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ACT ATOD Sector Research eBulletin - June 2012
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.




 
 


ACT Research Spotlight
 
Alcohol, drugs perceived to be involved in most assaults

Each year the Australian Bureau of Statistics (ABS) surveys a sample of the Australian population to determine the level of crime in the community. This information is provided nationally and by state and territory. Crime victim surveys are useful in establishing the profile of groups likely to be victims of crime as well as giving an indication of the amount of crime occurring which is not reported to the police.

The 2010–11 survey was the first time that victims of physical assault and face-to-face threatened assault were asked whether they believed alcohol or any other substance contributed to their most recent incident of assault. Nationally:
  • 64% of physical assault victims aged 18 years and over believed alcohol or any other substance contributed to their most recent incident
  • 57% of face-to-face threatened assault victims believed the same
Further information is available in Crime Victimisation, Australia, 2010–11 (cat. no. 4530.0)

http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4530.0Main+Features12010-11?OpenDocument

 
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The Canberra Collaboration
 
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 briefing. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on carrie@atoda.org.au or (02) 6255 4070.

Recent activities of the collaboration:

Implementation and Integration: ATOD Research, Policy and Practice
The Canberra Collaboration contributed to the 5th annual ACT Alcohol, Tobacco and Other Drug Sector Conference on 19 June at the National Portrait Gallery of Australia. Amongst other areas the conference challenged participants to consider:
  • How can we strengthen research, policy and practice?
  • Where have we come from over the past 20 years across research, policy and practice?
  • What is the role of markets and industry in prevention science and alcohol and tobacco?
  • What should our next steps be for injectable methadone, hydromorphone and diacetylmorphine?
  • How do we reconcile the ambiguities of synthetic cannabinoids?
  • How do we reconcile cultural kava use within current drug law reform regimes?
  • How can we learn from strategic advocacy and ‘the time lag’?
  • What are some drug law reform opportunities for the ACT?
Conference presentations will be available online soon at http://www.atoda.org.au/activities/conference/

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Research Findings

How many people are arrested for illicit drugs offences in the ACT?

Which drug substitution programs are most effective in reducing criminal behaviour?
Is it cost-effective to provide brief interventions for people arrested for alcohol-related offending in order to reduce their likelihood of re-offending?
Are brief interventions useful in reducing risk among high–frequency users of cannabis?
Are family-based interventions useful in reducing alcohol-related harm in Indigenous communities?

What are the implications of the ‘recovery’ paradigm?
Can people who inject drugs contribute to improving peer education programs?

What is chronic obstructive pulmonary disease and how serious a health problem is it in Australia?

Do increases in the minimum prices of alcohol reduce consumption?
Does alcohol increase the risk of breast cancer?
Using drugs can be pleasurable: is this a justification for their legalisation?


Note: Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s National Drugs Sector Information Service (NDSIS) http://ndsis.adca.org.au. NDSIS also provides, at its DrugFields professional development website, Research in Brief summaries of studies conducted at the National Drug and Alcohol Research Centre, University of NSW, Sydney; visit http://www.drugfields.org.au/research-in-brief.
 

How many people are arrested for illicit drugs offences in the ACT?

The Australian Crime Commission’s report on illicit drug arrests for the 2010-11 year has recently been released. It shows that, in that year, the ACT had 350 arrests for illicit drug offences, and that 94 Simple Cannabis Offence Notices (SCONs) were issued. 91% of the arrests plus SCONs were classified as drug consumers (89% in the previous year) and only 9% drug providers. In contrast, nationally 82% were consumers. With regard to cannabis specifically, 97% of ACT arrests plus SCONs were cannabis consumers (93% in the previous year), compared with 87% nationally. In the ACT that year there were also 51 arrests for amphetamine-type stimulants (100 the previous year), 22 for heroin & other opioids, 6 for cocaine, 2 for steroids and none for hallucinogens. In addition to detailed statistics, the report provides valuable information on drug cultivation, manufacture and trafficking, along with criminal justice agencies’ responses.

Australian Crime Commission 2012, Illicit drug data report 2010-11, Australian Crime Commission, Canberra, http://www.crimecommission.gov.au/publications/illicit-drug-data-report/illicit-drug-data-report-2010-11. Large file warning: 5.25 MB.

Comment: It continues to be disturbing that the vast majority of arrests are of consumers rather than providers, and that most of these are cannabis consumers. It raises questions about ACT Policing’s drug law enforcement strategies and priorities.

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Which drug substitution programs are most effective in reducing criminal behaviour?

