Stratégie nationale Addictions 2017–2024

Objectives

Switzerland’s National Addiction Strategy for 2017 to 2024, anchored in the Federal Council’s Health2020 framework, provides a coordinated national framework for the Confederation, cantons and other actors to address substance use, addictive behaviours and related risks. It extends the established four-pillar policy of prevention, therapy, harm reduction and law enforcement to all forms of addiction, including alcohol, tobacco, illegal drugs, psychoactive medicines, gambling and excessive internet use.[1][2][3]Its central aims are to prevent addictions, ensure appropriate help and treatment for affected people, reduce health and social harm, and lessen adverse consequences for society.[4][5]

• Promote health, quality of life, health literacy and health-supportive environments so that people can make informed decisions about risks and consequences.[2][6]
• Prevent risky and addictive behaviour through population measures, low-risk behaviour promotion, early detection and early intervention, with particular attention to children and adolescents, people with lower education or incomes, older people and migrants.[7][8][5]
• Provide diversified counselling, treatment, self-help, aftercare and harm-reduction support that is responsive to individual needs and available across psychosocial, medical and psychiatric settings.[9][6][10]
• Reduce premature deaths, overdoses, intoxications, accidents, violence, marginalisation and other health and social harms associated with addiction.[11][12]
• Protect health through regulation of product safety, availability, accessibility, pricing, taxation, advertising and age-based access where relevant, alongside enforcement against illegal production and trade.[6][13]
• Organise work across eight connected fields: health promotion, prevention and early detection; therapy and counselling; risk and harm reduction; regulation and law enforcement; coordination and cooperation; knowledge; awareness and information; and international policy.[14][5]
• Generate evidence for addiction policy, raise awareness among the public and professionals, and represent Swiss interests while exchanging knowledge internationally.[15][16][17]

Implementation

Implementation relies on a partnership model in Switzerland’s federal system: the Confederation, cantons, municipalities, specialist associations, non-governmental organisations, service providers, insurers, public-security bodies and other relevant sectors share responsibilities according to their competences. Measures are intended to use existing legal bases, structures and available resources where possible, and to be coordinated through an action plan so that the eight areas of action are complementary and mutually reinforcing.[18][8][19][20]

• Coordinate addiction policy with the National Strategy for the Prevention of Non-Communicable Diseases and mental-health activities, while incorporating health considerations into social protection, education, employment, taxation, customs, trade and other policy areas influencing health.[21][22][20]
• Strengthen cooperation between addiction-support services and primary care, psychiatry, social services, employment and disability insurance, education, migration services, justice and police, including interdisciplinary treatment networks and coordination between medical, psychosocial and medico-social providers.[23][6][24]
• Deliver prevention and early intervention in schools, municipalities, leisure settings, youth organisations and workplaces, supported by specialist organisations, professional exchanges and workplace health-promotion initiatives.[19][24]
• Provide low-threshold services, contact and support centres, prescribed substitution treatment, hepatitis C prevention and treatment access, alcohol-related support, emergency assistance, social reintegration and pathways into treatment.[9][12]
• Support treatment quality through professional training, continuing education, scientific guidance, self-help, innovative approaches such as brief interventions and motivational interviewing, and the Federal Office of Public Health’s QuaThéDA quality framework, meaning Quality Therapy Drugs Alcohol.[10][25]
• Use regulation and enforcement measures at federal, cantonal and municipal levels, including age-based sales restrictions, alcohol test purchases, smoke-free rules, tobacco-control measures and gambling oversight.[26][27][13][28]
• Establish linked monitoring arrangements drawing on existing data systems, targeted research and regular communication of trends, including emerging consumption patterns, new psychoactive substances, mixed consumption and behavioural addictions.[29][15]
• Review implementation through an interim evaluation scheduled for 2020, with scope to adapt the strategy for its second implementation phase; the supplied material does not specify a consolidated indicator set, reporting timetable or formal accountability framework for the strategy as a whole.[2][20]
• Secure and clarify financing for counselling, treatment and interdisciplinary coordination through existing channels, including solidarity mechanisms such as health, unemployment and disability insurance, the alcohol levy, the cantonal gambling-addiction levy and the Tobacco Prevention Fund; no separate budget total or quantified funding gap is specified.[8][3][20]

