Hello. Welcome to Module 2, social determinants of health and mental health. This is a focus in this brief lecture about substance use. I'm Barbara Peterson, your instructor for this module. The learning objective for this short piece of the lesson is to focus our attention on social determinants of health and substance use. What does substance use really mean? We're looking at three things, alcohol consumption, illicit drug use, and smoking. Alcohol consumption. Alcohol has historically and continues to be, it can hold an important role in social engagement, bonding, and for many, social drinking are moderate, alcohol consumption is pleasurable. However, alcohol consumption, especially in excess, is linked to a number of negative outcomes. As a risk factor for diseases and health impacts, crime, road accidents, and for some, alcohol dependence. Globally, alcohol consumption causes 2.8 million premature deaths per year. Then we think about illicit drug use. Illicit drugs are those drugs that have been prohibited under international drug control treaties. They include opioids, cocaine, amphetamines, and cannabis. How common is drug addiction across the world? We'll talk about that. Then smoking. Tobacco smoking is not considered to be a substance use disorder. However, it does have a large death toll in terms of indirect deaths from other diseases. How much do people smoke across the world and what are those health implications? Tobacco smoking is one of the world's largest health problems. It's been a major health problem for many decades. For the entire 20th century, it's estimated that around a 100 million people died prematurely because of smoking. Most of that has been in the more wealthy countries. The health burden of smoking is now shifting from high-income to low and middle-income countries. Some estimates had suggested that one billion people could die from tobacco during the 21st century. This is according to the Global Burden of Disease Study. That's what we mean by substance use. What's the global prevalence of substance use? We know that a 100 million people have drug and alcohol dependence. The highest rate of that is between the ages of 25 and 34. Males have a twice as much more frequent dependency than females. The global burden of drug use disorder can be seen in both direct and indirect costs, 11.8 million deaths each year from drug abuse. That includes smoking and alcohol and illicit drugs. Over 3,500 people die from overdoses. That would be direct costs, 2.8 million premature deaths a year, 1.5 percent of the global disease burden results from alcohol and illicit drug use. In your readings in this module, you will explore the work of Hannah Ritchie and Max Roser mental health. It's published online in ourworldindata.org. The Global Burden of Disease Study identifies and provides estimates for drug use deaths through two pathways. First, it's the direct death, the direct pathway from the drug use disorder. This drug use disorder is characterized by meeting the criteria for dependence as defined by the World Health Organization. Then deaths from drug use disorder can be considered things like drug overdoses. Then the second pathway is indirect. Drug use can increase the risk of premature death from a range of causes. For example, smoking, indirect costs are related to lung disease and cancers, heart disease, stroke, and diabetes. These deaths are those premature deaths. For instance, from illicit drugs can be the risk of diseases and injuries including suicide, liver disease, hepatitis, cancer, and HIV. That's the difference between direct and indirect costs when we consider the global burden of drug use disorder. There are multiple factors that influence drug use. On the model on the left, we can see the vicious cycle of limited education, limited employment, conflict, poverty, and drug use. This vicious cycle. Then the model on the right, we can consider the effects of COVID-19, that pandemic on drug use. We're learning that there's been an expanded drug cultivation and trafficking that's been coupled with protracted economic crisis, which may result in more drug use overall. You'll learn more about that as you read Booklet 5 of the UNODC that looks at this association between socioeconomic characteristics and drug use disorders, including the macro and community individual levels, with this focus on population subgroups that are impacted differently by drug use and drug use disorders. Definitely, there are unmet needs. The unmet global need for drug use prevention and treatment is astounding. Governments have repeatedly pledged to work together to address the many challenges posed by the world drug problem. As a part of these commitments to achieve the sustainable development goals, and most recently in the 2019 Ministerial Declaration adopted by the commission on narcotic drugs. But more must be done. Comprehensive, compassionate, and effective responses to drug addiction and drug use are needed from the government level, changes all the way to societal changes. Health-centered, rights-based, and gender responsive approaches to drug use and related diseases will produce better public health outcomes. Here are the references for this little mini-lecture. I hope that you enjoy the readings and continue to enjoy your lesson. Thank you.
