Pathways to risk:What can we do?
Ian Webster
“Ways of Seeing”
•Moral - legal issue
•Health - public health problem
•Psychosocial problems - education
•A social problem
Drugs can be seen as a problem forsociety or a problem of society.
Prevention Task Force - Tobacco
•Marketing measures – price, act against illicit trade, ban internetsales
•Social marketing – TV, campaigns, message placement, reachsocially disadvantaged
•Advertising – cease promotion, report expenditure, packaging
•Second-hand smoke - public places, childhood exposure, specificlocations
•Regulation – supply, packages,licensing, quality control products
•Health warnings
•Quit support - training and service development, NRT replacement& pharmacotherapies
•Community programmes – special measures for indigenouscommunities & disadvantaged
•Support parents and educators
•Maintain commitment (at all levels)
•Measure and evaluate
Prevention Task Force - Alcohol
•Safety of those who drink and those aroundthem
•Promote safer drinking culture
•Regulate alcohol promotion
•Reform alcohol taxation and pricing
•Improve the approach in Indigenouscommunities
•Upskill primary health care
•Build healthy children
•Strengthen the evidence base.
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 alcoholmisuse in Australia Alcohol Education Rehabilitation Foundation funded research project, 2008.
Supply
reduction
Demand
reduction
Harm
reduction
Settings
Stage of life
Disadvantage
Workforce
Evidence of effectiveness
Performance monitoring
Governance
Harm Minimisation
Partnerships
Illegal drugs
Tobacco
Prescribeddrugs
Other
drugs
Alcohol
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.
PATHWAYS TO RISK
Sven Silburn 2003
PATHWAYS TO RISK
Sven Silburn 2003
Society & social
Educationaldevelopment
Early development
MHS
Emotionaldevelopment
Opportunities for prevention -Anticipatory care
Impairment
of body &
mind
Misuse
Loss of
function
performance
Social
disadvantage
Disease
Injury
Use
Addiction
Mental health & suicide risk
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
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