Experience of harm from others’ drinking and support for stricter alcohol policies: Analysis of the Australian National Drug Strategy Household Survey

BackgroundPrevious research indicates that those who have experienced alcohol-related harm from others are more likely to support stricter alcohol control policies. This study investigates the association between types of harm experienced because of others’ drinking and support for stricter alcohol control policies.MethodsData from 20,570 Australians aged 18 and over who completed the 2013 National Drug Strategy Household Survey was used. Questions about experience of alcohol-related harm from others – being put in fear and abuse (verbal or physical) – were asked. Support for stricter alcohol control policies was quantified by a mean policy support score across 18 alcohol policy questions.ResultsTwenty seven percent of respondents reported harm from someone’s drinking. Respondents who were put in fear had a higher level of support for stricter alcohol control policies than respondents who were not harmed (p < 0.001), regardless of whether they were abused or not. Conversely, respondents who experienced abuse but were not put in fear did not significantly differ in their support for stricter policies from those who experienced no harm.ConclusionIt is the apprehension of harm (i.e. having been put in fear), and not the experience of harm itself (i.e. abuse), which is related to people’s support for stricter alcohol policies. These findings suggest that perceiving others’ intoxication as dangerous to oneself may motivate support for stricter alcohol policies.     

Assembling the dominant accounts of youth drug use in Australian harm reduction drug education

Education programs are a central element of Australian harm reduction drug policy. Considered less judgmental and more effective than the punitive policies of Australia's past, harm reduction drug education is premised on the goal of reducing ‘risks’ and harms associated with illicit drug use rather than an elimination of use per se. In this article I analyse two sets of key texts designed to reduce drug related harm in Australia: harm reduction teaching resources designed for classroom use and social marketing campaigns that are targeted to a more general audience. I identify two significant accounts of young people's drug use present in Australian harm reduction drug education: ‘damaged mental health’ and ‘distress’. I then draw on some of Deleuze and Guattari's key concepts to consider the harm reducing potential these accounts may have for young people's drug using experiences. To demonstrate the potential limitations of current drug education, I refer to an established body of work examining young people's experiences of chroming. From here, I argue that the accounts of ‘damaged mental health’ and ‘distress’ may work to limit the capacity of young drug users to practice safer drug use. In sum, current Australian harm reduction drug education and social marketing may be producing rather than reducing drug related harm.     

Authentic advice for authentic problems? Legal information in Australian classroom drug education

This article examines the legal information provided in Australian alcohol and other drug (AOD) classroom education documents. We focus first on the technical presentation of the information, analysed using Petraglia’s notion of ‘authenticity’ and, second, on the constitution of particular ‘problems’, analysed using Bacchi’s concept of ‘problematisation’. We argue that in working towards deterrence, drug education provides legal information in two ways. First, much of the information focuses on the legal status of drugs, warning young people about the illegality of drugs. Second, information is communicated through structured group activities posed as creating opportunities for discussion. We argue that these strategies aim for a goal of deterrence and that this fits awkwardly with Australia’s avowed commitment to harm reduction drug policies. We argue further that young people’s relationship with the legal aspects of AOD use is too complex for these approaches and the goal of deterrence generally to be productive. In contrast, we propose an approach to drug education that includes a process of open problematisation in which students are invited to consider all aspects of use including the current regulation of drugs. We argue that approaching drug education in this way may more effectively inform about current legal arrangements and encourage the identification of potential problems and solutions more relevant to the lives of its audiences.     

Unravelling the preventive paradox for acute alcohol problems

Kreitman's discussion of the preventive paradox in relation to the prevention of alcohol problems has had profound implications for alcohol policy and has generated considerable controversy [1]. It is argued here that although Kreitman should be credited with the important observation that alcohol-related harm is not confined to a few dependent drinkers, none the less an apparent paradox is not an ideal platform from which to recommend policy. Furthermore, Kreitman's own data and data from an Australian survey of drinking are used to demonstrate that a commonplace truth underlies his apparently paradoxical findings. It is shown that the preventive paradox disappears when consideration is given to the amount of alcohol consumed on either (i) the day of highest alcohol intake out of the last four, or (ii) the day on which acute alcohol-related harm occurred. Episodic heavy consumption by people whose average alcohol intake can be classified as 'low' or 'medium' risk contributes to the bulk of such experiences of harm. It is suggested that the importance of intoxication as a public health and safety issue has been neglected. This neglect is compounded when public education campaigns and prevention policy are only based on average rates of alcohol consumption. Advice regarding the low risk levels of consumption for different types of harm should form one component of a comprehensive harm reduction policy. Other elements of such a policy should include a variety of other measures of proven effectiveness in relation to reducing levels of intoxication and related problems.     

