New governance of addictive substances and behaviours

Key elements for a new governance of addictive substances and behavioursThe backgroundHarm done by drugsReplacement concept of addiction—heavy use over timeWell-being frame and ethical approach to drugsDrivers of drug-related harmDual approaches to reducing harmReducing drug-related harmYouth-centred policyWhole-of-society approaches to wicked problemsPrivate sector unpackedHearing civil society voicesTowards a policy frameReferencesNew concepts of addictionDefinitions of addictive behavioursHeavy use over time as a new definitionHeavy use over time as a diagnostic criterionPublic health implicationsImplications for preventive and clinical interventionsConclusionsReferencesThe ethical basis for preventing harm from heavy use of addictive productsIntroductionEthics vs moralsWhy do we need an ethical basis for preventing harm from addictive products?Philosophical ideas behind ethical governanceWhat components make up an ethical framework for public health?What is the special case of public health ethics in the area of heavy use over time of addictive products?Lifestyle choices—beyond the medical sector and in the private realmExtreme levels of social controlImpact on individual freedom of choiceInfluence from the corporate sectorStigma and discriminationA well-being framework as an ethical basis for prevention of harmMaximizing well-being: an inverted U-shaped curveConclusionsReferencesDrivers of the harm done by drugsIntroductionStructural drivers of harmBiological attributes and functionsHard-wiring that seeks out nicotine and other neurotoxinsHard-wiring that seeks out ethanolAn example of genetic influence: ADH1B rs1229984Population size and structureLevels of wealth and income disparitiesCore drivers of harmDrug potencyDrug exposureTechnological developmentsSocial influences and attitudesPolicies and measuresPolicies that reduce exposureIncentivizing individual behaviourResearch and development to reduce potencyResource allocation for advice and treatmentCo-benefits and adverse side effectsPrivate sector engagementHealth FootprintNations, regions, citiesSectorsConclusionReferencesApproaches to reducing the harm done by addictive substances and behaviours should be comprehensive and address the whole populationIntroductionRe-thinking the prevention paradoxHigh-risk groups approaches and population stratificationGenetics and personalized medicineMixed approaches: the inverted intervention pyramidDigital healthTowards a 'Culture of Health'ConclusionsReferencesPolicies and measures that impact on the harm done by addictive substancesIntroductionCounterbalancing market forcesPriceAvailabilityMarketingManaging corporate influenceEmpowering citizensCreating awarenessDealing with stigmaDe-criminalizing drug useAdvice and treatment servicesInformation and communications technologies and mHealthShifting use to safer delivery systems or safer drugsNon-health policiesThe impact of global treaties in the drug problemConclusionsReferencesEmpowering young people to manage drug-related riskIntroductionDrug use in young peopleAge of initiation and when to interveneRisk and protective factors for substance useYouth-informed drug and alcohol policy for the twenty-first centuryLimiting youth access to substances through age limitsEnforcing age limits without causing harmPricing policies and youth substance useYouth and the digital worldDigital marketing and young peopleInterventions promoting well-beingParental supervision and trainingEconomic and social conditions promoting well-beingUniversal school-based programmesTargeted interventions strategiesIndicated interventions for young peopleMulticomponent programmesConclusionsReferencesGovernment leadership for whole-of-society approachesIntroduction to the European public policiesNormalization: the need of new modelsGovernance of addictions: a wicked issueModels of governance of addictionsModel 1: trendsetters in illegal substancesModel 2: regulation of legal substancesModel 3: transitioning modelModel 4: traditional approachConnecting government: the whole of government challengeThe 'whole-of-government' approach for addictive substancesTwo main challenges: economic crisis and the role of the private sectorConclusionsReferencesPrivate sector impact on the harm done by addictive substancesIntroductionHow business operatesNetworksLevels of governance and domains of actionSupranational governance in focusLegal vs. illegal productsBusiness and government: illegal drugsBusiness and government: legal drugsUpstream and downstream strategiesDomains of action: business influence on policy—civil society, science, and the mediaThe multiple voices of the corporationPolicy, lobbying, and civil societyLobby groupsPolicy planning groupsFront groupsThink tanksScience and the insecurity of the evidence baseRoundtable on alcohol-related harmTobacco industry workMediaPolicy partnership and self-regulationHow to manage big business: problems of engaging with private companiesManaging the private sectorPartnership governance, social responsibility, and self-regulationConclusionsRegulation is the first watchwordNegotiation, partnership, and coalition buildingNotesReferencesCivil society approaches to reducing the harm done by addictive substancesThe role of civil societyRecent shifts in civil society responsibilityTransnational civil societyCivil society vs industryNew technology, new modes of activismReducing harm in low-income countriesConclusionsReferencesIntroductionHeavy use over time should be the replacement descriptor for concepts and terms such as 'addiction' or 'dependence'Policies should address and reduce the social stigma linked to drug usePolicies should be based on a sound understanding of evolutionary behaviourPolicies should be assessed for their impact on a range of societal well-being outcomes beyond physical and mental healthPolicies should be guided by standardized assessment procedures such as the toxicology-based margins of exposure analysesPolicies should ensure that they reduce heavy drug useDrug policies should recognize the vulnerability of the adolescent brain, particularly with respect to decision-making abilitiesSmart drug policies require whole-of-society and whole-of-government approachesGovernment policy-making for drugs should be free of the influence of relevant producer companies, while recognizing producer company responsibilities for reducing harmA health footprint should be used as the accountability tool to apportion the ill health and premature death imposed by the drivers of drug use and related harmDrug policies should ensure that programmes designed to prevent harm are assessed for their cost-effectiveness by agencies similar to those that assess pharmacological treatmentsDrug policies should ensure that gaps between need and advice and treatment are overcomeConclusionsReferences
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