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Fleur Braddick, Peter Anderson and Antoni Gual, members of the research network, ALICE RAP, published an opinion article to explain why it is time to re-think addictions and why we need to redesign the governance of drugs in Europe and globally.

In 2010, the European Commission, realizing and the inadequacy of research in any single discipline  to the harm and suffering caused by addiction problems, published a call for a multi-disciplinary research project to examine and reframe scientific understanding of addictions and drug policy.

ALICE RAP – Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project – was the response to that call; and has resulted in a research network bringing together around 200 scientists from more than 25 countries and 30 different disciplines, ranging from anthropology to economics to toxicology. The 5-year project aimed to synthesize knowledge and strengthen scientific evidence on addictions from multiple different research vantage points.

It also had a longer-term goal, to stimulate and contribute to a broad and productive debate on current and alternative approaches to substance use and addictive behaviours, and to inform the public and political dialogue leading to more effective policies and greater well-being.

Legal drug use is doing more harm than illegal use

Illegal drug use might be responsible for a significant amount of harm, causing suffering, illness and loss of life; but legal drug use (alcohol and tobacco) is responsible for an even greater amount of harm. These harms could potentially be reduced or prevented; but, as numerous authors have noted, and the ALICE RAP scientists concur, existing governance structures, systems and policies relating to drugs are poorly designed and fragmented, and often cause more harm to public health than good.

Analysis of different governance systems across countries suggests that a more linked-up, comprehensive and pan-substance approach to tackling addictions, aimed at improving population well-being, could improve addiction governance. Checks and balances and other mechanisms to control the direct and indirect influence of powerful corporate stakeholders (such as alcohol producers and industry lobbying groups) will also need to be strengthened to reduce harm from addictive substances.     

Redesigning drug control policies

At the end of ALICE RAP, we proposed three cross-cutting messages to reframe addiction for effective policy:

1. Humans have a biological disposition to seek out and use drugs, rooted in an ancient evolutionary need to overcome adversity to plant toxins. For our ancestors, however, the consumption of these drugs was beneficial only in small quantities and at low frequency, and had a much lower level of exposure than we see in the modern world. This understanding has two implications for policy design.  Firstly, as we have a biological predisposition to seek out these chemicals it means that stark prohibition policies are likely to fail. Secondly, it is the potency of the chemicals that is the central issue determining harm on us as organisms, so policies should address this by enforcing or encouraging reductions in product potency, and their availability in our modern-day natural environments.
2. Data from basic science, epidemiology and clinical research all suggest that ‘heavy use over time’ should replace current dichotomous concepts of “addiction” or “substance use disorders” in policy discussions. This is because heavy use over time is responsible for the burden of disease and mortality, and the main social consequences caused by drug use (legal and illegal). Furthermore, a shift is needed in policy and public discussions, focusing on addiction as a continuous behaviour, rather than dichotomous, to reduce the stigma around these behaviours and hopefully encourage individuals to seek help, get treated early and to reduce barriers to harm.
3. The risk that drugs pose to humans can be quantified to include both potency and levels of exposure. We propose a standard measurement of this risk or quantitative risk analysis based on toxicological methodologies, should be used to guide policies aimed at improving public safety and reducing harm.

A Health Footprint

After ALICE RAP, we hope to see changes in how addictive behaviour (or heavy use over time) is conceptualised and considered for policy purposes.  Here the three messages and their implications are important to guide specific aspects of policy development, but we also propose two underlying pillars on which to base drug policy and regulation.

Firstly, we think that societal well-being (rather than GDP or narrowly defined medical parameters) should be the overarching frame by which drug policy and governance are analysed, planned and evaluated.  Especially considering the harmful impact policies can have when non-violent drug offenders are incarcerated with individuals marked as criminals and can lead to families being split up.

Secondly, we would like to see the development of an accountability tool to understand and attribute the harm imposed by the different factors or actors (political, structural, biological, cultural) which ‘drive’ addictive drug use and behaviours.

A starting point could be a health footprint, modelled on the commonly used carbon footprint. The Health Footprint accounts for who and what causes the harm done by drugs and addictive behaviours, and could become a standard component of annual reporting by relevant public and private sector bodies.

The challenges that lie ahead

The greatest challenges will come from organisations who profit from consumer sales and use of addictive products and/or the maladaptive policies that govern these products. The alcohol, tobacco and industrial prison industries are all doing remarkably well under current fragmented and non-scientific approaches to regulating drug use – no stains on one addictive industry are automatically applied to another, there is a steady and growing stream of individuals to be incarcerated and accountability for harms from addictive behaviour, but the blame is easily shifted to the shoulders of family disintegration, medical shortages or the individuals themselves.

In addition, focusing on one single substance at a time – as is the case in many public administrations – prevents public and policy makers from either learning from other areas or applying what they’ve learned to other areas relevant to public health. Sugar, for example, which is driving the obesity epidemic of the Western world, could also be a candidate for stricter policy and regulation in the name of public well-being; but first we need to see the tools developed to understand, measure and apportion responsibility for the harms linked with contemporary lifestyles and “addiction”.