Alcohol supply,demand, and harm reduction: What is the strongest cocktail?

The concept of harm reduction emerged from the drug field in the 1980s in response to the urgent need to reduce the risk and spread of blood-borne viruses in people who continued to inject illicit drugs. The concept has since become increasingly influential in the alcohol and even tobacco fields. While there are many different applications of the term today, the distinction used by the International Harm Reduction Association (IHRA) between strategies relying on ‘use reduction’ and those that primarily strive for harm reduction without necessarily requiring reduction in consumption is used here. The evidence base for the effectiveness of harm reduction strategies on the one hand, and efforts that require a degree of use reduction via demand or supply reduction on the other hand, is summarised based on a comprehensive review funded by the Australian government. In the alcohol field, the concept of harm reduction has sometimes been proposed as an alternative to the view that alcohol-related harm will only be reduced via a reduction of the total population consumption of alcohol. This paper will present evidence to suggest that, in order to be most effective, a comprehensive policy to reduce alcohol-related harm needs also to include interventions to reduce the quantity of alcohol consumed per occasion. Furthermore, it is highly unlikely in most modern drinking societies that significant reductions in alcohol-related harm can occur without also a significant drop in total population consumption. Nonetheless, harm reduction is an important and influential principle in alcohol policy that can be incorporated alongside such effective strategies as controls on the physical and economic availability of alcohol and the routine delivery of brief interventions in primary health care settings.     

The new policy mix: Alcohol,harm minimisation,and determined drunkenness in contemporary society

This paper reflects on the relationship between harm reduction, demand reduction, and supply reduction (collectively, harm minimisation) in relation to the individual, socio-economic, and legal regulation of alcohol, focusing on changing consumption patterns of youths and young adults in the UK. Firstly, harm reduction and practices of self-regulation are considered within the British context of an apparent culture of intoxication, with evidence of determined drunkenness amongst young people that builds upon a longstanding tradition of northern European drinking characterised by weekday restraint and weekend excess. Secondly, demand reduction and the predominant public health programme of recommended sensible drinking levels are discussed in relation to the credibility gap between such messages and contemporary alcohol-related attitudes and behaviours. Thirdly, looking at supply, recent legislative changes and broader developments in the alcohol industry are explored. They counterbalance economic deregulation of licensed leisure with the increased criminalisation of some drinkers. In order to produce the most effective policy mix, individualised models of harm reduction and demand reduction need to be located within broader, culturally appropriate, and context-specific policies that consider the socio-economic, political, and environmental factors influencing harm, demand, and supply.     

“Undisciplined” drinking,multi-sectoralism and political power: Examining problematisations in the Botswana alcohol policy

The Botswana government has recently ramped up efforts to control alcohol consumption through various measures. These include the alcohol tax levy, reduction in trading hours for bars and other licenced premises and increased penalties for alcohol-related road offenses. Whilst these efforts have recently received considerable attention, the processes of alcohol policy development remain unknown and understudied. In this paper, I examine the alcohol policy processes in Botswana using What's the Problem Represented to be (WPR), a poststructural analytic approach that emphasises problematisations in policies. Drawing on alcohol-associated policy documents, I identify two key problematisations that relate to, (1) an emphasis on an “undisciplined” drinker, and (2) an appeal to an internationally-endorsed multi-sectoralism. I explore these problematisations as political formations and periodise them to the year 2008 when they were canonised. I argue that “undisciplined drinking” and an internationally-endorsed multi-sectoralism neglect the social and cultural contexts of drinking, pathologise drinking and do not consider other forms of knowledge. Unmaking current alcohol policy representations is needed to allow for the ‘emergence’ of alternative conceptualisations of the alcohol ‘problem’ in Botswana.     

