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

Peter Anderson, Virginia Berridge, Patricia Conrod, Robert Dudley, Matilda Hellman, Dirk Lachenmeier, Anne Lingford-Hughes, David Miller, Jürgen Rehm, Robin Room, Laura Schmidt, Roger Sullivan, Tamyko Ysa, Antoni Gual, Peter Anderson, Virginia Berridge, Patricia Conrod, Robert Dudley, Matilda Hellman, Dirk Lachenmeier, Anne Lingford-Hughes, David Miller, Jürgen Rehm, Robin Room, Laura Schmidt, Roger Sullivan, Tamyko Ysa, Antoni Gual

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.

Keywords: alcohol; evolutionary biology; governance; health footprint; illegal drugs; margins of exposure; nicotine; well-being.

Conflict of interest statement

Competing interests: PA and AG coordinated the ALICE RAP project. VB, PC, MH, DWL, AL-H, DM, JR, RR, LS, and TY undertook various aspects of research for the ALICE RAP project. PA reports receipt of fees for public health comment to AB InBev’s goals to reduce the harmful use of alcohol, outside the submitted work. PC reports having served as a technical advisor to ABInBev Global Health Foundation, outside the submitted work. AG reports grants and personal fees from Lundbeck, grants and personal fees from D&A Pharma, personal fees from AbbVie, outside the submitted work. AL-H reports grants and personal fees from Lundbeck, outside the submitted work. JR reports grants, personal and other fees from Lundbeck, outside the submitted work. All other authors report no conflicts of interest. The views expressed here reflect only the authors’ and the European Union is not liable for any use that may be made of the information contained therein. No funds were used to prepare the paper.

Figures

Figure 1.. Margin of exposure for daily…
Figure 1.. Margin of exposure for daily drug use estimated using probabilistic analysis.
Source: Lachenmeier & Rehm (2015) .
Figure 2.. Well-being framework, reproduced with permission…
Figure 2.. Well-being framework, reproduced with permission from the OECD Better Life Index initiative.
Source: OECD. (2011), How's Life?: Measuring Well-being, OECD Publishing, Paris. DOI: http://dx.doi.org/10.1787/9789264121164-en .
Figure 3.. Drivers of harm done by…
Figure 3.. Drivers of harm done by drugs and addictive behaviour.

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