New York 7 May 2003
Antonio Maria Costa
Executive Director
United Nations Office on Drugs and Crime
Preventing Substance Abuse
Good evening, ladies and gentlemen. It is so rewarding to be here, with you all engaged in such a compassionate service to society. It is with true admiration that I wish to thank the Smithers Foundation for its kind invitation and for the opportunity to address the distinguished company assembled tonight. I salute the Smithers Foundation for its sterling work over the last half century in providing help to those working in the field of alcoholism. The Foundations funding of innovative research on alcoholism as a preventable and curable health condition, and its contribution to removing the stigma associated with alcohol abuse merit the worlds appreciation.
In particular I would like to express my admiration for the volunteer work of Mrs. Adele Smithers-Fornaci: tonight, her lifetime commitment to improving the lives of countless people will receive well-deserved recognition.
My congratulations also go to this years recipients of the Brinkley Smithers Award. Your professional work and dedication have made a substantive difference in the lives of many, many people.
Before entering into the heart of my talk this evening, let me say a word about my presence. You see, my Offices line of business sounds rather sinister -- fighting drugs, crime, terrorism, corruption, trafficking in humans, money-laundering and the like. Our work involves us with people and situations so uncivil, at times so truly repulsive that I am often referred to as the UN Minister for Sinister Affairs. My travels normally take place under such security conditions -- in some countries under army escort complete with air cover, that some people, even friends, eschew my company. I do hope that tonight, my presence and my work with drugs and thugs will not spoil anybodys appetite or induce any of you to leave early, discreetly. If I am lucky, the contrary may happen. You may even be convinced that our mission at the United Nations and your volunteering efforts at the Foundation can be mutually supportive, both aimed at reducing the scope, size and consequences of problems that are mankinds oldest.
Tonight I will address three issues.
First, that there are many similarities between the prevention and treatment of both alcohol and illicit drug abuse. I will take advantage of these similarities to report on recent progress we have made in the international debate on, and activity against drug abuse.
Secondly, that the self-destruction of addicted people is often a symptom of an even more serious problem in life: the perceived need for a false supplement to freedom; for a journey, often of no return, into an artificial paradise where freedom is actually denied. Therefore, prevention and treatment will be more effective if they went beyond the particular substance (alcohol or drugs) and paid more attention to the individual abusing it, and to the social setting within which the abuse takes place.
Thirdly, that there is much common ground between the many organisations that, across the world, address the problems created by psychoactive substances. Of course, it is important to work together and learn on one anothers experience. But I want to be bolder than that. I will tonight launch an appeal to governments and international institutions to redefine their work in substance abuse according to the logic of subsidiarity -- namely I will call on public institutions to devolve funds, work and responsibility to groups and actors most closely associated with beneficiaries. Indeed, who is more intimately involved with substance abusers than the Smithers Foundation itself?
Now, my first point. I believethat, for prevention and treatment purposes, it is not very important to distinguish between alcohol and illicit drugs. Their psychological and behavioural mechanisms of dependency are similar. Their interconnection is aggravated by the fact that many people suffering from alcoholism also use drugs, and conversely, in forms of poly-abuse that cause most serious health damage.
Not surprisingly, therefore, our respective work covers common ground, for example the need: for (i) better information and understanding; for (ii) a compassionate approach; for (iii) policy to be informed by science, rather than prejudice; and for (iv) the recognition that treatment is better than punishment, and prevention still better than treatment.
Support for these simple, yet crucial principles, is growing. I am happy to report about the convergence of views among the 71 Ministers who attended the meeting of the Commission on Narcotic Drugs in Vienna a forth-night ago. The meeting was called to review of the progress made by United Nations Member States to significantly reduce illicit drug production, trafficking and abuse since the General Assembly session of 1998.
In Vienna Ministers unanimously agreed that there has been encouraging progressto respond to an aggressively complex drug situation. Positive is the fact that best practices aimed at reducing demand and improving treatment have been fortified and adopted more widely. Information is being reorganized and shared. International cooperation, notably joint actions in law enforcement have gained new breadth and depth.
Ministers were pleased to note that the decline of cocaine abuse in North America and heroine abuse in Western Europe give reason to hope that greater achievements are possible. However, in many parts of the world drug abuse is still on the rise. Most worrisome is the fact that from Eastern Europe to the Pacific, HIV/AIDS is spreading, and spreading at an enormous rate, because of injecting drug use.
Time will judge whether the goal set by the General Assembly in 1998, calling for a significant improvement of the drug situation in 10 years, will be met. Yet, I believe that more important than the specific goal is the general recognition by Governments that the destiny of individuals is at stake. Without our common work, for many abusers life will be permanently maimed -- even destroyed. For occasional drug users, formative years of their lives will be jeopardized, and full development of their potential put at risk.
For this reason I have noted with some concern the spreading, in some countries, of a permissive culture favoring the right to substance abuse. Such a laissez-faire to self-destruction collides with the alliance of citizens and institutions, such as the Smithers Foundation, who are working to reduce the damage caused by abuse.
