Substance Abuse and Rehabilitation Dovepress open access to scientific and medical research Open Access Full Text Article CommENtarY Substance abuse and rehabilitation: responding to the global burden of diseases attributable to substance abuse Li-Tzy Wu* Abstract: Alcohol, tobacco, and illegal drug use are pervasive throughout the world. Substance Department of Psychiatry and use problems are among the major contributors to the global disease burden, which includes Behavioral Sciences, Duke University disability and mortality. The benefits of treatment far outweigh the economic costs. Despite School of Medicine, Duke University the availability of treatment services, however, the vast majority of people with substance use Medical Center, Durham, NC, USA disorders do not seek or use treatment. Barriers to and unmet need for evidence-based treat- * Li-Tzy Wu is the Editor-in-Chief ment are widespread even in the United States. Women, adolescents, and young adults are of Substance Abuse and Rehabilitation especially vulnerable to adverse effects from substance abuse, but they face additional barriers to getting evidence-based treatment or other social/medical services. Substance use behaviors and the diseases attributable to substance use problems are preventable and modifiable. Yet the ever-changing patterns of substance use and associated problems require combined research and policy-making efforts from all parts of the world to establish a viable knowledge base to inform for prevention, risk-reduction intervention, effective use of evidence-based treatment, and rehabilitation for long-term recovery. The new international, open-access, peer-reviewed Substance Abuse and Rehabilitation (SAR) journal strives to provide an effective platform for sharing ideas for solutions and disseminating research findings globally. Substance use behaviors and problems have no boundaries. The journal welcomes papers from all regions of the world that address any aspect of substance use, abuse/dependence, intervention, treatment, and policy. The “open-access” journal makes cutting edge knowledge freely available to practitioners and researchers worldwide, and this is particularly important for addressing the global disease burden attributable to substance abuse. Keywords: global burden of disease, rehabilitation, substance abuse, substance use disorders Prevalence of substance use and substance use disorders Substance use and substance use disorders are prevalent worldwide. Scientific evidence has consistently shown that alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality.1 Results from the World Health Organization’s (WHO) World Mental Health (WMH) surveys of 17 countries reveal that substance use is pervasive throughout the world.2 As summarized in Table 1, alcohol is used by 41% to 97% Correspondence: Dr Li-Tzy Wu, Sc.D of adults in their lifetimes, and tobacco products are consumed by 17% to 74% of Department of Psychiatry and Behavioral Sciences, Duke University School adults. In addition, cannabis is the illicit drug most commonly used, but use varies of Medicine, Duke University Medical widely from a low rate of 0.3% in the People’s Republic of China to a high lifetime Center, Box 3419, Durham, rate of 42% in the United States and New Zealand. Lifetime cocaine use ranges from NC 27710, USA Tel +1 919-668-6067 less than 1% in some countries to 16.2% in the United States. These country-level Fax +1 919-668-5418 variations highlight that substance use is fairly heterogeneous both within a region Email [email protected]; [email protected] and across countries. submit your manuscript | www.dovepress.com Substance Abuse and Rehabilitation 2010:1 5–11 5 Dovepress © 2010 Wu, publisher and licensee Dove Medical Press Ltd. This is an Open Access article DOI: 10.2147/SAR.S14898 which permits unrestricted noncommercial use, provided the original work is properly cited. Wu Dovepress Table 1 Estimated cumulative incidence (lifetime) of substance usea Region Country Unweighted sample size Alcohol Tobaccob Cannabis Cocaine N % % % % Americas Colombia 4426 94.3 48.1 10.8 4.0 Mexico 5782 85.9 60.2 7.8 4.0 United States 5692 91.6 73.6 42.4 16.2 Europe Belgium 1043 91.1 49.0 10.4 1.5 France 1436 91.3 48.3 19.0 1.5 Germany 1323 95.3 51.9 17.5 1.9 Italy 1779 73.5 48.0 6.6 1.0 Netherlands 1094 93.3 58.0 19.8 1.9 Spain 2121 86.4 53.1 15.9 4.1 Ukraine 1719 97.0 60.6 6.4 0.1 Middle East and Africa Israel 4859 58.3 47.9 11.5 0.9 Lebanon 1031 53.3 67.4 4.6 0.7 Nigeria 2143 57.4 16.8 2.7 0.1 South Africa 4315 40.6 31.9 8.4 0.7 Asia Japan 887 89.1 48.6 1.5 0.3 People’s Republic of China 1628 65.4 53.1 0.3 0.0 Oceania New Zealand 12790 94.8 51.3 41.9 4.3 Notes: aData from Degenhardt L, Chiu WT, Sampson N, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Med. 2008;5(7):e1412; bTobacco includes cigarettes, cigars, and pipes. Globally, it