title: Policy implications of marked reversals of population life expectancy caused by substance use.
abstract: BACKGROUND
  Life expectancy has been increasing steadily over the past century in most countries, with only a few exceptions such as during wartimes.
  
  
  CONCLUSIONS
  Marked reversal of life expectancy has been linked to substance use and related policies. Three such examples are discussed herein, namely the double reversal of life expectancy trends (first to positive, then to negative) associated with reducing alcohol supply in the then Union of Soviet Socialist Republics (USSR), followed by a rapid increase in availability; the impact of the rapid increase of prescription opioids on white non-Hispanics in the US; and the systemic impact of the violence accompanying the drug war in Mexico on the life expectancy of men. Alcohol policies were crucial to initiate the positive reversal in the USSR, and different substance use policies could have avoided the negative impacts on life expectancy of the described large groups or nations. Substance use policies can be responsible for abrupt negative changes in life expectancies. An orientation of such policies towards the goals of public health and societal well-being can help avoid such changes.
authors.affiliation: Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, T505, Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.|Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada. jtrehm@gmail.com.|Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.|Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. jtrehm@gmail.com.|PAHO/WHO Collaborating Centre, CAMH, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.|Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. jtrehm@gmail.com.
authors.forename: Jürgen
authors.identifier: http://orcid.org/0000-0001-5665-0385
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, T505, Toronto, ON, M5S 2S1, Canada.|Institute of Health and Society, Newcastle University, Newcastle, NE2 4AX, UK.|School for Public Health and Primary Care, Maastricht University, Maastricht, 6200 MD, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, T505, Toronto, ON, M5S 2S1, Canada.|Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.|Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.|Centre for Criminology and Socio-legal Studies, University of Toronto, 14 Queen's Park Cres. W., Toronto, ON M5S 3K9, Canada.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Fischer
authors.affiliation: Grup de Recerca en Addiccions Clínic, Institut Clínic de Neurosciències, Villarroel, 170, 08036, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, IDIBAPS, Rosselló, 149-153, 08036, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Gual
authors.affiliation: Centre for Alcohol Policy Research, La Trobe University, 215 Franklin St., Melbourne, Victoria, 3000, Australia.|Centre for Social Research on Alcohol and Drugs, Stockholm University, Sveaplan, 106 91, Stockholm, Sweden.|Melbourne School of Population and Global Health, University of Melbourne, Carlton, 207 Bouverie St., Victoria, 3010, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Room
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends; D005260:Female; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009026:Mortality / Q000639:trends*; D011157:Population Dynamics / Q000639:trends*; D019966:Substance-Related Disorders / Q000401:mortality*; D014586:USSR / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality; D055815:Young Adult
keywords: Life expectancy; Marked reversals of trend; Policy; Public health; Substance use