Alcohol and Other Drugs (AOD) & Mental Health: A summary of evidence

Written by James Wallace.

A brief summary of recent data, best practices and treatment for AOD

Findings from the Latest Alcohol and Other Drug Treatment in Australia Annual report (22/23):

Primary Drugs of Concern (PDOC) Among Age Groups:

For young people aged 10-19 seeking treatment, Cannabis was the PDOC, (64%) followed by alcohol (14%). Amphetamines were the PDOC For people in their 20’s (25%) and 30’s (32%). For older Australians, alcohol remained the most common PDOC across those aged 40-49 (48%), 50-59 (63%) and 60+ (77%) (AIHW, 2024). 1 in 5 Australians over 14 were physically or verbally harmed or put in fear by someone under the influence of alcohol within the last year, with 18–24-year-olds the most likely to have experienced this (33%).

Mental Health:

The relationship between AOD and mental health can often be bi-directional in nature. In

2022, people with higher levels of psychological distress were 2.5 times as likely to use any illicit drug, 2.3

times more likely to smoke daily and more likely to drink alcohol at risky levels (39% compared with 30%)

(AIHW, 2024). Between 50-76% of people accessing treatment programs in Australia meet diagnostic

criteria for mental health disorders (AIHW, 2024, Mills, 2019).

At Risk Groups:

Young people, Aboriginal and Torres Strait Islander People and lesbian, gay, bisexual,

queer, transgender and intersex people remain at greatest risk for experiencing co-occurring AOD and

mental health issues. Unfortunately, there remains a lack of data that encapsulates all LGBTQIA+

people’s AOD use to allow for more timely and effective interventions. The 2022-23 NDSHS survey was

the first to include questions that represent people who are transgender or gender diverse and only had a

small sample size (AIHW, 2024).

Stigma:

In a 2023 study, two-thirds of Australian participants who injected drugs reported being treated

differently or poorly by health care workers within the last year. This proportion has remained stable since

2016 (Broady et al., 2023).

Best Practice - The Queensland Health Dual Diagnosis Clinical Guidelines (2010)

Treatment:

Dual Diagnosis Clinical Guidelines (Queensland Health, 2010) suggest that concurrent treatment

of both mental health and AOD disorders is generally best practice. Where possible, treatment within a single

service is ideal. If this is not possible, a strong focus on collaboration between services remains important in

ensuring non-conflicting messaging and approaches.

Where to refer? Priorities in treatment:

The Quadrant Model (Queensland Health, 2010) outlines a useful framework for General Practitioners in considering which service may take priority when a client presents with co-occurring disorders.

Some of the ways a psychologist may assist clients:

Addressing any underlying mental health issues such as trauma, depression and anxiety using evidence-

based therapies.

• Motivational interviewing: goal-oriented conversations aimed to support a person in their decisions to make change.

• Exploring functional roles in use and identifying alternatives (e.g. DBT “Tip the temperature” skills to

  reduce distress).

• Working through lapse and relapse – identifying triggers and developing strategies.

• Insight oriented therapies (e.g. Psychodynamic).

• May be suitable with clients who have difficulties that are complex and longstanding. The therapist

  may seek to support the client in further understanding themselves and their experiences. As a client

  increases their capacity to understand, tolerate and integrate difficult experiences, there may be

  changes to their substance use.

Ways we can all continue supporting clients and those around us:

• Work with the individual’s own goals - whether it be abstinence, a reduction in use or harm minimisation.

• Recognising that substance use is often viewed by clients as a spectrum - harm reduction can be applied

  at any point.

• Continue recognising the complex and often bi-directional relationship between mental health and

  substance use, and the best practices for this (e.g. Trauma informed care, concurrent treatment).

• Manage stigma, which has long been associated with reduced support-seeking and poorer outcomes:

  • Changing language that may make people feel criticised or shamed (e.g. “Addict” -> Person

    experiencing dependence).

  • Awareness of how our own experiences/biases shape our interactions, and expectations of others

    (e.g. expecting abstinence, reactions to lapse/relapse which reinforce negative beliefs and

    engagement).

  • Asking curious, non-judgemental questions (e.g. “Tell me about your substance use, what do you

    like? Is there anything you dislike?”).

• Recognising diversity, including cultural background and identity which may influence perceptions of

  substance use, disclosure/support seeking and appropriate treatment.

• Communicating and affirming confidentiality and considerations for this in a clear manner to service

  users, who may have concerns around disclosure of substance use.

• Creating safe spaces: clinic posters or information that is destigmatising, encourages conversation and

  that is also inclusive and accessible for all.

Many of these ideas (and more) can be found in the “Power of Words” resource by the Alcohol and Drug

Foundation: POW_Practical_Guide_2024.pdf (adf.org.au)