For a Comprehensive Public Health Approach to the Addiction Problem

On the occasion of the World Health Day, the Director General of Dianova International points out that it is critical to bridge the differences between medical and psychosocial approaches to build a comprehensive public health approach to substance abuse

Editorial, by Montse Rafel – The annual session of the United Nations Commission on Narcotic Drugs (CND) drew attention in particular to the need to implement comprehensive, public health approaches to drugs that take account  of the consequences and harms that may arise from certain drug policies which only criminalize the drug users.

If we really want to promote a comprehensive approach to the addiction issue, one should start by replacing the word "drugs" with "addictive behaviors" or "addictions". Illicit substances are far from being the only ones to pose a problem.  In fact, addiction professionals are quite unanimous about this: whatever their object (gambling, alcohol, drugs, etc.), all addictive behaviors may have serious health and social consequences, for those concerned and the people around them (isolation, job insecurity, disaffiliation, suicides, etc.).

These consequences alone challenge us to implement comprehensive addiction policies through proportionate and coherent strategies which take into account the applicable thresholds to designate specific behaviors as risky, then harmful and eventually, addictive. Difficult task indeed.     

Another pitfall one should carefully avoid: that of labeling these behaviors as pathological. Although neurobiological researches have remarkably advanced our understanding of the phenomenon, they have also led to a certain medicalization of the addiction issue, through a process much closer to politics than science.

Without entering into de debate on the details, we would like to remind that medicalizing  addiction implies to consider individual, explanatory factors at considerable detriment of contextual factors, and therefore at the expense of the understanding people may have of their own deeds and of their underlying causes. However, these aspects are precisely those we must fully integrate, should  genuine, comprehensive addiction approaches be implemented.

Our culture and the societies we live in are truly addictogenic. Each individual possess a remarkable autonomy while being constantly under utmost pressure. Modern societies' values are extremely demanding: one must take control of one's life, have a successful professional life, succeed in his or her marriage, ensure their children have the best start in life. In addition one must have fun, be handsome and most of all, happy!

When urged to perform in each and every area of their life, some people may find in addiction behaviors auxiliaries that are remarkably efficient in both replacing this urge for performance or managing the stress it generates. Finally, if we want to avoid the chains of addiction, or to break free from these chains, it is critical to have or gain some self-control, a sense of responsibility, an ability to make one's own choices, all of which are inconsistent with a purely medical approach.

In conclusion, we would like to call for a truly holistic approach to addiction treatment and prevention, that is to say capable of combining the undeniable advances of the biomedical approach with the psychosocial, contextual or cultural dimensions of the addiction issue. Only then shall we be able to understand what is the nature of the addiction phenomenon, to treat it and deal with it accordingly and as effectively and efficiently as possible.