QUESTION
Alcohol, abuse in Victoria or South Australia
SOLUTION
Alcohol is the most widely used drug in Australia and a serious public health problem.
Alcohol consumption is second only to tobacco as a preventable cause of death and
hospitalisation in Australia. The consequences of harmful consumption include fatal
road accidents and injuries, suicide, violence and serious long term health problems.
The state of Victoria in south east Australia is regarded as a world leader in health
promotion and public health research. Victoria has adopted a ‘harm minimisation’
approach to alcohol related harm, with an emphasis on education and persuasion
strategies to reduce the demand for alcohol. While alcohol related deaths across
Australia and Victoria have fallen over the last ten years, recent data shows an increase
amongst certain groups, including young people. This paper probes Victoria’s response
to alcohol related harm and suggests ways to further reduce alcohol related deaths and
injury in Victoria based on current research. The paper also considers how health
promotion theory has been used to develop successful alcohol harm reduction strategies in Victoria and opportunities to extend this research.
Alcohol or booze is widely used by teenagers. ‘Binge drinking’, drink driving and unsafe sex can all result from the misuse of alcohol. Alcohol is responsible for most drug-related deaths in the teenage population.
Parents believe alcohol is less dangerous than other drugs
Adolescence is typically a time of experimentation. This reflects Australia’s tolerant approach to alcohol use. Alcohol is one of the most commonly used drugs in Australia. Estimates suggest that around half of the population over the age of 14 years drinks alcohol at least weekly.
There is some evidence to suggest parents are so alarmed at the thought of their children using ‘harder’ drugs that alcohol is considered a lesser and more acceptable ‘evil’. Both of these are more than those attributed to illicit drug use.
In response to increasingly high levels of alcohol use doctors are calling for a reduction in the availability of alcohol, increased awareness of alcohol’s harms and improved access to detoxification services.
“Medical practitioners deal with the impacts of excessive alcohol consumption every day,” said AMA Victoria President Dr Harry Hemley. “It’s time for Victorians to reduce how much we are drinking and to find new ways to combat the harms of alcohol consumption.”
In its submission to the whole of government Victorian Alcohol and Drug Strategy, AMA Victoria has called for a multifaceted response to the growing problem of excessive alcohol use.
“A major problem in Victoria is the rising number of liquor outlets which make alcohol increasingly available and cheap,” said DrHemley. “A recent study in Melbourne found that levels of harmful alcohol consumption are strongly correlated with the density of alcohol outlets in an area.”
“AMA Victoria has called for community consultation to develop policies to cap the number of liquor outlets within specific areas. AMA Victoria has also called for alcohol license holders to be subject to harsher penalties if they breach the conditions of their license.
“It is essential that Victorian’s are educated about the risks of alcohol consumption. Such education campaigns should include a requirement that prominent warning messages be placed on alcohol labels.
“Victoria urgently needs more detoxification services for those that are trying to overcome alcohol addiction. Patients are currently experiencing wait times of up to two months in order to be assessed and then face a further delay before being admitted into a detoxification facility. Patients who have acknowledged their addiction and their need for treatment should not be forced to wait.
“Excessive alcohol consumption is linked to over 3,000 deaths and 65,000 hospitalisations each year,” said DrHemley. “Alcohol has been causally linked to more than 60 different medical conditions. Alcohol is also associated with many negative social outcomes.”
Research has found that many homicides are strongly linked with alcohol and over one third of parents with children entering foster care have alcohol problems.
“Urgent action is required if Victoria wants to slow rapidly increasing rates of alcohol use and its associated harms.”
Every Sunday evening on the television news you can see the impact of alcohol and other drugs in our community. Whether it’s a fight on the dance floor of a nightclub, a horror car crash or a party in the suburbs that’s got out of control, we can see what happens when the use of alcohol or other drugs becomes a problem.
What we don’t see is the quiet but equally deadly impact on the health, happiness and relationships of individuals who misuse drugs and alcohol. The people whose problems remain unacknowledged despite the fact they hurt them, their families and the broader community.
It is easy for politicians to talk about more police on the streets, speed cameras and roadside drug testing, and changing liquor licensing laws — all of which are critical components to these complex issues.
But we don’t hear about the bigger picture, and about policies that address the causes of drug and alcohol abuse, rather than the social symptoms we see on the news. Ways to change the culture surrounding drinking and drug use, and to allow people to get the help they need to battle their problems and change their lives.
In a culture where alcohol is seen as the natural accompaniment to any social occasion, and an essential part of a good time, we often underestimate the serious impact drinking has.
Take the case of a woman I will call Susie. Susie works full-time and has two boys aged eight and 11. She’s battled depression most of her life and more recently due to increasing violence and verbal abuse from her partner. Susie has been stable on her medication for more than three years, but over the past few months has been taking more than her doctor prescribes. She’s always been a social drinker but has now started to drink four to five glasses of wine on her own most nights of the week. She knows that her drinking is not helping her problems go away, but she says that “drinking numbs the pain”.
