There are many factors which influence the consumption of alcohol and other drug (AOD) use in the Australian community. These factors influence: characteristics of those people, the substance used, places of use, methods of use and reasons for use.
Traditionally, why people used alcohol and other drugs was answered by refering to a psycho-medical model of use. While this model of use is important in considering empirical and epidemiological patterns, it is insufficient when we consider that the consumption of alcohol and other drugs often takes place in a social context. As such, a socio-cultural perspective that examines the cultural drivers associated with alcohol and other drugs and their various patterns of consumption is important because it broadens our understanding of alcohol and other drug use by examining them in the context in which they occur.
NCETA is at the forefront of socio-cultural research into the behaviours and patterns associated with alcohol and other drug use. Knowledge gained from our examinations will be useful for informing the design and implementation of strategies to reduce the incidence of, and/or harm associated with, alcohol and other drug use and other risky behaviours.
Harm minimisation
The International Harm Reduction Association (IHRA) defines harm
minimisation as the policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. This focuses on the prevention of harm, rather than on the prevention of drug use itself and focusses on people who continue to use drugs [1].
A harm minimisation policy approach recognises that drug use may carry substantial risks, and that people who use alcohol and other drugs require a range of supports to progressively reduce drug-related harm to themselves and the general community, including families. This policy approach does not condone drug use.
The aim of the National Drug Strategy is
To build safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug-related health, social, cultural and economic harms among individuals, families and communities [2].
Since 1985, harm minimisation has been adopted by Australian Governments as the national framework for addressing the range of issues related to alcohol and other drugs in Australia. The National Drug Strategy 2017-26 (NDS) adopts a harm minimisation approach to the use of illicit drugs and the misuse of licit drugs.
Australia’s long-standing commitment to harm minimisation considers the health, social and economic consequences of drug use on individuals, families and communities as a whole and is based on the following considerations:
- Drug use occurs across a continuum, from occasional use to dependent use
- A range of harms are associated with different types and patterns of drug use
- The response to these harms requires a multifaceted response.
Australia seeks to adopt a balanced approach across the three pillars of harm minimisation, namely.
Reducing the demand for drugs: Preventing the uptake and/or delaying the onset of use of alcohol, tobacco and other drugs; reducing the misuse of alcohol, tobacco and other drugs in the community; and supporting people to recover from dependence through evidence-informed treatment
Reducing the supply of drugs: Preventing, stopping, disrupting, or otherwise reducing the production and supply of illegal drugs; and controlling, managing and/or regulating the availability of legal drugs
Harm reduction: Reducing the adverse health, social and economic consequences of the use of drugs, for the user, their families and the wider community [2].
Australia’s approach to harm minimisation aims to minimise a range of harms including:
Health harms such as:
- injury
- chronic conditions and preventable
- diseases (including lung and other
- cancers, cardiovascular disease and liver cirrhosis)
- Mental health problems
- Road trauma.
Social harms including:
- violence and other crime
- engagement with the criminal justice system more broadly
- unhealthy childhood development and trauma
- intergenerational trauma
- contribution to domestic and family violence
- child protection issues
- child/family wellbeing.
Economic harms associated
with:
- healthcare and law enforcement costs
- decreased productivity
- associated criminal activity
- reinforcement of marginalisation and disadvantage
- Road trauma.
Alcohol, tobacco and other drug problems are also associated with stigma and social and health determinants, such as discrimination, unemployment, homelessness, poverty and family breakdown [2].
Examples of harm reduction programs
- needle and syringe programs
- medication-assisted treatment for opioid dependence
- diversion programs
- sobering up services.
References
1. Stone, K., & Shirley-Beavan, S. (2018). The Global State of Harm Reduction 2018. London: International Harm Reduction Association
2. Department of Health. (2017). National Drug Strategy, 2017-2026. Canberra: Department of Health.
Conceptualising alcohol and other drug issues
It is important to recognise that people use alcohol and other drugs for a variety of reasons including:
- pleasure
- to alleviate physical or emotional pain
- to enhance performance
- boredom
- curiosity.
Alcohol and other drug use occurs across a continuum from no use,
unproblematic use, through to problematic use. Each point on the
continuum requires different responses as outlined in the diagram.
In terms of problematic substance use there are essentially three domains:
- intoxication
- regular hazardous use
- dependence.
Each of these domains can result in widely different harms experienced by both the individual using the substance and the wider community. When people think of alcohol and other drugs and related issues, often the first things they think about are the problems that occur at the more severe end of the scale, such as those associated with dependence. However, issues related to dependence represent a small subset of problems in the community that arise from alcohol and other drug use. That is not to say that those affected by alcohol or other drug dependence, and their loved ones, do not experience significant problems. However, far more people engage in substance use where intoxication and associated problems are the main risk and an even greater number engage in regular hazardous (but not 'dependent') substance use.
