Setting the Context. Report 1: Blue Mountains Drug & Alcohol Recovery Services Inc.

Transcription

1 Blue Mountains Drug & Alcohol Recovery Services Inc. A research project to investigate needs and options for a new alcohol and other drugs (AOD) service in the Blue Mountains Report 1: Setting the Context January 2010 Author: Kathryn Knight Researcher Blue Mountains Drug & Alcohol Recovery Services Inc. PO Box 197 Katoomba NSW 2780 Phone kathryn.knight7@gmail.com Blue Mountains Drug & Alcohol Recovery Services Inc. 2010

2 Contents Executive summary iii 1. Introduction About the Blue Mountains Drug & Alcohol Recovery Services Inc. 1.2 About Project Skylight 1.3 About this report 2. Drugs of concern 4 3. Definitions 7 4. Australian and NSW Government initiatives Patterns of drug use in Australia Overview 5.2 Alcohol 5.3 Illicit drugs 5.4 Summary 6. Social impacts of substance abuse General impact 6.2 Impacts for young people 6.3 Impacts for families, women and children 6.4 Impacts for substance users with mental health issues 6.5 Summary 7. Conclusion 32 References 33 Appendix 36 Definitions of alcohol risk ii BMDARS Project Skylight Report 1

3 Executive Summary This report represents the first stage of Project Skylight, the initial research project of the Blue Mountains Drug & Alcohol Recovery Services Inc. (BMDARS). This document provides an introduction to BMDARS and the project, and it provides background contextual information on drug use in Australia to inform the further development of the project. BMDARS, a coalition of community organisations and community workers, was incorporated in 2007 as a service committed to providing people in the Blue Mountains with responsive and accessible community based options for drug and alcohol treatment and recovery. It came into being following the liquidation of the West Mount rehabilitation centre (in Leura). Residual funds from the sale of the West Mount property became available for an alternative service; BMDARS was the successful bidder. The vision for BMDARS is as follows: To support people in the Blue Mountains who are affected by substance abuse to live full and productive lives, by minimising the harmful impacts of their substance use on themselves and their primary social networks. BMDARS mission is to provide community-based services that are equitable and accessible. With these goals in mind, Project Skylight was initiated to investigate needs and propose options for service delivery. This first stage of research considers the broad picture of substance use and its impacts in Australia. The Blue Mountains community is representative of Australian society and culture, and as such, the findings and discussion that follows are relevant and they enable consideration of issues that are addressed on a national (rather than local) basis. To set the agenda, the report provides a description of Drugs of concern as identified by the Australian Institute of Health and Welfare (AIHW) and others. Over the past decade a number of initiatives have been put into place by Australian and State Governments. A summary of these is provided, beginning with the establishment of the National Campaign Against Drug Abuse back in In Chapter 5, an overview of drug use in Australia in provided, largely based on the findings of the AIHW 2007 National Drug Strategy Household Survey. In summary: Approximately 6 million Australians aged 14 years and over are estimated annually to drink alcohol at risky or high risk levels for short term harm iii BMDARS Project Skylight Report 1

4 Young people (16-24 years), both males and females, have the highest rates of short term high risk (or binge) drinking of any age group At least 2.3 million Australians use illicit drugs at least once per year Cannabis is by far the most commonly used illicit drug, followed by ecstasy, meth/amphetamines and cocaine; approximately 9.1% of Australians report recent use of cannabis Males are twice as likely as females to use illicit drugs Those between the ages of 20 and 29 are the most likely to use illicit drugs on a regular basis. Data gathered over the past decade indicates that use of alcohol has risen slightly but use of most illicit drugs including cannabis, heroin and meth/amphetamines, has fallen from a peak in the late 1990s. However, rates of use of ecstasy and cocaine have risen. Of particular concern is poly-drug use : the majority of drug users, including injecting drug users, report combining their drug with alcohol, cannabis or ecstasy in particular, to create compounded risk of overdose. In 2003, 1,705 illicit drug-related deaths were recorded. Drug use continues to be pervasive across all sectors of Australian society, with a range of critical social impacts including family dysfunction, relationship breakdown, domestic violence, child abuse and neglect, alcohol and drug-related violence and sexual assault, death and injury caused by driving under the influence of alcohol and drugs, and elevated levels of crime. Chapter 5 focuses on three groups that have been identified as particularly vulnerable in terms of impacts related to substance use: young people; families, women and children; and substance users with underlying mental health issues. A large proportion of young people engage in high risk drinking. The adolescent brain (particularly the pre-frontal cortex and hypocampus) is more sensitive to the damaging effects of excessive alcohol, and consequently these young people are at risk of developing learning difficulties, problem solving abilities and memory deficits in the long term. For youthful cannabis users, the risks are similar; there is also evidence that excessive cannabis use can trigger the onset of psychosis in some people. In addition, young people who begin using substances at an early age have five times the risk of developing a dependence in adulthood. Young people who come from disrupted family environments, including substance-using families, are at compounded risk of developing on-going substance dependence. The family is the primary site where impacts of substance abuse are enacted. Researchers acknowledge that substance abuse is not the only cause, but part of a iv BMDARS Project Skylight Report 1

