Alcohol and other drugs: the prevention paradoxes

Alcohol's Harm to Children: Findings from the 2015 United States National Alcohol's Harm to Others Survey

OBJECTIVES

To examine the prevalence and severity of alcohol's harm to children in the US and the relationship of the harmer to the child, and to examine caregivers' sociodemographic characteristics, alcohol use, and exposure to harm due to a drinking spouse/partner or other family member as risk factors for alcohol's harm to children.

STUDY DESIGN

We report data on 764 caregivers (defined as persons with parental responsibility for at least 1 child aged ≤17 years) from the 2015 National Alcohol's Harm to Others Survey, a dual-frame national sample of US adults.

RESULTS

Overall 7.4% of caregivers reported alcohol's harm to children in the past year. Risk factors for alcohol's harm to children included the caregiver's own experience of alcohol's harm from a spouse/partner or other family member. Caregivers with a heavy drinker in the household were significantly more likely to report harm to children. A caregiver's own heavy drinking was not a significant risk factor for children in his or her care.

CONCLUSIONS

Alcohol places a substantial burden on children in the US. Although a caregiver's own drinking can harm children, other drinkers also increase the risk of alcohol's harm to children. Screening caregivers to determine whether there is a heavy drinker in the household may help reduce alcohol's harm in the family without stigmatizing caregivers, who themselves may not be heavy drinkers.

Public support for the prevention of alcohol-related problems

Support for a number of strategies and policies for the prevention of alcohol related harm was ascertained as part of a larger survey of public attitudes and behaviours in a representative sample of the Perth metropolitan area. Support for these policies varied, but was generally positive, with young male drinkers the least supportive. The greatest degree of support was found for a variety of training strategies for licensees and barstaff, while a number of restrictive practices, such as reduced trading hours and the banning of the sale of beer in jugs, were less popular. Those who had recently worked in the alcohol trade were less likely than the general population to be supportive of these policies. This effect could not be completely explained by their generally being younger and drinkers. It is concluded that governments generally have a mandate to introduce certain policies and practices into the licensed drinking environment, but that the resistance of the alcohol trade to such measures may need to be overcome if they are to be successfully introduced.

Alcohol and young people: minimizing the harm

In this paper the literature on patterns of use of alcohol by teenagers is reviewed. The model as proposed by Thorley is used to describe the specific nature of alcohol problems experienced by young people. A systemic approach to prevention is explored and recommendations are made about ways to minimise the harm associated with alcohol use by young people.

Mobilizing communities to reduce substance abuse in Indian country

The impact of substance abuse is notable on Indian reservations in the United States and in the border communities surrounding them. One Indian country community, McKinley County, New Mexico, developed and implemented a series of alcohol policy and programmatic reforms beginning in 1989 which have reduced the impact of substance abuse on this community. Learning from the McKinley County experience, Fremont County in Wyoming, home of the Wind River Indian Reservation, has implemented similar reforms. This article introduces the substance abuse reduction efforts and delineates specific innovations implemented in these communities. The influence that these two communities have had on changes in substance abuse policy and programming statewide in New Mexico and Wyoming is also reviewed.

National Drug Policy: Implications of the Tough on Drugs' Ideology

Australia has emerged over the last decade as a world leader in drug policy. According to Single and Rohl (1997 pvii) Australia's National Drug Strategy 'has been characterised by a unique combination of features which have brought it international attention and acclaim'. The strength of Australia's policy has been its emphasis on both licit and illicit drugs, and also its clear articulation of harm minimisation as a guiding principle in all areas of action. The key policy goals recognised the harm associated with all substances and sought results in key areas of alcohol-related problems, tobacco-related problems, under-age consumption, prescription medication problems and illicit drug use. However, Australia has a new drug policy document for the new millennium, The National Drug Strategic Framework 1998 - 2002. As a result of a conservative influence in national politics, this framework has moved from the harm minimisation philosophy to a moralistic 'tough on drugs' philosophy that stresses zero tolerance, law enforcement and abstinence. There is a risk that Australia will experience an increase in adverse health, social and economic consequences as a result of this new policy direction. Nurses need to think critically about the 'tough on drugs' ideology. There is a risk that significant adverse affects may occur for their drug-using patients as a result of this policy change. In their practice, nurses need to challenge the validity of a punitive response, and to commit themselves to improving the health and safety of the illicit drug-using community.

Programmes for tobacco and alcohol users in Australian work-places

This article presents findings from a survey of programmes available for tobacco and alcohol users working in 455 of Australia's top 600 companies. Companies were twice as likely to have programmes for smokers (43%) as for problem drinkers (24%) and these programmes were more apparent in large companies. The majority of programmes for smoking were delivered within a health promotion context which included other life-style issues, such as nutrition, exercise, weight management and stress management. Although Employee Assistance Programs (EAPs) were the most commonly available type of work-place programme for excessive drinkers and other drug users, followed by Alcoholics Anonymous and local hospital clinics, only 6% had an EAP for alcohol. Only 21% of programmes for smokers and 12% for excessive alcohol users were evaluated. Around one-quarter of companies knew the costs of smoking programmes, and 9% reported costs of conducting programmes for excessive alcohol consumers.

The Australian Debate about the Legalization of Heroin and other Illicit Drugs, 1988–1991

Since 1988 a number of public figures in Australia have argued that prohibitions on the use of cannabis, cocaine, and heroin should be relaxed because current drug policies do not reflect the comparative risks of licit and illicit drug use, and many of the social costs of illicit drug use are consequences of prohibition. They have advocated a variety of proposals for reforming drug policy. Proponents of “controlled availability” have proposed that currently illegal drugs should be provided under medical supervision to persons who are dependent on them. Critics concerned about the social costs of drug policies have advocated policies to undercut the black market by increasing the availability of currently illicit drugs. The mechanisms proposed for achieving this end have included de facto and de jure decriminalization of drug use, and the provision of currently illicit drugs to licensed adults by a government monopoly. Despite a vigorous debate, drug policies have not changed because reformers have failed to convince the public that their policies will not increase the use of illicit drugs, and hence the prevalence of drug dependence and drug-related problems.

Changes in reported drug prevalence among New South Wales secondary school students, 1983 to 1989

Three drug use surveys employing a standardised questionnaire format and sampling procedure were conducted on samples of New South Wales school students in 1983, 1986 and 1989. Alcohol and tobacco were the most frequently used substances across the surveys, with rates of use of illicit substances being considerably lower. Declines in the prevalence of alcohol, tobacco and stimulant use were found between 1983 and 1986 and between 1986 and 1989 for both males and females. Rates of use of inhalants, sedatives, hallucinogens and narcotics declined between 1983 and 1986, but remained unchanged between the 1986 and 1989 samples. Cannabis use declined significantly among females between 1983 and 1989, but not among males. Possible reasons for the general decline in drug use over the six-year period are discussed.