On Thursday 29 November 2018, the Academy of Medical Sciences and the French Académie Nationale de Médecine held a joint one-day symposium on mental health and addictions in people aged 15 to 24 years.
The full report is now available in both English and French, and provides an overview of the gaps in our understanding of addictions and highlights opportunities for future research that should be prioritised in order to improve responses to addiction in both the UK and France.
An overview of the five most important messages to emerge from the meeting include:
- In both the UK and France, rates of alcohol use are beginning to decline – although it is not clear why.
However, while overall trends may be decreasing, excessive alcohol use is still a major challenge in both countries and remains one of the leading contributors to morbidity and mortality in young people. Furthermore, decreasing use is not seen in all groups – for example, in the UK the number of young women who are drinking heavily has been growing. Certain communities, such as the military, also continue to have significant issues linked to ingrained drinking cultures.
Efforts to understand why alcohol use is declining in some groups is needed to help find ways to encourage further reductions in those people where alcohol use remains dangerously high.
- Rates of cannabis use are more stable across the UK and France, but the long-term harms are not fully understood.
In both the UK and France, rates of cannabis use have remained relatively stable in recent years. Nonetheless, cannabis use is a notable concern in France, where the number of young people using cannabis is higher than most other European nations.
Unlike alcohol, there is no standard measure of cannabis exposure, which can complicate efforts to learn more about the long-term harms associated with its use. This is a concern as evidence suggests the strength of cannabis is increasing, and new synthetic forms are becoming more available.
- Greater efforts to prevent addictions are needed.
Addictions are associated with ill-health and premature death, and with higher healthcare costs. It is important to identify ways to use the evidence of the harmful effects of alcohol and cannabis to more effectively prevent addictions from occurring in the first place. Participants at the meeting stressed that greater efforts are needed to better enforce national policies to limit the sale of alcohol, and to discourage the consumption of cannabis. Public health messaging to raise awareness of the harms of addictions during pregnancy is also needed.
As addiction to one substance may predispose people to additional addictions, there is also a need to better identify people most at risk of multiple addictions to help limit their progression to other substances.
- Addictions and their consequences are more common in some groups of society, for whom access to appropriate care is often limited.
Higher levels of alcohol and cannabis consumption are seen in those of poorer socioeconomic backgrounds, in both the UK and France. These groups are also less likely to engage with healthcare systems or addiction services, and so suffer the largest burden of addictions.
Access to the necessary healthcare and support is often limited. In the UK, there has been a decline in the number of addiction specialists, and funding for specialist services is low. In France, there is a particular lack of specialist care in rural areas, and hospitals are not set up well to offer long-term support to those living with addictions.
- Integrated healthcare is needed to address addictions, as is enhanced training for doctors and nurses.
People with one addiction tend to have addictions to other substances as well, and are more likely to also suffer from additional physical and mental health conditions. This is compounded by a lack of coordination between different specialists providing care, and addictions are rarely considered as the main concern.
Although challenging, there is therefore a need for integrated patient-centred care to help overcome the full range of health conditions often faced by those with addictions. To help, clinicians – and GPs in particular – would benefit from more training on recognising, preventing and managing substance use disorders.
Efforts to improve the care and outcomes of patients with multiple conditions is also a key focus of our international policy work on Multimorbidity: a priority for global health research.
To find out more about the work of the Academy policy team, visit our policy pages: https://acmedsci.ac.uk/policy. For more information about supporting the work of the Academy of Medical Sciences, please visit our dedicated ‘support us’ page.