The Impact of Addictive Substances and Behaviours on Individual and Societal Well-Being (Part of the Series: Governance of Addictive Substances and Behaviour)

Citation

Foster, J. (2017), "The Impact of Addictive Substances and Behaviours on Individual and Societal Well-Being (Part of the Series: Governance of Addictive Substances and Behaviour)", Drugs and Alcohol Today, Vol. 17 No. 3, pp. 200-201. https://doi.org/10.1108/DAT-04-2017-0015

This book is the second in a series of publications arising from the Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project cross-national study examining drug and alcohol use. Peter Anderson’s foreword outlines the study’s aims: to consider cross-European addictions and lifestyles in context “so that we can better redesign their governance”.

The first section puts substance use into a wider context. Sullivan and Hagen’s historical and anthropological perspective underlines that drug use has been driven by biological and behavioural reinforcers and that drug users are active in the constantly changing process, not the passive actors they are often portrayed as. They do this by discussing plant toxins which have been part of animal and human diets for millions of years, often with beneficial consequences. Schmidt reflects on the increasing number of behaviours considered under the heading “addictions”, calling this the “pan-addiction model”, largely in response to the rise of the internet and general globalisation. This means there are greater arrays of behaviours constantly available to potential “addicts”. She links this to the medicalisation of what may be “normal” behaviours, increasing medical power-bases. She concedes that the society has not been able to respond to the changes presented by the pan-addiction model; and medicine may be providing a valuable function, preventing greater societal harms.

Stoll and Anderson’s chapter provides a number of helpful models to consider health and well-being, individual and societal. They conclude that there is no country or group of countries which are “optimal in promoting quality of life, material living conditions and sustainability of well-being over time.” Shield and Rehm consider the global burden of disease and disability presented by addictive behaviours by considering alcohol, illicit/prescription drug use, gambling and tobacco. Using data from the Global Burden of Disease’s study, they conclude that the burden of addictive behaviours/substances increased between 1990 and 2010. They emphasise that the impact on deprived populations is greater than on affluent ones, leading to greater inequality.

Two chapters consider research on prevention and education. Conrod et al. focus on binge drinking and drug use amongst European youth, concluding that although some interventions have shown local promise, no recommendations can yet be made for broader policy implementation. Moskalewicz and Klingermann’s chapter summarises the impact of societal stigma, historical and current, on how substance users are regarded. They show how this has exaggerated health inequalities because of the way “treatments” have been operationalised through the addiction treatment and criminal justice systems and the moral judgements that underpin how substance users are regarded.

The remainder of the book discusses the socio-economic costs of substance use. Dubanowicz and Lemmens consider the impacts of austerity and economic downturns upon different types of substance use. Alcohol and tobacco use tends to fall in response to restrictions in affordability; however, the impact is increased, e.g. increased alcohol-related suicides. The impact on illicit drug use is inconsistent. The most important driver of inequality is welfare cuts, invariably introduced in times of economic austerity. Shields et al. summarise the social costs of addictive behaviours in Europe, estimating them at 300 billion euros. Robin Room’s chapter emphases how policies which aim to control addictions create greater social and economic inequalities as poorer users are subjected to greater marginalisation and stigmatisation. Miller and Harkins’ final substantive chapter summarises some of the evidence concerning how the behaviours of big alcohol and tobacco are at times “institutionally corrupt”, and that minimal governmental responses add to wider societal costs and greater inequalities.

In the final chapter, Room Anderson and Rehm identify what they regard as the book’s key messages. First, addiction is part of a continuum of substance use, with wider societal costs at all stages of this continuum. Second, the aim of policy makers should be to promote positive health, which requires balancing the interests of key stakeholders – opposing them if they act to wider public detriment. Third, “nudging” techniques should be employed to point the wider population in the direction of positive health changes.

The editors have made a commendable effort to combine a series of disparate topics. I recommend this book as an excellent overview of substance use and addictive behaviours for students and practitioners interested in gaining an international insight into the promotion of public health and understanding the interaction between this and substance use.