The model below, developed by Anthony Thorley in 1982, illustrates the domains of intoxication, regular use and dependence and attempts to demonstrate that regular hazardous use represents the greatest harm to the community by volume. Some people will experience difficulties with two or all three domains of problems.
National alcohol and drug knowledgebase
The National Alcohol and Drug Knowledgebase (NADK) was developed by NCETA with support from the Australian Government Department of Health.
The NADK is a website that draws on the highest quality Australian data to provide accurate, easy-to-understand and up-to-date information about alcohol and other drugs.
The alcohol and other drugs system in Australia
The alcohol and other drugs system in Australia (as at March 2020) involves the government, non-government (not for profit, charitable and religious organisations, and self help groups) and private sectors (private hospitals, pharmacists, medical practitioners and other private providers). These sectors work together to provide the full spectrum of alcohol and other drug services in Australia including:
Policy
The National Drug Strategy provides the overarching drug policy framework in Australia. Jurisdictions also have local strategies and action plans in place to address alcohol and other drugs issues.
Legislation
Legislation regarding alcohol and other drugs is developed at both a national and jurisdictional level in Australia, with the Commonwealth and the State and Territories each having responsibility for different areas. Responsibility for the enforcement of legislation lies with national and local police, other law enforcement agencies and regulatory bodies.
Treatment services
Treatment services in Australia are provided by a mix of government, non-government and private sector providers. A mix of government and non-government agencies deliver government-funded AOD treatment services.
Prevention programs
There is a broad range of government, non-government and community sectors involved in the prevention of alcohol and other drug use and related harms in Australia. National campaigns regarding tobacco, alcohol and illicit drug use are delivered and jurisdictions also implement their own local programs aimed at preventing harms from alcohol and other drugs.
Research
There are five national drug research centres which receive funding from the Australian government, of which NCETA is one. The other four centres are the:
- National Drug and Research Institute (Curtin University)
- National Drug and Alcohol Research Centre (University of NSW)
- National Centre for Clinical Research on Emerging Drugs (University of NSW)
- National Centre for Youth Substance Use Research (University of Queensland).
The five centres contribute to the understanding of a broad range of alcohol and other drug issues on national and international levels.
Advocacy
There are a number of organisations which provide advocacy in the alcohol and other drugs field. These organisations generally represent the needs of those affected by alcohol and other drug use (people who use drugs and their loved ones) and those who provide services in the alcohol and other drugs area. These include the Australia Alcohol and other Drugs Council, Australian Injecting and Illicit Drug User's League (AIVL), Family Drug Support Australia and Foundation for Alcohol Research and Education (FARE).
Each State and Territory also has a peak body representing the non-government alcohol and drug sector;
- AADANT - Association of Alcohol and other Drug Agencies NT
- ATDC - Alcohol, Tobacco and other Drugs Council of Tasmania
- ATODA - Alcohol, Tobacco and Other Drug Association ACT
- NADA - Network of Alcohol and other Drugs Agencies (NSW)
- QNADA - Queensland Network of Alcohol and other Drug Agencies
- SANDAS - South Australian Network of Drug and Alcohol Services
- VAADA - Victorian Alcohol and Drug Association
- WANADA - Western Australian Network of Alcohol and other Drug Agencies
Stigma
AOD use is a highly stigmatised behaviour in society. Instead of being approached as a health issue, many people mistakenly perceive AOD use as a moral deficit or individual failing.
Stigma may be perceived (e.g., real or imagined fear of discrimination), enacted (e.g., actual experiences of discrimination), and /or internalised (e.g., negative thoughts/feelings due to identifying with a stigmatised group).
The degree of stigmatisation that a person using drugs or alcohol experiences may vary depending according to their personal characteristics (including whether they are members of any other stigmatised groups), the type of substance used, and the frequency, method, context, and consequences of use. For example, illicit drug use is more likely to be stigmatised than alcohol use.
Stigma can be experienced by people who use or are dependent on AOD as well as the AOD workforce. Stigma is typically based on misinformation, misunderstanding and/or fear. For example, in contrast to some popularly held beliefs, most people who use AOD do so infrequently, are employed, do not experience significant problems and are not dependent.
Stigma has real implications for individuals and their families, as well as workers. For people who use AOD, stigma can cause feelings of shame and embarrassment that can prevent them from seeking or receiving the level of supports they may require. In some cases, stigma can contribute to increased or prolonged AOD use. For the AOD workforce, stigma can prevent workers from following a career path that is inherently rewarding, meaningful and impactful. To reduce stigma, it is important to recognise and interact with people at a human level, in isolation from their behaviours or those of the people with whom they work and relate. This is why our choice of words is so important when referring to people who use AOD. To that end, NCETA endorses person-centred language.