Alcohol policy and harm reduction in Australia

With consultations having been held across Australia this year as part of the process of developing a new National Alcohol Strategy, it seemed timely to invite my colleagues from the National Drug Research Institute who are experts in the alcohol field to write this Harm Reduction Digest. The authors have canvassed a range of alcohol policy options and discussed their effectiveness in reducing harm for what is arguably Australia's number one drug problem. Australia's response to alcohol and other drug problems has, historically, been based on ‘harm minimization‐incorporating supply reduction, demand reduction and harm reduction’. At this time where the policy options for alcohol are being set for the next 5 years in a climate of ‘small government’, removing restrictions of ‘fair competition’ in business and a belief in the free market, what does the research have to say about recommended policies and strategies to reduce alcohol‐related harm?     

Alcohol consumption in the Arab region: What do we know,why does it matter,and what are the policy implications for youth harm reduction?

Alcohol is a recognized global risk factor for many diseases and injury types and a major contributor to disability and death. While cost-effective interventions do exist, many countries lack a comprehensive national alcohol harm reduction policy. The Arab world includes 22 diverse countries stretching from North Africa to Western Asia having varying dispositions with regards to alcohol sale and consumption. Epidemiological data is scattered and the picture on alcohol consumption remains blurry. This paper presents the findings of an extensive review conducted on all 22 Arab countries, specifically describing: (1) the density and methodology of alcohol-related peer-reviewed publications over the last two decades (1993–2013); (2) the epidemiology of alcohol consumption given all available data; and (3) the current status of policies in the region. Our search revealed a strikingly low number of alcohol-related peer-reviewed published studies – a total of 81 publications across 22 countries and two decades. Most studies are based on clinical or student samples. Where data is available, age of onset is low and drinking is frequent, in the absence of any available or enforced harm reduction policies. We submit that countries in the Arab region can be divided into four categories by alcohol ban and published data. One category includes countries where alcohol is not banned but data is absent, suggesting an ostrich-like response to a controversial behavior, or reflecting a weak research infrastructure and/or policy landscape. Evidence-informed recommendations and future directions for policy and research are discussed and tailored to countries’ current stance on alcohol legislation and consumption. Given the particular vulnerability of youth to uptake of alcohol as well as the resulting short and long term consequences, the paper concludes by focusing on the implications of the findings for youth alcohol harm reduction.     

Making up a new drug user from depenalization to repenalisation of drug users in Denmark

BackgroundIn 2004 the Danish parliament repenalised possession of illicit drugs for personal use after it had been depenalised for 35 years. This article analyses the introduction of a more repressive drug policy in Denmark by studying how drug use and drug users were problematized in two key government whitepapers and how this problematization articulated a more general problematisation of ‘a culture of intoxication’ among young Danes. The analysis also shows how the policy change involved a change of governmentality away from a welfarist and towards a neo-liberal governmentality. The analysis particularly focuses on the implications of these problematisations for the constitution of young drug users a ‘governable subjects’.MethodsThe article takes its inspiration from research that has applied governmentality theory to analyse drug policy and particularly how the governmentalities that drug policies articulate involve different subjectifications of drug users. Within this overall framework the article also takes inspiration from Carol Bacchi's post-structural approach to policy analysis to show the assumptions about young people, drugs and how to govern them before and after the policy change.ResultsThe new drug policy articulated new ways of problematising drug use and the young drug user. Drug use was no longer defined as more or less socially conditioned but as an individual choice made by a rational actor. Punishment for violating the drug legislation should make the drug user responsible for his or her transgressions and deter others from making similar transgressions.ConclusionResearch has shown that neo-liberal discourses can lead to more empowering and harm reduction oriented drug policies. This is not the case in Denmark. Here neo-liberal discourses led to a more repressive drug policy. Briefly accounting for some of the lived effects of the new drug policy, the article shows how socially disadvantaged parts of the Danish population bears the burden on the more punitive drug policy. This more repressive drug policy goes against the trend in several other European countries that have become less repressive. However, even if Danish drug policy has become more repressive, the legal measures taken against drug users in Denmark are still fairly ‘mild’ compared with the legal measures taken against drug users in other countries.     

