Committee on Drugs

National Alcohol
and other Drug
A Sub-strategy of the National Drug Strategy 2010–15
Executive Summary                             iv   Part 2: The Strategy                           13

Part 1: The Context                           1    Goals                                          13
Background                                    1    Outcome area 1: Understand the specialist AOD
                                                   prevention and treatment workforce          13
The impact of alcohol and other drug
problems in Australia                         2    Outcome area 2: Create a sustainable specialist
                                                   AOD prevention and treatment workforce by
What is workforce development?                2
                                                   addressing recruitment and retention issues  14
Why have an Alcohol and other Drug
                                                   Outcome area 3: Match roles with
Workforce Development Strategy?               3
                                                   capabilities                                   17
Key principles underpinning the development
                                                   Outcome area 4: Enhance capacity to cater
of the AOD Workforce Development Strategy     4
                                                   for older AOD clients as well as those with
Who is the AOD workforce?                     6    co-and multiple morbidities and other
Future challenges                             8    complex needs                               18
                                                   Outcome area 5: Improve child and family
                                                   sensitive practice                             20
                                                   Outcome area 6: Improve consumer
                                                   participation in AOD service provision,
                                                   policy and planning                            21
                                                   Outcome area 7: Increase the capacity of the
                                                   workforce to respond appropriately to AOD issues
                                                   among Aboriginal and Torres Strait
                                                   Islander peoples                             23
                                                   Outcome area 8: Increase the capacity of the
                                                   workforce to respond appropriately to AOD issues
                                                   among culturally and linguistically diverse (CALD)
                                                   groups                                          25
                                                   Outcome area 9: Increase the capacity of the
                                                   workforce to respond appropriately to AOD issues
                                                   among lesbian, gay, bisexual, transgender and
                                                   intersex individuals                          26
                                                   Outcome area 10: Enhance the capacity
                                                   of generalist health, community, welfare and
                                                   support services workers to prevent and
                                                   reduce AOD harm                                27
                                                   Outcome area 11: Continue to develop the
                                                   criminal justice workforce to prevent
                                                   and reduce AOD harm                      29
                                                   Outcome area 12: Promote the ability of the
                                                   education sector to prevent and reduce
                                                   AOD harm                                    31

NATIONAL AOD WFD STRATEGY 2015-2020                                                                    ii
References                            32

Appendix: Links to other Strategies   34

Glossary of Terms                     40

Acknowledgements                      42

iii                                        NATIONAL AOD WFD STRATEGY 2015-2020
Executive Summary
This Strategy has been developed to support             The Strategy’s 12 key Outcome Areas are to:
the National Drug Strategy at the request of
the Intergovernmental Committee on Drugs                1. Understand the specialist AOD prevention and
in recognition of the need for a national focus            treatment workforce
on workforce development activities for the
                                                        2. Create a sustainable specialist AOD prevention
alcohol and other drug (AOD) workforce. The
                                                           and treatment workforce by addressing
Strategy development process was guided
                                                           recruitment and retention issues
by a Project Working Group appointed by the
Intergovernmental Committee on Drugs. It                3. Match roles with capabilities
followed an extensive consultation process
involving forums held in each jurisdiction, a written   4. Enhance capacity to cater for older AOD
submission process and key informant interviews.           clients as well as those with co-and multiple
                                                           morbidities and other complex needs
The AOD workforce includes workers whose
                                                        5. Improve child and family sensitive practice
primary role involves reducing AOD-related harm
as well as those whose primary work focus is on         6. Improve consumer participation in AOD
other issues but, nevertheless, play an important          service provision, policy and planning
role in reducing AOD harm. Consequently, this
document addresses the needs of workers from            7. Increase the capacity of the workforce to
the health, welfare, criminal justice and education        respond appropriately to AOD issues among
sectors. These could be workers acting in paid or          Aboriginal and Torres Strait Islander peoples
unpaid capacities.                                      8. Increase the capacity of the workforce to
                                                           respond appropriately to AOD issues
This document is a national policy framework
                                                           among culturally and linguistically diverse
that is complemented, supported and integrated
                                                           (CALD) groups
with a range of other existing national, state/
territory, government and non-government                9. Increase the capacity of the workforce to
strategies, plans and initiatives. The Strategy            respond appropriately to AOD issues among
identifies key strategic action areas to enhance           lesbian, gay, bisexual, transgender and
the capacities of Australia’s AOD workforce.               intersex individuals
It is intended to be a strategic, rather than
operational, document. The Strategy will link with      10. Enhance the capacity of generalist health,
other work already underway and be used to                  community, welfare and support services
inform future activity.                                     workers to prevent and reduce AOD harm

                                                        11. Continue to develop the criminal justice
The goals of the Strategy are:
                                                            workforce to prevent and reduce AOD harm
 • To enhance the capacity of the Australian
                                                        12. Promote the ability of the education sector to
   AOD workforce to prevent and minimise
                                                            prevent and reduce AOD harm
   alcohol and other drug-related harm across
   the domains of supply, demand and harm               Responsibility for implementing the actions
   reduction activities.                                outlined in the Strategy is shared by all
                                                        governments, recognising that jurisdictions face
 • To create a sustainable Australian AOD
                                                        different challenges and will undertake actions in
   workforce that is capable of meeting future
                                                        line with their own priorities, timing and resources.
   challenges, innovation and reform.

