SAFE GC Coalition: Social Determinants of Addiction Need to be Examined

According to the director of the National Institute on Drug Abuse (NIDA), the biomedical sciences are placing increasing emphasis on social determinants of health, which the World Health Organization (WHO) defines as “the conditions in which people are born, grow, work, live and parent the systems put in place to deal with illness, and the broader set of forces and systems that shape the conditions of everyday life.” Very often, commercial interests are intertwined with these social and environmental factors, leading to the recognition by WHO and other agencies of the need to study and address commercial health determinants. Commercial interests are an important part of the social determinants of addictive behavior and disorders.

Three of the four largest industrial contributors to global morbidity and mortality are alcohol, tobacco and ultra-processed foods (the fourth is fossil fuels). The CDC estimates that more than 178,000 people die each year in the United States from diseases related to excessive alcohol use, and more than 480,000 people die each year from causes related to tobacco use. According to the Center for Science in the Public Interest, approximately 678,000 people die each year from diet- and obesity-related diseases (including cancer, cardiovascular disease and type 2 diabetes) caused by unhealthy diets.

What these disease-causing foods (including the highly refined foods that contribute to obesity) have in common is that they activate the brain’s reward system in ways that are highly reinforcing. The success of these industries is maximized because their products can induce compulsive consumption, including consumption that leads to addiction. Because of reward’s well-understood role in motivating our behavior, existing industries are pushing new products to activate the brain’s reward system, and new industrial sectors are emerging to take advantage of our biological tendency to engage in seeking behavior to reward.

Progress has been made in reducing smoking in the United States, leading to major health improvements, but the rapidly growing vaping industry could jeopardize this if not properly regulated. The explosion in popularity of vaping in recent years has led to a sharp increase in nicotine exposure, especially among teens and young adults, who are most vulnerable to nicotine addiction. Although recognized as less harmful than combustible tobacco products, nicotine vaping is nevertheless associated with adverse health effects, including increasing risk of smoking initiation and dependence, and pulmonary and vascular dysfunction.

The cannabis industry has provided new opportunities for commercial interests to drive drug consumption among all ages and demographics. Cannabis products are often sold in colorful packaging that mimics child-friendly snacks, for example, making them attractive to children and young people. Adolescents exposed to cannabis marketing are more likely to use the drug. The legalization of cannabis by states and the diversification of cannabis products have led to a significant increase in the number of users and the amount of cannabis they consume in the US.

Commercial determinants also play a complex role in the overdose crisis that currently claims 108,000 lives annually. First, it is well known how, beginning in the late 1990s, some pharmaceutical companies were directly responsible for aggressively marketing powerful opioid analgesics known to cause addiction. As access to legal opioids became more limited, illicit drug markets, including drug cartels with sophisticated business models, stepped in to efficiently supply highly purified forms of heroin and then, more recently, more potent opioid drugs such as fentanyl.

The technology sector has also emerged as a contributor to addiction and addictive behavior. Not only are legal and illegal drugs marketed on social media, but numerous studies have linked social media use among adolescents to risky behaviors, including substance use.

NIDA researchers suggest that actual and potential harm can be reduced by implementing policy interventions similar to those successfully applied to tobacco and alcohol. For example, smoke-free workplace laws and restrictions on tobacco advertising have been effective in reducing smoking and its health consequences. More than 100 studies have shown that higher taxes on cigarettes significantly reduce smoking, especially among young people and people with lower incomes. For example, raising the minimum drinking age to 21 has saved lives, including fewer vehicle accidents.

Research is needed to understand how the lessons learned from these successful policy interventions can be applied to other domains and to study the impact of policies already in place. The U.S. Food and Drug Administration has taken steps to restrict the sale and marketing of flavored vapors, in part to limit their appeal to young people, while weighing these restrictions against the potential public health benefits for some adult cigarette smokers who use e-cigarettes to switch away from combustible tobacco products.

SAFE is the only alcohol and substance use prevention agency in the City of Glen Cove. The coalition campaigns against alcohol, tobacco and other drugs. “Keeping Glen Cove SAFE,” to educate and inform the community about addictive substances and their effects. For more information about the SAFE Glen Cove Coalition, follow us at www.facebook.com/safeglencovecoalition or visit SAFE’s website at www.safeglencove.org.