Patricio V Marquez

“There the world began over again every day in an ever new light. O light! This is the cry of all the characters of ancient drama brought face to face with their fate. This last resort was ours, too, and I knew it now. In the middle of winter I at last discovered that there was in me an invincible summer.”

Albert Camus, ‘The Myth Of Sisyphus And Other Essays’ (1955)

For many of us who have experienced addiction to alcohol or other substances, either personally or through family members, remembering these events brings painful memories that negate all our achievements, values, and aspirations—leaving behind shattered dreams, damaged relationships, and deep feelings of guilt and frustration. The relentless temptation to have “just one more” drink or dose, despite countless promises of “never again,” becomes a source of overwhelming despair.

In some cultures, like the one where I grew up in, high tolerance of heavy alcohol use and binge drinking was not only accepted but expected of men and peer-reinforced, both as a rite of passage from adolescence to adulthood, and later in life as a sustained behavior.  Common expressions, such as “por qué te vas, si todavía estás bien” (“why are you leaving the party if you are still sober”), clearly portray these deep-rooted social norms.

However, it is essential to recognize that substance use disorders (SUD) are not merely personal failings or a cultural element—they are a serious social disease.  The social acceptance of heavy use can obscure the dangers of dependency, making it harder for individuals to seek help and for society to implement effective prevention and treatment measures. 

Understanding Substance Use Disorder

SUD is a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications.  The severity of SUD can vary, ranging from mild to severe, with symptoms including a strong craving for the substance, loss of control over its use, withdrawal symptoms, and an increasing tolerance. These symptoms often lead to significant social, occupational, and health-related issues, creating a vicious cycle that can be challenging to break.

One of the most pressing issues in addressing SUD is the gradual transition from casual use to dependency. This slow progression often makes it difficult for individuals and their loved ones to recognize the problem until it has caused substantial damage. As the disorder advances, the individual's life becomes increasingly centered around the substance, leading to a deterioration in overall quality of life.

The Health Consequences of Substance Use Disorders

The health consequences of SUD are extensive and severe. Tobacco addiction, a decades-old scourge, is one of the leading preventable risk factors for premature mortality worldwide, killing more than 8 million people a year, including users and non-smokers being exposed to second-hand smoke. 

According to the World Health Organization (WHO), alcohol abuse alone is a risk factor in more than 200 disease and injury conditions, including liver cirrhosis, certain types of cancer, and cardiovascular diseases. And it is associated with the development of mental and behavioral disorders, unintentional and intentional injuries, including traffic injuries, violence, and suicides. 

Illicit drug use is another significant component of SUD, with profound health and social consequences. Drugs like cocaine, methamphetamine, and cannabis can lead to severe physical and mental health issues, including addiction, psychosis, heart disease, and neurological damage. The illegal nature of these substances also contributes to criminal activities such as drug trafficking and violence, which destabilize communities and strain law enforcement resources

One of the most severe manifestations of SUD is the opioid addiction crisis.  Opioids, including prescription painkillers like oxycodone, cheap synthetic opioids like fentanyl, and illegal drugs like heroin, are highly addictive and have been responsible for a dramatic increase in overdose deaths over the past two decades.  In some countries, it has become a public health emergency.  As documented by Princeton University professor, Anne Case, and Nobel Laurate in Economics, August Deaton, in their 2020 book "Deaths of Despair", life expectancy gains in the United States have stagnated since 2010 and even declined for three consecutive years between 2014 and 2017, largely due to the opioid epidemic. This reversal marked a significant and troubling development in the nation's health trajectory.

The Economic Burden of Substance Use

The economic impact of substance abuse is staggering, primarily due to lost productivity, healthcare costs, and law enforcement expenses. A report by the U.S. Surgeon General, for example, indicates that the annual economic impact of substance misuse is estimated to be $249 billion for alcohol misuse and $193 billion for illicit drug use. These costs highlight the urgent need for more effective public health interventions and policies to reduce substance use and mitigate its harmful effects.

Effective Strategies to Combat Substance Use Disorders

We have to be clear, as highlighted in a recent article by Prof. Kirsten E. Smith from Johns Hopkins University School of Medicine, "Addicted people deserve help because they either need or want it, regardless of labels that presume to describe the etiology or likely trajectory of their problems”.

For individuals already struggling with SUD, access to treatment is crucial. Addressing SUD requires a multifaceted approach.  Treatment options include behavioral therapies, support groups, medication-assisted treatment, and harm reduction programs.  Also, as described in a recent Scientific American article, growing awareness of how addiction and trauma are intertwined, has led to a new generation of treatment strategies that simultaneously address both issues.

Public policies can play a crucial role in targeting the entire population across their life course, helping to prevent addiction from taking hold of unsuspecting individuals:

• The 2005 Framework Convention on Tobacco Control (FCTC), the first global treaty negotiated under the auspices of the WHO that has been ratified by 182 countries with more than 90 percent of the world population, offers a menu of effective demand and supply reduction measures. Key measures range from raising taxes on tobacco products to increase prices and reduce consumption and health risks while mobilizing additional tax revenue that enhances fiscal capacity of countries to fund  priority investments and programs that benefit all; regulations to protect people from exposure to tobacco smoke in public places; comprehensive bans on tobacco advertising, promotion, and sponsorship; to interventions for strengthening governance arrangements to deal with illicit tobacco trade across the supply chain.  Raising taxes on tobacco, in particular, can do more to reduce premature mortality than any other single health policy. 

• Taxing alcohol to increase the prices of alcoholic beverages can limit the harm caused by alcohol abuse, either by reducing or preventing increases in the overall average consumption per person, particularly among heavy drinkers.  Moreover, taxing to increase the price of alcohol products, along with strict enforcement of drink-drive laws, can help reduce the high human and economic cost of road traffic injuries, fatalities, and domestic violence.

• Restricting drug advertising; monitoring drug prescription practices; and limiting the availability of substances; have also proven effective in reducing substance use and its associated harms.

Workplaces can play a critical role in promoting health and well-being among employees. Given that a significant portion of an individual’s time is spent at work, employers have a unique opportunity to address SUD as part of their broader health and well-being initiatives.

Building a Healthier Future

National Recovery Month, observed in September, is an opportune time to deepen our understanding of addiction in its various forms, recognize their profound consequences, and explore ways to combat this pervasive health and social challenge.

SUDs are a complex and widespread issue that demands a coordinated response from individuals, communities, and governments. By understanding the nature of SUD, acknowledging its far-reaching consequences, and implementing effective strategies to combat it, we can reduce the burden of substance abuse and help individuals and families achieve healthier, more fulfilling lives.

Source of Images:

First Image: Photo taken by the author, Fall 2022. 

Second Image:  Photo taken by the author of painting by Yayoi Kusama, a Japanese contemporary artist, at exhibition of her work held at GUGGENHEIM BILBAO Museum, 2023.