ADTRU National Alcohol Policy and Programs in Australia John B Saunders MD, FRACP Professor of Alcohol and Drug Studies, University of Queensland, Director, Alcohol and Drug Service, Royal Brisbane and Women’s Hospital, Queensland Health, Co-Director, WHO Collaborating Centre on Substance Misuse and Mental Health; Member, Australian National Council on Drugs

ADTRU The Spectrum of Use and Misuse Dependence Hazardous/Risky/ Harmful Use Non-Hazardous (Low Risk) Use Abstinence

ADTRU Substance Use in the Australian General Population: Findings from the Recent National Drug Strategy Household Surveys Lifetime Use % Change Alcohol % Tobacco % Cannabis % Heroin % Amphetamines % Cocaine % Any illicit drug % Injected illicit drugs %

ADTRU Prevalence of Alcohol Use and Misuse 90% of adults drink alcohol, at least occasionally 20% of men and % of women drink hazardously 10% of men and 2% of women experience significant alcohol-related harm 6% of men and 2-3% of women have alcohol dependence (515,000 in Australia) Alcohol intake doubled from 1945 to 1977 since when it has declined by 10%.

ADTRU Prevalence of Alcohol Use and Misuse Alcohol misuse is the attributed cause of approx 4,500 deaths per annum (5% of all deaths). Alcohol misuse accounts for 10% of premature years of life lost However, lives saved from moderate consumption amount to 3,500 per annum The cost of alcohol-related problems to the national economy exceeds $6 000 million per annum.

ADTRU Impact of Alcohol Misuse % of hospital inpatients have an underlying alcohol problem; in % it is the cause of underlying condition % of general practice patients have an underlying alcohol problem

ADTRU Responses to Alcohol Misuse Primary prevention Secondary prevention (Brief and early interventions) Tertiary intervention (Treatment and rehabilitation) Harm reduction

ADTRU Primary Prevention - Alcohol 1. Legislation on minimum drinking ages 2.Random breath testing of motor vehicle drivers 3.Labelling of alcoholic beverages 4. Controls on alcohol availability 5. Media campaigns 6.School-based educational programs 7.Alcohol policies in public places and the workplace 8.Role modelling by adults

ADTRU Random breath testing of motor vehicle drivers Introduced into Australia in 1982 Progressively extended to Australian states National blood alcohol limit of 50mg/100ml fro drivers (lower limits for young drivers) Random breath testing of all motor vehicle drivers Has reduced motor vehicle deaths by 40%

ADTRU Random breath testing of motor vehicle drivers Truly random Also provisions for testing on suspicion Compulsory to provide a breath sample Breath testing is frequent High intensity of testing Systematic Vigorously enforced

ADTRU Random breath testing of motor vehicle drivers Has reduced motor vehicle deaths by 40%

ADTRU Labelling of alcoholic beverages The alcohol beverage insert is developing a national, industry-wide approach to the labelling of alcoholic beverages, with - standard drink information - graphics to depict the number of standard drinks in the beverage

ADTRU A brief therapy, comprising advice and strategies to reduce risky/hazardous alcohol use Typically takes 5 minutes, though may be extended as appropriate to sessions Results in reduction in hazardous alcohol use by 35-40% Can prevent long-term alcohol-related harm Brief Intervention for Hazardous Alcohol Use

ADTRU A flexible form of therapy, comprising advice and strategies to reduce risky/hazardous substance use Ranges from 5 minutes to session of up to minutes Typically offered proactively or opportunistically, following identification of hazardous use (through screening or a clinical consultation) Usually offered to people whose substance use is risky/hazardous, rather than dependent Advice is usually to reduce use rather than abstinence Aims to prevent exacerbation of substance use related harm Responses to Hazardous Alcohol Use - Brief Intervention

ADTRU Audit No 2 Yes, but not in the last year 4 Yes, during the last year o 10. Has a relative, a friend, a doctor or another health worker been concerned about your drinking or suggested you cut down? 0 No 2 Yes, but not in the last year 4 Yes, during the last year o Select from the answers below and place the number that corresponds with your answer in the box 1. How often do you have a drink containing alcohol?Score 0 Never 1 or less 2 2 to 4 times a month 3 2 to 3 times a week 4 4 or more times a week o 2. How many standard drinks do you have on a typical day when you are drinking? 0 1 or to or 6 3 7, 8 or or more o 3. How often do you have six or more drinks in one occasion? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily o 4. How often during the last year have you found that you were not able to stop drinking once you had started? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily o 5. How often during the last year have you failed to do what was normally expected from you because of drinking? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily o 6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily o 7. How often during the last year have you had a feeling of guilt or remorse after drinking? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily o 8. How often during the lst year have you been unable to remember what happened the night before because you had been drinking? 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily o 9. Have you or someone else been injured as a result of your drinking? 0 RECORD TOTAL OF SPECIFIC ITEMS HERE o

ADTRU Decision Tree Offer AUDIT questionnaire Review AUDIT score Non-hazardous range Hazardous or harmful range Alcohol dependent range Feedback, or no further action Feedback Brief intervention Feedback Referral to specialist Need for detoxification? Pharmacotherapy

ADTRU Treatment of Alcohol Dependence 1.Information and advice 2.Detoxification 3.Pharmacotherapies 4.Psychological therapies (eg CBT) 5.Treatment of physical and psychiatric co- morbidity 6. Residential programs 7. Self-help groups

ADTRU Pharmacotherapies for Alcohol Dependence Naltrexone Acamprosate Disulfiram Ondansetron Buspirone (for alcohol dependence and comorbid social anxiety) SSRIs (for underlying or residual depression)

ADTRU Pharmacotherapies for Alcohol Dependence Naltrexone and acamprosate are subsidised by the Federal Government - monthly cost reduced from $250 to $28 ($4 for health care card holders) Treatment can be indefinite

ADTRU Treatments for Alcohol Misuse: Looking to the Future Correspondence-based, CD-ROM and Internet therapies Combined CBT/motivational therapy and pharmacotherapy Combined pharmacotherapies  Acamprosate and naltrexone  Acamprosate and disulfiram  Naltrexone and ondansetron Depot preparations

ADTRU Harm Reduction Addition of thiamine to bread and prescription of thiamine to prevent alcohol-related brain damage (Wernicke-Korsakoff syndrome) has reduced the incidence of this by >50% Hostels for homeless people with alcohol dependence

ADTRU The Australian National Alcohol Strategy Key Issues The cultural place and availability of alcohol in Australia Improving safety and public amenity Responding to intoxication Reducing negative health outcomes Responding to higher risk groups Developing partnerships Seeking effective policies and programs