5 web of interacting social and psychological factors that need to be addressed along with substance abuse. Domestic violence is an often raised consequence of substance use. In the 2007 Household Survey, 43.2% of females (compared with 8.5% of males) who had been physically abused in a drug-related incident were assaulted by a current or former spouse or partner. Researchers report that substance-abusing women are at high risk of being assaulted, and that this violence can, in turn, increase substance dependency, creating the vicious cycle that links victimisation, post-traumatic stress disorder and substance abuse in women (Dawe et al, 2006:52). There is also evidence to suggest that women with children are at greater risk of abuse than those without children. Indigenous women in NSW are six times more likely to experience domestic violence than non-indigenous women. Substance-using women access treatment services less frequently than men. Few treatment facilities in NSW offer places for women and their children. These women report feeling marginalised, and may fear that authorities will remove their children if they access treatment. For children living with substance-abusing parents, the impacts are far-reaching and include the development of internalising disorders (anxiety and depression); externalising disorders (aggression); behavioural and physical problems; Post Traumatic Stress Disorder (PTSD); separation anxiety; self-blame; eating disorders; sleeping difficulties; and inappropriate sexual behaviour. They are much higher risk of abuse and neglect than children whose parents are not substance users. They are almost at much higher risk of perpetuating a cycle of substance abuse and disadvantage in the future. Given the significant rates of alcohol and other drug use amongst young people, parents from a wide spectrum of family types will experience the impacts of substance abuse, including confusion, helplessness and guilt. Parents and family members can also be an important support for the recovering user, and yet until very recently, they have been omitted from consideration in most treatment programs. Around three-quarters of clients of alcohol and other drug (AOD) treatment services present with co-occurring mental health issues. In a recent survey, 50% of heroin users had accessed mental health services in the previous 12 months (Dawe et al 2006). In these cases, impacts on the individual and the family are compounded. Studies report that a high proportion of injecting drug users present with Trauma Spectrum Disorders such as PTSD and/or Borderline Personality Disorder (BPD), with co-occurring Dissociative Disorders (Gray 2009). These clients are survivors of trauma, in many cases childhood abuse and neglect. Children of these clients are also at risk of neglect. Treatment services for these most vulnerable of clients require long term strategies, case management and community support. v BMDARS Project Skylight Report 1

6 Responsive services for these three vulnerable groups need to provide integrated family and community support structures so that AOD issues are not treated in isolation from other interacting factors in the individual s environment. These findings will assist with prioritising and planning for the BMDARS project. The subsequent report will focus on issues specific to the Blue Mountains. vi BMDARS Project Skylight Report 1

7 1. Introduction 1.1 About the Blue Mountains Drug & Alcohol Recovery Services Inc. The Blue Mountains Drug & Alcohol Recovery Services Inc. (BMDARS) is an incorporated service that is committed to providing people in the Blue Mountains with responsive and accessible community based options for drug and alcohol treatment and recovery. BMDARS was incorporated in 2007 through the efforts of community members and community workers with leadership from the Katoomba Neighbourhood Centre. Other participating agencies were Blue Mountains Family Support Service, Gunedoo Child Protection Service and Elizabeth Evatt Community Legal Centre, organisations whose work with clients frequently brings them into contact with the consequences and impacts of substance abuse. BMDARS is administered by a Management Committee consisting of four people: three representatives of community services and one community member. BMDARS was established in the aftermath of the closure of the West Mount drug and alcohol rehabilitation centre in Leura in West Mount had provided treatment and recovery services to people from the Mountains and the wider NSW community for over 20 years. Following liquidation of this independently run facility, residual funds of approximately $0.5 million became available. The coalition of Mountains agencies applied for this funding, emphasising their commitment to provide ongoing services to the Mountains community. Their bid was successful. The subsequent incorporation of BMDARS presents a valuable opportunity to develop an alcohol and other drugs (AOD) service that responds to the needs of the Blue Mountains community. In recognition, the BMDARS Management Committee has developed a set of broad guidelines to inform the philosophy of service delivery. These are presented below. 1 BMDARS Project Skylight: Report 1

8 Blue Mountains Drug & Alcohol Recovery Services Inc. VISION To support people in the Blue Mountains who are affected by substance abuse to live full and productive lives, by minimising the harmful impacts of substance use on themselves and their primary social networks MISSION To provide services/programs that are: o Community based o Blue Mountains wide o Focused on the individual and social impacts of drugs (whether legal or illegal) o Centred on the needs of the individual and their primary social network (i.e. partner, family) o Holistic (recognising the various needs of the individual and their primary social network) o Integrated and co-ordinated (to support access to and navigation through the service delivery system) o Flexible (recognising the constraints and challenges faced by individuals) GUIDING PRINCIPLES In the provision of these services, to Acknowledge the multi-factorial nature of dependence/addiction, including o Mental health issues (e.g. psychosis, brain injury, depression, anxiety, trauma history) o Psychosocial issues (e.g. social displacement and disadvantage, neglect, generational substance abuse, exposure to domestic and other forms of violence) Recognise the multiplicity of effects of substance abuse on the individual, the family and the community Address the diverse range of needs of individuals affected by substance use, including housing, employment, transport, and service access needs 2 BMDARS Project Skylight: Report 1

