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8. CONCLUSION AND IMPLICATIONS FOR HEALTH POLICY

responsibilities has been to expand the scope of the Expert Committee, at
least in some years (WHO, 1993), in order to cover the whole range of
psychoactive substances and to consider a broader public health approach.
However, reaching an expert judgement and building a global response
concerning these matters will require other resources and expertise alongside
the existing mechanism of the WHO Expert Committee.

Implications for public health policy
A substantial portion of the global burden of disease and disability is
attributable to psychoactive substance use. In turn, a substantial portion of
the burden attributable to substance use is associated with dependence.
Tobacco and alcohol use are particularly prominent contributors to the total
burden. Measures to reduce the harm from tobacco, alcohol and other
psychoactive substances are thus an important part of health policy.
Neuroscience is a fast growing field of scientific research. Though the
knowledge base is far from complete, there is a considerable amount of useful
data with enormous potential for influencing policies to reduce the burden
of disease and disability associated with substance use. The following
recommendations are made to facilitate greater openness and assist all
stakeholders in mobilizing action:
• All psychoactive substances can be harmful to health, depending on
how they are taken, in which amounts and how frequently. The harm
differs between substances and the public health response to substance
use should be proportional to the health-related harm that they cause.
• Use of psychoactive substances is to be expected because of their
pleasurable effects as well as peer pressure and the social context of
their use. Experimentation does not necessarily lead to dependence
but the greater the frequency and amount of substance used, the higher
the risk of becoming dependent.

• Harm to society is not only caused by individuals with substance
dependence. Significant harm also comes from non-dependent
individuals, stemming from acute intoxication and overdose, and from
the form of administration (e.g. through unsafe injections). There are,
however, effective public health policies and programmes which can
be implemented and which will lead to a significant reduction in the
overall burden related to substance use.
• Substance dependence is a complex disorder with biological
mechanisms affecting the brain and its capacity to control substance
use. It is not only determined by biological and genetic factors, but
psychological, social, cultural and environmental factors as well.
Currently, there are no means of identifying those who will become
dependent, either before or after they start using drugs.

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