- Alcohol and other drugs services in Australia
- The National Drug Strategy 2017-2026 recognises seven ‘priority populations’ who are particularly vulnerable to alcohol and other drug (AOD)-related harm. This chapter evaluates Australia’s AOD service provision, with particular focus on the unique health challenges these priority populations face and the systemic barriers that impede their access to treatment. The discussion extends to critical workforce challenges within the AOD sector, and includes consideration of potential strengthening strategies, while also highlighting the essential contribution of family support and peer workers—individuals with living or lived experience of AOD harm—in delivering effective care.
Demand for services
4.2Most AOD treatment services are provided through the Australian Government’s Drug and Alcohol Program. Demand for such services is significant: according to the Australian Alcohol and Other Drugs Council (AADC), ‘Australia’s AOD sector provides 235,000 episodes of care to at least 131,000 Australians each year’.
4.3There are also a number of other harm reduction services that support people with AOD-related problems, such as, for example, Needle and Syringe Programs (NSPs) which distribute more than 50 million sterile needles, syringes and other injecting equipment annually. These programs also offer an estimated 1,800 occasions of care in the form of health education and referrals daily across the country.
4.4In its analysis of AOD treatment services in 2022-23, the Australian Institute of Health and Welfare (AIHW) found that more than 46 per cent of clients are new to treatment. Most clients lived in major cities and inner regional areas, although the rate of clients was highest in remote and very remote areas—1,133 and 1,412 per 100,000 people respectively, compared to 487 per 100,000 people in major cities.
4.5In its submission, the Alcohol and Drug Foundation (ADF) explained that individuals are generally required to contact the service personally, and they are able to access help and support via a range of access points or ‘front doors’:
Some access points refer through to other access points so people seeking help are connected to different providers as they seek to understand the best option for their needs … Many referrals come through other sectors: Emergency Departments, housing services, mental health providers, community health services, AOD treatment services directly, pharmacy, and the justice system.
4.6ADF further noted that many individuals simply use search engines, with the organisation’s website receiving 85 percent of its 10 million annual visits through Google.
4.7AOD telephone services often represent the first option for people experiencing substance use harm. Adis, which provides information, brief counselling and referral services for individuals with AOD concerns and their loved ones (as well as health professionals), currently operates in Queensland, South Australia, New South Wales, and Western Australia. Other states have similar AOD telephone support services. Mrs Kiara Palmer, Acting Director of Adis 24/7 Alcohol and Drug Support in Queensland, told the Committee that the service receives about 3,000 phone calls a month from different parts of the state, and about 300 contacts via their WebChat function.
4.8The Matilda Centre for Research in Mental Health and Substance Use (the Matilda Centre) submitted that AOD treatment episodes have increased more than 20percent in the last decade. There is, however, still substantial unmet demand for treatment. In 2019, the University of New South Wales Drug Policy Modelling Program estimated annual unmet need for AOD treatment to be between 26.8 and 56.4 per cent. There is also substantial delay in accessing treatment, with estimates indicating that, on average, Australians live with substance use problems for 18 years before making initial contact with treatment services.
4.9In reflecting on the process for accessing treatment services, the Queensland Nurses and Midwives’ Union (QNMU) asserted that long wait times are a significant challenge, and can result in lost opportunities for initial engagement:
After the initial referral has been made, it can take weeks before a suitable time slot for an intake assessment. It may be a further week for the service to discuss the suitability of the referral and, if accepted, to allocate a case manager, and another week before the first meeting between the case manager and consumer can take place. It is not unheard of for some consumers to wait up to 8 weeks before being able to start treatment.
4.10This challenge was echoed by Ms Stephanie Taylor, who shared her experience of navigating the health sector to support her brother Richard in his battle with alcohol use disorder. Ms Taylor’s submission outlines the difficulty of first having her brother agree to seek help, and then accessing treatment services:
This is a soul destroying process as you learn very quickly hospital detox beds and rehab spots are incredible hard to secure. For example, each time our family reached the desperate point of encouraging Richard to go to rehab, it had to be on his terms. He was an adult who had ultimate control of whether he went to hospital detox and rehab. The number of phone calls I made to hospitals and rehabs in sheer desperation, crying and begging for help, only to be met with, ‘call back in a month’ or ‘we do have a detox bed, but I’m sorry you are not in our local area’ or ‘can you please have Richard call us’.
4.11Ms Taylor also highlighted the challenge of navigating bureaucratic requirements to access help:
On some occasions, after days of ringing around, I would secure a rehab place for Richard, get him to a point of calling them to confirm he wanted to go to rehab, only to be told he must complete hospital detox first. We lost so many rehab places as we could not secure a hospital detox. On several occasions I would speak with a wonderful healthcare worker, very kind and compassionate, who had detox beds available but couldn’t offer Richard a spot as he was not in the local area.
4.12An inability to access services when they are needed, as Ms Taylor’s account demonstrates, can result in a lost opportunity to engage with health services:
On more than five occasions, we would secure a hospital detox bed and/ or rehab spot for a few weeks away, but Richard would then decide he did not want to go.
4.13This point was similarly highlighted by Ms Rachel Allen, who lost her son Dylan to alcohol use disorder:
We sometimes get a window—I have often talked about this—or a space to make a difference, and if all those resources don't come together and align at the time then that opportunity is gone.
4.14The Australian National Centre for Youth Substance Use Research (NCYSU) reiterated that long waitlists in public services, high gap fees in private services, and a lack of available services in regional and remote communities made it difficult for many Australians to access treatment. For those who do, the average number of service contacts per year is only 1.8, which is not regarded as effective or consistent with evidence-based clinical guidelines.
4.15Multiple witnesses highlighted that the lack of services was particularly grave in rural and remote areas. Drug ARM submitted that these areas are underserviced and explained that its Clean Needle Program in Adelaide saw clients travelling significant distances from rural areas to access essential harm reduction services.
4.16In her submission, Ms Taylor stated that ‘[t]here is, without question, a strong need for more services,’ adding that ‘[l]iving in Sydney, you can’t assume that a high population provides greater access to services’. Multiple submissions asserted that an inability to access services in a timely manner would ultimately result in increased presentations to emergency departments.
