Few diseases can compete with addiction in their capacity to generate misinformation, misjudgment, or misunderstanding. Illicit drug use has been around for as long as drugs themselves, but the acceptance of addiction to any substance as a disease rather than a choice is a far more modern concept. The first issue of The Lancet in 1996 introduced a six-part Series on addiction with the emphasis on relevant brain mechanisms, detoxification, treatment myths, and drug policy. Now, 16 years later in the 7 January 2012 issue of the Lancet, a three-part Series examines addiction from a global perspective.
The first paper in the 2012 Lancet Series on addiction addresses the global burden of disease due to illicit drug use, and estimates that about 200 million people worldwide use illicit drugs each year. Louisa Degenhardt and Wayne Hall discuss the adverse health effects of dependence on different drugs, and compare them with those of tobacco and alcohol. Most of the disease burden attributable to illicit drugs is in problem or dependent drug users, especially those who inject drugs.
The second paper, by John Strang and colleagues, examines the effectiveness of drug control initiatives, and explores evidence-based interventions to prevent drug use initiation in young people and to reduce drug use in established drug users.
The third paper, by Robin Room and Peter Reuter, discusses whether international drug conventions protect public health, or otherwise, and concludes that national policies aligned with risks of different drugs are needed. The authors state: “The cultural positions of different drugs vary enough to preclude universal policies on how to deal with all illicit or indeed licit drugs. From the perspective of public health, we need to move towards a control system that is more aligned with the risks that different drugs pose to users and shows an understanding of the effects of different regulatory approaches on drug use and harm.”
As the problem of escalating misuse of prescription drugs shows, particularly in the USA, prevention and treatment of prescription drug dependency offers challenges that differ from those of addiction to illicit drugs, and need innovative solutions. Addiction is a complex disease without a universal policy approach or treatment.