9 1.2 About Project Skylight Project Skylight is the initial project of BMDARS, undertaken from November 2009 to April 2010, with the objectives of researching needs, priorities and service delivery models to inform the future direction of BMDARS. A researcher with experience in community sector projects (Kathryn Knight) was contracted to undertake the project. The name (Project Skylight) has been adopted to promote identification in the wider community, and to focus on the symbolic goal of service delivery: to shine light in difficult places. The key aims of the research project are: i) To investigate best practice models for AOD treatment and recovery ii) To liaise with local AOD treatment services and identify any gaps in service provision iii) To consult with people in the Blue Mountains from diverse backgrounds who may be impacted by drug and alcohol use and abuse iv) To recommend ways of addressing gaps, building partnerships and networks to enhance outcomes for clients v) To identify sources of funding to ensure the longevity of the project. The research will employ secondary research methodology initially, accessing statistical data, policy documents and recent relevant research reports to set the agenda and inform subsequent primary research questions. Primary research will take the form of interviews with and surveys of Blue Mountains based AOD health service providers, and providers of services whose clients are impacted by AOD issues; relevant out-of-area AOD services, in particular independent non-government organisations; and Blue Mountains people affected by substance misuse. Further details of primary research methodology will be provided in a subsequent report. 1.3 About this Report This report addresses critical contextual issues in the Australian AOD landscape, understanding of which is an essential first step in developing agenda for service delivery. This report contains information on drugs of concern and patterns of use in Australia, and on social impacts of substance abuse, particularly impacts on vulnerable groups of people. The next stage of research will focus on the Blue Mountains LGA, with emphasis on patterns of substance use particular to this area, and relevant service delivery and perceived needs in the area. 3 BMDARS Project Skylight: Report 1

10 2. Drugs of concern The Australian Institute of Health and Welfare specifies the following major groups of drugs of concern, based on the Australian Standard Classification of Drugs of Concern (ABS 2000, cited in AIHW 2009, Appendix 6): Analgesics Sedatives and hypnotics Stimulants and hallucinogenics Anabolic agents and selected hormones Antidepressants and antipsychotics Volatile solvents Miscellaneous drugs of concern A simpler description of the principal drugs of concern that are commonly used by Australians follows 1 : Alcohol o A central nervous system depressant o Forms: liquids of varying concentrations ingested orally o Risks: impulsive behaviour (often associated with violence), impaired liver function, brain damage, overdose-related coma and possible death. Meth/amphetamines (speed) o Central nervous system stimulants o Forms: white or yellow powder, liquid, tablet or crystal (ice); swallowed, snorted, smoked, injected o Risks: dependence, psychosis, violent episodes, depression, general health problems, overdose -- causing heart attack, stroke, high fever and (rarely) death ; when snorted: nosebleeds and sinus damage; when injected: blood vessel damage, heart attack, endocarditis infection with hepatitis C and/or HIV, blood poisoning, skin abscesses Benzodiazepines (minor tranquillisers) o Central nervous system depressants o Form: tablets (swallowed or sometimes injected) o Risks: listlessness, headaches, skin rashes, sexual disorders; overdose (particularly dangerous when combined with alcohol or other drugs), injection of drug intended to be swallowed in tablet or capsule form can lead to severe damage to veins, organ damage and stroke; also hepatitis B or C, HIV and blood poisoning o Addictive: regular use for > four weeks can lead to dependence 1 Sources: NSW Health Factsheets, NSW Department of Health, 2008, drugandalcohol ; Fact sheets, Family Drug Support Australia, 4 BMDARS Project Skylight: Report 1

11 Cannabis/marijuana o Central nervous system depressant (though can induce hallucinations in large doses) o Forms: hydro, leaf or oil form; smoked but can also be cooked in foods and ingested o Risks: confusion and memory loss, general health problems, sexual and reproductive disorders; cannabis induced psychosis at any dose or amount smoked for those with a predisposition Cocaine o Central nervous system stimulant o Form: white powder (snorted, injected); freebase, crack cocaine (smoked); o Risks: overdose (especially when combined with other drugs or alcohol), paranoia and psychosis; risks associated with snorting and injecting (as for meth/amphetamines) o Highly addictive Ecstasy o Central nervous system stimulant with hallucinogenic properties o Form: tablets (swallowed), but also powder (snorted or injected) o Risks: overdose (very uncommon), overheating, dehydration, heart failure, heart attack, stroke, brain haemorrhage, high fever, coma and psychosis Hallucinogens o Forms: psilocybin (magic mushrooms) and LSD (acid); swallowed o Risks: bad trips, anxiety, panic attacks, hyperventilation and psychosis Heroin o A central nervous system depressant o Form: white powder, brown or pink rocks ; injected, snorted or smoked o Risks overdose (frequent), often leading to coma or death; heart and lung damage, collapsed veins, blood disorders, sexual and reproductive disorders, constipation; effects associated with injection: hepatitis B or C, HIV, tetanus o Highly addictive Inhalants o Central nervous system depressants o Forms: industrial or household substances -- aerosols, glues, petrol and liquid paper thinners; inhaled directly o Risks: overdose, breathing difficulties and Sudden Sniffing Death -- sudden shock while inhaling causing heart to stop 5 BMDARS Project Skylight: Report 1

