The monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.
Its contents cover research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.
This month the Australian Institute of Health and Welfare released ATOD treatment data for the year ended 30 June 2015. They reported that ‘In the Australian Capital Territory, 15 publicly funded alcohol and other drug treatment agencies provided 5,222 treatment episodes completed in 2014–15 to 3,663 clients…Most (88%) clients received treatment from 1 agency and received 1.4 treatment episodes. This is consistent with national results (1.5 episodes)...A total of 6,637 clients received treatment over these 3 years. Of these, 22% (1,477 clients) presented in 2014–15 only, and 16% (1,032) received treatment in both 2013–14 and 2014–15 only…Only 6.3% (415 clients) of the total 6,637 clients received treatment in all 3 collection years.’
‘Nearly all (97%) clients in the Australian Capital Territory in 2014–15 were receiving treatment for their own drug use and most (66%) were male. The picture was different for clients receiving treatment for someone else’s drug use, with almost 3 in 4 (71%) being female...In the Australian Capital Territory in 2014–15, 1 in 11 clients were Indigenous Australians (9.1%), which is lower than the national average (15%).’
‘In the Australian Capital Territory, alcohol was the most common principal drug of concern in episodes provided to clients for their own drug use in 2014–15 (47% of clients and 47% of episodes) ...Amphetamines were also relatively common as a principal drug, accounting for one-sixth (18%) of treatment episodes, followed by cannabis (17% of episodes) and heroin (8.8%).
‘When additional drugs of concern are considered, nicotine (24% of episodes) was the most common additional drug, followed by cannabis (19%) and alcohol and amphetamines (both 14%)...
‘Over the 5 years from 2010–11 in the Australian Capital Territory, alcohol remained the most common principal drug of concern in episodes provided to clients for their own drug use, followed by cannabis, until 2014–15 when amphetamines became the second most common principal drug of concern. Heroin remained the third most common drug for clients seeking treatment for their own drug use until it was replaced by amphetamines in 2013–14 and cannabis in 2014–15. The proportion of episodes involving heroin was higher than the national average (ranging from 8.6% to 16% in the Australian Capital Territory compared with 6.1% to 9.3% nationally). Amphetamines as a principal drug of concern increased from 6.4% to 18% of treatment episodes over the 5 years from 2010–11...’
‘Assessment only was the most common type of main treatment (28% of both clients and episodes), followed by counselling (24% of episodes) and information and education only (16% of episodes)…Rehabilitation (1.7%), was the most common type of additional treatment, followed by counselling (1.5%), withdrawal management (1.2%) and pharmacotherapy (0.9%).’
Australian Institute of Health and Welfare 2016, Alcohol and other drug treatment services in Australia 2014–15: state and territory summaries, AIHW, Canberra,
The Foundation for Alcohol Research and Education (FARE) commissioned ReachTEL to undertake polling of Australian Capital Territory (ACT) residents to gain an understanding on attitudes towards alcohol, perceptions of safety and support for trading hour ‘last drinks’ policies.
What is drug policy and why does it matters?
At the Canberra Satellite Conference of the 2016 ISSDP Conference, referred to above, the President of the ISSDP, Prof Alex Stevens from the University of Kent, gave this keynote address. The Conference title was ‘What is drug policy and why does it matter?’, and Professor Stevens responded to the question as follows:
‘There are at least two ways to answer this question. The first is to treat it as a technical matter; what techniques and interventions are used in addressing drug use and related harms? The second is to think of it is a political question; how do these efforts relate to the distribution of power, resource and respect? This talk will consider both ways of approaching the question. It will briefly consider the range of interventions that fit the technical definition of drug policy, and the strength of the evidence for their effects. But it will also consider how political questions of drug policy affect our efforts to reduce harms. Specifically, it will argue that politically established inequalities in the distribution of power, resource and respect have more impact on drug-related harms than do the technicalities of interventions that are targeted at drug users.’
He goes onto explicate these two approaches, and conclude with his core theme (Stevens’ emphasis): ‘I am not arguing that we should not use the evidence on which drug-focussed interventions are technically effective. I am arguing that drug policy is also a political matter, and that the distribution of power, resources and respect should be central issues in any discussion of how to reduce the harms that are associated with currently illicit drugs. Perhaps we should expand the definition of what drug policy is. Drug policy is all the things we do that affect drug users, whether we expect them to or not.
