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PreventionResearchQuarterly

current evidence evaluated

February 2008 ISSN 1832-6013

Prevention of harm

from alcohol consumption

in rural and remote

communities


Prevention Research Quarterly: Current evidence evaluated

ISSN 1832-6013

© DrugInfo Clearinghouse 2008

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Contents

Prevention of harm from

alcohol consumption in rural

and remote communities

Issues Paper no. 4 1

Reading and Resource List no. 22 15


Issues Paper

No. 4 • February 2008

DRUG

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Prevention of harm from

alcohol consumption in rural

and remote communities

Mr Ged Dibley, PDF Management Services

Introduction

Alcohol consumption is part of daily life in rural and

remote Australia: celebrating with friends; drinking

with a meal; or just relaxing at the end of a hard day’s

work. Many people use alcohol responsibly and for

them drinking alcohol is a pleasurable and arguably

safe activity that does not lead to harm.

However, the short-term harms that can result

from alcohol consumption are well documented.

For individuals there are acute health risks, such as

alcohol poisoning, motor vehicle accidents, falls and

other injuries and the risk of physical or sexual assault.

Chronic health consequences include liver cirrhosis,

cancer, mental health and acquired brain injury,

irreversible nerve damage and premature death.

Major social consequences may also include

family breakdown, domestic violence, crime and

public violence, property damage and decreased

workplace productivity through absenteeism and

unemployment.

Research tells us that:

◗◗ the extent of alcohol consumption, particularly

at risky levels, is disproportionately higher in rural

and remote regions of Australia (Strong et al.

1998);

◗◗ services and systems that might otherwise prevent

or reduce harm from alcohol consumption are less

readily available in rural and remote communities

(AIHW 1998);

◗◗ in recent times, in particular, rural communities are

feeling the social and economic pressures of the

drought (Stehlik, Gray & Lawrence 1999).

The purpose of this paper is to:

◗◗ provide a description of some of the issues facing

rural and remote communities around Victoria in

relation to alcohol-related harms; and

◗◗ explore the range of practical prevention and early

intervention strategies available to them to prevent

and reduce such harms.

The paper draws on recent literature on the subject

and is also informed by input and advice from people

actively working to reduce alcohol and other drugrelated

harm in rural and remote areas across Victoria.

For simplicity, the term “rural” is used in this paper to

refer to non-metropolitan areas of Victoria, that is,

population centres of less than 100 000 people, and

includes remote areas.

The diversity between rural areas in terms of

demographic, socioeconomic, aspirational and many

other factors means that general statements should

be treated with caution and any local action should

be underpinned with local analysis and consultation.

Alcohol consumption and

harm in rural Victoria

As stated above, the extent of alcohol consumption,

particularly at risky levels, is disproportionately higher in

rural and remote regions of Australia, including Victoria.

In rural and remote regions, the consumption of high

levels of alcohol by men is inversely proportional to

the size of the population, ranging from 5% of men

in a large rural centre to 8% in remote areas with less

than 5000 people. The consumption of high levels of

alcohol by women does not follow the same linear

pattern seen for men, with increased levels of high

alcohol consumption by women seen only for small

rural centres and in remote areas with less than 5000

Issues Paper | No. 4 | February 2008

1


people. These areas show a doubling of the proportion

of women consuming high levels of alcohol (2.4%

and 2.1% respectively) compared to capital cities

(1.2%; Strong et al. 1998).

The incidence of alcohol-related harm is frequently higher

across a range of indicators such as: alcohol-related

assaults, family violence incidents and serious road

injuries. In Table 1 the regional rates are generally higher

than the figure for Victoria for these indicators and two

regions stand out as significantly higher in relation to

“deaths”. The figures for these indicators also vary for

local government areas within regions, and vary again at

the township or small area level within municipalities, so

that there are some small towns with rates far in excess

of the figure for Victoria or for their region.

Some population groups in rural areas also emerge

as being at greater risk of harm from alcohol

consumption. Young people, in particular (including

underage drinkers), living in regional Victoria

routinely drink at levels that put them at a high risk

of harm compared with those in metropolitan areas.

For example, 43% of young people living in nonmetropolitan

Melbourne consumed 20 plus drinks in

one day at least once in the past 12 months, compared

to 37% of those from metropolitan areas. Figure 1

shows the higher prevalence among young men.

Seventeen per cent of young people living in nonmetropolitan

areas of Melbourne (compared to 13% of

young people living in metropolitan areas) consumed

20 plus drinks in one day, monthly or more frequently

(Victorian Premier’s Drug Prevention Council 2005).

Table 1: Incidence of alcohol-related harm from 2002/03–2003/04

Health region Assaults* Family

incidents

Serious road

injury

Medical

hospital

admissions

Deaths

Barwon South West 10.29 17.96 2.84 22.70 1.84

Grampians 12.83 20.91 3.89 18.95 1.27

Loddon Mallee 11.16 22.12 3.31 19.97 1.28

Hume 10.94 22.96 3.67 19.21 1.35

Gippsland 15.59 24.22 3.78 22.06 1.93

Victoria 9.65 15.80 3.42 26.92 1.49

*Rates are annual per 10 000 population. Source: Laslett, Dietze & Matthews 2005.

Figure 1: Consumption of 20+ standard drinks in one day during last 12 months

60

50

40

30

20

10

0

Source: Victorian Premier’s Drug Prevention Council 2005.

2 Prevention of harm from alcohol consumption in rural and remote communities


Figure 2: Major contributors to harm from alcohol consumption

Supply factors

Place

• High numbers of outlets:

– licensed premises

– bottle shops and other liquor stores

• Ready availability in outlets

– longer opening hours

– irresponsible serving

– underage access

• Drinking in public places condoned

Promotion

• Inappropriate advertising

Price

• Low prices

• High strength

Harmful alcohol

consumption

Alcohol is

consumed at

risky and high

risk levels*

Demand factors

Population-wide

• Wide acceptance of alcohol:

– to celebrate

– to commiserate

– to relax

• Social pressure

– to join in

Population specific

• People from rural and regional areas

• Young people

• People with mental health problems

• Homeless people

Social harms

• Public violence

• Accident victims

• Property damage

• Family violence and breakdown

• Decreased workplace productivity

• Costs to the community of acute and chronic

health care

• Costs to the community of related crime and

other social impacts

Individual harms to users

• Acute health risks, such as alcohol poisoning

• Motor vehicle accidents

• Falls and other injuries

• Physical or sexual assault risk

• Disrupted education and training

• Unemployment

• Chronic health risks, such as liver cirrhosis,

cancer and irreversible brain damage

• Premature death

*Current Australian Alcohol Guidelines that define alcohol consumption risk are available

from www.alcoholguidelines.gov.au. These are periodically revised and updated.

Adapted from Dibley 2007.

Based on these statistics, it would be easy to focus

solely on young people or some other specific

population groups. However, it is important to

recognise the risks of harm from alcohol consumption

across the entire population and respond with broad

based strategies as well.

Factors influencing harm

from alcohol consumption

The factors that contribute to harm from alcohol

consumption are very complex. One way of thinking

about it is to consider the “supply side” (the factors

that result in alcohol being readily available to

consumers) and the “demand side” (the factors

that are more likely to draw people into patterns of

harmful drinking). Figure 2 illustrates these broad

factors and the harms that can result.

Geographical location can clearly influence these

factors. This influence will vary between locations and

will potentially differ depending on the prevailing

culture regarding alcohol consumption.