Priority populations
4.17Evidence presented in the course of this inquiry repeatedly highlighted that whole-of-population strategies play an important role in reducing total harm and social impact of alcohol and drug use. There are, however, populations that are known to have a ‘higher risk of experiencing disproportionate harm (direct and indirect) associated with alcohol, tobacco and other drugs’. The Committee accepts that, for these populations, it is appropriate that a more tailored approach is taken to tackle the impact of AOD. The National Drug Strategy2017-2026 identifies the following priority populations:
- Aboriginal and Torres Strait Islander people
- people with mental health conditions
- young people (between ages 10 and 24)
- older people (aged 60 or over)
- people in contact with the criminal justice system
- culturally and linguistically diverse (CALD) populations
- people identifying as lesbian, gay, bisexual, transgender, and intersex.
- Some state and territories identify additional priority groups in their AOD strategies. TheTasmanian Drug Strategy 2024-2029, for example, includes people living in rural or remote areas, pregnant women and their partners, people experiencing sexual abuse and violence, families, friends and carers of people with AOD use problems, as well as people who use performance and image enhancing drugs as at-risk populations.
Aboriginal and Torres Strait Islander people
4.19The impact of AOD harms on Aboriginal and Torres Strait Islander peoples is recognised in the National Agreement on Closing the Gap(the Agreement), and efforts to address harmful substance use cut across most targets and outcomes set out in the Agreement. The following suite of documents further frames the national approach to addressing AOD harm among the Indigenous population:
- The National Drug Strategy 2017-2026, along with its sub-strategy National Aboriginal and Torres Strait Islander Peoples Drug Strategy 2014-2019,
- The National Aboriginal and Torres Strait Islander Health Plan (2021-2031), and
- The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing (2017-2023).
- In its submission, the Institute for Urban Indigenous Health (IUIH) stated that Aboriginal and Torres Strait Islander people are less likely to drink alcohol and use illicit drugs than non-Indigenous Australians. Those who do, however, are more likely to do so at problematic levels. The significant adverse health impacts of alcohol and other drugs on Aboriginal and Torres Strait Islander people in Australia continues to present a major source of concern.
- The Committee received substantial evidence demonstrating that Aboriginal and Torres Strait Islander people experience greater AOD harm than non-Indigenous Australians. Data from the AIHW and the National Indigenous Australians Agency (NIAA) reveals that mental health and substance use disorders continue to be the largest disease groups contributing to the health gap between First Nations people and non-Indigenous Australians. First Nations people (who comprised 3.3 per cent of Australia’s population in 2021) are overrepresented in the AOD treatment data, constituting 18 per cent of the AOD client cohort in 2022-23 and 12 per cent of opioid pharmacotherapy clients in 2023.
- The IUIH submitted that the rate at which Aboriginal and Torres Strait Islander people are hospitalised with alcohol related and substance use related diagnosis reflects the inadequacy of culturally responsive prevention and early intervention strategies. In the decade leading up to 2018-2019, hospitalisation for someone with a drug related diagnosis increase by 144 per cent for Aboriginal and Torres Strait Islander people, compared to 29 per cent for non-Indigenous Australians.
- The National Aboriginal Community Controlled Health Organisation (NACCHO) submitted that AOD use within Aboriginal and Torres Strait Islander communities must be viewed through the lens of trauma, and informed ‘by an understanding of the unique history of colonisation of Aboriginal and Torres Strait Islander peoples, their ongoing experiences of dispossession and marginalisation, of systemic and interpersonal racism, and intergenerational trauma’.
- Evidence presented to this inquiry identified the experience of trauma and the associated distrust of official institutions (including the health system) as a major barrier for accessing AOD treatment. Negative experience, magnified by the AOD-related stigma, presents a major challenge in providing timely AOD interventions. Uncertainty about where to access help, misunderstanding of treatment and diagnosis, and logistical challenges (such as the lack of transportation) all present additional barriers to care.
- A healthcare approach that is exclusively grounded in Western medical tradition can also adversely impact Aboriginal and Torres Strait Islander peoples. The submission provided by La Trobe University Centre for Alcohol Policy Research offers an example of the use of screening tools that were designed for Australians of western background, and which may not be effective for Aboriginal and Torres Strait Islander people. These tools rely on western frames of reference and assume western drinking patterns, which are relatively stable over time. National surveys tend to ask about overall frequency of drinking and the usual quantity consumed on each occasion. Such methods tend to be inadequate for the screening of Aboriginal and Torres Strait Islander peoples, whose drinking patterns may be more episodic and irregular.
- Multiple witnesses further highlighted that while Aboriginal and Torres Strait Islander people represent a significant percentage of the demographic receiving AOD treatment, the AOD service system is dominated by mainstream providers who may lack cultural competence. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) noted that the AOD service delivery is often hindered by difficulties in adapting mainstream work practices to meet the specific needs of Aboriginal or Torres Strait Islander clients, and called for system-wide recognition of the significance of culture and community in the healing process.
- Multiple witnesses emphasised the value of applying a ‘bicultural model of care’, which recognises Aboriginal and Torres Strait Islander ways of knowing, being and doing in the delivery of AOD services. The Aboriginal Health and Medical Research Council of NSW further endorsed community-based treatment, which predominantly occurs in an individual’s home or local community, and where the community becomes the ‘treatment facility’.
- The role of the Aboriginal Community Controlled Organisations (ACCO) in the delivery of AOD treatment services, and the emphasis on service designed in line with the Aboriginal Drug and Alcohol Residential Rehabilitation Network model of care, which prioritises life skills in addition to withdrawal management, are recognised as being central for AOD care in Indigenous communities. This is illustrated in the work of the Glen Group, an AOD rehabilitation service located on the Central Cost of New South Wales operated by Ngaimpe Aboriginal Corporation. According to research conducted by the Glen Group, its participants have higher treatment completion rates than counterparts at non-ACCO services.
- Evidence gathered in the course of this inquiry emphasised a strong preference for these services among Aboriginal and Torres Strait Islander peoples, whether in rural and remote communities, or in a metropolitan context. As IUIH noted, nearly 66percent of Aboriginal and Torres Strait Islander people live in urban areas in major cities and inner-regional centres, and it is expected that this population will continue to grow. There is an expectation that Aboriginal and Torres Strait Islander people will access mainstream services in urban areas, but the proximity to these services does not mean that Aboriginal and Torres Strait Islander people will access them. The IUIN stated that more community-controlled services in urban areas are needed, along with better referral pathways between ACCO and mainstream services.