12 It is not the purpose of this report to describe the chemical nature or particular effects of these drugs on the individual. Further information is available to this effect is available at the following locations, amongst others: Family Drug Support website ( National Health and Medical Research Council (2009) Australian guidelines to reduce health risks from drinking alcohol. Canberra: Commonwealth of Australia (available at National Drugs Campaign website drugs/publishing.nsf/content/drug-info Note: While the negative effects of tobacco and steroid use are acknowledged, these substances will not be considered in this report as use of these substances is not within the scope of current BMDARS agenda. 6 BMDARS Project Skylight: Report 1

13 3. Definitions The following terms common to the drug and alcohol sector appear in this document. Harm minimisation (or harm reduction) Harm reduction In the context of alcohol or other drugs, describes policies or programmes that focus directly on reducing the harm resulting from the use of alcohol or drugs. The term is used particularly of policies or programmes that aim to reduce the harm without necessarily affecting the underlying drug use; examples includes needle/syringe exchanges to counteract needle-sharing among heroin users, and self-inflating airbags in automobiles to reduce injury in accidents, especially as a result of drinking-driving. Harm reduction strategies thus cover a wider range than the dichotomy of supply reduction and demand reduction. Synonym: harm minimization World Health Organisation, Lexicon of alcohol and drug terms downloaded 20 April 2010 The principle of harm minimisation has formed the basis of the National Drug Strategy since Australia implements a comprehensive and balanced approach between the reduction of supply, demand and harm associated with the use of drugs across sectors and jurisdictions. National Drug Strategy Content/national-drug-strategic-framework-lp Prevention Prevention refers to measures that prevent or delay the onset of drug use as well as as measures that protect against risk and prevent and reduce harm associated with drug supply and use. National Drug Strategy: Australia s integrated framework EAED77A78166EB5CA2575B A4/$File/framework0409.pdf 7 BMDARS Project Skylight: Report 1

14 Early intervention Early intervention A therapeutic strategy that combines early detection of hazardous or harmful substance use and treatment of those involved. Treatment is offered or provided before such time as patients might present of their own volition, and in many cases before they are aware that their substance use might cause problems. It is directed particularly at individuals who have not developed physical dependence or major psychosocial complications. Early intervention is therefore a pro-active approach, which is initiated by the health worker rather than the patient. The first stage consists of a systematic procedure for early detection. There are several approaches: routine enquiry about use of alcohol, tobacco, and other drugs in the clinical history, and the use of screening tests, for example, in primary health care settings. Supplementary questions are then asked in order to confirm the diagnosis. The second component, treatment, is usually brief and takes place in the primary health care setting (lasting on average 5-30 minutes). Treatment may be more extensive in other settings. World Health Organisation, Lexicon of alcohol and drug terms downloaded 20 April 2010 Recovery Recovery Maintenance of abstinence from alcohol and/or other drug use by any means. The term is particularly associated with mutual-help groups, and in Alcoholics Anonymous (AA) and other twelve-step groups refers to the process of attaining and maintaining sobriety. Since recovery is viewed as a lifelong process, an AA member is always viewed internally as a "recovering" alcoholic, although "recovered" alcoholic may be used a description to the outside world. World Health Organisation, Lexicon of alcohol and drug terms downloaded 20 April 2010 The WHO definition above focuses on an abstinence view of recovery. The term recovery when used in relation to addiction behaviours, however, is debated amongst academics and practitioners, and was the subject of several articles published in the Journal of Substance Abuse and Treatment, volume 33 (October 2007). This debate is passionately articulated below: The addiction field s failure to achieve consensus on a definition of recovery from severe and persistent alcohol and other drug addiction undermines clinical research, compromises clinical practice, and muddies the field s communications to service constituents, allied service professionals, the public and policymakers. WL White, Addiction recovery: Its definition and conceptual boundaries. Journal of substance abuse and treatment, 33, Oct 2007, pp BMDARS Project Skylight: Report 1

15 As an alternative to abstinence-focused interpretation of recovery, it is proposed that, in line with a harm minimisation perspective, the following approach be adopted: Recovery is a process or journey along a continuum; it is not a destination point. Accordingly, a person s progress on this journey can be supported, validated and respected. 9 BMDARS Project Skylight: Report 1

