酒精与健康以及物质使用障碍治疗问题全球现状报告（英）-334正式版-WN8

Globalstatusreport

onalcoholandhealthandtreatment

ofsubstanceusedisorders

Globalstatusreport

onalcoholandhealthandtreatment

ofsubstanceusedisorders

Globalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisorders

ISBN978-92-4-009674-5(electronicversion)

ISBN978-92-4-009675-2(printversion)

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Content

Foreword.....................................................................................................iv

Acknowledgements.........................................................................................v

Abbreviations..............................................................................................viii

Executivesummary........................................................................................xi

Introduction...............................................................................................xvii

1.Psychoactivesubstanceuse,healthanddevelopment...........................................1

2.Alcoholconsumption,alcohol-relatedharmandpolicyresponses............................23

2.1Globalstatusandtrendsinalcoholconsumption(SDG3.5.2indicator)....................26

2.2Globalstatusandtrendsinthehealthconsequencesofalcoholconsumption............43

2.3Alcoholpolicies....................................................................................64

3.Strengtheningtreatmentforsubstanceusedisorders:towardsuniversal

healthcoverage.........................................................................................79

3.1Treatmentofsubstanceusedisorders..........................................................82

3.2TreatmentcoverageandServiceCapacityIndex(SCI)forsubstanceusedisorders.....105

4.Conclusions:towardsattainmentofSDGhealthtarget3.5...................................119

Annexes....................................................................................................129

Annex1.Datasourcesandmethods...............................................................131

Annex2.Statisticalannexonalcoholandhealth.................................................165

Annex3.Statisticalannexontreatmentofsubstanceusedisorders...........................244

Annex4.Estimatesofdrug-attributablediseaseburden........................................294

References.................................................................................................297

iii

Foreword

Psychoactivesubstanceuse,includingdrugsandproductscontaining

alcohol,carriesasignificanthealthandsocialburden.In2019alone,

alcoholcaused2.6milliondeathsworldwide,andpsychoactive

drugsaccountedfornearly600000deaths.Psychoactivesubstance

usealsoresultsinnegativesocialandeconomicconsequencesfor

communities.Assuch,theimpactofsubstanceuseonhealthand

developmentisrecognizedinthe2030AgendaforSustainable

Development,throughSustainableDevelopmentGoals(SDG)health

target3.5,whichcallsforthestrengthenedpreventionofsubstance

useandtreatmentofsubstanceusedisorders.

DrTedrosAdhanomGhebreyesus

Director-General

WorldHealthOrganization

Thisreportpresentsacomprehensiveglobalupdateonthestatusandprogressaroundthetwo

keyindicatorssetoutinSDGhealthtarget3.5:alcoholconsumptionandtreatmentcoveragefor

substanceusedisorders.Itsetsouteightpriorityareaswhereactionneedstobetaken.

Despitesomereductioninalcoholconsumptionandrelatedharmworldwidesince2010,the

healthandsocialburdenduetoalcoholuseremainsunacceptablyhigh.Youngerpeopleare

disproportionatelyaffectedbyalcoholconsumption:thehighestproportionofalcoholattributable

deaths–13%–in2019wasamongpeopleaged20-39years.

Whilewehaveseenaslightincreaseinthenumberofcountriesadoptingnationalalcoholpolicies,

littleprogresshasbeenmadeinimplementingthehigh-impactpolicyinterventionsprovento

reducealcohol-relatedharm,suchasimpactfulpricingpoliciesorcomprehensivemarketingand

availabilityrestrictions.TheWHOGlobalalcoholactionplan2022-2030setsoutthese‘bestbuys’and

supportscountriestostrengthenactionsonreducingalcohol-relatedharms,butimplementation

effortsmustbesteppedupurgently.

Thereportalsohighlightsanothercriticalgap:accesstoqualityandethicaltreatmentforsubstance

usedisordersisstilllargelylimitedorunaffordableforthosemostinneed.Thisaffectsalmosthalf

abillionofpeopleworldwidewholivewithalcoholordrugusedisorders.Stigma,discrimination

andmisconceptionsabouttheefficacyoftreatmentcontributetogapsinhealthservicesandlow

prioritizationofsubstanceusedisordersbyhealthanddevelopmentagencies.

