Drugs and Public Health: Australian Perspectives on policy and practice



Edited by DavidMoore and PaulDietze . Published by Oxford University Press , South Melbourne , 2008 , Paperback , 242 pages plus index . ISBN 9780195561029 . RRP$69.95 .

Reviewed by Alex Wodak

Alcohol and Drug Service, St Vincent's Hospital, New South Wales

This multi-author compilation of commentaries about the alcohol and drug field in Australia has several major strengths. One is that prevention and treatment of alcohol and drug problems in Australia compares well with efforts made in many other countries. As international best practice in this area is so poor, thoughtful books about prevention and treatment of alcohol and drug problems in Australia are well worth having.

Chapters in this book cover a wide range including the processes of engaging communities, approaching treatment, evolving practice and transferring knowledge. Several chapters are excellent. One of the highlights is a thoughtful chapter on effective responses to the unjustly neglected problems resulting from the use of volatile substances. Another wonderful chapter analyses what harm reduction may have to offer cigarette smokers who have no intention of quitting. This is an area that few harm reduction practitioners have thought through while the tobacco control movement is often split by consideration of harm reduction.

A fascinating case history provides a record of dogged attempts over many years to translate research into more effective and more evidence-based cannabis policy. It is disappointing that there is so little discussion of some of the areas where impressive Australian responses to alcohol and drug problems have been recognised internationally. For example, the huge advances made in recent decades by the Australian public health David against the tobacco industry Goliath have arguably prevented more deaths and saved more resources than any other alcohol and drug policy intervention in the country. Australia now has a remarkably low prevalence of smoking. The history of Australia's swift and effective response to the threat of an HIV epidemic, though well known and a public health triumph, receives barely a mention. Although the need for comprehensive drug law reform is now even acknowledged by senior law enforcement figures in Australia, the subject is rarely sighted in this volume. The strident political rhetoric and the raining down of gold bars on high-cost, low-impact drug law enforcement continues while relatively cheap and high-impact drug treatment is starved of funds. The end of the bi-partisan approach to harm reduction and the decade long experiment with a ‘Tough on Drugs’ approach is not discussed by any of the authors.

Some chapters, such as the discussion of dual diagnosis, are data-free and thinly disguised, uncritical, self promotion. Public health in Australia is still too often concerned with novelty rather than effectiveness. This is especially true of the most politicised branch of public health. Chapters are brief and several do not have enough space to develop the arguments needed. Although there have been a spate of books about alcohol and drugs in Australia, we still lack a book that does justice to the subject. The references are up to date and the book is well indexed.

This book provides useful snapshot of the alcohol and drug field in Australia as it was at the end of the Howard era.