- A significant portion of AOD services in Australia are funded by the Australian Government through the Primary Health Networks (PHNs), and many PHNs provide and support programs that focus on Aboriginal and Torres Strait Islander people. NACCHO submitted, however, that ‘PHNs often do not have the skills to engage with, commission or deliver services for Aboriginal and Torres Strait Islander communities’. NACCHO further explained that while there is a Guiding Principles document for PHN engagement with ACCHOs, this document:
… has not been updated in over a decade, does not reflect the Priority Reforms of the National Agreement and does not include accountability for engagement or any requirement for PHNs to demonstrate their performance against the Guiding Principles.
4.31NACCHO further expressed its disappointment that the National Aboriginal and Torres Strait Islander Peoples Drug Strategy 2014-2019 has not been updated in over a decade, and there were currently no mechanisms to support the inclusion of Aboriginal and Torres Strait Islander voices in the development of policies and programs for AOD use:
Aboriginal and Torres Strait Islander people have no direct voice to government in relation to AOD issues, since defunding of the National Indigenous Drug and Alcohol Committee (NIDAC). Furthermore, there is no Aboriginal and Torres Strait Islander representation on the Australian National Advisory Committee on Alcohol and Drugs (ANACAD), which is the principal advisory body to the government on AOD matters.
4.32Reflecting upon this situation, NACCHO stated that ‘[i]t is clear that the policy foundations for guiding government responses to AOD are woefully out of date and that urgent systemic reform is required’.
4.33The intersection between AOD abuse and family and domestic violence in Aboriginal and Torres Strait Islander communities has also been a feature of evidence presented to this inquiry. The Southern Aboriginal Corporation—an Aboriginal Community Controlled Organisation operating across the Great Southern, Southwest and Wheatbelt regions of Western Australia—noted, for example, that rates of reported drug offences, family assaults and breaches of violence restraining orders combined have almost doubled in the port city of Albany since 2016. In the same period, rates of Aboriginal children in the out-of-home care system in the Great Southern region have continued to grow. In 2023, more than 57 per cent of children in care in the region were Aboriginal.
4.34Adverse health and social outcomes related to parental AOD exposure continues to be a major concern within Australia’s Indigenous population. In its submission, NIAA highlighted the need for increased support for pregnant and parenting First Nations women and their children. Pregnant women frequently face the stigma associated with AOD use and difficulties in accessing AOD treatment (such as services that can accommodate parenting responsibilities) and support if they are experiencing family and domestic violence. These difficulties are further compounded for First Nations women.
4.35The impact and prevalence of Fetal Alcohol Spectrum Disorders (FASD) in Australia among priority populations, such as First Nations communities, is substantial. Multiple witnesses drew the Committee’s attention to the case of the Banksia Hill Detention Centre in Western Australia, where one third of 10 to 17 years olds were diagnosed with FASD in 2015–16, with 74 per cent of the detention population being First Nations children. These witnesses highlighted both the need for further research into FASD, and the need for campaigns such as Strong Born, designed to raise awareness of FASD and the harms of drinking alcohol while pregnant and breastfeeding among Aboriginal and Torres Strait Islander peoples.
4.36Petrol sniffing is also identified as a significant issue for Indigenous communities, causing serious health impact, including brain damage and death. NIAA expressed support for arrangements that facilitate the supply of low aromatic fuel to replace regular unleaded petrol. Low aromatic fuel is an unleaded petrol that has been designed to discourage people from sniffing by lowering the amount of the toxic aromatic components, which can cause intoxication. Drawing on longitudinal studies, the University of Queensland have indicated that introduction of low aromatic fuel has been highly effective, with a 95 per cent reduction in petrol sniffing from 2006 to 2018 in communities surveyed that stock low aromatic fuel.
People with mental health conditions
4.37AOD use disorders are often accompanied by co-occurring mental health disorders. In its submission, RANZCP noted that one third of individuals with an AOD use disorder also experience at least one co-existing mental health disorder. Some research indicates that only seven per cent of people with co-existing mental illness and substance use disorders will receive treatment for both conditions.
4.38Some witnesses noted that AOD use is to be expected in people accessing mental health services, and that the sector needs to adopt a collaborative approach to services. For example, RANZCP highlighted that for AOD services to be truly effective, AOD-related harm needed to be recognised as a mental health condition.
4.39Mind Australia Limited, a community-managed mental health provider, noted however, that entry criteria often restrict those who are experiencing mental health complexities from accessing AOD services, and vice versa. In some cases, this was a decision made by organisations delivering services, but as Mind Australia Limited submitted ‘in many cases this is a problem created by restrictive commissioning by government departments and other funding bodies, that excludes mental health or AOD considerations’.
4.40Ms Caroline Radowski, Executive Manager, Mental Health and Wellbeing at Brisbane North Primary Health Network further explained:
If you enter a mental health service and you come with a substance use disorder as well, what often happens is that you will be segregated back to the AOD sector. You will be asked to work on your substance problem and then come back to the mental health service. Straight away, you are fragmented in that way. What often then happens is that the practitioners on the AOD side don't have the mental health practitioners. It's very difficult to treat somebody separately for those two areas. You need to treat them holistically as a person.
4.41Describing the difficulties she experienced in accessing adequate support for her son, Ms Allen told the Committee:
In terms of community mental health and mental health facilities, he was overlooked due to his problems being considered purely alcohol related and not mental health related, although it was profoundly evident that his alcohol misuse was associated with his mental health. It couldn't be separated.
4.42Dr Elizabeth Moore, RANZCP President, acknowledged these difficulties, which can result in poor, and even tragic, outcomes:
The college notes that the current AOD services do not adequately address substance use disorders as a mental health condition. This leads to fragmented care, particularly in rural areas and among Aboriginal and Torres Strait Islander communities. For individuals experiencing substance use disorders alongside a comorbid mental health condition, they are likely to receive less effective management and treatment, as services are often ill-equipped to support individuals with complex presentations.
4.43While mental health issues and substance use are a common comorbidity, multiple witnesses asserted that neither mental health services nor AOD services are positioned to care for individuals experiencing both conditions. The Matilda Centre explained that ‘AOD workers feel overwhelmed when treating clients with co-occurring mental disorders, as they don’t have access to adequate knowledge and resources’. The latest national AOD workforce survey underscores this point, finding that more than 60 per cent of AOD workers want additional training to manage clients with co-occurring mental health issues.