has been estimated that 3.5% to 5.7% United States.5 In developing countries, this public health of the population aged 15 to 64 years, or approximately concern may be complicated further by issues of nonphar- 155 to 250 million people, had used an illicit drug at macy (black market) sales of pharmaceuticals, marketing of least once in the past year.3 When taking into account counterfeit drugs, and self-treatment with pharmaceuticals. the pattern of use, an estimated 16 to 38 million people As with substance use, substance use disorders (ie, abuse are considered problem drug users (regular or frequent or dependence) do not distribute equally across countries. users), and 11 to 21 million people are injection drug Estimates of alcohol/drug use disorders assessed by the users. This wide range of estimations is related, in part, to Composite International Diagnostic Interview (CIDI) from 6 a lack of reliable epidemiological data on use of specific countries (Brazil, Canada, Germany, Mexico, Netherlands, and drugs other than marijuana (eg, inhalants, cocaine/crack, the United States) are listed in Table 2. Approximately 10% to amphetamines/methamphetamine, hallucinogens, ecstasy/ 28% of nonelderly adults had a history of alcohol or drug use MDMA [3,4-methylenedioxymethamphetamine], sedatives, disorders in their lifetimes, and an estimated 6% to 13% had tranquilizers, heroin, and opioid analgesics), especially in an alcohol or drug use disorder in the past 12 months.7 These countries where resources for research and evidence-based data suggest that personal and societal problems associated treatment are comparatively limited but illicit drug use has with alcohol/drug use disorders are highly prevalent among increased.3,4 In particular, research is needed to monitor and nonelderly adults in many countries worldwide because sub- investigate the extent of health problems associated with stance addiction in general is a chronic condition with a high misuse and abuse of prescription drugs in both adolescents rate of relapse.8,9 However, the true extent of substance use and adults.5,6 Misuse and abuse of prescription drugs, espe- disorders is much larger than these estimates suggest because cially analgesic opioids, has become an epidemic in the they do not include nicotine (tobacco) dependence. Table 2 Prevalences of DSM-III-R alcohol or drug use disordersa Country Brazil Canada Germanyb Mexico Netherlands USA Sample size, n 1464 6261 1626 1734 7076 5388 Age in years $18 18–54 18–25 18–54 18–64 18–54 Alcohol or drug disorder % % % % % % Lifetime disorder 16.1 19.7 21.5 9.6 18.7 28.2 12-month disorder 10.5 7.9 13.2 5.8 8.9 11.5 Notes: aData from WHO International Consortium in Psychiatric Epidemiology. Cross-national comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ. 2000;78(4):413–4267; bDSM-IV criteria were used in Germany. 6 submit your manuscript | www.dovepress.com Substance Abuse and Rehabilitation 2010:1 Dovepress Dovepress An Introduction to Substance Abuse and Rehabilitation Globally, there are an estimated 1.3 billion tobacco burden resulting from substance abuse is enormous. smokers, and half of them (or approximately 650 million Substance abuse not only affects personal health and accom- smokers) are expected to die prematurely of a tobacco-related plishments, but also negatively affects the quality of life disease.10 Unless effective preventive interventions are imple- of abusers’ family members (eg, financial security, mental mented widely, the number of tobacco smokers will rise to health, social networks, and productivity) and the functioning 1.7 billion by 2025.10 In the United States, nicotine dependence of society at large (eg, the criminal justice and health care is the most prevalent substance addiction, with an estimated systems). For example, in the United States, the direct and 13% of American adults with nicotine dependence in the past indirect economic cost to individual users, their families, year – a figure that is close to twice the estimate of the most and society was estimated to be $21.9 billion for heroin common nonaddictive disorder, major depression (7%).11 Nic- addiction and $184.6 billion for alcohol use problems per otine dependence also is highly comorbid with alcohol/drug year.16,17 Indeed, problems associated with substance abuse use and other mental disorders (eg, depression),12,13 and lon- are so pervasive that they can affect nearly every aspect of gitudinal data have shown that tobacco smoking increases the the abuser’s life. These problems may include: employment risk for the subsequent onset of depression.13,14 Comorbidities issues, injuries, violence, assaults, child neglect or abuse, not only exacerbate adverse health risks but also complicate incarceration, suicidal behaviors, psychiatric disorders, treatment strategies aiming to promote smoking cessation.