Supply side factors in rural communities

There are major strategies designed to control or

manage the supply of alcohol at a national and/or

statewide level. This includes measures such as:

◗◗ border controls, which limit what alcohol gets into

the country

◗◗ high level policies, laws and regulations regarding

availability, strength and advertising

◗◗ taxes and excise, which impact on price (Loxley et

al. 2005)

◗◗ social marketing and media campaigns aimed at

promoting responsible use.

Issues Paper | No. 4 | February 2008

3


Broadly speaking, the reach of these is reasonably

uniform regardless of geographical location.

Shortcomings in communication systems, however,

might limit coverage for some media campaigns,

particularly television and more recently the Internet.

There are nonetheless, local supply side factors

that will vary between locations. Primarily these are

concerned with licensing (including distribution) and

enforcement.

For example, research indicates that the level of outlet

density is highly predictive of alcohol-related harm

(Loxley et al. 2004). Rural Victoria has significantly

more licensed premises per head of population than

Victoria as a whole (Table 2).

Again, these figures are calculated across a region,

which means that for some municipalities and some

townships, the outlet density is higher still. In some

areas this increased outlet density may be connected

to tourism and hospitality operations. Nonetheless,

the increased availability is likely to impact adversely

on visitors and local residents.

Enforcement at a local level falls predominantly to

local policing and to an extent the social support and

cooperation of the community.

Demand side factors in rural communities

As with supply side factors, there are many national

and statewide policies and strategies aimed directly

at reducing demand for alcohol, for example through

education, and health promotion.

Factors influencing demand in rural communities are

numerous and might include:

◗◗ diverse impacts of social isolation, such as

loneliness and boredom

◗◗ infrastructure limitations, such as access to

facilities and transport

◗◗ individual, family and community stresses, such as

drought or bushfires.

Social isolation

The potential for social isolation will vary enormously

between townships and will also reflect diverse

individual needs. However, individuals in rural

communities are at greater risk of social isolation

given the barriers involved in getting together with

others—distance, transport, time and cost.

Small, sparsely distributed populations and a smaller

pool of people can mean more pressure to “fit in”.

The consequences of this social isolation are complex

and broad. For some, it might lead to the solitary

consumption of alcohol for company or solace.

For others, it might mean that getting together, on

whatever basis, is ample cause for celebration. This

can be accompanied by a view that opportunities

should not be squandered and events should

be memorable—buoyed by sometimes excessive

consumption of alcohol. This may be reinforced by

the seasonal nature of some rural activities or the

influxes of visitors in the holiday season in some areas.

Table 2: Number of licensed premises per head of population

Health region Outlet density* Variation †

Barwon South West 39.29 +5.48

Grampians 48.68 +14.87

Loddon Mallee 47.83 +14.02

Hume 59.72 +25.91

Gippsland 44.63 +10.82

Victoria 33.81

*Number of licensed premises per 10 000 population.

†Variation in comparison to Victorian figure.

Source: Laslett, Dietze & Matthews 2005.

4 Prevention of harm from alcohol consumption in rural and remote communities


Examples include annual events like harvest or

bachelor and spinster balls, but also include more

regular interaction around local sporting clubs.

Research suggests alcohol has been a major part of

country sports clubs. Football clubs and, to a lesser

extent, cricket clubs and bowls clubs have been

associated with a culture of excessive and unsafe

drinking (Snow & Munro 2000).

Higher consumption of alcohol in rural areas and

even binge drinking can often be associated with

values of “self-reliance”, “hardiness” and “mateship”

(Dunn 1998). It can be regarded as a reward for hard

work or consolation for hard times.

Infrastructure limitations

There is often limited access to suitable

entertainment, recreation and sporting facilities in

many rural areas—with local pubs becoming the

major social hub.

This lack of facilities is felt particularly strongly by

young people. The view that “there’s nothing to do”

for young people, it is often associated with boredom

which may lead to a greater propensity (traditionally

among young men) to drink large quantities of

alcohol, resulting in feelings of alienation and

marginalisation making them more vulnerable to

depression and suicide (Patterson & Pegg 1999).

The lack of leisure facilities for rural people and

young people in particular is often compounded by

a lack of transport options and lower road quality.

For example, transport availability and ease of travel

would enable young people in small country towns

to access more entertainment facilities in the nearest

provincial centre.

Individual, family and community stresses

It is well documented that people who live in rural

and remote Australia experience many health

disadvantages when compared to their urban

counterparts. This is demonstrated by higher

morbidity and mortality rates, with health worsening

the further one travels away from urban areas

(Humphreys 1998).

In addition, access to employment and education is

limited compared with urban areas (Strong et al. 1998).

In recent years, drought conditions in many parts of

Victoria have disrupted rural enterprises, sometimes to

the point of collapse. This has resulted in pressure on

family finances and subsequently on local economies.

In addition, calamities such as bushfires and floods

have cut deep into personal and community resilience.

Cases of mental illness and suicide have consequently

been on the increase in rural areas. Alcohol

consumption has been identified as a major risk factor

for suicide, particularly when it occurs in association

with other risk factors (De Leo et al. 1999).

The challenge of reducing harm

from alcohol consumption

The capacity of rural communities to respond to

the challenges presented by the harms from alcohol

consumption varies considerably. In general, rural

areas are socioeconomically disadvantaged compared

to metropolitan areas (see population-weighted

socioeconomic indexes for areas in Laslett, Matthews

& Dietze 2006).

This means lower revenue bases for local councils to

draw on and less disposable income for residents to

contribute to community initiatives or meet the costs

associated with accessing services themselves.

Of course, many programs and services tackling

prevention and early intervention of alcohol-related

harm in rural and remote areas are provided by way

of federal or state funding. However, geographical

location has a significant impact on the capacity for

delivery. Services can be restricted by:

◗◗ Difficulties recruiting and retaining suitable

health professionals

There is a recognised global shortage of health

professionals. The shortage of nurses for example

is being felt around Australia and is most

pronounced in rural and remote areas.

Funding uncertainty, inadequate information

and management systems, lack of professional

supervision, limited access to further training and

professional development are commonly reported

and lead to stress and burnout among rural and

remote alcohol and other drug practitioners.

In the absence of specialised practitioners,

considerable pressure is placed on law enforcement

officers, welfare workers, youth workers and

teachers who frequently deal with alcohol and

other drug related problems in their daily work.

Issues Paper | No. 4 | February 2008

5


◗◗ The need to travel considerable distances to

outlying townships

For service providers, this translates as higher

costs per client contact and less client contact

time. Conversely the need for clients to travel

considerable distances to access services brings

with it ongoing transport pressures for clients and

is a barrier to seeking assistance.

◗◗ Client concerns regarding confidentiality and

anonymity

Concerns regarding confidentiality and anonymity

often occur in small “close-knit” communities

in which most people know or recognise each

other. This means attending health services may

not go unnoticed. This is exacerbated by the lack

of transport options to visit larger regional or

metropolitan services.

◗◗ The lack of early intervention, treatment and

rehabilitation pathways

There is a lack of detoxification and rehabilitation

services for young people in some rural areas,

which means that services based in larger regional

or metropolitan centres are the only option—

isolating clients from their families and existing

social supports.

◗◗ Responding to clients with dual diagnosis

There are strong links between alcohol and other

drug use and some forms of mental illness,

particularly depression and anxiety. In areas where

specialist services are limited, “bouncing around

the service system” on the basis of diagnosis fit

can be a serious risk.

Taking up the challenge

Research tells us that prevention strategies at the

community level are a key ingredient to enabling

change to occur (Loxley et al. 2004). This is because

many of the factors influencing harm from alcohol

can be affected by locally driven regulation and

enforcement, social marketing, service provision,

advocacy and planning.

