Patterns and bio-psycho-social issues of tobacco and alcohol use: implications for research and prevention.

Abstract

Substance use is as old as mankind. Humans have always used various types of substances, probably as part of their evolutionary and nutritional heritage. Alcohol and tobacco can be considered as the most dangerous substances used by people across the world and Sri Lanka is no exception (1-3), and the use of the two substances has become a serious and a growing public health issue in Sri Lanka. The poorest population groups in poor nations are found to be the most affected victims of the two habits (3, 4). The dangers of alcohol and tobacco use are not confined only to their adverse health effects, socio-t:conomic and ecological consequences of the use of the two substances have even greater adverse effects on the humans (2-7). Clear understanding of the dangers of tobacco and alcohol use has led many countries in the world to put alcohol and tobaccci use prevention and research at the top of their country development agendas (8, 9). In the recent past, the government of Sri Lanka and many other non­ governmental organizations operating in Sri Lanka made numerous efforts to control the use of the two substances aiming at minimizing the harm associated with the two substances. However, many such programs were not based on baseline data and need assessments, and have not been evaluated in a scientific manner to identify strengths and weaknesses. One reason for not using baseline substance use data by program planners in developing preventive strategies is non-availability of such information in the country. Thus, there has been a long felt need to understand consumption patterns of and factors associated with tobacco and alcohol use among people in Sri Lanka to formulate effective policies and prevention strategies to curb this menace. I have been working in the field of substance use prevention and research for more than 20 years and was able to establish research links with several foreign institutions in the recent past to get their support to improve the quality of substance usIndiana University, USA to study addictive behaviors, and in 2006, another research lint was established with Duke University, USA to study behaviora patterns of people in Southern Sri Lanka. In this presentation, I will discuss briefly (a) the epidemiological aspects of alcohol arid tobacco use in the world, (b) the patterns of alcoho and tobacco use in Southern Sri Lanka, (c) bio-psycho-social issues relat d to consumption of the two substances and finally (d) methodological issues and implications for prevention and research. My presentation is based mainly on the results of the research studies that I hfiVe conducted in collaboration with the two universities in the USA. Boards for the protection of human subjects of the universities in the United States and Sri Lanka approved the protocols of these research programs.