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The Victorian Alcohol and Drug Association
The Victorian Alcohol and Drug Association (VAADA) is the peak body for alcohol and other drug
(AOD)servicesinVictoria.Weprovideadvocacy,leadership,informationandrepresentationonAOD
issuesbothwithinandbeyondtheAODsector.

As a stateͲwide peak organisation, VAADA has a broad constituency. Our membership and
stakeholders include ‘‘drug specific’’ organisations, consumer advocacy organisations, hospitals,
community health centres, primary health organisations, disability services, religious services,
generalyouthservices,localgovernmentandothers,aswellasinterestedindividuals.

VAADA’’sBoardiselectedfromthemembershipandcomprisesarangeofexpertiseintheprovision
andmanagementofalcoholandotherdrugservicesandrelatedservices.

Asapeakorganisation,VAADA’’spurposeistoensurethattheissuesforbothpeopleexperiencing
theharmsassociatedwithalcoholandotherdruguse,andtheorganisationsthatsupportthem,are
wellrepresentedinpolicy,programdevelopment,andpublicdiscussion.


VAADA’s consultation process

AsthepeakbodyonalcoholandotherdrugissuesinVictoria,VAADAhasreferredtoconsultations
whichwereundertakeninlate2009andearly2010inresponsetotheearlierNationalDrugStrategy
Consultation Paper. We conducted both general and targeted consultation with member services
across the Victorian AOD sector to determine their views on emerging trends and issues, key
directionsandpriorities,andworkforceneedsunderthenewNationalDrugStrategy2010Ͳ2015.

DiversityisamongthestrengthsanddefiningfeaturesoftheVictorian,andindeed,Australian,AOD
sector.Thisresponseisbasedonadiverserangeofopinionsfromacrossourmembership,andsome
comments may not reflect the individual views of all those who have provided input. While there
waspowerfulconsensusonmanyofthekeyissuesandprioritiesoutlinedinthisdocument,thefinal
analysisrepresentstheviewsofVAADA.

WeagainextendourthankstothoseVAADAmemberswhohavegenerouslygivenoftheirtimeand
professionalinsighttocontributetothedevelopmentofthisresponse.


2
Contents
Introduction4

SummaryofRecommendations6

RecommendationsinresponsetothecurrentNDS      9

Abetterbalance          11

Theinvestmentmix          11

Anationalpreventionagenda         12

Keyissuesandpriorities         13

Agrowingpopulation          13

Anagingpopulation          14

PrescriptionandoverͲtheͲcountermedicines       14

Addressingthesocialandstructuraldeterminantsofdruguse     16

EnhancingcommunityawarenessandunderstandingofAODissues    18

Knowledgegaps          18

Improveddatacollection         19

Supportingtheworkforce         20

Fundingandfundingmodels         20

Professionalism,payandconditions        21

Coordinationandgovernance         21

Policycoordination          22

Transparency           23

Consumerandserviceproviderparticipation       23

Performancemeasuresandreporting        24

Findingsfromstate/territoryjurisdictions       24

References           26

3
Introduction

We welcome the opportunity to respond to the National Drug Strategy 2010 –– 2015 Consultation
Draft (hereafter the NDS). We believe that the NDS is critical in further developing a holistic
response to AOD issues involving all stakeholders. We also believe that it plays a crucial role in
providingafoundationforpolicyandpublicdiscourseonAODissuesandisacorepolicydocument
outliningthegovernment’’sstance,strategiesandresponsestotheseissuesoverthenextfiveyears.

AspeakbodyforVictorianAODtreatmentproviders,ourresponseillustratestheunderpinningroles
of our membership and their capacity to maintain a high level of quality in the delivery of their
servicestothecommunitywithintheframeworkoftheNDS.

WehavecarefullyconsideredtheNDSandidentifiedsomecorestrengthsaswellassignificantgaps
whichwewilladdressinthissubmission.WesupportthefourcommitmentsoutlinedintheNDS:

x buildingworkforcecapacity;
x evidenceͲbasedandevidenceͲinformedpractice,innovationandevaluation
x performancemeasuring;and
x Buildingpartnershipsacrosssectors.


Wedo,howeverseekfurtherdetailonhowthosecommitmentswillbeappliedtotheNDS.

Wewouldliketoreaffirmthefourthematictenetswhichunderpinnedourprevioussubmissionto
Australia’’sNationalDrugStrategyinFebruary2010,whichwere:

1. Theneedforabetterbalanceininvestmentacrossthethreepillarsofsupply,demandand
harmreduction;
2. Keyissuesandpriorities
3. Theneedtobuildworkforcecapacity;and
4. NDScoordinationandgovernance.

Asinourearliersubmission,thesetenetswillprovidetheframeworkforourrecommendations.

We note that the NDS has addressed some of the recommendations contained in our previous
submission.However,itisevidentthatsomeofourrecommendationshavenotbeenadaptedand
would urge the Ministerial Council on Drug Strategy (MCDS) to revisit them. This submission will
detailthoserecommendationswhichhavebeenomitted.

4
WebelievethattheNDSshouldprovideablueprintforactiononcontemporaryAODissuesaswell
asenablealevelofflexibilitytosecurepositiveactiontodevelopingtrendsandpatternsinharmful
substance use. We are conscious that policy development is a fluid process and that the current
status of AOD issues is a precursor to future AOD policy direction. We are therefore mindful that
AODissuesarehighlypoliticalandsocialinnatureandinfluencedbyaraftoffactors.

 

5
Summary of recommendations


TherecommendationscontainedbelowdrawonsomeofVAADA’’searlierthoughtsinourprevious
submission which we believe are absent in the NDS. We have omitted relisting those
recommendationswhichhavebeentakenupbytheMCDSinthepreparationofthedraftNDS.

Itiscrucialthattheserecommendationsareconsideredastheyaretheresultofstrategicandcareful
consultation with experts from the Victorian AOD sector. These recommendations represent a
culmination of the vast experience and expertise of these stakeholders and provide sensible,
strategic,longͲtermsolutionstothechallengesfacingserviceusersoftheAODsector.