Despite the challenges, there are many features of

rural areas that lend themselves to tackling issues of

this kind. For example, a small “close-knit” community

may raise concerns for confidentiality and anonymity

but it might also mean strong partnerships can be

developed based on interpersonal relationships,

good will and a shared vision. A willingness to

respond with flexibility (and sometimes outside

the strict parameters of what might be regarded

as core business) is often required in less well

resourced communities.

Many active community members are also likely

to have multiple roles, sitting on professional and

community organisations, for example, being a

member of the community health agency and a

member of the football and netball club. This can

fast-track communication and consultation; speed up

decision-making and action; and mobilise strategies

that span different settings.

A “close knit” community can also mean behaviours

that might otherwise escalate unobserved are

picked-up early enough for timely and effective

intervention. For example, the preservation of close

family relationships in rural areas can offer timely

or early motivational intervention and support for

a family member engaging in risky levels of alcohol

consumption.

There are many people and organisations in any rural

community whose work or other roles means that

they might be interested in preventing harm from

alcohol consumption. Examples include:

◗◗ Local councils

◗◗ Government and non-government community

health agencies

◗◗ General practitioners

◗◗ Primary care partnerships

◗◗ Police

◗◗ Residents groups

◗◗ Traders and business associations

◗◗ Community development and health promotion

workers

◗◗ Alcohol and other drug workers

◗◗ Youth workers

◗◗ Primary health care practitioners

◗◗ Teachers

◗◗ School health nurses

◗◗ Indigenous workers

◗◗ Cultural and Linguistic Diversity workers

◗◗ Sporting clubs

◗◗ Social groups of various kinds.

6 Prevention of harm from alcohol consumption in rural and remote communities


Many are already actively involved with the health

and wellbeing of the community, which means

they have many areas of interest that overlap with

prevention of harm from alcohol consumption.

Some of these people may be in a position to take

on a leadership or coordination role, others may be

able to assist with information and training, while

others may simply support local initiatives through

advocacy within their specific local interest group.

Local councils already significantly influence the

impact of alcohol consumption on their communities

(King & Richards 2003). This includes measures

that impact on the entire population, for example,

public space strategies and regulations and targeted

strategies intended for those groups within the

community who may be more vulnerable to harm

from alcohol consumption, such as maternal and

child health programs or youth services.

Prevention and early

intervention strategies

The Monograph, Prevention of substance use, risk

and harm in Australia: A review of the evidence

(Loxley et al. 2004), provides a valuable resource in

examining numerous types of prevention strategies

for their effectiveness.

This research suggests that some strategies designed

to reduce harm from alcohol consumption are

demonstrably more effective than others. This includes

effective and timely early intervention responses. Of

particular interest for rural areas are also prevention

strategies designed to regulate the physical availability

of alcohol, modify the drinking context and work with

communities, homes, schools and workplaces.

Some ways in which rural communities in Victoria have

responded to the challenge of reducing harm from

alcohol consumption are set out in Table 3. Importantly,

the evidence strongly indicates that integrated

and collaborative responses that span regulation,

enforcement, social marketing, service provision and

advocacy are generally more effective in achieving

sustainable change than isolated and one-off activities.

Table 3: Some ways in which rural communities in Victoria are attempting to reduce harm from

alcohol consumption

Regulatory and enforcement

Strategies

Limiting the number of local

licensed premises

“No drinking” areas or

events

Enforcement of liquor

licensing regulations

Enforcement of drink driving

laws

Comment

Members of the community may object to the granting of a liquor licence if they believe that the

amenity of the area will be adversely affected.

For more information see the Objections to Liquor Licensing Applications fact sheet (PDF,

138Kb; www.consumer.vic.gov.au/CA256902000FE154/Lookup/CAV_Publications_Liquor_

Licensing_1/$file/liquor_factsheet_objections.pdf).

Alcohol free zones may be prescribed under local laws or may be instigated by event organisers.

This can result in more family-friendly social events.

For example, the City of Shepparton maintains an alcohol ban zone for the annual Springcar

Nationals auto show which attracts tens of thousands to the regional centre. Shortly after that

event, the nearby Numurkah community also runs the popular Showusyarwheels as a “strictly

no alcohol” event.

Enforcement is not just responding to breaches. Liquor licensing forums and accords in local

communities bring together police, licensees, local government and community representatives

to proactively improve compliance with regulations (for example, ensuring easy access to

responsible serving of alcohol training) and also improve community safety (see case study

on page 12).

Random breath testing at particular times of the year (for example, holiday periods) or during

particular events and locations provides an important means to influence driver behaviour.

Designated driver programs, including where water and soft drink are provided free by the

licensee, provide strong support to reducing drink driving.

Issues Paper | No. 4 | February 2008

7


Regulatory and enforcement

Diversionary approaches

for minor alcohol-related

offences

Lockout regulations

Implementation of a banned

persons list

An example of this kind of strategy is Your Choice, a program developed by Victoria Police aimed

at tackling underage drinking. When apprehended by a police officer or a council local laws

officer, offenders can either formally commit to attending a responsible drinking seminar with a

parent or be issued with an infringement notice.

A lockout at hotels and clubs can be used to curb antisocial late night behaviour. It might be

informally agreed through an accord or forum or enforced through the Director of Liquor

Licensing. Under a lockout, patrons are not able to enter premises after a specified time

(for example, 3 am) They can leave at any point before closing time but will not be readmitted.

Identification of individuals with a history of antisocial behaviour occurs at times through alcohol

accords or forums.

Developing a united approach among members, a banned persons list means that a consistent

message is conveyed to both the individual and to others in the community.

Advocacy and community programs

Strategies

Local plans to reduce harm

from alcohol consumption

Local networks or

partnerships

Community renewal and

social connection programs

Comment

Local area drug and alcohol plans are effective in bringing together key stakeholders, such

as local council, alcohol and other drug services, police, and community representatives

to address local alcohol issues. A formal planning process enables integrated action to be

agreed at a “whole of community” and population group level.

Plans can be developed between agencies and across council boundaries. See, for example,

the Glenelg and Grampians Drug Action Plan (www.sthgrampians.vic.gov.au/Page/Download.

asp?name=DrugActionPlan.pdf&size=1866299&link=../Files/DrugActionPlan.pdf).

In some instances other formal plans may deal with alcohol. For example, local council Municipal

Public Health Plans or Community Safety Plans often deal with alcohol issues as health and

wellbeing matters or because of the safety risks experienced by both those drinking and those

in the vicinity.

Local networks or partnerships may emerge from formal planning approaches as described

above and meet to monitor the plan. Some may form in response to a pressing issue or to

coordinate a specific activity; others may form to pool resources, collaborate on programs or

address the ongoing needs of a given population group.

An example is the Barwon South West Youth Alliance which is a collaboration of nine services

committed to reducing drug related harm among young people across the Barwon South West

Region of Victoria (see case study on page 13).

Another example is the SSMART (Surviving Substance Misuse & Alcohol Risk Taking) Network,

a collaboration of local government with health, welfare, community, education and justice

organisations and young people, brought together to tackle the issues of binge drinking

and unsafe party behaviour. One of its projects, the ASSK (Alcohol and Substance Survival

Knowledge) Program—is a harm minimisation program for year 9 students, delivered in a

nightclub environment. Young people learn how to do a risk audit, understand the amount of

alcohol in drinks, risks of drink spiking, risks of binge drinking and substance use and what to do

in an emergency.

