PHE5CSP: Social and Culture Perspective in Public Health - Assessment Answer

Introduction

The term substance abuse is defined as the excessive usage of the drug in a manner that is detrimental to society, self, or both. The definition comprises both psychological and physical dependence. It comprises patterns for compulsive usage that is marked by recurrent relevant occupational, interpersonal, social, legal, and adverse consequences (Jordan & Andersen, 2017). The question that is considered here is, What is the impact of substance abuse within the Aboriginal Community and how can it be mitigated by providing them with the inclined care and guidance?

The issue that is considered here is restricted to the specific community so that extensive guidance and care can be delivered to them for mitigating the usage of the substances that can create adverse influence on their health. The essay will provide insight into the topic considered where the issue will be broadly defined, literature associated, and approaches utilized for addressing the question considered. Further, critical reflection will be provided to illustrate the understanding of the topic and its interpretation.

Main Body

The problem that is considered here is substance abuse among the Aboriginal communities of Australia. The term substance abuse denotes the illegal usage of drugs or over-the-counter or usage of prescription alcohol for rationale other than what they are supposed to be utilized or in the inclined amounts. The common type of drug that was related to hospitalization is Methamphetamines which accounted for around 3,126 or 25% of hospitalizations. There is an incline in the usage of analgesics or painkillers for non-medical reasons by the Indigenous Australians and the proportion has been significantly fluctuating. Drugs and other substances act as the contributing factor to disease & illness, injury & accident, crime & violence, workplace & education, and social disruption problems. Illicit drug usage comprises a wide range of categories that includes inadequate pharmaceutical usage, psychoactive substances, and illegal drug usage (James et al., 2020). Substance usage is related to mental health issues and has also led to the critical factor in the occurrence of suicides. The studies illustrate that there is a higher proportion of hospitalization for Indigenous people who have been diagnosed with substance use disorders for suicidal tendencies and mental health conditions. The usage of substances such as inhalants or drugs is associated with different medical situations. It also comprises drug users injecting them that inclines the blood-borne viruses such as HIV or hepatitis, opioid, and heroin consumption. 

Additionally, there are risky sexual behaviors that are related to illicit drug and alcohol usage that leads to inclined STIs (sexually transmitted infection) among younger people. Considering the communities there is an inclined possibility for the social disruption that occurs due to domestic crimes, assaults, and crime. Substance abuse and other drugs have a critical role in indigenous involvement within the criminal justice system (Gibberd et al., 2019). The volatile substance usage that includes inhaling products such as spray paints, glue, and aerosol deodorants is difficult to control due to the active substances that are present within the common products due to their legitimate usage. Society is involved here as the extensive substance abuse impacts the young population and it is identified that they are most impacted due to this. Common inhalants are readily available, inexpensive, and legal substances. Individuals who are making use of these substances as inhalants are risking sudden death, the continuous usage leads to social alienation for the people who sniff, long-term health issues, declined self-esteem, and violence (Government, 2023). These instances depict the impact that might be created on society and the well-being of the people who make substance use. The literature review will be providing insight into the facts and figures illustrating the problem.

The data obtained through the Australian Burden of Disease study on the causes and impact of the death and illness of the Aboriginal people was the illicit drug usage in the year 2018 and it is regarded as the fourth highest contributor that lead to the total disease burden. The highest contributor that led to an impact on the health of the Aboriginal community was the use of cannabis around 1.6%, 2.2% opioid use, and amphetamine usage 1.9%. The information illustrated that more than that quarter i.e. around 28.3% of the Australians who are above 15 were making use of the illicit substances. The consumption among males was high as compared to females which is 36.7% in comparison to 21.1%. The people who are around 45 years or above had a substance usage of 21.2% as compared to the people who are between 15 to 29 years is 32.9% and for those who are between 30 to 44 years is 31%. The illicit drug or substances utilized by the Aboriginal people were hashish, cannabis, and marijuana resins at 24% within the last 12 months. Here, the consumption of females was around 17.7% and 31.4% of the males but it illustrates that both the entities are making use of the substances that will be harmful to them and might lead to severe health concerns.