WearenotontracktoachievesignificantprogressforSDGtarget3.5unlessweaccelerateaction

now.WHOremainscommittedtoworkingwithgovernments,internationalpartners,civilsociety

organizationsand,asappropriate,otherstakeholderstomakerealandmeasurableprogress

towardsthesetargets.Giventheheavyhealthandsocialburdenthatpsychoactivesubstanceuse

continuestohaveonpeople,theirfamiliesandcommunitiesacrosstheworld,effortstoreduce

psychoactivesubstanceusemustbeapublichealthpriority.

iv

Acknowledgements

ThisreportwaspreparedbytheAlcohol,DrugsandAddictiveBehavioursUnit(ADA)inthe

DepartmentofMentalHealth,BrainHealthandSubstanceUse(MSD)oftheWorldHealth

Organization(WHO),Geneva,Switzerland.Thereportwasconceptualizedby,anddeveloped

undertheoverallguidanceof,DévoraKestel(Director,MSD)andVladimirPoznyak(UnitHead,

ADA)withintheframeworkofWHOactivitiesonglobalmonitoringtoinformprogresstowards

achievementofSustainableDevelopmentGoal(SDG)healthtarget3.5andimplementationof

theGlobalstrategytoreducetheharmfuluseofalcohol.Thedevelopmentofthisreportislinked

toWHO’sworkontheglobalinformationsystemsonalcoholandhealthandresourcesforthe

preventionandtreatmentofsubstanceusedisorders.

WithinWHO’ssecretariat,MinghuiRenattheinitialstageandsubsequentlyJérômeSalomon

providedguidanceandsupporttotheprojectintheirconsecutiverolesasAssistantDirector-

General,UniversalHealthCoverage/CommunicableandNoncommunicableDiseases(UCN).

ProductionofthisreportwasledbyVladimirPoznyakwhoalsoservedasanexecutiveeditorof

thereport.TheWHOstaffinvolvedindevelopmentandproductionofthereportwere:Alexandra

Fleischmann,DzmitryKrupchankaandDagRekveoftheADAunitatWHOheadquartersinGeneva.

IlincaRaduandJiangLongcontributedtothedatacollection,compilationandproductionofthe

reportintheircapacityasconsultants.JuanTellooftheWHODepartmentofHealthPromotion

providedtechnicalinputtothedevelopmentofthechapteronalcoholandhealth.BochenCao,

HaidongWang,JessicaHoandAnnetMahananioftheWHODivisionofData,Analytics&Delivery

forImpact(DDI)contributedtotheestimatesofalcohol-anddrug-attributablediseaseburdenand

providedtechnicalinputatdifferentstagesofthereport’sdevelopment.Estimatesofdrug-attributable

diseaseburdenwereproducedbyColinMathers.LeanneRiley,ReginaGutholdandMelanieCowanof

WHO’sNoncommunicableDiseasesDepartmentprovideddatafromtheWHO-supportedsurveysand

technicalinputtothereport.KtFriarandCameronDenneyoftheDDIdivisioncreatedthemapsused

inthereport,andPhilippeBoucher,ZoeBrillantesandJovenLarinofthesamedivisionweretechnical

counterpartsfromtheGlobalHealthObservatoryforupdatingtheglobalinformationsystems.

Fortheirsignificantcontributionstoindividualchaptersandannexesweacknowledgethe

following:

Chapter1:RobinRoom,MeganCook,Anne-MarieLaslett,ThomasBabor,VladimirPoznyak.

Chapter2:JürgenRehm,KevinShield,DavidJernigan,PamelaTrangenstein,DagRekve,Vladimir

Poznyak.

Chapter3:DzmitryKrupchanka,TomasFormanek,ThomasBabor,VladimirPoznyak.

Chapter4:VladimirPoznyak,MaristelaGoldnadelMonteiro,DavidBramley.