Abetterbalance

x Review the balance of expenditure across the three pillars of supply, demand and harm
reduction
x Ensurethatallinvestmentdecisionsandpolicyinitiativesacrosssupply,demandandharm
reductionareinformedby,andequallysubjectto,independentevidenceandcritique
x Ensure all investment decisions and policy initiatives across supply, demand and harm
reductionarebasedonevidenceofmeasurableoutcomesandcosteffectiveness
x Make funding allocations and information on proportional investment across the three
pillarstransparentandcompileandpublishtheinformationannually
x Developindicatorsfortheeffectivenessoflawenforcement,andforhowlawenforcement
andsupplyreductioninterventionsinteractwithandimpactonharmreductionefforts
x Invest in the development and expansion of treatment and harm reduction services and
actions

Agrowingpopulation

x Undertakeforecastingandplanningforshort,mediumandlongtermAODtreatmentneeds
basedonAustralia’’sgrowingpopulation
x Enhance links and engagement with local government as well as local and state planning
authoritiestoadviseonpopulationshifts,localprofilesandcommunityandservicesystem
needs

Anagingpopulation

x Supportresearchonalcoholandotherdruguseandharmsamongolderadults,including
o Riskandprotectivefactors
o Bestpracticetreatmentoptions

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 o Interactionsofprescriptionmedicationswithalcoholandotherdrugs
x StrengthenpartnershipsbetweenAOD,mentalhealth,agedcareandprimaryservicesand
sectors

PrescriptionandoverͲtheͲcountermedicines

x Work with relevant bodies to incorporate AOD training components in underͲ to postͲ
graduate nursing and medical curricula, vocational education and continuous professional
developmentlevelsandtoenhancerecognitionofaddictionasaspecialistfield
x Support and extend research to build the evidenceͲbase around prescription drugs. This
could include research into: longͲterm effects of various medications on cognitive
functioning; longͲterm efficacy and therapeutic value of a range of prescription drugs and
current and emerging treatment modalities for benzodiazepines and other pharmaceutical
drugs
x Increase the scope and effectiveness of national mechanisms to monitor and assess
consumption and misuse to minimise the harms derived from prescribed medications,
including‘‘doctor/pharmacyshopping’’
x Increase access to and availability of pharmacotherapy and opiate substitution therapy
options, including addressing the impact of dispensing fees for both clients and service
providers, the need for alternative models of pharmacotherapy, and the need for greater
numbersofprescribers.

Addressingthesocialandstructuraldeterminantsofdruguse

x Promoteadefinitionofpreventionthatfocusesonthesocialandstructuraldeterminantsof
druguse
x Invest in mechanisms to ensure crossͲsectoral collaboration and linkages between AOD,
mental health, indigenous, family and community health, housing, employment and
communitylegalservices
x Ensuredrugpolicyiscoordinatedwithsocialandwelfarepoliciesaddressingdisadvantage,
poverty,homelessness,marginalisationandsocialexclusion;andactivelydevelopanddirect
resourcestoinitiativesthatstrengthencommunitycapacity

Enhancingcommunityawarenessandunderstandingofdrugissues

x Developacommunicationstrategywhichprovidesclear,consistentmessagestopoliticians
abouttheworkoftheNDSandtheAODsectormorebroadly
x Encourageinformedcommunitydebateaboutdrugissuesandapproachesforrespondingto
drugͲrelatedharm
x Ensure all NDS funded health promotion and education campaigns are developed in
consultationwithAODexpertinput(includingserviceproviderinput)andprovidenuanced,
wellͲevidencedmessagestodrugͲrelatedharms

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Knowledgegaps

x Buildtheevidencebaseforpreventionandlawenforcementinitiativesandstrategies
x Build the knowledge base for addressing alcohol and drug use among refugees and newly
arrivedcommunities,includingspecificallyhowtreatmentandotherdrugservicescanbetter
engagewiththesegroups
x Increasetheknowledgebaseandwiderawarenessofthesocialandstructuraldeterminants
ofdruguse
x Implement strategies to mitigate the compounded harm associated with serving a prison
sentencewithsubstanceuseissues
x Allocate more energy and resources to diversion from the criminal justice system and
supportinthecommunity

Improveddatacollection

x Identify measures to better assess outcomes and effects of treatment and other
interventions. Any outcome measures must be developed in consultation with service
providersandanyexpansionofdatacollectionprocessesmustbeappropriatelyresourced
x ItiscrucialtoimprovemethodsfornationalandStatedatacollectionandexpandthescope
and capacity of national data collection systems to produce accurate trend and outcome
dataandreportbacktoagenciesonlocalͲleveltrendsandoutcomes
x Improveaccesstolawenforcementdataforthepurposesofevaluation,reviewandplanning
ofservices

Fundingandfundingmodels

x DevelopandimplementalternativeandbestpracticemodelsforfundingcommunityͲbased
AODservices

Professionalisation,payandconditions

x SupportthedevelopmentofanindustryplanforthecommunityAODsectorthatwillensure
theworkforceisabletocontinuetoprovidequality,effectiveservicesandsetstheagenda
for addressing issues of workforce pay, employment conditions and parity with related
sectors.
x Facilitateruralandregionaltreatmentstafftoaccesstechnologieswhichwillassisttraining
uptake,knowledgeacquisition,andbetterintegrationofservicedelivery

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Policycoordination

x Ensure coordination and integration of the NDS with NDS subͲstrategies including the
National Alcohol Strategy. Consider developing the National Alcohol Strategy concurrently
withtheoverarchingNDS
x IdentifyandprioritisethenationalsocialandhealthpolicesofrelevancetotheAODsector
andthedevelopmentofthenextNDS
x EnsuretheNDSisalignedwithidentifiedsocialandhealthpolicies
x Provide a rational, coordinated framework or action plan for the integration of identified
policiesintoservicepractice
x Ensure the new NDS complements and builds on, rather than replicates, alcoholͲrelated
policydirectionsandinitiativesproposedbytheNationalPreventativeHealthTaskforce