16 4. Australian and NSW Government Initiatives Since 1984 a number of initiatives by Federal and State Governments have set the policy agenda for responses to drug use in Australia. These initiatives in general support the principle of harm minimisation, which addresses three dimensions: demand reduction, supply reduction and harm reduction. Australia was one of the first countries to embrace harm minimisation strategies. The Timeline below 2 provides a summary of the major initiatives adopted by the Australian and NSW Governments. Note that this list is not exhaustive. Timeline 1984 National Campaign Against Drug Abuse launched with a harm minimisation focus following Prime Minister Bob Hawke s emotional disclosure about his daughter s heroin addiction on national television Parliamentary Joint Committee on the National Crime Authority: highly critical of harsh penalties to suppress illicit drug use; emphasised costs of prohibition to users, court system and society 1998 Tough on drugs strategy launched by Howard Government; additional funding to Police, National Crime Authority and Customs, as well as funding for anti-drug education and support for non-government service providers with abstinence basis NSW Drug Summit convened; recommendations across 12 areas inc. families, young people, communities, education, law enforcement, and regional & rural areas 2000 NSW Drug Treatment Services Plan launched (outcome of Summit) 2001 National Action Plan on Illicit Drugs 2001 to launched Sydney Medically Supervised Injecting Centre opens on recommendation of Wood Royal Commission 2003 NSW Summit on Alcohol Abuse: many initiatives, particularly for Aboriginal people, young people and women, inc: routine domestic violence screening for women at drug & alcohol facilities and antenatal services; antenatal drug & alcohol screening National Drug Strategy Aboriginal & Torres Strait Islander People s Complementary Action Plan launched 2004 National Drug Strategy launched 2006 National Cannabis Strategy launched National Alcohol Strategy launched, with aim to develop safer and healthier drinking cultures in Australia NSW Health Drug and Alcohol Plan launched 2007 Parliamentary Committee headed by Senator Bronwyn Bishop calls for zero tolerance approach to substance abuse; report shelved when Howard Government loses election 2010 Australia s National Drug Strategy beyond 2009: Consultation process closes with submissions due by 24 February Sources: en.wikipedia.org; Pennington, D (1999) An overview of drug use and drug policy in Australia. Museum of Victoria Lecture Series BMDARS Project Skylight: Report 1

17 5. Patterns of drug use in Australia 5.1 Overview Drug use is a serious and complex problem. It impacts on individuals, families, communities and the economy. Each year drug use contributes to thousands of deaths, significant illness, disease and injury, social and family disruption, workplace concerns, violence, crime and community safety, reports Australia s National Drug Strategy Beyond 2009: Consultation Paper (Aust Govt, 2009). In spite of concerted efforts over the past decade by Australian and State governments through drug summits, integrated drug strategies, initiatives to address particular substances and targeted sectors of the population, the use and abuse of alcohol and other drugs remain at levels that severely impact, either directly or indirectly, the lives of countless Australians. While the concept of drugs often centres upon illicit drugs, the drugs overwhelmingly used by Australians are legal drugs: alcohol and tobacco. Approximately 6 million Australians aged 14 years and over are estimated annually to drink alcohol at risky or high risk levels for short term harm; over 3 million Australians are smokers (AIHW, 2008b). Illicit drugs, in comparison, are used at least once per year by 2.3 million Australians, with cannabis by far the most commonly used illicit drug, followed by ecstasy, meth/amphetamines and cocaine. The aim of this chapter is to present a brief summary of the extent of the use of drugs of concern in Australia. National Drug Strategy Household Survey The National Drug Strategy Household Survey (NDSHS) is a project of the Australian Institute of Health and Welfare, and is the main source of information on drug use by the Australian population, and the only survey that addresses the full range of drugs of concern. Data has been gathered at regular intervals since 1993 for these surveys, using the drop and collect method and computer assisted telephone interview methodologies. For the 2007 survey, over 23,000 people aged 12 years or older provided information on their drug use, and their knowledge and attitudes about drugs. The NDHDS has limitations, however: based on households, the survey methodology excludes those who are homeless or residing in institutions (including correction facilities, rehab centres and hospitals) in fact, people with a high incidence of drug and alcohol abuse. Due to the sample size, there are also some questions about the survey s access to all groups of Australians and, as with all such self-reporting instruments, there may be a tendency of people to under-report their 11 BMDARS Project Skylight: Report 1

18 drug use. The instrument is, nevertheless, an important indicator of social trends in drug use behaviours. Key findings of the 2007 survey indicate that there has been a steady decline in the use of tobacco over the reported period ( ), evidence that anti-smoking campaigns have had a significant impact on the smoking behaviour of Australians. There has been a rise, however, in the same period in both the overall use and levels of use of alcohol, with 8.6% of the population reporting drinking at levels considered risky or high risk for both short and long term harm 3. Those living in remote or very remote areas were significantly more likely to drink at risky and high risk levels. Aboriginal or Torres Strait Islander people were more likely to abstain from alcohol consumption, but also more likely to drink at risky or high risk levels. A high proportion of young people also consume alcohol at risky and high levels (2008b). The use of illicit drugs in Australia reached a peak toward the end of the 90s, and since then there has been a small decrease in the use of all illicit drugs with the exception of ecstasy and cocaine, both of which have increased in use over the past three years. In 2007, reported cannabis use reached the lowest level on record. Heroin, the substance most commonly reported to be associated with illicit drug use, is used by only a very small number of people (the risks, however, associated with heroin use, are significantly higher than most other drugs). Table 1 overleaf provides a summary of reported rates of use of alcohol and other drugs from 1993 to Descriptions of levels of drinking risk based on NHMRC Guidelines are provided in the Appendix. 12 BMDARS Project Skylight: Report 1