A systematic review examined studies that assessed the impact of methadone, buprenorphine, heroin, naltrexone, dihydrocodeine or levo-α-acetylmethadol (LAAM) substitution on the criminal behaviour of opioid users. The reviewers concluded that ‘Heroin maintenance has been found to significantly reduce criminal involvement among treated subjects, and it is more effective in crime reduction than methadone maintenance. Methadone maintenance greatly reduces criminal involvement, but apparently not significantly more so than other interventions. Buprenorphine and Naltrexone have been found to be promising, although few studies have been identified using these substances in maintenance treatment’.

Egli N, Pina M, Skovbo Christensen P, Aebi MF, Killias M. 2009, revised 2011, ‘Effects of drug substitution programs on offending among drug-addicts’, Campbell Systematic Reviews, vol. 2009:3. http://campbellcollaboration.org/lib/project/79/.

Comment: The evidence continues to build that heroin assisted treatment should be available for some opioid dependent people, alongside other evidence-based therapies.

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Is it cost-effective to provide brief interventions for people arrested for alcohol-related offending in order to reduce their likelihood of re-offending?

The British Home Office introduced the Alcohol Arrest Referral (ARR) pilots to test whether brief interventions to reduce alcohol consumption could also reduce re-offending. Phase 2 of these pilots was conducted by eight police forces between 2008 and 2010. An evaluation of this phase found that ‘Overall, the intervention appeared to be ineffective for this client group in terms of reducing re-arrest but there was some limited evidence of reduced alcohol consumption among the intervention group. A larger proportion of dependent drinkers were identified by schemes than anticipated and individuals were not found to be prolific offenders. Average costs per intervention varied from £62 to £826. Only one scheme appeared to demonstrate a sufficient reduction in arrest to break even… the research presents arguments for custody-based interventions, which screen for alcohol needs and refer clients to appropriate support’.

McCracken, K 2012, Evaluation of Alcohol Arrest Referral Pilot Schemes (Phase 2), Home Office Occasional Paper no. 102, London, http://www.homeoffice.gov.uk/publications/science-research-statistics/research-statistics/crime-research/occ102.

Comment: This study is consistent with others that demonstrate that brief interventions, while effective in some population groups, are not cost-effective in others. For these arrestees, more intensive diversion programs are needed.

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Are brief interventions useful in reducing risk among high–frequency users of cannabis?

A study has found that brief interventions (BIs) have the potential for risk reduction in Canada ‘where cannabis use is prevalent among young people, and BIs have largely been ignored in the substance use arena to date…At this point, the vast majority of intervention resources for cannabis use control in Canada are expended for criminalization (e.g., arrests of users); in addition, large-scale abstinence education or promotion campaigns are implemented with questionable impact. A small proportion of the resources used for the aforementioned programs would allow broadbased BI programs to be implemented for high-risk cannabis users in settings (e.g., universities, colleges) where such populations are disproportionately present and offer themselves well for such measures, as has been shown for other public health oriented intervention campaigns (e.g., sexual health education or nutritional education, etc.). In addition, other key stakeholders – e.g., non-governmental public health associations – could become involved in offering such BI programming.

Fischer, B, Jones, W, Shuper, P & Rehm, J 2012, ‘12-month follow-up of an exploratory “brief intervention” for high-frequency cannabis users among Canadian university students’, Substance Abuse Treatment, Prevention, and Policy, vol. 7:15, http://www.substanceabusepolicy.com/content/pdf/1747-597X-7-15.pdf.

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Are family-based interventions useful in reducing alcohol-related harm in Indigenous communities?

A systematic review of nineteen intervention studies describes the characteristics of the interventions and identifies those that appear most promising in reducing alcohol-related harm in Indigenous communities. The reviewers conclude that, ‘Given the central role that family relationships play in reinforcing behavior and maintaining social cohesion in indigenous communities, family-based approaches offer considerable promise for reducing alcohol-related harms among indigenous peoples. Family-based interventions are more likely to be acceptable, appropriate, and effective for indigenous peoples if (a) adapted with the input of indigenous community members…(b) the involvement of family members who are themselves problem drinkers is not automatically excluded, because their exclusion is not practical in the context of routine delivery of health care services due to clustering of alcohol problems within racial minority family groups…(c) therapists delivering the intervention are trained and supervised to optimize intervention fidelity…and (d) the intervention is manualized for integration into health service protocols and procedures but has sufficient flexibility to meet the needs of individual clients’.