Transparency

x Clearly articulate the various roles, responsibilities and aims of NDS bodies and make this
informationpublicallyavailableviatheNDSwebsiteandothermeans
x PublishdocumentsongovernanceoftheNDSanditsadvisorybodiestoenhancetheAOD
sector and wider community understanding of how the structures supporting the NDS
operate
x Improve documentation of policy discussions, processes and decisionͲmaking by the NDS
bodies

Consumerandserviceproviderparticipation

x EnhanceengagementanddirectdialoguewiththeAODNGOsector
x Developformalmechanismstogatherviewsofserviceprovidersandincorporatetheseinto
the development and implementation of the new NDS. This could be done through
state/territoryandnationalpeakbodies
x IncorporateconsumerrepresentationandviewsintotheNDS,potentiallythroughnational,
stateandterritoryconsumerorganisations

Performancemeasuresandreporting

x DefineresponsibilityforthefurtherdevelopmentandimplementationofNDSperformance
measures,monitoringandevaluationwiththeNDSstructures

RecommendationsinresponsetothecurrentNDS
Further to the recommendations listed above which were included in our previous submission,
VAADAproposesfurtherrecommendationsinresponsetotheNDS.

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Findingsfromstate/territoryCoronialJurisdictions

x DevelopaprocessinwhichNDSmonitoringandgovernancebodiescanaccessanycoronial
findingsfromallstate/territoryjurisdictionswhichhaverelevancetotheAODsector
x Review and strongly consider relevant coronial findings in implementing and executing
relatedpolicies
x Lead a public discourse promoting coronial findings which aim to reduce the harm
associatedwithalcoholanddruguse
x Usethisevidencetopursuesystemicandpolicychangeswithaviewtoreducingmorbidity

 

10
Abetterbalance
VAADA is supportive of the NDS’’s intention to retain ‘‘harm minimisation’’ as the overarching
principle.Wearealsosupportiveoftheretentionofthethreepillarsofsupply,demandandharm
reduction,whichisinlinewiththeviewsofthemajorityofthememberorganisationsweconsulted.

As discussed in our previous submission, VAADA acknowledges that there is a level of community
misunderstanding regarding the principle of harm minimisation but also accepts that harm
minimisationisnowentrenchedinAODdiscoursesandprovidesabasisfororganisationalpractice
anddirectionforthesector.Thisshouldbeprotectedandmaintained.

Theinvestmentmix

VAADAbelievesthattheNDSdoesnotstriketherightbalanceininvestmentandresourceallocation
acrosslicitandillicitdrugsandthethreepillarsofsupply,demandandharmreduction.Demandand
harm reduction continue to be eclipsed by supply reduction, which attracts the most resources
(Siggins Miller 2009: viii). Our previous submission noted that demand and harm reduction have
endured long term chronic underfunding, as opposed to law enforcement and interdiction, which
continuesto bewellresourced.Asitisnotpossibletodevelopabalanceofexpenditurebetween
thethreepillarswhichwillremainstaticthereafter,itisnecessarytoengageinacontinuousprocess
ofreviewandevaluation,andmoreover,ensurethatthisprocessistransparentandaccessibletoall
stakeholders(VAADA2010:10).

As we asserted in our earlier submission, given the significant expenditure, there is a need to
undertake further evidence based research on the efficacy of supply reduction, and further, in
particularontheassumptionswhichinformthesuccessofthisapproach.

We note with some concern the penultimate action listed under Objective 1 (NDS 2010: 17)
‘‘research, investigate and gather information on all aspects of drug supply markets …… to properly
inform law enforcement responses’’. This action is premised on the assumption that law
enforcementresponsesareappropriateandresearchshouldbeconductedonlytoensurethatthey
cancapturedrugsupplymarkets.Indicatorsofsuccessinlawenforcementareofteninformedbya
number of assumptions which are not often evaluated. The supply reductive practices (in boarder
securityandlawandorder)resultingfromthoseassumptionsarereviewedwithanimpliedstandard
andviewthattheyarethemostcostandhealtheffectivemeansofpreventingtheimportationof
illegaldrugs.

VAADAdoesnotnecessarilydisagreewiththeefficacyofsupplyreductionpracticessuchasborder
security and law and order responses. We do, however, assert that these strategies need to be
reviewed with the same level of vigour as demand and harm reduction strategies. For instance,
needleandsyringeprogramshavebeenregularlyreviewed,asnotedinourprevioussubmissionand

11
iteratedintheNDS,andtheresultsoftheevaluationprocessesindicatethattheyshouldcontinueto
beexpandeddueto‘‘ongoingefficacy,costͲeffectivenessandpublichealthvalue(NDS2010:31).’’

Resourcing issues are particularly poignant in the AOD sector, as the review of the cost of
Counselling,ConsultancyandContinuingCare(CCCC)serviceswithintheVictorianDrugandAlcohol
Sector(2010a:5),ascommissionedbyVAADA,illustratedthatmanyservicessufferashortfallofup
to 18% in base funding in this program area alone. Many CCCC providers are required to access
reservestomaintainconsistentlevelsofserviceprovision.Wewouldrecommendthatthefindings
of this review be considered in light of the disparity in funding allocation between the pillars and
that the first step towards achieving a balance is to apply rigorous evidence based evaluation
processesequallybetweenthepillars.

Anationalpreventionagenda

Our previous submission provided a comprehensive discussion on the need to ‘‘promote a more
accurate and meaningful understanding of prevention’’ (VAADA 2010: 11). We discussed the
overarchingnotionthatcontemporarypreventionstrategiesarecentredonprohibitionandthatthis
is a limited and narrow approach which does not encapsulate a full understanding of the term
prevention.

Wereaffirmthatpreventativeactionshouldembedcontemporaryunderstandingsofthestructural
determinants of harmful drug use (VAADA 2010: 11). In order to develop these understandings,
there is a need for further research into what works with preventative strategies. Moreover, this
researchshouldbecentredonthesocialandstructuraldeterminantsofdruguseratherthanstrict
adherencetoaprohibitionistframework.

