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Reducing Real Disease Burden

Objectives. Outline the world drug situation.List the impact of drugs on society.Describe Disease Burden Concept and its relation to disease prevalence.List challenges and opportunities of drug response.Demonstrate an understanding of drug response investment.Provide alternatives on contributin

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Reducing Real Disease Burden

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    1. Reducing Real Disease Burden

    2. Objectives Outline the world drug situation. List the impact of drugs on society. Describe Disease Burden Concept and its relation to disease prevalence. List challenges and opportunities of drug response. Demonstrate an understanding of drug response investment. Provide alternatives on contributing to drug response. 2

    3. World Drug Situation Difficulty in defining accurate data Data is only available for illicit drug use. Problem is estimated to be 10% of actual size. 4.9% of global population have used drugs. 0.6-0.9% with substance abuse dependence. 3

    4. Regional & Local Situation Regionally Increasing and changing pattern of drug use (emerging ATS). Locally Problem magnitude is not yet defined due to the lack of structured local surveillance system. 4

    5. Opiate Ranking 5

    6. Disease Burden A global view on chronic illnesses 6

    7. A Global Epidemic of Chronic Disease Chronic diseases are the major causes of adult illness and death e.g. heart diseases. Many are related to lifestyle because behavior is a major contributor. It is estimated that out of the 64 M deaths projected for 2015, 41 M is due to chronic diseases, e.g.: - 11.5 M due to heart diseases. - 1.8 M due to alcohol. 7

    8. Alcohol: A global Disease Burden Drugs and alcohol contributed to 12.4% of global mortality rates. Alcohol is estimated to have a total cost of 0.6-2% of global GDP. Alcohol accounted to 4% of global DALYS and illicit drug use to 0.8% (WHO-2002). 8

    9. Drug and Alcohol Disease Burden Global and Regional 9

    10. Burden in Dollars Global economic burden of alcohol ranged from $210 billion to $665 billion in 2002: $40 to 105 billion for health. $55 to 210 billion for premature mortality. $30 to 65 billion for absenteeism. $15 to 50 billion for criminal damage. $30 to 85 billion for criminal justice system. 10

    11. Regional and Local Burden Limited structured surveillance data. Injecting drug use represents the 2nd prevailing mode of HIV transmission in the region. 400,000-900,000 injecting drug users (IDU) and 670,000 people living with HIV. 11

    12. Regional and Local Burden < 1% ( Vs. 4% globally) of DALYs due to alcohol (WHO 2002; Rehm et al 2003; Room et al 2002). 5.3% (Vs 12.4% globally) of total deaths can be attributable to alcohol use & 0.4% to the consumption of illicit drugs (WHO 2002). 12

    13. Disease Burden by Age 13

    14. Disease Burden and Cost of Illness Economic Cost and Social Cost 14

    15. Disease Burden 15

    16. Economic Cost Economic Cost can be viewed in the context of Opportunity Cost. i.e. money spent on drugs, alcohol, treatment of associated disorders now deferred to positive aspects. Economic Cost can be quantified using four categories: a) Health Care Costs. b) Productivity Costs . c) Property Cost. D) Incarceration &Crime Control related Costs. 16

    17. Social Costs Includes estimates that are not accounted for by economic costs. Additionally, social cost should account on the influence on human social interaction. Social cost can be estimated secondary to behavioral problems , psychological distress, child neglect, immediate partner violence, educational dysfunction, and above and beyond NON monetary estimations . 17

    18. Drug Economy A destructive economy 18

    19. Drug Economy Summary Driven by generation of income through engagement in drug related activities i.e. production, cultivation and trafficking. This income is spent on non productive domains that is not investment oriented. Drug use is inversely proportional with economic development. Decline in economic development even with drug producing countries. (ICNB/2002/1) 19

    20. What has been covered Global drug situation Global disease burden Problem Drug Economy Statement IS THERE A SOLUTION??! 20

    21. Barriers 21

    22. STIGMA 22

    23. Barriers to Treatment Seeking High level of social stigma. Fear of legal prosecution. Lack of Awareness of treatment services. Lack of Availability of treatment service. Lack of Accessibility to treatment. Lack of confidence in treatment effectiveness. 23

