1. The case for developing more effective approaches to alcohol and drug problems Probation and Community Corrections Officers Conference Dr Alex Wodak AM St. Vincent’s Hospital awodak@stvincents.com.au 27 October 2011 1

2. Topics: Scale current problems Current policy settings Barriers to improvement Forces for change Overcoming barriers Conclusions 2

3. Scale current problems: Almost every family experience Sense despair, hopelessness Often identified as major problem High health, social, economic costs Major impact alcohol, tobacco on ‘the gap’ Consumption alcohol rising ? Increasing binge drinking among young Prescription opioids 3

4. Scale current problems: 37 murders Victoria linked meth Major official corruption 4

5. Current policy settings: Tobacco – Big recent drop smoking rates – More action recently: price, packaging – But now ‘islands’ 1960s prevalence – Ban smoking prisons? 5

6. Current policy settings: Alcohol – Tax chaos – Very liberal availability – Restrictions undermined competition – Advertising, marketing unregulated – Drinks industry omnipotent, gets its way 100% – Parties intimidated – Community powerless 6

7. Current policy settings: Prescription drugs – Increasing consumption SR opioids 20 years – Following US, Canadian trends – US serious harms from 2000 – Mainly chronic non-cancer pain – Also benzodiazepines – insidious 7

8. Current policy settings: Illicit drugs – Framed as criminal justice problem – Rhetoric, funding follows – Ineffective, counterproductive, expensive – Difficult identify benefits – Works well politically 8

9. Barriers to improvement: Tobacco – Major progress over long time – Shows progress is possible – Tobacco industry tamed – Decrease smoking disadvantaged 9

10. Barriers to improvement: Alcohol – Drinks industry too powerful – Newspapers afraid – Excessive concentration newspaper owner – TV, radio lives off newspapers 10

11. Barriers to improvement: Prescription drugs – Messy – DoHA, states, territories – Whose responsible? – Multiple interventions needed 11

12. Barriers to improvement: Illicits What works isn’t popular, what’s popular doesn’t work Fear vs evidence 12

13. Forces for change: Alcohol – Rising community concern alcohol – NAAA – Global action – WHO 13

14. Forces for change: Illicit drugs – Growing recognition failure War on Drugs – Global Commission Drug Policy – UN Commission HIV, Law – Sovereign debt crisis USA, W Europe – New models e.g. Portugal – Crisis prisons USA – Mexico – Changing community attitudes, internet 14

15. Overcoming barriers: Funding flowing to drug law reform New drug law reform organisations LEAP 15

16. Conclusions: Exciting time Change starting drug law reform Pressure building effective response alcohol Also action SR opioids Benzodiazepines Harm reduction debate over Drug law reform debate following 16