Our 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.
Report of a high level roundtable held at the University of Sydney on Tuesday 31st January 2012 on the topic “What are the likely costs and benefits of a change in Australia’s current policy on illicit drugs?”
It is time to reopen the national debate about drug use, its regulation and control. In June 2011 a prestigious Global Commission stated that the 40-year “War on Drugs” has failed, with devastating consequences for individuals and societies around the world. It urged all countries to look at the issue anew.
In response to the Global Commission report, Australia21, in January 2012, convened a meeting of 24 former senior Australian politicians and experts on drug policy, to explore the principles and recommendations that were enunciated by the Global Commission. The group also included two young student leaders, a former senior prosecutor, a former head of the Australian Federal Police, representatives of Families and Friends for Drug Law Reform and a leading businessman.
The Australian group agreed with the Global Commission that the international and Australian prohibition of the use of certain “illicit” drugs has failed comprehensively. By making the supply and use of certain drugs criminal acts, governments everywhere have driven their production and consumption underground and have fostered the development of a criminal industry that is corrupting civil society and governments and killing our children. By defining the personal use and possession of certain psychoactive drugs as criminal acts, governments have also avoided any responsibility to regulate and control the quality of substances that are in widespread use. Some of these illicit drugs have demonstrable health benefits. Many are highly addictive and harmful when used repeatedly. In that respect they are comparable to alcohol and nicotine, which are legal in Australia and, as a result, are under society’s control for quality, distribution, marketing and taxation. Australia has made great progress in recent decades reducing the harm from tobacco – a drug which kills half the people who use it.
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT.
In late 2011, a discussion paper was developed and distributed to identified researchers based within the ACT. A workshop was then held with cross-institutional researchers, practitioners and policy makers in the ACT. At the workshop it was agreed to progress establishing a collaboration, such as a Centre for Drug Research, Policy and Practice in the ACT. Participants included representatives from the Australian National University, University of Canberra, Australian Catholic University, ACT Government Health Directorate, ATODA and the ATOD sector. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
A Service Users’ Satisfaction Survey was conducted across ACT ATOD services in 2009. The survey filled two functions, the first was to obtain a snapshot of the levels and patterns of satisfaction of the service users; and the second was to provide baseline information for monitoring and assessing the outcomes of quality assurance programs implemented by the services that participated in the survey. Another survey is being conducted in the coming months. Stakeholders are invited to participate, including attending a forum on 23 April to discuss the survey findings and next steps.
Stakeholders are invited to attend any or all of three workshops that will be held on Thursday 10 May, facilitated by Professor Ann Roche, National Centre for Education and Training on Addiction.
Members have developed the conference program and will be participating in the 2012 sector conference which will be held at the National Portrait Gallery on Tuesday 19 June 2012.
Dr Alex Wodak, Alcohol and Drug Service, St. Vincent's Hospital
Dr Michael Tedeschi, Alcohol and Drug Services, ACT Government Health Directorate
The editors write: ‘To mark two decades of publication of Tobacco Control, we have published a special anniversary issue to reflect on major achievements over the last 20 years and look forward to future developments’: Tobacco Control
, Volume 21, Issue 2,
March 2012, http://tobaccocontrol.bmj.com/content/current
. The topics covered are Editorials, News analysis, A shameful past, The tobacco epidemic today, Reviews, The Lighter Side, Strategic directions and emerging issues in tobacco control, Debates, The future of tobacco control and Endgame visions.
The Australian National Preventive Health Agency has recently published a report that also looks back at achievements in tobacco control: 50 years on: gains and opportunities in tobacco control in Australia. Marking the 50th anniversary of the Report of the Royal College of Physicians of London Smoking and Health
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What effect does national smoke-free legislation have on smoking in the home?
Research into the effect of national smoke-free legislation in four European countries (Germany, France, Ireland and the UK) has shown that ‘smoke-free legislation may stimulate smokers to establish total smoking bans in their homes’. The researchers found that ‘After implementation of national smoke-free legislation, the proportion of smokers with a total [home smoking ban] increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly…that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation [home smoking ban]. Prospective predictors of imposing a [home smoking ban] between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child.’