    24. Challenges & Opportunities When a challenge becomes an opportunity 24

    25. Challenges & Opportunities Absence of national drug strategy. Drug and crime nexus not understood. Increasing un-met demand for services. Growing population (high risk population). High affluent and metropolitan population. Regional transit zone. 25

    26. Opportunities Lowest reported alcohol DALYs world wide. Lack of structured local surveillance system. Visionary and responsive policy makers. Effective treatment and increasing body of research on addiction intervention and treatment. 26

    27. Investing in the Solution: Addiction Intervention and Drug Response 27

    28. There is increasingly strong evidence that substance abuse treatment probably does pay for itself. Studies have demonstrated that client populations have improved outcomes with respect to use of alcohol and drugs, criminal behavior and social functioning, and often have improvements in utilization of health care services and reductions in health costs. (The Lewin Group 2002) 28

    29. Lets not let this recession go to waste 29

    30. Addiction Treatment: A High Return Investment Different studies has provided results on dollar return on investment in treatment. Up to 23 USD return on investment for every dollar spent Dollar for dollar: Treatment of cocaine users is 10 times more effective at reducing drug abuse than drug interdiction schemes. 23 times more effective than trying to eradicate coca at its source. 30 Gerstein, Harwood, and Suter 1994; Finigan 1995; French et al. 2000; Koenig, Harwood, Sullivan, and Sen 2000b) 30

    31. Impact of Addiction Treatment Every dollar invested in drug treatment saves taxpayers $7.46 in social costs. Decline from 23% to 55% in health care costs among alcohol miss-users before and after treatment. 50% reduction in drug related crimes. (Millar et al 2008; Holder et Close 1992;Georson 2001). 31

    32. Moving Forward A practical outline 32

    33. Addiction and Population Health A comprehensive Action 33

    34. Taking Action - a detailed look What - Who - How 34

    35. Needs Assessment for Treatment Frame the size and pattern of substance abuse. Define the population (special population, hidden population). Outline co morbid diseases (medical and psychiatric). Design continuum of services. Develop Policies. 35

    36. National Rehabilitation Center: An Investment for the community at large Provides a comprehensive drug response Service provisions treatment & Rehabilitation. Demand reduction and prevention. Training and professional development. Advocacy and policy making. Resource center. 36

    37. How can you contribute? Advances in Science: Support in research execution and funding. Research to provide capacity in information age. Research to advance intervention, outcome and policy development. Advances in Practice: Translation of science to practice. Translation of science in to public policy. Aiming to target larger critical mass. 37

    38. Further Thoughts on Contribution Contribute to stigma alleviation: Support recovering patients (recovering job opportunities, volunteering etc). Participate in demand reduction activities. Contribute to public awareness mobilization. Provide recovery job opportunities. 38

    39. Thanks 39

    40. References Anderson, P. (2006). Global use of alcohol, drugs and tobacco. Drug and Alcohol Review, 25, 489502. Andlin-Sobocki P. (2004). Economic evidence in addiction: a review. Eur J Health Econ;5(S1):S5 12. Baumberg, B. (2006). The global economic burden of alcohol: a review and some suggestions. Drug and Alcohol Review, 25, 537-551. Bener, A. and Crundall, D. (2005). Road traffic accidents in the United Arab Emirates compared to Western countries. Advances in Transportation Studies an international Journal, Section A 6. Chisholm, D.; Doran, C., Shibuya, K. and Rehm, J. (2006). Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug and Alcohol Review, 25, 553-565. Collins D, Lapsley H. Estimating the economic costs of drug abuse in Australia. Canberra: Australian Government Printing Service, 1991. 40

    41. References continue Cruze, A.M., Harwood, J.J., Kristiansen, P.C. Collins, J.J. and Jones, D.C. (1981). Economic costs to Society of Alcohol and Drug Abuse and Mental Illness, 1977. Research Triangle, NC: Research Institute Degenhardt, L., Wai-Tat Chiu, W.-T., Sampson, N., Kessler, R.C., Anthony, J.C., Matthias Angermeyer, M., Bruffaerts, R. et al. (2008). Toward a Global View of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys. PLoS Med 5(7): e141.doi:10.1371/journal.pmed.0050141 Drake, R. E., Osher, F. C., Noordsy, D. L., Hurlbut, S. C., Teague, G. B. and Beaudett, M. S. (1990). "Diagnosis of alcohol use disorders in schizophrenia." Schizophrenia Bulletin 16, 57-67. 41

