Management of substance abuse

The global burden

Psychoactive substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. The extent of worldwide psychoactive substance use is estimated at 2 billion alcohol users, 1.3 billion smokers and 185 million drug users.

World extent of psychoactive substance use

Disability Adjusted Life Years (DALY) are calculated by adding the years of life lost due to premature mortality and the years of life lost due to living with disability. The years of life lost due to disability are determined from morbidity, where each disease has been given a certain disability weight, which is multiplied with the time spent with that disease, to arrive at the years of life lost due to disability.

In an initial estimate of factors responsible for the global burden of disease, tobacco, alcohol and illicit drugs contributed together 12.4% of all deaths worldwide in the year 2000. Looking at the percentage of total years of life lost due to these substances, it has been estimated that they account for 8.9%.

The global burden of these three psychoactive substance categories varies across the WHO Regions. The disease burden in Disability Adjusted Life Years (DALYs) is significantly higher in Europe and the Western Pacific than in Africa and the Eastern Mediterranean. Also the share of the burden for the different substances varies, tobacco is the largest burden in Europe and South-East Asia while alcohol poses the largest burden in Africa, the Americas, and Western Pacific.

WHO Regions disease burden in 2000 attributable to selected risk factors

The level of economic development in countries also plays an important role. The burden from psychoactive substance use is higher in the developed countries than especially in the high mortality developing countries. The sex ratio for the attributable deaths of psychoactive substance use varies from 80% male for tobacco and illicit drug use and 90% for alcohol. With regard to DALYs it is between 77 and 85% for all substances. The largest proportion of DALYs is on males in the developed countries, where psychoactive substance use accounts for 33.4% of all DALYs.

One of the differences between these three categories of psychoactive substances is the fact that they inflict their disease burden on different age groups. Illicit drug use inflicts its mortality burden earliest in life, alcohol also mainly (65%) before the age of 60, while 70% of the tobacco deaths occur after the age of 60. For more data on the global burden of psychoactive substance use and other risk factors please see the homepage of the World Health Report 2002.

WHO seeks to promote the concept of Health for All through its strategy of reducing the incidence and prevalence of psychoactive substance use and to provide the best available evidence on management of substance related problems. The achievement of this goal is designed to lead to reductions in the demand for psychoactive substances and to reduce the health and social problems associated with such use.

Additional information regarding psychoactive substances can also be found in the following links:

Proportion of DALYs in 2000 attributable to selected risk factors, by sex