NDARC Monograph No. 21 (1994)
PREFACE
This monograph contains eight papers presented at the Sixth NDARC Annual Symposium, held on December 3, 1993. The symposium: "Health for All? Social Justice Issues in the Alcohol and Other Drug Field", was organised by Wendy Swift and Jan Copeland from NDARC. The proceedings, which were chaired by Associate Professor Wayne Hall of NDARC, were opened by the Honorable Kevin Rozzoli, M.P., Member for Hawkesbury and Chairman of the NDARC Board of Management.
As highlighted by the Hon. K Rozzoli, the theme for the 1993 symposium arose because the 1992 Second Task Force on Evaluation of the National Campaign Against Drug Abuse (NCADA) had identified a number of groups which were disadvantaged relative to the rest of the community. The Task Force suggested that these groups required special attention in the proposed National Drug Strategy. The symposium provided a forum in which issues relevant to alcohol and other drug use among the priority groups of NCADA, namely Aborigines, prisoners, people from non-English speaking backgrounds, women and youth, could be addressed from research and clinical perspectives.
The morning session began with a presentation by Joseph Murphy outlining the historical development of the Aboriginal and Torres Strait Islander Commission's (ATSIC's) alcohol and other drug policy, as well as reviewing the current and future directions of ATSICs initiatives. The author stressed that the existing policy and strategies of ATSIC were developed prior to the availability of reports from the National Aboriginal Health Strategy (NAHS) Working Party and the Royal Commission Into Aboriginal Deaths In Custody, the findings of which are considered to have important implications for the revision of ATSIC guidelines. The process by which the updating of ATSICs policy will be achieved was also discussed.
Dr Ingrid van Beek then presented the preliminary findings of a methadone treatment program being piloted, using a randomised control trial, at the Kirketon Road Centre (KRC). The aim of the study is to reduce HIV risk behaviour by providing opioid dependent injecting drug users, who have not sought treatment before or who have experienced trouble accessing existing programs, with access to methadone treatment. The retention rate for treatment at KRC was reported to be promising when compared to that for all methadone programs in NSW at 3 months. The author concluded that KRC had successfully attracted and retained a younger, more criminally involved group of IDUs for whom access had previously proved difficult, and that while it was too early to assess the effect of treatment on HIV risk taking behaviour, the clinical picture was promising.
Deborah Allen then addressed alcohol and other drug treatment issues in the NSW criminal justice setting. Having described how the rigid prison officer culture has in the past been obstructive and hostile to rehabilitation programs in general, the author went on to say that improvements in officer training and changes in the management of prisoners are slowly bringing about positive change. Evaluation studies of drug and alcohol services in the prison system have revealed that there is a lack of cohesion among gaols in terms of treatment philosophies and options. However, Ms Allen highlighted some significant developments such as the initiation of case management files and the heightened awareness of the differing needs of inmates at various points of their sentence, which represent practical ways in which this problem is beginning to be dealt with. The author concluded by outlining some of the difficulties encountered in attempting to provide a Drug and Alcohol (D&A) service within the unique environment of the prison system.
Bruce Flaherty then presented a paper, co-authored by Nelida Jackson, on the challenge of providing D&A services to a multicultural society. The demographic profile given, of the non-English speaking background (NESB) component of the population of NSW, highlighted the cultural diversity that D&A services have to cope with. Having acknowledged that there is a paucity of literature on D&A issues in relation to people of NESBs, Mr Flaherty gave a broad description of what is known about usage patterns, and treatment services for this group. Barriers to service access were discussed in detail and recognition was given to the strategy being adopted by the Drug and Alcohol Directorate in an attempt to address these problems. The authors concluded that while NSW has made some significant breakthroughs in meeting the `multicultural challenge', a lot of work remains to be done before all Australians can enjoy equitable access to appropriate D&A services.
An overview of alcohol use in Aboriginal Australia followed, presented by Dr Ernest Hunter. It was suggested that the racist legislation prohibiting Aboriginals access to alcohol, which has only relatively recently been repealed, influenced the manner of alcohol consumption among the indigenous people in a way that still impacts upon alcohol use today. The author dispelled many of the stereotypes of Aboriginal alcohol consumption, which are widespread in the broader society, by highlighting some of the similarities between Aboriginal people and other Australians with regard to alcohol use. In terms of differences, it was noteworthy that a greater proportion of Aboriginal people compared to non-indigenous Australians are abstainers, but as Dr Hunter stressed, of greater relevance is the fact that the Aboriginal population experience more extreme harmful consequences. In his discussion of contemporary alcohol use, the author described the problematic nature of its use in remote parts of Australia, and referred to the political importance of alcohol in such regions. In concluding it was proposed that the harmful patterns of alcohol use will continue among Aboriginal Australians until the social and economic disadvantage of Aborigines is redressed.
Kate Dolan then presented the results of a recent study, in which ex-prisoners in NSW were interviewed regarding their HIV risk-taking behaviour during time spent in and out of prison. All subjects had a history of injecting drug use. Both HIV positive and negative people were recruited, allowing interesting comparisons to be made between these two groups. While it was indicated that a low level of HIV infection is known to exist in Australian prisons, particularly relative to other parts of the world, the study revealed that incarceration deterred injecting drug users from injecting safely. Not only were subjects more likely to share needles in prison, but they also shared with a greater number of people. The author concluded that the potential for the transmission of HIV and other infections is now a significant concern in NSW prisons, and proposed several recommendations aimed at addressing the problem.
The treatment needs of women were then discussed in a presentation by Jan Copeland. Several barriers to women seeking treatment for their alcohol and other drug problems were identified. The limited research that has been conducted to date on women's specialist treatment services was described and priority areas for continuing research were highlighted. A brief outline was given of two relevant studies currently in progress at NDARC. One study is seeking to identify alcohol and other treatment issues for women, while the other is examining the relationship between childhood sexual assault (CSA) and substance misuse problems among women. Ms Copeland finished by making some general recommendations regarding the provision of treatment services appropriate to women.
John Howard concluded the symposium with a paper addressing treatment issues for drug-using youth. A review was given of what is known about the extent, origins and progression of drug use among young people, followed by a comprehensive coverage of the obstacles preventing them from gaining relevant treatment. Mr Howard identified several issues that drug and alcohol staff, and program developers should be aware of if they wish to increase the effectiveness of treatment programs and maximise retention of young clients. In closing, the author indicated that while there is currently a scarcity of appropriate treatment options for young drug users, existing programs could alleviate the situation somewhat by being open to the findings of self-appraisal and external reviews, and by willingly experimenting with different approaches to the problem of engaging youth in treatment.
It is hoped that this monograph successfully highlights the need for specialist treatment services capable of catering for the unique needs of women, prisoners, Aborigines, people from non-English speaking backgrounds and youth. The authors have addressed several of the barriers to equality in drug treatment and have made sensible recommendations aimed at improving the efficacy of treatment services.