Mons, U et al. 2012, ‘Impact of national smoke-free legislation on home smoking bans: findings from the International Tobacco Control Policy Evaluation Project Europe Surveys’, Tobacco Control
, vol. Published Online First 13 February 2012, http://tobaccocontrol.bmj.com/content/early/2012/01/20/tobaccocontrol-2011-050131.abstract
While it is clear that smoking bans in public places have widespread public support, prohibiting smoking in the home (particularly homes in which young children reside) is not at present on the policy agenda. This study suggests, however, that a spill-over from prohibiting smoking in public into less smoking in the home may be occurring.
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Does continuing to wear nicotine patches, even after a lapse back to smoking, assist smokers to achieve abstinence?
A clinical trial conducted in eight sites in the USA examined whether active nicotine patch use improved the chances of recovering abstinence from smoking. The trials demonstrated that ‘Continuing treatment to aid smoking cessation with active patches promotes recovery from lapses. Smokers should be encouraged to persist with patch treatment if they lapse to smoking’.
Ferguson, SG, Gitchell, JG & Shiffman, S 2012, ‘Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence’, Addiction
, (Accepted article published online).
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Are mass media campaigns effective in promoting smoking cessation?
A recent review by Australian scholars ‘summarises the impact of mass media campaigns on promoting quitting among adult smokers overall and for subgroups; the influence of campaign intensity and different channels; [and] the effects of different message types’. The researchers found that ‘Mass media campaigns to promote quitting are important investments as part of comprehensive tobacco control programmes to educate about the harms of smoking, set the agenda for discussion, change smoking attitudes and beliefs, increase quitting intentions and quit attempts, and reduce adult smoking prevalence. Jurisdictions should aim for high reach and consistent exposure over time with preference towards negative health effects messages.’
Durkin, S, Brennan, E & Wakefield, M 2012, ‘Mass media campaigns to promote smoking cessation among adults: an integrative review’, Tobacco Control
, vol. 21, no. 2, pp. 127-38, http://tobaccocontrol.bmj.com/content/21/2/127.full
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What is Australia21 doing to get drug law reform onto the public policy agenda?
Australia21, based in Canberra, describes itself as ‘an independent, non-profit organisation whose core purpose is multidisciplinary research and inquiry on issues of strategic importance to Australia in the 21st century’. Having reviewed the report of the Global Commission on Drug Policy http://www.globalcommissionondrugs.org/Report
the organisation’s Board decided to initiate action to try to get drug law reform more prominently on the national public policy agenda. This is because, in the view of the Board, much of Australian (an international) drug policy and its implementation cause more harms that it actually prevents or resolves. Australia21 commissioned a background paper on the topic, and convened a high-level Roundtable that has produced a report, launched at Parliament House, Canberra, on 3 April 2012, as initial steps towards strengthening the national conversation on moving Australian drug policy to something better attuned to current conditions, and reflecting the research evidence on the topic.
McDonald, D 2011, A background paper for an Australia21 Roundtable, Sydney, 31 January 2012, addressing the question “What are the likely costs and benefits of a change in Australia’s current policy on illicit drugs?”
, Australia21, Canberra, http://shapingaustraliasfuture.blogspot.com.au/
Douglas, B & McDonald, D 2012, The prohibition of illicit drugs is killing and criminalising our children and we are all letting it happen. Report of a high level Australia21 Roundtable.
, Australia21, Canberra, http://www.australia21.org.au/our_research/illicit_drugs.html#a
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Is there a link between drivers aged 60 and over being prescribed psychoactive medications and having a motor vehicle crash?
A study which linked data from the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme examined the association between psychoactive medications and motor vehicle crash risk in drivers aged 60 and older. It showed that 981 people in this age group were hospitalised as the result of a crash in Western Australia between 2002 and 2008. After excluding those who did not meet the eligibility criteria (e.g., driver, motor vehicle crash), the final sample consisted of 616 individuals prescribed 6,671 psychoactive medications.
The researchers concluded that, ‘In this whole-population study, prescribed benzodiazepines and antidepressants significantly increased the risk that drivers aged 60 and older would be involved in a motor vehicle crash requiring hospitalization, whereas only a marginal association was found for those prescribed opioid analgesics’.
Meuleners, LB, Duke, J, Lee, AH, Palamara, P, Hildebrand, J & Ng, JQ 2011, ‘Psychoactive medications and crash involvement requiring hospitalization for older drivers: a population-based study’, Journal of the American Geriatrics Society
, vol. 59, no. 9, pp. 1575-80.
This Australian study is a timely reminder that drug-impaired driving is a broad public health issue. The current emphasis on driver saliva testing for three illegal drugs fails to address this broader issue.