NATIONAL AOD WFD STRATEGY 2015-2020                                                                        iv
PART 1: The Context

Background                                          The NDS addresses alcohol, tobacco, illegal
                                                    drugs, pharmaceuticals and other substances.
Alcohol and other drug (AOD)-related harm           The approach of harm minimisation has guided
represents a significant social and economic        the NDS since its inception in 1985. This
burden to the Australian community.                 encompasses the three pillars of:
Consequently, preventing and minimising this
                                                     • Demand reduction:
harm is an important national priority which
requires commitment from all levels of government        »» preventing the uptake and/or delaying
and a range of sectors and agencies. The National           the onset of use of alcohol, tobacco and
Alcohol and other Drug Workforce Development                other drugs;
Strategy (NADWFDS) was developed at the                  »» reducing the misuse of alcohol and the
request of the Intergovernmental Committee                  use of tobacco and other drugs in the
on Drugs in recognition of the need to enhance              community; and
the capacity of the diverse workforce involved in
preventing and responding to AOD-related harm.           »» supporting people to recover from
                                                            dependence and reintegrate with the
The multi-level and intersectoral nature of                 community.
Australia’s approaches to preventing and
                                                     • Supply reduction:
minimising AOD-related harm is reflected in its
national framework for action on alcohol and             »» preventing, stopping, disrupting or
other drugs, the National Drug Strategy 2010-               otherwise reducing the production and
2015 (NDS) (Ministerial Council on Drug Strategy,           supply of illegal drugs; and
[MCDS] 2011). The NDS provides an overarching            »» controlling, managing and/or regulating
policy context for the NADWFDS. The Mission of              the availability of legal drugs.
the NDS is:
                                                     • Harm reduction:
To build safe and healthy communities by
                                                         »» reducing the adverse health, social and
minimising alcohol, tobacco and other drug-
                                                            economic consequences of the use of
related health, social and economic harms
                                                            alcohol and other drugs.
among individuals, families and communities
(MCDS, 2011).                                       These three pillars are underpinned by strong
                                                    commitments to supportive approaches which:

                                                     • build workforce capacity;

                                                     • promote evidence-based and evidence-
                                                       informed practice, innovation and evaluation;

                                                     • encourage performance measurement to
                                                       enhance quality; and

                                                     • build partnerships across sectors.

NATIONAL AOD WFD STRATEGY 2015-2020                                                                    1
The impact of alcohol and other                          Tobacco smoking is one of the top risk factors for
                                                         chronic disease, including many types of cancer,
drug problems in Australia                               respiratory disease and heart disease. Likewise,
                                                         illegal drugs can not only have dangerous health
Alcohol and other drug-related harm places a high
                                                         impacts, but are a significant contributor to crime.
burden on the Australian community. The cost of
                                                         Unsafe injecting drug use is also a major driver of
harmful alcohol, tobacco and other drug use in
                                                         blood-borne virus infections such as hepatitis C
2004–05 was estimated at $56.1 billion, of which:
                                                         and HIV/AIDS.
    • Tobacco accounted for 56%;
                                                         In light of these substantial costs, it is important
    • Alcohol accounted for 27.3%; and                   that Australia has a workforce with the capability
                                                         to prevent and reduce this harm.
    • Illegal drugs accounted for 14.6%
      (Collins & Lapsley, 2008).
In 2004-05 in Australia, there were:                     What is workforce
    • 3,494 deaths attributable to alcohol;
                                                         Workforce development (WFD) in the AOD field
    • 15,050 deaths attributable to tobacco; and
                                                         aims to build the capacity of organisations and
    • 872 deaths attributable to illicit and other       individuals to prevent and respond to AOD-
      drugs (Collins & Lapsley, 2008).                   related problems and to promote evidence-
                                                         based practice. It goes beyond the provision of
Alcohol and other drug-related harm does not             education and training to include issues such as
only accrue to those using these substances. In          recruitment and retention, workforce planning,
2005 an estimated:                                       professional and career development and worker
                                                         wellbeing. As such, WFD can be defined as:
    • 367 people died and almost 14,000 people
      were hospitalised because of another’s alcohol     …a multi-faceted approach which addresses the
      consumption;                                       range of factors impacting on the ability of the
                                                         workforce to function with maximum effectiveness
    • 77 deaths stemmed from alcohol-related             in responding to alcohol and other drug-related
      violence attributable to another’s alcohol         problems. Workforce development should have a
      consumption                                        systems focus. Unlike traditional approaches, this
    • 277 people aged 15 years and over died as a        is broad and comprehensive, targeting individual,
      result of another’s drinking and driving; and      organisational and structural factors, rather than
                                                         just addressing education and training of individual
    • 70,000 Australians were victims of alcohol-        mainstream workers (Roche, 2002a).
      related assault, of whom 24,000 were victims
      of alcohol-related domestic violence (Laslett et   This broad definition of WFD mandates a focus
      al., 2010).                                        on a wide range of individual, organisational,
                                                         structural and systematic factors that impact on
In addition, an estimated 20,000 children across         the ability of the workforce to effectively prevent
Australia were victims of substantiated alcohol-         and respond to AOD issues. Without addressing
related child abuse or neglect in 2006/07 (Laslett       these underpinning and contextual factors,
et al., 2010). Other alcohol-related harms include       the ultimate aim of increasing the workforce’s
road and other accidents, domestic and public            effectiveness is unlikely to be achieved
violence, crime, chronic disease, birth defects and      (Roche & Pidd, 2010).
disability, family breakdown and broader social

2                                                               NATIONAL AOD WFD STRATEGY 2015-2020
Why have an Alcohol and other                         that develops the capacity of the workforce to
                                                      effectively respond to current and emerging AOD
Drug Workforce Development                            issues. A number of jurisdictions in Australia have
Strategy?                                             considered and/or developed AOD Workforce
                                                      Development Strategies. There is not, however, a
Practices aimed at preventing and responding          nationally consistent approach to addressing the
to AOD harm need to continuously evolve in            challenges facing the AOD workforce.
response to changes in societal needs and
advances in knowledge. In recent decades, shifts      A WFD strategy can also help to:
have occurred in patterns of consumption and
                                                       • Identify the workforce implications of the
the types of substances consumed. Advances
                                                         current strategic and operational environment;
in knowledge have also led to changes in clinical
practice and prevention strategies. These include:     • Enhance the professionalisation of the
 • Shifting patterns of use, particularly poly-drug
   use;                                                • Meet current needs and prepare for the future;

