Substance Use Around the World vs. the U.S.: What Can We Learn?
Substance use is a global issue—but how countries handle it varies dramatically. While the United States has long taken a tough-on-drugs approach, many other nations have adopted more lenient, public-health-centered strategies, including legalizing certain substances, lowering drinking ages or decriminalizing personal drug use.
At Silvermist, we believe that understanding how different cultures and governments respond to substance use can help us reflect on our own system’s strengths and shortcomings—and highlight opportunities for improvement in prevention, treatment and recovery.
Substance Use in the United States
The U.S. has some of the strictest drug laws in the world and a minimum drinking age of 21, the highest of any developed country. Despite this:
- The U.S. leads the world in opioid-related overdose deaths
- Alcohol use disorders affect over 29 million Americans
- Recreational marijuana is still illegal federally, though legal in many states
- Many people with substance use disorders face incarceration instead of treatment
This hardline stance has created a complex web of addiction, stigma and limited access to care—leading many experts to examine how other countries have approached the issue differently.
Portugal: Decriminalization & Public Health
In 2001, Portugal decriminalized the possession of all drugs for personal use. Instead of facing jail time, individuals caught with small amounts are referred to a dissuasion commission, which offers education, treatment referrals or fines.
The results:
- Drug-related deaths dropped significantly
- HIV transmission rates declined
- Treatment engagement increased
- Portugal now has one of the lowest drug-related death rates in Europe
Portugal’s success demonstrates how treating addiction as a health issue—not a crime—can lead to better long-term outcomes.
Netherlands: Harm Reduction and Legal Cannabis
The Netherlands is famous for its “coffee shops,” where the sale of cannabis is tolerated. While technically illegal, the Dutch government allows regulated cannabis sales under strict conditions.
They also embrace harm reduction programs, including:
- Safe injection sites
- Needle exchanges
- Opioid substitution therapies
Interestingly, drug use rates in the Netherlands are often lower than in the U.S., despite the perception of a more relaxed drug culture.
Canada: Progressive Cannabis Laws and Supervised Consumption
Canada legalized recreational marijuana nationwide in 2018, becoming the second country in the world to do so. They’ve also embraced supervised consumption sites in major cities, where individuals can use drugs safely under medical supervision to prevent overdoses.
Canada’s public health approach aims to reduce deaths and connect users with addiction services—prioritizing life and safety over punishment.
Germany & Spain: Lower Drinking Ages, Fewer Alcohol Issues
In Germany and Spain, the legal drinking age is 16 or 18, and alcohol is a common part of daily life. However, these countries tend to have lower rates of binge drinking and alcohol-related harm compared to the U.S.
Why? Experts suggest that alcohol is introduced in a more responsible, less taboo environment, where moderation is emphasized and open conversations are more common.
In contrast, the U.S.’s 21+ drinking age may contribute to secretive, high-risk drinking behaviors among teens and college students.
What Can the U.S. Learn?
While every country has unique cultural and political factors, there are valuable lessons the U.S. can take from global approaches:
- Decriminalization can reduce stigma and improve treatment rates
- Public health strategies often outperform criminalization
- Harm reduction saves lives and builds trust with at-risk communities
- Early education and open dialogue may be more effective than abstinence-only messages
- Treating substance use as a health issue—not a moral failing—is essential
Why Recovery Support Still Matters
Even in countries with progressive policies, substance use disorders still exist—and treatment remains a critical part of the solution. At Silvermist, we provide evidence-based care for individuals struggling with addiction, regardless of the substance or background.
Our programs offer:
- Personalized recovery plans
- Aftercare and relapse prevention
- A compassionate, stigma-free environment
Whether you were raised in a culture of strict prohibition or normalized use, healing starts with recognizing the problem and asking for help.
One Problem, Many Paths
Substance use affects every corner of the globe—but the way each country responds makes a world of difference. While no system is perfect, the growing shift toward compassion, education and public health is clear.
If you or someone you love is struggling with substance use, Silvermist is here to help you find your path to lasting recovery—no matter where you’ve been or how the journey started.
Reach out today to learn more about how we’re redefining recovery with care that meets you where you are.