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Is ‘ecstasy’ use falling as methamphetamine use is increasing?
‘Recent data from the Australian Institute of Criminology’s Drug Use Monitoring in Australia (DUMA) program indicate a decrease in the use of ecstasy among police detainees. Specifically, only five percent of police detainees in 2010 (n=187) and 2011 (n=170) reported using ecstasy; 50 percent lower than in 2009 (n=428) when ecstasy use peaked at 11 percent.
‘Self-report data also indicate that ecstasy was considered by users to be lower in quality and harder to obtain in 2011 compared with earlier years. Ecstasy users also reported a decrease in the number of people selling the drug.’
‘The decline in ecstasy use coincides with a reported increase in methamphetamine use among DUMA participants.’
Sweeney, J & Macgregor, S 2012, Decrease in use of ecstasy/MDMA
, Research in Practice no. 26, Australian Institute of Criminology, Canberra, http://www.aic.gov.au/publications/current%20series/rip/21-40/rip26.aspx
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Does recovery from harmful drug use equal abstinence?
This article summaries changes in the concept of recovery from the nineteenth century to the present, comparing policies in the USA and the UK.
‘The British Government’s recent drug strategy, Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug-Free Life
(2010), focuses on recovery from addiction. The strategy claims that it has recovery at its heart. Long-term extended treatment using methadone or other substitute prescribing, without a definite endpoint, is now out of favour. Many addicts say that they want to come off drugs and so the Government aims to facilitate that desire. This so-called new abstentionism has been a controversial change in the drug field. Some commentators have feared that the focus on abstinence will end the era of harm reduction in drug policy.’
Berridge, V 2012, The rise, fall, and revival of recovery in drug policy’, The Lancet
, vol. 379, pp. 22-3.
While all of us in the ATOD field are keen to support recovery among people with drug-related disorders, as this article points out the term ‘recovery’ is gaining worrying political connotations. This is occurring in both Australia and abroad. Emphasising ‘recovery’ is being used to attack opioid maintenance therapy and harm reduction, two interventions for which we have particularly high levels of evidence for effectiveness and cost-effectiveness.
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What are the most cost-effective treatment options for methamphetamine dependence?
‘Methamphetamine (MA) is a public health problem both in Australia and internationally and very little is known about the most cost-effective treatment options. This study is a review of recent studies and an assessment of current treatment options for MA dependence. Treatment options for MA dependence can be divided into outpatient and inpatient modality settings according to the level of drug use. Moderate improvements through higher rates of retention in treatment (especially residential rehabilitation) have been found in individuals who completed either cognitive-behavioural therapy or counselling as a form of outpatient treatment and in those users who completed a residential rehabilitation treatment programme at an inpatient treatment modality. There remains a need for further research to investigate the efficacy of existing treatment options in individuals with MA use problems and to address the economic impact of those interventions in terms of cost-effectiveness/cost utility.’
Ciketic, S, Hayatbakhsh, MR, Doran, CM, Najman, JM & McKetin, R 2012, ‘A review of psychological and pharmacological treatment options for methamphetamine dependence’, Journal of Substance Use
This careful review by Australian scholars adds to the evidence base on treating methamphetamine dependence. Earlier claims that we have no way of treating this population are clearly wrong.
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What can be achieved through school drug education programs focusing on harm reduction?
A study in Victoria investigated what alcohol prevention benefits could be achieved by a harm reduction-focused school drug education program that addressed the use of all drugs, both legal and illegal. It examined the effects of an intervention with years eight and nine students. The findings were that ‘The students, who received the intervention, were more knowledgeable about drug use issues, communicated more with their parents about alcohol, drank less, got drunk less, and experienced fewer alcohol related harms. They also remembered receiving more alcohol lessons. They were, however, no less likely to have tried alcohol’.
Midford, R, Cahill, H, Ramsden, R, Davenport, G, Venning, L, Lester, L, Murphy, B & Pose, M 2012, ‘Alcohol prevention: what can be expected of a harm reduction focused school drug education programme?’, Drugs: Education, Prevention, and Policy
, vol. 19, no. 2, pp. 102-10.
too often we hear that school-based drug education does not work. This Australian research team has shown the opposite: it works when focused on harm reduction rather than on the unrealistic goal (for most young people) of total abstinence.
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How effective are street drinking bans?
