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.
The Australian Crime Commission (ACC) Illicit Drug Data Report 2012–13 provides a snapshot of the Australian illicit drug market. The report combines illicit drug data from a variety of sources including law enforcement, health and academia. The Illicit Drug Data Report is the only report of its type in Australia and provides the important evidence base to assist decision makers in the development of strategies to combat the threat posed by illicit drugs.
There were numerous record detections at the Australian border in 2012–13. The number of amphetamine-type stimulants (ATS excluding MDMA), MDMA, cannabis, cocaine, tryptamine, anaesthetic and performance and image enhancing drug (PIED) detections are the highest on record, with the weight of ATS (excluding MDMA) and heroin detections also at a record high. The number of ATS precursor (excluding MDMA) detections at the Australian border is the highest reported in the last decade.
Deaths from viral Hepatitis B and C have surpassed HIV/AIDS in many countries, including Australia and in Western Europe, according to an analysis of the 2010 Global Burden of Disease study.
The analysis was conducted by Dr Benjamin Cowie and Ms Jennifer MacLachlan from the University of Melbourne and Melbourne Health, and was presented at The International Liver Congress in London earlier this month.
“Liver cancer is the fastest increasing cause of cancer deaths in Australia, increasing each year by 5 per cent, so by more than seventy people each year. In 2014 there was an estimated number of deaths of around 1,500 from liver cancer. The predominant cause is chronic viral Hepatitis,” Dr Cowie said.
NHMRC TRIP Fellowships provide support for health care professionals (e.g medical specialists, general practitioners, public health practitioners, physiotherapists, nurses, midwives, radiologists, and other allied health providers), health care personnel (health service managers, hospital department leaders, clinical trial managers) health systems and health policy makers to translate evidence into health care and public health improvements.
was chosen by the Scientific Program Committee to reflect the changing times and increased pressures faced by the drug and alcohol sector.
The conference will feature an exciting program of international and national speakers, focusing on new treatments, prevention and policy in the areas of drug and alcohol research. With original and innovative work from the field, the program will encourage alternative presentation styles.
The 2014 Scientific Program Committee invites the submission of abstracts for original work in consideration for symposia at the 2014 APSAD Conference.
What myths about opioid overdose need debunking to improve preventive interventions?
The current issue of the journal
Drug and Alcohol Review has a valuable editorial by Professor Shane Darke from the National Drug and Alcohol Research Centre with the title ‘Opioid overdose and the power of old myths: what we thought we knew, what we do know and why it matters’. Darke identifies four powerful myths about who is dying and how they are dying:
Myth 1. It is the young, inexperienced user who overdoses
Myth 2. It is variation in the purity of illicit opioids that is the major cause of overdose
Myth 3. It is the opioid that is crucial in overdose, not other drugs
Myth 4. Impurities in illicit opioids are the major cause of overdose.
The research evidence that debunks each of these myths is presented. The author emphasises that opioid overdose is not an unpredictable, random event. Rather, it is concentrated in ‘older, very experienced polydrug users who die from multiple drug toxicity’. Furthermore, these deaths can be prevented through enrolling many more long-term opioid users in treatment, better overdose response including the provision of naloxone, focussing on the high-risk period when tolerance is reduced (immediately after detoxification and the first weeks after release from prison), and educating users about the risks of polydrug use—especially combining alcohol and/or benzodiazepines with opioids.
Darke concludes: ‘Drug use patterns, however, are never static and the opioids are no exception. New trends in the demography of opioid use are emerging, most prominently the use of pharmaceutical opioids such as oxycodone, which will require new interventions. At least we now know these events are not random. The fact that we can now identify who is likely to overdose and why substantially increases our chances of successful intervention to reduce the considerable harm attributable to overdose. In terms of overdose, the past few decades of research have been crucial’.
Darke, S 2014, ‘
Opioid overdose and the power of old myths: what we thought we knew, what we do know and why it matters’, Drug and Alcohol Review, vol. 33, no. 2, pp. 109-14.
Comment: This article is a must-read for people working in the ATOD sector, and is something that would be usefully widely disseminated in the media and the community broadly.
back to top
How effective are cognitive and behavioural therapies as treatments for methamphetamine dependence?