Additionally, there is a low proportion of the usage of other drugs that included cocaine and heroin where the consumption was around 5.9% (AIHW, 2023). Further, sedatives and analgesics which include sleeping pills, tranquilizers, and pain killers were 3.8%, speed or ice, amphetamines were 3.3% and designer drugs or ecstasy were 3.3%. The statistics from NDSHS s2019 illustrate that drugs other than cocaine, hallucinogens, and ecstasy high proportion of Indigenous Australians who were aged 14 made use of illicit drugs. It is identified that 23% or one-quarter of Indigenous Australians are making use of the illicit drug and it accounts for 1.4 times more as compared to the non-Indigenous Australians which is 16.6%. Further, 15.5% of the Indigenous or Aboriginal people are making use of cannabis within the last 12 months and it is 1.3 times higher in comparison to the non-Indigenous Australians which is around 12.0%. Approximately, 3.1% of the Aboriginals are making use of amphetamine/meth within 12 months, which is 2.4 times higher as compared to the non-Indigenous Australians (1.3%). In the year 2018-2019, more than half of the Indigenous Australian smokers who were above 15 years attempted to quit smoking in the last 12 months, 18% had attempted to minimize their smoking and a further 21% had attempted to do both (AIHW, 2023).

The Indigenous Australians smoked around 10 cigarettes a median per day in the year 2018-19 which illustrates a decline in consumption in 2008 by 12 cigarettes. It is determined that 1 among the 2 Indigenous Australians have mental health issues for daily smokers which accounts for 46% and around 2 in the 5 approximately 39% are making use of the substances in the last 12 months. Additionally, it is high for the Indigenous people who possess long-term health situations that is 24% and 33% respectively, and those who do not have long-term issues account for nearly around 29% and 39% simultaneously. From the timeframe of 2013 to 2017 the alcohol-related deaths from the 100,000 population was around 23.8% and for non-indigenous Australians, it is approximately 4.7% as per ABS 2018. The annual report of the Penington Institute illustrated that in the year 2020, the state per capita for unintentional drug-associated deaths was 3 times high for the 100,000 population for the indigenous population. It was 18.1 and 5.6 for the indigenous and non-indigenous people. The rate of unintentional drug-induced deaths that have taken place from 2001 to 2019 is a fluctuation that ranged from 19.3 deaths to 21.9 (AIHW, 2023).

The age-standardized rate for hospitalizations associated with drug usage among Indigenous Australians has been inclined to 8.1 from 3.4 per 1,000 population. The indigenous patients that were hospitalized for drug usage from 2017 to 2019 were because of behavioral or mental disorders that happened due to the substance usage and poisoning resulted in 39% and 2% was of the other direct harms that were imposed. It is anticipated that approximately 16,645 healthy lives were lost via Indigenous Australians in 2018 attributable to the illicit usage of the drugs. Illicit drug usage is regarded as the second leading risk factor that contributes to the burden that was imposed on indigenous Australians that are aged between 15 to 24 years. The difference in age structure among Non-Indigenous and Indigenous populations illustrates the complete burden that is attributable to illicit drug usage which is 3.7 times more for the Indigenous or Aboriginal community (Government, 2023). The total health gap of around 7.4% was determined between the two communities.

