Addiction, addiction treatment, and substance use policy have been topics of hot debate in recent years, and for good reason. An estimated 275 million individuals between ages 15 and 64 worldwide used drugs in 2019, of which 36.6 million suffered from drug use disorders. Given global population growth, these numbers are projected to rise enormously. With this global surge of addiction behaviour and resulting disabilities, many researchers have begun investigating the various biological factors that contribute to the development of these disorders. However, it was not until more recently that science started exploring the impact of socioeconomic, political, and cultural characteristics that may also be at play. Several new studies, including one published in May 2022, have done precisely this, identifying a few critical global indices that correlate to higher rates of disability due to substance use and addiction. These findings underscore the importance of a bigger-picture “healthicization” approach to addiction, urging policymakers to consider these global correlates to better target the factors exacerbating the issue and close the global health gap.
Many of us are already somewhat cognizant that lower socioeconomic groups are at greater risk of consuming and becoming addicted to substances. However, we know and have done surprisingly little in the way of targeting and resolving the issue. The study published by Walker et al. in May of 2022 initiates this process by investigating the relationships of 38 economic, political, and cultural characteristics with how many years individuals aged 15-49 lived with a disability (YLD) due to substance addiction in 78 countries. By looking at national indices of the considered variables, the study ultimately found 13 factors to be significantly correlated with YLD, including political stability; control of corruption; economic freedom; voice and accountability; Human Development Index; women’s economic opportunity; individuality; long-term orientation; masculinity; indulgence; personal contact; uncertainty avoidance; and religious diversity. Walker et. al identified several more specific trends. Among these, tobacco addiction was found to be influenced by governance and economic factors but only in females and not in males. This suggests that increased gender equality can improve outcomes for addiction in females. It was also found that more supportive and empathetic societies, identified by ranking as less patriarchal and distant, were associated with less disability due to addiction. Overall, it was found that the “indulgence” factor was not related to tobacco or food addiction, despite the popular notion that addiction is due to over-indulgence.
A central idea discussed in the paper as a potential solution is the “healthicization” of addiction, which contrasts with “medicalization” and the emphasis on pharmaceutical treatments. Healthicization focuses more so on how country-level characteristics and societal behaviour shape individual behaviour and the “forced choices” available to individuals. This idea proposes a shift in our approach to addiction, from viewing it less as an individual’s choice and more as the environment and various external factors that create the opportunity for addiction to occur. However, this argument has a crucial nuance; a healthicization perspective does not mean neglecting the biological foundations and pharmaceutical treatments of addiction. A medical viewpoint is essential to effective treatment and plays a critical role in the development of addiction and its outcomes. The paper calls attention to the less-considered influences within our capacity to change for the better.
Still, there are several limitations to the findings of the paper:
- The research only undertakes substance addiction, specifically to tobacco, alcohol, drugs, and food. Hence, the findings may not apply to behavioural addiction, an area that is becoming increasingly relevant concerning video games and other technology addictions.
- The authors do not clarify what specific drugs are included in the “drug” addiction category. For example, tobacco and alcohol could be considered drugs, but they are separated from this broader category, a choice that is not explained nor justified. In essence, we do not know the extent of substances to which the correlations with this category apply.
- The primary indicator used by researchers to measure food addiction is BMI, which is, as you may recognize, not a reliable way to define food addiction. There are many reasons why an individual would have an elevated BMI unrelated to addiction.
A final confounding factor is that many of these variables are profoundly intertwined, and we are simply looking at correlations. Therefore, we can not make conclusions about any specific social, political, economic, or cultural causes of addiction and addiction disability.
Although the results of the study do not point to any specific factors to target, the key idea is that these national indices have a significant, albeit complex, influence on addiction outcomes and disability. Hence, when policymakers implement education and treatment programs and evaluate existing policies, they must adopt a holistic view of the issue and examine the specific variables relevant to that nation. For example, abstinence-based rehab and 12-step programs have become a staple of treatment as opposed to harm reduction approaches. The existing policies in many regions do not accommodate this, advocating abstinence instead. The data clearly shows that addiction is not a moral failure, and viewing it as a tendency to indulge is not always accurate. Thus, when other factors, such as personal connection and political stability, are at play, the existing solution of abstinence is unreasonable and ineffective. Similarly, using policy to decrease one variable will not always resolve the problem. Decreasing personal contact, for example, could increase levels of depression and aggravate the problem. The identified global indices are profoundly interconnected and interact in complex ways, and it is paramount not to oversimplify these relationships.
Addiction is a tragedy that takes thousands of lives a year and irrevocably impacts millions more. Research is being done to identify the aspects we can target to alleviate the issue. Still, it is paramount that policymakers consider this information. Factors including political stability, hyper-masculinity, personal contact, and religious diversity, among several others, correlate to addiction disability outcomes. The application of this data is even more compelling when one considers the case of future global events or crises similar to the pandemic that may cause spikes in stress and, therefore, addiction. Likewise, global population growth will likely result in a massive increase in the number of people affected by drug use and disorders. This increase will amplify these effects in lower-income nations. Policy-makers must recognize that addiction and drug use outcomes are not siloed. Along with considerations of a nation’s specific social, political, economic, and cultural characteristics, policy-makers must acknowledge how sophisticated and complex these influences are if there is to be any hope of closing the global health gap.
Edited by Ruqayya Farrah
Setareh Setayesh is a second year student at McGill University, currently pursuing a B. Sc degree in Psychology. She joined Catalyst as a staff writer this year and is particularly interested in social epidemiology and the interaction between culture and politics in relation to human rights and development.