The National Drug Strategy 2010-2015: consultation draft
Pillar 2: Demand reduction
Demand reduction includes strategies to prevent the uptake of drug use, delay the first use of drugs, and reduce and stop drug misuse. This can include the provision of information and education, for example through school based programs or public awareness campaigns. Evidence-based early intervention programs, counselling, treatment, rehabilitation, relapse prevention, aftercare and social integration can help drug users reduce or cease their drug use. The demand for drugs can also be affected by their availability and affordability; which can, depending on the drug, be influenced through supply control, regulation and taxation.
Drug misuse is influenced by a complex interaction of physical, social and economic factors. Disadvantaged populations are at heightened risk of drug misuse and its associated harms. People can also be at risk of different patterns of misuse at different ages – for example, younger people may be more at risk of short-term harms from binge drinking while older people may be more at risk from chronic alcohol misuse.
The appropriate mix of educational and social marketing approaches will also vary between drug type – whole-of-population strategies may be more appropriate for alcohol and tobacco and for those illicit drugs that are widely used, while approaches targeted to users and key at-risk groups may be more appropriate for those drugs which only a small percentage of the population uses.
Settings-based approaches will be a key feature of the National Drug Strategy 2010-2015. The COAG Preventive Health National Partnerships includes a focus on prevention activities for alcohol and tobacco in communities, childcare and school settings and workplaces.
No one strategy on its own can prevent and reduce the demand for drugs. Rather, broad-based, multidisciplinary and flexible strategies are needed to meet the many and varied needs of individuals and communities.
Demand reduction requires the cooperation, collaboration and participation of a diverse range of sectors. It is important to recognise the range of sectors that can influence drug demand and develop closer linkages with them.
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Objective 1: Prevent uptake and delay onset of drug misuse
Objective 2: Reduce misuse of drugs in the community
Objective 3: Support people to recover from dependence and reconnect with the community
Objective 4: Support efforts to promote social inclusion and resilient individuals, families and communities
Objective 1: Prevent uptake and delay onset of drug misuseIn general, preventing drug misuse can be more cost-effective than treating established drug problems. Prevention efforts can help reduce personal, family and community harms, allow better use of health system resources, generate substantial economic benefits, and produce a healthier workforce.
A key step in preventing the uptake of drugs is changing population culture so that drug misuse is no longer seen as a cultural norm. This involves improving community understanding and awareness of the drugs that are being used, their effects and harms associated with their misuse, and the choice of effective interventions and treatments. For some drugs, such as tobacco, cultural acceptance has been successfully challenged, contributing to a significant reduction in use over many years. Harmful alcohol consumption, on the other hand, still remains a challenge.
There is an increased risk of harms associated with the early uptake of drugs. The earlier a person commences use, especially heavy use, the greater their risk of harm in the short and longer term (eg mental and physical health problems), and the greater their risk of continued drug misuse.
- Explore and implement strategies that contribute to the development of a population culture that promotes healthy lifestyles.
- Develop and implement strategies aimed at breaking intergenerational patterns of drug misuse.
- Recognise the diverse range of factors that influence drug misuse and connect with other national policies to work collaboratively to reduce risk factors and build protective factors.
- Continue to implement well-planned social marketing campaigns that address the dangers of drug misuse, dangers about specific drug misuse practices (eg injecting, risky drinking) and promote healthy lifestyles, including targeted approaches and local complementary initiatives for different population groups.
- Use the internet and other new media to sustain and strengthen the provision of credible and accurate information and target different population groups.
- Limit or prevent exposure to alcohol and tobacco advertising and promotion through a staged approach to regulation.
- Explore ways of influencing responsible media reporting/portrayal.
- Support community-based initiatives, including in indigenous communities, to change the culture of smoking, risky drinking and illegal drug misuse.
- Strengthen evidence-based approaches to school drug education.
- Consider and respond to the report of the Preventative Health Taskforce as it relates to alcohol and tobacco, and implement responses.
Objective 2: Reduce misuse of drugs in the communityThe effects of misuse of drugs go beyond injury and illness/ disease to a range of social and economic consequences. People experiencing problems with drugs can find it difficult to form or maintain relationships, may have their educational and vocational paths disrupted and their general social development hampered. To reduce the occurrence and cost of such problems interventions need to be implemented early, preferably before problems emerge. For dependent users, reducing and/or ceasing the misuse of drugs can help them to lead stable, healthy and productive lives.
Successfully reducing the misuse of alcohol and drugs requires a range of approaches across the continuum of use, from experimental to dependent use. It is important to ensure that appropriate treatment is available and accessible to those who seek it. Engaging the support of family and friends for those seeking treatment is an important part of helping people to reduce their drug use.
Brief interventions can also be very effective. Brief interventions aim to identify current or potential problems with drug misuse and motivate those at risk to change their behaviour. They can range from five minutes of brief advice to thirty minutes of brief counselling. Brief interventions are commonly delivered by general practitioners, but can also be used by other service providers, police officers, liquor licensing inspectors or family members.
In instances of dependence, it is important for people to have access to effective treatment services and where needed, provision of support to rebuild their lives and to reconnect with the community. Evidence supports the effectiveness of a range of appropriately targeted treatment approaches. However, people can find it difficult to locate and access the service that meets their needs, and people with multiple and complex needs have the added difficulty of finding a number of different, sometimes unrelated, services.
A range of appropriate, specialised services should be available to anyone with a drug problem, irrespective of personal history, complex circumstances or socioeconomic status. A 'no wrong door' approach should be adopted so that people are provided with, or are guided to, appropriate services regardless of where they enter the system of care.