Young people
4.44It is common to first commence AOD use during adolescence. The Matilda Centre noted that this is ‘the peak time for the onset of AOD use, with the initiation of alcohol use typically occurring during middle to late adolescence, and the onset of drug use during late adolescence’. This is a particularly vulnerable age, as the transition to adulthood is often associated with significant personal and social changes, such as the commencement of new employment or study, new living arrangements, and increased autonomy and responsibility.
4.45In recent years, Australia has seen some positive developments regarding AOD use among young people, with data showing a reduction in tobacco smoking and alcohol consumption among those aged between 18 and 24 years old. There has also been an increase in the average age of the initiation of tobacco smoking, drinking alcohol, and using illicit drugs.
4.46Unfortunately, however, young people remain the most vulnerable age group for risky drinking behaviours and illicit drug use. AOD use remains the top preventable cause of death among young people. In 2022-23, 42 per cent of individuals aged between 18 and 24 years old were at risk of alcohol related disease or injury. The Australian Research Alliance for Children and Youth also expressed concern that the average age of initiation of alcohol consumption, tobacco smoking and illicit substance use continues to be below 20 years old. The age of initiation is critical, as the Matilda Centre noted, because:
… early initiation of alcohol and other drugs increases the risk of negative outcomes, many of which can have long-term impact, including poor school performance, school dropout, juvenile offending, increased risk of drug dependence and mental illness during adulthood.
4.47The South Australian Commissioner for Children and Young People, Ms Helen Connolly, informed the Committee that ‘as young people navigate adolescence, it is normal for some to be curious, experiment and take risks, while others may never try drugs or alcohol’. Within the cohort of young people that does use AOD, only a small portion will develop substance use problems. Young people who do develop serious AOD issues often have a range of other vulnerabilities, such as experience with the justice system, exposure to family violence or a mental health diagnosis, which requires a multipronged AOD response.
4.48Ms Allen’s experience with her son Dylan echoes this evidence:
When he was 18 he started to drink along with many of his friends, however little did we know at that time that for him this was a decision that would destroy his life. Initially it was the need to fit it that drove him to drink however [over time] he became fully dependent on it, to the point where he was completely preoccupied with needing to drink on a daily basis. Because this coincided with him getting depression I felt it was a means for him to numb out his low opinion of himself while also drawing out his negative thoughts.
4.49Young people face numerous barriers in accessing services. According to the National Centre for Youth Substance Use Research (NCYSUR), only 11 per cent of male and 18 per cent of female young Australians with AOD disorders seek treatment. The Australian Association of Psychologists Incorporated (AAPI) suggested that young people are often reluctant to engage in health and treatment services. At times they may also have limited health literacy and difficulties navigating the health system. Other challenges may include geographic isolation, poverty, social exclusion, language barriers, and concerns about confidentiality.
4.50To enhance access to support, NCYSUR submitted that AOD treatment services and early intervention programs for young people need to be accessible in the environments in which they interact, including social media and messaging applications, as well as settings where they are at higher risk of AOD-related harm, such as universities, colleges and nighttime economies. Integration of AOD services with other youth specific service systems, such as primary and mental health services, homelessness services and services that address violence, is also acknowledged as being vital for tackling substance use problems in young people.
4.51Mr Andrew Bruun, Chief Executive Officer of Youth Support and Advocacy Services, further emphasised that effective engagement with young people requires a proactive approach:
… take the services to the young people, and make the right door for them to get through. Don't sit back and wait with no wrong door; go out there, engage, and create the right door. That now goes for South Sudanese young people, young people from Aboriginal and Torres Strait Islander backgrounds, and young people who are LGBTIQA+. Often, they all have their own requirements for how to make a service accessible and useful, and work on their terms.
Older people
4.52The National Drug Strategy notes that harmful use of prescription medication, and the effects of illicit drugs and alcohol is on the increase among older people (aged 60years and over) in Australia. Older people can be more susceptible to alcohol, tobacco and other drug problems as a result of difficulties with pain and medication management, isolation, poor health, significant life events and loss of independent living.
4.53In the course of this inquiry, dependency on benzodiazepines emerged as a particularly concerning issue among this population. Benzodiazepines, such as Valium, Xanax and Temazepam, are central nervous system depressants typically prescribed for anxiety and insomnia. Reconnexion, a service that provides treatment, education, and support for benzodiazepine dependency and withdrawal, noted in its submission that this class of medication is also commonly misused in illicit drug use for the same effects. Benzodiazepines are the leading pharmaceutical and single-drug contributor in polysubstance overdose deaths in Australia (65 per cent) and are the most common substance involved in drug-induced suicides (44 per cent).
4.54When benzodiazepines are indicated, Reconnexion explained, their use should be limited to short term dosages because of their high risk of dependency. About 80percent of people taking benzodiazepines as prescribed for longer than sixmonths will experience withdrawal if they stop. For some people, Reconnexion highlighted, withdrawal will be a protracted and debilitating experience, which can also cause seizures.
4.55These medications are prescribed disproportionately to older adults. Reconnexion submitted that this cohort is up to 56 per cent more likely to suffer hip fracture if prescribed a benzodiazepine. In older adults, benzodiazepines have also been linked to an increased risk of pneumonia, dementia and mortality. Reconnexion emphasised that, ‘with an ageing population, and high rates of older adult hospitalisations and emergency department presentations than ever before, Australia should be leading international efforts to curb inappropriate benzodiazepine prescription’.
4.56Reflecting on AOD use among older Australians, Emeritus Professor Jake Najman, Chair of the National Policy Council, Drug ARM, told the Committee:
We're starting to see a quite unexpected ageing of the illicit drug use pattern in the community. It's coming in a number of ways. One is that we're starting to see more middle-aged and older people affected by illicit drugs—or licit but overprescribed. At one stage, I looked at the number of people aged 65 and over, I think, who were being prescribed opioids. The percentage was extraordinary. Between 15 and 20 per cent of older women were receiving opioid treatment. I looked at that and thought it was extraordinary. We're finding that middle-aged men are now being diagnosed with attention deficit disorder and being prescribed amphetamines. We're also seeing a spike in alcohol use into older age. We're looking at this and thinking that the pattern of illicit drug use, which used to be tightly concentrated in young people, is now starting to reoccur in a different way in older age groups.