Stevens, A 2016, ‘What is drug policy and why does it matter?’, paper presented to 10th Annual Conference of the International Society for the Study of Drug Policy (ISSDP) Canberra Satellite event, Canberra, 20 May 2016, https://www.academia.edu/25627151/What_is_drug_policy_and_why_does_it_matter?auto=download
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Will the Australian Government's response to its National Ice Taskforce deliver more treatment, as promised?
The Development Editor of the journal Drug and Alcohol Review
, Associate Professor Rebecca McKetin (who has recently moved from ANU, Canberra to NDRI, Perth), has written an editorial reflecting on the changes to the models of funding of the AOD sector in Australia that are being introduced by the Commonwealth Government. She draws attention to the substantial injection of new money for specialised AOD treatment services, as part of the Government’s response to the National Ice Taskforce, and to the fact that this will be allocated through the Primary Health Networks (PHNs) whose role will be to commission AOD services. This is a substantial change in the funding model, one that is intended to be more responsive to local needs and opportunities. In early May 2016, each of the 35 PHNs submitted to the Commonwealth their needs assessment relating to AOD, mental health and suicide prevention within their regions. It is expected that this will be the basis of the allocation of the new funds for specialised drug treatment and primary health care AOD services.
The author discusses the potential strengths and weaknesses of this new model. She points out that ‘It remains unclear to what extent funding will support primary care services versus existing or new specialist AOD services. A pressing question is then whether existing specialist non-government AOD treatment services will be able to access the treatment funding allocated under the national Ice Taskforce (or under Federal funding thereafter), adding to the considerable uncertainty about their ongoing funding and the complexity of their current funding arrangements. There are also questions about what capacity PHNs will have to fulfil their new role, which forms a small component of their broader mandate…In sum, early indications suggest that the provision of additional federal treatment funding under the guise of the National Ice Taskforce signals a shift from a predominantly specialist model of AOD treatment to a primary health care model of treatment provision. This shift has far more broad reaching implications for the AOD sector than is apparent from the Ice Taskforce action plan…Research needs to be put in place that will accurately document the impact of this new funding model on service access, quality of care and broader outcomes, such as drug related harms.’
McKetin, R 2016, ‘Will the Australian Government’s response to its “National Ice Taskforce” deliver more treatment as promised?
’, Drug and Alcohol Review
, vol. 35, no. 3, pp. 247-9.
Comment: ATODA is working closely with the ACT’s PHN, known as Capital Health Network. This has entailed providing expert independent advice in collaboration with ACT specialist AOD treatment and support services, ACT Health and researchers, and has included developing and documenting the needs assessment that has formed the basis of future additional Commonwealth funding for the ACT under the National Ice Taskforce response. In this new funding, to be commissioned through the ACT PHN, the ACT will receive $903,429 per annum for 3 years (2016 – 2019), a proportion of which is to be specifically used for specialist AOD treatment for Aboriginal and Torres Strait Islander people. For further information see the Joint Communique No.2.
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What are the impacts of introducing closed-circuit television on the level and patterns of street-based heroin purchase and injection?
Researchers based in Melbourne investigated whether there were shifts in the settings (e.g., street or house) in which heroin was purchased or injected by people who inject drugs (PWID) in the Melbourne suburb of Footscray following the introduction of closed-circuit television (CCTV) in June 2011. Using heroin purchase data from the Melbourne Injecting Drug User Cohort Study, they estimated the percentage of (1) heroin purchased on the street, from mobile dealers and in house settings; and (2) heroin injections occurring in street, car, public toilet, and house settings. Displacement effects were investigated with a statistical model capturing the likelihood of traveling to Footscray to purchase heroin. They found that, ‘Following CCTV introduction, the percentage of heroin injections occurring in public toilet settings decreased by 13%...This was accompanied by a non-significant increase in the percentage of heroin injections in street settings of 23%...Changes in other settings were small and non-significant. No suburb displacement effects were found’. They concluded that ‘Footscray’s street-based heroin market appears to operate much as it did before CCTV. The introduction of CCTV in Footscray coincided with a decrease in the percentage of heroin injections occurring in public toilet settings, perhaps due to a particular camera covering a toilet block frequented by PWID, but this decrease may have been largely offset by a non-significant increase in injections in street settings’.