The vocal minority of citizens who favour drug liberalization base their argument on the fact that the lethal consequences of narcotics are at a fraction of those caused by licit substances, like tobacco and alcohol. Statistically this is correct, thanks God. (For example, in North America alone tobacco-related deaths approach the half a million mark per year. Deaths related to alcohol amount to half that, while those caused by narcotics are less than one-tenth).
Yet, lets not turn the argument up side down: the fact that todays licit substances cannot be banned, cannot possibly be a reason for legalizing drugs. Worldwide efforts at promoting ever stronger tobacco controls should be a lesson to those advocating weaker drug controls. When tobacco abuse started to spread centuries ago, there could not be an international consensus banning it. Today, many tens of millions deaths later, society regrets its absence.
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My second point is related to all this: it is centred on the recognition that, behind substance dependence there is most often a hidden plea for help by individuals left alone without recognition or appreciation -- without love, as old fashioned as this sounds. Society has to answer to this call before problems become unmanageable. Namely, we should focus on the substance, yes, but especially on the person abusing it and the social setting within which the abuse takes place.
Understanding the reasons for abuse are preconditions for success in helping the abuser overcome the condition. Though the aetiology of abuse is complex, when seriously conducted it can enrich policy, helping determine the most effective interventions, starting from preventive education.
Prevention work is effective when all social actors play a constructive role: the family, the schools, the place of faith, the peers, the leisure industry, media and alike. This is quite a tall list. We all know that the environment is not always helpful and wrong messages are at times sent. For example, pop music is known to have an impact on drug abuse. Recent news is good in this regard: we seem to be entering a period when disco-music generally sings against drugs, and this is a disincentive to abuse. But please note that in the 70s and the 90s, the opposite happened: then, some pop music celebrated drugs and our youth indulged. I personally have touched this with my own hands, as a Berkeley flower kid at the time of the free-speech movement, peoples park on Shattuck Avenue, and the vietnik movement.
The Smithers Foundation has inspired countless activity focused on the human dimension of the alcohol abuse. Therefore, I am honored to celebrate with you all the vision of the founder, R. Brinkley Smithers, who promoted vigorous preventive action. Many of the seeds he planted beginning 50 years ago are now bearing fruit. As with my Offices counter-narcotic work, the goal of significantly reducing the dimensions of alcohol abuse is still distant. However, we should not despair. Alcohol ranks high as a cause of death and disease. A recent World Health Report estimates alcohol to cause between 1% and 3% of all deaths. In addition, alcohol imposes a high economic cost on society, estimated at a similar percentage of GDP.
I mentioned these numbers because, I believe, recognition of the nature and size of a problem is a necessary, though not sufficient, condition for action. It is hard to say whether governments will eventually consider for alcohol measures similar to those being introduced for tobacco. Still, only a few years ago the idea of imposing some kind of control system on tobacco was not conceivable. Even without formal international agreements, countries could do a lot more to reduce alcoholism: for example, by deploying the legal, fiscal, medical, together with the advocacy and insurance measures that have indeed rendered smokers daily life increasingly miserable.
My third and final point is about the fact that prevention work for alcohol, tobacco and drugsneeds to be made synergetic. I see three crucial areas of work here.
First of all, I emphasize the importance of an early start, namely the focus on young people, at school. Teenagers establish behavioural patterns for a life-time. In substance abuse prevention terms, these years constitute a period of both opportunity and risk. Reducing experimentation by young people does reduce the numbers of individuals that will go on to develop sustained and problematic abuse patterns.
Second, let us focus on the workplace where preventive intervention and support can reduce individual abuse and collective damage. My Office has recently published a study (Alcohol and Drug Problems at Work: the Shift to Prevention, done with ILO) to demonstrate that -- leaving aside the human dimension -- fighting substance abuse at the workplace is profitable: early intervention reduces accidents and absenteeism. It increases productivity and competitiveness.
One important lesson, in this regard, is that providing treatment to substance dependent staff is not enough. In general, only 3 per cent of the workers are addicted, while three times this number (perhaps 10%) have substance abuse problems these are individuals who, intoxicated, remain engaged in work carrying risks to themselves and others. Not surprisingly, in North America and growingly in Europe, companies that care about staff safety and about the balance sheet are promoting substance abuse tests at the work place.
Last, but not least, is the case of abuse in leisure settings (discos, for example), and outside them. On the front of alcoholism, news is improving. Measures introduced to counter drunken driving, for example, have generally improved safety and have reduced terrible pains to individuals and their families. Unfortunately in my own area, drug abuse, similar tests are not being conducted. In fact, society does not seem to have the same vigilance about driving under the influence of drugs as under the effect of spirits, although related road accidents are no less serious.
This final observation -- regarding the importance of synergy in the prevention work against drugs, tobacco and alcohol -- brings me to the conclusion that public institutions cannot do everything. Governments, and the United Nations as their collective expression, need to base their work on the principle of subsidiarity, counting on the strong commitment and dedication of individuals and the civil society organizations the latter have launched. The long-term vision and the continued and sustained efforts of the Smithers Foundation have produced results that integrate perfectly well with the work of public institutions.
I congratulate you, not only for the important work you do, but also for the example you set for us all.