Research Article: Toward a Global View of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys

Date Published: July 1, 2008

Publisher: Public Library of Science

Author(s): Louisa Degenhardt, Wai-Tat Chiu, Nancy Sampson, Ronald C Kessler, James C Anthony, Matthias Angermeyer, Ronny Bruffaerts, Giovanni de Girolamo, Oye Gureje, Yueqin Huang, Aimee Karam, Stanislav Kostyuchenko, Jean Pierre Lepine, Maria Elena Medina Mora, Yehuda Neumark, J. Hans Ormel, Alejandra Pinto-Meza, José Posada-Villa, Dan J Stein, Tadashi Takeshima, J. Elisabeth Wells, Phillipa Hay

Abstract: BackgroundAlcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization’s (WHO’s) World Mental Health (WMH) Survey Initiative.Methods and FindingsHousehold surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People’s Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex–cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male–female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use.ConclusionsGlobally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation.

Partial Text: Alcohol, tobacco, and illegal drug use are held responsible for considerable mortality and morbidity [1], but in the most recent World Health Organization (WHO) Global Burden of Disease estimates, the authors unanimously asserted that better epidemiological data on use were needed, particularly in less established market economies [2–4]. This paper presents data on lifetime alcohol, tobacco, cannabis, and cocaine use from rigorously conducted field surveys using a common research approach in the first 17 countries to participate in the WHO’s World Mental Health (WMH) Survey Initiative [5,6]. A number of less established market economies are included in this set of countries.

Globally, drug use is not distributed evenly. In general, the US had among the highest levels of use of all drugs. Much lower levels were observed in lower income countries in Africa and the Middle East, and lower levels of use were reported in the Asian locales covered.



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