SSMART is part of Strengthening Generations, a City of Ballarat and local community services

program that originally focussed on community renewal in the areas of Sebastopol, Delacombe

and Wendouree. Since its evaluation in 2005, Strengthening Generations moved from a model

focusing on specific small communities to a model focusing on specific risk factors such as

alcohol and other drug use (www.ballarat.vic.gov.au/Community_and_Culture/index.aspx).

Programs and activities aimed at increasing the social cohesion and resilience of communities

provide a strong opportunity to tackle how alcohol is regarded within the community.

For example, Neighbourhood Renewal communities commonly confront the issues of alcohol as

a community safety or social issue (www.neighbourhoodrenewal.vic.gov.au/).

8 Prevention of harm from alcohol consumption in rural and remote communities


Advocacy and community programs

Safe transport options

Alcohol-free activities for

young people

Good Sports program

Community sponsorship and

fundraising alternatives

Safer parties and events

Getting home safely has been a focus for many alcohol accords and community safety initiatives.

In addition to designated driver programs, these have resulted in:

• the provision of additional community bus services, in some instances funded by licensees

and the local council

• the establishment of reliable taxi services

• the creation of safe taxi ranks monitored by security and in some instances paid for by

accord members.

Creating opportunities for young people to take part in interesting and engaging activities

provides an important alternative to “drinking because there’s nothing better to do”.

Alcohol-free events reduce the peer pressure to drink that often accompanies events

where alcohol is present.

Examples include:

The FReeZA program is a Victorian Office for Youth initiative that supports young people to

organise drug, alcohol and smoke-free music and cultural events for other young people in

their local community. In rural communities many businesses and organisations support

the FReeZA events, ranging from traders, local schools, councils and health services

(www.freeza.vic.gov.au).

The Blue Light initiative provides alcohol-free entertainment for many young people in

country Victoria. Originally providing discos supervised by off duty police officers and other

community members, activities have expanded to include camps and forums for young

people; self defence classes; clinics for basketball, abseiling, canoeing, skate-boarding,

tennis and cricket; and educational excursions and trips to sporting events

(www.bluelight.com.au/districts_victoria).

The Good Sports program is an Australian Drug Foundation (ADF) initiative that helps sporting

clubs manage alcohol responsibly and reduce alcohol related problems such as binge and

underage drinking. Many clubs have turned around club cultures that previously encouraged

high risk alcohol consumption and have created much safer environments for players, members,

families and supporters. In many instances this has improved their financial viability as well.

For more information and examples visit www.goodsports.com.au.

Alcohol is often a key component in community fundraising and sponsorship. The local hotel

might sponsor the local sports team; a brewing company might sponsor a local community

event—sometimes with cash, sometimes with alcohol. Community clubs and groups themselves

often rely on alcohol sales, bar takings and alcohol as prizes, to maintain their viability.

The experience of Good Sports and of many alcohol-free events, is that less alcohol can create

a more family-friendly environment, which in turn can attract greater attendance and a greater

mix of sponsors. For some alternative fundraising ideas visit the Good Sports website

(www.goodsports.com.au/about/partners1/fundideas/).

Private parties and community events with alcohol available can be made safer.

For example, PartySafe is a Victoria Police program that “provides information to help minimise

the risk of having intoxicated guests or gatecrashers ruin a private party”. Party organisers

can register their party and local police will assist in ensuring it is safe (www.police.vic.gov.au/

content.asp?Document_ID=9566).

Local communities in popular “schoolies week” destinations, such as Torquay and Lorne,

Phillip Island, Sorrento and Portsea have all invested in strategies to limit harm from alcohol

consumption for the young people arriving to celebrate the end of school. These include

mobile support services, safe transport options and activities for those aged over 18 years and

for younger people. One example is Surf Coast Shire Council which has developed a dedicated

website that is focused on having fun in safety (www.schooliesdownsouth.com.au).

Issues Paper | No. 4 | February 2008

9


Social marketing

Strategies

Community information

Drug Action Week activities

School based education

programs

Parent education

Comment

Community information campaigns are often centrally funded and coordinated.

To be effective in rural areas media campaigns need to be backed up with locally available

material, internet based information or other innovations, such as SMS promotions via

mobile phones.

Consideration should be given to using images and depictions familiar to rural people and

focussing on issues and solutions relevant to rural communities, for example, designated

driver promotions.

Drug Action Week is an initiative of the Alcohol and other Drugs Council of Australia, to raise

awareness about alcohol and other drug issues.

Information is able to be shaped and driven by local groups working on Drug Action Week

activities and is often presented in engaging and novel ways. For example, the Drug Action Week

website (www.drugactionweek.org.au) describes:

“A play titled ‘Toxic’ was performed at schools in the Mitchell Community Health Services

District, Victoria, to entertain students and share some important messages”.

‘‘‘Within Reach’ was an art exhibition in which young people involved with alcohol and other

drug services in Victoria created art works in a variety of media on the theme of drug use and

other social issues” .

Schools provide a convenient and effective setting in which to provide information and

create a sense of social connectedness and resilience that can help to reduce the likelihood of

consumption of alcohol at risky levels among young people.

Available evidence suggests that school based drug education is more likely to be effective when

a broad multilayered approach is used.

The Victorian Department of Education has useful resources and information on its website including

information and case studies on School Community Approaches to Drug Education (SCADE) projects

(www.education.vic.gov.au/studentlearning/programs/drugeducation/funding.htm).

The Australian Government Department of Education, Science and Training developed

Principles for School Drug Education (Meyer & Cahill 2004) which contains 12 principles that

are recommended to underpin drug education programs in schools. This document and other

resources are available at www.redi.gov.au.

Parent education can often go hand in hand with school based education programs so

that messages are reinforced and consistent. Separate parent forums can help to clarify

key information.

Resources available at www.redi.gov.au include parent focused materials. More information can

also be accessed at the Victorian Department of Education website (www.education.vic.gov.au/

studentlearning/programs/drugeducation/funding.htm).

Workplace education and

promotion

The use of alcohol can have a significant impact on workplaces in terms of accidents, lost

productivity and absenteeism. Work related factors such as stress may influence the way people

use alcohol. Workplaces therefore are a key setting for tackling alcohol.

Taking an occupational health and safety perspective provides a practical motivation for

employers and employees to embrace workplace education concerning alcohol harms.

Examples of workplace strategies include training programs to raise awareness of alcohol issues

developed by industry bodies and health agencies (see the case study on page 14) and Employee

Assistance Programs provided within particular businesses or organisations that provide services,

including alcohol and drug counselling.

10 Prevention of harm from alcohol consumption in rural and remote communities


Service provision

Strategies

Recruitment and retention

initiatives

Screening initiatives at health

care contact points

Increased training for health

professionals, working in

alcohol related areas

Comment

Recruitment to rural health services has been addressed with varying degrees of success.

Increasing the pool from which to recruit by:

• increasing undergraduate rural-health curricula

• preferential university admission of rural students

• scholarships

• rural attachments and international recruitment.

Providing incentives including:

• community involvement in welcoming newcomers

• financial incentives

• appropriate accommodation

• mentoring and accessible professional development

• assistance finding employment for spouses and partners

• provision of good equipment.

Alternatives to resident health professionals including:

• visiting or sessional services

• electronic and telecommunication-based service options.

Screening provides an effective early intervention strategy for identifying those who may be at

risk of harm from high levels of alcohol consumption.

For example, Northeast Health Wangaratta and Wodonga Regional Health staff routinely

administer a simple screening test to those attending hospital accident and emergency

departments or other wards. This provides an opportunity to identify people at risk and provide

a brief intervention or a referral if required.

