Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys.
BACKGROUND
Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative.


RESULTS
Household surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People's Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex-cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male-female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use.


CONCLUSIONS
Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation.
Degenhardt
Louisa
L
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia. l.degenhardt@unsw.edu.au
Chiu
Wai-Tat
WT
Sampson
Nancy
N
Kessler
Ronald C
RC
Anthony
James C
JC
Angermeyer
Matthias
M
Bruffaerts
Ronny
R
de Girolamo
Giovanni
G
Gureje
Oye
O
Huang
Yueqin
Y
Karam
Aimee
A
Kostyuchenko
Stanislav
S
Lepine
Jean Pierre
JP
Mora
Maria Elena Medina
ME
Neumark
Yehuda
Y
Ormel
J Hans
JH
Pinto-Meza
Alejandra
A
Posada-Villa
José
J
Stein
Dan J
DJ
Takeshima
Tadashi
T
Wells
J Elisabeth
JE
D000293:Adolescent; D000328:Adult; D019973:Alcohol-Related Disorders / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D002188:Cannabis; D019970:Cocaine-Related Disorders / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D014943:Global Health; D006306:Health Surveys; D006801:Humans; D038622:Internationality; D008297:Male; D002189:Marijuana Abuse / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D008603:Mental Health; D014029:Tobacco Use Disorder / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D014944:World Health Organization