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.

Supply reduction Demand reduction Harm reduction 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 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