Many qualifications, including those dealing with alcohol, such as the Certificate IV in Alcohol

and Other Drugs Work, are supported with high quality, text-based material and software

featuring scenarios, images and interactive activities that simulate real life.

Online learning of this kind helps to cut the distance between student and the learning centre.

Flexible service delivery and

case management

Overcoming the distance

to services

Alcohol and other drug and mental health sectors have long highlighted the plight of people

with dual diagnosis and recognised that working more closely together would achieve the

most effective outcomes. The structural and organisational barriers to making this happen can

be overcome.

Health agencies in the Central Hume Primary Care Partnership catchment area set out to do

this by developing the “Integrated Protocol 2006: paving the way to a ‘No Wrong Door’ service

system” (www.health.vic.gov.au/pcps/coordination/care_planning.htm).

The intent of the protocol is to establish:

• common intake and assessment processes used by all services

• referral pathways within and across services and sectors

• jointly developed care plans (involving the client) and joint case management

• collection and reporting on a common set of dual diagnosis data.

Overcoming the distance to services for the client can make the difference in terms of service

access. Options include:

• taking the service to the client through outreach services, including family home visiting

• low cost statewide telephone services, for example, the 24 hour DirectLine operated by

Turning Point

• locally based telephone or videoconference support services, for example, to support family

support program

• videoconference specialist support services

• online service and support , for example, Counselling Online (www.counsellingonline.org.au)

also operated by Turning Point

Issues Paper | No. 4 | February 2008

11


Conclusion

There is no one solution for all communities and each will

need to find what is needed and what will work locally.

Whether communities choose to advocate for change,

deliver information and services themselves, or support

others to do so, it is critical to understand the issues

and identify the strategies that are most likely to achieve

results. Planning a response in an integrated way will

mean available resources are used to greatest benefit.

References

De Leo D, Hickey PA, Neulinger K & Cantor CH 1999 Ageing and

suicide: A report to the Commonwealth Department of Health

and Aged Care, Canberra: Australian Institute for Suicide Research

and Prevention

Dibley G 2007 Local Government reducing harm from alcohol

consumption, Melbourne: Australian Drug Foundation

Dunn P 1998 “Rural health and drug and alcohol dependence:

double jeopardy” in S Griffiths, P Dunn & S Ramanathan (eds)

Drug and alcohol services in rural and remote Australia, Wagga

Wagga: The Gilmore Centre, pp. 1–6

Humphreys J 1998 Rural health and the health of rural

communities, Bendigo: La Trobe University

King T, Richards J 2003 Australian Local Government: Alcohol

Harm Minimisation Projects—A good practice guide, Melbourne:

Turning Point Alcohol and Drug Centre

Laslett A-M, Dietze P & Matthews SM 2005 The Victorian alcohol

statistics handbook Volume 7: a summary of alcohol-related harm

for Victorian local government areas 2005, Melbourne: Turning

Point Alcohol and Drug Centre

Laslett A-M, Matthews SM & Dietze P 2006 The Victorian Alcohol

Statistics Handbook Volume 8: Alcohol use and related harm

among young people across Victorian Local Government Areas

2006, Melbourne: Turning Point Alcohol and Drug Centre

Loxley W, Toumbourou JW, Stockwell T, Haines B, Scott K et al.

2004 The prevention of substance use, risk and harm in Australia:

a review of the evidence, Canberra: Commonwealth of Australia

Loxley W, Gray D, Wilkinson C, Chikritzhs T, Midford R & Moore D

2005 “Alcohol policy and harm reduction in Australia”, Drug and

Alcohol Review, 24:6

Meyer L & Cahill H 2004 Principles for School Drug Education,

Canberra: Department of Education, Science and Training

Patterson I & Pegg S 1999 “Nothing to do: The relationship

between ‘leisure boredom’ and alcohol and drug addiction: is

there a link to youth suicide in rural Australia?”, Youth Studies

Australia, 18:2, pp. 24–9

Snow P & Munro G. 2000 “Alcohol consumption in amateur

Australian rules football clubs: evidence from a rural region”,

Health Promotion Journal of Australia, 10:237–243

Stehlik D, Gray I & Lawrence G 1999 Drought in the 1990s:

Australian farm families’ experiences. Canberra: Rural Industries

Research and Development Corporation

Strong K, Trickett P, Titulaer I & Bhatia K 1998 Health in Rural and

Remote Australia. Canberra: Australian Institute of Health and

Welfare, AIHW Cat No PHE 6

Victorian Premier’s Drug Prevention Council 2005 The Victorian

Youth Alcohol and Drug Survey 2004—Alcohol findings,

Melbourne: Victorian Government Publishing Service

Case studies

A sample of rural liquor

licensing accords

There are dozens of accords and forums in

place across rural Victoria. Below are just a

few of them; some newly formed; some in

place and updated over many years. Meetings

are generally four to six times per year.

The Winchelsea, Moriac and District accord was

formed in March 2007 and jointly launched in

August 2007.

The licensees of this accord are enthusiastic to comply

with best practice in order to achieve the objectives of

the accord, which are to:

◗◗ work cooperatively to protect the welfare of

the community

◗◗ discuss and resolve relevant issues that impact on

the local community

◗◗ discuss antisocial behaviour both in and near

licensed premises

◗◗ eliminate illegal underage patronage at licensed

premises

◗◗ set a good example and promote the community

as a safe place to be

◗◗ acknowledge those who achieve good results.

The Colac Otway and District accord was officially

formalised in October 2006. The accord has been

able to initiate a number of incentives including a

Responsible Serving of Alcohol course for hospitality

workers and arranging guest speakers to attend

meetings. Members have agreed on the standards

they will tolerate in their premises and put steps in

place to deal with patrons who display unacceptable

behaviour. The accord has also made alcohol

management and anger management counselling

available to patrons who require it.

The Far East Gippsland accord has been running

since December 2004. The aim of this accord is

to create safer licensed venues for patrons. This in

turn, will create a safer environment for the Far East

Gippsland community. One particular outcome of the

accord is the improvement of the local taxi service.

12 Prevention of harm from alcohol consumption in rural and remote communities


When the accord commenced the taxi service was

sub standard and unreliable. Through the accord,

licensees were able to collectively write to the Taxi

Licensing Authority which responded promptly and

addressed all the issues. The service has improved

beyond licensees expectations.

Members of the accord believe the cooperation with

police and Liquor Licensing to assist with day to day

operations of businesses has been invaluable.

The Swan Hill accord was established in 2001.

Guest speakers at meetings inform members on a

range of issues. These include drink spiking/drug

issues, insurance, fire safety and security cameras.

Through the accord, members have also been able

to access Responsible Serving of Alcohol courses and

club seminars. It is a great opportunity for licensees

to share ideas and initiatives. Recently the Oasis Hotel

in Swan Hill developed its own in-house poster about

drink spiking. This was then made available to other

licensed premises in the area.

Source: Consumer Affairs Victoria (www.consumer.vic.

gov.au). Each of these accords along with many more can

be found at this website follow the Liquor link and scroll to

Forums and Accords

The Barwon South West

Youth Alliance

From a membership of three organisations seven

years ago, the Barwon South West Youth Alliance

(BSWYA) has grown to a membership of nine:

◗◗ Barwon Youth (BASYA Ltd)

◗◗ Western Region Alcohol and Drug Centre (WRAD)

◗◗ Glenelg Southern Grampians Drug

Treatment Service

◗◗ Colac Area Health

◗◗ Brophy Family and Youth Services

◗◗ Kikkabush Aboriginal Advancement

Association Inc

◗◗ Odyssey House Victoria

◗◗ Salvation Army Geelong Withdrawal Unit Geelong

◗◗ Winda Mara Aboriginal Corporation.

