Pathways to risk: What can we do?

1. Pathways to risk:What can we do? Ian Webster

2. “Ways of Seeing” • Moral - legal issue • Health - public health problem • Psychosocial problems - education • A social problem Drugs can be seen as a problem for society or a problem of society.

3. Prevention Task Force - Tobacco • Marketing measures – price, act against illicit trade, ban internet sales • Social marketing – TV, campaigns, message placement, reach socially disadvantaged • Advertising – cease promotion, report expenditure, packaging • Second-hand smoke - public places, childhood exposure, specific locations • Regulation – supply, packages,licensing, quality control products • Health warnings • Quit support - training and service development, NRT replacement & pharmacotherapies • Community programmes – special measures for indigenous communities & disadvantaged • Support parents and educators • Maintain commitment (at all levels) • Measure and evaluate

4. Prevention Task Force - Alcohol • Safety of those who drink and those around them • Promote safer drinking culture • Regulate alcohol promotion • Reform alcohol taxation and pricing • Improve the approach in Indigenous communities • Upskill primary health care • Build healthy children • Strengthen the evidence base.

5. Cost-effectiveness study • Volumetric taxation • Advertising bans • Minimum drinking age to 21 • Brief interventions • Licensing controls • Drink driving mass media campaign • Random breath testing • Residential treatment & use of naltrexone Doran C, Vos T, Cobiac L et al., Identifying cost-effective interventions to reduce the burden of harm associated with alcohol misuse in Australia Alcohol Education Rehabilitation Foundation funded research project, 2008.

6. Harm Minimisation Disadvantage Supply reduction Settings Illegal drugs Stage of life Partnerships Demand reduction Harm reduction Workforce Evidence of effectiveness Performance monitoring Governance Alcohol Tobacco Prescribed drugs Other drugs

8. Harms to others • ~ 75% adults negatively affected by others’ drinking. • > 30% neg affected by someone well known • >10 m neg effects of a stranger’s drinking in one year. • >70,000 assault victims per year • >24,000 victims of domestic violence • >20,000 children abused [in 2006/07]. • $14 b out-of-pocket expenses lost wages & productivity. • > $6 b in intangible costs. • Additional $20 billion added to the Collins and Lapsley (updated to 2008) of $17.2 billion = $36 billion annually.

9. PATHWAYS TO RISK Sven Silburn 2003

10. PATHWAYS TO RISK Society & social MHS Educational development Emotional development Early development Sven Silburn 2003

11. Opportunities for prevention - Anticipatory care Addiction Social disadvantage Loss of function performance Impairment of body & mind Disease Injury Misuse Mental health & suicide risk Use

12. Keys to success • Engagement • Harm minimisation/anticipatory care/limit setting • Long haul & follow-up (‘chain of care’) • Patient’s autonomy • Practical focus - ‘material’ & ‘structural’ • Medication choice • Dependence treatment works

13. Connections – “Chain of Care” Ensuring links in the chain to - Structured follow through Other health services Social welfare (‘fare well’) Housing, corrections, law enforcement, homeless agencies, Indigenous organisations