Alcohol and drug consumption (both legal and illegal) is a leading cause of preventable harm in Australia (AIHW 2020), with alcohol alone attributed to over 4,000 deaths every year (DoH 2019).
The use of alcohol and drugs is associated with a variety of adverse health, social and economic effects including:
Decreased workplace productivity
Relationship issues or family breakdown
Increased healthcare and law enforcement costs
The perpetuation of marginalisation and disadvantage
Social isolation
Unemployment
Homelessness and poverty
Impaired childhood development or trauma
Criminal prosecution
Violence and crime
Motor vehicle accidents
Injury
Disease
Mental illness
Pregnancy complications
Harm related to injections
Overdose
Mortality.
(DoH 2019; Better Health Channel 2019; AIHW 2020; NCETA 2021)
Despite this, 1 in 4 Australians are consuming alcohol at levels considered risky (DoH 2019), and about 1 in 20 Australians are experiencing addiction or substance abuse (Healthdirect 2020).
There is no level of alcohol or drug use that is completely safe. However, there are ways to reduce the risk of harm (ADF 2019a).
The Three Pillars of Harm Minimisation
Adapted from the Department of Health 2017.
Australia’s National Drug Strategy is guided by three pillars of harm minimisation. They are:
Demand Reduction, which involves preventing and/or delaying alcohol and drug use, reducing the misuse of alcohol and drugs, and using evidence-informed treatment to support recovery from dependence.
Supply Reduction, which involves reducing the production and supply of illicit drugs and regulating the supply of legal drugs.
Harm Reduction, which involves reducing the risk of adverse alcohol and drug-related consequences.
(DoH 2019)
What is Harm Reduction?
Despite the known dangers of alcohol and drugs, some people are unable or unwilling to stop using them in risky ways (ADF 2019a).
Harm reduction aims to combat this issue by decreasing the risk of negative effects associated with ongoing alcohol and drug use (Better Health Channel 2019).
The practice of harm reduction originated during the 1980s HIV epidemic, where healthcare workers attempted to reduce the spread of the virus by providing injection drug users with unused syringes (ADF 2019a).
According to Harm Reduction International (2019), harm reduction describes ‘policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws’.
Harm reduction is not about preventing people from using alcohol or drugs, nor does it condone alcohol and drug use. Instead, it acknowledges the risks associated with alcohol and drugs, with the aim of preventing harm to both the individual and the greater community as much as possible (ADF 2019a; NCETA 2021).
Harm reduction includes interventions such as establishing safe environments for drug use, training healthcare workers to assist with and treat drug-related incidents, and providing education programs (ADF 2019a).
Priority Substances
The following substances have been identified as posing an increased risk of harm to individuals and the community:
Alcohol
Tobacco and nicotine
Cannabis
Methamphetamines and other stimulants
Opioids (e.g. heroin)
Pharmaceuticals such as opioids, benzodiazepines and analgesics being used for non-medical reasons
New psychoactive substances such as synthetic cannabis, mephedrone and methylenedioxypyrovalerone.
(DoH 2017)
Priority Populations
Specific groups of people have been identified as being at higher risk of disproportionate harm from alcohol and drugs (DoH 2017). These include:
First Nations peoples
People with comorbidities such as mental illness, heart disease, diabetes, cognitive impairment and chronic pain
Young people aged between 10 and 24
Adults in their 40s, 50s or 60s
Older adults aged over 65
People in contact with the criminal justice system
Culturally and linguistically diverse populations
Members of the LGBT community
People living in remote areas
People who are pregnant or planning a pregnancy
People with diagnosed or suspected fetal alcohol spectrum disorder
People whose parents or guardians are experiencing alcohol dependence.
(DoH 2017, 2019)
Examples of Harm Reduction Strategies in Australia
Needle and syringe programs, which enable injection drug users to access sterile injecting equipment
Opioid pharmacotherapy treatment (medicinal treatment for opioid dependence)
Peer education programs
Drug diversion programs, which offer treatment to illicit drug users and aim to help them avoid a criminal record
Supervised injection rooms
Outreach services
Sobering-up services, which provide an area for intoxicated people to withdraw safely and receive care if needed
Testing for infections (e.g. HIV, viral hepatitis, STIs) and subsequent discussion and counselling
Referral to treatment programs
Overdose prevention activities such as first aid training
Access to primary health care.
(Better Health Channel 2019; NCETA 2021; HRVIC 2018)
Working With Clients
When implementing harm reduction strategies with a client, it is important to keep the following principles in mind:
Be sensitive to the client’s age, stage of life, disadvantages (if applicable) and settings of use
Do no harm
Focus on potential harms to the client rather than the fact that they use alcohol and/or drugs
Focus on optimising the client’s quality of life rather than cessation
Maximise potential intervention options
Ensure any goals made are appropriate, practical and achievable
Always respect the client’s rights
Be non-judgmental in your interactions and treat all clients with dignity, compassion and respect
Use evidence-based and cost-effective interventions
Allow clients to actively and meaningfully participate
Acknowledge social determinants such as poverty, social inequality and discrimination that may increase the client’s risk of harm
Empower the client.
(YouthAOD Toolbox 2018; HRVIC 2018)
It is also important to remember that every client is different. Some people may use alcohol and drugs more frequently than others, and the potential risks will depend on the type of substance being used and the pattern in which it is being used. Therefore, multifaceted interventions are required (NCETA 2021).
Management of a Client Who is Experiencing a Bad Drug Reaction
When managing a client who is experiencing a bad drug reaction, it is important to prevent the situation from escalating.
Alcohol and drugs interrupt normal brain function and may cause aggressive behaviour in some cases. A client may be impulsive, irritable or have difficulty assessing situations (ADF 2019b).
When managing a client who is affected by alcohol or drugs and acting aggressively, it is important to know how to address the situation (ADF 2019b).
1. Assess the Risks
You should consider:
Behavioural triggers such as feeling threatened, unwelcome, judged, impatient, ignored or excluded
The environment you are in (e.g. whether children are nearby, where exit routes are located)
The type of substance being taken by the client, if known.
(ADF 2019b)
2. Prevent Escalation
Stay calm:
Move slowly and avoid prolonged eye contact
Give the client space
Use a low, calm and steady tone when speaking
Remove any dangerous objects
Avoid asking too many questions
Say ‘I am not angry with you – I just want to make sure you are safe’
Use the client’s name when speaking to them
Reassure the client:
Be supportive and tell the client that they will be okay
Move the client to a quiet area if possible
Listen to the client and respond in a calm manner
Avoid arguing
Call emergency services (police, ambulance etc) if you have any concerns for the client or yourself
After conflict:
Stay alert
Keep the client calm
Ensure others are safe
Avoid mentioning the incident unless the client wishes to discuss it.
(ADF 2019b)
Additional Resources
Drugs contacts:A list of organisations, websites and services that offer support, counselling and information about drugs.
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