ADDICTION-A GLOBAL PROBLEM WITH NO GLOBAL SOLUTION

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 this week's issue, 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.