4.57The Committee was particularly concerned to hear about an increase in the use of counterfeit drugs. Mr Cameron Francis, Chief Executive Officer of the Loop Australia, which provides drug checking services, explained:
An example of what we are seeing at the moment … are significant numbers of people using counterfeit benzodiazepines. A lot of that is in response to untreated or undiagnosed mental health conditions. People are self-medicating using counterfeit benzodiazepines that they are purchasing on the internet. In that context they are developing dependence and, in some cases, worsening their mental health symptoms.
4.58Reflecting on Committee questions about the use of drug checking services among elderly people, Mr Francis drew the Committee’s attention to the use of counterfeit weight loss medications:
Their GP has prescribed them a weight loss medication, they've gone to fill the prescription and they can't afford it. They've gone online and searched for 'weight loss medication' on the internet and imported something from overseas then brought that down to us to have it tested because they're aware that there can be counterfeit substances.
Prison population
4.59People entering adult prison are more than four times as likely to report recent illicit drug use than people in the general community, and seven times more likely to drink to excess, according to the Legal Aid Commission of New South Wales (Legal Aid NSW). Mental health conditions also tend to be over-represented in the prison population.
4.60The Committee received evidence that there is at present an inequitable gap in the provision of harm reduction and prevention services in prisons. UNSW Drug Policy Modelling Program submitted that while people in prisons have high levels of drug and alcohol use compared to the general Australian population:
… a number of key harm reduction interventions are not available to people in prison. As a result, people in prisons experience much higher rates of blood borne viruses than the general public, including hepatitis C and HIV, and are at risk of overdose and highly-complex injecting-related injuries and disease such as septicaemia.
4.61This situation appears common, despite the fact that, as foregrounded in the submissions made by Drug Policy Modelling Program and the Australian Research Centre in Sex, Health and Society, Australia is a signatory to the United Nations Standard Minimum Rules for the Treatment of Prisoners. Often referred to as ‘the Mandela Rules’, these principles require healthcare in prisons to be equivalent to that in the community.
4.62In discussing health care provision in prison settings, Dr Simon Holliday highlighted that:
There is a natural tension between the prison authorities and those delivering healthcare to prisoners. Prison authorities need to ensure control of the environment ensuring the avoidance of any risks. Those delivering healthcare are trying to reduce symptoms and prevent or treat disease. My impression is that this is not a meeting of equals but one where the former dominates the latter. Given that incarceration is not an infrequent transit point in the lifecycle of a AOD consumer, prison policy may drive AOD outcomes.
4.63Multiple submissions criticised the lack of provision of clean injecting equipment in prisons (with the exception of the ACT), or NSPs, which are known to reduce the transmission of blood borne viruses. As such, people who inject drugs often use makeshift injecting equipment or share syringes, which increases the likelihood of spreading blood borne viruses like hepatitis C and HIV. The lack of NSP, it is suggested, runs counter to the Australian Government target to end HIV transmission and hepatitis C by 2030. The lack of access to ongoing AOD counselling as well as Opioid Treatment Programs (OTP) in the prison setting presents additional barriers to the equitable treatment for people in the prison system.
Culturally and linguistically diverse populations
4.64In Australia, the term CALD refers to ‘culturally and linguistically diverse’ individuals who were born, or have parents who were born in countries where English is not the predominant language, or whose culture may not align closely with Anglo-European norms. In 2021, nearly half of Australians were either born overseas or had at least one parent born overseas, and one in five spoke a language other than English at home.
4.65According to NCYSUR, CALD individuals remain substantially underrepresented in AOD research. Targeted programs for this cohort remain underfunded, NCYSUR further noted, and stated that ‘AOD services in Australia are failing to deliver equitable outcomes for individuals from Culturally and Linguistically Diverse backgrounds’.
4.66In its submission, NCYSUR explained that while people who are born overseas generally report lower rates of AOD use compared to people born in Australia who only speak English at home, those who are at risk of experiencing AOD related harms face significantly greater challenges and barriers to accessing treatment and support services. The scale of the problem is likely underestimated due to language and cultural barriers, and reluctance in some communities to speak about the AOD use due to stigma and cultural taboos.
4.67In instances where CALD individuals do seek help, current AOD services are said to lack culturally appropriate interventions and support systems. In its submission, Drug ARM, which provides mental health, AOD awareness, rehabilitation and management programs, reported ‘having to turn away non-English speaking clients due to lack of funding for interpreter services’.
4.68NCYSUR further highlighted similar barriers for the CALD population:
Research demonstrates that this lack of cultural tailoring results in distrust towards health services, decreased engagement, reduced self-efficacy in managing health, and poorer health outcomes. Limited availability of interpreter services, particularly in regional areas, combined with insufficient multilingual resources can lead to delayed or inadequate treatment for non-English speaking individuals seeking help.
Gay, lesbian, bisexual, transgender or intersex people
4.69Sexuality and gender diverse people continue to be a priority population in many state and federal alcohol and other drug strategies. According to ACON, an HIV and LGBTQ+ health organisation, there is a higher prevalence of AOD use, riskier use, and higher proportion of people accessing treatment within the lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) community compared to the general population.
4.70LGBTIQ+ people typically underutilise health services and delay seeking treatment. ACON explained:
The challenges that arise for LGBTQ people access health services, including AOD support, encompass a lack of cultural safety and inclusivity, fear of stigma relating to their gender and/or sexuality, compounded by multiple minority status such as Aboriginality, HIV status, disability or cultural background, the stigma associated with AOD use, and, in addition, the belief that AOD services lack appropriate expertise to treat LGBTQ people.
4.71In their submissions, researchers from the Australian Research Centre in Sex, Health and Society at LaTrobe University noted that AOD services do not adequately meet the demand for specialist LGBTIQ+ service provision. ACON further explained that many services in the community are run by faith-based organisations, and ‘while the work of these organisations is admirable, accessing such services can be challenging for members of the LGBTIQ+ community for fear of discrimination’.
4.72The Committee also heard evidence that mainstream services are generally not set up for the LGBTIQ+ population, which was reflected, for example, in residential rehabilitation programs often being segregated by gender. This approach is said to make these programs unsafe for some trans and gender diverse people.
4.73Similar to other population cohorts, there is a strong preference among LGBTIQ+ people for tailored support and tailored services, which produce better outcomes than mainstream AOD services. According to ACON, ‘[p]art of this is due to an inherent recognition of the unique profile and patterns of use within sexually and gender diverse communities, which may lead to different treatment needs and responses’.
