GLOBAL DIMENSION AND BURDEN OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE Isidore S. Obot, PhD, MPH. Department of Mental Health and Substance Abuse World Health Organization Geneva

Introduction Pattern of Substance Use World-wide –Tobacco –Alcohol –Illicit Drugs Global Burden of Psychoactive Substance Use –Tobacco –Alcohol –Illicit Drugs Conclusions

Smoking in the World Number of cigarettes smoked in – trillions – trillions – trillions Number of cigarettes smoked everyday: over 15 billion One in three smoked in China where average number of cigarettes per man per day rose from 10 in 1992 to 15 in 1996.

Smoking in Brazil Annual per capita consumption declined from 1,309 in 1970 to 858 in 2000, with the peak in 1980 at 1,895 per person. Overall rate, 2000: 31% –Males - 35% –Females - 27% –Youth - 11%

Framework Convention on Tobacco Control FCTC Adopted in 2003 Signed by 94 countries Ratified by 9 countries No of countries needed: 40

Proportion of alcohol consumers in WHO sub- regions

Drinking Pattern Values for Selected WHO Regions

12 leading selected risk factors as causes of disease burden measured in DALYs Developed countries Developing countries High Mortality Low Mortality 1 UnderweightAlcohol(6.2%)Tobacco (12.2%) 2 Unsafe sexBlood pressure Blood pressure 3 Unsafe waterTobacco (4.0%)Alcohol (9.2%) 4 Indoor smokeUnderweightCholesterol 5 Zinc deficiencyBody mass index Body mass index 6 Iron deficiencyCholesterolLow fruit & veg intake 7 Vitamin A deficiencyLow fruit & veg intake Physical inactivity 8 Blood pressureIndoor smoke - solid fuels Illicit drugs (1.8%) 9 Tobacco (2.0%)Iron deficiency Unsafe sex 10 CholesterolUnsafe waterIron deficiency 11 Alcohol Unsafe sexLead exposure 12 Low fruit & veg intake Lead exposureChild sexual abuse

World Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s)

World Disease burden (DALYs) in 2000 attributable to selected leading risk factors Number of Disability-Adjusted Life Years (000s)

World Disease burden (DALYs) in 2000 attributable to Addictive Substances related Risks Number of Disability-Adjusted Life Years (000s)

World Deaths in 2000 attributable to Addictive Substances related Risks Number of deaths (000s)

World Deaths in 2000 attributable to Addictive Substances related Risks Number of deaths (000s)

WHO Regions Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s)

WHO Regions Disease burden (DALYs) in 2000 attributable to selected leading risk factors Number of Disability-Adjusted Life Years (000s)

Burden of disease attributable to addictive substances related risks: ALCOHOL (% DALYs in each subregion) % 1-1.9% 2-3.9% 4-7.9% <0.5% % Proportion of DALYs attributable to selected risk factor

Burden of disease attributable to addictive substances related risks: TOBACCO (% DALYs in each subregion) Proportion of DALYs attributable to selected risk factor % 1-1.9% 2-3.9% 4-7.9% <0.5% %

Proportion of DALYs attributable to selected risk factor <0.5% % 1-1.9% 2-3.9% Burden of disease attributable to addictive substances related risks: ILLICIT DRUGS (% DALYs in each subregion)

Conclusions The burden of licit and illicit drug problems is increasingly evident. From a public health perspective tobacco and alcohol use carry much higher burdens that illicit drug use. Alcohol and drug polices need to address the relative harms of these substances. In the management of psychoactive substance problems (prevention and treatment) more attention should be paid to epidemiologic evidence and developments in neuroscience.