‘It’s good being part of the community and doing the right thing’: (Re)problematising ‘community’ in new recovery-oriented policy and consumer accounts

The renewed focus on ‘recovery’ in alcohol and other drug policy over the last decade has been subject to sustained international attention and academic critique. However, little scholarly work has addressed how new recovery discourse has harnessed the ideals of community participation and cohesion and how people who use drugs, the targets of such proposals, experience these injunctions. Analysing the two most recent Australian National Drug Strategies – in which new recovery has featured – and interviews with people who inject drugs, I draw on Bacchi’s problematisation approach to make visible the politics of community in new recovery. My analysis demonstrates that there has been a shift in the way new recovery is framed from recovery through community reintegration and reconnection to recovery through ‘evidence-based’ treatment. However, community endures as an important dividing practice that targets people who regularly use drugs as dependent, unproductive and marginal to social life, while also claiming to be the solution to the disorder attributed to alcohol and other drug use. In the second half of this article, I draw on people’s accounts of regular drug use and recovery to explore the ‘lived effects’ of these problematisations and to pursue a critical practice of thinking otherwise. I argue that these accounts disrupt and contest the problematisations and promises underpinning recovery through community reintegration by: 1) drawing attention to the way in which the boundaries of community exclude inclusion for people who use drugs, and emphasising people’s already existing social relationships; 2) making present hitherto silenced and unproblematised barriers to social connection; and 3) critiquing the normative fantasies of healthy society and citizenship that underpin recovery. In concluding I consider the politics of appeals to community in new recovery-oriented policy, and suggest the need to foreground consumer accounts in problematisation-oriented analyses in order to better contest authoritative enactments of drug ‘problems’ that bear little resemblance to the challenges people face.     

“Everyone can loosen up and get a bit of a buzz on”: Young adults,alcohol and friendship practices

In countries with liberalised alcohol policies, alcohol harm reduction strategies predominantly focus on young adults’ excessive drinking harms and risks. However, research shows such risks are largely irrelevant for young adults, who emphasise the sociability, release, pleasure and fun of drinking. Friendship is a central part of their lives and an integral part of their drinking experiences. This study aimed to explore everyday friendship practices, drinking, and pleasure in young people's routine and shared social lives. Twelve friendship discussion groups were conducted in urban and non-urban New Zealand, with 26 women and 25 men aged 18–25 years. Our Foucauldian discursive analysis enabled us to identify how the young adults drew on drinking as ‘friendship fun’ and ‘friends with a buzz’ discourses to construct drinking as a pleasurable and socially embodied friendship practice. Yet the young adults also drew on ‘good always outweighs bad experiences’ and friendship ‘caring and protection’ discourses to smooth over disruptive negative drinking experiences. Together these discourses function to justify young adults’ drinking as friendship pleasure, minimising alcohol harms, and setting up powerful resistances to individualised risk-based alcohol-harm reduction campaigns. These findings are discussed in terms of new insights and implications for alcohol harm reduction strategies that target young adults.     

Modification of a traditional motivational interviewing-based brief intervention training for hospital staff: The approach and refer method

Under the new Alcohol Harm Reduction Strategy for England published by the Prime Minister's Strategy Unit in , there has been an increasing focus on crime and public order issues and alcohol-related harm experienced by ‘vulnerable’ or ‘at risk’ groups. Prisoners have been identified as a vulnerable group who have high rates of dependence on alcohol and problems with alcohol-related offending. In late 2004, the Prison Service launched its first alcohol strategy. Based on an analysis of key policy documents, official enquiries and research, this paper explores how the ‘problem’ of alcohol can be defined within the prison setting and the issues it raises for both the individual prisoner and the institution. It examines the lack of policy and strategic direction prior to the publication of the new prison alcohol strategy and the possible reasons for the complacency around alcohol in prisons in contrast to illicit drugs. The paper critically assesses the new strategy in relation to the testing and treatment initiatives proposed and the lack of research and resources underpinning them. There is a real risk that the strategy will fail unless adequate resources are forthcoming to expand treatment provision. Given the neglect and complacency around alcohol, policy champions or policy entrepreneurs are needed to lobby for funding and keep the prison alcohol issue on the policy agenda.     