Annexes:KevinShield,PamelaTrangenstein,AlexandraFleischmann,DzmitryKrupchanka,

IlincaRadu.

v

Globalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisorders

ThecollectionofdatawithintheframeworkoftheWHOglobalsurveyonprogressonSDGhealth

target3.5andthedevelopmentofthisreportwasundertakenincollaborationwiththesixWHO

regionalofficesandWHOcountryoffices.Keycontributorstothedatacollectionandcompilation

intheWHOregionalofficeswere:

WHOAfricanRegion:FlorenceBaingana

WHORegionoftheAmericas:MaristelaGoldnadelMonteiro,SohiIvneet

WHOEasternMediterraneanRegion:KhalidSaeed,WafaaElsawi

WHOEuropeanRegion:CarinaFerreira-Borges,SergeyBychkov,MariaNeufeld

WHOSouth-EastAsiaRegion:NazneenAnwar

WHOWesternPacificRegion:MartinVandendyck,CarolineLukaszyk,KiraFortune,Amy

Bestman.

ThefollowingcolleaguesfromtheWHOregionalofficesprovidedtechnicalinputatdifferent

stagesoftheprojectdevelopment:FlorenceBainganaandChidoRatidzaiRwafaMadzvamutse

(AfricanRegion),RenatoOliveiraandMarioZapata(RegionoftheAmericas/PanAmericanHealth

Organization),KhalidSaeedandDaliaElasi(EasternMediterraneanRegion),CarinaFerreira-

BorgesandMariaNeufeld(EuropeanRegion),AndreaBruni(South-EastAsiaRegion),Martin

Vandendyck,XiYinandDanFang(WesternPacificRegion).

Technicaladviceandreviewsduringtheprocessofdevelopmentofthedatacollectiontooland

productionoftheestimatesincludedinthisreportwereprovidedbymembersoftheTechnical

AdvisoryGrouponAlcoholandDrugEpidemiology,includingSawitriAssanangkornchai,Prince

ofSongklaUniversity,Songkla,Thailand;GuilhermeBorges,NationalInstituteofPsychiatry,

MexicoCity,Mexico;LouisaDegenhardt,NationalDrugandAlcoholResearchCentre,Universityof

SouthWales,Sydney,Australia;GerhardGmel,UniversityHospitalCentre,Lausanne,Switzerland;

GopalakrishnaGururaj,NationalInstituteofMentalHealthandNeurosciences(NIMHANS),

Bangalore,India;WeiHao,MentalHealthInstitute,CentralSouthUniversity,Changsha,China;

MatthewHickman,UniversityofBristol,Bristol,UnitedKingdomofGreatBritainandNorthern

Ireland;SusumuHiguchi,KurihamaMedicalandAddictionCenter,Kanagawa,Japan;PiaMäkelä,

FinnishInstituteforHealthandWelfare(THL),Helsinki,Finland;IsidoreObot,CentreforResearch

andInformationonSubstanceAbuse(CRISA),UniversityofUyo,Uyo,Nigeria;CharlesParry,

MentalHealth,Alcohol,SubstanceUseandTobaccoResearchUnit(MASTRU),SouthAfrican

MedicalResearchCouncil,CapeTown,SouthAfrica;FlavioPechansky,CenterforDrugand

AlcoholResearch,FederalUniversityofRioGrandedoSul,PortoAlegre,Brazil;AfarinRahimi-

Movaghar,IranianNationalCenterforAddictionStudies,TehranUniversityofMedicalSciences,

Tehran,IslamicRepublicofIran;JürgenRehm,CentreforAddictionandMentalHealth(CAMH),

Toronto,Canada;IngeborgRossow,NorwegianInstituteofPublicHealth,Oslo,Norway;Emanuele

Scafato,NationalCentreonAddictionsandDoping,Rome,Italy;TimStockwell,CanadianInstitute

forSubstanceUseResearch,UniversityofVictoria,Victoria,Canada;JallalToufiq,Moroccan

ObservatoryonDrugsandAddictions,RabatFacultyofMedicine,Rabat,Morocco.