A systematic review of the literature on the effectiveness of cognitive and behavioural therapies for methamphetamine dependence found that ‘Treatment with CBT [cognitive-behaviour therapy] appears to be associated with reductions in methamphetamine use and other positive changes, even over very short periods of treatment (two and four sessions). CM [contingency management] studies found a significant reduction of methamphetamine during application of the procedure, but it is not clear if these gains are sustained at post-treatment follow-up’. The reviewers state that these findings highlight that ‘…there are effective treatments for methamphetamine dependence. Alcohol and other drug (AOD) clinicians are familiar with these types of interventions and should use them and convey to clients that they are effective. Services and policy makers should ensure that best practice interventions are implemented within AOD services’.
Lee, NK & Rawson, RA 2008, ‘
A systematic review of cognitive and behavioural therapies for methamphetamine dependence’,
Drug and Alcohol Review, vol. 27, no. 3, pp. 309-17.
Comment: This is a timely article, reminding our treatment services that the knowledge and skills that practitioners already have can be used to good advantage with methamphetamine dependent people.
back to top
What are the risk factors for the development of cannabis use disorder, and what types of therapies are appropriate for its treatment?
Authors’ summary: ‘Cannabis is the most widely used illicit drug in the world, with the highest rates of use seen in New Zealand, North America and Australia. There is evidence of a decrease in the age of commencement of cannabis use in some developed countries, and a prolongation of risk of initiation to cannabis use beyond adolescence in more recent cohorts of users. Early initiation of cannabis use and regular use during adolescence are particular risk factors for later problematic cannabis and other drug use, as well as mental health problems, delinquency, loss of cognitive capacity and educational achievement, risky sexual behavior and criminal offending. Cannabis use with tobacco complicates treatment for each condition and should be addressed concurrently. Cannabis users often have a long history of use before seeking treatment, and early screening, assessment and treatment are recommended. There are a number of valid and reliable screening and assessment tools now available. Severity of withdrawal is a factor that increases relapse, and pharmacotherapy for withdrawal management is developing rapidly and showing great promise. Finally, a combination of motivational enhancement therapy and cognitive-behavioral therapy alone or within a family systems model are the proven treatment protocols for cannabis use disorder.’
Copeland, J, Clement, N & Swift, W 2014, ‘
Cannabis use, harms and the management of cannabis use disorder’,
Neuropsychiatry, vol. 4, no. 1, pp. 55-63.
back to top
Are cannabis users who quit likely to increase their use of tobacco or alcohol?
A study conducted in Sydney tested whether ceasing cannabis use is associated with increased use of alcohol and/or tobacco. The researchers found that ‘…substitution increases are much more likely in those who consume alcohol and tobacco at lower levels prior to their cannabis quit or reduction attempt, and that cigarette substitution is more likely in those experiencing more severe cannabis withdrawal related sleep difficulty (insomnia), restlessness and physical symptoms. As such, treatment providers should be cognizant of these factors and make appropriate risk assessments and provide advice when guiding cannabis treatment. Cannabis withdrawal symptoms have a complex association with substitution and cannabis users should be made aware of the potential effects of withdrawal and given appropriate coping mechanisms to mitigate interactions with substitution. Finally, it is important to point out that the substitution effect was not observed in all study participants, with those people who maintained their cannabis abstinence for the full six weeks of the study showing no significant increases in either alcohol or tobacco use. Whilst there were only six people in this “extended abstinence” group, limiting statistical power, the lack of any substitution effect is suggestive of potentially differential motivators that warrant further investigation, particularly in treatment seeking cannabis users during abstinence in outpatient settings’.
Allsop, DJ
et al. 2014, ‘
Changes in cigarette and alcohol use during cannabis abstinence’,
Drug and Alcohol Dependence, vol. 138, pp. 54-60.
back to top
Where does 'recovery' fit in the current focus of drug policy in the United Kingdom?
