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 for society or a problem of society.

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

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.

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.

Supplyreduction

Demandreduction

Harmreduction

Settings

Stage of life

Disadvantage

Workforce

Evidence of effectiveness

Performance monitoring

Governance

Harm Minimisation

Partnerships

Illegal drugs

Tobacco

Prescribed drugs

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

Educational development

Early development

MHS

Emotional development

Opportunities for prevention - Anticipatory care

Impairmentof body &mind

Misuse

Loss offunctionperformance

Socialdisadvantage

DiseaseInjury

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