Substance Use, Substance Abuse and Injuries: An Overview

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Substance Use, Substance Abuse and Injuries An
Overview

• Robert Mann, PhD,
• Senior Scientist, Social Prevention and Health
  Policy Research, Centre for Addiction and Mental
  Health
• Director, Collaborative Program in Addiction
  Studies and Associate Professor, Dalla Lana
  School of Public Health, University of Toronto

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Overview of this presentation

• Injury as a major health problem in Canada
• Epidemiology of alcohol and drug use
• Contribution of alcohol and drugs to injury risk
• Prevention paradox
• Prevention approaches evidence

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Injury as a major health problem in Canada

• Injuries are the leading cause of death up to age
  44 in Ontario
• In 1989, injuries were the second leading cause
  of Potential Years of Life Lost in Canada
• Motor vehicle collisions by themselves are the
  leading cause of death for children and
  adolescents

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The Economic Burden of Unintentional Injury in
Canada, 1998
Source Smartrisk, 1999
The Economic Burden of Unintentional Injury in
Ontario, 1999
Source Smartrisk, 2006
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Epidemiology of alcohol and drug use in Canada

• Alcohol and drugs are widely used in Canada
• Use differs substantially by type of substance,
  region/province, age group and other demographic
  factors

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Source Canadian Addiction Survey, 2005
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Source Canadian Addiction Survey, 2005
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Percentage Reporting Lifetime and Past Year Drug
Use, 2007 OSDUHS (Grades 7-12)
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Contribution of alcohol and drug use to injury
risk
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How do you measure the effects of a substance on
injury risk?

• Relative Risk (RR)
• Incidence of substance in those with injury
  outcome
• Incidence in those without outcome
• -or, it is the risk of an outcome or event (e.g.,
  an injury) relative to exposure to a risk factor
  (e.g., substance use, or a specific amount of
  substance use)

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• Measuring alcohol and drugs in those with an
  injury outcome is relatively simple
• Measuring drugs, and to a lesser extent alcohol,
  in those without an injury outcome, i.e., the
  control sample, is typically much more difficult

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Survey

• If someone stopped you by the side of the road
  and asked you for a blood sample, would you
  provide one?

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Relative Risk of Fatal Collision Involvement
Relative to Blood Alcohol Content (BAC)
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Effects of alcohol, cannabis and cocaine on fatal
collision risk Quebec data, Dussault et al,
2002.
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Prevention Paradox

• Alcohol and drug abuse and dependence, although
  serious, are relatively rare in the population
• It is clear that those suffering from abuse and
  dependence are at increased risk of injury
• However, most of the problems caused by alcohol
  (and possibly illicit drugs too) are caused by
  those of us who are social or occasional users
• One simple example comes from drinking driving
  the large majority of impaired drivers who are
  caught by police, or involved in collisions, do
  not meet the criteria for alcohol dependence or
  abuse

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Comparison of injury fatality rates, current
drinkers vs. nondrinkers, Chen, Baker and Li,
AAP, 2005
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Prevention Approaches

• How can we prevent injuries related to alcohol
  and drug use?

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Some prevention approaches are popular but arent
very effective...
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Some prevention approaches are effective but may
not be popular
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The role of education
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Factors influencing drinking driving fatalities
in Ontario 1962-1995. From Asbridge et al,
Journal of Studies on Alcohol, 65, 450-459.
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Factors influencing alcohol-related driver
fatalities

• Alcohol consumption 1 litre increase in per
  capita consumption increases drinking driver
  fatalities between 8 14

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Factors influencing alcohol-related driver
fatalities

• Breathalyser law introduction of the original
  legal limit reduced drinking driver fatality
  rates by 18

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Factors influencing alcohol-related driver
fatalities

• Formation of MADD Canada reduces drinking
  driver fatality rates between 19 23

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Factors influencing alcohol-related driver
fatality rates Summary

• Alcohol availability and consumption 1 litre
  increase in per capita consumption increases
  drinking driver fatalities between 8 14
• Legal initiatives introduction of the original
  breathalyzer law reduced drinking driver fatality
  rates by 18
• Social action - Formation of MADD Canada reduces
  drinking driver fatality rates between 19 23

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Policies can have negative effects!

• We saw that alcohol policies can affect drinking
  driving rates, and they also can affect rates of
  other alcohol-related problems too
• Suicide is very strongly related to alcohol
  consumption at the individual and the population
  level

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Policies can have negative effects!

• There has been a lot of pressure on governments
  by the private sector to deregulate alcohol
  retailing over the past several decades
• The Province of Alberta, in a series of events,
  turned the retail sale of alcohol over to the
  private sector in the 1970s-80s
• We evaluated the effects of this deregulation on
  male and female suicide mortality rates in the
  province with time series analyses

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The effects of privatization in Alberta
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The effects of privatization of alcohol sales in
Alberta
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Concluding Comments

• Alcohol and illicit drugs are leading
  contributors to the burden of injury in Ontario
  and Canada
• The contribution of alcohol is substantially
  greater than any illicit drug
• The majority of these injuries may involve
  individuals who would not be considered as having
  a clinically defined substance dependence or
  substance abuse problem

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Concluding Comments (contd)

• With regard to alcohol-related injuries, policies
  on the economic, legal and physical availability
  of alcohol are the most powerful determinants of
  population injury rates
• As well, other legal and societal factors can
  exert important influences on these rates
• Thus, while alcohol and drug injury rates are
  unacceptably high, research identifies effective
  means to reduce those problems