The meaning of substance use and need for prevention

The conference started by underlining the need for preventive measures of substance use. Several arguments underscored the health benefits and cost effectiveness of substance use prevention. The second speech presented an overview of the diverse and complex meanings behind psychoactive substance use.

Given their intoxicating and dependence-producing properties, psychoactive substances are no ordinary commodity. Vladimir Poznyak, Head of the unit on Alcohol, Drugs and Addictive Behaviours at the World Health Organisation (WHO), says the high prevalence of substance use places a significant burden on society. He presents a number of arguments in favour of substance use prevention.

– Harms of substance use are both extensive and significant. They are also largely preventable. Substance use – which covers the use of alcohol, tobacco, or drugs – is the most serious risk factor to population health. Removing or diminishing such use would lead to significant health gains.

Vladimir Poznyak argues that while many psychoactive substances may lead to the development of cancer or other diseases, the main burden is their intoxicating or dependence-producing effect or a combination of both. This leads to unique problems.

– This is why psychoactive substances are no ordinary commodities. They cannot be compared to asbestos or red meat or other environmental factors which have an impact on health but do not produce dependence or intoxication.

There are many different pathways to substance use-related harm, which calls for different prevention approaches on a political level.

– It is not only individual users that bring harm to society. Societal responses themselves can lead to significant costs.

”It is not only individual users that bring harm to society. Societal responses themselves can lead to significant costs.”

A society can choose to intervene in different ways, from liberalisation to prohibition. Vladimir Poznyak describes this as a pendulum. If substances are easily available and promoted by society, social and health-related harms will increase. The same is true if there is rigid prohibition, in which case the illegal market will fill the need. Strict legal regulation is the sweet spot in the middle where harms can be kept at a minimum.

Another argument in favour of alcohol and tobacco prevention is the cost effectiveness of intervention programmes. Vladimir Poznyak cites WHO estimates, which show that the investment in prevention will in many cases yield tenfold returns for society within a time span of ten years.

Why do we drink alcohol or do drugs, even though we know it is bad for us? Associate professor Øystein Skjælaaen at VID Specialized University in Norway recalls the long history of substance use.

– People at all times, everywhere, have used drugs, and will continue to do so. We do it because there must be something to gain from it. It gives us enjoyment or pain relief, as well as feelings of love, friendship, freedom, and community.

Skjælaaen argues that various forms of intoxication are common human experiences. The meaning of substance use lies not within the intoxication itself, but in the memories created in an intoxicated state.

– The meanings we ascribe to substance use are based on an interaction between the drug, the person who uses it, and the context or setting. And the meanings we ascribe to our own substance use do not at all have to correspond with the meanings that others ascribe to them.

”The meanings we ascribe to substance use are based on an interaction between the drug, the person who uses it, and the context or setting.”

Meanings are shaped within a culture. In Norway, it is seen as normal to open a bottle of champagne on one’s birthday, but not on the streets on the morning of an ordinary day. The meanings may also vary greatly between different groups within a society. Skjælaaen gives a striking example of older people who might sneer at youngsters’ drinking trips in the sun but forget that their own wine-tasting vacation tour was equally centred around alcohol.

Cannabis is the most popular illegal drug in Norway, and its illegal status gives it a different cultural meaning, Skjælaaen argues. Users may bond around the fact that it is illegal and condemned by society at large.

– Substance use and intoxication are complex phenomena with a deeper meaning. Conversations about this phenomenon should take this into account, and the discussions should be true and honest. If there is a huge gap between what young people experience and the message they get from the adult world, why should they believe anything at all?