Calabria, B, Clifford, A, Shakeshaft, AP & Doran, CM 2012, ‘A systematic review of family-based interventions targeting alcohol misuse and their potential to reduce alcohol-related harm in indigenous communities’, Journal of Studies on Alcohol and Drugs, vol. 73, no. 3, pp. 477-88.

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What are the implications of the ‘recovery’ paradigm?

A systematic review of the last ten years’ recovery literature was conducted. It found that ‘The historical evolution of the concept of recovery has been shaped by several driving forces, including consumer experience, the need to better define our treatment outcome and parallel elaboration of the concepts of health, quality of life, and chronic disorders… The various forms of recovery, such as “natural”, “transformational” or “medication-assisted”, describe a choice of pathways to a common goal. The management implications are far-reaching and call for system shifts from acute stabilization to sustained recovery, including the growth of alternative institutions, and roles complementary to mutual help…Although first-person accounts of recovery abound, a more systematic empirical investigation of the concept has just begun, including demographic and cultural differences. Management implications are derived from the experience with other “mainstream” chronic disorders with treatment providing stabilization and initiation of recovery and a range of long-term resources becoming available to sustain it’.

el-Guebaly, N 2012, ‘The meanings of recovery from addiction: evolution and promises’, Journal of Addiction Medicine, vol. 6, no. 1, pp. 1-9.

Comment: The ‘new recovery movement’ is attracting much attention in Australia at present with the development by Turning Point staff of the Australian Recovery Academy. The approach has recently been brought to Australia from the USA via the UK. While widespread support exists across the ATOD sector for a broad approach to recovery, including strengthening continuing care services, concern exists that little evidence exists for the recovery approach’s effectiveness, and that many of its proponents are opposed to evidence-based treatment modalities such as opioid maintenance treatment, and harm reduction initiatives such as NSPs.

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Can people who inject drugs contribute to improving peer education programs?

An NSW study examined the structural context of peer education and its implications for peer training. People who inject drugs (PWID) participated in focus group discussions to develop peer education messages and strategies which were then trialled within their networks and their experiences discussed in subsequent focus groups. ‘The influence of structural factors (such as the policing of public space) on participants’ peer education attempts were identified and discussed’. The researchers propose that ‘despite the damaging impact of structural factors on the lives of PWID, they can in turn be used by peer educators to develop innovative interventions designed to increase resilience and reduce internalized stigma. Peer education programmes need sufficient flexibility and resources to allow for the negotiation of participants’ immediate needs and for collaborative learning between PWID and peer educators’.

Treloar, C, Rance, J, Laybutt, B & Crawford, S 2012, ‘Structural constraints on the training of peer educators in hepatitis C prevention’, Health Education Research, vol. 27, no. 2, pp. 248-57.

Comment: This study adds to the developing evidence base supporting peer programs as an integral part of the Australia ATOD sector.

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What is chronic obstructive pulmonary disease and how serious a health problem is it in Australia?

‘Chronic obstructive pulmonary disease (COPD) limits airflow in the lungs. This can lead to mild or severe shortness of breath that is not fully reversible even with treatment. People with COPD often have emphysema (damaged lung tissue) and/or chronic bronchitis (indicated by a frequent cough caused by excessive mucus production). The terms COPD, emphysema and chronic bronchitis are sometimes used interchangeably but COPD is the current preferred medical term that includes both emphysema and chronic bronchitis. Smoking is its main, but not only, cause…In Australia in 2003, compared with all other health conditions, COPD was the sixth leading cause of male burden and the seventh leading cause of female burden of disease…The death rate from COPD for males in 2009 was one third of that in 1970. In 1970, the male death rate from COPD was 8 times the female rate. In 2009, the male death rate was only twice the female death rate.’

Australian Institute of Health & Welfare 2012, COPD (chronic obstructive pulmonary disease), AIHW, http://www.aihw.gov.au/copd/.

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Do increases in the minimum prices of alcohol reduce consumption?

A study in British Columbia (BC), Canada, analysed provincial government data on quarterly alcohol sales, quarterly alcohol prices and both quarterly and annual economic indicators over a 20-year period. The results of the study ‘suggest that minimum pricing at the levels implemented over our sampling period in BC effectively reduced both beverage specific and aggregate consumption: the estimates indicate that a 10% increase in the minimum price of a given type of beverage reduced consumption of that type by about 16.1% relative to all other beverages, and a simultaneous 10% increase in the minimum prices of all types reduced total consumption by 3.4%’.

Stockwell, T, Auld, MC, Zhao, J & Martin, G 2012, ‘Does minimum pricing reduce alcohol consumption? The experience of a Canadian province’, Addiction, vol. 107, no. 5, pp. 912-20.