 • New psychoactive substances;                        • Raise the profile of strategic workforce
                                                         planning within organisations and influence
 • An expanded range of pharmacotherapies                change from the top down;
   and other treatment options;
                                                       • Integrate workforce planning with future
 • Greater awareness of co-existing mental               directions for organisations and sectors;
   health disorders and multiple morbidities
   (especially in the context of an ageing             • Assess the current state of the workforce;
   population);                                        • Facilitate the seamless movement of AOD
 • Greater awareness of foetal alcohol spectrum          workers within and across jurisdictions as a
   disorder, child protection and family sensitive       result of more standardised qualifications;
   practice issues;                                    • Create, drive and implement workforce
 • Problematic use across a widened age                  planning;
                                                       • Improve performance;
 • Greater emphasis on cost efficiency,
   professional practice efficacy, improved            • Enhance service quality and outcomes;
   outcomes and intersectoral collaboration;
                                                       • Enhance career development options; and
 • A better understanding of effective preventive
   measures; and
                                                       • Optimise implementation of evidenced based
 • Greater recognition of the wide variety of            practice.
   workers involved in reducing AOD-related
   harm.                                              Another aim of the Strategy development process
                                                      is to achieve general agreement about the future
Factors such as these increase the demand             directions of workforce development in the AOD
to prevent and respond to AOD problems. As            field, which will shape practice in this area and
a result, there is growing recognition of the         be reflected in service tendering processes and
need for a workforce development approach             funding agreements.

NATIONAL AOD WFD STRATEGY 2015-2020                                                                     3
Key principles underpinning                           4. While recognising that a broad range of
                                                         workers have a role in reducing AOD harm the
the development of the AOD                               primary focal point of the Strategy is on the
Workforce Development                                    workforce development needs of specialist
                                                         AOD workers.
The development of the NADWFDS has been                  The scope of the Strategy includes a wide
predicated on a number of principles. Specifically:      range of workers with a role in reducing AOD-
                                                         related harm. Nevertheless, having a highly
1. The Strategy should reflect the National Drug         skilled specialist prevention and treatment
   Strategy’s overarching approach of harm               workforce is fundamental to positively
   minimisation and address its three pillars of         influencing the activities of generalist workers
   supply reduction, demand reduction and harm           (i.e. those whose primary role is not reducing
   reduction.                                            AOD related harm). From this perspective, the
                                                         role of the specialist workforce is not only to
    Australia’s National Drug Strategy adopts a          provide specialist services, but also to support
    balanced approach to reducing AOD harm               non-specialists.
    involving the three pillars of supply, demand
                                                      5. The reduction of AOD harm in Australia will be
    and harm reduction. It is therefore important
                                                         optimised by having a workforce engaged in
    that the NADWFDS reflects the National Drug
                                                         evidence-based practice.
    Strategy’s balanced approach to reducing
    AOD-related harm.
                                                         The evidence base concerning effective
2. The Strategy should have a systems focus              practice in preventing and responding to AOD
   which addresses the range of factors                  harm continues to grow. The Strategy should
   impacting on the ability of the workforce to          therefore promote strategies to enhance the
   prevent and reduce alcohol and other drug-            uptake of these evidence-based practices.
   related problems.
                                                      6. Workforce planning and development
                                                         in the AOD field should be built on a
    Using a systems approach will enable the
                                                         comprehensive understanding of the national
    Strategy to move beyond a simple focus on
                                                         workforce including demographics, roles and
    education and training to include the wide
                                                         qualifications as well as modelling of future
    range of factors which impact on workforce

3. The Strategy should be developed following            Considerable work has been undertaken in
   an extensive consultation process.                    workforce development as well as workforce
                                                         planning activities and it is important to
    The Strategy was developed following                 build on this and increase our knowledge
    consultation involving:                              and understanding of the specialist AOD
    • Forums held in each state and territory;
                                                      7. The key driver of the AOD Workforce
    • A written submission process; and                  Development Strategy is enhancing the quality
                                                         of AOD service provision.
    • Key informant interviews.
                                                         Having a skilled, professional and adaptable
                                                         AOD workforce is essential to enhancing the
                                                         quality of AOD services in Australia.

4                                                           NATIONAL AOD WFD STRATEGY 2015-2020
8. The Strategy should recognise the diversity, and        demand for workers; the emergence of new
   acknowledge the contribution of the totality of         substances of concern; the need to link with
   the workforce with a role in reducing AOD harm          other agencies and sectors to meet the needs
   regardless of roles, professional qualifications,       of clients with complex needs; and changes
   or whether paid or unpaid.                              in funding arrangements. In addition, future
                                                           prevention and intervention efforts are likely to
   A broad range of workers have a role in                 involve greater attention directed towards the
   reducing AOD harm in Australia. These include           social determinants of AOD problems. The
   workers from the health, welfare and criminal           Strategy should aim to provide a foundation
   justice sectors. The AOD sector itself is also          for the AOD workforce to meet these
   diverse, with workers from many different               challenges.
   backgrounds. For example, those with
   professional training in a range of disciplines,     11. In recognition of the often complex needs of
   those with vocational or on-the-job training,            individuals experiencing AOD-related harm
   and those with lived experience of recovery              and their families, the Strategy should foster
   from AOD dependence. Each group has                      enhanced cooperation between sectors and
   unique needs that warrant attention in the               agencies.
                                                           Alcohol and other drug treatment services
9. The Strategy should provide a framework for             cannot effectively meet all the needs of clients
   national AOD workforce development while                with multiple morbidities. For this reason,
   recognising jurisdictional differences and              agencies will require new ways of working that
   facilitating innovation.                                cater for these complex needs.