Different treatments are provided across Australia for assisting people who are going through problematic drug usage to minimize the harm created through the usage of the drug involves education or counseling. Further, certain treatments utilize abstinence-oriented interventions that will furnish assistance in the development of the skills that will furnish substance-free lifestyles. In the year 2021 to 2022, approximately 228,451 treatment episodes are delivered to people for drug or alcohol use. Nationally, 1.8 treatment episodes were received via clients on average (Australia, 2021). Under this, counseling is regarded as the common treatment that is being delivered to the Aboriginals who are involved in substance abuse. It involves 36% which is 1 in 3 for all the treatment episodes that are being followed via assessment that is 21% and 15% support & case management is provided (AIHW, 2023). The individuals who are experiencing dependency on opioid drugs that comprises oxycodone, codeine, and heroin are being provided with pharmacotherapy treatment. It involves the replacement of the opioid drug that has a dependence on long-lasting medically prescribed opioids (such as buprenorphine or methadone formulation).

The NOPSAD (National Opioid Pharmacotherapy Statistics Annual Data Collection) is liable for providing data on the clients who are attaining opioid pharmacotherapy treatment. The treatment was given to nearly 6,318 clients who are Indigenous Australians which denotes 71 per 10000 people. Buprenorphine is a long-lasting injectable that was utilized in 2020 for the first time and they have 0.9% of the Indigenous clients, the proportion of these people attaining this treatment inclined in 2022 by 7%. The OSR (Online Service Report) illustrated that 80 organizations across Australia were providing treatment or alcohol and drug services to nearly 39,400 people. The HPF (Health Performance Framework) for Aboriginal and Torres Strait Islanders is liable for monitoring the progress in terms of health system performance, and wide determinants of health (AIHW, 2023).

The drug strategy is formulated by the concerned authorities for National Aboriginal and Torres Strait Islander Peoples to improvise the health & well-being of the people through prevention and reduction of the harmful impact of alcohol and drugs on the families, individuals, and communities to which they belong. The three pillars that have been included for harm minimization are demand, supply, and harm reduction. Under demand reduction, the strategies are included for prevention of uptaking the drug usage delay within the usage, reduction in misusing the alcohol and using the tobacco along with other drugs for supporting the people for recovering from the dependence and reintegrating with the community. Supply reduction involves strategies for work for prevention, stopping, disruption, or reduction within the production as well as supply of illegal drugs. Controlling, managing, and regulating the availability of legal drugs (McKenzie et al., 2016). Within harm reduction, the strategies work for the reduction of the adverse social, economic, and health consequences related to tobacco, alcohol, and drugs on individuals, communities, and their families. The National Drug Strategy is based on building up the longstanding partnership among law and health enforcement sectors that aims at building healthy and safe communities for the minimization of tobacco, alcohol, and various other drugs. A petrol sniffing strategy executed by the Australian Government that replaces unleaded petrol with alternatives of low aromatic has created a significant decline in petrol sniffing (Health, 2022). In Australia, the treatment might be delivered in the community or residential settings via the assistance of specialist alcohol along with other drug treatment services, such as Aboriginal Medical and primary health care services.

I have determined that there is a broader range of initiatives, actions, and initiatives that are underway or planned that will allow individuals to attain the inclined outcomes for the Aboriginal community. The Health Plan is created by the respective healthcare professionals and concerned authorities with the evidence-based long-term policy framework for closing the Gap that furnishes Indigenous people with the disadvantage. It is determined that the cross-sectoral efforts are being supported, and improvised for ensuring the integrated approach. Under this the continuous involvement among police, AOD services, communities, local government, and retailers in limiting the supply of methylated spirits, volatile substances, and various other intoxicated retail products (Committee on Drugs, 2019). The illicit drugs are anticipated to cause nearly 3.4% of the disease burden, and deaths of 2.8% of the indigenous people.

The strategies that are efficient within this context comprise indirect price controls through the ban of cheap high alcohol content beverages, for example, cask wine, few outlets, culturally sensitive enforcement of the existent laws, and dry-community declarations. The preventive strategies that can be utilized here include health promotion, early intervention, provisions for the alternatives for AOD usage, alcohol bans, education, restrictions & bans on supply hours, and community-led initiatives (Snijder et al., 2019). For optimized treatment results, different treatment options are applicable that aim at the reduction of the individual demand, it comprises brief intervention, screening, pharmacotherapies, social & ongoing support, counseling, and withdrawal management for reducing the relapse rates that have to be available. The efficient harm reduction strategies include imposing bans on the serving of alcohol within the glass containers, sobering-up shelters, night patrols, drink-driving laws, community alcohol, community alcohol, and efficient management plans.

