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MENTAL ILLNESS AND ILLICIT DRUG USE:
TRUE COSTS TO THE GLOBAL ECONOMY

The leading causes of non-fatal illness on the planet are mental disorders and substance abuse, according to an ambitious analysis of data from around the world.

A companion report, the first of its kind, documented global impact of four illicit drugs: heroin and other opiates, amphetamines, cocaine and cannabis. This group of drugs were labeled "an important contributor to the global burden of disease."

These papers were  published by The Lancet as part of a continuing project called the Global Burden of Disease.

Conventional thinking used to use mortality as the most important metric. While mental illness and substance abuse do lead to premature deaths, the authors say, that's hard to track because deaths are usually ascribed to the immediate physical cause rather than the underlying reason.

Suicides often are categorized as deaths due to injury, and illicit drug overdoses are often coded as accidental poisonings.

With an updated perspective and modern definitions — using illness and disability as determinants instead of motality — the global burden of mental disorders and drug use is clear:

Nearly 25% of the total disease burden stems from drug use and mental illness. The reports couch it in DALYs –- disability-adjusted life-years. One DALY is a year of healthy life that is lost to disease. By that measure, mental and substance abuse disorders cost nearly 184 million years of healthy life in 2010.

It goes almost without saying, sadly, that the burden of these disorders far outweighs resources devoted to prevention and treatment. A third to a half of people with mental and drug use disorders go without treatment in wealthier countries, and up to 85 percent go untreated in less-developed countries.

The current analysis of mental disorders, led by Australian Harvey Whiteford, finds that depression is the biggest contributor, accounting for about 40 percent of the burden. The other illnesses, in descending order, are related to anxiety, illicit drug use, alcohol use, schizophrenia, bipolar disorder, developmental disorders, childhood behavioral disorders and eating disorders.

The report on global drug dependency marks the first time researchers have tried to document its impact. It's a tough thing to do because countries differ widely in their statistics on illicit drug use, among other reasons.

Relying on available surveys and detailed computer manipulations of data, Australian Louisa Degenhardt and her colleagues conclude that illicit drugs account for 20 million years of healthy life lost.

Heroin and other opioids lead the list of abused drugs, followed by amphetamines.

Over two-thirds of drug-dependent people worldwide are male, but the burden is unevenly distributed. The worst-affected countries are largely high-income nations such as the U.S., the U.K. and Australia, which have drug dependency rates 20 times higher than least-affected countries.

Disability and illness due to opioids, amphetamines, cocaine and cannabis increased by more than 50 percent over the two decades prior to 2010. This is partly due to global population growth and partly to an increased prevalence of drug use disorders, particularly opioid dependence.

Even so, the total disability burden from these four illicit drugs is still less than from smoking and alcohol. Together those legal drugs account for around 10 percent of the worldwide burden of illness and death.





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