A study was undertaken to review community-based evaluations of street drinking bans, with a view to understanding the effectiveness of these laws in reducing alcohol-related harm and benefiting the community. Reviewing evaluations of street drinking bans in sixteen locations in the UK, Australia and New Zealand, the researchers found that these bans ‘often (1) negatively impact marginalized groups; (2) result in displacement; (3) improve perceptions of safety; (4) are enforced inconsistently; (5) improve perceptions of environment/amenity; and (6) are supported by police, traders and older people’. The researchers found ‘It is unclear whether street drinking bans: (7) reduce public drinking; (8) reduce alcohol-related crime or harm; and (9) are understood and adhered to’. The conclusion of the evaluations is that ‘There is no evidence that street drinking bans reduce alcohol-related harm or benefit the community in the other ways (aside from perceptions of safety and improvement to amenity)’.
Pennay, A & Room, R 2012, 'Prohibiting public drinking in urban public spaces: a review of the evidence', Drugs: Education, Prevention, and Policy
, vol. 19, no. 2, pp. 91-101.
This is another study demonstrating how many drug policies, while superficially attractive and popular with politicians and the public, have limited empirical support for effectiveness and can even have unintended adverse consequences.
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How aware are Australians of low-risk drinking levels?
A study using data from the National Drug Strategy Household Survey examined Australians’ perceptions of low-risk drinking. It found that ‘few Australians are aware of the recent 2009 Australian [NHMRC] drinking guidelines, with more than 40 per cent of respondents unable to even provide an estimate of low-risk drinking levels and just 5 per cent accurately providing low-risk levels for both long and short-term harms…[E]stimates for low-risk short term drinking were high, with two-thirds of men and one-third of women providing estimates in excess of the four drinks recommended in the guidelines. Heavier drinkers and young people provided the most concerning estimates with...a mean low-risk level of nine drinks per occasion estimated by 14-19 year old males.’
The researcher concludes ‘much of the population is making poorly informed decisions about drinking and placing themselves at substantial risk of harm. This is especially the case amongst sub-populations at high-risk of acute harm from alcohol (heavy drinkers and young people)…it is clear that most Australians are not aware of the recommendations in the 2009 guidelines. For these guidelines to contribute in any major way to reducing the harm from alcohol, a coordinated and substantial dissemination campaign is required, with a particular focus on high-risk population groups.
Livingston, M 2012, Perceptions of low-risk drinking levels among Australians during a period of change in the official drinking guidelines
, Foundation for Alcohol Research and Education (FARE), Canberra, http://www.fare.org.au/wp-content/uploads/2011/07/Perceptions-of-low-risk-drinking-levels-among-Australians-FINAL.pdf
The March 2012 issue of the journal Drug and Alcohol Review
(vol. 31, no. 2) is a special issue on low-risk drinking guidelines:
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What are barriers to and the facilitators of providing alcohol screening and brief interventions in health care settings?
A review by the National Institute for Health and Clinical Excellence in the UK examined 47 papers on barriers to and facilitators of the effective implementation of screening and brief intervention for alcohol misuse in adults and children. The review revealed that ‘implementation of brief interventions was facilitated or limited by organizational, provider and service user factors. The evidence shows that patients prefer to discuss alcohol related issues with their GP or nurse rather than a specialist; this is in line with the aim of brief interventions. However, the extent to which this can be implemented in practice may be restricted by existing workload as well as limited resources and support.’
The reviewers concluded that ‘[S]creening and brief interventions for alcohol misuse can be effective…primary care, and especially wellbeing clinics and new patient registration sessions provide a potentially acceptable context for patients to discuss drinking behaviour. For screening and brief intervention to be implemented effectively, adequate financial and managerial support is required in terms of training opportunities and covering workload. Practitioners require sufficient confidence and knowledge to address drinking behaviour appropriately with at risk individuals, without stereotyping particular groups.’
Johnson, M, Jackson, R, Guillaume, L, Meier, P & Goyder, E 2011, ‘Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence’, Journal of Public Health (Oxf)
, vol. 33, no. 3, pp. 412-21.
For some years we have known that screening and brief interventions in primary care settings can work, but usually do not. This review adds to knowledge of how to make them effective.
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What is the latest evidence on the risks of prenatal alcohol exposure?