19 Table 1: Summary of recent drug use of Australians 14 years or older (%) Drug used Tobacco Alcohol Marijuana/cannabis Painkillers/analgesics Tranquillisers Steroids Barbiturates Inhalants Heroin Methadone/Buprenorphine n/a n/a Other opiates/opoids n/a n/a Meth/amphetamine(speed) Cocaine Hallucinogens Ecstasy Ketamine n/a n/a n/a n/a GHB n/a n/a n/a n/a Injected drugs Any illicit drug None of the above Source: Australian Institute of Health and Welfare (2008c) National drug strategy household survey 2007: first results In a recent radio interview, Professor Steve Allsop, Director of the National Drug Research Institute at Curtin University of Technology, acknowledged this general reduction in illicit drug use, attributing the drop in cannabis and meth/amphetamine use to better public health education. But Professor Allsop gave a cautious interpretation of the trend, saying that it may well be due to natural correction after the peak years of the late 1990s. He also stated that it is generally the dabblers who are giving up; there is worrying evidence on two fronts: initiation into drug use is now occurring at a younger age, and those who are heavy users are continuing to do so at highly problematic levels. 4 NSW Population Health Survey This annual survey is conducted by the NSW Department of Health, Centre for Epidemiology and Research. It addresses general health issues of the NSW population and is based on a total sample size of 12, ,500 people in each of the State s eight area health services (see Centre for Epidemiology and Research, 2008). 4 ABC Radio National, Life Matters, interview with Professor Steve Allsop, 13 January BMDARS Project Skylight: Report 1

20 In terms of drug use, this survey addressed only the three most prevalently used drugs: tobacco, alcohol and cannabis. The survey found that just over one third of adults (33.8%) in NSW engaged in any risk drinking behaviour; this behaviour decreased with age. Those living in rural areas were more likely to drink at risky levels. One in 10 adults engaged in high risk drinking (regular binge drinking); this behaviour also decreased with age, and was most prevalent amongst males. In contrast to the national survey, high risk drinking levels for NSW were similar in both urban and rural area health services. High risk drinking was least prevalent amongst the most economically disadvantaged fifth of the population. The survey found that 1 in 20 adults aged years in NSW currently smoked cannabis daily or occasionally, with significantly more males than females involved. Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS- NMDS) The AODTS-NMDS, administered by the Australian Institute for Health and Welfare, compiles data on all publicly funded government and non-government agencies that provide specialist alcohol and other drug treatment services. This brief summary of findings serves to provide an indication of the extent of AOD treatment nationally. The MDS records closed treatment episodes, which are periods of contact between a client and a services with defined start and end dates, rather than number of clients. Some clients may be involved in more than one treatment episode per year. A total of 147,325 closed treatment episodes were provided by 633 governmentfunded agencies (52% non-government) in (AIHW, 2008a). Findings of the report included the following: The median age of persons receiving treatment was 31 years Male clients accounted for two-thirds of all closed treatment episodes 10% of episode clients were of Aboriginal and/or Torres Strait Islander background Alcohol was the most common principal drug of concern (42%), followed by cannabis (23%), opoids (14% -- heroin accounted for 11%), and amphetamines (12%). Some clients reported more than one drug of concern; when this was taken into account, 57% of episodes included alcohol as a drug of concern, and 44% included cannabis Counselling was the most common form of treatment (38% of episodes), followed by withdrawal management (17%) and assessment only (15%) 14 BMDARS Project Skylight: Report 1

21 17% of episodes ended because the client ceased to participate without notice to the service provider. Drug and alcohol treatment services in NSW: Minimum Data Set In , 294 government-funded agencies in New South Wales provided 43,502 closed treatment episodes. A much lower proportion of these agencies were nongovernment (28%) than the total national proportion (NSW Dept of Health, 2007b). Similar to the national MDS findings, two-thirds of clients were male; the average age of clients was 32.2 years; alcohol accounted for 41.7% of episodes; cannabis accounted for 20.3%; heroin and amphetamines accounted for 15.6% and 11.2% of episodes respectively (NSW Dept of Health, 2007). The most common forms of treatment in these closed episodes were counselling (32.6%), assessment (14.6%), inpatient withdrawal (8.1%), support and case management (9.8%), and outpatient withdrawal (6.2%). Clients who were receiving only methadone and buprenorphine treatments were not included in these statistics (16,355 clients were receiving these services during the reporting period. Also not accounted for were 15,383 open or ongoing episodes. Sydney West Area Health Service (SWAHS), Drug & Alcohol Service Network In , SWAHS Drug & Alcohol Service Network provided 302,173 occasions of service to a total of 22,549 clients (SWAHS 2008). Further consideration of SWAHS Drug & Alcohol Services will be provided in a subsequent report. 5.2 Alcohol As the statistics presented above indicate, alcohol is by far the most prevalently used drug of concern in Australia. As alcohol may be used in small quantities that do not present a health risk to the individual (see Australian Alcohol Guidelines, National Health and Medical Research Council 2001), misuse or abuse is consequently considered as a level of consumption that represents higher risk. Two definitions of risk are identified: short-term risk of harm (i.e. binge-drinking) and long-term risk of harm (i.e. regular daily patterns of drinking). Both these categories are further divided into Low risk, Risky and High risk. See the Appendix for fuller current definitions of these categories. Alcohol and young people While alcohol misuse applies across all sectors of the Australian population, young people report the highest proportion of risky and high risk drinking behaviour. Table 2 15 BMDARS Project Skylight: Report 1