Scott, N, Higgs, P, Caulkins, JP, Aitken, C, Cogger, S & Dietze, P 2016, ‘The introduction of CCTV and associated changes in heroin purchase and injection settings in Footscray, Victoria, Australia
’, Journal of Experimental Criminology
, vol. 12, no. 2, pp. 265-75.
How effective is drug testing as a harm reduction strategy? How useful is it as a method for revealing similarities and differences between areas?
Drug testing is a harm reduction strategy that has been adopted by certain countries in Europe. Drug users are able to hand in their drugs voluntarily for chemical analysis of composition and dose. Drug users will be alerted about dangerous test results by the drug testing systems directly and through warning campaigns. An international collaborative effort was launched to combine data of drug testing systems, called the Trans European Drug Information (TEDI) project. Drug testing systems of Spain, Switzerland, Belgium, Austria, Portugal, and the Netherlands participated in this project. This study presents results of some of the main illicit drugs encountered: cocaine, ecstasy and amphetamine and also comments on new psychoactive substances (NPS) detected between 2008 and 2013. A total of 45 859 different drug samples were analyzed by TEDI. The drug markets of the distinct European areas showed similarities, but also some interesting differences. For instance, purity of cocaine and amphetamine powders was generally low in Austria, whilst high in Spain and the Netherlands. And the market for ecstasy showed a contrast: whereas in the Netherlands and Switzerland there was predominantly a market for ecstasy tablets, in Portugal and Spain MDMA…crystals were much more prevalent. Also, some NPS appearing in ecstasy seemed more specific for one country than another. In general, prevalence of NPS clearly increased between 2008 and 2013. Drug testing can be used to generate a global picture of drug markets and provides information about the pharmacological contents of drugs for the population at risk.
Brunt, TM, Nagy, C, Bucheli, A, Martins, D, Ugarte, M, Beduwe, C & Ventura Vilamala, M 2016, ‘Drug testing in Europe: monitoring results of the Trans European Drug Information (TEDI) project
’, Drug Testing and Analysis
, online ahead of print.
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What are the links between income inequality and adolescent cannabis use at the national level in the so-called developed countries?
To answer this question, the author undertook a fuzzy set qualitative comparative analysis of two data sets that contain information on the national prevalence of past year cannabis use among 15 and 16 year olds, taken from two international surveys (The European School Survey Project on Alcohol and Other Drugs (ESPAD) and the Survey of Health Behaviour in School-Aged Children (HBSC), with additional data from USA and Australian surveys. The data sets also include data on national rates of income inequality (Gini coefficient), wealth (GDP per head), welfare support (average benefit replacement rates), urbanization and labour market conditions (youth unemployment). The study found that ‘The combination of high inequality and high urbanization forms part of configurations that are consistent with being usually sufficient to cause high-adolescent cannabis use, alongside high GDP per head in the ESPAD data set, and low welfare support in the HBSC data set…Social conditions, and particularly the combination of income inequality and urbanization, should be considered when studying the causation of high levels of adolescent cannabis use at the national level in developed countries.’
Readers interested in drug policy research methods will note that ‘This article introduces the use of qualitative comparative analysis (QCA) to the field of drug policy studies.’
Stevens, A 2016, ‘Inequality and adolescent cannabis use: a qualitative comparative analysis of the link at national level
’, Drugs: education, prevention and policy
, online ahead of print.
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What is the latest information on the prevalence of, and trends in, cannabis use disorders among adolescents in the USA?
Researchers based in the United States analysed trends in the past-year prevalence of DSM-IV marijuana use disorders among adolescents, using data from the adolescent samples of the 2002 to 2013 administrations of the [US] National Survey on Drug Use and Health. They observed ‘A decline in the past-year prevalence of marijuana use disorders…This was due to both a net decline in past-year prevalence of use and a decline in the conditional prevalence of marijuana use disorders. The trend in marijuana use disorders was accounted for by a decrease in the rate of conduct problems among adolescents (e.g., fighting, stealing)’. They concluded that ‘Past-year prevalence of marijuana use disorders among US adolescents declined by an estimated 24% over the 2002 to 2013 period. The decline may be related to trends toward lower rates of conduct problems. Identification of factors responsible for the reduction in conduct problems could inform interventions targeting both conduct problems and marijuana use disorders’.