Monitoring & Evaluation

The strategy envisages an evidence-informed monitoring and evaluation system spanning addiction prevalence, behaviours, treatment demand, health outcomes, mortality, social consequences, legal implementation and emerging markets. It provides for an interim evaluation in 2020, with adaptation for the second implementation phase if required.[14][2][20]

• Establish a monitoring system that links existing data systems, commissions research to address knowledge gaps, supports dialogue between research and practice, and communicates significant trends to partners and the public.[15]
• Monitor consumption methods and trends, affected groups, legal and illegal markets, mixed consumption, illegal drugs, new psychoactive substances, gambling and internet-related addictions.[29]
• Use prevalence, mortality, hospital data, treatment admissions, service use, police reports, gambling exclusions and trend data as evidence sources.[30][31][32][33][34]
• Assess regulatory implementation and public-health effects through mechanisms including alcohol test purchases, tobacco and alcohol regulatory maps, studies of night-time alcohol-sale restrictions and smoke-free legislation, and Federal Gaming Board oversight of casino social-protection measures.[13][28][27]
• Evaluate strategy measures using monitoring and enable comparison with other European countries through the European Monitoring Centre for Drugs and Drug Addiction.[15]
• Support quality improvement through professional exchange, training, scientific guidance and the Federal Office of Public Health’s QuaThéDA quality framework, meaning Quality Therapy Drugs Alcohol.[24][10]

Available evidence includes major health and social harms, such as annual tobacco-related deaths, alcohol-related deaths, drug-overdose deaths, hospital diagnoses, treatment activity and hepatitis C prevalence among users of low-threshold institutions.[11][35][36][33]Data limitations are recognised: act-info treatment-entry data do not cover every admission, survey tools have limited value for illegal-substance data, and some indicators, including data on lysergic acid diethylamide treatment, are unavailable.[37][38][33]The supplied material does not set out a consolidated quantitative indicator set, routine reporting timetable or overarching formal accountability framework beyond legal oversight, regulatory monitoring, policy-impact studies and the planned interim review.[13][28][15][20]

Costing & Financing

The strategy seeks to sustain financing for prevention, harm reduction, counselling and treatment, including interdisciplinary treatment networks and coordination services. A measure plan was intended to identify required resources, financing by participating actors, responsibilities and timing, while implementation was expected to use existing structures and available resources.[4][7][6][20]

• Use solidarity mechanisms, including health, unemployment and disability insurance, to support people affected by addiction.[2][8][5]
• Clarify financing arrangements for coordination between medical, psychiatric, medico-social and psychosocial providers, particularly within interdisciplinary treatment networks.[6][10]
• Align public funding channels, including the alcohol levy, cantonal gambling-addiction levy and Tobacco Prevention Fund, with the addiction and non-communicable disease strategies.[3][20]
• Recognise the substantial societal burden of addiction, including direct healthcare expenditure, wider economic losses and productivity losses.[1][36][39]

Reported annual costs include approximately 4.2 billion Swiss francs for alcohol, tobacco-related medical and work-related costs totalling 5.6 billion Swiss francs, approximately 4.1 billion Swiss francs for illegal drugs in 2005, and between 550 million and 650 million Swiss francs for gambling addiction.[39]Direct costs of addictions and risk behaviours are estimated at more than 2.5 billion Swiss francs annually, with further economic and societal costs amounting to several billion Swiss francs.[36]The material identifies no dedicated programme budget, allocation by activity, quantified financing gap, costed resource-mobilisation plan or economic assumptions for implementation.[4][20]