   Alcohol and other drug workforce                     12. The Strategy should focus on building
   development efforts in Australia cannot be               capacity in specific areas of need.
   undertaken without cognisance of the sector’s
   history. There are already many effective               Alcohol and other drug related harm
   jurisdictionally-based initiatives in place, upon       differentially impacts groups of Australians.
   which the Strategy can build. In addition there         Some groups, such as Aboriginal and Torres
   are historical variations between jurisdictions         Strait Islander peoples, lower socio-economic
   and complex differences in funding                      groups and children living in families in which
   arrangements which can impact the provision             AOD-related harm is occurring, experience
   of AOD services in different jurisdictions              greater levels of harm. The Strategy should
   (Chalmers, Ritter, & Berends, 2013). All these          therefore focus on these areas of need.
   factors were be taken into consideration in the      13. Reducing AOD harm among Aboriginal and
   Strategy’s development. The Strategy should              Torres Strait Islander peoples is dependent
   also not be so restrictive as to stifle innovation       on recognising that Aboriginal and Torres
   in approaches to preventing and reducing                 Strait Islander culture is a source of strength,
   AOD harm.                                                resilience, happiness, identity and confidence.
10. The Strategy should reflect a range of future
    trends and challenges likely to impact on the          The promotion and protection of culture
    AOD workforce into the future.                         is critical to progressing improvements in
                                                           Aboriginal and Torres Strait Islander health and
   It is evident that a range of issues will impact        is inextricably linked to health and wellbeing. In
   on the AOD workforce into the future. These             order to reduce AOD harm among Aboriginal
   include: an ageing population; an ageing                and Torres Strait Islander peoples, the
   AOD workforce in the context of increasing              Australian AOD workforce must be responsive

NATIONAL AOD WFD STRATEGY 2015-2020                                                                          5
to cultural differences and the impacts of                      government, not-for-profit (non-government) and
    racism (conscious and unconscious) and a lack                   private sectors. Specialist AOD workers are the
    of cultural safety1 on Aboriginal and Torres Strait             primary focus of the NADWFDS.
    Islander peoples. Aboriginal and Torres Strait
    Islanders are also more likely to access, and                   Generalist workers are employed in the
    will experience better outcomes from, services                  mainstream workforce and have non-AOD-related
    that are respectful and culturally safe (Australian             core roles, but nonetheless can prevent and
    Indigenous Doctor’s Association, 2013).                         minimise AOD harm. Examples include:

                                                                        • The criminal justice workforce, including the
Who is the AOD workforce?                                                 court system, police2, Aboriginal and Torres
                                                                          Strait Islander law enforcement and community
The NDS recognises that an appropriately skilled
                                                                          liaison officers and correctional officers;
and qualified workforce is critical to preventing
and responding to AOD-related harm. The NDS                             • Emergency medical services, paramedics and
also highlights that a broad range of workers are                         emergency department personnel;
involved in preventing and minimising AOD harm.
However, there is currently limited information                         • The mental health workforce;
concerning the characteristics of the AOD                               • The broader health and medical workforce
workforce in Australia. A primary goal of the                             including general practitioners, other primary
Strategy is to gain a better understanding of the                         healthcare workers and hospital workers;
extent and nature of the AOD workforce.
                                                                        • Community, welfare and support services
The AOD workforce is commonly considered in                               including those working with culturally and
terms of two main components, specialists and                             linguistically diverse communities, in child
generalists.                                                              protection, in disability support services, and
                                                                          in the homelessness, unemployment, income
Specialist AOD workers are those whose core                               support and youth sectors;
role involves preventing and responding to AOD
harm. They include AOD workers, nurses, social                          • Pharmacists and the pharmacy workforce;
workers, doctors, peer workers, needle and
                                                                        • The aged care sector; and
syringe program workers, prevention workers,
addiction medicine specialists and specialist                           • The education sector.
psychologists and psychiatrists. These workers
                                                                    As is evident, there is a diverse range of workers
may be employed in AOD specialist organisations
                                                                    involved in preventing and responding to AOD
or in AOD programs within non-specialist
                                                                    harm in Australia across the supply, demand and
organisations (Roche & Pidd, 2010). They may
                                                                    harm reduction domains. It is important that the
have specialised degrees or little or no formal
                                                                    Strategy addresses this diversity and focusses
training (Libretto, Weil, Nemes, Copeland Linder,
                                                                    attention on the developmental needs of each
& Johansson, 2004), and can be employed in the
                                                                    group. The levels of prevention and response
                                                                    activities can be categorised into four tiers.
  Cultural safety refers to the accumulation and application        Generalist and specialist workers have roles
of knowledge of Aboriginal and Torres Strait Islander values,       across these tiers (see Figure 1.).
principles and norms. Aboriginal and Torres Strait Islander
AOD workers are more likely to stay and thrive in learning
and working environments that consistently demonstrate
cultural safety. Aboriginal and Torres Strait Islander AOD
professionals’ experiences of a lack of cultural safety, racism     2
                                                                      It is important to note that some police have highly specialised
and discrimination significantly detract from their mental health   AOD functions. This includes those involved in drug investigations,
and wellbeing and negatively impact on their job satisfaction       the policing of licensed premises and in AOD-related aspects of
(Australian Indigenous Doctor’s Association, 2013).                 road safety (such as random AOD screening and testing).

6                                                                            NATIONAL AOD WFD STRATEGY 2015-2020
Whole of population focus, prevention, social
                                  Tier 1                                                                                               determinants, education, law enforcement,
                                                                                                                                       community services

                                  Tier 2                                                                                               Primary healthcare, community services, information
                                                                                                                                       services, NSP’s peer support, self help groups

                                  Tier 3                                                                                               Specialist assessment and referral, corrections,
                                                                                                                                       case management, relapse prevention, community
                                                                                                                                       pharmacotherapy, counselling
                                    4                                                                                                  Services for people with complex needs,specialist
                                                                                                                                       withdrawal management, residential rehab

Figure 1: Tiers of activity involving different services/workers.

Based on these tiers it is possible to identify the ways in which different occupational groups make their
contributions to preventing and reducing AOD-related harm (see Figure 2).13

                                               and Welfare workers


                                                                                                                                       Pharmacy workers
                                                                                                                       Mental Health
                                                                     Specialist AOD, Clinical and Prevention Workers

                                                                                                                                                                              Tier 1: Whole of population focus,

                                                                                                                                                                              prevention, social determinants, education,
                                               Generalist health

                                                                                                                                                                              law enforcement, community services.

                                                                                                                                                                        Tier 2: Primary healthcare, community
                                                                                                                                                                        services, information services, NSPs, peer
                                                                                                                                                                        support, self-help groups.

                                                                                                                                                                Tier 3: Specialist assessment and referral,
                                                                                                                                                                corrections, case management, relapse prevention,
                                                                                                                                                                community pharmacotherapy, counselling.

