The 'high' cost of substance abuse

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To celebrate Research Week 2018, UQ is proud to share how UQ research is creating change, right across the world, every day.

Discover how our researchers are collaborating with research partners both in Australia and abroad to tackle substance abuse head-on.

University of Queensland (UQ) researchers have long been interested in the topic of substance abuse, whether alcohol, tobacco, narcotics or prescription drugs, and have been researching the subject from a variety of perspectives.

Working as advisers to national and international policymakers, their work is of vital importance at a time when, according to the UN Office of Drugs and Crime, at least 190,000 mostly avoidable drug-related deaths occur globally each year, along with millions of new cases of associated diseases such as HIV, hepatitis and tuberculosis.

It's ironic, but using substances to improve our mood can often leave us – and society in general – infinitely worse off. The chemical reactions produced by our bodies when using licit and illicit substances in order to get ‘high’ can spiral out of control, creating even more problems: psychosis, mental illness and addictive behaviours, to name just a few.

Of concern to the wider community from these individual behaviours are the higher costs to business from employee disability and reduced productivity, and increased health costs from higher patient patronage.

In 2015, around five per cent of the global adult population used drugs at least once and about 29.5 million of those drug users, or 0.6 per cent of the global adult population, suffered from drug use disorders. The net result was an estimated 28 million years of ‘healthy’ life (disability-adjusted life years) lost worldwide.

And, with UQ research input, the World Health Organization reports that mental and substance use disorders are the leading cause of disability globally, suggesting that governments worldwide need to change their health planning priorities.

As one of our researchers says, it’s an endless battle against drugs. But through dedicated research and by giving governments and other health policymakers the best possible advice, there is hope for the future.

Gathering the data

With the help of funding from the Bill & Melinda Gates Foundation, Professor Harvey Whiteford from UQ’s School of Public Health is contributing data to the Global Burden of Disease project, which measures the actual costs of ill-health for the economy, society and individuals – for different conditions in different countries.

Collaborating with scores of researchers, clinicians, epidemiologists, economists and statisticians from every continent in the world, Professor Whiteford – who also works as an adviser to the World Bank, World Health Organization and the Australian government – is responsible for modelling the data for all mental and substance use disorders for the world’s 196 countries.

Which is how he is aware of the great toll mental health and substance abuse disorders take on society.

“By using a single metric for all medical conditions, we can count the years of life lost through premature mortality and the years lived with disability,” says Professor Whiteford.

“Mental illness is documented to cost countless billions of dollars across the globe, but even then, not all costs are evident. Our primary goal is to get the burden down.”
Professor Harvey Whiteford

And it seems that prevention is better than cure.

“We need to spend more effort in childhood than waiting until the problem becomes diagnosable in later years and trying to intervene then.”

Professor Whiteford and his team also receive funding from the National Health and Medical Research Council and Queensland Health for their work.

Read more about Professor Whiteford's research on UQ Research Impact.

Drug and alcohol use in young people

Working with colleagues Professor Jason Connor and Sarah Yeates, Professor Wayne Hall, founder of the Centre for Youth Substance Abuse Research (CYSAR) within UQ’s Faculty of Health and Behavioural Sciences, has spent many years exploring how and why young people ‘escape reality’ through drugs and alcohol.

His research has spawned countless books and papers, and has been used to provide advice to the World Health Organization and other major policymakers such as the UN Office of Drugs and Crime, European Monitoring Centre for Drugs and Drug Addiction, and Australian state and federal governments.

Professor Hall’s specific expertise is in the costs to, and impact on, public health from tobacco, drug and alcohol addiction. He is also interested in public health ethics, the cost burden of drugs, the value of addiction interventions, and genetic and neuroscience research.

Through his work with CYSAR, he aims to promote the health and wellbeing of young people by increasing our capacity to respond effectively to the harm associated with alcohol, tobacco and other drug misuse. He also hopes that by discovering new and innovative ways of preventing and treating substance misuse, we can provide better health outcomes for all.

Read more about how UQ research is helping to prevent and treat substance misuse in young people on the CYSAR website.

