David Hawks

Sharpening the focus of alcohol policy from aggregate consumption to harm and risk reduction.

An argument is presented for shifting the main focus of the alcohol policy debate away from aggregate level of consumption as the key determinant of alcohol problems in favour of a sharper focus on the reduction of harm and of high risk drinking. This argument is developed by highlighting the advantages of the latter approach in relation to: (i) the ability to distinguish between low risk and harmful consumption of alcohol (ii) the ability to predict which drinkers are most likely to experience harmful consequences of drinking (iii) the acceptability of policy objectives to government and industry, and (iv) the acceptability of prevention strategies to the general public. It is suggested that this focused approach to the measurement and reduction of alcohol related harm is more likely to achieve tangible success in the policy arena than one which is overtly predicated upon the need to reduce total population consumption of alcohol.

Harm reduction in Australia: has it worked? A review

The literature is reviewed with a view to determining what evidence exists for the success of Australias policy of harm minimization in relation to drug use. While there are relatively few examples of strategies which can unequivocally be said to have succeeded, there are many more for which the evidence is suggestive. While there has been a considerable mushrooming of research since the advent of the National Campaign on Drug Abuse, it would appear that little of this has measured the extent to which harm has been reduced. The National Drug Strategy would benefit from more policy-orientated research which measures drug-related harm if it is to be, as claimed, research driven.

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.

The watering down of Australia's health policy on alcohol

The draft National Health Policy on alcohol in Australia, prepared by the Alcohol Sub-Committee of the Ministerial Council on Drug Strategy and presented to that Council in November 1987, is compared to that approved by Ministers at their meeting in March 1989. Attention is directed to those policies and strategies which were substantially altered from the draft document and which, it is argued, represented the policys most significant recommendations. The role of the alcohol industry in effecting these changes is speculated upon.

Lying down with the lion: co-operating with the alcohol industry? The 1991 Leonard Ball Oration

The author examines the extent to which the alcohol industry, while purporting to be a responsible industry sensitive to the potential harm associated with alcohol, has attempted to subvert the efforts of those seeking to reduce that harm. Reference is made to recent attempts to circumvent the advertising code, exaggerate the beneficial health effects of alcohol, co-opt the NH & MRC guidelines regarding responsible drinking and minimize community support for control measures. Notwithstanding these manifestations of the industrys duplicity, it will be argued that the lion and the sheep will need at some stage to lie down together if the alcohol industry is not to suffer the same fate as the tobacco industry. It will be suggested that among the issues on which both sides might co-operate are the advertising and promotion of alcohol, the responsible serving of alcohol and the design of the licensed drinking environment. It will, moreover, be argued that such co-operation is in the long-term interest of the alcohol industry, which like any other must be responsive to community concerns.

Changes in drug use and HIV/AIDS risk-taking 1989-90

The Australian National AIDS and Injecting Drug Use Study was designed to monitor the risk behaviour of Australian injecting drug users (IDUs) in a number of major cities, and to estimate the seroprevalence of those interviewed. Differences in risk behaviour found across 2 years in Perth are reported. One hundred and ninety-six Perth IDUs were interviewed in 1989, and 150 in 1990 using the same survey questionnaire, with a small cohort of 38 respondents being followed up across the 2 years.Significant injecting differences between 1989 and 1990 in both the cohort and independent samples were found. In general, these amounted to a greater likelihood that a new needle and syringe would be used on each injecting occasion, and a greater use of bleach in 1990 than in 1989. The most common response of respondents who said they had changed their drug use behaviour in 1990 was to report ceasing to share needles, while the most common response in 1989 was reduced sharing. There was an increased use of condoms for vaginal intercourse with all partners in both studies across the 2 years. Seropositivity for all new cases across the 2 years was 1.75%. It is apparent that there has been a significant shift in risky behaviour in the direction of greater safety across the 2 years. There is also objective corroborative evidence in increased demand for sterile injecting equipment sold through pharmacists, although there is no evidence that drug use increased significantly during the same period. It is concluded that the availability of sterile needles and syringes should be maintained and improved and that emphasis should be placed on encouraging safer sexual behaviour among IDUs.

AIDS and injecting drug use: very risky behaviour in a Perth sample of injecting drug users

This research was carried out in 1990 to examine high-risk injecting and sexual behaviour in a sample of injecting drug users (IDUs) in Perth. The study was a cross-sectional survey with a convenience sample drawn from drug treatment (54%) and non-treatment (46%) populations. In the sample of 150 IDUs, there were 11 very risky drug behaviour (VRDB) and 63 very risky sex behaviour (VRSB) respondents. Four respondents fell into both categories. Independent comparisons were made between each risk group and the rest of the sample. The VRDB respondents were heterosexual men, most of whom were in long-term monogamous relationships, with heavier levels of drug use than the rest of the sample. The VRSB respondents were largely single and mainly heterosexual, with more sexual partners than the rest of the sample. It was concluded that there was little evidence that very risky behaviour was related to a general risk-taking dimension, to inadequate knowledge about AIDS or to a low assessment of personal vulnerability to AIDS. However, situational influences in association with heavy drug use appeared to be a major component of high-risk injecting behaviour, while high-risk sexual behaviour appeared more to be a reflection of community norms about heterosexual sexual behaviour. The study should be replicated with larger samples, particularly as the VRDB group was so small, but if the findings are reproduced in other studies, it suggests that serious attention should be paid to the promotion of safer sex among injecting drug users.

“Who is responsible for my health—is Nanny always right?”

Allegations of nannyism on the part of the State are examined in relation to alcohol and drug policies. It is argued that some form of protectionism is inherent in public health, and that the argument turns not so much on whether the State has a mandate for such protectionism but what limitations should be placed on the States mandate.