Trends Across the Night in Patronage,Intoxication, and Licensed Venue Characteristics in Five Australian Cities

Background: While alcohol-related harm is reportedly greater on weekend evenings, research investigating trends in the intoxication levels of patrons and factors that increase risk of harm over the night is lacking. Objectives: The aim was to observe trends over the course of the night for patron demographics, venue characteristics and patron intoxication. Methods: Observations of licensed venues and patrons in night-time entertainment districts of five Australian cities were conducted. In total, 798 observations occurred between 9 pm and 2 am on Friday and Saturday nights across 61 unique bars, nightclubs, and pubs. Patron characteristics such as gender and percentage of patrons under 25 years of age were estimated. Measures of venue characteristics included number of patrons, percentage venue capacity, ease of patron movement, bar crowding, and time to service. Measures of intoxication included the percentage of patrons showing any signs of alcohol intoxication, percentage of patrons too intoxicated to remain in the venue, overall level of intoxication, and percentage of patrons showing signs of drug use. Results: Patron capacity increased across the night, peaking at 11 pm in bars, and 1 am in nightclubs. Patron intoxication measures increased for all venue types across the night. Patrons showed more signs of drug use in nightclubs than other venue types. Conclusions: Increasing intoxication and decreasing patron numbers later in the night provides support for restricted trading hours and improved responsible service of alcohol policies. Specific venue types should be targeted to reduce drug use in the night-time economy.     

Culture clash: alcohol marketing and public health aspirations

It is of no coincidence that a number of recent Harm Reduction Digests have addressed the issue of the reduction of alcohol-related harm. Despite the dominant focus on illicit drug use in the popular discourse, alcohol remains Australia's number one drug problem, as it is in many other developed countries. In this Digest Munro and de Wever use the 'four Ps' of marketing: product, price, place and promotion, to critique the two decades industry self-regulation of alcohol marketing. They conclude that if we are going to develop policies which effectively change Australian drinking culture to reduce alcohol-related harm, we need first to accept that the alcohol industry and the health field have separate and conflicting interests.     

‘It's just a social thing’: Drug use,friendship and borderwork among marginalized young people

This article joins a growing chorus of researchers who doubt the utility of the concept of peer pressure for explaining young people's initiation to and use of drugs. Drawing on interview data with 45 patrons of a youth drop-in centre in Ottawa, Canada, we argue that drug use is more intricately woven into friendship – affective relationships of trust and intimacy, belonging and sharing – rather than simply part of the unidirectional pressures some young people put on others to fit in to a subculture. Marginalized young people's narratives show that drugs and alcohol furnish them with a relatively inexpensive pastime to share with friends, introducing opportunities for intimacy that are otherwise difficult to attain at the individualistic and isolating margins of neoliberal cities. We demonstrate how young drug users draw boundaries between acceptable and unacceptable relationships to drugs and alcohol, articulating an important sense of belonging to a superior group of drug users. Through this ‘borderwork’, they solidify the bonds they share with the people with whom they smoke cannabis and drink alcohol.     

Prevalence of responsible hospitality policies in licensed premises that are associated with alcohol-related harm

This study aimed to determine the prevalence of responsible hospitality policies in a group of licensed premises associated with alcohol-related harm. During March 1999, 108 licensed premises with one or more police-identified alcohol-related incidents in the previous 3 months received a visit from a police officer. A 30-item audit checklist was used to determine the responsible hospitality policies being undertaken by each premises within eight policy domains: display required signage (three items); responsible host practices to prevent intoxication and under-age drinking (five items); written policies and guidelines for responsible service (three items); discouraging inappropriate promotions (three items); safe transport (two items); responsible management issues (seven items); physical environment (three items) and entry conditions (four items). No premises were undertaking all 30 items. Eighty per cent of the premises were undertaking 20 of the 30 items. All premises were undertaking at least 17 of the items. The proportion of premises undertaking individual items ranged from 16% to 100%. Premises were less likely to report having and providing written responsible hospitality documentation to staff, using door charges and having entry/re-entry rules. Significant differences between rural and urban premises were evident for four policies. Clubs were significantly more likely than hotels to have a written responsible service of alcohol policy and to clearly display codes of dress and conditions of entry. This study provides an indication of the extent and nature of responsible hospitality policies in a sample of licensed premises that are associated with a broad range of alcohol related harms. The finding that a large majority of such premises appear to adopt responsible hospitality policies suggests a need to assess the validity and reliability of tools used in the routine assessment of such policies, and of the potential for harm from licensed premises.     