Grucza, RA, Agrawal, A, Krauss, MJ, Bongu, J, Plunk, AD, Cavazos-Rehg, PA & Bierut, LJ 2016, ‘Declining prevalence of marijuana use disorders among adolescents in the United States, 2002 to 2013
’, Journal of the American Academy of Child & Adolescent Psychiatry
, vol. 55, no. 6, pp. 487-94.e6.
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What significant missing links exist with respect to medicinal cannabis in Australia?
This opinion piece, published in the Medical Journal of Australia
, presents the authors’ perspectives on the recent legislative initiatives at the Commonwealth level and in Victoria, and policy initiatives elsewhere in Australia, relating to medicinal cannabis (medical marijuana). They point out that, ‘In Australia, the New South Wales Government Terminal Illness Cannabis Scheme (TICS), established in 2014, enables compassionate access to adults with a terminal illness. Under TICS, a registered medical practitioner involved in a person’s ongoing care must certify that he or she has a terminal illness as defined by the scheme. In 2015, the New South Wales Government-funded trials of cannabis in palliative care and in children with a specific type of epilepsy, and in Victoria, a cannabidiol study for paediatric epilepsy is also in process’. They go on to discuss what they considered to be ‘missing links’ in these initiatives: ‘Although Minister for Health, Sussan Ley referred to this federal legislation as the “missing link” in the supply of cannabis for patients, there are multiple missing links before patients can access medicinal cannabinoids in Australia. Several changes to medicines and poisons legislation, as well as significant scientific, pharmaceutical, pharmacological and clinical input are required. In this article, we discuss (in order of priority from a patient efficacy and safety perspective) what we believe are the missing links, based on the assumption that the legislation sets out to cover all of pharmaceutical grade extracts and use of plant products.’
The ‘missing links’ discussed are:
- Data required on indications, efficacy, safety and dose range of cannabinoids
- Confirmation that drug constituents are consistent and of high, reproducible quality
- Confirmation of drug stability in different storage conditions
- Concerns specific to prescribing
- Concerns around medical supply of a potentially misusable substance.
They conclude that ‘If trial data for cannabis reveal evidence that supports its use, and if this use can be regulated in a way that enables suitable provision to those who may benefit, then it appropriately becomes another agent in the armamentarium of pharmacotherapy’.
Martin, JH & Bonomo, YA 2016, ‘Perspective: Medicinal cannabis in Australia: the missing links’, Medical Journal of Australia
, vol. online ahead of print, open access https://www.mja.com.au/journal/2016/204/10/medicinal-cannabis-australia-missing-links
Comment: This paper has attracted widespread interest, and a great deal of criticism, from people and organisations advocating for the development and implementation of compassionate medicinal cannabis schemes in Australia. Many have argued that the key ‘missing link’ is not the slow, scientific development of cannabis-based pharmaceutical products approved by the Therapeutic Goods Administration, but rather a compassionate approach that allows sick people to legally use cannabis, in whatever form they and their doctors find most suitable, at least as an interim measure until a full range of approved cannabis-based pharmaceutical products becomes available to treat their health conditions. ATODA has consistently supported the development of an interim compassionate medicinal cannabis access scheme for the ACT, and is disappointed that the ACT Government has not yet enabled this policy option.
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What does the research demonstrate on the effects of cannabis intoxication on motor vehicle crashes?
Research undertaken in Norway replicated and revised previous studies on the effects of cannabis intoxication on motor vehicle collision rates. They concluded that ‘Acute cannabis intoxication is associated with a statistically significant increase in motor vehicle crash risk. The increase is of low to medium magnitude’. They drew attention to the policy implications of their research: ‘The growing interest in the crash risk associated with cannabis use is related to the ongoing debate about cannabis policy. Concerns have been raised that liberalized laws would increase cannabis use, increasing the number of cannabis-intoxicated drivers and raising the trafﬁc crash rate. While our estimates suggest that the impact on crash rates would be low to moderate, even if this argument were correct we would stress that such simple extrapolations are unlikely to be robust to larger policy changes: driving under the inﬂuence of legal cannabis would probably be made a direct target for policy, leading to efforts with documented effects from the alcohol ﬁeld. Cannabis use may also inﬂuence trafﬁc risks through other causal channels: an ecological study using the staggered introduction of medical marijuana laws across US states found a net reduction in trafﬁc crashes associated with the introduction of these laws. The authors suggest that this could be due to consumers shifting from alcohol (with high crash risk) to cannabis (with lower crash risk), or due to cannabis users driving less than they would have after drinking (e.g. smoking at home rather than driving to a bar). This underscores the larger policy point that a low-to-moderate causal effect of acute cannabis intoxication on crash rates is likely to play a limited role in the overall policy picture surrounding cannabis legislation’.