Generalist health care and social welfare services should also notice, assess and respond to people with alcohol and other drug misuse problems. There is a range of brief interventions, for example, that can be delivered by generalist services or over the internet. These could refer people to specialised services where necessary or provide support before harms and long-term dependence occur.
- Sustain efforts to increase access to, and links between, a greater range of treatment and other support services.
- Sustain efforts to increase access to a greater range of culturally sensitive services.
- Improve access to screening and targeted interventions for at risk groups eg. young people, people living in rural and remote communities, pregnant women, Aboriginal and Torres Strait Islander people.
- Increase the community's understanding of effective drug interventions through the provision of factual, credible information.
- Continue efforts in diverting people from traditional criminal justice pathways by providing information and/or referring them to assessment and treatment.
- Increase awareness, availability and appropriateness of telephone and internet counselling and information services.
- Develop planning models for treatment services that anticipate needs, and develop and implement quality frameworks for treatment services.
- Create incentives for, and encourage people who misuse or are dependent on drugs to access effective treatment and to make healthier decisions about their lives.
- Encourage family members to access and make use of support services to help improve treatment outcomes for clients.
- Explore and develop opportunities in the criminal justice system, including correctional services, to assist drug users through education, treatment and rehabilitation services.
Objective 3: Support people to recover from dependence and reconnect with the communityRecovering from drug dependence can be a long term process in which individuals need support and empowerment to achieve independence, self-esteem and a meaningful life in the community. Successful support for longer term recovery after treatment requires strategies that are focused on the whole of the individual and look across the life span.
While different people will have different routes to recovery, support for recovery is most effective when the individual's needs are placed at the centre of their care and treatment. Treatment service providers can assist individuals to recover from drug dependence, help the individual access the internal resources they need (eg. resilience, coping skills, physical health); and ensure referral and linkage with a range of external services and supports (stable accommodation, education, vocational and employment support, and social connections).
Noting the above, in maintaining and strengthening the current system of treatment and other support services across jurisdictions, the following principles will be continued under the next cycle of the National Drug Strategy:
- In designing treatment services, it is important to recognise that all drug users are not homogenous. Consequently, treatment services should incorporate a fundamental principle of consumer involvement in planning and operations. In addition, treatment interventions should be tailored to the varying needs of individuals (including the potential for access to substance-specific treatment and services).
- In designing and coordinating referral pathways, it is important to recognise that trigger points for entry into treatment come from a broad range of sources which should be reflected in those pathways (including through drug and alcohol diversion programs and linkages with primary health care).
- In designing and coordinating support after treatment to help individuals rebuild their lives and reconnect with the community, it is important to recognise that individuals often become marginalised or socially isolated as a result of their drug use, losing touch with their families and friends as well as opportunities for education, vocational, employment, housing and other areas of social participation. Drug treatment alone cannot solve these problems which, if not dealt with, can place an individual at risk of relapsing to drug use and related issues. Consequently, it is important that treatment services be linked to that broader range of services able to provide these supports and the necessary relationships and processes developed to better ensure these linkages are effective.
- Develop a set of nationally agreed principles for treatment services based on the above premises to support the strengthening of the existing service system.
- Develop a new evidence based national planning model to better estimate the need and demand for drug and alcohol health services across Australia including the full spectrum of services from prevention and early intervention to the most intensive forms of care, and the spectrum of services across the life span.
- Develop a set of national clinical standards for drug and alcohol treatment services.
- Improve the linkages and coordination between primary health care and specialist drug and alcohol treatment services to enhance the capacity for all health needs to be dealt with as well as to facilitate the earlier identification of health problems and access to treatment.
- Improve the communication and flow of information between primary care and specialist providers, and between clinical and community support services to promote continuity of care and development of cooperative service models.
- Consider appropriate structures that could be developed to help engage families and other carers in treatment pathways including ensuring that information about the pathways is readily accessible and culturally relevant.
- Establish linkages with the necessary services to provide those impacted by drug use and dependence, such as family members, children and friends, with on-going support including linkages to child welfare and protection services.
- Move towards national consistency of approach toward the non government treatment services sector including in relation to contract and performance arrangements and a transparent and comparable cost structure.
- Develop a sustained and comprehensive stigma reduction strategy to improve community and service understanding and attitudes to drug dependence and the related problems of individuals.
- Improve linkages and coordination between health, education, employment, housing and other sectors to expand the capacity to effectively link individuals from treatment to supports required for them to reconnect with the community.
Objective 4: Support efforts to promote social inclusion and resilient individuals, families and communitiesSocially inclusive communities and resilient individuals and families are less likely to engage in drug misuse. Resilient individuals are able to adapt to changes and negative events more easily and reduce the impacts that stressors have on their lives – and are less likely to misuse drugs.
Resilient and inclusive communities are characterised by strong social networks and work together to support individuals who may need assistance. They also promote safe and healthy lifestyles. Supportive and informed families and communities can prevent the uptake of drug use, identify drug misuse in its early stages and help individuals to access and maintain treatment. A resilient community will support people to avoid relapse and help them reconnect with the community.
Responsibility for building resilient communities lies at all levels — from governments, to communities, non-government organisations, families and individuals.
- Support whole-of-government and whole-of-community efforts to build parenting and family capacity, creating communities that support the positive development of children. This may include evidence-based approaches to drug prevention in schools.
- Continue to implement skills training to provide individuals with coping skills to face situations that can lead to risky behaviours including drug misuse.
- Implement preventive support programs targeting life transition points – primary to high school, school to work, prison to community – to help individuals with the skills to manage the next stage of life.
- Support efforts to encourage participation of at-risk groups in community life including recreational, sporting and cultural activities.
- Provide support services to parents in recovery to ensure the needs of dependent children are met.