A review of the evidence on the risks from low and moderate levels of prenatal alcohol exposure found that ‘[H]arm is well-documented with heavy exposure and moderate levels of exposure, 30-40 g per occasion and no more than 70 g per week, have been demonstrated to increase the risk of child behaviour problems’. The reviewers state that ‘With such a small margin before there is increased risk to the fetus, it would be morally and ethically unacceptable for policies and guidelines to condone consumption of alcohol during pregnancy’. They conclude that ‘The policy advice that “the safest choice for pregnant women is to abstain from alcohol during pregnancy” should be maintained’.
O'Leary, CM & Bower, C 2012, ‘Guidelines for pregnancy: what's an acceptable risk, and how is the evidence (finally) shaping up?’, Drug and Alcohol Review
, vol. 31, no. 2, pp. 170-83.
health workers have noticed reports that have confused the messages about drinking during pregnancy. This review confirms the earlier advice that abstinence is best, but that the abstinence message needs to be given sensitively and non-judgmentally. Note: a standard drink contains 10 grams of alcohol.
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Does imprisonment deter young offenders from further offending?
Many young people are caught up in the criminal justice system owing to drug use. A study reported in the Australian & New Zealand Journal of Criminology
tested the proposition that imprisonment deters future criminal activity among juvenile offenders. It used data covering all court appearances of juveniles in the NSW Children’s Court from 2003 to 2004. Re-offending among a group of young offenders sentenced to custodial orders was compared to a matched group of offenders who received community-based sanctions. The researchers found that ‘No differences were observed between the two groups. The young offenders given detention orders had a slightly lower rate of reoffending, but this difference was not significant. The results of this study indicate that, over the time period examined in this study, the imposition of a custodial sentence had no effect on the risk of reoffending’.
McGrath, A & Weatherburn, D 2012, ‘The effect of custodial penalties on juvenile reoffending’, Australian & New Zealand Journal of Criminology
, vol. 45, no. 1, pp. 26-44.
this NSW study strengthens the evidence base showing that detaining in custody juvenile offenders, many of whom are drug-involved, is ineffective. At the same time, increasing proportions of juvenile offenders are being placed on custodial orders. Policy-makers need to look at the evidence and reverse this worrying trend.
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New Book - Drugs and Drug Policy
Kleiman, MAR, Caulkins, JP & Hawken, A 2011, Drugs and drug policy: what everyone needs to know
, Oxford University Press, Oxford, $19.95.
‘Drugs and Drug Policy
is the product of scholarly work but comes in the form of a guidebook of answers to questions simple and complex about everything to do with the two topics. It is fit for both the policymaker and the concerned parent (how many books can this be said of?) because it combines a rigorous analytical approach to drugs without skipping over the social reasons the topic deserves to be discussed in the home. Kleiman, Caulkins and Hawken’s review of the nuances of the drug issue can’t help but elicit an appreciation for the variety of approaches against drug use that could supplement or substitute for our current top-down one.’ --Forbes.com
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Australia, Standing Committee on Transport 2011, National Road Safety Strategy 2011–2020
, Commonwealth Department of Infrastructure and Transport, [Canberra], http://www.atcouncil.gov.au/documents/atcnrss.aspx
Center for Substance Abuse Treatment (U.S.) 2011, Addressing viral hepatitis in people with substance use disorders
, Treatment Improvement Protocol (TIP) Series 53. HHS Publication No. SMA11-465, Substance Abuse and Mental Health Services Administration, Rockville, MD, http://store.samhsa.gov/product/TIP-53-Addressing-Viral-Hepatitis-in-People-With-Substance-Use-Disorders/SMA11-4656.
Centers for Disease Control and Prevention (USA) 2012, ‘Community-based opioid overdose prevention programs providing naloxone — United States, 2010’, MMWR; Morbidity and Mortality Weekly Report
, vol. 61, no. 06, pp. 101-5, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm?s_cid=mm6106a1_e
Australian Institute of Criminology on behalf of the Australian and New Zealand Crime Prevention Senior Officers’ Group 2012, National Crime Prevention Framework
, Australian Institute of Criminology, http://www.aic.gov.au/crime_community/crimeprevention/ncpf.aspx
Sweeney, J & Payne, J 2012, Drug Use Monitoring in Australia: 2009-10 annual report on drug use among police detainees
, Monitoring Reports 17, Australian Institute of Criminology, Canberra, http://www.aic.gov.au/en/publications/current%20series/mr/1-20/17.aspx
For information on other reports, please visit the ‘Did you see that report?’ page at the website of the National Drugs Sector Information Service: http://ndsis.adca.org.au/report.php
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