Rogeberg, O & Elvik, R 2016, ‘The effects of cannabis intoxication on motor vehicle collision revisited and revised
, online ahead of print.
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How likely is it that drivers using medicinal drugs alone will be involved in road crashes?
Coroners files and toxicological records of fatally-injured drivers in Victoria from 2000 to 2006 and from 2007 to 2013 were reviewed in separate studies to establish the role of prescribed drugs on crash risk. 2638 driver fatalities were included in the study, which represented over 97% of all driver fatalities in this period. The detection limits of the drugs were at the low end of those seen with common illicit drugs or prescribed drugs. Drugs of any type were found in 34.4% of the study group, medicinal drugs 21.2%, and alcohol (>/=0.05 gram/100mL) was found in 24.8%. The prevalence of the most common drugs detected that are legally available by prescription were anti-depressants (7.9%), benzodiazepines (7.0%), opiates/opioids (6.6%), and sedating anti-histamines (1.1%). Each driver was assessed for responsibility using a previously published and validated method [responsibility/culpability analysis]. The crash risk of drivers taking opioids, benzodiazepines, or anti-depressants (primarily the serotonin reuptake inhibitors), were not significantly over-represented compared to the drug-free control group, although there was a suggestion of increased crash risk for benzodiazepines. Crash risk was elevated for drivers using cannabis (by presence of THC in blood at >2ng/mL) and amphetamines. These data show that drivers using medicinal drugs alone are unlikely to show significant crash risk even if drugs are potentially impairing.
Drummer, OH & Yap, S 2016, ‘The involvement of prescribed drugs in road trauma
’, Forensic Science International
, vol. 265, pp. 17-21.
Comment: This study, which is based on expert judgement of the culpability of the fatally-injured drivers rather than the epidemiological methods more frequently used to identify patterns of causality, has produced findings which differ from those of many other researchers. See, especially, European Monitoring Centre for Drugs and Drug Addiction 2012, Driving under the influence of drugs, alcohol and medicines in Europe—findings from the DRUID project, http://www.emcdda.europa.eu/publications/thematic-papers/druid.
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What evidence is available on the applicability of the Ottawa Charter framework to inform health promotion effectiveness?
There is evidence of a correlation between adoption of the Ottawa Charter’s framework of five action areas and health promotion programme effectiveness, but the Charter’s framework has not been as fully implemented as hoped, nor is generally used by formal programme design models. In response, we aimed to translate the Charter’s framework into a method to inform programme design. Our resulting design process uses detailed definitions of the Charter’s action areas and evidence of predicted effectiveness to prompt greater consideration and use of the Charter’s framework. We piloted the process by applying it to the design of four programmes of the Healthy Children’s Initiative in New South Wales, Australia; refined the criteria via consensus; and made consensus decisions on the extent to which programme designs reflected the Charter’s framework. The design process has broad potential applicability to health promotion programmes; facilitating greater use of the Ottawa Charter framework, which evidence indicates can increase programme effectiveness.
Fry, D & Zask, A 2016, ‘Applying the Ottawa Charter to inform health promotion programme design
’, Health Promotion International
, online ahead of print.
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What evidence is available on the effectiveness of harm reduction programs delivered by computers and the internet?
A systematic review examined programs for the prevention of alcohol and other drug use and related harm targeted at adolescents and which were delivered by computers and the internet. The researchers advise that ‘A total of 12 papers reporting outcomes from trials of nine universal online prevention programs were identified. Of the identified interventions, five targeted multiple substances, two focused solely on alcohol, one targeted only cannabis and one primarily addressed smoking. The majority of programs were delivered at school; however one was implemented in a primary care setting. Six programs demonstrated significant, but modest, effects for alcohol and/or other drug use outcomes’. They concluded that ‘Evidence to support the efficacy of computer and Internet-based prevention programs for alcohol and other drug use and related harms among adolescents is rapidly emerging, demonstrating that online prevention is an area of increasing promise. Further replication work, longer-term trials and attempts to increase the impact are required.’