                                                                                                                                          Tier 4: Services for people with complex needs,
                                                                                                                                          specialist withdrawal management, residential

Figure 2: Tiers of activity in which different occupational groups make their contribution to
reducing AOD-related harm.
  Figures 1 and 2 are intended to be indicative, rather than definitive, as services may have different roles in different tiers at different

NATIONAL AOD WFD STRATEGY 2015-2020                                                                                                                                                                                         7
Tier 4: Inpatient Detox,
                   Residential rehab
                                                               Tier 1: Whole of population

      Tier 3: Specialist assessment,
      case management
                                                              Tier 2: Primary Health Care, Community
                                                              Services Needle and syringe programs,
                                                              peer support

Figure 3: Wrap-around services, particularly for clients with complex needs.

It is important to note that individuals may receive   non-communicable diseases (World Health
services from multiple providers working within or     Organization, 2011), along with ageing, fertility and
across multiple tiers at the one time (see Figure      mortality trends. If, as predicted, baby boomers
3). Indeed this ‘wrap around’ approach can be an       have greater rates of lifetime alcohol and drug use
important part of service provision for individuals    than previous generations, this will lead to more
with complex needs.                                    older people experiencing AOD harm in the future
                                                       (Hunter, Lubman, & Barratt, 2011). This trend will
Future challenges                                      require a better understanding of the physiological
                                                       and psychological impact of drug use in ageing
The development of the Strategy occurred in the        populations (Colliver, Compton, Gfroerer, &
context of a range of challenges which will be         Condon, 2006). The ageing population also
facing the AOD workforce into the future. These        means that programs will be required to prevent
challenges and their implications are explored in      harmful AOD use among older Australians.
more detail below.
                                                       The ageing of the population has particular
The ageing population                                  significance for Aboriginal and Torres Strait
Australia’s population, like that of most developed    Islander Australians who have a shorter than
countries, is ageing as a result of sustained low      average life expectancy. Many chronic illnesses
fertility and increasing life expectancy (Australian   (including those stemming from harmful AOD use)
Bureau of Statistics, 2011). This has major            that are often evident among older Australians
implications for the NADWFDS.                          are common in middle age among Aboriginal
                                                       and Torres Strait Islander peoples. Therefore,
Health and welfare professionals and workforces        services focussed on meeting the needs of older
(including those focussing on reducing AOD             Australians experiencing AOD harm also need to
harm) need to be better equipped to deal               target middle aged Aboriginal and Torres Strait
with a dramatic increase in the incidence of           Islander people.

8                                                             NATIONAL AOD WFD STRATEGY 2015-2020
Different substances and patterns of use                 Smart drugs are a further issue on the horizon.
                                                         These are prescription drugs used to treat
The landscape of available psychoactive
                                                         conditions such as attention deficit hyperactivity
substances is rapidly changing. In Europe
                                                         disorder, narcolepsy and Alzheimer’s disease.
new psychoactive substances are reported to
                                                         When used by healthy people they may improve
authorities at a rate of approximately one per
                                                         cognitive functions (Partridge, Bell, Lucke, Yeates,
week (European Monitoring Centre for Drugs and
                                                         & Hall, 2011). The harmful use of these powerful
Drug Addiction, 2012). These trends are highly
                                                         medicines could significantly impact on AOD
likely to impact Australia because the Internet
                                                         treatment services in the future.
has increased the flow of information about these
drugs, and provides a means through which they           New paradigms and treatments
can be purchased (European Monitoring Centre
for Drugs and Drug Addiction, 2012). This is             In the future, approaches to preventing and
likely to present particular difficulties for treating   responding to AOD problems are likely to arise
individuals who experience acute and chronic             from a much broader foundation. Dealing with
harms stemming from the use of these drugs,              the end results of problematic substance use will
because the nature of the substance they have            always be important, and there will always be a
taken can be unclear to both the client and the          role for specialist treatment services. However,
treating clinician (Arnold, 2013).                       future responses will be shaped by drivers that
                                                         extend this orientation, including increased
Furthermore, over the past decade there                  emphasis on the prevention and treatment
have been significant changes in the profile of          implications of:
substances for which Australians are seeking
treatment. Since 2001-02, among publically                • Social determinants of health (e.g. early life
funded AOD treatment episodes in which the                  experiences, work, unemployment, social
client was seeking help for their own problems:             exclusion) which will feature more prominently
                                                            in our understanding of causal factors as
 • Alcohol problems increased from 37 to 47%;               well as response strategies to ameliorate
   and                                                      problems;
 • Heroin problems halved from 18% to 9%                  • Integrated models of care (mental health,
   (Australian Institute of Health and Welfare,             aged care, child and family, Aboriginal and
   2012).                                                   Torres Strait Islanders, prisoners, non-English
Prescription drugs such as smart drugs, opioids,            speaking) will become more prominent as
antipsychotic medicines and sedative hypnotics              pressure and expectations grow for more
as well as performance and image enhancing                  coordinated and holistic care;
drugs have the potential to displace the demand           • Complex health and comprehensive
for illicit drugs. This will require quite different        community services models; no longer will
responses from AOD treatment and prevention                 narrow and simplistic models be adequate
services, and has important implications for the            (Roche, 2013); and
development of the AOD workforce (Roche,
2013). In the past twenty years, for example,             • Technology-based approaches to treatment
there has been a dramatic increase in the                   (Cunningham, Kypri, & McCambridge, 2011).
prescribing of pharmaceutical opioids in Australia       The development of a Quality Framework for
and correspondingly increasing harms (Royal              Australian Government funded drug and alcohol
Australasian College of Physicians, 2009).               treatment services, funded by the Australian
                                                         Government Department of Health, is also likely to