Recommendations

x Review the balance of expenditure across the three pillars of supply, demand and harm
reduction
x Ensurethatallinvestmentdecisionsandpolicyinitiativesacrosssupply,demandandharm
reductionareinformedby,andequallysubjectto,independentevidenceandcritique
x Ensure all investment decisions and policy initiatives across supply, demand and harm
reductionarebasedonevidenceofmeasurableoutcomesandcosteffectiveness
x Make funding allocations and information on proportional investment across the three
pillarstransparentandcompileandpublishtheinformationannually
x Developindicatorsfortheeffectivenessoflawenforcement,andforhowlawenforcement
andsupplyreductioninterventionsinteractwithandimpactonharmreductionefforts
x Invest in the development and expansion of treatment and harm reduction services and
actions

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Keyissuesandpriorities
Wereaffirmourconcernsoutlinedinourprevioussubmissionregardingsomeofthekeyissuesand
prioritieswhicharenotcontainedintheNDS.

Agrowingpopulation

As population growth is predicted to reach almost 30 million over the next 15 years (ABS 2008),
there is likely to be considerable strain on the AOD sector as growth corridors emerge to soak up
vast swathes of population ahead of the necessary infrastructure required to service growing
communities. There are a number of regions which are growing at rapid rates in the various
AustralianStates,forexampletheCityofCaseyinVictoriaisgrowingattherateof146peopleper
weekandis predictedto increasefrom240,000in2009to375,000people by2026(CityofCasey
2010).TheremustbeprovisionintheNDSfortheidentificationandscopingofacceleratedgrowth
corridors such as this region and the subsequent needs of these expanding community groups.
Failure to respond to these issues will result in communities enduring significant disadvantage
comparedtotheirestablishedcounterparts,creatingagreaterchasmofaccessandequityinwelfare
services. This will impact on the development of harmful (and in part preventable) substance use
trendsandotheradversestructuraldeterminantswhichresultinharminthecommunity.

Further, due to cheaper housing, newly arrived and culturally and linguistically diverse (CALD)
communitygroupsaremorelikelytoresideintheseareas.Thesegroupsaremorelikelytorequire
assistancefromcommunityservicesandwillthereforefarepoorlyintheabsenceofcomprehensive
andresponsiveserviceprovision.

Therefore,VAADAreaffirmstheneedfortheNDStooutlineprocessesforengagingwithstateand
local government planning authorities who can advise on population shifts, local profiles and
concurrent needs. This will enable the AOD sector to proactively gauge future service need and
thereforeadoptapreventativeapproachandminimiseharmtothesecommunities.

Recommendations

x Undertakeforecastingandplanningforshort,medium,andlongtermAODtreatmentneeds
basedonAustralia’’sgrowingpopulation.

x Enhance links and engagement with local government and local and state planning
authoritiestoadviseonpopulationshifts,localprofilesandconcurrentneeds.

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Anagingpopulation

VAADAcommendstheNDSontherecognitionthattherearecertaintimesinpeoples’’liveswhere
theyareatgreaterriskofharmfromdrugsandalcoholandmoreover,someofthespecificharms
whichareemergingasthedemographicsshifttoanolderpopulation.WefurthercommendtheNDS
forpromotingacollaborativeapproachtoholisticservicedeliveryincludingthepromotionof‘‘strong
partnerships and integrated service approaches –– with social welfare, income support and job
services,homelessservices,mentalhealthcareprovidersandcorrectionalservices’’(NDS2010:11).
However, further specificity is required outlining how these partnerships and integrated service
approaches will work on the ground and whether those sectors also include aged care service
provisionforexample.

ItisimportanttoreiteratethatAustraliahasagrowingpopulationofolderpeopleandthereforea
raftofnewchallengesfacingtheAODsectorwillemerge.Theseincludevarioussocialphenomena
such as increased isolation, periods of transition (from fulltime employment to retirement) and a
lackofawarenessofsubstanceuseissues.Thesearefurtherexacerbatedbylimitedsocialsupport,
themanifestationofageͲrelatedphysiologicalandpsychologicaldisordersandanincreaseintheuse
ofprescriptionmedicinewhichwhenmixedwithalcoholandotherdrugsmaycauseharm.

We reiterate the recommendations listed in our previous submission. The latter recommendation
shouldbe consideredinlightofprovidingclarityonthe particularrolesofthevarioussectorsand
strategiesemployedtostrengthenpartnerships.

Recommendations

x Supportresearchonalcoholandotherdruguseandharmsamongolderadults,including
Ͳ riskandprotectivefactors
Ͳ bestpracticetreatmentoptions
Ͳ theinteractionofprescriptionmedicationswithalcoholandotherdrugs.

x StrengthenpartnershipsbetweenAOD,mentalhealth,agedcareandprimaryhealthservicesand
sectors.

PrescriptionandoverͲtheͲcountermedicines

Wenotedinourearliersubmissionthatthemisuseofprescriptiondrugsincludingbenzodiazepines,
opioids, antiͲdepressants and other pharmaceuticals is an emerging challenge in contemporary
Australiansociety.Wealsoassertedthatmisuseofprescriptiondrugsisinmanycasesreplacingthe
use of illegal opiates, with ‘‘…… many opiate dependent people now using prescribed opiates both
legallyandillegallyratherthanchasing““streetheroin””’’(Serviceprovider,VAADAconsultation2010).
AOD treatment providers have also noted that some medical practitioners are engaging in

14
inappropriate prescribing practices, which has been echoed by the Drugs and Crime Prevention
Committee(DCPC)2007:273).