22 below presents data for drinking behaviours for particular age groups from the 2007 National Drug Strategy Household Survey. Table 2: Risky and high-risk alcohol consumption, by age and sex, 2007 (%) Age group Type of risk Aged 12+ Males Abstainer Short-term risk weekly Short-term risk monthly Long-term risk Females Abstainer Short-term risk weekly Short-term risk monthly Long-term risk Note: Short-term risk monthly includes Short-term risk weekly : these two categories should not be added. Source: AIHW (2008b) 2007 National Drug Strategy Household Survey: detailed findings, As the table shows, a large proportion of both males and females aged binge drink on a monthly basis. A higher proportion of girls of years binge than their male counterparts, and year old girls have the highest overall rates of monthly bingeing at 46%, almost half the population. Males over 20 years binge more frequently (weekly) than females, and sustain higher levels of binge drinking into their twenties. A significant proportion of young people also drink at levels that present long term risks (i.e. drinking above recommended rates on a regular or daily basis). The NSW Population Health Survey found that between 1997 and 2007 there had been a significant decrease in risky drinking behaviour (particularly amongst young people in rural areas (Centre for Epidemiology and Research, 2008). In % of young men between 16 and 24 reported drinking at risky levels; in 2007 the proportion was 49.1%. For young women, the proportions were 48% in 1997, and 41.8% in There had also been a reported decrease in high risk drinking, particularly amongst young females, young people in urban areas, and those in the most disadvantaged sector of the population. In 2007, 21.7% of males aged drank at high risk levels, compared with 27.7% in In 2007, 15.9% of females in the same age group were high risk drinkers, compared 28.3% in BMDARS Project Skylight: Report 1

23 While these reported decreases may be encouraging, the statistics continue to produce a alarming picture of youth drinking behaviour. The National Centre for Education and Training on Addiction reports that the age of initiation into alcohol use has been decreasing for each successive 10 year generation over the past 50 years (Roche et al, 2007). The authors claim that the proportion of year olds who drink at risky levels doubled between 1990 and 2005; in addition, the proportion of year olds who engage in risky drinking has increased from 15% to 20%. While the majority of young people moderate their drinking behaviour as they move into adulthood, a significant number of people, both men and women, continue to binge after age 30. This is particularly high for men aged According to the AIHW, 2% of the total burden of disease in Australia in 2003 was attributable to excessive drinking, with males under 45 years accounting for a large proportion of this figure. Almost 1,100 deaths attributable to alcohol were caused primarily by alcohol abuse followed by suicide and self-inflicted injuries (AIHW, 2007). 5.3 Illicit drugs In 2007, more than 6.6 million (38.1%) Australians aged 14 years or older had used an illicit drug in their lifetime. More than 2 million had used in the previous 12 months. While those aged years were more likely to have used an illicit drug in their lifetime, year olds were more likely to have used an illicit drug in the previous 12 months. Males were much more likely than females to use illicit drugs AIHW, 2008b). Marijuana/cannabis was the most commonly used illicit drug over lifetime (i.e. ever used) and for recent use. Ecstasy and hallucinogens were the second and third most common for lifetime use. Ecstasy and pain-killers/analgesics were the second and third most common drugs for recent use (AIHW, 2008b) Cannabis Cannabis or marijuana, the illicit drug that is used most prevalently by Australians, comes in a number of forms: head (the most commonly used form), hydro, leaf, resin, and oil. The drug is typically obtained from a friend or acquaintance or a dealer, and is consumed primarily in the home or at private parties. Table 3 below summarises the proportion of the population that has used cannabis. 17 BMDARS Project Skylight: Report 1

24 Table 3: Marijuana/cannabis use, persons aged 14 years or older, by age, by sex, 2007 Age group Sex Period Males Females Persons (per cent) In lifetime In the last 12 months In the last month In the last week Source: AIHW (2008b) National Drug Strategy Household Survey 2007 As Table 3 indicates, 5% of males of all ages in Australia used cannabis at least weekly, compared with just over 2% of females. Half of year-olds had tried cannabis, and 7.5% of people used at least weekly. Four per cent of adolescents were also regular users. In NSW, just under one person in 20 between the ages of 16 and 34 is reported to be a current user of cannabis (i.e. smoking either daily or occasionally), with a significantly higher proportion of males (6.4%) than females (2.6%) (Centre for Epidemiology and Research, 2009: 29). Table 4 provides information on the frequency of cannabis use amongst users nationally. Table 4: Frequency of marijuana/cannabis use, recent users aged 14 years or older, by age, by sex, 2007 (per cent) Age group Sex Frequency Males Females Persons Every day Once a week or more About once a month Every few months Once or twice a year Source: AIHW (2008b) National Drug Strategy Household Survey 2007 As Table 4 indicates, just under 30% of adolescent users consumed cannabis on a daily or at least weekly basis. Adult users over 30 were the most frequent users, which suggests that those who continue to consume the drug past their young adulthood tend to be more regular users. Female users tended to use less frequently than males. 18 BMDARS Project Skylight: Report 1