Champion, KE, Newton, NC & Teesson, M 2016, ‘Prevention of alcohol and other drug use and related harm in the digital age: what does the evidence tell us?
’, Current Opinion in Psychiatry
, vol. 29, no. 4, pp. 242-9.
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How effective are family training programs in reducing anti-social behaviours?
A group of international researchers recently updated a meta-analysis on early family/parent training programs on antisocial behaviour and delinquency which they originally published in 2009. Screening of eligible studies was carried out for the period between January 2008 and August 2015. An additional 23 studies were identified, which were added to the original database of 55 studies, giving an overall sample of 78 eligible studies. They found that ‘…early family/parent training is an effective intervention for reducing behavior problems among young children…In short, early family/parent training programs are an important evidence-based strategy that deserves continued application and expansion as part of a more general strategy for building a safer society’. Their conclusion was that ‘Early family/parent training programs are an effective evidence-based strategy for preventing antisocial behavior and delinquency’.
Piquero, AR et al.
2016, ‘A meta-analysis update on the effects of early family/parent training programs on antisocial behavior and delinquency
’, Journal of Experimental Criminology
, vol. 12, no. 2, pp. 229-48.
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How common is it for parents to supply alcohol to their adolescent children in Autralia?
A study of national trends in parental supply of alcohol to adolescent children in Australia since 1998 examined six Australian National Drug Strategy Household Surveys (1998-2013) to determine rates of parental supply of current and first ever alcohol consumed. Over 7,000 adolescents aged from 14 to 17 years were surveyed. The researchers found that ‘There was a significant drop in parental supply of current alcohol use from 21.3 % in 2004 to 11.79 % in 2013…The lower prevalence of parental supply coincided with legislative changes on parental supply of alcohol to adolescents, but causality cannot be established because of the variation in the timing and reach of parental supply legislation, and small samples in some states. There were downward trends in adolescent experimentation, quantity and frequency of alcohol use across years, with the largest drop in alcohol use in 2010 and 2013’. They concluded that, ‘In Australia, there has been a substantial reduction in parental supply of alcohol to adolescents from 2010, and this factor may partially account for reductions in adolescent alcohol use’.
Kelly, AB, Chan, GC, Weier, M, Quinn, C, Gullo, MJ, Connor, JP & Hall, WD 2016, ‘Parental supply of alcohol to Australian minors: an analysis of six nationally representative surveys spanning 15 years
’, BMC Public Health
, vol. 16, no. 1, p. 325.
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What is 'penal populism', and can it play a positive role in the criminal justice system?
An article in a recent issue of the Australian & New Zealand Journal of Criminology
‘…aims to explore how citizens engage politically in new and progressive ways, particularly in the criminal justice context’, taking as a starting point ‘the most significant influence on contemporary criminal justice policy, “penal populism”…most commonly associated with the trend in many Western countries (US, UK, NZ and Australia) since the 1980s towards punitive and populist penal policies and sentencing laws…Penal populism equates effective punishment with severity and particularly in the form of incarceration’.
The author argues that ‘populism is not by definition a punitive influence on crime prevention policy. The Thomas Kelly case study [Thomas Kelly was killed by a single-punch attack in King’s Cross in 2012] illustrates that populism can have a constructive impact on government policy and legislation. The central role that a populist campaign played in framing the problem and, subsequently, the solutions, as one of “alcohol-related violence” produced the conditions of possibility for the nuanced and complex set of responses made by the NSW Government. It also provided the conditions for a powerful realignment of the police with other emergency service workers away from “law and order” politics and towards harm minimisation strategies. This case study invites further research into alcohol-related violence and other crime problems, in order to shed further light on the optimal conditions for generating constructive policy responses that are informed by non-punitive populism. Key insights offered by the Thomas Kelly case study are to take seriously rather than dismiss the rhetoric of populism and the potential of centring the emotions, the role of the media and the unifying power of a popular identity’.
Quilter, J 2015, ‘Populism and criminal justice policy: an Australian case study of non-punitive responses to alcohol-related violence
’, Australian & New Zealand Journal of Criminology
, vol. 48, no. 1, pp. 24-52.