AnumberofissueswereraisedintheprevioussubmissionwhichisstillhighlypertinenttotheNDS:

o The need for better information, including independent, researchͲbased evidence on the
relativebenefitsandharmsofprescribedmedication,ondruginteractionsandiatrogenic
illness

o Limited training and knowledge within the primary and allied health workforce on
addictionandmisuseofprescriptionmedicines

o Substitutionofillicitforlicitsubstances

o Limitedavailabilityandaccesstopharmacotherapyandopiatesubstitutiontherapyoptions

o Chronicpainmanagement

o The need for better monitoring and assessment of consumption and usage of prescribed
medications,including‘‘doctor/pharmacyshopping’’

o OverͲprescriptionofpharmaceuticaldrugsbyGPs

TheNDSdoesnotprovidestrongcoverageofthesechallengesorthoserecommendationslistedin
our previous submission; misuse of prescription drugs is in part subsumed into discussions on
reducing supply of other licit drugs with minimal attention given to the process of procurement.
VAADA reaffirms our assertion from our previous submission that this is an issue which spans
multiple contexts with those misusing prescription drugs originating from a wide variety of social
groups.Further,TurningPoint(2008:7)highlightedsignificantchallengesinthisarea,indicatingthat
‘‘we are only seeing the ‘‘tip of the iceberg’’ of pharmaceutical misuse’’ and called for research to
ascertain ‘‘the extent of pharmaceutical misuse in the community, the range of pharmaceutical
related problems and how to develop appropriate interventions to increase awareness and
treatmentuptake’’(TurningPoint2008:7).

VAADA has previously recommended the development of further AOD training components under
andpostgraduatenursingandmedicalcurricula,vocationaleducationandcontinuousprofessional
developmenttoassistprimaryhealthprofessionalstobetterrespondtoAODissues.Wecommend
theNDSforrespondingtothetrainingneedsofworkersandspecialistskillsrequiredtoworkinthe
AODsectorthroughproposingtoaccreditAODservicesandsetaminimumsetofqualifications(we
notethatthishasalreadyoccurredinVictoria).Webelievethatmoreworkneedstobeundertaken
intheareaofworkforcedevelopmentandminimumstandards.

We note that the NDS proposes the development of a Pharmaceutical Drugs Misuse Strategy. We
would be keen to ascertain further information regarding this strategy, including the consultation
processeswhichwillbeundertaken,termsofreferencegoverningthedevelopmentofthisstrategy
anditsrelationshipwiththeNDSandotherrelevantsectors.

15
Recommendations

x Work with relevant bodies to incorporate AOD training component in underͲ to postͲgraduate
nursing and medical curricula, vocational education and continuous professional development
levelsandtoenhancerecognitionofaddictionasaspecialfield

x Support and extend research to build the evidenceͲbase around prescription drugs. This could
include research into: longͲterm effects of various medications on cognitive functioning; long
termefficacyandtherapeuticvalueofarangeofprescriptiondrugsandcurrentandemerging
treatmentmodalitiesforbenzodiazepinesandotherpharmaceuticaldrugs

x Increase the scope and effectiveness of national mechanisms to monitor and assess
consumptionandmisuseofprescribedmedications,including‘‘doctor/pharmacyshopping’’

x Increaseaccesstoandavailabilityofpharmacotherapyandopiatesubstitutiontherapyoptions,
including addressing the impact of dispensing fees for both clients and service providers, the
need for alternative models of pharmacotherapy, and the need for greater numbers of
prescribers.

Addressingthesocialandstructuraldeterminantsofdruguse

Our previous submission outlined our recommendations regarding the social and structural
determinantsofdruguse.Wereaffirmourpositionasoutlinedinourprevioussubmission.

‘‘Peoplewhoexperiencethemostseriousharmsassociatedwithdruguseareoftenamongthemost
marginalisedandsociallydisadvantagedpopulations.Socialcohesion,accesstoservices,incomeand
employmentarestructuralandsocialdeterminantsofhealth.Thesehavebeenclearlyidentifiedby
the Preventative Health Taskforce (National Preventative Health Taskforce 2008) and inform the
nationalsocialinclusionagenda.Importantworkhasbeendoneinenhancingunderstandingofthe
multiple and causal factors that drive harmful alcohol and drug use, however VAADA believes this
knowledgemustbemoremeaningfullyembeddedineffectivepolicy.’’

TheparticularneedsandchallengeswithinAboriginalandTorresStraitIslandercommunitiesarean
exampleofthewayssubstanceuseandharms,butalsoprotectivefactors,areshapedbysocialand
historical processes. Disparities in health and life expectancy between Aboriginal and Torres Strait
Islandercommunitiesandthebroaderpopulation,onwhichsubstanceuseisasignificantinfluence,
are a caseͲinͲpoint of the critical need to integrate drug policy with broader social policy efforts.
VAADArecognisesthatthespecificandparticularneedsandissueswithinIndigenouscommunities
require tailored policies, and supports the continuation of aseparate Complementary Action Plan.
However,wealsocontendthatthebroaderNDSshouldensureculturalrelevanceandvalidity,and
believethiswouldbeachievedthroughgreaterattentiontothestructuraldeterminantsofhealth,of
whichbelongingtoaminoritygroupisone.

VAADAbelievesthenextphaseoftheNDSshouldbeheavilyinformedbyanunderstandingofthe
complexinteractionsbetweensocialdisadvantageandharmfromdruguse.Thiswillrequirethatthe
NDSandgovernancebodiesbettercoordinatedrugpolicywithsocialandwelfarepoliciesaddressing

16
disadvantage, poverty, homelessness, marginalisation and social exclusion; actively develop and
direct resources to initiatives that strengthen community capacity; and ensure transparency and
participationinitsprocesses,asdiscussedbelow.

TheNDSmustalsorecognisethatatpracticelevel,addressingalcoholordrugusecannotbedone
effectively without also addressing financial, legal, housing and other support needs. Currently
however,treatmentservicesareobligedtodealwiththeseissues,inadditiontoclients’’druguse,
without additional funding. As one service provider observed, ‘‘social isolation, marginalisation,
disadvantage,poverty[and]homelessnessallimpactnegativelyonindividualswhoareexperiencing
problemsassociatedwiththeiruseofdrugs’’(Serviceprovider,VAADAconsultation2009Ͳ10).