Conclusion

From the above analysis on the topic, it is determined that substance abuse takes place when prescription medicine, alcohol, and illegal and legal substances are consumed in the wrong way or too much. It is determined that substance abuse is high among the Aboriginal or Indigenous people in Australia as compared to the non-Indigenous people across the country. The different treatment programs are initiated by the concerned authorities to reduce the demand of the individual for the usage of the drug. It comprises withdrawal management, counseling, residential rehabilitation, and pharmacotherapies. Different initiatives are being taken by healthcare professionals and the government for ensuring that drug abuse can be minimized or eradicated. It is essential that identical services are being given to the indigenous or aboriginal community and non-indigenous community.

References

AIHW. (2023a, April 26). 2.17 drug and other substance use including inhalants. AIHW Indigenous HPF. https://www.indigenoushpf.gov.au/measures/2-17-drug-other-substance-use-including-inhalants

AIHW. (2023b, April 26). Alcohol, Tobacco & Other Drugs in Australia, Aboriginal and Torres Strait Islander people. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/aboriginal-and-torres-strait-islander-people

Australia, C. of. (2021). National Aboriginal and Torres Strait Islander Health Plan 2021 – 2031. health.gov.au. https://www.health.gov.au/sites/default/files/documents/2022/05/national-aboriginal-and-torres-strait-islander-health-plan-2021-2031.docx

Committee on Drugs , I. (2019). National Aboriginal and Torres Strait Islander Peoples Drug Strategy. health.gov.au. https://www.health.gov.au/sites/default/files/national-aboriginal-and-torres-strait-islander-peoples-drug-strategy-2014-2019_0.pdf

Gibberd, A. J., Simpson, J. M., Jones, J., Williams, R., Stanley, F., & Eades, S. J. (2019). A large proportion of poor birth outcomes among aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2252-4

Government, A. (2023, January 30). 2.17 drug and other substance use including inhalants. AIHW Indigenous HPF. https://www.indigenoushpf.gov.au/measures/2-17-drug-other-substance-use-including-inhalants

Health, A. I. (2022, March 30). Drug strategy in Australia. Alcohol and Other Drugs Knowledge Centre. https://aodknowledgecentre.ecu.edu.au/key-resources/drug-strategy-in-australia/

James, D. B., Lee, K. K., Patrao, T., Courtney, R. J., Conigrave, K. M., & Shakeshaft, A. (2020). Understanding the client characteristics of aboriginal residential alcohol and other drug rehabilitation services in New South Wales, Australia. Addiction Science & Clinical Practice, 15(1). https://doi.org/10.1186/s13722-020-00193-8

Jordan, C. J., & Andersen, S. L. (2017, June 20). Sensitive periods of substance abuse: Early risk for the transition to ... sciencedirect. https://dash.harvard.edu/bitstream/handle/1/33490762/5410194.pdf?sequence=1

McKenzie, H. A., Dell, C. A., & Fornssler, B. (2016). Understanding addictions among indigenous people through social determinants of health frameworks and strength-based approaches: A review of the Research Literature from 2013 to 2016. Current Addiction Reports, 3(4), 378–386. https://doi.org/10.1007/s40429-016-0116-9

Snijder, M., Stapinski, L., Lees, B., Ward, J., Conrod, P., Mushquash, C., Belone, L., Champion, K., Chapman, C., Teesson, M., & Newton, N. (2019). Preventing substance use among indigenous adolescents in the USA, Canada, Australia and New Zealand: A systematic review of the literature. Prevention Science, 21(1), 65–85. https://doi.org/10.1007/s11121-019-01038-w

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