Technicaladviceandinputtothedevelopmentofthereportanditskeymessageswereprovided

bytheeditorialgroupthatincludedHamadAlGhaferi,SchoolofHealthandEnvironmental

Studies,HamdanBinMohammedSmartUniversity,Dubai,UnitedArabEmirates;Sawitri

Assanangkornchai,PrinceofSongklaUniversity,Songkla,Thailand;ThomasBabor,University

ofConnecticutSchoolofMedicine,Connecticut,UnitedStatesofAmerica;ColinDrummond,

NationalAddictionCentre,InstituteofPsychiatry,PsychologyandNeuroscience,King’sCollege

vi

Acknowledgements

London,London,UnitedKingdomofGreatBritainandNorthernIreland;WeiHao,MentalHealth

Institute,CentralSouthUniversity,Changsha,China;DavidJernigan,BostonUniversitySchoolof

MentalHealth,Boston,UnitedStatesofAmerica;EvgenyKrupitsky,BekhterevNationalMedical

ResearchCentreforPsychiatryandNeurology,St.Petersburg,RussianFederation;Nazarius

MbonaTumwesigye,SchoolofPublicHealth,MakerereUniversity,Kampala,Uganda;Maria

ElenaMedina-Mora,NationalInstituteofPsychiatry,MexicoCity,Mexico;NeoMorojele,Faculty

ofHumanities,UniversityofJohannesburg,Johannesburg,SouthAfrica;JacekMoskalewicz,

InstituteofPsychiatryandNeurology,Warsaw,Poland;PratimaMurthy,NationalInstituteof

MentalHealthandNeurosciences(NIMHANS),Bangalore,India;JürgenRehm,CentreforAddiction

andMentalHealth(CAMH),Toronto,Canada;RobinRoom,LaTrobeUniversity,Melbourne,

Australia;KevinShield,CentreforAddictionandMentalHealth(CAMH),Toronto,Canada.

Preparationoftheestimatesonalcoholconsumptionandalcohol-attributablediseaseburden

includedinthereportwasacollaborativeeffortoftheADAunitintheWHODepartmentofMental

HealthandSubstanceUsewiththeCentreforAddictionandMentalHealth(CAMH),Toronto,

Canada.ParticularthanksareduetoKevinShield,JürgenRehm,AshleyWhettlauferandAri

Franklin.

AngelaMe,ChloeCharpentier,HernanEpsteinandKamranNiazofthefromResearchand

TrendAnalysisBranchandGiovannaCampelloandAnjaBussefromthePrevention,Treatment

&RehabilitationSectionoftheUnitedNationsOfficeonDrugsandCrime(UNODC)provided

technicalinputtothechapterontreatmentforsubstanceusedisorders.

ThereportwouldnothavebeenpossiblewithoutthecontributionsoftheWHOMemberStates

nationalcounterpartsforimplementationoftheGlobalstrategytoreducetheharmfuluseof

alcoholandthecountryfocalpointsnominatedforparticipationintheWHOsurveyonprogress

onSDGhealthtarget3.5whoprovidedcountry-leveldataandotherrelevantinformationon

alcoholconsumption,alcohol-relatedharm,policyresponsesandservicecapacityfortreatment

ofsubstanceusedisorders.WHOextendsitsgratitudetoallcontributorsandreviewersnot

otherwisestated.

WHOinternswhocontributedtotheprocessofdatacollectionandcompilationinclude:Sibella

Breidahl,RuchikaJain,LinmiaoJiang,AanisahKhanzadaJiang.

Finally,WHOgratefullyacknowledgesthefinancialsupportoftheNationalRehabilitationCentre

inAbuDhabi(UAE)andtheGovernmentofNorwayforthedevelopmentandproductionofthis

report.

