Addiction-related problems in Japan: A regional perspective

Japan's addiction landscape appears paradoxical. The lifetime use of illicit drugs is among the lowest in Organisation for Economic Cooperation and Development countries, but harm from alcohol, tobacco, and gambling ranks among the world's highest. Historically, methamphetamine accounted for the majority of drug-related offenses, but the number of people who were apprehended for cannabis offenses in 2023 exceeded the number who were apprehended for stimulants for the first time since 1958. Nevertheless, the lifetime prevalence of illicit drug use among adults remains under ~3%. In contrast, heavy drinking among working-age men, decades of tobacco consumption, and rapid digitalization that has more recently led to a surge in online gambling and gaming disorder have imposed a substantial disease burden. The present review discusses Japan's epidemiology, social impact, policy changes, prevention, and treatment infrastructure of drug-related problems and the latest trends in addiction science and proposes ways to link policy and research. Japan's experience, balancing strict enforcement with health-centered care, may offer lessons for regions that have similar social contexts.