Pregnant women and their partners
4.74FASD describes a range of neuro-developmental impairments. It is recognised as a lifelong disability, which impacts the brain and body of individuals who were prenatally exposed to alcohol.
4.75In recognition of the harm caused by alcohol use during pregnancy, the National Drug Strategy contains a specific sub-strategy that focuses on FASD as a major alcohol-related form of harm for pregnant women and their children. Some state and territory AOD strategies also identify pregnant women and their partners as a priority population within the context of AOD harm reduction efforts.
4.76Multiple submissions noted that, while there is a level of awareness of the health risks associated with drinking during pregnancy, and before confirmation of pregnancy, public education in this area needs to be further enhanced. Mrs Sophie Harrington, Interim Chief Operating Officer of the National Organisation for Fetal Alcohol Spectrum Disorders stated:
The Australian Department of Health and Aged Care should be applauded for their commitment to the implementation of the National FASD Strategic Action Plan. However, FASD prevention and training must be embedded into the national AOD framework. Universal screening for alcohol use in pregnancy, sustained public awareness campaigns and culturally safe education programs tailored to at-risk communities are essential. FASD informed care must be implemented across AOD services … with treatment models adapted to recognise the approaches required to support individuals with a brain based disability rather than continuing cycles of ineffective rehabilitation.
4.77Although the focus tends to be placed on mothers in the context of FASD, the National Drug Research Institute (NDRI) highlighted that father’s alcohol consumption has a direct impact on pregnancy and child outcomes through sperm development and biological changes to the foetus. These impacts include increases in spontaneous abortion, stillbirth, low gestational birth age, congenial heart disease, lymphoblastic leukaemia, and intellectual developmental disorders.
4.78NDRI further drew the Committee’s attention to a male partner’s role in social facilitation of maternal drinking, noting that women were more likely to drink alcohol during pregnancy if their male partners consumed alcohol. According to NDRI research, Australian pregnant women tend to drink in their own home, with over 75per cent of pregnant women drinking with their partner, and male partners initiating 40 per cent of drinking occasions. In reflecting on the evidence, NDRI suggested that:
Decisions about alcohol use during pregnancy are not solely made by women but also involve their male partner. Therefore, social facilitation of maternal drinking leading to alcohol exposed pregnancies is an important prevention strategy.
4.79The Committee heard that there are presently significant challenges associated with obtaining correct diagnoses for FASD, as well as supporting individuals living with FASD in an optimal manner. In sharing her experience of living with FASD, Ms Jessica Birch told the Committee:
Time today doesn't actually allow me to fully communicate the difficulty, confusion, humiliation and profound emotional pain of living with undiagnosed FASD or the many, many years of physical and mental illness during my journey to diagnosis, throughout which I was often blamed for my functioning, denied referral, gaslit, scoffed at and regularly dismissed and belittled by the medical professionals from whom I was seeking help, nor can I fully detail the ongoing challenges I face today in accessing informed health care and informed NDIS support. Suffice to say, had my mother not intervened in my health care or had I not received the family support that I did, it is arguable that I would be a living, breathing person in front of you today, such was the deterioration of my physical health and the severity of my despair.
4.80Ms Angelene Bruce, whose son is diagnosed with FASD, outlined similar challenges in obtaining correct diagnosis:
My son's first misdiagnosis was also moderate autism, even with his high risk exposure having been disclosed—they were told. I challenged that with a second opinion, and he was formally diagnosed with FASD at four, so he was really young. He also lives with extremely high anxiety and low confidence. I thought the correct diagnosis would open many doors to appropriate FASD-informed allied health services and I wouldn't have to disclose again. Sadly, this was not the case as, whilst ASD is broadly known by the public and extensively studied by allied health and medical students across Australia, FASD is not, even though it is the largest spectrum of non-genetic disability in this country.
4.81QNMU drew the Committee’s attention to the challenge that women with children face in accessing AOD support. The lack of women-only rehabilitation facilities that allow children to accompany their mothers can deter women from seeking treatment due to concerns about childcare and the fear of intervention from child protection services. QNMU submitted that there was a value in exploring alternative models of care for public detox and rehabilitation services. This could include home detox programs with appropriate staffing by nurses and other healthcare professionals to provide daily support and monitoring as an option for low-risk individuals.
Workforce
4.82Australia’s AOD workforce comprises specialist and generalist staff. Specialist AOD workers, whose core role involves preventing and responding to AOD harm, include nurses, social workers, doctors, peer workers, NSP workers, prevention workers, addiction medicine specialists and specialist psychologists and psychiatrists. More generally, many non-AOD-related roles can prevent and minimise AOD harm, such as, for example, emergency medicine staff, general practitioners, or pharmacists.
4.83Throughout the inquiry, witnesses repeatedly highlighted the nation-wide shortage of specialists working in the AOD field. This is the case, for example, in the field of addiction medicine, which involves the provision of medical care to people with substance use and addiction disorders, including drug and alcohol addiction and pharmaceutical dependency. According to a 2021 audit of the Australian Fellows in the Chapter of Addiction Medicine, this area faced a significant challenge as the majority of addiction specialists were close to retirement age.
4.84Within the AOD workforce, psychiatrists serve as both generalists and addiction subspecialists, as RANZCP explained in its submission. RANZCP drew the Committee’s attention to a ‘chronic and severe psychiatry workforce shortage in Australia’ that also accounted for the undersupply of addiction psychiatrists within the AOD sector.
4.85Multiple submissions asserted that the specialist AOD workforce is in short supply throughout the nation, and especially in rural and remote Australia. As a result, AOD care is often transferred to general practitioners or emergency departments, which do not always have the capacity or expertise to manage AOD patients.
4.86The Australasian College for Emergency Medicine (ACEM) noted that identifying and responding to AOD related harm accounts for a significant proportion of the emergency department (ED) workload, as EDs often serve as default entry points into the healthcare system. Emergency physicians are responsible for providing the initial response during the acute intoxication phase and have a significant role minimising harm from AOD through identification, assessment and referral of patients with AOD problems.
4.87ACEM highlighted, however, that the lack of capacity within the AOD workforce generates a rise of AOD crisis presentations in EDs, and creates substantial strain on the emergency medicine workforce:
EDs experience a surge in patient presentations and alcohol and drug-related incidents, overdoses, injuries and mental health crisis during peak times, typically on weekend nights and public holidays. These higher presentation numbers add strain to ED capacity, resourcing and staff stress. Treating these patients is resource and time intensive.