vii

Abbreviations

15+Populationofthoseaged15yearsandolder

AAFAlcohol-attributablefraction

ABVAlcoholbyvolumeADAlcoholdependenceADH1BAlcoholdehydrogenase1B

AFRWHOAfricanRegion

AFROWHORegionalOfficeforAfrica

AIDSAcquiredimmunodeficiencysyndrome

ALDAlcoholicliverdisease

AMRWHORegionoftheAmericas

AMRO/PAHOWHORegionalOfficeforAmericas/PanAmericanHealthOrganization

APCAlcoholpercapitaconsumptionARBDAlcohol-relatedbirthdefects

ARIMAAutoregressiveintegratedmovingaverage

ARNDAlcohol-relatedneurodevelopmentaldisorder

ASDRAge-standardizeddeathrate

ASSISTAlcohol,SmokingandSubstanceInvolvementScreeningTest

AUDAlcoholusedisorder

AUDITAlcoholUseDisordersIdentificationTest

BACBloodalcoholconcentration

BMIBodymassindex

BrACBreathalcoholconcentration

CAMHCentreforAddictionandMentalHealth

CBTCognitive-behaviouraltherapy

CEACost-effectivenessanalysisCIConfidenceinterval

CMContingencymanagement

CVDCardiovasculardisease

DALYDisability-adjustedlifeyear

EMRWHOEasternMediterraneanRegion

viii

Abbreviations

EMROWHORegionalOfficefortheEasternMediterranean

EURWHOEuropeanRegion

EUROWHORegionalOfficeforEurope

ESPADEuropeanSchoolSurveyProjectonAlcoholandOtherDrugs

FAOFoodandAgricultureOrganizationoftheUnitedNations

FAOSTATFoodandAgricultureOrganizationoftheUnitedNations(FAO)statisticaldatabase

FASFetalalcoholsyndrome

FASDFetalalcoholspectrumdisorder

GBDGlobalburdenofdiseaseGDPGrossdomesticproduct

GENACISGender,alcohol,andculture:aninternationalstudy

GHEGlobalhealthestimatesGHOGlobalhealthobservatory

GISAHWHOglobalinformationsystemonalcoholandhealth

GNIGrossnationalincome

GSHSGlobalschool-basedstudenthealthsurveys

GSRAHGlobalstatusreportonalcoholandhealth

HAARTHighlyactiveantiretroviraltherapy

HCDHeavycontinuousdrinking

HCVHepatitisCvirus

HEDHeavyepisodicdrinking

HIVHumanimmunodeficiencyvirus

IARCInternationalAgencyforResearchonCancer

ICDInternationalClassificationofDiseases

IHMEInstituteforHealthMetricsandEvaluation

IHRInternationalHealthRegulations

INCBInternationalNarcoticsControlBoard

IWSRInternationalWineandSpiritsResearch

LMICLowandmiddle-incomecountries

MDGsMillenniumDevelopmentGoals

METMotivationalenhancementtherapy

MVAMotorvehicleaccidentsNCDNoncommunicablediseaseNGONon-governmentalorganization

ix

Globalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisorders

NSPNeedleandsyringeprogramme

OIVOrganisationInternationaledelaVigneetduVin

OAMTOpioidagonistmaintenancetreatment

PAFPopulation-attributablefraction

pFASPartialfetalalcoholsyndrome

PPPPurchasingpowerparity

RBSResponsiblebeverageservice

RRRelativerisk

SACUSouthernAfricanCustomsUnion

SAMHSASubstanceAbuseandMentalHealthServicesAdministration

SCIServicecapacityindex

SDGsSustainableDevelopmentGoals

SEARWHOSouth-EastAsiaRegion

SEAROWHORegionalOfficeforSouth-EastAsia

SESSocioeconomicstatus

STDsSexuallytransmitteddiseases

STIsSexuallytransmittedinfections

STEPSSTEP-wiseapproachtosurveillance

SUDSubstanceusedisorder

TBTuberculosis

UIUncertaintyintervals

UNUnitedNations

UNODCUnitedNationsOfficeonDrugsandCrime

UNWTOWorldTourismOrganization

USDUSdollar

WHAWorldHealthAssemblyWHOWorldHealthOrganization

WIWineInstitute

WPRWHOWesternPacificRegion

WPROWHORegionalOfficeforWesternPacific

YLDYearsoflifewithdisability

YLLYearsoflifelost

x

Executivesummary

Chapter1.Psychoactivesubstanceuse,healthanddevelopment

Inviewoftheparticularpropertiesofpsychoactivesubstancesandtheirimpactonhealth

anddevelopment,mostpsychoactivesubstancesrequirespecialprovisionsforregulationof

theirproduction,distribution,marketinganduse.