Initially responsible for youth residential services, the

BSWYA now brings together complementary skills,

knowledge and expertise from a wider range of drug

and alcohol and youth specific services. Together,

the alliance is able to provide an integrated service

response to young people affected by or at risk of

harm from alcohol and other drug use across the

entire Barwon South West Region. Services include:

◗◗ youth residential and home based withdrawal

◗◗ community development

◗◗ alcohol and other drugs counselling

◗◗ youth alcohol and drug day program

◗◗ general practice

◗◗ drug education

◗◗ youth outreach.

The Youth Access Program (YAP) is one example of

a regional program operating through the alliance

which provides a level of prevention and early

intervention in relation to alcohol and other drugs

issues associated with young people. The program

works with local services and schools, including those

in more remote areas, to get in touch with young

people and identify those at risk.

Outpost arrangements and protocols have been

established with schools, which are visited once a

week or fortnightly. Frequent visits help to build

relationships with the school community and mean

that alcohol and other drug workers become more

familiar to students and more approachable to them.

The program’s three outreach workers routinely

travel up to 3000 kilometres a week to reach up to

500 young people in rural and remote communities

such as Apollo Bay, Colac, Warrnambool, Hamilton,

Heywood and Portland.

While drug education is not strictly core business

for YAP, demand means that workers deliver drug

education sessions in some identified schools that

are more rural and remote. For example, although

the Corangamite area has a WRAD alcohol and other

drugs clinician visiting the health service weekly, it

does not have an alcohol and other drugs mainstream

service. This means the local capacity to deliver drug

education to schools is limited.

Issues Paper | No. 4 | February 2008

13


In 2006, YAP received an award for excellence

in services for young people from the Australian

National Council on Drugs. Attracting resources to

support the work of YAP has been a challenge since

its earliest days; however funding of $750 000 over

the next three years under a Commonwealth Proceeds

of Crime Grant will see the program continue to

respond to this vital need.

The BSWYA is actively involved in finding ways

to assist other existing services and programs on

the ground to access or make the most use of the

resources available. For example, writing submissions

for grants to focus on health promotion or drug

education or establishing working groups for projects

that pool resources and expertise.

The BSWYA is governed by an Executive Committee

made up of the Executive Directors/Managers of the

services operating under a joint Memorandum of

Understanding. The BSWYA is also supported by a

Regional Reference Group that meets quarterly and

allows input from a broad range of professionals

working with young people across the region. It

also provides a great opportunity for workers and

community members to get together to build and

strengthen relationships that make the alliance and

the services it supports work.

Contact: Shannon Luttrell, Senior Project Officer,

Barwon Youth, Ph: (03) 5244 7306;

Email: Shannon.luttrell@barwonyouth.org.au

Drugs or alcohol? The Victorian

building and construction

industry says “Not at work”

Incolink is a joint enterprise of unions and employer

associations in the building and construction industry

and provides a range of services to its members,

including a drug and alcohol program. Drug and

alcohol use has been identified as one of the

pressures likely to be faced by young workers and

apprentices who are commencing their careers.

Under the slogan “Drugs or Alcohol? Not at Work!”

the Incolink drug and alcohol program aims to make

sure that young workers and apprentices are aware

of the risks in using drugs and/or alcohol and are

aware of the supports available to them. With over

1000 apprentices per year participating in the Incolink

Drug and Alcohol Awareness Program run in TAFE

and industry training centres, this slogan and its key

message are well and truly “front of mind” for young

workers and apprentices entering the building and

construction industry across Victoria.

The building industry has long had a drugs and

alcohol policy and Incolink provides information and

assistance for industry members, family members

and employers on the harm caused by the misuse of

alcohol and other drugs. This includes free counselling

and confidential drug and alcohol treatment and

referral services where required.

More recently Incolink has been in discussion

with TAFE colleges and other Registered Training

Organisations in rural Victoria to extend the drugs

and alcohol module to these areas on a regular basis.

The idea is to provide modules dealing with alcohol

and drugs to apprentices who are participating in

Incolink’s Life Care Skills Program, funded through

the Federal Government Department of Health and

Ageing and supported by CBUS.

The success of Incolink’s Life Care Skills Program, a

suicide prevention program based in Bendigo, has

provided a great deal of momentum for responding

to the issue of alcohol in rural areas. The program

supports young people facing the many changes

and transitions that occur as they move into the

construction industry. Alcohol and other drug use is

an issue that many apprentices and young workers

may confront and the program will ensure this

important issue is kept at the forefront.

TAFEs in Mildura, Geelong, Bendigo and Ballarat

are already expressing interest and it is anticipated

many more will follow. Incolink also hopes to link

in with local alcohol and other drug services to

ensure material is accurate and locally relevant, and

that appropriate support and referral pathways

are provided.

Contacts: David Clark, Support for Apprentices,

Ph: (03) 9639 3000

Troy Matisons, Life Care Worker—Life Care Skills Program,

Ph: 0438 059 859

Contact INCOLINK on (03) 9639 3000 or toll free on

1800 337 789 or visit www.incolink.org.au

14 Prevention of harm from alcohol consumption in rural and remote communities


Reading and Resource List

No. 22 • February 2008

DRUG

NFO

clearinghouse

www.druginfo.adf.org.au

Prevention of harm from

alcohol consumption in rural

and remote communities

This list is intended as a guide and a starting point for the researcher. It does not aim to be

comprehensive of the subject. For further information please search the library online public

access catalogue, or contact DrugInfo for assistance. The list is sorted chronologically and by

author within each time period. All of the following resources are available in the

DrugInfo Clearinghouse Library.

Books and reports

Drugs and Crime Prevention Committee

2006 “An overlooked problem: harmful alcohol

consumption in rural and regional Victoria” in

Inquiry into strategies to reduce harmful alcohol

consumption: final report, volume two, Melbourne:

Drugs and Crime Prevention Committee,

pp. 1015–1048

This chapter discusses the particular problems related

to alcohol misuse in the rural and regional areas of

Victoria, with significant comment from Dr Rodger

Brough. Nine specific recommendations for the

management of alcohol use in rural areas are made,

and a discussion of the importance of Local Alcohol

and Drug Action Plans is included.

www.parliament.vic.gov.au/dcpc/

Laslett A–M, Matthews S & Dietze P 2006

The Victorian alcohol statistics handbook, volume 8.

Alcohol use and related harm among young people

across Victorian Local Government Areas 2006,

Fitzroy: Turning Point Alcohol and Drug Centre

This handbook, the eighth in a series providing

information on alcohol consumption and related harms

in Victorian statewide, regional and local government

areas, focuses on young people aged 15–24 years.

www.turningpoint.org.au/library/vas08.pdf

DrugInfo Clearinghouse no. STATS

Mission Australia 2006 Rural and regional

Australia: change, challenge and capacity,

Sydney: Mission Australia

Using a capitals framework—economic, human,

institutional, social and natural capital—the report

considers the various resources required to develop

functional, resilient communities and the impact of

resources or “capital” deficits on the wellbeing of

individuals and communities. (Mission Australia)

www.mission.com.au/cm//resources/documents/

Regional_Rural_snapshot_2006.pdf

DrugInfo Clearinghouse no. JF246 MIS

Fortney J & Booth BM 2001 “Access to substance

abuse services in rural areas” in M Galanter (ed.)