4.88There may also be some reluctance among the generalist workforce to take on AOD patients due to the complexity of their presentations. This reluctance is, in part, related to a lack of knowledge about AOD among medical and nursing staff. As Australian College of Nurse Practitioners explained in its submission, generalist staff:
receive a limited amount of drug and alcohol education as part of their preparation for practice and as a result, they can have negative attitudes and stereotyped perceptions of persons experiencing drug and alcohol problems … The integration of a substance misuse component in the undergraduate and postgraduate curriculum is essential. Interdisciplinary and multidisciplinary education programs and mentorship are also key to developing a health workforce ready to provide contemporary best practice.
4.89The National Centre for Education and Training on Addiction (NCETA) echoed this point, noting that there is limited exposure to AOD content in tertiary-level qualifications ‘for workers seeking AOD-related career pathways, let alone for all the workers who are highly likely to engage with clients impacted by AOD use, such as psychology, nursing, and social work’. This lack of AOD related content made it challenging, NCETA argued, ‘to attract new entrants to the sector and to counter stigmatised attitudes toward AOD in the broader health workforce’.
4.90The Salvation Army similarly recommended embedding AOD treatment and support education within undergraduate programs for nursing, medicine and social work. The organisation emphasised that early exposure to AOD training ‘may also go some way to establishing clear succession plans for specialists in AOD treatment by exposing junior staff early enough to this specialist area’.
4.91The Matilda Centre further explained that there is no national accreditation body for AOD workers. Minimal qualification standards for AOD workers have been implemented in select jurisdictions only. While some specialist AOD workers are registered under the Australian Health Practitioner Regulation Agency, the most recent national AOD workforce survey indicates that less than half of workers have AOD related qualifications at a vocational or tertiary level.
4.92An aging specialist workforce, combined with insufficient exposure to AOD training that would attract younger cohorts to specialise in the field has hindered efforts to develop a sustainable AOD workforce in Australia. The capacity of this workforce has also been undermined by the current funding model for the sector, which perpetuates employment uncertainty and precarity.
4.93In reflecting on AOD workforce challenges, ADF noted that the ‘AOD sector is staffed by a dedicated workforce, but jurisdictional workforce surveys show that many AOD workers are experiencing job insecurity and low remuneration’. According to these findings:
Up to 25% of workers across Australia feel that there is at least a medium chance that they could lose their job within the next 12 months. Up to 75% of AOD workers are earning less than jurisdictional average salaries. Job insecurity and low remuneration are often cited by both AOD workers and employers as reasons for leaving the AOD sector as well as challenges for recruiting and retaining staff.
4.94To address the current situation, multiple organisations have called for an urgent renewal of the National Alcohol and Other Drug Workforce Development Strategy 2015-2018, which was one of the sub-strategies under the National Drug Strategy 2017-2026, but which has not been renewed since it lapsed in 2018.
4.95In addition to renewing the AOD workforce strategy, it was impressed upon the Committee that there are many current opportunities for addressing shortages in the AOD workforce by mobilising, enabling, and upskill staff from other areas. The Australian College of Nurse Practitioners noted, for example, that nurse practitioners who work with patients experiencing AOD problems can support them through withdrawal, prescribe pharmacotherapy and facilitate access to counselling services. Patients of nurse practitioners, however, have restricted access to the national Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS), which means that some medications and services requested by nurse practitioners may require patients to pay full costs. This model, consequently, hinders nurse practitioners to support AOD clients.
4.96QNMU acknowledged that recent addition of an MBS item for nurse practitioners conducting long assessment—which are necessary in the AOD context—is a positive step in recognising the role of nurses in this area. QNMU insisted, however, that MBS system overall failed ‘to adequately recognise and remunerate the valuable work of nurses and midwives in the field of AOD’. QNMU added that there is a need within MSB ‘for more targeted items that incentivise primary health clinicians to engage in AOD screening, assessment, and prevention activities’.
4.97The Salvation Army echoed some of these concerns and emphasised that general practitioners and nurse practitioners should be better incentivised to work in the AOD service. This should be the case in particular in the context of service models that work with community members ‘who are harder to reach or experiencing greater disadvantage’.
4.98Reflecting on the shortage of psychologists working in the AOD field, the AAPI suggested an expansion of MBS eligibility to provisional psychologists as a measure that could meet some of the demand for psychology services. As APPI explained, provisional psychologists are at a minimum, four or five-year educated psychologists embarking on a final period of supervised practice, overseen and mentored by a qualified psychologist. They have studied each of the competencies required for registration and are gaining relevant experience and supervision to meet full registration requirements. An expansion of Medicare rebate to provisional psychologist would see an 8,000 additional staff enter the system.
4.99According to the Pharmacy Guild of Australia (the Guild), pharmacists too can play a role in improving the capacity of the AOD sector. Community pharmacies are, the Guild submitted, no longer ‘just a place to go to get a prescription dispensed or to get a non-prescription medicine or free advice to manage common ailment’, but rather a space that can offer multiple services. As such, the Guild advocated for an enhanced capability of pharmacists to manage alcohol, nicotine and other drug use where appropriate.
4.100Throughout the inquiry, the relationship between AOD and mental health disorders emerged as a common theme and was frequently raised in relation to the sustainability of the AOD workforce. In its submission, Mind Australia Limited supported greater integration between mental health and AOD service provision in recognition of the fact that there is a ‘bi-directional relationship between mental health and AOD use’, adding that:
Best practice AOD treatment, prevention and workforce training should similarly acknowledge the frequent co-occurrence of these challenges. Regardless of whether an individual’s use meets the criteria for an AOD use disorder, people with mental health challenges and their families are vulnerable to the effects of AOD use and the subsequent impact this can have on their health and lives.
4.101Reflecting on the need for a multidisciplinary approach to AOD, ACEM submitted that some hospitals have begun to invest in reorienting EDs to include models of care that integrate specialist expertise in mental health, emergency medicine, and drugs and alcohol. Some examples include:
- the Psychiatric and Non-prescription Drug Assessment (PANDA) Unit at St Vincent’s Hospital Sydney in New South Wales
- the Mental Health Observation and Assessment (MHOA) Units and Urgent Care Centres (Toxicology) in Western Australia
- the Alfred Mental Health Service at the Alfred Hospital in Victoria.
