Eric Single

Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada.

OBJECTIVES This study estimated morbidity and mortality attributable to substance abuse in Canada. METHODS Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs. RESULTS There were 33,498 deaths and 208,095 hospitalizations attributed to tobacco, 6701 deaths and 86,076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992. CONCLUSIONS Substance abuse exacts a considerable toll on Canadian society in terms of morbidity and mortality, accounting for 21% of deaths, 23% of years of potential life lost, and 8% of hospitalizations.

The definition of harm reduction

Welcome to the Harm Reduction Digest, where in each regular edition of Thug and Alcohol Review invited co-authors will contribute to pieces on the theory and practice of harm reduction. While the focus of subsequent HR Digests will be accounts of the practice of harm reduction interventions, programmes and policies from around the world, it was decided that the first Digest ought to address the definition of Harm Reduction. Consequently the style of this digest is probably more formal than most that will follow it. Many of you will have read DARs special issue on harm reduction (1995, 14(3)) where Alex Wodak, Bill Saunders, Patricia Erickson, Eric Single and Nick Heather all addressed the issue of definition in their respective contributions. Since this there have been a handful of papers and reports which have also grappled with the issue of definition. Co-author of this piece is Professor Eric Single, from the Department of Public Health Sciences at the University of Toronto. Eric addressed issues around the definition of harm reduction in the 1996 Dorothy Black lecture in London and, with Professor Timothy Rohl, as independent evaluators of Australias National Drug Strategy, wrote on the topic in their report ‘Mapping the Future’.

Harm Reduction: Concepts and Practice. A Policy Discussion Paper

This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]

Sharpening the focus of alcohol policy from aggregate consumption to harm and risk reduction.

An argument is presented for shifting the main focus of the alcohol policy debate away from aggregate level of consumption as the key determinant of alcohol problems in favour of a sharper focus on the reduction of harm and of high risk drinking. This argument is developed by highlighting the advantages of the latter approach in relation to: (i) the ability to distinguish between low risk and harmful consumption of alcohol (ii) the ability to predict which drinkers are most likely to experience harmful consequences of drinking (iii) the acceptability of policy objectives to government and industry, and (iv) the acceptability of prevention strategies to the general public. It is suggested that this focused approach to the measurement and reduction of alcohol related harm is more likely to achieve tangible success in the policy arena than one which is overtly predicated upon the need to reduce total population consumption of alcohol.

Beyond Ischemic Heart Disease: Are There other Health Benefits from Drinking Alcohol?:

Evidence is growing that alcohol consumption confers health benefits beyond protection from ischemic heart disease. We review this evidence with regard to cerebrovascular disease, peripheral vascular disease, diabetes, cholelithiasis (gallstones), cognitive functioning, and stress reduction and subjective psychosocial benefits. Other possible benefits are briefly considered. The weight of evidence suggests that low-level alcohol consumption offers some protection against ischemic stroke. The evidence that moderate alcohol consumption protects against diabetes and gallstones is also fairly strong. The possibility of other health benefits cannot be dismissed. For all the conditions considered, more research is indicated. The application of more appropriate statistical techniques, studies of patterns of drinking, and experimental approaches to delineating underlying mechanisms should enable firmer conclusions to be drawn. A better understanding of both the benefits and the risks of alcohol use for individuals and populations will facilitate the development of appropriate program and policy interventions to promote health.

Estimating the Costs of Substance Abuse: Implications to the Estimation of the Costs and Benefits of Gambling

This presentation describes a recently developed set of guidelines for estimating the economic costs of substance abuse, summarizes the findings from a Canadian study that utilized these guidelines, and discusses the implications to the potential development of guidelines for estimating the costs and benefits of gambling. The guidelines for estimating the costs of substance abuse present a general framework of costs to be included and discuss methodological issues such as the definition of abuse; determination of causality; comparison of the demographic and human capital approaches; the treatment of private costs; the treatment of nonworkforce mortality and morbidity; the treatment of research, education, law enforcement costs, the estimation of avoidable costs and budgetary impact of substance abuse, and the significance of intangible costs. Utilizing these guidelines, a study was undertaken to estimate the economic costs of alcohol, tobacco, and illicit drugs to Canadian society in 1992. Based on this experience, it is argued that cost/benefit research should be conducted by multidisciplinary teams, that the real value of such work lies more in the detailed findings than in the bottom line results, and that focus should be placed on developing an ongoing process for developing consensus on how to conduct studies of the costs and benefits of gambling, rather than attempting to find a precise methodology that everyone agrees upon.

Towards a standardised methodology for estimating alcohol‐caused death, injury and illness in Australia

Two key methodological issues underlying different methods for calculating estimates of the number of alcohol‐caused deaths are identified and recommendations suggested for future work.

The economic costs of illicit drug use in Ontario, 1992

The use of illicit drugs causes health and social problems which imply economic costs to society. This paper uses the cost-of-illness method, in particular, the human-capital approach to estimate the prevalence-based economic costs of illicit drug use in Ontario in 1992. This methodology is consistent with international guidelines formulated at the 1994 International Symposium on Economic and Social Costs of Substance Abuse. The economic cost of illicit drug use is estimated at

The Concept of Harm Reduction and its Application to Alcohol: The 6th Dorothy Black Lecture

489.29 million (Canadian dollars) in 1992. Associated with these costs are health-related harms: 211 deaths, half of which occur before the age of 35; and 20 690 days stay in public hospitals.

Public Drinking, Problems and Prevention Measures in Twelve Countries: Results of the WHO Project on Public Drinking

Harm reduction has proved to be effective, and has gained increasing official. acceptance in many countries. However, the concept is poorly defined, as virtually any drug policy or programme, even abstinence-oriented programmes, attempts to reduce drug-related harm. The principle feature of harm reduction is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time. Harm reduction accords a high priority to short-term realizable goals, but is consistent with a long-term goal of abstention. The trend toward harm reduction in illicit drugs is closely paralleled by a similar trend in alcohol prevention toward measures aimed at reducing the consequences of hea y drinking occasions. Examples of harm-reduction approaches to alcohol are discussed, including measures to reduce non-beverage alcohol consumption by ‘Skidrow’ inebriates, measures to reduce intake of alcohol by drinkers (e.g. promotion of low-alcohol beverages, server training programmes) and measur...