SAFE GC Coalition: Social Determinants of Addiction Must Be Researched

According to the Director of the National Institute on Drug Abuse (NIDA), Biomedical sciences are bringing increased focus to social determinants of health, which the World Health Organization (WHO) defines as “the conditions in which people are born, grow, work, live, and age, the systems put in place to deal with illness, and the wider set of forces and systems shaping the conditions of daily life.”. Very often, commercial interests are intertwined with these social and environmental factors, which has led to the recognition by WHO and other agencies of the need to study and address commercial determinants of health. Commercial interests are an important component of the social determinants of addictive behaviors and disorders.

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

What these disease-causing products (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 by their products being able to trigger compulsive consumption, including consumption that results in addiction. Because of the well-understood role of reward in motivating our behaviors, existing industries are pushing novel products to activate the brain’s reward system, and new industry sectors are emerging to capitalize on our biological propensity to engage in reward-seeking behaviors.

Progress has been made in reducing smoking in the United States, which has led to major improvements in health, but the rapidly growing vaping industry, if not properly regulated, could jeopardize this. The explosion in popularity of vaping in the last few years has led to a steep rise in nicotine exposure particularly among teenagers and young adults who are the most vulnerable to nicotine addiction. While recognized as less harmful than combustible tobacco products, nicotine vaping nonetheless has been associated with adverse health consequences, including increasing risk for tobacco initiation and dependence and pulmonary and vascular dysfunction.

The cannabis industry has presented new opportunities for commercial interests to drive drug consumption across all ages and demographics. Cannabis products are often sold in colorful packages that mimic kid-friendly snack foods, for example, making them appealing to children and to young people. Adolescents exposed to cannabis marketing have greater odds of using the drug. The legalization of cannabis by the states and the diversification of cannabis products have led to significant increases in the number of users and the amount of cannabis consumed by them in the US.

Commercial determinants also play complex roles in the overdose crisis that currently claims 108,000 lives annually. First, it is well-known how some pharmaceutical companies were directly responsible for aggressively marketing powerful opioid analgesics with known addiction liability starting in the late 1990s. As access to legal opioids became more restricted, the 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 powerful opioid drugs such as fentanyl.

The tech sector has also emerged as a contributor to addiction and addictive-like behaviors. Not only are licit and illicit drugs marketed on social media, but numerous studies have linked adolescent social media use to risky behaviors including substance use.

Researchers at NIDA suggest mitigating the actual and potential harms, by implementing policy interventions similar to those that have been successfully applied to tobacco and alcohol. For instance, smoke-free workplace laws and restrictions on tobacco advertising have been effective at reducing smoking and its health impacts. Over 100 studies have shown that higher taxes on cigarettes produce significant reductions in smoking, especially among youth and lower-income individuals. Raising the minimum legal drinking age to 21 saved lives, for example, including through reduced vehicle crashes.

Research is needed to understand how the lessons learned from these successful policy interventions may 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 vapes, in part to limit their appeal to youth, while balancing these restrictions against the possible public health benefits for some adult cigarette smokers who use e-cigarettes to transition away from combustible tobacco products.

SAFE is the only alcohol and substance use prevention agency in the City of Glen Cove. Its Coalition is conducting alcohol, tobacco and other drug campaigns entitled. “Keeping Glen Cove SAFE,” to educate and update the community regarding addictive substances and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website at www.safeglencove.org.