The author reminds us that ‘In 2010 a major paradigm shift occurred in UK drug policy’ and proceeds to discuss how ‘recovery’ is now a major focus of that nation’s drug treatment policy. ‘The paper explores the factors that helped shape that transformation and notes that in the main the influences were external to those directly involved in delivering drug treatment (research, politicians, media, think tanks) and that whilst the combined influence of these elements succeeded in reframing policy it has left the realm of drug treatment service delivery unclear in a number of key areas including: determining how long drug users should remain in treatment, avoiding relapse, relations between professional drug workers and peer supporters, meeting the diverse needs of drug users including those who are not seeking to become drug free. The paper concludes by considering what kind of initiatives and mechanisms may be needed to ensure a closer alignment between policy and practice within the drug treatment sphere’.
McKeganey, N 2014, ‘
Clear rhetoric and blurred reality – the development of a recovery focus in UK drug treatment policy and practice’,
The International Journal of Drug Policy, online ahead of print.
How effective is buprenorphine in the management of opioid-dependence compared to placebo or methadone?
A systematic review of 31 randomised controlled trials of buprenorphine maintenance treatment versus placebo or methadone in the management of opioid-dependent people found that ‘…buprenorphine at high doses (16 mg) can reduce illicit opioid use effectively compared with placebo, and buprenorphine at any dose studied retains people in treatment better than placebo. Buprenorphine appears to be less effective than methadone in retaining people in treatment, if prescribed in a flexible dose regimen or at a fixed and low dose (2-6 mg per day). Buprenorphine prescribed at fixed doses (above 7 mg per day) was not different from methadone prescribed at fixed doses (40 mg or more per day) in retaining people in treatment or in suppression of illicit opioid use’.
Mattick, RP
et al. 2014, ‘Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence’,
Cochrane Database of Systematic Reviews, vol. 2, p. CD002207,
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002207.pub4/abstract.
back to top
Which interventions are most effective in preventing hepatitis C and HIV in people who inject drugs?
A review of reviews assessed the effectiveness of harm reduction interventions in relation to HIV transmission, Hepatitis C virus (HCV) transmission and injecting risk behaviour (IRB) among people who inject drugs (PWID). ‘Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs).’ The reviewers concluded that ‘Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID’.
MacArthur, GJ
et al. 2014, ‘
Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness’,
The International Journal of Drug Policy, vol. 25, no. 1, pp. 34-52.
Comment: These findings are consistent with other studies showing no or limited evidence of beneficial impacts on HCV transmission among people who inject drugs using current harm reduction interventions. This is not, however, evidence that such interventions are not effective. It seems that what is needed is a substantial expansion of the coverage of the harm reduction interventions to reflect very high prevalence of HCV in this population. In addition, more high-quality evaluation studies are needed.
back to top
Does tougher law enforcement result in higher prices for illicit drugs?
A review of the research into the relationships between the level of drug law enforcement and the price of illicit drugs conducted by leading drug policy researchers found that ‘Regarding markets for the most prominent and socially costly substances, the existing research base suggests…there is not sufficient evidence to state whether a particular intensification of enforcement will raise prices’. The researchers state that ‘In the absence of evidence that enforcement can raise prices—or that price increases are actually welfare enhancing across a range of interventions—some wealthy societies should probably spend less on enforcement at the margin, particularly enforcement measures that bring high social costs in other domains. In particular, these findings suggest more discriminating policies regarding street-level sellers. Stringent policies in this domain have resulted in mass incarceration in the United States, with its attendant human costs. Policymakers should also revise approaches to source country crop eradication. Given the lack of evidence that such efforts have substantial impacts on street drug prices, and the strong theoretical argument that the effects should be slight, greater attention to the environmental, economic and social challenges of such approaches is especially wise’.
Pollack, HA & Reuter, P 2014, ‘
Does tougher enforcement make drugs more expensive?’,
Addiction, online ahead of print.
back to top
How successful are workplace-based interventions on helping smokers to quit?
A review of trials that compared the success rates of smokers in a work-based stop-smoking programs with those not involved in a work-based stop-smoking program found that ‘…programmes based on group behaviour therapy (eight trials; 1309 participants), on individual counselling (eight trials; 3516 participants), on medications (five trials; 1092 participants), and on several interventions combined (six trials; 5018 participants) helped people to stop smoking. The chances of stopping smoking using these methods are about the same in the workplace as they are in other settings. This review found that the following do not help people to stop smoking when delivered in the workplace: self-help methods, support from friends, family and workmates, relapse prevention programmes, environmental cues, or comprehensive programmes aimed at changing several high-risk behaviours. Results were mixed for incentives, with one high-quality trial finding a clear benefit for incentives while the remaining five did not’.