NATIONAL AOD WFD STRATEGY 2015-2020                                                                           9
influence future directions and standards in AOD      disadvantage, and needs to be understood in the
service provision in Australia. The project aims to   context of a history of dispossession, denial of
develop a quality framework for alcohol and other     culture, and conflict (Gleadle et al., 2010).
drugs treatment services that:
                                                      Aboriginal and Torres Strait Islander AOD
 • Complements other models/frameworks that           workers play an important role in preventing and
   services currently comply with;                    responding to AOD-related harm among this
                                                      population, and are critically important in the
 • Is adaptable, flexible and suitable for a range    context of the NADWFDS. Nevertheless they
   of service types and settings, including           cannot bear total responsibility for addressing
   Indigenous-specific services;                      AOD-related harm among Aboriginal and Torres
                                                      Strait Islander peoples. Aboriginal and Torres
 • Considers clients with comorbidity and the
                                                      Strait Islanders seeking treatment for their AOD
   need to build and/or maintain capacity of
                                                      problems may not have the option of accessing
   services to appropriately manage these
                                                      an AOD service established to cater for their
                                                      needs. Even in Aboriginal and Torres Strait
 • Considers all funding sources for services         Islander-specific services, not all AOD workers
   including client/patient contributions;            are Indigenous. Consequently, these clients are
                                                      highly likely to have contact with non-Aboriginal
 • Clearly describes the expected quality             and Torres Strait Islander service providers. From
   standards for each service type;                   this perspective, it is critically important that all
 • Has clear guidelines, policies and procedures      AOD workers, regardless of their own Indigenous
   to support the achievement and maintenance         status, are capable of preventing and responding
   of these quality standards;                        to AOD harm among Aboriginal and Torres
                                                      Strait Islander Australians in a culturally safe and
 • Allows incorporation of accreditation models       sensitive manner.
   that services currently have in place or may
   have in place in the future; and                   Aboriginal and Torres Strait Islander AOD workers
                                                      are usually employed in comparatively low status,
 • Considers related aspects such as                  lower paid positions such as Health Workers or
   accreditation and minimum qualifications.          community workers (Gleadle et al., 2010). Against
                                                      a background of disadvantage and complex AOD
Additionally, the project will aim to provide
                                                      use, these AOD workers face unique stressors
a detailed draft implementation plan for the
framework, with recommendations drawn from
the project and other information that informs use
                                                       • Heavy work demands and a lack of clearly
and future development needs.
                                                         defined roles and boundaries reflecting high
The needs of Aboriginal and                              community need and a shortfall of Aboriginal
Torres Strait Islander Australians                       and Torres Strait Islander AOD workers;

Aboriginal and Torres Strait Islander Australians      • Dual forms of stigmatisation stemming from
have higher rates of tobacco and other drug use          attitudes to AOD work and racism;
compared to the non-Indigenous population.
                                                       • Difficulties translating mainstream work
Alcohol and other drug use by Aboriginal and
                                                         practices to meet the specific needs of
Torres Strait Islander Australians contributes
                                                         Aboriginal and Torres Strait Islander clients;
to compromised physical and psychosocial
health status and ongoing socio-economic               • Challenges of isolation when working in
                                                         remote areas;

10                                                           NATIONAL AOD WFD STRATEGY 2015-2020
• Dealing with clients with complex                   Increased emphasis on service outcomes
   comorbidities and health and social issues;
                                                       Future service funding is likely to be increasingly
                                                       linked to agencies’ ability to deliver demonstrable
 • Lack of cultural understanding and support          outcomes for clients and the broader community.
   from non-Indigenous health workers (Roche,          Outcomes in relation to prevention and treatment
   Nicholas, Trifonoff, & Steenson, 2013).             and recovery are as yet undefined. The
                                                       implications of a movement towards outcomes-
These challenges mean that Aboriginal and
                                                       based funding extend beyond changes in service
Torres Strait Islander AOD workers have distinct
                                                       provision. Such a movement will also mean that
workforce development needs, and that WFD
                                                       the AOD sector will need to be more familiar with
strategies are required that can be implemented
                                                       the collection, interpretation and presentation of
in a culturally safe manner.
                                                       data in order to ensure continued funding. It will
Responding to multiple morbidities                     also be important to ensure that outcomes focus
                                                       on the characteristics and clients of individual
Individuals experiencing AOD harm are at risk          services, so as not to disadvantage programs
of a range of comorbid conditions including            which cater for clients with more entrenched
infectious and non-communicable diseases               problems.
(Australian Government Preventative Task Force,
2009). Mental illnesses are a particularly prevalent   Increasing consumer input into their own
comorbidity among AOD clients.                         treatment and care
The appropriate management of long-term                Consumer input into service provision is an
multi-morbid disorders is a key challenge for          important part of providing person-centred
health systems internationally. It is increasingly     care. The challenge for the AOD sector is to
apparent that multi-morbidities are the norm for       turn widespread acceptance of the principle
people with chronic health problems, particularly      of service user participation into processes
the most socio-economically disadvantaged.             and resourcing that make it both feasible and
Co-and multiple morbidities have important             effective. As well as involvement in service
implications for the training and structure of the     planning, clients should have:
AOD workforce. Strategies such as co-location,          • Improved knowledge and confidence to make
multi-disciplinary health professionals and teams,        choices about their treatment and awareness
inter-professional education and cross sectoral           of how to self-manage after formal treatment;
workforce development will increasingly be
required.                                               • High levels of active involvement in their
                                                          treatment including planning, setting goals and
This issue will become a growing challenge                decision making; and
for AOD service provision in the future. AOD
services will need to develop ways of meeting           • A comprehensive assessment and care
the multi-morbidity needs of their clients through        plan that is oriented towards their goals
a combination of enhanced generalist in-house             and designed with them according to their
service provision and enhanced linkages with              choices, preferences and changing needs
other service providers. This ‘no wrong door’             (Department of Health Victoria, 2012).
approach means that regardless of where clients
with complex needs present they can obtain the
services they require.

