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Substance Misuse in Australia

Dependency in modern society presents itself in many forms. While many such as alcohol, tobacco, and illicit drug misuse have been an issue for a long time, prescribed substances are now posing just as much of an issue. The impacts of dependency are felt by the individual both physically, mentally, and by their friends and family. The effects on Australia are substantial, with them being felt throughout society, the health system, and the economy. Working in community services gives you the opportunity to play a part in helping those with dependency issues, with roles in community services, rehabilitation, and alcohol and drug recovery providing many different options to make a difference.

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Misuse of alcohol

While alcohol plays a prominent part in the social lives of Australians, the negative side effects cannot be ignored. Alcohol related health issues account for approximately 4.5 percent of the burden of disease. Additionally, with 1,452 people dying because of alcohol misuse in 2020, 1 in 3 Australians saying that they use alcohol at a risky level (drinking more than 2 standard drinks per day), and the highest rate of drug and alcohol related ambulance call outs being due to excessive alcohol use, it is easy to see why alcohol is one the biggest substance related issues facing Australia today.

Alcohol is a depressant, which does not necessarily mean it makes you depressed, rather it depresses the nervous system, it slows it down. This means that your brain and body take longer to communicate with each other. Short term effects of alcohol include making you feel relaxed, it can cause you to have trouble moving, say things you would not normally say, become angry, and have blurred vision. In the long term, alcohol can cause health issues such as cancer, liver damage, heart problems, and diabetes. Furthermore, alcohol can lead to financial troubles, relationship breakdowns, and depression. As well as inflicting harm on the individual using alcohol, the consumption of it leads to more car accidents than any other factor in Australia and is the number one contributing factor in approximately 30% of fatal crashes.

Aboriginal and Torres Strait Islander peoples, while less likely to consume alcohol overall, are more likely to drink at dangerous levels over their lifetime or on a single occasion. The reasons for this are varied and include generational trauma, racism, difficulty finding housing and work, and family separation. Aboriginal and Torres Strait Islander peoples are more likely to die from alcohol related conditions and alcohol accounts for 8.3 percent of the burden of disease for Aboriginal and Torres Strait Islander people, which is 2.3 times that of non-Indigenous people.

There are many resources, programs, and services available for those who have an alcohol dependency or are misusing it. Groups who provide these include Lifeline, Alcoholics Anonymous Australia, DrinkWise, and the Alcohol and Drug Foundation. Each of these are Australian based organisations who can provide help and advice anonymously. Organisations such as Lifeline and Beyond Blue aid in dealing with mental health issues that may be contributing to or have occurred because of the alcohol use.

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Misuse of tobacco

According to the Australian Government, smoking tobacco is the leading cause of preventable diseases in Australia and contributes to 9.3 percent of the burden of disease. In recent decades, there has been a concerted effort by Australian governments to reduce the number of smokers through both advertising campaigns and making tobacco more expensive through taxes on cigarettes. This has resulted in a 10 percent drop in adults who are daily smokers, from 23.8 percent in 1995 to 13.8 percent in 2017-18. Furthermore, the proportion of adults who have never smoked has risen, as has the number of young adults who have not smoked. Men are more likely than women to be a daily smoker and the average number of cigarettes smoked per day is 12.3, which is approximately half a pack, where a pack is 20 cigarettes.

The chemical in tobacco which causes it to be so addictive is called nicotine. As opposed to alcohol, which is a depressant, nicotine acts as a stimulant on the brain, which speeds up messages between it and the body. Nicotine occurs naturally in tobacco and is also present in other smoking related products such as e-cigarettes and vapes which do not use tobacco but instead use a flavoured liquid with a heating element. When first using tobacco or other smoking products containing nicotine, an individual may experience things such as nausea, dizziness, or headaches. Those who use it consistently and build up a tolerance can experience an increased heart rate, relaxation, and mild stimulation. A large quantity of nicotine taken at once can cause serious effects such as confusion, seizures, and in the worst case, respiratory arrest and death.

Although nicotine has its negative effects, it also can be used to help people quit smoking through nicotine replacement therapy. This therapy is based on an individual taking reduced amounts of nicotine through products such as gums, lozenges, or slow-release patches. This allows smokers to get their nicotine fix without having to smoke and to then stop smoking tobacco slowly. Organisations such as the Lung Foundation Australia and Quit offer free help for people looking to quit smoking or who are in the process of quitting. Quit operates the Quitline, which is a service that smokers looking to quit can call to speak to professionally trained counsellors for advice on quitting.