Cahill, K & Lancaster, T 2014, ‘Workplace interventions for smoking cessation’,
Cochrane Database of Systematic Reviews, no. 2, art. no. CD003440, p. CD003440,
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003440.pub4/abstract .
Comment: This Cochrane review provides encouraging evidence that the quit-smoking programs that work best in the community at large are effective when applied in workplace settings. Value would lie in more clearly identifying those occupational groups and workplace settings with elevated proportions of smokers, and targeting programs there.
ATODA is supporting the Under 10% Project that aims to improve the health and wellbeing of the Canberra community by strengthening tobacco management practices in health and community sector workplaces that support disadvantaged people. Services are encouraged to look at the support available through the Project and consider signing on as Project Partners. See http://under10percent.org.au/about/ for more information.
back to top
How effective is school drug education that focuses on harm minimisation?
The Drug Education in Victorian Schools (DEVS) program comprises 18 lessons, provided successively over two years to junior secondary school students in that state. An evaluation of the first ten lessons was conducted in 21 schools nine months after the program’s implementation. The intervention ‘…dealt with both licit and illicit drugs, employed a harm minimisation approach that incorporated interactive, skill based, teaching methods and capitalised on parental influence through home activities’. The results of the evaluation were ‘In comparison to the controls, there was a significantly greater increase in the intervention students’ knowledge about drugs, including alcohol…there was a significant change in their level of communication with parents about alcohol…they recalled receiving significantly more alcohol education…their alcohol consumption increased significantly less…and they experienced a lesser increase in harms associated with their drinking…There were no significant differences between the two study groups in relation to changes in attitudes towards alcohol or in the proportion of drinkers or risky drinkers. There was, however, a notable trend of less consumption by risky drinkers in the intervention group’. The researchers concluded that ‘A comprehensive, harm minimisation focused school drug education programme is effective in increasing general drug knowledge, and reducing alcohol consumption and harm’.
Midford, R
et al. 2014, ‘Preventing alcohol harm: early results from a cluster randomised, controlled trial in Victoria, Australia of comprehensive harm minimisation school drug education’,
The International Journal of Drug Policy, vol. 25, no. 1, pp. 142-50,
http://linkinghub.elsevier.com/retrieve/pii/S0955395913000868?showall=true.
Comment: The long-standing disillusionment with school-based drug education is increasingly being challenged by modern approaches that focus on harm minimisation rather than alcohol and other drug use as such. This Victorian program is an important demonstration and evaluation project.
ATODA brought the primary author, Professor Richard Midford, to the ACT to discus this initiative in late 2012, positive feedback was received by workshop and forum participants.
back to top
What do we know about the effectiveness of brief alcohol interventions on primary healthcare?
An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol interventions in primary healthcare published between 2002 and 2012 found that ‘…it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effectiveness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in transitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness’.
O’Donnell, A
et al. 2014, ‘
The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews’,
Alcohol and Alcoholism, vol. 49, no. 1, pp. 66-78.
back to top
How effective is community action reducing risky alcohol consumption and harm?
A cluster randomised control trial (RCT), the Alcohol Action in Rural Communities project, was conducted in 20 Australian communities with populations from 5,000 to 20,000, the first non-USA RCT of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and alcohol-related harms. ‘Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department–based SBI.’
Data were collected on alcohol-related crime, traffic crashes, hospital inpatient admissions, long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. The researchers found that ‘…there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption…and less alcohol-related verbal abuse…the low survey response rates…require conservative interpretation’. They concluded ‘This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms’.
Shakeshaft, A
et al. 2014, ‘The effectiveness of community action in reducing risky alcohol consumption and harm: a cluster randomised controlled trial’,
PLoS Medicine, vol. 11, no. 3, p. e1001617,
http://tinyurl.com/p2mrowo .
Comment: Although the findings of this well designed and implemented Australian study are disappointing, they highlight the importance of investing in this type of research. The authors’ conclusions about the importance of alcohol control legislation to underpin or complemented community initiatives, is soundly based.
back to top
What types of alcohol control strategies do young people believe are most effective?
