The AOD field is dynamic and fluid and is constantly being shaped by a variety of forces. It is important to be aware of these in order to understand why certain changes have, or have not, happened and to keep abreast with key issues.
In this topic you will examine the key factors that have shaped the sector and focus on a major AOD issue that affects young people in your area and the response to it.
Investigating a local AOD issue
Key factorsKey factors affecting the AOD sector include politics, funding, philosophies, factional battles, research findings, personalities, changes in drug availability and changes in the demographics of people who use. Importantly, all of these factors are interrelated and impact on each other.
PoliticsPolitics plays a major role in the AOD field. This factor is changeable, however, as it is subject to the philosophical ideas of the government. For example, while the Labor government in Western Australia recently stated that they support consideration of a heroin trial on principle, the Liberal party is opposed to the idea. Because drug issues do not win votes, government policies tend to follow perceived public opinion rather than shape it (Saunders & Marsh, 1999). Consequently, there are numerous instances where governments have failed to follow the recommendations of research in favour of doing what the general public wants. For example, harsher drugrelated penalties have been introduced in response to public demand, despite the fact that research shows that the threat of legal consequences fails to deter many users of illegal drugs.
FundingHeavily impacted by the political agenda, public concern and visibility of the issues, funding exerts a significant influence in the AOD field. For example, given the recent concern raised by families and parents of drug users, more funding has been directed into initiatives targeting this population. As a result, there has been a swing towards increased service provision and research relating to parent and family-based interventions.
PersonalitiesThe personalities of key players in the field have a significant influence on directions taken, funding and community attitudes. If a very vocal and visible but conservative key figure in the field talks about the dangers of harm reduction and pushes for stronger zero tolerance, there may be a corresponding change in policy direction in terms of education, community-based programs, as well as in community attitudes.
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Factional battlesFor many years, the AOD field has been characterised by factional battles. Perhaps one of the most well known relates to harm reduction versus zero tolerance or 'abstinence only' based approaches. While the harm reduction model has become widely accepted, in the early 1990's there was an uproar when it was suggested that perhaps the community should accept drug use as a fact, and seek to reduce the harm associated with it (Single, 1995) rather than focusing all of our efforts on stopping drug use altogether. A number of people suggested that such a policy was both unethical and untenable and that the only 'right' way to approach drug use was to advocate abstinence and support the 'war on drugs'.
Another famous (or perhaps infamous) factional battle is still going on between proponents of the disease model of addiction and social learning theorists. Such battles influence the AOD field through the manipulation of research topics, community attitudes (through political and media agendas), treatment regimes and even education and training programs.
Drug availabilityDrug availability changes according to time and place, not only influencing what people use, but determining research, treatment and professional education and training. For example, recently there was a noticeable reduction in the availability of heroin and a corresponding increase in the availability of methamphetamine and cocaine. Not only has this temporarily altered the nature of drug use and drug-related problems most commonly experienced by drug users (for example, a decrease in overdose and increase in drug-related psychosis) but it has also had wider ramifications for the field as a whole.
The nature of some treatment programs has changed, and in particular the role of pharmacotherapies has been reduced. There has been a decrease in requests for methadone and naltrexone, and an increase in psycho-social treatments and alternative medical responses for stimulant-related problems (Towers, 2002). In line with this trend, there has been a change in the focus of some professional education and training programs, as well as funding for new research programs.
To demonstrate the interaction between the various factors that influence the AOD field, it is interesting to note some of the sources of this change in drug availability. Increasingly, the world is becoming a global village, with the llicit drug trade being one of the largest global industries. World events such as wars, natural disasters, and even changes in weather patterns can significantly alter drug use around the world. For example, when the Taliban came to power in Afghanistan, growing the opium poppy was banned. As a result, the quantity of heroin available in Australia was reduced significantly. At the same time, the manufacture of methamphetamine in Burma increased resulting in an increase in amphetamine availability in Australia. Following the defeat of the Taliban in Afghanistan, changes in heroin availability are thought to be imminent.
PhilosophiesCurrent popular perceptions of drug users and the nature of addiction are important in terms of responding to drug-related issues. For example, in the eighteenth and nineteenth centuries drug users and excessive drinkers were perceived to be moral deviants who lacked willpower and were making a conscious choice to 'behave badly'. The most appropriate treatment was punishment and most appropriate prevention program was the threat of punishment and the strengthening of moral fibre and 'good moral values'.
