Substance Related Harms Research Articles

From scrubland to vintage wine: Australia's response to substance-related problems in the last 40 years.

Over the last 40 years Australia's response to substance-related problems compared with most western nations has been outstandingly good. Since the 1960s concerns about problems of substance use have expanded from a focus on alcohol to include tobacco and a wide range of other licit as well as illicit psychoactive substances. During this period there have been major advances in our knowledge and understanding of substance-related problems and effective methods of prevention, intervention and treatment. In parallel has been the development of a large number of non-government, government and professional organizations concerned with problems of substance use. These groups, individually and collectively, have contributed to the development of policies, plans, resources and programmes to prevent and minimize substance-related harm. Although significant progress in these endeavours took place between 1960 and 1986, there has been accelerated growth since and largely as a result of the establishment of the National Campaign Against Drug Abuse in 1986 and the ensuing National Drug Strategy and the Illicit Drug Strategy. However, much of this more recent success was possible because of the existence of the organizations, networks and infrastructures established in the earlier period and the Nation's general health, social and educational programmes. These initiatives have been associated with reductions in alcohol and tobacco use and related problems and evidence of reductions in some problem areas associated with illicit drug use. Despite these gains, there have been areas of failure and missed opportunities. Finally, it is critical to ensure that past achievements and opportunities for continued successful initiatives are not undermined by identifiable impediments and risks that could imperil the philosophy, goals, infrastructure and programmes that form the basis for Australia's success to date.

Making Treatment Decisions

The role of the non-specialist, with particular reference to the general psychiatrist, in treating substance misuse problems is examined. Two models, the Model of Change and of Relapse Prevention, that inform clinical treatment decision-making are described. Emphasis is given to non-specialists combining existing skills with a knowledge of assessment technique to develop so called minimal interventions fitting their own style of practice. While minimal interventions may be adequate for the ‘uncomplicated case’, more intensive treatment will be required where high levels of dependence are present. Psychopathology will be a complicating factor in 30–60% of patients but is not necessarily a reason to refer on to a specialist service. The specific function of the specialist service is seen to be the treatment of dependence, although it is argued that co-existing substance related harm should so far as possible be treated under the one roof. Training, information, consultancy and support from the specialist un...