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What do we know about the natural history of substance use disorders, and how could policy makers and health professionals make use of this knowledge?
An article in Current Opinion in Psychiatry
examines the literature on the natural history of substance use disorders: the course and outcomes of these disorders. The key findings of the research were as follows.
‘Incidence of alcohol and drug disorders is predicted by early depressive symptomatology, although this relationship likely varies throughout the life-course.
Cannabis use disorder (abuse or dependence) is highly remitting in the US general population (42.4% over 3 years) and is predicted by lower frequency of use, abuse rather than dependence, and presence of other medical conditions.
Adverse childhood experiences are implicated in substance use disorder persistence and this mechanism may be mediated by personality disorder.
Risk drinking, smoking, and a history of severe alcohol use disorder are risk factors for relapse among those in remission from alcohol use disorder.
General population prospective studies avoid selection and other biases inherent to treatment studies, and are necessary despite high costs and participant retention challenges. No general population follow-up studies in low-income and middle-income countries exist, leaving the natural history of substance use disorders in these countries unknown. Future studies should also address potential differences in the sets of risk factors for incident substance use disorders and incident substance use per se’.
Sarvet, AL & Hasin, D 2016, ‘The natural history of substance use disorders
’, Current Opinion in Psychiatry
, vol. 29, no. 4, pp. 250-7.
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What are the impacts of social networks on substance use, offending and wellbeing among young people attending specialist alcohol and drug treatment services?
The rather strangely-titled paper reports on a study that aimed to assess the impacts of alcohol and other drug treatments among young people on substance use, offending and wellbeing. In particular, ‘The paper examines the impact of treatment engagement on the size and substance use profile of the young person’s social network and hypothesises that the best treatment outcomes are associated with maintaining the size of the young person’s social network but changing its composition to reduce the representation of substance use in social networks.’ A cohort study of 112 young people (aged 16 to 21 years) engaged in specialist youth alcohol and drug treatment services in Victoria, were recruited at the beginning of treatment and re-interviewed six months later. The researchers found that ‘There were improvements in substance use, social functioning, mental health and life satisfaction from baseline to follow-up. While network size was associated with mental health and quality of life markers, only having a lower proportion of substance users in the social network was associated with lower substance use and offending at follow-up.’ This led them to conclude that ‘Social networks are a key component of wellbeing in adolescence. This study suggests that through independent analysis of network size and network composition, both the size and the composition of social networks have an important role to play in developing interventions for adolescent substance users that will sustain behaviour changes achieved in specialist treatment.’
Best, DW & Lubman, DI 2016, ‘Matter but so does their substance use: The impact of social networks on substance use, offending and wellbeing among young people attending specialist alcohol and drug treatment services
’, Drugs: education, prevention and policy
, online ahead of print.
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What factors affect treatment outcomes for clients of specialist alcohol and drug treatment services?
Australian researchers investigated how treatment outcomes are influenced by continuity in specialist alcohol and other drug treatment, engagement with community services and mutual aid, and explored differences between clients who present with a primary alcohol problem compared with those presenting with other drugs as the main concern. Almost 800 clients from 21 alcohol and other drug services in Victoria and Western Australia were interviewed between January 2012 and January 2013. The researchers found that ‘Just over half of the participants…showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/amphetamine…as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern…with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance…and community service engagement…for clients with alcohol as the primary drug of concern, and completion of the index treatment…and continuity in Alcohol and Other Drug care…when drugs were the primary drugs of concern’. The researchers concluded that ‘This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug services. Results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to maximise outcomes’.
Manning, V et al.
2016, ‘Substance use outcomes following treatment: findings from the Australian Patient Pathways Study
’, Australian and New Zealand Journal of Psychiatry
, online ahead of print.
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What changes have been made to the Standard Minimum Rules for the Treatment of Prisoners?
The Standard Minimum Rules for the Treatment of Prisoners were adopted by the United Nations in 1955 and have been used, since that time, to underpin legislation and policy on the treatment of prisoners in Australia. In December 2015, the General Assembly of the United Nations adopted a revised set of Rules. They are known as the ‘Nelson Mandela Rules’ ‘…to honour the legacy of the late President of South Africa, Nelson Rolihlahla Mandela, who spent 27 years in prison in the
course of his struggle for global human rights, equality, democracy and the promotion of a culture of peace’ (clause 1).