Along with greater funding to recognise work already being done, collaboration and linkages
between services that span the AOD, mental health, Indigenous, family and community health,
housing, employment and community legal systems are key to ensuring that individual and family
needscanbeaddressedmeaningfully.Bettercollaborationandservicenetworkscouldbeachieved,
for example, through encouraging funding applications based on working partnerships and
consortia, and by mandating MOUs and partnerships for crossͲsector projects and programs.
Investment in a connected network of quality services will result in better, more sustainable
outcomes.

Further,VAADAstronglybelieves,asdiscussedabove,thatthenextphaseoftheNDSshouldengage
government,policymakersandthepublicininformeddebatethatgeneratesbetterunderstandings
oftherealdriversofsignificantharmstodrugusersandthewidercommunity.Thiswouldinclude
acknowledgement that the criminalisation of some drugs directly contributes to negative health,
socialandlegalconsequences,andtothesocialexclusionofusersofillicitdrugs(VAADA2010:14Ͳ
15).’’

The NDS (2010: 11) does provide commentary on partnerships and collaboration between various
sectorswithreferencesto‘‘……reducepotentialharms’’,‘‘……recoverfromdrugandalcoholproblems’’
and‘‘……recogniseandmanagetheimpactsofdrugmisuseonfamiliesandchildren’’.Thesegeneral
statementsarepositiveinnaturebutfurtherelaborationisrequiredonthecontentandsubstance
of the partnerships which will result in these positive outcomes. Comprehensive partnerships
between sectors need to be established to break down the minutiae of social and structural
determinantswhichcontributetodisadvantageinourcommunities.Thesepartnershipsneedtobe
developedwithlongtermgoalsinmind,andneedtooperatebeyondthepoliticalcycle.


Recommendations

x Promoteadefinitionofpreventionthatfocusesonthesocialandstructuraldeterminantsofdrug
use

x InvestinmechanismstoensurecrossͲsectoralcollaborationandlinkagesbetweenAOD,mental
health, Indigenous, family and community health, housing, employment and community legal
services.

17
x Ensure drug policy is coordinated with social and welfare policies addressing disadvantage,
poverty, homelessness, marginalisation and social exclusion; and actively develop and direct
resourcestoinitiativesthatstrengthencommunitycapacity.

EnhancingcommunityawarenessandunderstandingofAODissues

Community understanding of AOD issues is crucial as inflamed public opinion can rapidly
deconstructandsabotagesoundAODpolicyresponses.Ourprevioussubmissionnotedtheviewsof
our members citing community understanding of AOD issues as ‘‘impoverished’’. We reiterate our
argument for the ‘‘urgent need for nuanced, wellͲevidenced health promotion and education
addressingdrugͲrelatedharms,ratherthandrugsperse’’(VAADA2010:16)andthesubsequentneed
foraninformedandsupportivecommunity.VAADAbelievesthatAODeducationmustbeconveyed
insimpleandplainterms,withaconsistentandevidenceͲbasedfoundation.

Further, as noted in our previous submission, the media strongly influences public opinion.
Therefore,inordertoensureahighlevelofconsistentandeffectivedrugpolicy,thereisaneedto
develop strategies to engage with the media with the aim of encouraging them to commit to
accurate and responsible reporting of AOD issues. The NDS has actioned this point. We would,
however,urgetheMinisterialCouncilonDrugStrategytoincludestrategiesoutliningaprocessto
communicatesoundevidenceͲbasedpolicyandadvicetopoliticians.

Recommendations

x Developacommunicationstrategywhichprovidesclear,consistentmessagestopoliticiansabout
theworkoftheNDSandtheAODsectormorebroadly.

x Encourage and lead informed community debate about drug issues and approaches for
respondingtodrugͲrelatedharm.

x EnsureallNDSfundedhealthpromotionandeducationcampaignsaredevelopedinconsultation
with AOD expert input (including service provider input) and provide nuanced, wellͲevidenced
messagestoaddressdrugͲrelatedharms.

Knowledgegaps

WereaffirmtherecommendationscontainedinourprevioussubmissiontotheNDSregardinggaps
inknowledge.

VAADAbelievesthatthereisaneedtoundertakeacomprehensiveanalysisoftheharmsassociated
with incarceration of people who have experienced harm through substance abuse. The NDS

18
acknowledges that these people have endured significant harm. However, it does not outline a
processtomitigatethoseharmsorthecompoundedharmsassociatedwithhavingservedaprison
sentence.Werecommendthatstrategiestomitigatethecompoundedharmassociatedwithserving
aprisonsentencebeoutlinedintheNDS.

Recommendations

x Buildtheevidencebasesforpreventionandlawenforcementinitiativesandstrategies.

x Buildtheknowledgebaseforaddressingalcoholanddruguseamongrefugeesandnewlyarrived
communities, including specifically how treatment and other services can better engage with
thesegroups.

x Enhance the NDS focus on particular groups including: people transitioning back into the
community from correctional facilities; people transitioning back into the community from
residentialfacilities;andruralandremotecommunities.

x Increasetheknowledgebaseforandwiderawarenessofthesocialandstructuraldeterminants
ofdruguse.

x Implement strategies to mitigate the compounded harm associated with serving a prison
sentencewithsubstanceuseissues

x Allocatemoreenergyandresourcestodiversionfromthecriminaljusticesystemandsupportin
thecommunity

Improveddatacollection

Ourprevioussubmissionhighlightedthelimitationsindatacollectionidentifiedbyourmembership:

o Timeliness(reportsontrendsthathaveoftenpassed)
o Levelofdetail(globaldataratherthanlocal)
o Lackofuseful‘‘return’’andfeedbackonlocalleveldata
o Need for a balance in the kind of data –– a better balance between statistical data;
effectivenessandefficiencydataandotheroutcomesmeasures
o Lackofconsistencyacrossjurisdictions
o Lackofavailabilityoflawenforcementdata

19
Recommendations

x Identify measures to better assess outcomes and effects of treatment and other interventions.
Any outcome measures must be developed in consultation with service providers and any
expansionofdatacollectionprocessesmustbeappropriatelyresourced.

x Improve methods for national and State data collection and expand the scope and capacity of
nationaldatacollectionssystemstoproduceaccuratetrendandoutcomedataandreportͲback
toagenciesonlocalͲleveltrendsandoutcomes.

x Improveaccesstolawenforcementdataforthepurposesofevaluationandreview.