These models are multidisciplinary in their staffing mix, targeted to manage the health effects of drug and alcohol use while also reducing the risks related to aggression and violence in the ED.
4.102In recognising the need to increase mental health capability in the AOD sector, the Commonwealth Department of Health and Aged Care invested in the development and dissemination of Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment setting (the Guidelines). The Guidelines are accompanied by resources to facilitate their update intro practice, including a website, an online self-paced and skill-based training program, an online community of practice, an organisational implementation toolkit and the first National Practice Standards for co-occurring conditions, which will be available in 2025.
4.103While many of those who contributed to the inquiry emphasised the need for better coordination between the areas of mental health and AOD care, some witnesses called for a cautious approach to service integration, highlighting that AOD’s unique characteristics and complexities necessitated its establishment as a distinct speciality area. QNMU noted that there has been a trend to view AOD as a subspeciality within the broader field of mental health, even though the AOD sector has developed its own expertise and workforce separate from mental health. QNMU warned, ‘[m]erging AOD into mental health risks overlooking or “diluting” this distinct body of knowledge and expertise’.
4.104Evidence presented in the course of this inquiry indicates that an integrated model of care is essential for effectively servicing AOD clients, whose needs are often complex and interconnected. While coordination between AOD and mental health service providers is important, witnesses suggest that integration should extend further to include, for example, domestic violence services, employment support, Centrelink assistance, and community engagement programs. As highlighted in the Salvation Army’s submission, such a comprehensive approach would likely best be achieved through ‘cross-sector partnerships, co-location of services and specialists and the development of cross-sector training loops’.
Peer workforce
4.105Much of the evidence presented in support of this inquiry foregrounded the importance of attracting people with lived or living experience of AOD use into the sector workforce. The Australian Research Centre in Sex, Health and Society submitted that ‘employing people with lived and living experience in the AOD sector contributes to more effective services and better outcomes for people accessing services, their families, supporters and communities'.
4.106Multiple witnesses discussed in particular the vital role peer workers have in supporting priority populations. The IUIH explained, for example, that peer workforce referred to an Aboriginal and Torres Strait Islander health or support worker, a health support worker with lived or living experience of substance use, or a health or support worker who both identifies as Aboriginal and Torres Strait Islander and has experience of substance use. This workforce is seen as being central in shaping a culturally safe AOD service provision for Aboriginal and Torres Strait Islander communities, across both Indigenous-led and within mainstream services.
4.107In highlighting the importance of First Nations AOD peer workforce, NACCHO advocated for a systemic workforce development and support for this staff, including through establishment of a national professional body for Aboriginal and Torres Strait Islander AOD workers; peak body for Aboriginal and Torres Strait Islander controlled AOD services; and Aboriginal Identified AOD Worker positions. NACCHO submitted training should be strengthened in this area, along with promotion of AOD work as a career of choice for Aboriginal and Torres Strait Islander people.
4.108Students for Sensible Drug Policy similarly asserted that peer-led harm reduction services are highly effective among young people, as peer workers are perceived to be ‘credible, legitimate, approachable, and trustworthy by the communities the services are designed to support’. Peer workers are said to present a vital point of contact for people who require support but feel uncomfortable approaching medical staff, police, security or other services. ACON similarly suggested that in the context of LGBTIQ+ AOD services, ‘peer-led interventions typically allow for an earlier entry point into interventions and services via brief, peer-led, non-judgemental intersections that encourage people to consider reducing their use’.
4.109While employing people with lived experience in the AOD sector is thought to promote better health outcomes, according to the Australian Research Centre in Sex, Health and Society, efforts to resource and support the needs of this unique workforce remained underexplored. Existing research suggests that a high prevalence of lived and living experience workers in the AOD sector in Australia face stigma and discrimination. There are also a series of inherent legal and other risks associated with this employment.
4.110With a view to better supporting the AOD peer workforce, NCETA is currently developing a National Harm Reduction Peer Workforce Framework in collaboration with the Australian Injecting and Illicit Drug Users League (AIVL). This initiative aims to provide information and guidance for people working in peer positions and organisations considering or already employing peer workers.
Family support
4.111Engaging family, friends, carers and the wider community is vital in supporting the recovery and ongoing wellbeing of individuals experiencing AOD related harm. Achieving such support, however, can be very challenging.
4.112While being a major source of support, as ADF noted, family and friends are themselves impacted by their loved one’s AOD use. Family Drug Support submitted that families and friends actively conceal their AOD issues, in fear both for the person they care about, and for being judged by the broader community. AOD-related shame and stigma is ultimately not specific to the people who use AOD, but extends its negative effects toward their immediate circle and networks.
4.113Mental Health Families and Friends Tasmania highlighted the fact that carers of those suffering AOD harm often experience social exclusion, as they do not, for example, go on holidays, participate in social activities, or cultivate other relationships as a result of ‘the hypervigilance they experience to be ready for crisis and the unpredictability of their loved one’s addition’. Many families of AOD users experience significant financial hardship, often associated with legal or drug debts, rehabilitation costs, and reduced hours of work.
4.114In discussing the impact of her brother’s alcohol use disorder, Ms Taylor submitted:
I feel that Richard’s alcoholism put my life on hold. He went to rehab nine (9) times before he died, some stints were 4 weeks long, his longest was 8 months long. It was ALL consuming. It was very hard to live a full life when you are on the rollercoaster.
4.115In seeking to recognise the work undertaken by friends and families of those who suffer from AOD harm, and the unique impact that AOD use has on this cohort, the Royal Commission into Victoria’s Mental Health System recommended creating a number of dedicated family and friends hubs to address the needs of this vital, but often invisible, cohort. In Tasmania, carers of people who have an AOD dependence are formally recognised in the Carer Recognition Act 2023 (Tas), the only Australian jurisdiction which does this.
Committee comments
4.116The Committee acknowledges the substantial unmet demand for AOD services across Australia and emphasises that no single approach can adequately address the diverse needs of those seeking support. A flexible and responsive model of care is essential for ensuring that meaningful and effective assistance is received by individuals experiencing AOD-related issues. The sustainability of the AOD workforce—encompassing generalists, specialists and those with lived and living experience—presents significant challenges that require careful attention. The Committee also recognises that AOD-related harm extends far beyond the individual, profoundly affecting families and support networks in enduring ways. Supporting these often-overlooked caregivers and family members must be an integral part of any comprehensive response to the AOD challenge.