The rules commence with a statement of ‘Basic Principles’, the first of which is ‘All prisoners shall be treated with the respect due to their inherent dignity and value as human beings. No prisoner shall be subjected to, and all prisoners shall be protected from, torture and other cruel, inhuman or degrading treatment or punishment, for which no circumstances whatsoever may be invoked as a justification. The safety and security of prisoners, staff, service providers and visitors shall be ensured at all times’.
Other provisions directly relevant to the alcohol and other drug field include the following:
1. The provision of health care for prisoners is a State responsibility. Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.
2. Health-care services should be organized in close relationship to the general public health administration and in a way that ensures continuity of treatment and care, including for HIV, tuberculosis and other infectious diseases, as well as for drug dependence.
2. Clinical decisions may only be taken by the responsible health-care professionals and may not be overruled or ignored by non-medical prison staff.
A physician or other qualified health-care professionals, whether or not they are required to report to the physician, shall see, talk with and examine every prisoner as soon as possible following his or her admission and thereafter as necessary. Particular attention shall be paid to:
(a) Identifying health-care needs and taking all necessary measures for treatment;
(b) Identifying any ill-treatment that arriving prisoners may have been subjected to prior to admission;
(c) Identifying any signs of psychological or other stress brought on by the fact of imprisonment, including, but not limited to, the risk of suicide or self-harm and withdrawal symptoms resulting from the use of drugs, medication or alcohol; and undertaking all appropriate individualized measures or treatment;
United Nations General Assembly 2016, United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules)
, Resolution adopted by the General Assembly on 17 December 2015 [on the report of the Third Committee (A/70/490)] 70/175, http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/70/175
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American Academy of Pediatrics, Section on Tobacco Control 2015, ‘Policy statement from the American Academy of Pediatrics: Electronic Nicotine Delivery Systems’, Pediatrics, vol. 136, no. 5, pp. 1018-26, open access http://pediatrics.aappublications.org/content/136/5/.abstract.
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Butler, K & Breen, C 2016, ACT drug trends 2015. Findings from the Illicit Drug Reporting System (IDRS), Australian Drug Trend Series no. 147, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.drugtrends.org.au/reports/report-act-drug-trends-2015-findings-from-the-illicit-drug-reporting-system-idrs/.
---- 2016, ACT trends in ecstasy and related drug markets 2015. Findings from the Ecstasy and Related Drugs Reporting System, Australian Drug Trend Series no. 156, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, http://www.drugtrends.org.au/reports/report-act-drug-trends-2015-findings-from-the-ecstasy-and-related-drugs-reporting-system-edrs/.
Foundation for Alcohol Research and Education (FARE) 2016, 2016 Australian Capital Territory poll: support for 3am last drinks and perceptions of safety, FARE, Canberra, http://fare.org.au/2016/06/2016-act-poll-support-for-3am-last-drinks-and-perceptions-of-safety/.
International Drug Policy Consortium 2016, A public health approach to drug use in Asia: principles and practices for decriminalisation, International Drug Policy Consortium, International HIV/AIDS Alliance & ANPUD, London, http://idpc.net/publications/2016/03/public-health-approach-to-drug-use-in-asia-decriminalisation.
MacRae, A & Hoareau, J 2016, Review of illicit drug use among Aboriginal and Torres Strait Islander people, Australian Indigenous HealthInfoNet, http://www.healthinfonet.ecu.edu.au/health-risks/illicit-drugs/reviews/illicit-drug-use-review.
van Kempen, PH & Fedorova, M 2016, International law and cannabis II. Regulation of cannabis cultivation and trade for recreational use: positive human rights obligations versus UN Narcotic Drugs Conventions Radboud University, Nijmegen, The Netherlands, http://www.ru.nl/english/news-agenda/vm/law/2016/international-law-allows-legalisation-cannabis/.
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Weier, M, Chan, GCK, Quinn, C, Hides, L & Hall, W 2016, Cannabis use in 14 to 25 years old Australians 1998 to 2013, The University of Queensland Centre for Youth Substance Abuse Research, Brisbane, https://cysar.health.uq.edu.au/article/2016/05/how-many-young-australians-use-cannabis-new-report.
World Health Organization 2016, The health and social effects of nonmedical cannabis use, WHO, Geneva, http://www.who.int/substance_abuse/publications/cannabis/en/.
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