Supportingtheworkforce
VAADAmembershipisunanimouslyoftheviewthatworkforcedevelopmentandcapacityissuesare
paramount if the sector is to retain experienced staff and continue to be able to respond to the
needsofserviceusers.

TheNDSstronglycommitstobuildingworkforcecapacityandcitesthat‘‘anappropriateskilledand
qualifiedworkforceis criticaltoachievingandsustaining effectiveresponsestodrug misuse’’(NDS
2010:29).

We note that a working group will be convened to develop a workforce strategy. We would
recommend that the working group is drawn from a wide range of organisations from the AOD
sectortoensurethatthestrategyiswellinformedandresponsivetothesector’’sneeds.

Fundingandfundingmodels

Wereaffirmthediscussionoutlinedinourprevioussubmissionregardingthefundingmodels,which
highlightsthemultipletreatmentneedsofserviceuserspresentingtoAODagencies.Wenotethat
currentreportingmodelsdonotallowforagenciestoadequatelyrepresenttheworkwhichtheyare
undertakinginresponsetothediversetreatmentandwelfareneedsofserviceusers.

Our previous submission noted that there is a significant amount of administrative requirements
which are not reported on, but consume resources, including ‘‘quality accreditation processes,
professional training and development, supervision, data collection and reporting, funding
applications and administration, human resource management, and OH&S requirements. VAADA
believesonewayinwhichwecanimproveresponsestoclientsistodevelopflexiblefundingmodels
that allow services to manage complexity and emerging needs and trends, and that capture the
scopeofworkundertaken’’(VAADA2010:19Ͳ20).

20
Recommendations

x DevelopandimplementalternativeandbestpracticemodelsforfundingcommunityͲbasedAODservices

Professionalisation,payandconditions

VAADAcommendstheNDSontheprioritisationofasetofminimumqualificationsofworkersand
accreditationofservices.WefurthercommendtheNDSonthecommitmenttoprovidesupportfor
the workforce and establishing and maintaining worker wellbeing. We anticipate that the national
workforce strategy will provide a comprehensive discussion and outline on the establishment and
maintenanceofworkerwellbeingandsupport.

Wereaffirmcommentsregardingourproposalforthedevelopmentofanationalindustryplanfor
considerationindevelopingthenationalworkforcestrategynotedintheNDS.

‘‘Inconsultationwithpeakbodies,anindustryplanwouldprovideaframeworkforensuringtheAOD
workforceisabletoprovidequality,effectivetreatmentandharmreductionservicesintothefuture.
It could support system and organisational change, serve to set a benchmark for quality and
professionalism,andcontributetoenhancingtheprofileofAODprofessionalsandwork.Anindustry
planwouldenableidentificationofworkforcecapacityissuesofcrossͲjurisdictionalsignificance,and
could be supported by strategies to address the need for specialisation, for greater diversity of
skilledprofessionals,andtoincreasecareerpathwaysthroughthesector(VAADA2010:20).’’

VAADA is aware of the challenges facing regional AOD workers regarding accessing training and
remainingabreastofcontemporarypracticeandknowledge.WethereforerecommendthattheNDS
make provision for the development of technology which will provide regional workers access to
appropriateavenuesoftrainingandknowledgeacquisition.


Recommendations

x SupportthedevelopmentofanindustryplanforthecommunityAODsectorthatwillensurethe
workforce is able to continue to provide quality, effective services and sets the agenda for
addressingissuesofworkforcepay,employmentconditionsandparitywithrelatedsectors.

x Facilitate rural and regional treatment staff access to technologies which will assist training
uptake,knowledgeacquisition,andbetterintegrationofservicedelivery

Coordinationandgovernance
Asstatedinourprevioussubmission,‘‘VAADAbelievestheoverallcoordinationandgovernanceof
theNDScouldbeimprovedbyenhancingtransparencyandaccountabilitywithinNDSstructuresand
by increasing broader stakeholder participation and representation in NDS policy and decision
makingprocesses.Inparticular,webelievethereisaneedforfurtherengagementwithAODservice

21
providersandserviceusers,andforstrongerlinksbetweentheAODNGOsectorandtheNDS.There
isalsoaneedtobuildcapacitytomonitoroutcomesoftheNDS(VAADA2010:21Ͳ22).’’

Policycoordination

As asserted in our previous submission, the coordination and oversight of national drug policy is
highly complex with a broad spectrum of stakeholder views, variance in practice between
jurisdictionsaswellaschangingpoliticalpriorities.

WenotethatsomeofthesubstrategiesintheNDShaveexpiredorareduetoexpireinthenear
future.Asweassertedpreviously,thereisaneedtoensurethatallsubstrategiesarecurrentand
that they are structured in a collaborative and strategic manner which minimises duplication of
scarce resources. Building on the need for collaboration, we reiterate our previous comments
regardingtheneedtoaligntheNDSwithabroaderrangeofstrategieswhichcontendwithrelated
social and structural determinants of disadvantage, such as ‘‘the Social Inclusion Agenda; national
homelessness strategies; taxation reform; education initiatives and health care reform (VAADA
2010:22)’’. Meaningful collaboration equates to collaboration across sectors at all levels of
government as well as the community services sector. As service users of the AOD sector do not
present exclusively with AOD issues, strategies aiming to promote safe and healthy communities
needtoacquireacumenfromotherrelatedareassuchasthosesuggestedabove.

VAADAreaffirmsitsviewsontheneedfortheNDStoincludethesignificantworkundertakenbythe
NationalPreventativeHealthTaskforce.Asstatedinourprevioussubmission,theNDS(andthenext
NationalAlcoholStrategy)shouldcomplement,notreplicate,theworkofthetaskforce.Weareof
the view that there should continue to be a separate National Alcohol Strategy, as there are too
manychallengeswithalcoholusewhichdeserveprimacy.