    42. References continue Garcia-Altes, A., Olle, J.M., Antonanzas, F. and Colom, J. (2002). The social cost of illegal drug consumption in Spain. Addiction, 97, 1145-1153. Harwood, J.J., Napolitano,D.M., Christensen, P.L. and Collings, J.J> (1984). Economic Costs to Society of Alcohol and Drug Abuse and Mental Ilness, 1990. Report to the Alcohol, Drug Abuse and Mental Illness Administration. Research Triangle Park, NC: Research Triangle Institute. Harwood H, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the United States 1992. Report prepared for the National Institute on Drug Abuse (NIDA) and the 42

    43. References Continue National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, Department of Health and Human Services. NIH publication no. 98-4327, Washington edn. Rockville, MD: National Institutes of Health, 1998. Healey, A., Knapp, M, Astin, J., Gossop, M., Marsden, J., Stewart, D., Lehmann, P. and Godfrey, C. (1998). Economic burden of drug dependency. British Journal of Psychiatry, 173, 160-165. Jarl J, Lyttkens C-H. The societal burden of alcohol misuse: literature review and cost of alcohol related hospitalisation in Skane, Sweden2003. Lund: Nationalekonomiska Institutionen, Ekonomiho gskolan vid, Lunds Universitet, Kandidatuppsats 10 poang, 2005. Millar, T. Jones, A. and Donmall, M. (2008). Changes in Offending Following Prescribing Treatment for Drug Misuse. National Treatment Agency for Substance Misuse. London: Department of Health. 43

    44. References ONDCP, The Economic Costs of Drug Abuse 1992-1998 (2001), and The Economic Costs of Drug Abuse 1992-2002 (2002), prepared for the ONDCP by The Lewin Group. Rajendram, R., Lewison, G. and Preedy, V.R. (2006). Worldwide Alcohol-related research and the disease burden. Alcohol & Alcoholism, 41, 99106. Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos C.T. (2003). The relationship of average volume of alcohol consumption and patterns of drinking to burden of diseasean overview. Addiction, 98, 1209 1228. Rehm, J., Taylor, B. and Room R. (2006). Global burden of disease from alcohol, illicit drugs and tobacco. Drug and Alcohol Review, 25, 503 513 44

    45. References continue Rice DP, Kelman S, Miller LS, Dunmeyer S. The economic cost of alcohol and drug abuse and mental illness 1985. Report submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration. DHHS Publication no. (ADM) 90-1694. San Francisco: Institute for Health and Aging, University of California, 1990. Robson L, Single E. Literature review of studies on the economic costs of substance abuse. Ottowa: Canadian Centre for Substance Abuse, 1995. Rufener, B.L., Rachal, J.V. and Cruze, A.M. (1977). Management Effectiveness Measures for NIDA Drug Abuse Treatment Programmes: Vol. II. Costs to Society of Drug Abuse. DHEW publication no. (ADM) 77-424. Rockville, MD: National Institute on Drug Abuse. 45

    46. References continue Single, E., Collins, D., Easton, E., Harwood, H., Lapsley, H., Kopp, P. and Wilson, E. (2001). International Guidelines for Estimating the Costs of Substance Abuse2nd Edition. Trathen, B., O'Gara, C., Sarkhel, A., Sessay, M., Rao, H. and Luty, J. (2007). "Co-morbidity and cannabis use in a mental health trust in South East England." Addictive Behaviors 32: 2164-2177. World Health Organisation. World health report 2002: reducing risks, promoting healthy life. Geneva: World Health Organisation, 2002. 46

    47. References continue Weaver, T., Hickman, M., Rutter, D., Ward, J., Stimson, G. and Renton, A. (2001). "The prevalence and management of co-morbid substance misuse and mental illness: results of a screening survey in substance misuse and mental health treatment populations." Drug and Alcohol Review 20, 407-416. Ustun, T.B. et al. The World Health Surveys. In: Murray, C.J.L., Evans, D.B. eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organisation, 2003. 47

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