A study conducted by means of an online questionnaire in south-east England examined young people’s belief in the effectiveness of various alcohol control strategies and identified demographic, attitudinal and behavioural correlates of perceived effectiveness. The authors found that ‘The most effective strategies were perceived to be enforcing responsible service legislation, strictly monitoring late-night licensed premises and teaching alcohol refusal skills. Greater belief in the effectiveness of alcohol control strategies was expressed by older participants, those who consumed less alcohol and those who expected more negative outcomes from alcohol consumption…Women expressed significantly greater belief in the efficacy of four strategies: enforcing the law against serving drunk people, strictly monitoring late-night licensed premises, restricting late-night alcohol sales and banning alcohol sponsorship of sporting events’. The researchers concluded that ‘The data suggest that in order to increase the perceived effectiveness of alcohol control strategies, we may need to address young people’s beliefs about the negative outcomes of alcohol use. Strategies that young people believe are effective may be easier to implement, but this does not imply that unpopular but effective strategies should not be tried’.
de Visser, RO
et al. 2014, ‘
Which alcohol control strategies do young people think are effective?’,
Drug and Alcohol Review, vol. 33, no. 2, pp. 144-51.
back to top
What is the association between using alcohol and/or tobacco at a harmful level and mental health problems?
A study conducted in NSW examined socio-demographic characteristics and mental health comorbidities associated with using tobacco and harmful levels of alcohol concurrently. The study participants were all over 45 years of age. They completed a survey instrument that assessed alcohol use, smoking, psychological distress, treatment for depression and anxiety, and a range of indicators of socio-economic status. The researchers found that ‘Being female, younger, lower individual and area-level socioeconomic status (SES) and depression and psychological distress were associated with tobacco use alone. Factors associated with alcohol use alone were older age, male gender, higher SES, and lower psychological distress and no recent depression treatment. Factors associated with concurrent risky alcohol consumption and tobacco use included being 45-64, being male, less education, earning <$30 000, being employed, and living in lower-SES areas, treatment for depression’. The researchers concluded that ‘Results suggest strong links between SES, treatment for depression, psychological distress, and concurrent tobacco and alcohol use. This has implications for public health policies and clinical treatment for tobacco and alcohol use, suggesting greater emphasis on addressing multiple health and social concerns’.
Bonevski, B
et al. 2014, ‘
Associations between alcohol, smoking, socioeconomic status and comorbidities: evidence from the 45 and Up Study’,
Drug and Alcohol Review, vol. 33, no. 2, pp. 169-76.
Comment: Although the findings of this well designed and implemented Australian study are disappointing, they highlight the importance of investing in this type of research. The authors’ conclusions about the importance of alcohol control legislation to underpin or complemented community initiatives, is soundly based.
back to top
Do the current Australian threshold quantities for drug trafficking place people who use at risk of unjustified criminal justice sanctions?
A recent issue in the Australian Institute of Criminology’s series,
Trends & Issues in Crime and Criminal Justice examines whether Australian drug users are at risk of exceeding the legal thresholds for personal use of drugs, placing them at risk of being convicted of drug trafficking. The researchers discovered that ‘…some, but not all users are at risk, with those most likely to exceed current thresholds being consumers of MDMA and residents of New South Wales and South Australia. The implication is that even if the current legal threshold system helps to convict and sanction drug traffickers, it may be placing Australian drug users at risk of unjustified charge or sanction’. The authors note that ‘…while the results support the findings from the Australian Capital Territory of thresholds posing clear risks to users, they also show how risks can be mitigated with better design—namely with thresholds that better reflect using patterns in the particular state of concern and how the wholesale adoption of the Model Criminal Code quantities across Australia would serve to increase the likelihood of a drug user being unjustly charged and/or sanctioned for trafficking’. They comment that ‘...the findings suggest that instances of users exceeding the threshold quantity identified would be much less problematic if the threshold quantity were not also linked to the “deemed supply” laws. The question arises—to what extent is it reasonable to expect a drug user in such circumstances to prove the absence of trafficking or intent to traffic?’
Hughes, C
et al. 2014,
Australian threshold quantities for ‘drug trafficking’: are they placing drug users at risk of unjustified sanction?, Trends & Issues in Crime and Criminal Justice no. 467, Australian Institute of Criminology, Canberra,
http://www.aic.gov.au/publications/current%20series/tandi/461-480/tandi467.html.