Recent developments in alcoholism, 15, New York:

Kluwer Academic, pp. 177–208

Access to effective treatments for substance use

disorders is a critical public health issue, especially in

rural areas. Difficulties in access to care may account

for the large proportion of individuals with alcohol

and/or drug use disorders who do not receive any

care for their disorder and the small proportion that

engage in, or achieve sustained involvement with,

treatment. (Kluwer Academic)

DrugInfo Clearinghouse no. ref GC58 REC

Reading and Resource List | No. 22 | February 2008

15


Australian Drug Foundation 1999 1998 Regional

youth alcohol campaign. Project report, West

Melbourne: Australian Drug Foundation

This campaign was, in essence, a partnership between

the Department of Human Services and the Australian

Drug Foundation, regional working groups and local

young people. Emphasis was placed on developing

creative strategies to reduce associated harm from

excessive alcohol use and to ensure that the strategies

developed were positive reflections of young people

rather than feeding off stereotypical or negative

images. (Australian Drug Foundation)

DrugInfo Clearinghouse no. adf JP14 ADF

Diamantopoulou K, Mullan N, Dyte D &

Gantzer S 1997 Evaluation of the country random

breath testing publicity program in Victoria,

1993–1994, Clayton: Monash University Accident

Research Centre

This evaluation, carried out by Monash University

Accident Research Centre on behalf of the Transport

Accident Commission, evaluated the program in

terms of its implementation characteristics and

effects on road trauma, and provided information to

optimise the mix and levels of the major components

of random breath testing programs in the future.

DrugInfo Clearinghouse no. MO6 CAM

Salter A & Boots K 1996 “Rural alcohol harm

reduction strategies for young people—the COMPARI

experience in Geraldton” in Reshaping the future:

drugs and young people: a conference examining

how schools and communities address young

people’s use of alcohol and other drugs,

29 September–1 October, 1996, the Holme Building

University of Sydney, New South Wales: conference

proceedings, pp. 301–320, South Melbourne:

Australian Drug Foundation

This paper describes some of the work undertaken

by a rural health promotion project called COMPARI

in Geraldton, Western Australia, which undertook a

range of strategies to reduce alcohol-related harm,

including addressing fraudulent use of proof of age

cards, community development relating to relocation

of a licensed premises, an art exhibition relating to

underage drinking and health marketing to promote

designated drivers.

DrugInfo Clearinghouse no. JF36 RES

Sheehan M, Schonfeld C & Davey J 1995

A community based prevention/rehabilitation

programme for drink drivers in a rural region:

“Under the limit”, Canberra: Australian Government

Publishing Service

This report describes the development and

implementation of a trial drink driving prevention and

rehabilitation model in a rural region of Queensland. The

program, called “Under the limit”, used an intersectoral

framework for change which involved coordination and

collaboration between all the major agencies who play a

role in the management of the issue.

DrugInfo Clearinghouse no. AN66 SHE

Sturmey R 1994 “Rural/remote women: drugs and

alcohol” in J Copeland & W Swift (eds) 1994 National

Women and Drugs Conference: challenge, consensus

and change issues papers, Sydney: National Drug and

Alcohol Research Centre, pp. 99–151

This paper brings together available statistics on

women’s drug and alcohol usage in rural and remote

areas. It also outlines a service delivery oriented

rural and remote area classification for Australia,

the key types of communities that exist in rural and

remote areas, the differences in the way smaller rural

communities function, and a summary of models and

principles considered important in servicing such areas.

DrugInfo Clearinghouse no. GC101 COP

Journal articles

Hamdan-Mansour AM 2007 “Perceived social

support, coping strategies and alcohol use among

rural adolescents/USA sample”, International Journal

of Mental Health and Addiction, 5:1, pp. 53–64

Rural adolescents are under-researched in substance

use studies. The purpose of this study was to

determine whether perceived social support and

coping strategies predict rural adolescents’ alcohol

use. Avoidance coping strategies and perception of

social support from family are strong predictors of

alcohol use among rural adolescents. (Springer)

DrugInfo Clearinghouse no. HAMDAN-MANSOUR 07

Spence R 2007 “Treatment seeking in populations in

urban and rural settings on the border”, Alcoholism:

Clinical and Experimental Research, 31:6, June, pp.

1002–1011

16 Prevention of harm from alcohol consumption in rural and remote communities


This framework for understanding treatment seeking

in border communities suggests that pathways to

treatment seeking vary by locality in ways that may

reflect variations in local environments and service

systems. Design of outreach efforts should be tailored

to the unique social and service system challenges of

each local community. (Blackwell)

Graham ML 2006 “Rural parents, teenagers and

alcohol: what are parents thinking?”, Rural and

Remote Health, 383, Feb., pp. 1–13

Rural parents are unsure how to respond to teenagers’

alcohol use and drunkenness. While some parental

strategies for harm reduction (such as supplying

adolescents with a small amount of alcohol) may have

good face validity in reducing alcohol consumption

among adolescents, these strategies are not supported

by previous research findings.

DrugInfo Clearinghouse no. vf GRAHAM 06

Kenny A, Kidd S, Tuena J, Jarvis M &

Robertson A 2006 “Falling through the cracks.

Supporting young people with dual diagnosis in rural

and regional Victoria”, Australian Journal of Primary

Health, 12:3, Dec., pp. 12–19

For young people with a dual diagnosis, particularly in

rural and regional areas, there are significant barriers

to the provision of optimal care. Currently, a lack of

communication between mental health, drug and

alcohol services and consumers results in the inadequate

provision of treatment for young people, with a

resultant significant service gap.(La Trobe University)

DrugInfo Clearinghouse no. vf KIDD 06

Miller AS 2005 “Adolescent alcohol and substance

abuse in rural areas: how Telehealth can provide

treatment solutions”, Journal of Addictions Nursing,

16:3, pp. 107–115

In the past decade, adolescent alcohol and

substance abuse has grown significantly as a

problem for rural areas. Deficits in adolescent

alcohol and substance abuse treatment have

predictably contributed to this phenomenon.

As a solution to these deficits, videoteleconferencing

(VTC) creates an opportunity for rural communities to

increase the accessibility and quality of alcohol and

substance abuse treatment. (Ingenta)

DrugInfo Clearinghouse no. vf MILLER 05

Booth BM, Curran GM & Xiaotong H 2004

“Predictors of short-term course of drinking in

untreated rural and urban at-risk drinkers: effects of

gender, illegal drug use and psychiatric comorbidity”,

Journal of Studies on Alcohol, 65:1, pp. 63–73

The purpose of this study was to examine predictors

of changes in drinking and drinking consequences

in untreated at-risk drinkers in a community sample.

Rural residents maintained higher drinking quantity

and were less likely to be safe drinkers than urban

residents were. These data distinguish which drinkers

might benefit from short interventions, and which

should receive more intensive treatment. (Rutgers)

Nietert PJ, French MT, Kirchener J, Han X &

Booth BM 2004 “Health services utilizations

and cost for at-risk drinkers: rural and urban

comparisons”, Journal of Studies on Alcohol, 65:3,

May, pp. 353–362

The purpose of the study was to examine differences

between healthcare use and associated costs in rural

and urban at-risk drinkers. While overall healthcare

costs were not significantly different between

rural and urban residents in this sample of at-risk

drinkers, there are some notable differences in the

costs associated with inpatient and emergency room

services. (National Institute on Alcohol Abuse

and Alcoholism)

SAMHSA, Office of Applied Studies 2004

“Underage drinking in rural areas”, The NSDUH

Report, Aug., at www.oas.samhsa.gov/2k4/

ruralYouthAlc/ruralYouthAlc.htm (accessed 2/11/07)

This report presents comparisons from the 2002

NSDUH on the prevalence of any past month and

binge alcohol use among persons below the legal

drinking age (aged 12 to 20) who lived in rural and

nonrural areas.