Theimpactofpsychoactivesubstanceuseonhealthanddevelopmentisdeterminedby

multiplesocioeconomic,psychosocialandbiologicalfactorswhichneedtobeaddressedin

effectiveprevention,treatmentandharmreductionstrategiesandinterventions.

Theimpactofalcohol,tobaccoandpsychoactivedruguseonthehealthoftheworld’s

populationisunacceptablyhighbyanymetric,andfortheworkingagepopulationitexceeds

theimpactofanyotherriskfactor.

Thereisacomplexrelationshipbetweensubstanceuse,alcohol-anddrug-relatedharmsand

socioeconomicstatus,andpeoplewithlowersocioeconomicstatusaredisproportionally

affectedbyharmsduetosubstanceuse.

Substanceusehasasignificantimpactonmentalhealth,andsubstanceusedisorder

co-occurwithmentalhealthconditionsandworsentheirhealthoutcomes,includingall-cause

prematuremortalityaswellasmortalityduetosuicides.

Substanceusehasasignificantimpactonthedevelopmentandoutcomesofanumberof

majornoncommunicablediseases,andtheglobalimpactofpsychoactivedrugsandsubstance

usedisordersonnoncommunicablediseaseshastobefurtherexploredanddocumented.

InjectingdrugusecontinuestobeanimportantdriverofepidemicsofHIVandviralhepatitis

insomepopulations,andsubstanceuseandsubstanceusedisordersareassociatedwithan

increasedriskofacquiringinfectionsandwithnegativeeffectsontreatmentoutcomes.

Substanceuseandsubstanceusedisordersaremajorcontributorstovarioustypesofinjuries,

includingtraffic-andviolence-relatedinjuries.Reducingthenumberofglobaldeathsdueto

injuriesrequiresimplementationofeffectivestrategiesandinterventionstopreventinjuries

associatedwithalcoholanddruguse.

Commercialdeterminantsofsubstanceusehavetobeaddressedasapartofcomprehensive

policyresponsestoreducethenegativeimpactofpsychoactivesubstanceuseonhealthand

developmentinpopulations.

Chapter2.Alcoholconsumption,alcohol-relatedharmandpolicyresponses

Alcoholconsumption

Totalalcoholpercapitaconsumptionintheworldpopulationdecreasedslightlyfrom5.7litres

in2010to5.5litresin2019(relativereductionof4.5%)withthehighestlevelsofpercapita

consumptionin2019intheWHOEuropeanRegion(9.2litres)andtheRegionofAmericas(7.5

litres).

xi

Globalstatusreportonalcoholandhealthandtreatmentofsubstanceusedisorders

TheCOVID-19pandemichadasignificantimpactonglobalalcoholconsumption,withan

estimated10%relativereductionfrom2019to2020butwithdifferent,andsometimes

opposite,impactsindifferentcountriesandpopulationgroups.

In201956%oftheworld’spopulationaged15+abstainedfromdrinkingalcohol–thenumbers

ofdrinkersandabstainersintheworldarerelativelystableovertime.

Thelevelofalcoholconsumptionpercapitaamongdrinkersamountsonaverageto27grams

ofpurealcoholperday,whichisassociatedwithappreciablyincreasedrisksofnumerous

healthconditionsandassociatedmortalityanddisability.

In2019,17%ofpeopleaged15+yearsand38%ofcurrentdrinkersengagedinheavyepisodic

drinkingor“bingedrinking”(consumingatleast60gofpurealcoholononeormoreoccasions

inthelastmonth),whilecontinuousheavydrinkingwashighlyprevalent(6.7%)amongmen.

Trendsintotalalcoholpercapitaconsumption(APC)differbetweenWHOregionswitha

substantialdecreaseinEuropeandamarkedincreaseinAPCinSouth-EastAsiasince2000.

InallWHOregionsgenderdifferencesinalcoholconsumptionaresignificantwithnomajor

changesovertimeglobally.

In201