Susie is worried enough to talk with her GP about her concerns and the doctor wants to refer her to a service that can spend more time resolving her problems and giving her alternatives to alcohol. Not surprisingly, like the last time they tried to refer a patient, they are struggling to find a service that can see Susie immediately.
Without urgent and intensive support Susie may increase her drinking, begin to use other drugs to meet her needs or even increase her use of the prescription medication, which places her mental health at greater risk. This will in turn damage the lives of her children, and may eventually lead to them developing mental health or substance abuse problems.
The benefits to her, and to the health system, of early intervention will be lost.
Victoria has a comprehensive alcohol and other drug treatment and support system. We have hospitals and community health centres with specialist workers; “drug specific” organisations and rehabilitation centres; self-help services; numerous programs to reduce the harms associated with alcohol and drug misuse; and a range of general health and community service practitioners who see alcohol and other drug-affected people most days of the given week.
What we don’t have are enough staff and money to provide enough services right across Victoria. Our alcohol and other drug services save lives, but only if people are able to access programs when they are most needed.
Some of our treatment services have long waiting lists and this can be a significant barrier when people are trying to access help straight away.
It shouldn’t matter whether you are a long term heroin user or a young person starting to get into trouble when drunk – when you need help, you should be able to get it.
What’s worse is that we are seeing increases in hospital admissions and ambulance attendances related to alcohol misuse. This indicates we’re not seeing people early enough to intervene and address the potential for more serious harm.
We have a good understanding of what needs to be done, there is a skilled workforce and we know that treatments work for many people. What we are lacking is the capacity to deal with the level of demand we face.
We need to develop a sustainable plan to ensure that the misuse of alcohol and/or other drugs is able to be managed for the sake of individuals, families and the broader Victorian community
In these final days of the Victorian election campaign, we would like to see comprehensive alcohol and other drug policy positions from all major and minor parties.
We need to build on the good work that has been done in recent years, and tackle the root causes of drug and alcohol abuse.
Because on a Sunday night in the not-too-distant future, I’d like to tune into the evening news and see how a more co-ordinated approach could help, knowing that Victoria’s alcohol and drug sector is not just best practice but available to those who really need it.
The Victorian Government is committed to ensuring the health and wellbeing of all Victorians, and is committed to reforming the way that the Government, business, families and communities work together to address alcohol and drug related harms in Victoria.
Currently 1 in 10 Victorians drink at risky levels at least weekly, and alcohol consumption is a major contributor to disease, injury and other social harms. In the period since 1999, there has been a 47 per cent increase in alcohol-related hospital admissions and a 49 per cent increase in alcohol-related assaults. At the same time there have been significant increases in alcohol-related ambulance attendances and road trauma.
Over the same period, there have been ongoing problems with the use of illicit drugs. While the numbers of people using cannabis, amphetamine type substances, pharmaceutical drugs, hallucinogens and opioids have remained relatively steady, their harms continue to be a major burden for Victorians.
Pharmaceutical drug misuse and the development of synthetic drugs are emerging as new challenges in this area.
The Australian National Alcohol Strategy
Victoria has endorsed the Australian National Alcohol Strategy (2006-2009), which
‘outlines priority areas for coordinated action to develop drinking cultures that support
a reduction in alcohol-related harm in Australia’.most policy frameworks,
this document sets out broad goals to reduce alcohol related harm across Australia. The
four priority areas of the strategy are
· Reduced levels of intoxication,
· Prevention and reduction of alcohol related injuries,
· Better health outcomes for individuals and communities effected by alcohol,
· Facilitate safer and healthier drinking cultures through better community
understanding, and tighter regulation.
While this document provides a coherent and legitimate basis for a national alcohol
harm reduction framework, at least one recent Australian review suggests there has
been poor follow-through on the actual implementation of the recommended strategies
[12]. The National strategy is currently being reviewed and updated.
The Victorian Alcohol Strategy
In addition to the national alcohol strategy, Victoria is currently developing its own
alcohol strategy with two main purposes: to inform the community about the dangers
of alcohol, and to decrease the harms related to alcohol in the community. The
strategy also aims to reduce the social tolerance of harmful drinking across all age
groups, especially amongst young people, and to reduce dangerous levels of drinking
where third parties are most likely to be harmed (for example on the roads, in the
workplace, at sporting events and at large social gatherings).
KEY FEATURES OF THE VICTORIAN APPROACH
Harm minimisation
The Australian and Victorian response to alcohol and drug problems is based on a
harm minimisation model – incorporating supply reduction, demand reduction and
harm reduction. Harm reduction is an approach to drug use and treatment which
aims to reduce the harm from drugs without necessarily reducing consumption per se.
Alternative approaches often focus on the supply side and reducing consumption – the
Swedish system is one example. The United States, on the other hand, has consistently
emphasised complete abstinence in its approach to drug and alcohol related harms,
although the effectiveness of this strategy has been questioned.
Reference links:
http://www.health.vic.gov.au/aod/
http://www.theage.com.au/national/alarming-increase-in-alcohol-abuse-20090501-aq9x.html
http://amavic.com.au/page/News/Doctors_call_for_urgent_action_on_alcohol_abuse/
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