous system, and over the time the repeated drug abuse cause changes in the brain, impairing one’s ability to control the use of the addictive substance, leading to addiction. 2, 8.

The human brain, being the most complex organ in the body, is the centre of all human activity. The way drugs change the brain function and create addiction is complex, and different psychoactive drug acts differently in the brain 2, 89. I will not go deeply into the neurophysiological effect of drug addiction, but to put in a simple way: some psychoactive drugs increase the production and release of dopamine, which regulates motivation, emotions, and feeling of pleasure 2, 8. Why some rewards, such as drugs, are more addictive than other natural rewards? The human brain registers all the pleasure in the same way, whether it comes from psychoactive drugs, or from a satisfying meal. However, depending on the type of drugs, they can release 2 to 10 times higher amount of dopamine compared to natural rewards. The high amount of dopamine is released almost immediately when the drugs are taken, and it last longer, compared to natural rewards. The pleasure gained when taking drugs dwarfs the pleasure gained by natural rewards9.

About 27 million, or 0.6 % of the world’s adult population are problem drug users5. On a global level, the use of illicit drugs has been steady, however in developing countries the use of drugs has increased. Among the problem users, diseases such as HIV (~20 %), hepatitis C (~46,7 %), and hepatitis B (~14.6 %) add to the global burden of disease, especially among injecting drug users 4. Illicit drug use also creates other health consequences, non-fatal overdose being a common one, which is related to morbidity and serious health consequences, and quality of life5. The most extreme consequence of illicit drug use are the related deaths. Despite that, drug-related deaths could be preventable45, the number of deaths among persons aged 15-64 account for 0.5-1.3 % of all cause-mortality on the global level. However, there are significant regional differences, and the drug-related death rate is highest in the North America and Oceania, partly due to the better monitoring and reporting system4.

Drug use is not only causing harm on an individual level, but it also creates an economic burden on society. In economic terms, it impacts the society’s productivity and is associated with drug-related crimes. Additionally, illicit drug use undermines social development and contribute to insecurity and instability4.  

Several factors that increase the likelihood of developing addiction have been recognised and they can be divided into environmental and biological factors. What I personally find interesting are the environmental factors, that can be influenced on. For example: family history of drug addiction, lack of family involvement, and peer pressure are strongly affecting the likelihood of starting to use and abuse drugs. In addition, having mental health disorders can increase the risk of being addicted to drugs. Using drugs can also be a coping mechanism for several mental health problems, such as anxiety2.

But what can be done when we think about drug addiction from the public health perspective? It is important to ensure that everyone who is having drug-use related disorders has access to treatment, but we should rethink the prevention strategies, and change the way how we think about addicted people 5. It’s a brain disease 2, 3, so we should move from threatening and judgment to support 5. It’s rather a social recovery than an individual recovery, as mentioned by Johann Hari in his TED talk 6. Like Hari says: “the opposite of addiction is connection” 6.

 

References

  1. The Dana Foundation (2017) Brain Awareness Week. Available at: <http://www.dana.org/BAW/>. [Accessed 9 March 2017].
  2. National Institute on Drug Abuse (2016) Understanding Drug Use and Addiction. Available at: <https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/df_understanding_drug_use_final_08_2016.pdf>. [Accessed 9 March 2017].
  3. Turton, S. and A. Lingford-Hughes (2016) Neurobiology and principles of addiction and tolerance. Medicine, 44(12), pp. 693-696.
  4. United Nations Office on Drugs and Crime (UNODC) (2012) World Drug Report 2012. Available at:  <http://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf>. [Accessed 9 March 2017].
  5. UNODC (2015) World Drug Report 2015. Available at: <https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf>. [Accessed 9 March 2017].
  6. Johann Hari (2015) TED talk: Everything you think you know about addiction is wrong. Available at: <https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong>. [Accessed 13 March 2017].
  7. Vonasch, A. J., C. J. Clark, S. Lau, K. D. Vohs and R. F. Baumeister (2017) Ordinary people associate addiction with loss of free will. Addictive Behaviors Reports, 2017.
  8. Volkow, N. D. and M. Morales (2015) The Brain on Drugs: From Reward to Addiction. Cell, 162(13), pp. 712-725.
  9. National Institute on Drug Abuse (2014) Drugs, Brains, and Behavior: The Science of Addiction. Available at: <https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/soa_2014.pdf>. [Accessed 9 March 2017].

 

Bio_picture_Niina-Maria Nissinen Niina-Maria Nissinen is a public health master student at Lund University, and a news writer at GHNGN. Her interest in public health is in drugs, alcohol and mental health with a special focus on social structures. 

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