Improving in-depth, epidemiological and economic understanding of substance use, harm and its prevention across countries

Abstract

Welcome to the second issue of Volume 8 of IJADR for 2020. This issue includes papers that focus on the global burden of different substances and their costs as well as studies of substance use and related harm by authors in Scandinavia and North America. The five papers include qualitative and quantitative studies and involve diverse populations from Canada, Sri Lanka, Germany and the United States.

In an attempt to identify substance use research priorities for Canada, Sornpaisarn and colleagues (2020) reviewed 2014-2019 publications and analysed secondary data sources to study the relative substance-attributable burden of disease for alcohol, tobacco and other drugs in Canada, finding that tobacco followed by other drugs contributed more to the burden of disease estimates than did alcohol. This pattern was also evident in North America and differs considerably from that observed in the overall global burden of disease estimates, where alcohol ranks higher than other drugs in terms of its contribution to GBD. Secondly, this article reported on wholly attributable relative substance use disorder diagnoses in Canada, finding that relative to alcohol, opioid use disorders required more admissions to hospital. Finally, this article highlights that the greatest societal costs tallied in 2014 were for the costs of alcohol, followed by tobacco and all other drugs combined. Both other drug use and alcohol diagnosis costs increased in the period between 2007 and 2014, with cannabis and opioid costs increasing and tobacco costs declining.

Leifman and Trolldal (2020) undertook an interesting study of price and income elasticity in Sri Lanka, finding that the economic drivers of alcohol sales appeared not to be affected by price and income changes to the same extent as sales in high-income countries or in the few studies that have been undertaken in other low- and middle-income countries. Their paper discusses aspects of Sri Lankan drinking culture including limitations on women’s drinking, the greater prevalence of lighter drinking and abstinence, banning of drinking on public holidays and drinking by tourists that may explain why general patterns of alcohol sales are less affected by price and income than expected, but argues that further research is needed to understand drivers of consumption in Sri Lanka.

In a study among sexual minority and non-sexual minority men and women in the United States, Karen Trocki and her colleagues (2020) examined the extent to which the protective effects of marriage on substance use that are commonly observed among heterosexual men and women apply to sexual minority groups. They found that marriage confers protective effects against substance use depending on individuals’ sexual minority or non-sexual minority status, their sex, and the substances under study. The researchers call for further research to unpack the factors that may explain the role of marriage as a protective factor against substance use in sexual minority individuals.

Egerer and Hellman’s (2020) study considered techniques that may be employed for interpreting researchers’ subjectivity – a well-recognized element – in qualitative research. They introduced three techniques: a form of content analysis, quantification of researchers’ expectations, and analysis of speaker positions among study participants. Using examples of data from focus groups among social workers in Germany, the paper discusses some of the contrasting impressions of qualitative data that can emerge from the use of the different techniques. This paper is likely to be very informative for many readers, and particularly, for those who may not be familiar with methods of analyzing and interpreting qualitative data.

Using multi-level data, Julie Croff and her colleagues (2020) examined the extent to which individual-level and school-level parental factors, school environmental factors, alcohol, tobacco and other drug (ATOD) descriptive norms and peer deviance are associated with early adolescents’ lifetime alcohol consumption in a study conducted among seventh grade students in the United States of America. They found that parents’ educational involvement and peer deviance at both the individual and school levels were associated with the adolescents’ alcohol use; however, only individual level ATOD norms were associated with lifetime alcohol use. A key implication of the findings concerns the role of parental involvement at the school level in early adolescents’ alcohol use. The authors concluded that “Parent educational engagement programs need not target all parents, as strong results at the school level may come from a core team of key parent leaders.” (page 93).