In contrast, the pharmacological model demanded a different response. Both prevention and treatment involved the eradication of the 'demon drink' (or other substances). The disease model advocated a more humanistic approach that put addiction into the health realm, whereas the social learning model advocates a multidisciplinary, systemic approach to both treatment and prevention.
ResearchThe AOD sector is influenced to a large extent by research findings and the strong links between research, practice and education. Australia, in particular, emphasises evidence-based practice, which involves the integration of research and clinical wisdom into education, prevention and treatment. This program follows the evidence-based model in that both research and the experiences of other key stakeholders such as clinicians and clients support its teachings.
For example, until quite recently it was believed that abstinence was the only treatment option for people with addiction-related problems. Research by the Rand corporation and Sobell, Sobell and Davies suggested that controlled drinking (as opposed to abstinence) was an option for some people. While this caused an uproar in the field at the time (and a significant factional battle in which the Sobells were wrongly accused of falsifying data - Heather & Robertson 1989), such treatment outcomes are now well accepted for some populations (such as young people).
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Demographics of drug usersWho is actually using what also plays a big role in terms of research directions, community attitudes and treatment responses. For example, the National Drug Household Survey (1998) shows that increasing numbers of young people are using drugs at a younger age. This means that greater emphasis is being put into treatment and prevention and education designed specifically for working with young people (such as this training program). Research also shows that, contrary to popular opinion, there are a large number of young professionals who use illegal drugs on a recreational (and sometimes not so recreational) basis (Dale, 2002). As a consequence, some harm reduction and community-based interventions have been developed to target this population.
Community attitudesLargely shaped by the media, community attitudes influence political agendas and funding bodies. In turn, this impacts on the directions in the AOD field. In addition, the more subtle and insidious influences of community attitudes are directly felt by drug users themselves, families and workers in the field. This can shape people's drug-using patterns (in terms of increasing secrecy of use etc), and also their approach to and experience of treatment. Since alcohol and drug use is so much in the public eye, it is natural that community attitudes are among the most influential of the factors that shape the context of the AOD sector.
MediaThe role of the media in terms of shaping community attitudes and political agendas has been mentioned many times in this module. Since we live in such a media-driven society, the media has the power to shape attitudes and responses to AOD issues positively (highlighting the need for funding, giving people good information on AOD use) and negatively (sensationalizing and demonizing drug users and failing to present accurate information and balanced points of view).
Investigating a local AOD issue
Task - workplace learning activityIdentify a specific issue that you consider is important relating to AOD use by young people in your local community. Select an issue that has generated some interest in the local press.
- the introduction of an alcohol free zone in your main street or at the local beach
- the closure or opening of a needle exchange facility
- the opening of a youth drop-in centre in an area known for drug trading
- fears of the local community about the use of a particular drug (e.g. amphetamines, heroin)
- perceived links between local crime and drug use by young people
Question - Who are the key stakeholders in this issue? (Who is affected by the issue? Who will have something to say about the issue? Describe their role or their interest in the issue.)
Question - What do your local newspapers have to say about the issue? Can you identify any themes? (Remember to read the letters to the editor as well as the editorials.)
Question - What do your work mates think about the issue? Are they of one opinion or are there a variety of views?
Question - What do you think about this issue? Have you always felt this way or have your views been influenced by the young people with whom you work or your co-workers?
Question - What social, cultural or economic factors impact on this issue? Does the issue relate to a particular group of young people? How does this group compare socially, culturally and economically with the rest of the community?
Question - What research findings exist about this issue? (Use your library or the Internet to find out what is known about the issue or how it has been dealt with in other communities.)
Question - How have the key stakeholders in your community responded to this issue? Does the response of your local community fit with a harm minimisation approach, an abstinence model, or some other model? Can you identify why?
Question - Does this issue impact on your organisation? Has it responded in any particular way?
Question - In your opinion, how should this issue be dealt with? Can you identify any possible blocks to your solution? (Consider local politics, funding limitations and the impact on young people)
Question - Can you think of any strategies for overcoming these obstacles?
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SummaryThe AOD sector is a dynamic and fluid area that is constantly changing as a result of:
- factional battles
- research findings
- personalities in the field
- changes in drug availability
- changes in the demographics of people who use