01.09.2010 Moving towards a future oriented policy on addiction
«The Challenge of Addiction». An addiction policy that focuses exclusively on dependence on tobacco, alcohol and illegal drugs does not go far enough for present-day needs – and it misses the most urgent problems. To address both the current and the future realities of addiction, a broader understanding of addiction policy is required, i.e. one that employs a public-health approach. The report on the «The Challenge of Addiction» outlines the basics of such an approach.
Switzerland’s current addiction policy concentrates primarily on the three areas of alcohol, tobacco and illegal drugs. A separate commission of experts exists for each of these areas. Until now, these organisations (the Federal Commissions for Alcohol Issues, Drug Issues and Tobacco Control) have had few points of intersection. In the past few years, they have – independently of one another and to varying extents – begun to pursue a public-health strategy, or at least elements of such a strategy. Now, in response to a mandate from the Federal Office of Public Health (FOPH), they have produced a report on «The Challenge of Addiction» and a new framework for a coherent policy on addiction.
Broadening the scope of addiction policy
This report essentially proposes that Swiss policy on addiction be extended to three conceptual enlargements and three new strategic directions. In terms of content, the policy should not focus exclusively on the narrow definition of dependence but should primarily take problematic consumption and the constantly changing patterns of consumption into account («more than dependence»). The rationale for this is the fact that most of the adverse consequences of consumption of addictive substances are not due to dependence in the medical sense of the term, but to problematic consumption. In addition, the report proposes that the not very helpful distinction made between legal and illegal drugs should be discarded («more than legal status»). This is because the formulation of an effective addiction policy based on a public-health approach does not depend so much on whether a substance is or is not permitted, but on how much harm it does. In fact, legal substances such as tobacco or alcohol cause much more health-related, social and economic harm than illegal drugs. Moreover, the use of additional potentially addictive legal substances such as medicines and psychopharmaceutical products designed to enhance mental and physical performance is growing rapidly. Finally, the authors stress that a comprehensive addiction policy has to encompass not only substances but also potentially addictive forms of behaviour such as gambling («more than substances»).
Change of strategy
The new strategic direction as outlined in the report also testifies to a broad underständing of addiction policy. In future, through coherent behavioural and structural measures, it should help make the healthier choice the more attractive and more beneficial option («more than personal responsibility»). There should continue to be a focus on youth protection, but account must also be taken of the fact that the elderly account for a growing proportion of the population and that problematic consumption and dependence are by no means confined to the young («more than youth protection»). In addition, a successful addiction policy requires not only a common strategy for all addiction policies but also cooperation with other policy areas at all federal levels and with the business community and civil society («more than health policy measures»).
Policy framework with ten guiding principles
On the basis of this broad understanding of addiction policy, the authors of the report have agreed on a cross-sectoral policy framework consisting of ten principles for a future oriented addiction policy. The principles are geared to the same goal as the report: preventing problematic consumption of addictive substances and problematic forms of behaviour, and reducing harm. The policy framework proposes possible approaches to incorporating existing sectoral and substance-specific measures into an integrated addiction-policy framework.
Principle 1: A coherent policy
Through a public-health approach, Switzerland will pursue a coherent policy in relation to the harmful and risky use of psychoactive substances and to potentially addictive behaviours.
Principle 2: Objective determined by potential harm and the actual disease burden
Action arising from addiction policy in Switzerland will be shaped and determined by the potential harm and the burden of disease caused by substances or potentially addictive behaviours affecting the individual, his or her environment and society. Such an approach thus distances itself from a simplistic distinction between legal and illegal substances and an exclusive emphasis on dependence.
Principle 3: Broader scope
Swiss addiction policy will focus not only on alcohol, tobacco and illegal drugs, but will also include medicines, addictions not related to substances, and products aimed at physical and mental enhancement. The specific characteristics of the different types of addiction will need to be recognised by the policy.
Principle 4: Securing treatment and care
Addiction is an illness. People afflicted by problematic consumption, problem behaviour or dependence have a right to receive treatment and care. Their family members, partners and children are also entitled to support. There must also be access to measures for early diagnosis, counselling and support in achieving withdrawal and reintegration into society. The aim is to create and consolidate an integrated approach to services.
Principle 5: Harm reduction
Effective harm reduction measures relate to the consumers and their environment. They are provided where they constitute an option from a public health perspective. In relation to tobacco, the current evidence does not support harm reduction measures.
Principle 6: Prevention through structural measures
Addiction policy in Switzerland will put the emphasis on structural measures aimed at environments, with the objective of making the healthier choice the attractive option. To achieve this, different policy sectors will increasingly be involved in addiction policy measures.
Principle 7: Obligations for producers, distributors and retailers
Producers, distributors and retailers of products with potential for harm or addiction will be obliged to make a greater contribution to the control of supply and demand through a coordinated legal framework This will apply at all federal levels in Switzerland.
Principle 8: Differentiated approach to target groups
The protection of young people will continue to be an important area of addiction policy and will require consistent implementation. Addiction policy instruments must, however, be broadly directed at all target groups. Special attention must be paid to ensuring that no one should be discriminated against on grounds of social inequality or social diversity. In addition, health literacy should be encouraged through specific training programmes aimed at prevention and early detection.
Principle 9: Civil society
Responsible organisations within civil society such as sports and trade associations or professional organisations need to become increasingly active, especially in prevention and harm reduction.
Principle 10: Research, training and monitoring/evaluation
Switzerland will increase its commitment to addiction research and to training of addiction specialists. To this end, it will develop an efficient and integrated system of addiction monitoring that reflects the approach put forward in this policy framework. The Federal Council will initiate a national addiction research programme. Addiction research will be further consolidated at university level by involving medicine and psychiatry.
The Federal Office of Public Health will continue the «Challenge of Addiction» process in order to disseminate, consolidate and mainstream the contents of the report and the policy framework.
The full report «The Challenge of Addiction” and a summary version can be downloaded or ordered as a booklet from: www.herausforderungsucht.ch
The public-health approach to addiction policy
According to the WHO, the public-health approach is an approach to health policy «that has the objective of improving health, longevity and the quality of life for entire populations through the promotion of health, the prevention of illnesses and other health-related interventions». A public-health approach is gaining in importance throughout Europe, not least because it can offer a common foundation for areas of activity that have hitherto remained separate, and it enables structural and behavioural prevention and health to be integrated into all policy areas.
Like the multiple-cause model in the drug sector, the public-health approach to addiction policy takes account of the interactions between the individual, his or her social environment and the addictive substance or addictive behaviour. But because of the effects on health and the problems they cause, its measures incorporate not only addiction but also problematic consumption. There is broad consensus among healthcare specialists on such a coherent public-health approach to addiction policy and there have been repeated calls for this approach to be adopted in Switzerland as well.
Markus Jann, Head, Drugs Section, firstname.lastname@example.org