Substance use and social and economic transition: the need for evidence

The transition in the former communist countries of Eastern Europe has had both good and bad consequences for health. Some countries have seen substantial improvements, reflecting changes such as improved diets. Others have seen a sharp increase in mortality, accompanied by growing levels of substance use, in particular alcohol but also drugs. Unlike many common exposures and disease outcomes, such as smoking and lung cancer, research on the impact of substance use on health is difficult. Exposure is not easy to measure and outcomes are diffuse, affecting not only users but those around them. Yet evidence is needed, as a basis for designing effective policies and for advocacy. This paper argues that evidence is available, albeit in sources that are rarely used by academic researchers. They include accounts by journalists and travel writers, who can provide important insights into the scale and meaning of substance use in societies in transition. Their stories show that what is now happening is not unique and other commentators have noted similar phenomena in societies now and in the past in which individuals are pushed to the margins of society, in the state that Durkheim called anomie. As well as the accounts of ordinary people, these sources of information point towards some of the challenges that must be addressed, in particular the deeply embedded corruption in some societies, that allows political leaders to grow rich at the expense of their subjects. The paper concludes that efforts to reduce the health effects of substance use must be embedded in policies that address the underlying causes and which serve to rebuild shattered communities. © 2002 Elsevier Science B.V. All rights reserved.