There are variances between cultures relative to the view of self-prescribed substance use, the conditions under which it is used and viewed as abusive/problematic, views toward its relationship to health care and its role relationship to the justice system, views about what, if any, penalties and punishments should and are applied to users, etc.

The sociologists, anthropologists and ethicists can speak to these variable much more eloquently than can I, but I can offer that in nursing, one part of establishing and sustaining therapeutic relationships with patients is built upon assessing and remaining sensitive to cultural beliefs, values and attitudes as they impact health-seeking and health protective/choice behaviors.

http://www.physorg.com/search/?search=neurobiology+addiction

PhysOrg is a science wire service, and you can read for yourself the very real biological and neuroscience research and evidence about addiction to various substances.

GHF is a service of the Kaiser Network (the independent health policy arm of the Kaiser Health Foundation). It allows for the creating of country comparison charts on various health indicators. I created one for the US, Portugal, Brazil, Mexico and Canada if anyone is interested. The data are from 2007, so the current recession/depression/global economic crises data are not reflected.

http://tinyurl.com/b78g8n

A link to the Global Health Reporting website of Kaiser is at my name.

The Commonwealth Fund is an independent health policy organization. It has a website feature called the Chart Cart which allows access and retrieval of Fund produced charts and graphs. Link at my name.

There are a lot of resources there to do comparisons between Portugal and the US on a variety of health measures (cost, access, legislation, life expectancy, morbidity and mortality rates, patient outcomes, etc.).

In performing a casual search, on many measures, Portugal and the US are ranked almost identically, and so Glenn's choice of this country to study provides a potentially highly reliable and valid country for comparison.

http://www.commonwealthfund.org/Charts-and-Maps/ChartCart.aspx

http://www.commonwealthfund.org/Charts-and-Maps/Performance-Snapshots.aspx

Thank you for investigating and reporting on this. It brings up so many interesting questions about US health policy:

What similarities and differences are there between Portuguese and US culture around health beliefs and self-care behaviors?

To what extent is the drug use as included in the study a result of attempts at self medication?

To what extent is drug use as presented in the EU graph correlated with overall national indicators of overall health?

Is incarceration used as a vehicle by which to obtain psychiatric and mental health/addiction services in Portugal as it is in the US? (over50% of all inpatient psychiatric care is delivered in prisons, and mental health courts are springing up as ways to segregate people with mental illness in courts instead of affected people who cannot access mental health care and treatment being provided with health care in health care settings by health care providers)

Has anyone investigated how the Portuguese program and approach may be adapted for use in the US, where multi cultural needs might create different requirements for use?

Thank you for writing your comment. I used to blog about the critical role that nurses provide in assuring adequate health care to service members and veterans. I also wrote about the use of nurses as agents of abuse and torture by the uniformed services. Yesterday in Glenn Greenwald's column comments section, I wrote several comments which may serve as a synopsis. They may be of use to you and others who would like to pursue charges/action against licensed healthcare providers who are neglecting patients or committing malpractice. (You can find them by clicking on the "read other letters by Nequals1" link under my name)

There are diagnostic criteria for PTSD and complex PTSD, and there are treatments which have varying degrees of success for them both. Withholding treatment and intentionally making wrong diagnoses are acts of malpractice, and they should be investigated and acted upon as such.