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Misuse of illicit drugs

The phrase illicit drug use encompasses a range of different substances which include illegal drugs, pharmaceutical drugs, and other substances which can be legal or illegal such as synthetic drugs like kava (synthetic cannabis), and substances such as glue and petrol. The most used illegal substance is cannabis, followed by cocaine and then ecstasy. In 2019, 1,865 deaths were caused by drug misuse and in the past decade, the most drug-induced deaths were caused by opioids, equating to 4.6 deaths per 100,000 members of the population. Opioids include drugs such as heroin and prescribed opioid based painkillers like codeine, oxycodone, tramadol, and fentanyl. Illicit drug use contributes to approximately 3 percent of the burden of disease in Australia, 37 percent of which is opioids, followed by amphetamines (21%), cocaine (11.4%) and cannabis (8.3%).

More people die each year from prescription opioid overdose compared to deaths caused by heroin, which is a reverse of the 1990’s where heroin was the opioid causing the most deaths. It was at the end of the 1990’s that companies who make opioid based painkillers, told the medical community that patients would not become addicted to their medication. This has led to a worldwide opioid crisis, with 70% of worldwide drug related deaths being caused or related to opioid use. Opioid based substances are so addictive and prone to misuse because they cause your brain to release a large amount of endorphins, which are the feel good neurotransmitters which muffle feelings of pain and create a powerful sense of pleasure and well-being. This feeling drives people to increase their dose more and more as they develop a tolerance to the drug.

Numerous plans have been put in place to try and halt the worsening situation with the misuse of opioid based substances. In Australia, the TGA (Therapeutic Goods Administration) will require companies to use smaller pack sizes for their opioid products. They will also require changes to warnings on the packaging, as well as the inclusion of precautions and warning information. Indications (which are the appropriate circumstances for the use of medicine) will also be altered to state that they are only to be used when other painkillers have been shown to be ineffective.

Groups such as Turning Point provide online and telephone support for those who are dependent on a substance. State governments, including those of New South Wales and Queensland, fund programs to help those with opioid dependence. These treatment programs allow people to access opioid replacement therapy, which helps them stop their illicit opioid misuse and to focus on improving their health and lifestyle to eventually live drug-free.

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Withdrawal after misuse

When an individual stops using a substance that they have been dependent on, they can experience withdrawal symptoms. The severity of the symptoms depend on a range of factors which include the type of substance, the duration it was used, the individuals age, physical and psychological traits, and the type of withdrawal process used. Symptoms include anxiety, changing moods, aches and pains, cravings, and nausea. The worst symptoms can include paranoia, tremors, and disorientation. The most dangerous method of withdrawal is going “cold turkey”. Cold turkey is when a person suddenly stops, without medical assistance, using the substance they were dependent on. Doing so is extremely dangerous and can in the worst-case scenario, cause death. Overall, withdrawal is a process which requires strong support from medical professionals, family, and friends. The support is pivotal in the case of relapse, to be there to reassure the person that they have not failed and to then assist them back on track to reach their goal of conquering their dependency.

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Careers in alcohol and other drugs

Apart from medical professionals such as doctors, psychologists, and psychiatrists there are many other positions which work with people to overcome their substance misuse and dependency. Additionally, there is strong growth predicted in roles relating to alcohol and other drugs. Some of these include:

• Alcohol and other drugs worker: As an alcohol and other drugs worker, your tasks include supporting, providing information and advice to clients about alcohol and other drugs and supporting the families of clients. You may also be responsible for coordinating community service agencies and you will be in communication with government organisations to promote awareness about drug issues. Currently, the average salary of an Alcohol and Other Drugs Worker is between $51,900 and $64,800 per year. To be qualified for this role, you will need to hold a diploma of mental health.

• Case Manager: Working as a case manager, your main roles and responsibilities will include providing counselling to individual clients and conducting group sessions, monitoring each person’s progress, developing relationships with various stakeholders involved in the support of your clients, and developing individually tailored case management plans for each client which address issues such as employment, family, health, and education. The average salary for a case manager in Australia is $79,600 per year. Attaining a diploma of counselling or a diploma of community services is generally required for this role.

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Substance misuse continues to be a serious issue in Australia. Alcohol and tobacco have been and still are the most misused substances, while the misuse of prescription and illicit opioids present as some of the most dangerous and insidious substances available. Despite this, government programs and the hard work of organisations such as Quit, Lifeline, and Turning Point are making a real difference in the lives of people who are dependent on a substance.

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