25 In addition, the HDSHS 2007 reported that the majority of cannabis users consumed the drug concurrently with alcohol (87.3% of users), and over one-third had used cannabis together with ecstasy or a designer drug Other illicit drugs Ecstasy: In 2007 over 1.5 million people reported having used ecstasy at some time. Of the 600,000 recent users, 8.3% used the drug at least once a week, and 17.3% of year old users consumed the drug at least once per week. In 2007 most ecstasy was consumed at dance parties, in public places and at private parties. 85.4% of ecstasy users had consumed alcohol at the same time (AIHW, 2008b). Meth/amphetamine: In 2007 approximately one in forty Australians had used meth/amphetamine for non-medical purposes in the past 12 months; of these 14% had used at least once per week. The most common form of the drug used was powder, followed by crystal and base (AIHW, 2008b). Cocaine: About 300,000 Australians had used in 2007; in the years age group, 5.1% had used, and of these, almost 20% used at least once per month. Cocaine powder was the preferred form (96.9%), and one in seven used crack cocaine. A small proportion injected the drug (AIHW, 2008b). Heroin, methadone and other opioids: The NDSHS 2007 found that almost 350,000 Australians aged over 14 years had ever used this group of drugs for nonmedical purposes; about 57,000 people had used these drugs in the previous year, and the commonest form of administration was by injection. Sixty per cent of recent heroin users used weekly or more frequently (AIHW, 2008b). Injecting drugs: In 2007, about 80,000 Australians had injected drugs over the previous 12 months. Drugs that were injected included steroids, speed, heroin, pethidine, cocaine and ecstasy. Males were twice as likely to inject as women, and the average age at which users first injected illicit drugs was 21.3 years. Approximately 3 in 10 injected daily. Around 60% had never shared a needle (AIHW, 2008b: 79). As cited in AIHW drug use statistics, illicit drug use was responsible for 2% of the total burden of disease in Australia in 2003, with a total of 1,705 deaths reported. For injecting drug users (primarily heroin users), overdose is generally considered to be the highest risk factor. But the primary cause of death amongst injecting drug users was disease: Hepatitis C and B accounted for around two-thirds of illicit drug-related deaths; and approximately 15% of deaths were caused by heroin or polydrug use overdose (AIHW, 2007). 19 BMDARS Project Skylight: Report 1

26 Nevertheless, overdose presents an ongoing risk. In 2005, 60% of injecting drug users in New South Wales surveyed for the Illicit Drug Reporting System had survived non-fatal overdoses of heroin, 11% at least once in the past year. There were 31.1 deaths per million people from accidental opioid overdose in Australia in 2004, down from a peak of deaths in Polydrug use: A very high proportion of users of any illicit drug consumed the drug concurrently with alcohol or other illicit drugs, commonly cannabis but also ecstasy. Polydrug use presents high and compounded risk to users. The Medical Journal of Australia reported in 1999 that most deaths attributable to heroin overdose were in fact the result of polydrug use: More typically, morphine [the metabolite in heroin] was found in combination with intoxicating levels of alcohol or other central nervous system depressants, such as benzodiazepines (Hall, 1999). This finding continues to be relevant ten years on. 5.4 Summary National and NSW State databases indicate that a high proportion of people use drugs of concern at levels that present health risks. The most prevalently used drug is alcohol by all sectors of the population. Young people are most likely to engage in high risk binge drinking. The most prevalently used illicit drug is cannabis, followed by ecstasy. People aged years are most likely to use illicit drugs on a regular basis, and males are much more likely to used than females. While all drug taking behaviour presents risks, of particular concern is the very high proportion who use drugs concurrently. 20 BMDARS Project Skylight: Report 1

27 6. Social impacts of substance abuse in Australia 6.1 General impacts The wide range of social impacts of drug use in Australia include family dysfunction, relationship breakdown, domestic violence, child abuse and neglect, alcohol and drug-related violence and sexual assault, death and injury caused by driving under the influence of alcohol and drugs, and elevated levels of crime. The alcohol or drug dependent individual may face unemployment, homelessness, destitution, social withdrawal and isolation, depression, cognitive deficits due to drugrelated brain damage, and/or psychosis. Overdose of some drugs can lead to death. Children of substance abusers present with higher incidence of behavioural and psychological disorders. They are more likely to suffer abuse and neglect, and are more likely to become substance abusers themselves. They may have been exposed to foetal alcohol syndrome, and consequently experience learning difficulties, social maladjustment and behaviour problems. Babies born to illicit drugusing mothers are likely to be underweight, premature and may experience symptoms of withdrawal in their early weeks of life. Families of drug-dependent young people experience guilt, confusion and helplessness as they negotiate through the unfamiliar territory of addiction and treatment services. Drug and alcohol dependency is not simply a consequence of age, geography or social divide. If affects people from all backgrounds and walks of life, observes John Hatzistergos, former NSW Minister for Health in the Foreword to the NSW Health Drug and Alcohol Plan Campaigns and strategies addressed by various governments over the past decades have addressed a raft of drug related public health issues. In recent years these have focused particularly on alcohol, and the entrenched culture of drinking in Australia, and cannabis, in particular the dangers of cannabis use for young people and the association of heavy cannabis use with the development of psychosis. But the impacts of substance abuse continue to spread across both the public and private spheres and affect all sectors of society, rippling out across relationships and families, over generations and throughout communities. Research on the impacts of substance use and abuse in Australia is vast and addresses a wide and complex agenda of topics and issues. It is outside the scope of this report to attempt to incorporate this broad range of material. In this Chapter, a brief overview of the impacts of on-going substance abuse on several of the most vulnerable sectors of our society will be discussed: young people, women and children, and those with significant mental health issues in addition to their substance use. 21 BMDARS Project Skylight: Report 1