Substance use disorders (1) Mortality in people with substance use disorders

7 November, 2022

Below are extracts from a commentary in The Lancet Psychiatry. 'The magnitude of 10–40 life-years lost for most of the physical health conditions they investigated is both compelling and concerning.'

Death and suffering are worsened by societal dysfunction: lack of reliable information, lack of understanding, and lack of compassion, resulting in castigation, discrimination, stigma, care-seeking behaviour, imprisonment. Over the coming months HIFA will explore the information needs of the general public, health workers and policymakers in relation to substance use disorders, and how these can be better addresssed.

CITATION: A death by any other name: substance-induced or substance-related mortality

Carsten Hjorthøj, Anne Emilie Stürup, Marie Starzer

The Lancet Psychiatry - Published: November 03, 2022


Tomáš Formánek and colleagues [see citation below] have used the Czech national registers to shed light on the contribution of alcohol and substance use disorders to the risk of mortality following a range of physical health conditions. The scope is impressive, and while the general results of increased mortality are unsurprising, the magnitude of 10–40 life-years lost for most of the physical health conditions they investigated is both compelling and concerning.

Some of this excess mortality can be attributed directly to the use of alcohol and other substances. Direct negative effects have been observed for alcohol and other substances on most organ systems, including the heart, liver, and pancreas. However, several other factors also contribute to the excess mortality. Of the WHO-defined major risk factors for early mortality, tobacco smoking and sedentary lifestyle are overrepresented in populations with substance misuse. Living in deprived areas, living under poor conditions, and social isolation have been linked to excess mortality, and such situations are common for people with substance misuse. Substance misuse is further associated with prejudice and stigma, reducing the likelihood of seeking medical care and of receiving adequate care once contact has been established. Finally, it is also likely that both common and severe mental illness have a role in the excess mortality.

The study by Formánek and colleagues clearly indicates that something needs to be done.

The question becomes what can be done and how... Focus on what drives the initiation and continued misuse of substances is very important... In practice, people whose substance misuse is detected are often castigated not helped. It is not uncommon for people to be expelled from educational institutions or psychiatric treatment facilities for having alcohol or other substance misuse problems. Whether this approach is a manifestation of so-called tough love, to prevent contagion of behaviour that is considered inappropriate, or simply a lack of will or knowledge to deal with these issues, there can be little doubt that it will only exacerbate the problems of the person being sanctioned.

Furthermore, it is extremely unlikely that punishment in the form of fines or imprisonment for substance misuse will have a positive effect on health...

CITATION: Formánek T Krupchanka D Mladá K Winkler P Jones PB

Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia.

Lancet Psychiatry. 2022; (published online Nov 2.)

Best wishes, Neil

Joint Coordinator, HIFA Mental Health: Substance use disorders

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. HIFA is administered by Global Healthcare Information Network, a UK based non-profit in official relations with the World Health Organization.

Twitter: @hifa_org