By Andy Stonard, Consultation Event Alcohol Panel Chair is the CEO of Esprit du Bois and the Former CEO of Rugby House – Drug & Alcohol Treatment Services. He is author of A Glass Half Full: Drinking - Reducing The Harm

Professor Philippe de Witte, Head of the Laboratory of Behavioural Biology at the Université Catholique de Louvain (UCL), Belgium. He is Editor-in-Chief of Alcohol and Alcoholism and Chairman of the Advisory Board of the European Foundation for Alcohol Research. He is a former Fulbright Scholar, specialising in brain research at the US National Institutes of Health.

Boys and girls are binge-drinking, creating problems in their daily lives

Alcohol is a major cause of harm on a global basis, increasingly for our youth, but health policy and treatment responses have been inconsistent and ineffective. What is needed is a complete overhaul of our current thinking. It is time to go much further in actually listening to, and applying, what the latest brain research is telling us.

By Dr. Marjana Martinic, Consultation Event Alcohol Panel Presenter and Deputy President, International Center for Alcohol Policies (ICAP) Washington DC.

Problems and diseases related to the harmful use of alcohol are high on the agenda of global public health policy. Alcohol ranks fifth among risk factors for disease and disability, according to the most recent calculations from the Global Burden of Disease study1, and has become the focus of considerable political attention. In 2010, the 63rd World Health Assembly adopted the WHO Global Strategy to Reduce the Harmful Use of Alcohol,2 and the Global Action Plan for the Prevention and Control of NCDs 2013-20203 identifies the harmful use of alcohol as one of the main areas for action. Yet alcohol stands apart from other risk factors for health, making it a unique challenge for prevention and policy.

Due to its dual nature, alcohol is implicated in outcomes that sit on a continuum from benefit to harm. The relationship between drinking and its consequences is influenced by many individual, societal and cultural factors.4 At a political level, efforts to address alcohol-related harm may be impeded by tensions between local needs and priorities, and politicised global imperatives. The ability to effectively address alcohol-related harm both at the micro and the macro level requires an understanding of the role that drinking (and alcohol itself) plays in society, and how that role affects the relationship with outcomes. This allows a crafting of responses that are appropriate and flexible enough to meet particular needs and circumstances. Most importantly, policy and prevention must not be driven by ideology or moralistic positions, but by pragmatic considerations aimed at maximising benefits and minimising harm. They must be inclusive of opportunities, resources, and a broad range of stakeholders.

By Dr. Christopher Proctor, Consultation Event Nicotine Panel Presenter is British American Tobacco’s Chief Scientific Officer, working at Group Research and Development in Southampton. A PhD chemist, Dr Proctor has represented BAT in public hearings on the World Health Organisation’s Framework Convention on Tobacco Control and has recently been invited as a scientific expert presenting at US FDA workshops. In 2003 Dr Proctor published: ‘Sometimes a cigarette is just a cigarette’.

The World Health Organisation estimates that over the course of the 21st Century tobacco use may cause the premature deaths of a billion people or more unless urgent action is taken.

Although use of all forms of tobacco and nicotine carries some health risks, cigarette smoking is both by far the most risky and also the dominant form of tobacco use in most countries. I can understand skepticism in some quarters as to why we, the manufacturers, can claim to have perhaps the most important role to play in delivering reduced harm. As first and foremost a scientist driven by this challenge, I believe we have turned an important corner. The opportunities at our fingertips and in the pipeline thanks to recent scientific and product development advances are truly of immense significance.

By M.D. Delon Human, Consultation Event Nicotine Panel Chair; President & CEO, Health Diplomats; Adviser to the UN Secretary-General; Secretary-General of the Africa Medical Association; Former Secretary-General of the World Medical Association; Author: Wise Nicotine

One of the public health triumphs of the last century has been the prevention of the spread of the human immunodeficiency virus (HIV). UNAIDS reported a decline of 33% in the number of new infections from 2001 to 2012. Part of this success can be ascribed to the decrease in transmission of HIV among intravenous drug-users. Here harm reduction methods, such as education and encouraging countries to implement needle exchange programmes, have been successful in preventing disease and premature deaths. UNAIDS still recommends that countries provide a minimum of 200 sterile syringes per year for each person who injects drugs as a harm reduction measure.

The term “harm reduction” may have started with HIV, but is in fact an age-old practice. We know that the use of alcohol, tobacco and other psychoactive substances goes back many thousands of years. In most cultural settings, norms, social codes or rituals regulating consumption and associated behaviour were present. Over time these harm reduction practices have grown into a philosophy and science within public health, offering a progressive alternative to the prohibition of certain potentially dangerous lifestyle choices. Recognising that certain people always have and always will engage in behaviours which carry risks, the aim of harm reduction is to mitigate the potential dangers and health risks associated with this, without achieving total abstinence.

By Dr. Wilson Compton, MD, MPE, Consultation Event Co-Chair & Deputy Director, National Institute on Drug Abuse (NIDA), National Institutes of Health, Department of Health and Human Services, USA.

Drugs, both legal (e.g., alcohol, nicotine) and illegal (e.g., cocaine, methamphetamine, heroin, marijuana) as well as abused psychotherapeutics (opioid analgesics, stimulant medications, benzodiazepines) can be abused for several reasons, including the pursuit of pleasure, altered mental states, improved performance or, in certain instances, alleviation of a psychiatric disorder. However, stunning advances in the neurosciences have shown that, whatever the reason behind the initiation of an abuse trajectory, chronic drug abuse affects the brain in ways that undergird the stereotypic behavioural disruptions that characterise addicted individuals.

Addiction researchers have started to shed light on the ways in which chronic drug abuse changes the brain to cause the profound disruption we see in the behaviour of an addicted person. This is because drugs of abuse co-opt the brain’s neuronal circuits necessary for insight, reward, motivation, and social behaviours. These drug-induced changes are long-lasting, persisting even after years of drug discontinuation, which has led to the recognition of addiction as a chronic and relapsing disease. This model of addiction explains why addicted individuals make poor choices despite awareness of the negative consequences; why previously rewarding life situations and the threat of judicial punishment may not stop drug taking and why a medical rather than a criminal approach is more effective in curtailing addiction. When considered together, these effects amount to a compelling argument for considering addiction a bona fide chronic and relapsing disease of the brain. Importantly, they also point the way for the development of more effective interventions for the prevention and treatment of addiction.

By David Budtz Pedersen21, Co-Director, Humanomics Research Center, Aarhus University; Strategic Adviser, Danish Ministry of Science

Policy-making depends for its legitimacy on robust scientific advice, says Dr. Budtz Pedersen. But there has to be a fine balance between the roles of scientific adviser and policy-maker. It is not for scientists to make policy, or for politicians to bend or ignore science to serve their own political ends. Only if this balance is achieved can citizens be confident that they are getting ‘evidence-based policy’ rather than ‘policy-biased evidence’, as coined by Aidan Gilligan

Science-based policy-making has grown ever more important in recent years, in parallel with the dramatic increase in the complexity and uncertainty of the ways in which science and technology interact with society and economy at the national and global level. Installing a proper framework for ensuring the integrity of, and public trust in and support for, science is becoming an urgent task for European and global policy-makers.