Recommendations

x Ensure coordination and integration of the NDS with NDS subͲstrategies including the National
Alcohol Strategy. Consider developing the National Alcohol Strategy concurrently with the
overarchingNDS.

x IdentifyandprioritisethenationalsocialandhealthpoliciesofrelevancetotheAODsectorand
thedevelopmentofthenextNDS.

x EnsuretheNDSisalignedwithidentifiedsocialandhealthpolicies.

x Providearational,coordinatedframeworkoractionplanfortheintegrationofidentifiedpolicies
intoservicepractice.

22
x Ensure the new NDS complements and builds on, rather than replicates, alcoholͲrelated policy
directionsandinitiativesproposedbytheNationalPreventativeHealthTaskforce.

Transparency

TheNDShasnotprovidedfurtherdiscussionoranoutlayoftheprocessesforenablingpublicaccess
to policy decisions. The various governance structures and a synopsis of their roles and
responsibilities are included but the NDS provides limited commentary their decision making
processesandcommunicationstrategies.

Recommendations

x Clearly articulate the various roles, responsibilities and aims of NDS bodies and make this
informationpubliclyavailableviatheNDSwebsite.

x ProvideinformationonthevariousworkinggroupsoftheIGCDandANCDandmakethispublicly
availableviatheNDSwebsite.

x PublishdocumentsonthegovernanceoftheNDSanditsadvisorybodiestoenhanceAODsector
andwidercommunityunderstandingofhowthestructuressupportingtheNDSoperate.

x Improvedocumentationofpolicydiscussions,processesanddecisionͲmakingbytheNDSbodies.

Consumerandserviceproviderparticipation

ThecoverageoftheIGCDandANCDintheNDSprovidesscopeforselectiveconsumerandservice
provider input and flexibility in the development of responsive working groups. However, the
development of further formal mechanisms for consumer and service provider engagement is
lacking (beyond annual jurisdictional meetings facilitated by the ANCD). Our previous submission
discussed the need for greater consumer participation to be included in the NDS and we reaffirm
thatview.Followingfromthis,asdiscussedinourearliersubmission,thereisaneedtoensurethat
mechanismsaredevelopedtoprovidefeedbacktoallstakeholders,includingAODserviceproviders
andconsumers(VAADA2010:24).

Recommendations

x EnhanceengagementanddirectdialoguewiththeAODNGOsector.

x IncorporateconsumerrepresentationandviewsintotheNDS,potentiallythroughnational,state
andterritoryconsumerorganisations.

x ProvideregularupdatesontheimplementationofNDSinitiativestoallstakeholders.

23


Performancemeasuresandreporting

VAADAreaffirmsitsviewsoutlinedintheprevioussubmission;‘‘majorcomponentsoftheNDShave
been developed with limited monitoring and evaluation, making it difficult to assess the
effectivenessandefficiencyofvariousprogramsandinitiatives(VAADA2010:24).

Thereisaneedforclearlinesofresponsibilitywithregardtoreportingandevaluationmeasuresfor
incumbent and developing sub strategies so responsibility for actioning policies is clearly
demarcated.Furthermore,thereisaneedtoensurethatthisinformationistransparent.

Recommendations

x Define responsibility for the further development and implementation of NDS performance
measures,monitoringandevaluationwithintheNDSstructures.

x BuildmonitoringandevaluationprocessesintothenewNDSandsubͲstrategiesfromtheoutset
asrecommendedintheSigginsMillerevaluation.

Findingsfromstate/territorycoronialjurisdictions
Coronial systems are part of the legal and justice landscape within each state and territory
jurisdiction. Coroners are responsible for the investigation of unexpected deaths, or those which
haveoccurredwithincertaininstitutions,suchashospitalsandprisons.Theroleofthecoroneristo
identifythedeceasedandascertainthecauseofdeath.

The coroner also has a public safety mandate, executed through the power to propose
recommendations with a view to death prevention. The power of these recommendations varies
betweenstateandterritoryjurisdictions.

VAADAbelievesthattheCoronersCourthasasignificantcommunitysafetyandpreventativerole.
Webelievethatthehealthandsafety benefitsof theCoronersCourt,with particularreference to
recommendations,isnotbeingutilisedtofullcapacityintheAODsectoraswellaswithinalllevelsof
governmentalpolicydevelopment.Webelievethatthereisalackofawarenessofthecommunity
safetyandharmminimisationrolesofcoronersintheAODsector,aswellasalackofunderstanding
regarding the value which inquest findings and recommendations can make to positive policy
development.

24
Accessing and utilising coronial findings aligns strongly with the principle of harm minimisation. A
further benefit is that the findings are public, as is the process of inquiry and therefore has the
capacitytocontributeatransparentandindependentadditiontoAODpolicydevelopment.

VAADAbelievesthattheNDSmonitoringandgovernancebodiesmustaccesscoronialfindingsand
recommendations which are relevant to the AOD sector. These findings and recommendations
shouldinformthedevelopmentofrelevantpolicy.

The public generally has a limited understanding of the role of the coroner and generally are not
awareofthedeathpreventionaspectstothecoroner’’srole.TheNDSshoulddevelopstrategiesto
disseminate those findings and recommendations which are relevant to the AOD sector into the
widercommunitytoderivepublicsupportforthedevelopmentofeffectiveAODrelatedpolicy.

Finally, the NDS should provide for the promotion of coronial findings to pursue systemic policy
reform which will lead to a reduction in morbidity in the AOD sector. Coronial recommendations
have contributed strongly to death prevention in many areas of public life. Coronial findings and
recommendationshavethepotentialtobeavitalresource,giventhehighprevalenceofmorbidity
amongstAODserviceusers.

Recommendations

x Develop a process in which NDS monitoring and governance bodies can access any coronial
findingsfromallstate/territoryjurisdictionswhichhaverelevancetotheAODsector

x Review and strongly consider relevant coronial findings in implementing and executing related
policies

x Lead a public discourse promoting coronial findings which aim to reduce the harm associated
withalcoholanddruguse

x Usethisevidencetopursuesystemicandpolicychangeswithaviewtoreducingmorbidity

 

25
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