Comment: Minimum pricing policies are now being developed in England and Scotland. Australian regulators have to date largely ignored the emerging evidence as to their effectiveness as public health measures. This is unsurprising considering their refusal to introduce volumetric taxation of alcohol.

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Does alcohol increase the risk of breast cancer?

An analysis of the evidence of a link between the consumption of alcohol and the risk of breast cancer led to the conclusion that ‘Women should not exceed one drink/day, and women at elevated risk for breast cancer should avoid alcohol or consume alcohol occasionally only’. The researchers found that ‘A significant increase of the order of 4% in the risk of breast cancer is already present at intakes of up to one alcoholic drink/day. Heavy alcohol consumption, defined as three or more drinks/day, is associated with an increased risk by 40–50%. This translates into up to 5% of breast cancers attributable to alcohol in northern Europe and North America for a total of approximately 50,000 alcohol-attributable cases of breast cancer worldwide. Up to 1-2% of breast cancers in Europe and North America are attributable to light drinking alone, given its larger prevalence in most female populations when compared with heavy drinking’.

Seitz, HK, Pelucchi, C, Bagnardi, V & Vecchia, CL 2012, ‘Epidemiology and pathophysiology of alcohol and breast cancer: update 2012’, Alcohol and Alcoholism, vol. 47, no. 3, pp. 204–212.

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Using drugs can be pleasurable: is this a justification for their legalisation?

A recent issue of The Conversation examines the reasons why some drugs are prohibited and others are legal. The authors go on to argue that ‘The public discourse on drugs includes liberty, health, and crime, but it so rarely includes the value of pleasure. We do not have to be hedonists to believe that pleasure is one of the important goods in a person’s life. A liberal society should be neutral with regard to which pleasures people may pursue; it should not force people to conform to a particular conception of “good” and “bad” pleasures.
‘But more importantly, if every pleasurable behaviour can be addictive, then there can be no reason to believe that the pleasures of drug use are less important than the pleasures of good food and wine, of rock-climbing and football, or of browsing the internet. Each of these things is pleasurable, and hence each is addictive, and each can be harmful if done to excess. But we all have a right to pursue the pleasures we find valuable, even though each of these pleasures puts us at risk of addictions or addiction-like problems: alcoholism, pathological internet use, sex addiction, binge eating disorders, and so on.
‘The right to pursue pleasure gives us reason to legalise drugs, while addiction and self-harm fail to give us good reason to prohibit them. That is the essence of a strong moral argument against the war on drugs’.

Savulescu, J & Foddy, B 2012, ‘A moral argument against the war on drugs’, The Conversation, no. 5 April, http://theconversation.edu.au/a-moral-argument-against-the-war-on-drugs-6304.

Comment: People opposed to drug law reform often cite moral justifications for their positions. These scholars present what they see as the moral arguments for a more relaxed approach to drug control.

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New Reports

Chikritzhs, T, Evans, M, Gardner, C, Liang, W, Pascal, R, Stockwell, T & Zeisser2, C 2011, Australian alcohol aetiologic fractions for injuries treated in emergency departments, National Drug Research Institute, Curtin University, Perth, WA., http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/aaafed-report

Office of National Drug Control Policy (USA) 2012, National Drug Control Strategy 2012, Office of National Drug Control Policy, Washington, DC, http://www.whitehouse.gov/blog/2012/04/17/drug-policy-21st-century.

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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Contact ATODA:

Phone: (02) 6255 4070
Fax: (02) 6255 4649
Email: info@atoda.org.au
Mail: PO Box 7187,
Watson ACT 2602
Visit: 350 Antill St. Watson

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The Alcohol Tobacco and Other Drug Association ACT (ATODA) is the peak body representing the non-government and government alcohol, tobacco and other drug (ATOD) sector in the Australian Capital Territory (ACT). ATODA seeks to promote health through the prevention and reduction of the harms associated with ATOD. 

Views expressed in the ACT ATOD Sector eBulletin do not necessarily reflect the opinion of the Alcohol Tobacco and Other Drug Association ACT. Not all third-party events or information included in the eBulletin are endorsed by the ACT ATOD Sector or the Alcohol Tobacco and Other Drug Association ACT. No responsibility is accepted by the Alcohol Tobacco and Other Drug Association ACT or the editor for the accuracy of information contained in the eBulletin or the consequences of any person relying upon such information. To contact us please email ebulletin@atoda.org.au or call (02) 6255 4070.








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