Alcohol prevention for school students: Results from a 1-year follow up of a cluster-randomised controlled trial of harm minimisation school drug education

Aims: The Drug Education in Victorian Schools (DEVS) programme taught about licit and illicit drugs over two years (2010–2011), with follow up in the third year (2012). It focussed on minimising harm and employed participatory, critical-thinking and skill-focussed pedagogy. This study evaluated the programme’s residual effectiveness at follow up in reducing alcohol-related risk and harm. Methods: A cluster-randomised, controlled trial was conducted with a student cohort during years eight (13–14?years old), nine (14–15?years old) and 10 (15–16?years old). Schools were randomly allocated to the DEVS programme (14 schools, n?=?1163), or their usual drug education (7 schools, n?=?589). Multi-level models were fitted to the data, which were analysed on an intent-to-treat basis. Statistically significant findings: Over the 3 years, there was a greater increase in intervention students’ knowledge about drugs, including alcohol. Their alcohol consumption did not increase as much as controls. Their alcohol-related harms decreased, while increasing for controls. There were fewer intervention group risky drinkers, and they reduced their consumption compared to controls. Similarly, harms decreased for intervention group risky drinkers, while increasing for controls. Conclusions: Skill-focussed, harm minimisation drug education can remain effective, subsequent to programme completion, in reducing students’ alcohol consumption and harm, even with risky drinkers.     

Does alcohol advertising have an impact on the public health?

This presentation draws on recent New Zealand and international research to examine a number of questions about the possible public health impact of policy which allows alcohol to be advertised on the broadcast media. The relevant public health questions include: the contribution of alcohol advertising to aggregate levels of consumption and alcohol-related problems; the impact on the drinking and attitudes of the heaviest drinking sector, young males, who tend to be a primary target for the advertising; the impact on those already experiencing problems associated with their drinking and wanting to abstain or cut down; the impact on the young as they move towards becoming drinkers; the impact on the likely efficacy of educational campaigns about drinking; and the impact on the social climate surrounding alcohol and in turn on the support for effective public policies to reduce alcohol-related harm. Research in this area has increased in both conceptual and methodological sophistication in the past decade and studies using a number of complementary methods are available to assist our understanding of the likely impact of broadcast alcohol advertising. Evidence that advertising is likely to contribute to higher levels of drinking and related problems has strengthened over the past decade, suggesting that public health interests should be considered as one of the relevant voices in the ongoing policy debate around alcohol advertising.     

Critical policy frontiers: The drugs-development-peacebuilding trilemma

Recent years have seen the emergence of a policy consensus around the need for fundamental reforms of global drug policies. This is reflected in the call for ‘development-oriented drug policies’ that align and integrate drug policies with development and peacebuilding objectives, as captured in the Sustainable Development Goals (SDGs). These calls have been important in acknowledging the damage caused by the war on drugs and in drawing attention to how drugs are inextricably linked to wider development and peacebuilding challenges. Yet there is surprisingly limited academic research that looks critically at the drugs-development-peace nexus and which asks whether the goals of a ‘drug-free world’, ‘sustainable development’ and ‘the promotion of peace’ are commensurate with one another, can be pursued simultaneously, or are indeed achievable. This article studies these policy fields and policy-making processes from the geographical margins of the state – frontiers and borderland regions – because they offer a privileged vantage point for studying the contested nature of policymaking in relation to the drugs-development-peace nexus. We set out a historical political economy framework to critically assess the assumptions underlying the integrationist agenda, as well as the evidence base to support it. By developing the notion of a policy trilemma we are critical of the dominant policy narrative that ‘all good things come together’, showing instead the fundamental tensions and trade-offs between these policy fields. In exploring the interactions between these policy fields, we aim to advance discussion and debate on how to engage with the tensions and trade-offs that this integrationist agenda reveals, but which have to date been largely ignored.