Comment: This research report builds on a ground-breaking study conducted by the research team in the ACT. The national study reported upon here has produced sound evidence that policy makers can use to fine tune the drug quantity thresholds that, in law, differentiate between a person being convicted for drug use compared with drug trafficking. The authors’ comment about the reverse onus of proof is important: it is an abuse of the human rights of people who use drugs for them to have to prove to a court that they were not trafficking drugs when, in criminal law generally, the prosecution has to prove that the offences had been committed.
This study has informed recent changes to drug laws in the ACT. For further information see the special ATODA eBulletin summarising developments here.
back to top
How sound is the evidence base for paternalistically-motivated compulsory treatment?
In a recent commentary, Australian scholars have noted the currently-operating initiatives in NSW and Victoria to provide compulsory treatment for people with severe alcohol and/or other drug dependence whose drug use makes them a risk to themselves and/or to others, i.e. paternalistically-motivated compulsory treatment. Sometimes the families of these people ask for their loved-ones to be placed into compulsory treatment, although the people most likely to be subjected to such orders are homeless, without family supports. The authors point out that this approach reflects well-established practice in psychiatric services, but that those programs have rarely been evaluated, meaning that the evidence supporting their efficacy in that sector is wanting.
The same applies to compulsory addiction treatment: 'A major problem shared by all forms of paternalistic coerced addiction treatment is the lack of evidence on its safety and efficacy. There are no randomised controlled trials or observational studies showing that persons who have been compulsorily treated have lower rates of re-hospitalisation, premature death and morbidity than similarly addicted persons who have not been compulsorily treated'. Furthermore, there is no evidence that compulsory treatment saves money for the health or other sectors (although the authors point out that it is questionable that such a motive is ethically justifiable). The authors conclude their commentary by posing, and answering, the question 'What should we do?' They list five responses needed, stressing the importance of building an evidence base through high quality evaluations of the NSW and Victorian interventions, including clarifying the program effectiveness and how well the inmates' civil rights are protected in compulsory treatment programs.
Hall, W, Farrell, M & Carter, A 2014, ‘
Compulsory treatment of addiction in the patient’s best interests: more rigorous evaluations are essential’,
Drug and Alcohol Review, online ahead of print.
back to top
Is it cost effective to divert non-violent offenders with substance abuse disorders into treatment rather than incarcerating them?
An article in the prestigious
American Journal of Public Health describes a study of the costs and savings attributable to the California Substance Abuse and Crime Prevention Act (SACPA), which mandated probation or continued parole with substance abuse treatment in lieu of incarceration for adult offenders convicted of non-violent drug offences and probation and parole violators. The authors explain that ‘The goal of SACPA passage was to reduce incarceration rates for nonviolent drug users in the State of California while offering a mechanism for these individuals to receive treatment for their SUDs [substance abuse disorders]. As such, SACPA can be considered a successful program, enrolling tens of thousands of offenders each year and resulting in outcomes comparable to those commonly observed in SUD treatment research. Among the chief arguments raised against SACPA passage was that the ultimate cost of the initiative would be “far higher than its promised savings after considering costs for law enforcement, probation and court expenses”…Our work shows the converse: California will realize long-term cost savings by offering treatment to nonviolent drug offenders rather than incarcerating them’.
Anglin, MD, Nosyk, B, Jaffe, A, Urada, D & Evans, E 2013, ‘
Offender diversion into substance use disorder treatment: the economic impact of California’s proposition 36’,
American Journal of Public Health, vol. 103, no. 6, pp. 1096-102.
back to top
New Reports
ABC Fact Check 2014, Did the NT’s banned drinker register work? http://tinyurl.com/o2k8wu8
- |Fact Check’s verdict: “Senator Peris is correct that alcohol-related emergency admissions in Northern Territory hospitals have increased by 80 per cent since the banned drinker register was scrapped. However attributing this significant change to the banned drinker register does not present the full picture. Firstly, the register did not stop the long-term increasing trend in alcohol-related emergency presentations. Also, the serious upward spike in alcohol-related emergency presentations began in May 2012 when the register was still in place. Experts say it is too early to assess the reasons for the spike.’