The case against neurobiology of addiction

Professor Hall and Sarah Yeates are also researching the neurobiology – or brain disease model – of addiction. Their interest began following the 1997 US National Institute on Drug Abuse’s assertion that drug addiction is a chronic, relapsing brain disease, where drugs flick a neurochemical switch in the brain, making it very difficult for those affected to stop using them. The theory helped explain the high relapse rate of those treated for addiction, boosted support for medical treatment, and had a major impact on all addiction-related research funding thereafter – but has had only modest success in actually reducing drug addiction.

Hall and Yeates believe that the neurobiology of addiction is part of the answer, but not all.

“Addiction is a complex biological, psychological and social disorder that needs to be addressed by various clinical and public health approaches,” Professor Hall says.

“Economic, epidemiological and social scientific evidence shows that the neurobiology of addiction should not be the overriding factor when formulating policies toward drug use and addiction.”
Professor Wayne Hall

He points to anti-smoking campaigns in Australia as an example, where the combination of advertising, higher priced cigarettes and plain packaging to reduce the ‘glamour effect’ have been highly successful in reducing the number of smokers.

Professor Hall concedes that the problem is difficult, that people have different levels of addiction, and that drug use can impair cognitive function and motivational processes – which make finding solutions even harder. But his findings are being passed on to public health policymakers around the world, and he is confident that improvements can occur.

Read more about Professor Hall's research on the brain disease model of addiction in the Lancet.

Helping prevent alcohol-related violence 

Advising policymakers about the best way to manage state liquor licensing laws to quell violence has been the driving force for several UQ researchers, and their preliminary recommendations have already created change on the streets.

The Queensland Alcohol-related violence and Night Time Economy Monitoring (QUANTEM) project, co-led by biostatistician Associate Professor Jason Ferris from UQ’s Centre for Health Services Research, is evaluating the impacts of the Queensland Government’s 2016 Tackling alcohol-fuelled violence policy across the state. His team of more than 20 social scientists, psychologists, counsellors and epidemiologists from universities across the country have been measuring the change in levels of harm should lock-out laws and 5am alcohol serving cut-offs be introduced in Queensland.

So far, their data analysis has led to the Queensland Government halving the number of extended trading hour permits issued and deciding not to introduce 1am lockout laws as originally planned in February 2017.

The team has used a number of innovative data sources – police, ambulance and court records; foot traffic volume; banning notices and data from ID scanners; data from the music industry (APRA AMCOS); and people’s drinking and drug habits – to evaluate behaviours that affect businesses and live music, as well as the general community.

The final outcome of QUANTEM’s work will have a major impact on how police, policymakers and venue staff enforce behaviour in an effort to reduce alcohol-fuelled violence in Queensland, and possibly the rest of Australia too.

Read more about the QUANTEM project's findings on The Conversation.

The long-term view

For more than 30 years, esteemed UQ researcher Emeritus Professor Jake Najman from UQ’s School of Public Health has been following the mental and physical wellbeing of thousands of mothers and their children through the Mater–University of Queensland Study of Pregnancy. His observations of licit and illicit drug usage across the generations have helped inform his work in his other roles as director of the UQ-based Queensland Alcohol and Drug Research and Education Centre and chair of the Queensland Coalition for Action on Alcohol, where he provides advice to governments and health authorities, as well as the general public.

“It’s an endless battle against drugs,” he says, “but they are here to stay. In 2015 alone, a total of 75 new synthetic drugs came on the market.”

A message of educated moderation is his mantra to drug and alcohol use, as opposed to politicking for stringent abstinence across the board. And, although being fully aware that as many as 4500 people die each year as a consequence of drinking alcohol, Emeritus Professor Najman says it is pointless to call for a blanket ban on the ‘demon drink’.

“What we should be more concerned about is the rise of prescribed opiates, and the rejuvenation of methamphetamine usage.

“Governments need to change their policies.”
Emeritus Professor Jake Najman

All images credited to: Getty Images/Benjavisa

Read more about Emeritus Professor Najman's research on UQ Research Impact.

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