A time for everything: changing attitudes and approaches to reducing substance abuse.

In their article about drug use among teenage students in Ontario (page 451) Drs. Edward Adlaf and Frank Ivis present us with a warning. Their 1997 survey of students in grades 7, 9, 11 and 13 showed that cigarette smoking and alcohol use were continuing at high rates (reported by 27.6% and 59.6% of the sample respectively), that cannabis use had increased from 11.7% to 24.9% between 1991 and 1997, that cocaine use had risen to 2.7% and that heroin was being used by 1.8% of the students surveyed. Substance abuse is an enormous problem in Canada. Its total costs have been estimated at $18.4 billion and its direct costs at $6.6 billion annually. But the nonmonetary costs are even more important. • Tobacco use continues to be the leading lifestyle-related cause of death in Canada. • Alcohol abuse causes high rates of disease, disability and death from cirrhosis, various types of cancer, injuries and congenital defects. • In some jurisdictions in Canada, narcotics overdose has become the leading cause of death among adults aged 30–49 years. The leading risk factor for new cases of HIV infection in BC is injection drug use, which is also responsible for current epidemics of hepatitis B and C. These problems are not new. So why have we been unable to implement strategies to reduce the widespread health impacts of substance abuse that are consuming so many tax dollars and leaving so many people sick or dead? Several factors have been working against the efforts that have been made. For example, we now know that the tobacco companies have intentionally targeted their marketing efforts toward young people and that these efforts have been effective in attracting new recruits to tobacco addiction from among young people. Furthermore, some policies, such as reduced tobacco taxation, appear to have increased tobacco use among the young. Epidemics of heroin and cocaine use have occurred because of the combined influences of cheap prices and increased supplies, along with inadequate prevention and treatment services. So what can be done?