Demonising drug users doesn’t help them, or us

WE don’t need a war on drugs. Reducing the damage done by drug and alcohol abuse is only effective if we deal with the demand, writes Michael White.

EVERY Australian should be concerned about the impact of alcohol and drugs in our community.

However, headlines which highlight the problems caused by a single drug hide the complex and often intractable problems of people who use drugs, the challenges faced by those who treat them and the costs to society of strategies implemented to control use.

In the alcohol and other drug sector, workers provide services for people who are dependent on and (at the extreme end) addicted to substances. Very few use a single substance. When people come in to treatment, most report using a mix of substances, including large amounts of alcohol. Data shows many people dependent on drugs may also have serious alcohol problems.

Further, most will have other issues making their lives challenging. They may have experienced trauma, been born with foetal alcohol syndrome, or been harmed in alcohol-or drug fuelled violence or accidents. Many have significant mental health problems. Sometimes these problems predate, co-occur or are caused by problematic alcohol and drug use. Their mental health issues are often associated with poverty, unemployment or social exclusion.

Daniel Carling, 36, of Roebourne, WA, is seeking treatment for his ice addiction. (Pic: Gary Ramage)

These issues may have started with problems at school, due to lack of access to or support for education. Significant numbers of Aboriginal people develop substance use issues because of the cultural dispossession or racism they experience. The same is true for many people in culturally and linguistically diverse communities and people who are lesbian, gay, bisexual, transgender, intersex or queer.

Often these vulnerable people are exploited by those who deal in drugs. They engage in the drug trade to support their own dependence. Those higher up the business chain reap the financial rewards and avoid the risks of dealing themselves.

H.L. Mecken, an American journalist said, “If there is a simple solution to a complex problem, it is probably wrong”. This is true of how our society has attempted to deal with dependence.

To reduce alcohol and other drug harm requires that we reduce demand. Gainful employment, treatment for trauma and mental health issues, and providing stable housing are some of the things we can do for adults. Intervening early for children and young people is also essential. Making sure their early years are as healthy and happy as possible. Ensuring their engagement in education from early childhood through high school. Supporting their and their parent’s mental health is also critical.
Accessibility is a key factor in the development of dependence. Alcohol is the first drug that most people get into trouble with, often because of the drinking culture they encounter in their family, peer group, post school education or sporting groups. Our health-focused tobacco interventions saw Australia become an international leader in reducing the harms of smoking.

A young indigenous man is brought to the Emergency Department at Royal Perth Hospital in a state of psychosis caused by ice use. (Pic: Gary Ramage)

We could do the same with alcohol by reducing access through volumetric taxation (tax on alcohol content) or a floor price (minimum price per standard drink).

We also need to better control access to pharmaceutical drugs. Re-scheduling codeine is a positive start. Real time prescription monitoring has been shown to cut access to dangerous prescription drugs. Ongoing professional development for doctors and pharmacists is vital as we learn more about the limited efficacy of some drugs. Emerging knowledge about the limited usefulness of opioids for longer term pain management is a good example.

Illicit drug markets are harder to control but focusing on the higher-level dealers is essential. Those who deal to manage their own dependence need to be supported into treatment. Our jails should not be full of people who are dependent and people should not leave jail as dependent as when they entered. We need effective and comprehensive treatment in prison.

Demonising people who have a significant health issue such as substance use will not help them or us. These people are more often the collateral damage of our ‘troubled society’, not the cause of it. The stigma they experience, driven by the media, is one of the most significant barriers they face in accessing treatment and maintaining their recovery. The media must recognise they are demonising our sons, daughters, brothers, sisters, mothers and fathers. They should be treated the same as anyone else with a significant health problem. Having moved so far in our understanding of the negative impact of stigmatising mental health, we need to do the same with dependence.

Society relies heavily on non-government services to do the heavy lifting when it comes to providing compassionate health and social supports for individuals and families affected by substance use. These services require significant increases in stable long term funding. Both state and federal governments need to step up and fund the gap between the demand and availability of treatment. Even with the recent funding growth, only about 60 per cent of those who need and want treatment can access it.

We do not need a war on drugs. We do need sustainable interventions to address poverty, dispossession, unemployment, under-education, and social exclusion. Then we will reduce drug and alcohol related harms, and enable individuals and families to get the help they need, when they need it.

Michael White is the executive officer of the South Australian Network of Drug and Alcohol Services.