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1. INTRODUCTION

Table 1.4 Percentage of total global mortality and DALYs attributable to
tobacco, alcohol and illicit drugs, 2000

Risk factor High mortality Low mortality Developed Worldwide
developing countries developing countries countries
Males Females Males Females Males Females
Mortality
Tobacco 7.5 1.5 12.2 2.9 26.3 9.3 8.8
Alcohol 2.6 0.6 8.5 1.6 8.0 –0.3 3.2
Illicit drugs 0.5 0.1 0.6 0.1 0.6 0.3 0.4
DALYs
Tobacco 3.4 0.6 6.2 1.3 17.1 6.2 4.1
Alcohol 2.6 0.5 9.8 2.0 14.0 3.3 4.0
Illicit drugs 0.8 0.2 1.2 0.3 2.3 1.2 0.8
Source: WHO, 2002.

Table 1.4 offers ample evidence that the burden of ill-health from use of
psychoactive substances, taken together, is substantial: 8.9% in terms of
DALYs. However, GBD findings re-emphasize that the main global health
burden is due to licit rather than illicit substances.
The primary emphasis in this report, however, is not on the harmful
consequences which can result from substance use (except as they occur in
the body’s nervous system) and neither is it primarily on the toxic qualities of
the substances. Rather the emphasis is on patterns of substance use, and on
the mechanisms of psychoactivity and of dependence (as indicated in Fig. 1.2).
Since dependence refers to mechanisms by which use is sustained over time –
thereby multiplying the probabilities of harmful consequences of use – special
attention is given in this report to the neuroscience of dependence.

References
American Psychiatric Association (1994) Diagnostic and statistical manual of
mental disorders, 4th ed. (DSM-IV). Washington, DC, American Psychiatric
Association.

Babor T et al. (forthcoming) No ordinary commodity: alcohol and public policy.
Oxford, Oxford University Press.
Corrao MA et al., eds. (2000) Tobacco control: country profiles. Atlanta, GA, The
American Cancer Society.

Degenhardt L et al. (2002) Comparative risk assessment: illicit drug use. Geneva,
World Health Organization, unpublished manuscript.
Drummond DC et al. (2000) Craving research: future directions. Addiction,
95(Suppl. 2):S247–S258.

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