Substances – Science – Politics Addictions: Regulating Risk Gert-Jan Meerkerk PhD, IVO Addiction Research Institute Rotterdam SciCom, Brussels, Tuesday 18 June 2015

Substances in society: alcohol & drugs Positive consequences: pleasure… Negative consequences: –Toxic → chronic diseases –Accidents / injuries –Criminality, drunk driving –Risky sexual behavior –Social problems –Abuse / Addiction Brussels, Tuesday 18 June 2015

Science in society: addiction research Two main reasons for addiction research (Babor, 2015) : 1.Generate knowledge about why addiction occurs, how it develops, how it causes medical and social problems and what accounts for the rise and fall of addiction- related problems in human populations 2.Apply knowledge to treatment, prevention and public policy at the local, national and international levels “ The aim … was to inform national governments and public health authorities about the best means to prevent or reduce alcohol- and drug-related problems.” (p. 40) Brussels, Tuesday 18 June 2015

Science learns: determinants of use and abuse Brussels, Tuesday 18 June 2015 Substance Set (person) Setting (environment) Use and abuse After Zinberg (1984)

Science learns: determinants of use and abuse Drug Time needed to feel effect Half-life Physical dependency Psychotropic effect (upper, downer, hallucinogenic) –NB Nicotine small psychotropic effect but high risk of addiction, vs. XTC or mushrooms strong psychotropic effect but small risk of addiction Set (person) Genetic make-up: predisposition Personality traits –Reward sensitivity / impulsivity / sensation seeking –Coping capabilities –Anhedonia Setting Availability and accessibility Legal / illegal status Culture, image Peer pressure Family circumstances Brussels, Tuesday 18 June 2015

Drugs ordered by their overall harm scores (Nutt et al., 2010) Brussels, Tuesday 18 June 2015

Scientific findings relevant for alcohol policy (From Alcohol: No Ordinary Commodity, Babor et al., 2010 ) Alcohol is “one of the leading preventable causes of death and disability” (p. 769) Three mechanisms explaining alcohol’s ability to cause medical, psychological and social harm –Physical toxicity (carcinogenic) –Intoxication –Alcohol dependence Three key messages (Babor, 2015) : –Taxation, availability controls and drink driving countermeasures are the most effective policy measures from a public health perspective –The evidence for or against regulations on marketing is not strong enough to warrant a clear endorsement, however, alcohol marketing is potentially harmful enough to warrant regulatory control (Precautionary Principle) –The impact of education and persuasion programs tends to be small, at best. When positive effects were found, they did not persist. Brussels, Tuesday 18 June 2015

‘Best practice’ policy measures (From Alcohol: No Ordinary Commodity, Babor et al., 2010) Price control: –Taxes, minimum pricing Physical availability, restrictions on time and place of sales, density of alcohol outlets: –Ban on sales, minimum legal purchase age, rationing, government monopoly of retail sales, hours and days of sale restrictions, restrictions on density of outlets, different availability by alcohol strength Altering the drinking context: –Enhanced enforcement of on-premises policies and legal requirements Drink-driving countermeasure –Random breath testing, lowered BAC limits, administrative licence suspension, low BAC for young drivers Regulating alcohol advertising and other marketing Screening and brief intervention in health care settings; increase availability of treatment programs Brussels, Tuesday 18 June 2015

From science to policy… Should science have a bigger influence on policy? Facts vs. beliefs Findings vs. hope Evidence vs. ideology Theory vs. pragmatism Critics: does science have something to offer, could science loose its autonomy and independence? (Weiss, 1995) Brussels, Tuesday 18 June 2015

From science to policy… Why policy makers do not apply scientific findings instantly… (Weiss, 1995) Politicians are not completely naïve, often long-term experience, not changing because of one study –‘for every position you can find a study supporting it’ Science does not necessarily covers all aspects of a phenomenon (e.g. costs, public opinion, political feasibility, ideologies, other agendas, practical implementation aspects) Politicians have limited authority: limited power to change things Changes go slowly: process of gradual assimilation of research: enlightenment Brussels, Tuesday 18 June 2015

From science to policy… Aspects of research that increase usefulness for policy makers… (Weiss, 1995) Direct relevance for the policy maker Conformity with prior knowledge, experience and beliefs of the decision maker Research quality: high technical proficiency (resistant against critique) Orientation to tangible action Studies that criticize existing policy and bring in fresh ideas Brussels, Tuesday 18 June 2015

From science to policy… Some general suggestions for scientists… Scientists should focus less on journal articles and more on integrating knowledge across research areas to provide policymakers with a comprehensive and integrated view of public health implications (e.g. Alcohol: No Ordinary Commodity, Babor et al., 2010) Scientists should invest more in education: part of (university) curriculum Scientists should understand politicians' motivation for asking scientists: –Clarifying questions: enlightenment –Legitimation/validating own opinion –Warning for failing policy (or socially unacceptable situation) →Scientists should listen more to politics; not only to the subject of the question but also to the background: why do politicians ask this question? Brussels, Tuesday 18 June 2015

From science to policy… Two examples: Science: adolescent brain is extra vulnerable for negative consequences of alcohol Politics: adaption of age limits Science: closing coffee shops doesn't reduce cannabis use and nuisance Politics: closes coffee shops (under European pressure and public opinion) Brussels, Tuesday 18 June 2015

From science to policy… Subject of discussion: The role of the industry… ‘Industry’: “The new global organization will serve as a dedicated resource in the companies' ongoing work to help reduce harmful use of alcohol and promote understanding of responsible drinking.” ‘Science’: “…the global alcohol industry should have no role in the formulation of public health policies.” (Babor, 2013) Brussels, Tuesday 18 June 2015

Thank you Gert-Jan Meerkerk, PhD IVO Addiction Research Institute Rotterdam Netherlands Brussels, Tuesday 18 June 2015