Substance Use Prevalencean APS Position Statement Summary
1) The vast majority of Australians use psychoactive substances. Patterns of use vary according to individual and environmental influences and type of substance.
a. Legal substances such as caffeine, alcohol and tobacco are most widely used.
b. Harmful use of prescription medication is common and often overlooked.
c. Cannabis is the most commonly used illicit substance.
d. While substances such as heroin and cocaine are perceived to be most harmful, their use is rare.
e. The use of many substances has decreased in the last 5-10 years. The exception to this is alcohol and, to a lesser extent, ecstasy, where use has increased.
2) Not all alcohol and other drug use is harmful, but the use of any substance, legal or illegal, has the potential to cause harm.
a. Harmful effects can occur from intoxication, regular use and dependence.
b. Alcohol and other drug use can cause a wide range of harms to users themselves and also to families, friends, workplaces, and the community
through accidents, violence, and crime.
c. Legal substances including tobacco and alcohol are associated with the greatest overall harm in Australia.
d. Harmful alcohol and other drug use is commonly associated with other mental disorders; this is the norm rather than the exception.
e. Alcohol or drug use is a risk factor for precipitating and maintaining mental health problems and mental disorders.
f. Harmful alcohol and other drug use is a significant risk factor for suicide, particularly harmful alcohol use.
Understanding Substance Use
3) People use alcohol and other drugs for a wide range of reasons, and there are many diverse theories and models of substance use—none of which fully capture its complex nature.
a. The biopsychosocial model recognises the complex interactive contributions of biological, psychological, and socio-cultural factors to substance use.
b. Identifying a person’s motivation to change their substance use behaviour is helpful in understanding both initiation and cessation of alcohol and other drug use.
c. Substance use patterns vary across the lifespan, with adolescence and early adulthood being life stages of particular risk for harmful use.
d. It is essential to understand the social and cultural context of substance use. This is critical for all people, but is particularly salient for youth, Aboriginal and Torres Strait Islander peoples, and in the context of the use of performance enhancing substances.
4) Societal responses to substance use have been shown, historically, to be politically, socially, culturally and economically motivated; they are not related to the nature of the substance nor its level of use.
a. On their own, prohibition responses do not lead to reduced substance use in the long-term because they ignore the adaptiveness of human behaviour in meeting needs and desires.
b. A harm minimisation approach to alcohol and other drug harm is required, which includes minimising the supply of substances through law enforcement approaches and minimising the demand for substances through treatment and prevention.
5) Effective prevention of harmful substance use needs to focus on social determinants and multiple risk and protective factors.
a. The media has a clear role in prevention, particularly in educating the public and influencing social norms and public opinion.
b. Prevention strategies should aim to prevent both uptake of substance use and progression to harmful substance use.
6) Many people recover from harmful substance use without therapy, but there is now a wide range of effective treatments.
a. Most people with substance use problems do not attend specialist alcohol and other drug agencies. Consequently, competencies in treating substance use problems need to be widely available among psychologists and other health professionals.
b. There is no single superior approach to treatment for all individuals: different individuals respond best to different treatment approaches at different times and it is important to match clients to their stage of change to maximise treatment effectiveness and efficiency.
c. Comprehensive assessment, including mental health assessment, is essential as substance use and mental health problems often occur together.
d. Treatment approaches should consider the needs and engagement of other family members, including children, to improve outcomes for all those affected by an individual’s problematic alcohol or other drug use.
e. There are effective withdrawal and replacement pharmacotherapies for some substances, which can be important adjuncts to psychological treatments.
f. Current evidence-based psychological interventions include contingency management, CBT, and motivational interviewing approaches. Other intervention approaches await evaluation.
g. Relapse is an expected part of the treatment process and relapse prevention should be routinely incorporated. Relapse prevention needs to focus on enabling clients to identify and cope with risky situations for relapse.
h. It is important to recognise that alcohol and other drug problems occur in social and cultural contexts, and treatments need to take these broader issues into account. This is best done through the adoption of a biopsychosocial approach that views people in treatment holistically