Australian Bureau of Statistics 2014,
Apparent consumption of alcohol, Australia, 2012-13, Australian Bureau of Statistics, Canberra,
http://www.abs.gov.au/ausstats/abs@.nsf/mf/4307.0.55.001.
- ‘The volume of pure alcohol available for consumption in the form of spirits increased by 4.1% between 2011-12 and 2012-13. The volume of pure alcohol available for consumption in the form of Ready to Drink (pre-mixed beverages) decreased by 2.9%, beer by 0.6% and wine by 0.5% during this period. Of all pure alcohol available for consumption in 2012-13, beer contributed 40.9%, wine 37.4%, spirits 13.1% and RTDs 6.6%. Cider contributed a further 2.0%... On a per capita basis there were 9.9 litres of pure alcohol available for consumption per person in 2012-13, 1.6% less than the amount in 2011-12 (10.0 litres) and 8.2% less than 2007-08 (10.8 litres).’
Chalmers, J & Ritter, A 2014, Alcohol and other drug treatment utilisation in Australia, Working Paper no. 8 - Review of AOD prevention and treatment services, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://dpmp.unsw.edu.au/sites/default/files/dpmp/page/WP8_0.pdf.
Foundation for Alcohol Research and Education (FARE) 2014, Annual alcohol poll: attitudes and behaviours 2014, Foundation for Alcohol Research and Education (FARE), Canberra, http://www.fare.org.au/research-development/community-polling/2014-poll/ .
Gomez, M & Ritter, A 2014, “Hard to count” or unrecorded treatment utilisation for alcohol and other drugs, Working Paper no. 6 - Review of AOD Prevention and Treatment Services, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.dpmp.unsw.edu.au/content/WP6.
Goodwill, R 2014, Media release: Public approval for driving limits for 16 drugs, UK Department for Transport, https://www.gov.uk/government/news/public-approval-for-driving-limits-for-16-drugs.
- ‘Today (27 March 2014) the [UK] government’s ambition to create a new drug drive limit moved a step closer following the results of 2 public consultations. The recommended limits for 16 different drugs have now been approved and will see 8 generally prescription and 8 illicit drugs added into new regulations that will come in to force in the autumn 2014. The new rules will mean it will be an offence to be over the generally prescribed limits for each drug and drive vehicle, as it is with drink driving.’
Hull, P & Ritter, A 2014, The potential role of pay-for-performance in alcohol and other drug treatment funding: a literature review, Working Paper no. 5 - Review of AOD Prevention and Treatment Services, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.dpmp.unsw.edu.au/content/WP5.
John K See Consulting 2013, Survey of secondary school principals on the use of alcohol and other drugs in schools, ANCD Research Paper (online) no. 26, Australian National Council on Drugs, Canberra, http://www.ancd.org.au/publications-and-reports-list/research-papers/2061-ancd-research-paper-26.
Lubman, D et al. 2013, Alcohol and energy drinks in NSW: leading responses to alcohol and drug issues, Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, large file warning: 4.6 MB http://www.health.nsw.gov.au/mhdao/publications/Pages/alcohol-and-energy-drinks.aspx.
Ritter, A, Chalmers, J & Berends, L 2014, Australian alcohol and other drug treatment spending, Working Paper no. 7 - Review of AOD prevention and treatment services, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://dpmp.unsw.edu.au/sites/default/files/dpmp/page/WP7.pdf.
Ritter, A., Chalmers, J. & Berends, L 2014, The Non Government Organisation Treatment Grants Program (NGOTGP) and the Substance Misuse Service Delivery Grants Fund (SMSDGF) – a descriptive overview, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://dpmp.unsw.edu.au/content/WP4.
Ritter, A. et al. 2014, Planning processes for alcohol and other drug treatment in Australia, Working Paper no. 9 - Review of AOD prevention and treatment services, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://dpmp.unsw.edu.au/sites/default/files/dpmp/page/WP9.pdf.
Ritter, A. et al. 2014, Approaches to purchasing alcohol and other drug treatment in Australia, Working Paper no. 10 - Review of AOD prevention and treatment services, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.dpmp.unsw.edu.au/sites/default/files/dpmp/page/WP10.pdf.
back to top