DrugInfo Clearinghouse no. SAMHSA 04

Reading and Resource List | No. 22 | February 2008

17


Williams P 2001 “Alcohol-related social disorder

and rural youth”, Youth Studies Australia, 20:3,

Sept., pp. 11–19

The consumption of alcohol is embedded in the

cultural psyche of rural Australia. By their early teens,

most rural young people have tried alcohol, and some

consume alcohol regularly. When they drink, the

young often do so at hazardous and harmful rates,

increasing their likelihood of being involved in social

disorder as victims or perpetrators, or both. Paul

Williams analyses the available data, and suggests

strategies to lower the rates of alcohol-related social

disorder in rural regions.(Australian Clearinghouse for

Youth Studies)

Booth BM & McLaughlin YS 2000 “Barriers to

and need for alcohol services for women in rural

populations”, Alcoholism: Clinical and Experimental

Research, 24:8, pp. 1267–1275

We discuss the prevalence of alcohol problems, helpseeking

behavior and barriers to help-seeking for rural

women and suggest directions for future research for

rural women with alcohol problems. We also address

key methodological issues in measuring rurality that

must be considered when designing research on rural

women. (Blackwell Synergy)

d’Abbs P & Togni S 2000 “Liquor licensing and

community action in regional and remote Australia:

a review on recent initiatives”, Australian and New

Zealand Journal of Public Health, 24:1, pp. 45–53

The objective of this research was to review the

effectiveness of community-based initiatives involving

restrictions on alcohol availability in remote and

regional locations in Australia, and to assess their

implications for other communities or towns

contemplating similar measures. (Public Health

Association of Australia.)

Snow P & Munro G 2000 “Alcohol consumption in

amateur Australian rules football clubs. Evidence from

a rural region”, Health Promotion Journal of Australia,

10:3, pp. 237–243

This paper examines the extent to which amateur

rural sporting clubs are settings in which harmful and

hazardous levels of alcohol are consumed by players,

and suggests that rural sporting clubs should be

targeted as health promotion settings so that policies

and practices which promote the responsible service

and consumption of alcohol can be developed,

implemented and evaluated. (Australian Health

Promotion Association)

DrugInfo Clearinghouse no. vf SNOW 00

Stewart L & Conway K 2000 “Community action to

reduce rural drink and drive crashes in New Zealand:

adapting approaches in dynamic environments”,

Substance Use and Misuse, 35:1&2, pp. 141–155

This paper discusses the evolution of a two-and-ahalf

year pilot community action project aimed at

developing strategies to reduce alcohol-use-related

crashes in a rural police district in New Zealand.

(Marcel Dekker Inc.)

Patterson I & Pegg S 1999 “Nothing to do: the

relationship between ‘leisure boredom’ and alcohol and

drug addiction: is there a link to youth suicide in rural

Australia?”, Youth Studies Australia, 18:2, pp. 24–29

This review of research in regard to young adults

and adolescents suggests that there may be a causal

link between leisure boredom and high-risk health

behaviours such as substance abuse as well as various

forms of mental distress. The findings support the

hypothesis that adolescents and young adults who

perceive their leisure to be unsatisfying, or in some

way incomplete, may be at greater risk of engaging

in patterns of leisure behaviour that are detrimental

to their physical and/or psychological well-being.

(Australian Clearinghouse for Youth Studies)

Peach HG, Bath NE & Farish SJ 1998 “Comparison

of unsafe drinking between a rural and metropolitan

area”, Drug and Alcohol Review, 17:1, pp. 117–120

Factors associated with unsafe drinking in a rural

area were identified and the prevalence of unsafe

drinking and alcohol related mortality compared with

a metropolitan area. Alcohol consumption data were

collected from a random sample of adults in Greater

Ballarat. (Australian Professional Society on Alcohol

and Other Drugs)

Pozzi R, James R, Kirby G, Cassells J &

Wylie I 1996 “Using media to increase community

discussion: the rural alcohol campaign in Western

Australia”, Health Promotion Journal of Australia,

6:3, pp. 50–51

18 Prevention of harm from alcohol consumption in rural and remote communities


A media-based alcohol education campaign was

developed to address the high alcohol-consumption

levels and associated harm occurring in the North

West and Goldfield regions of Western Australia. The

aim of the campaign was to encourage community

discussion of the personal and social effects of unsafe

alcohol consumption. (Australian Association of

Health Promotion Professionals)

Sitharthan T, Kavanah DJ & Sayer G 1996

“Moderating drinking by correspondence: an

evaluation of a new method of intervention”,

Addiction, 91:3, pp. 345–355

Recognising the need to offer alternative methods of

brief interventions, this Australian study developed

correspondence treatments for low-dependent

problem drinkers and evaluated their impact. High

levels of consumer satisfaction, a high representation

of women and a substantial participation from

isolated rural areas attested to the feasibility of

the correspondence programme as an alternative

treatment. (Society for the Study of Addiction to

Alcohol and Other Drugs)

Major C 1995 “More feet on the … ground”,

Connexions, 15:5, pp. 22–25

This Australian article investigates a change in the

Murrumbidgee and Hume Districts in South Western

New South Wales where a shared alcohol and drug

coordinator position was replaced by two worker

positions. This was seen as not only increasing

services but redirecting responsibility through the

local community health centre. This trial may be seen

as a model for future structural changes in country

NSW. It does however depend on commitment to

alcohol and drug issues from local health authorities

to make it a success.

Helliwell D, Reilly D & Rippingale C 1992

“Establishing a drug and alcohol service in an

Australian rural area”, Drug and Alcohol Review, 11:4,

pp. 371–378

This paper describes the development of a drug

and alcohol service from the perspective of a local

general practitioner. Reference is made to problems

of community resistance, hospital issues and the

steps taken to acquire knowledge and skills in the

management of patients presenting to the practice.

(Australian Medical and Professional Society on

Alcohol and Other Drugs)

Audiovisual

Rural Health Education Foundation 2006

The “Can Do” initiative. Managing mental health and

substance abuse in general practice, ACT: Rural Health

Education Foundation

This DVD, presented in a panel discussion style, aims

to equip general practitioners in rural and remote

areas, to identify, treat and support people with

mental health and substance abuse issues. Support

information is available at www.rhef.com.au

DrugInfo Clearinghouse no. av GC42 RUR

Lillie S & Parkin J 2003 Club Eyerus, Windsor, NSW:

Hawkesbury Film Project

This is the second video production of the

Hawkesbury Film Project, an initiative of Hawkesbury

District Health Service and Hawkesbury Police

Command. This prevention project was aimed at

involving young people, from the region, in the

creation of drug education videos that were relevant

to their environment and experiences.

DrugInfo Clearinghouse no. VID JF24 HAW

All material listed is available from the Australian Drug Foundation library.

Membership to the library is open to professionals in Victoria who work in the areas of health, welfare, and education.

Members are able to borrow from the collection as well as access other services provided by the library. Membership is free

to these groups.

For more information about membership or how to access material:

Tel. (03) 9278 8121 (Monday to Friday, 9am to 5pm)

Fax. (03) 9328 3008

Email library@adf.org.au

Or visit our website at www.druginfo.adf.org.au/library

Reading and Resource List | No. 22 | February 2008

19


www.druginfo.adf.org.au

DrugInfo Clearinghouse

409 King Street West Melbourne VIC 3003

Email. druginfo@adf.org.au

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