Summary - Department of Health and Ageing

Reduction of the demand for drugs across the general population is achieved by a number
of different means. Treatment for drug problems is one of the best ways of assisting users
to reduce, or abstain from, use. The efficacy of programs addressing alcohol and drug use
in the workplace is a matter of debate, particularly in relation to drug testing.
Community-based programs are vital because the community is a primary locus of
demand reduction. Mass media campaigns are a common means of community education
and prevention in Australia, while national drinking guidelines and standard drink
labelling serve a similar purpose. This chapter considers all these strategies as well as the
critical importance of demand reduction in Indigenous communities.
Investment in effective treatment programs should be a key ingredient of comprehensive
prevention policies. Treatment can have population level impacts e.g. on levels of crime
and health problems in the community. Interventions can occur with family members of
people with drug problems. This often increases treatment effectiveness and may minimise
the intergenerational transmission of mental health and substance use problems. There is
strong evidence that treatment programs for alcohol and other drug problems can be
effective in reducing drug use and drug-related crime, and improving mental and physical
health and social functioning. Programs targeting high-risk and dependent drinkers reduce
the harms experienced across the community, but most people with an alcohol problem
do not receive treatment for it. The evidence suggests that:
for smokers, nicotine replacement therapy is effective;
for alcohol problems, effective approaches include motivational interviewing, brief
interventions, social skills training, community reinforcement approach, relapse
prevention and some aversion therapies; and
for illicit drug use, treatment normally entails addressing both the physical and the
psychosocial aspects of drug dependence.
This last may include pharmacotherapies, detoxification, counselling and psychosocial
interventions. The effectiveness varies according to the drug and pattern of use. The
strongest evidence for efficacy is in the treatment of opioid dependence with methadone
maintenance treatment, which has achieved reductions in drug use, criminal behaviour,
mortality; and improvements in health status. Various treatments for cannabis and
amphetamines have been trialled but the evidence for their efficacy is not as strong.
There is no direct evidence promoting any particular treatments for people with comorbid
mental health and substance use problems, or for drug-related problems in older
people. There is some evidence for matching different treatment modalities to different
types and intensities of drug problems. There is a clear potential for increasing the impact
of society’s investments in treatment programs on levels of risky drug use and harm at the
population level.