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Evidence-based solutions for complex drug problems – APSAD Sydney 2016  

Pill testing services, debt-reduction strategies, the innovative use of technology to deal with drug and mental health issues and drug use among LGBT communities, were just some of the issues covered at the recent Australasian Professional Society on Alcohol and other Drugs (APSAD) annual meeting.

 As APSAD President, Dr Lynda Berends, outlines below, the focus on the meeting was on finding evidence-based strategies to address the complex issues associated with drug use, rather than on adding to the ‘shock value’ tactics often used when reporting on drug use in the mainstream media. [divide]

Dr Lynda Berends writes:

Alcohol and drugs is an area of health that never fails to capture the attention of both the public and politicians, and this year’s annual meeting of the Australasian Professional Society on Alcohol and other Drugs (APSAD) was no different, making media headlines across the country.

And it’s no wonder.

New data showed that methamphetamine use in rural Australia is double that in metro areas and rising, raising concerns over the lack of services to meet escalating need.

According to national statistics, 10 000 Australians were hospitalised due to alcohol-related assaults in a single year – over 200 per week nationwide.

And the true cost of over-the-counter codeine containing drug misuse was uncovered, with a study of hospital records putting the average price of overdosing at more than $10 000 per person, with people taking up to 90 pills a day. Yet alarmingly few patients taking these pills are aware of the risks.

But what last week’s APSAD Conference reiterated is that we need services to tackle these issues, not scare.

 

Fortunately, this forum provided the perfect opportunity to share evidence-based, practical strategies to improve the lives of those with alcohol and other drug problems.

Pill Checking

Dr Monica Barratt, a drug policy researcher at UNSW reported on a major study about pill testing services, which involved 851 Australians who used illicit psychostimulant and psychedelic substances and attended nightclubs or festivals.

The study showed there was overwhelming support for pill testing services at Australian events, with 94 per cent of participants saying they would use drug-checking services at clubs and festivals, 85 per cent would use a fixed-site service at a central location and 53 per cent would use a laboratory that accepted samples by mail.

Dr Barratt explained this information would be invaluable for the various stakeholders involved: “Police, health and welfare agencies that deal with the fall-out from drugs are better equipped to do their jobs and drug users can avoid ingesting unknown, unexpected and potentially more dangerous substances”.

These findings demonstrate that drug-checking services are feasible for Australia. An important next step is to secure cooperation among policy makers, law enforcement, consumer groups and the general public.

Dealing with Debt

Pip Bowden and colleagues, from the Western Sydney Local Health District and Legal Aid NSW reported on a unique approach to reduce the stress associated with legal problems among alcohol and other drug treatment clients.

They promoted the uptake of Work Development Orders (WDO), which reduce fine debt in return for participation in treatment. This is a practical way of helping clients to escape a vicious cycle of spiralling debt that adds to an already difficult circumstance.

Reducing fine debt may also indirectly enhance treatment motivation through improved general health and wellbeing. Further work would clarify the impacts on treatment retention and other outcomes.

Bowden and colleagues have suggested that the judicious use of WDO in services would be supported by including questions in client assessments and by providing standardised procedures for staff.

LGBT communities

The importance of having receptive and capable alcohol and other drug treatment services resonated in a presentation by Dr Adam Bourne, from the London School of Hygiene & Tropical Medicine, who spoke about the patterns and impacts of substance use among sexual minorities.

Dr Bourne noted that most research indicates a higher prevalence of alcohol and other drug use among LGBT groups. Further, the most popular and problematic substances among sexual minorities can vary significantly from heterosexual populations, along with the settings and motivations for their use.

However, alcohol and other drug services may not account for issues specific to this population or to the diverse sub-groups that exist. Dr Bourne raised questions about the capacity of organisations to provide appropriate services for LGBT people, encouraging practitioners to consider if their organisation is sufficiently knowledgeable.

The invisibility of the LGBT population in many organisations was illustrated by Rei Alphonso’s presentation on the failure to acknowledge sexual minorities in organisational policies. Collectively, this work suggests the need for assertive inclusion at policy and practice levels, to enable welcoming and accessible services.

Enhanced care through technology

Finally, the potential for enhanced continuity of care through technology was illustrated in a keynote presentation by Professor Maree Teesson, who spoke about on-line services for people with co-occurring mental health and alcohol and other drug use problems.

These services promote the agency of individuals to draw from multiple and diverse interventions and modes of delivery. While further evidence is needed, combining e-health and clinic based interventions may enhance care in a system where demand for treatment exceeds availability.

Providing strategies and interventions that address the diverse needs of people affected by alcohol and drug problems is complex. Implementing effective policy even more so.

Continuing to invest in quality research and demonstrate what has been learnt is essential to guide evidence-based policy for community benefit.

Dr Lynda Berends is the APSAD President and Service Development Consultant at the Western Region Alcohol and Drug Centre and Visiting Fellow, University of New South Wales.

 

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