The EU treat addiction as a behavioural problem to be regulated away, with different policy options per substance. We treat mental health as a separate system with its own referral pathways, its own funding streams, its own policy silo. Yet evidence shows that mental health and addiction are co-occurring phenomena, and that addiction is the same phenomenon no matter what one may be addicted to.
Such an example of the disconnection between our mental health and addiction policies took place very recently. The European Commission published the evaluation of its tobacco control framework since its last revision over a decade ago.
The progress is noticeable, but slow. Smoking prevalence fell from 28% to 24% between 2012 and 2023, and tobacco-related economic costs dropped significantly. But it varies significantly from one category to another. Smoking rates range from 8% to 37% across Member States. The 55+ age group actually saw prevalence increase. We are not there yet, and we should wonder why. What more could be done, what have we missed? It would have been valuable to model the welfare costs of “dual disorders”, meaning the co-occurrence of substance dependence and mental health conditions that disproportionately affects lower-income populations.
The evaluation treats tobacco dependence primarily as a product regulation problem. Tighter rules, higher prices, restricted marketing. These measures are insufficient for a lot of people, as the numbers indicate. Many people have spent decades managing anxiety, depression or economic stress through consumption, no matter the substance or behaviour. Addiction does not disappear because a product becomes less accessible or more expensive. For people with established dependence, particularly those whose mental health is bound up in their substance use, the framework currently offers one pathway: abstinence. Despite progress, more could be done on psychosocial support mechanism, especially from the policy side. This creates a risk to leave the most vulnerable (to poor psycho, socioeconomic living conditions) behind, regardless of how well product regulations are enforced.
We propose three considerations that would make a concrete difference:
Firstly, mainstreaming mental health into all drug-related policies. Member States need guidance and support to integrate psychosocial components into their national plans. Prevention must address the social and psychological drivers of use, not only product availability. This means for example, low-threashold intervention at community-level.
Secondly, providing data for under-measured factors. The Commission should commission systematic research on dual disorders and expand its methodology to capture the full burden of subtance-mental health comorbidity.
Finally, adopting a graduated approach to addiction management. A revised framework should recognise intervention, and not just cessation, as a legitimate policy goal. Structured support pathways for people with established dependence are both more humane and more cost-effective than a one-size-fits-all abstinence model.
For young people specifically, age restrictions and marketing bans need to be complemented by evidence-based psychosocial prevention starting at primary school level. The goal should be reducing uptake at its roots, not just restricting access.
Tobacco is just one case study, but the lesson it illustrates applies across EU health policy: as long as mental health and addiction are designed and evaluated in isolation from one another, or as a single market issue, we may risk failing our long term public health objectives.
