Alcohol and drug abuse. Prevention and control of public health hazards

ENGLISH :
Abuse and dependence on alcohol and other drugs is a particularly complex public health problem. The complexity of alcohol and other drug abuse is a function of its diverse nature. Dependence disorders involve biomedical, pharmacological, psychological, and social factors. Substance abuse often involves multiple pharmacological agents used within a complex social environment in which some substances are legal and others illegal. Furthermore, the distinctions among use, abuse, and dependence are often blurred. The consequences of alcohol and other drug abuse are many and varied. Some are acute and put an individual at immediate risk, such as driving while intoxicated. Use of addictive substances such as alcohol by biologically vulnerable individuals may result in long-term consequences such as chronic alcoholism and cirrhosis of the liver. Sharing of injection equipment by intravenous drug users immediately increases their risk of exposure to the human immunodeficiency virus (HIV) and, once exposed, their life-styles compromise health and may lead to accelerated development of acquired immunodeficiency syndrome (AIDS). Thus simple definitions, explanations, or solutions for substance abuse are inadequate, inefficient, and potentially counterproductive. The examination of the appropriate match between individuals and the major interventions of diagnosis, prevention, and treatment has only recently begun. This chapter indicates some of the broad concepts necessary to understand substance abuse and dependence disorders, their consequences, and potential solutions. The focus in the first section of the chapter is dependence on alcohol and other drugs. Whilst recognizing that problems of alcohol and drug abuse occur worldwide and across diverse cultures (Babor 1986), this discussion is limited by both space and data to the United States where the problem is most profound. The history and current conditions in the United States illustrate many of the issues that exist or can be expected to emerge in many countries in the future. The abuse of alcohol (Aaron and Musto 1981) and other drugs (Brecher et al. 1972) has persisted for centuries. Since 1900, attention to alcohol and other drug abuse has waxed and waned in the United States (Jaffe 1979). Some of the foremost reasons for renewed attention on alcohol and drug abuse in the 1980s and the 1900s are the increasing costs for treatment for dependence, the violent crime associated with cocaine distribution, and the role of intravenous drug use in the transmission of HIV. Intravenous drug use is now the second most common risk behaviour associated with AIDS. It is also the major contributing factor to pediatric and heterosexual AIDS cases in the United States (Turner et al. 1989). (Extract of the publication)