Substance Use or Abuse a Public Health Issue

In 1849, French writer Jean-Baptiste Alphonse Karr wrote “plus ça change, plus c'est la même chose,” which translates to “the more things change, the more they stay the same.”

For Decades the National Council on Substance Abuse (NCSA) has been advocating for Substance use/abuse to be seen as a public health issue and not a criminal justice issue. Drug use itself should be considered a disease, not a crime. Substance Use is defined as: ‘Substance use is any consumption of alcohol or drugs. Something as commonplace as having a beer with friends during dinner is considered substance use. Substance use may not be a problem or lead to abuse or dependency in some people.’ Substance Abuse is defined as: ‘Substance abuse is when someone continues to use drugs or alcohol even when it causes problems, such as trouble with work, family, or their health. For instance, continuing to use drugs knowing you’ll be fired if you fail a drug test is a sign of abuse.’ 

According to an article published by the (University of Nevada, ND), ‘A public health problem, is a medical issue that affects a significant portion of a specific population. Some examples include chronic illnesses like Type 2 diabetes, infectious diseases such as HIV and tuberculosis, mental health challenges, and even motor vehicle accidents.’ These issues include but is not limited to obesity, drug abuse, teenage anxiety, and senior mental health. 

Traditionally, drug use and abuse have been viewed largely as a criminal justice issue. To combat this activity, traditionally we have used the heavy hand of the law with members of the Barbados Police Service raiding these so-called blocks and arresting persons for breaches of the law. These breaches would include possession of marijuana and others such offences.  As soon as the police leave these aeras the activities continue along with the vicious cycle. Is this approach working?  However, in modern Barbados, on every street corner we can see a group of young men and women gathering (a block) engaging in substance use or abuse. These substances are mainly marijuana or alcohol. What we are seeing is consistent with the NCSA’s Barbados Drug Information Network Report (BARDIN,2020) with marijuana, alcohol and cocaine being reported as the substances for problematic substances use locally. 

Research has shown that the’ War on Drugs’ have resulted in more resources being poured into drug trafficking interdiction and jail time for drug offenders than into treatment and rehabilitation.  The NCSA’s ( BARDIN, 2020) Report stated, ‘incarceration was $32,000 per inmate per year (Ellis, 2020) and 89 inmates were incarcerated for drug offences in 2020. Therefore, the annual cost for incarceration for all drug offenders in 2020 is approximately $2,848,000.00.’ The report went on to state that, ‘the Substance Abuse Foundation had 110 clients in 2020. The approximate cost of this primary treatment is $15,030.00 per client which resulted in a total of $1,653,300.00 for care of 110 clients. The government assumes approximately $9450.00 of the $15,030.00 for each client. Therefore, the government spends $1,039,500.00 for 110 clients.’ 

The facts are clear for all to see, it is cheaper for the government to focus on treatment and rehabilitation than to incarcerate its citizens. Drug abuse should be treated as a public health issue. However, this would call for a paradigm shift resulting in redirecting resources currently used for law enforcement. Access to treatment will have to be vastly expanded.  In addition, legislation must be amended to reflect the change in perspective.  It must also be noted anecdotal reports suggest that health care providers tend to overlook or ignore signs of drug and alcohol abuse in their patients. This must also be addressed. Last but not least, more research needs to be done to increase the understanding of the biology, psychology and sociology of drug abuse with a view to develop evidence-based interventions.  

In closing, a public health-based approach will address the broad individual, environmental and societal factors that influence substance misuse and its consequences, to improve the health, safety, and well-being of the entire population.

The NCSA remains committed to giving you the facts and letting you make the choice. If you or someone you know needs help with substance use or need additional information about a drug, feel free to contact us at the National Council on Substance Abuse at telephone (246) 535-6272 or visit our website at