National Drug Research Institute Preve event nting ing Harmful Drug Use in Austral ralia ia Steve Allsop Director National Drug Research Institute Preventing and responding to drug problems: where does the evidence take us? www.ndri www. dri.curtin .curtin.edu.au .edu.au
NDSHS: Summary of recent drug use: proportion of the population aged 14 years, 1993 to 2007 Source: Australian Institute of Health and Welfare, (2008). 2007 National Drug Strategy Household Survey: detailed findings. Drug Statistics Series No. 22. Cat no. PHE 107. Canberra: Australian Institute of Health and Welfare. p. 4.
Some background comments • Is drug use getting worse? – It ain‟t necessarily so, but a mixed picture • Tobacco • Cannabis • Amphetamine • Alcohol • Ecstasy • Pharmaceuticals • Cocaine • “Research chemicals” • Heroin
Last Drug Injected
Some background comments • Overall apparent changes may hide some important information – Estimates of alcohol consumption have been underestimates – Heavier use among some people (some young people; some Indigenous communities) – Patterns/frequency of use among some – Specific risks of early onset use
We need to better communicate & respond to the complexity of drug use and related harm
What causes drug use and drug problems? • Drug use, drug related harm and dependence emerge from risk factors and protective factors and the relationship amongst these
Risk factors • Individual factors • Genetic characteristics and vulnerabilities - Sensation/novelty seeking • Poor problem solving • Self-esteem and alienation • Family factors • Favourable attitudes to drug use/drinking/ poor supervision and monitoring • Family disharmony, conflict, violence, abuse and/or neglect • Life events • Trauma • Community factors • Poor housing and economic circumstances; deviant peers • Poor connectedness • Availability • Actual and perceived
Protective factors • Quality family life – harmony, support • Connectedness and sense of belonging • School – Social and academic competence • Adults • Community • “Spiritual”, not just material
PLUS • The fact that some people like to take risks, enjoy the effects etc etc
How do our more popular interventions fit with these observations?
When will we learn- What doesn’t work? • Avoid making it worse
What doesn’t work? • Making it worse • Reliance on „masterstrokes‟/magic bullet – Singular punitive approaches – Singular psycho/social/biological approaches – Moral persuasion – Education as propaganda – „show them the dangers and they won‟t do it‟
What works? • Reduce known risk factors – (e.g. access to alcohol; supporting vulnerable families) and • Encourage known protective factors – (e.g. connectedness to schools etc) • Target interventions to groups or contexts known to have high level risk factors (e.g. particular work contexts; certain entertainment settings) • Delay onset of use and heavy use
What works? • Universal interventions for alcohol and tobacco (e.g. taxation policy) • Law enforcement influence on shaping patterns of illicit drug use and hazardous supply of licits • Targeted interventions to high risk contexts and some disadvantaged populations (e.g. school engagement for at-risk children; vulnerable families interventions) • Brief and opportunistic interventions, treatment, and harm reduction strategies
But many of our interventions are still inaccessible for many
We need to re-invest in harm minimisation
Harm minimisation • RBT • Thiamine enrichment • Managing school leavers • Intelligence about particularly harmful drug formulations • Enforcing laws about not smoking in cars with children? • Enforcing liquor licensing legislation • Avoiding compromising NSP programs
Bring the community onside
Bring the community onside • How community perceives issue(s) matters – e.g. models of drug use/dependence – Marginalisation vs humanisation of consumers • May tolerate impersonal distal outcomes of drug use (e.g. alcohol causes cirrhosis for some people) but less willing to tolerate more immediate outcomes that have personal relevance (alcohol intoxication puts me at risk) • If we wish to engage communities: – How drug use has personal relevance – How cost-efficient interventions have personal and community wide benefits – It is possible to act and things will improve
Seriously invest in the development of integrated services • Many of the factors that predict risk of hazardous drug use also predicts a range of other problems (e.g. CD; MH probs. etc) – Avoid fragmented responses
Seriously invest in the development of integrated services • Many of the factors that predict risk of hazardous drug use also predicts a range of other problems (e.g. CD; MH probs. etc) – Avoid fragmented responses • But feature of many of our services is disaggregated funding, performance indicators, management, physical location, hours of service – e.g. management of ATS intoxication
What new challenges should we anticipate? • Changing patterns of alcohol use – Significant proportion of young Australians who are drinking at risky to very risky levels • Increases in hospitalisations and emergency departments • Increases in longer term adverse health outcomes – E.g. cirrhosis; prostate cancer; breast cancer? • Increases in costs to public amenity and safety? • Increases in combined ATS and alcohol use?
What new challenges should we anticipate? • The challenges and opportunities of new technologies – Information and misinformation/poor information about drugs – Purchasing drugs over the internet and across borders • Confusion about legality • The emergence of smaller distribution networks – Opportunity to inform and provide interventions
What new challenges should we anticipate? • The development and marketing of “research chemicals” – Rapid changes in patterns of use – Unclear risk profile – Confusion about safety/risk/legality – New challenges for law enforcement and health services
What new challenges should we anticipate? • Increased numbers of children raised by parents with alcohol/other drug problems – Disadvantaged biology/increased genetic vulnerability – Disadvantaged environments – Increased risks – Inter-generational risky drug use – Note quality of parenting/home environment important determinant of risk irrespective of drug use
What new challenges should we anticipate? • Ageing population – Consumers of illicit drugs - Cohorts ageing, creating new clinical challenges – Population increasing – without any other changes, creates significant public health challenge – Drinking and drug use histories of current older population distinct from those who will be over 65 in 10-20 years – There is evidence of change - increasing size of population who are drinking/using drugs at hazardous levels
What challenges should we meet? • The comparatively poor investment in prevention – Short term – Sporadic – Not linked to mainstream strategies that are effective • The predictors of hazardous drug use are predictors of a range of adverse health/social outcomes – e.g. academic and social competence; CD; family functioning • Yet most prevention strategies are drug specific
What challenges should we meet? My wish list in short term • Address: – the increasing availability of alcohol – better resourcing of responses to co-existing mental health and drug problems – the needs of Indigenous communities where things are probably getting worse, not better • Invest in interventions within the criminal justice system
What challenges should we meet? My wish list in short term • Respond to the needs of the vast majority of people affected by drug use who do not come into contact with our services, or have a tenuous link with them
What challenges should we meet? My wish list in short term • Respond to the needs of the vast majority of people affected by drug use who do not come into contact with our services, or have a tenuous link with them • Challenge the marginalisation of consumers – Reduced resources and service provision – Reluctance to seek help • Challenge the misunderstanding and demonisation of harm reduction
What challenges should we meet? My wish list in short term • Respond to the needs of the vast majority of people affected by drug use who do not come into contact with our services, or have a tenuous link with them • Challenge the marginalisation of consumers – Reduced resources and service provision – Reluctance to seek help • Challenge the misunderstanding and demonisation of harm reduction • Speak with a louder more coordinated voice
Steve Allsop National Drug Research Institute s.allsop@curtin.edu.au www.ndri.curtin.edu.au
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