NATIONAL AOD WFD STRATEGY 2015-2020                                                                    11
Child and family sensitive                                Differences between government
policy and practice                                       and non-government sectors
The AOD, family and child welfare sectors                 In some jurisdictions there are significant
have increasingly recognised the relationship             differences in workforce profiles between
between AOD problems, child and adolescent                government and non-government organisations
development, and child wellbeing and protection.          (NGOs) (Roche & Pidd, 2010). Some of these
Child and family sensitive policy and practice            differences are due to alternative service delivery
involves raising awareness of the impact of               models, different funding levels and different client
substance use problems upon families, addressing          groups. As a result, workforce development
the needs of families (Addaction, 2009), and              issues may be different for NGO and government
seeing the family-rather than an individual adult         workforces. This, in turn, has workforce
or child-as the unit of intervention. It includes         development implications (Duraisingam, Pidd,
identifying and addressing the needs of adult             Roche, & O’Connor, 2006). In several jurisdictions
clients as parents, as well as the needs of their         there are also significant disparities between
children, as part of prevention, treatment and            salaries and conditions offered by NGO agencies
intervention processes, in order to ensure that as        and public sector agencies. Staff employed by
parents they are supported and child wellbeing            NGO agencies are generally paid considerably
and safety is maintained (Battams & Roche, 2010).         less due to funding arrangements and differences
                                                          in awards (Roche & Pidd, 2010). This can lead
Workforce-related challenges                              to a workforce drain from the NGO to the public
The AOD workforce faces a number of future                sector, with the NGO sector bearing a significant
challenges which impact on the development of             burden for recruiting and training new entrants to
NADWFDS.                                                  the AOD workforce.

Ageing workforce
As a result of an ageing population, demand for
workers in health care and social assistance in
Australia will outstrip all other sectors over the next
few years (Community Services & Health Industry
Skills Council, 2013) which will increase pressure
on AOD services to attract and retain suitable
staff. This will be particularly relevant for medical
practitioners and nurses (Australian Bureau of
Statistics, 2003). As older workers retire, the
human services workforce is likely to be negatively
impacted by a loss of highly skilled workers. This
means that the AOD sector will continue to age
and will have to compete with other sectors for
staff in an increasingly difficult human resource
environment. Furthermore, the demand for
workers will not be confined to Australia. As the
human services workforce becomes increasingly
globalised, AOD agencies will be required to
compete with other countries for staff.

12                                                               NATIONAL AOD WFD STRATEGY 2015-2020
Part 2: The Strategy
The Strategy addresses a broad range of factors        Some jurisdictions have undertaken surveys
designed to improve the quality and functioning        of their AOD workforces, but these are often
of the AOD sector and systems responses. It            confined to either government or non-government
contains a series of suggested actions which           sectors. In addition, they also do not always
jurisdictions may take to implement the goals of       include data on individuals employed in prevention
the Strategy. Jurisdictions already have a range of    roles, peer workers or needle and syringe
measures in place and face different challenges.       workers. Differing criteria and terminology also
It is therefore anticipated that jurisdictions will    mean that findings may not be comparable
undertake actions in line with their own priorities,   between jurisdictions.
timing and resources.
                                                       There is a need to continue to work across
                                                       jurisdictions to strengthen the knowledge
Goals:                                                 base required for workforce development
                                                       and planning. This includes issues such as
To enhance the capacity of the Australian AOD          employee demographics, qualifications, roles
workforce to prevent and minimise alcohol and          and employment intentions. Data is also needed
other drug-related harm across the domains of          about specialist workers within non-specialist
supply, demand and harm reduction activities.          organisations.

To create a sustainable Australian AOD workforce       Once obtained, this information could be linked
that is capable of meeting future challenges, of       to the results of work currently being undertaken
innovation and reform.                                 to estimate AOD treatment demand such as the
                                                       Drug and Alcohol Clinical Care & Prevention (DA-
                                                       CCP) project. The DA-CCP project aims to:
Outcome areas
Outcome area 1: Understand the specialist               • Build the first national population-based model
AOD prevention and treatment workforce                    for AOD service planning by estimating the
                                                          need and demand for services;
Considerable work has already been undertaken
in workforce development and planning, and              • Use clinical evidence and expert consensus
it is important to build on this and increase our         to specify the care packages required by
knowledge and understanding of the specialist             individuals and groups;
AOD workforce. To be able to conduct effective
                                                        • Calculate the resources needed to provide
workforce development and planning, information
                                                          these care packages; and
on three issues is required:
                                                        • Provide an AOD service planning tool
 • The existing workforce and their
                                                          for jurisdictions. (e.g. Ritter, Chalmers, &
                                                          Sunderland, 2013).
 • The demand for the workforce; and

 • Entries to and exits from the workforce (Health
   Workforce Australia, 2013).

NATIONAL AOD WFD STRATEGY 2015-2020                                                                      13
Actions could include:                                Outcome area 2: Create a sustainable
•    Developing a nationally agreed taxonomy          specialist AOD prevention and treatment
     of specialist AOD prevention and treatment       workforce by addressing recruitment and
     roles as a basis for systematic workforce        retention issues
     enhancement and workforce development.           The demand for workers in the health and
                                                      welfare sectors is projected to increase
•    Undertaking a national census of workers
                                                      substantially (Community Services & Health
     employed in specialist AOD prevention and
                                                      Industry Skills Council, 2013). Consequently, the
     treatment roles, including those working in
                                                      AOD sector will be competing for workers with
     non-specialist organisations. The census
                                                      other Australian health and welfare agencies.
     should utilise the nationally agreed data
                                                      Globalisation of the health and welfare workforce
     definitions, and be supplemented with other
                                                      will also result in international competition for
     sources of data such as that provided by
                                                      staff. The recruitment and retention of specialist
     Health Workforce Australia, the Australian
                                                      staff in the AOD sector is therefore a critical
     Bureau of Statistics and peak bodies. As
                                                      issue. While there are significant gaps in our
     well as basic demographic/occupational
                                                      understanding of the characteristics of the AOD
     data, the census should collect information
                                                      specialist workforce, it is understood that:
     on issues such as employment intentions,
     Indigenous status, ethnicity and language         • The majority are female;
     skills. This information could be collated to
     create a comprehensive picture of the current     • The majority are aged 45 years or older; and
     workforce.                                        • Approximately one third are employed part
                                                         time (Roche & Pidd, 2010).
•    Using this workforce data along with
     projections of treatment demand to enhance       Recruitment and retention strategies should be
     workforce planning and identify workforce        based on consideration of these demographic
     needs.                                           characteristics and refined as more detailed
                                                      information becomes available. Effective
•    Encouraging all jurisdictions to consistently    strategies are particularly important in rural and
     adopt the workforce census data definitions      remote areas and for medical and nursing staff.
     in all future workforce development surveys
     and analyses to enable ongoing workforce
     monitoring and mapping.
                                                      Actions could include:
Key Performance Indicators could include:             Improving recruitment into specialist AOD roles
•    Nationally consistent terminology to describe    by:
     the roles of the specialist AOD prevention and
     treatment workforce.                              • Developing and implementing measures to
                                                         reduce the stigma associated with working
•    Comprehensive knowledge of the extent and           within the AOD sector;
     nature of the specialist AOD prevention and
                                                       • Investigating the value of registration or
     treatment workforce.
                                                         credentialing for the AOD sector to enhance
                                                         its professionalism and desirability;

14                                                          NATIONAL AOD WFD STRATEGY 2015-2020
• Promoting the AOD sector as a career of               • Exploring alternative pathways through which
  choice for suitable individuals via marketing           medical graduates can become Fellows of the
  to universities and vocational education                Chapter of Addiction Medicine which do not
  institutions (particularly in schools of medicine,      require basic physician training, or fellowship
  psychology, public health/policy, nursing;              of other colleges; and
  occupational therapy and social work);
                                                        • Examining current supervisory arrangements
• Increasing opportunities for placements                 for trainees enrolled in the Royal Australian
  in AOD settings during vocational,                      and New Zealand College of Psychiatrists
  undergraduate and post graduate education;              Certificate in Addiction Psychiatry to determine
                                                          the viability of broadening the range of
• Better defining career pathways for workers in
                                                          potential supervisors.
  prevention roles;
                                                       Improving specialist workforce retention by
• Develop clear articulation pathways (within          enhancing the availability of:
  and between vocational education and training
  (VET) and higher education systems) to ensure         • Flexible working arrangements (part time work,
  that workers have access to qualifications that         position sharing, time-in-lieu and working from
  enable career progression within the AOD                home);
  field. This will include the mapping of entry
                                                        • Flexible access to education and training
  points for workers from associated fields;
                                                          opportunities including enhanced use of on-
• Enhancing early exposure to drug and alcohol            line learning and other technologies;
  nursing as a career path among nursing
                                                        • Parental leave;
  students and graduates;
                                                        • Comprehensive orientation programs to
• Expanding the number of AOD nurse
                                                          support transition into the sector;
  practitioner positions available and developing
  a structured career pathway for progression           • Mentoring and clinical supervision programs;
  into nurse practitioner positions;
                                                        • Meaningful career pathways which do not
• Enhancing early exposure to addiction medicine          necessarily require clinicians to move into
  as a career path among medical students                 management roles in order to gain promotion;
  and junior medical officers by increasing
  opportunities for placements/rotations through        • Strategies to facilitate re-entry of former
  addiction medicine specialty areas;                     specialist AOD workers;

• Increasing AOD teaching in undergraduate              • Roles for experienced workers which focus
  clinical and public health/policy tertiary              on expanding their skills into more clinically
  courses;                                                complex areas or mentoring and transferring
                                                          their skills;
• Establishing a critical mass of addiction
  medical specialists to enable vertical                • Management and leadership development
  integration of teaching involving medical               programs focussing on responding to the
  students, interns/junior medical officers,              needs and expectations of the workforce;
  registrars and consultants;

NATIONAL AOD WFD STRATEGY 2015-2020                                                                     15
• Pay increments related to competency/            • Percentage of agencies providing specialist
   qualification acquisition as appropriate;          AOD prevention and treatment services that
                                                      report they are able to attract and retain
 • Opportunities for service linked scholarships
                                                      requisite staff.
   and education cost payments;
                                                    • Appropriate turnover rates in specialist AOD
 • Employment exit interviews/surveys to better
                                                      prevention and treatment services.
   understand the reasons for leaving the AOD
   sector;                                          • Percentage of specialist AOD prevention
                                                      and treatment staff receiving mentoring and
 • Portability of long service and sick leave
   entitlements as workers move between
   agencies;                                        • Career paths defined and expanded for AOD
 • Enhanced job security via longer-term
   employment contracts/permanent positions;        • Career satisfaction enhanced and stress and
                                                      burnout rates minimised among specialist
 • Succession planning for staff and
                                                      AOD prevention and treatment staff.

 • Measures to assist existing staff to embrace
   new technologies and new philosophies;

 • Medicare Benefits Schedule items for
   professional attendances provided by
   addiction medicine specialists to ensure that
   services provided by these specialists attract
   equivalent remuneration to similar medical

 • Medicare Benefits Schedule items for
   professional services provided by AOD nurse

 • Appropriate medical officer career structures
   in the public and private sectors which
   combine teaching, clinical research and public
   health roles to make the addiction medicine
   speciality more attractive; and

 • Mechanisms to showcase the achievements
   of the sector.

Key Performance Indicators could include:
 • Number of long-term filled positions in
   agencies providing specialist AOD prevention
   and treatment services.

 • Level of available mentoring, clinical
   supervision and appraisal programs.

16                                                       NATIONAL AOD WFD STRATEGY 2015-2020
Outcome area 3: Match roles with                        Actions could include:
capabilities                                             • Formulating a workforce development
The AOD field involves a diverse range of roles,           matrix which includes the capabilities
requiring differing levels of knowledge and skills.        required to fulfil all roles in the specialist
To-date these roles have not been differentiated           AOD field and defines pathways to achieve
and fully and uniformly described on a national            these capabilities.
basis (see Outcome Area 1-nationally agreed              • Ensuring that capabilities which are pivotal
taxonomy of specialist AOD roles), nor have the            to the future of the AOD sector are included
sets of capabilities required to undertake them            in the workforce development matrix.
been explicitly identified.                                These include capabilities concerning
                                                           client-centred service provision, program
The establishment of a workforce development
                                                           evaluation, inter-professional practice,
matrix involving the major roles in the specialist
                                                           responding to multiple morbidities,
AOD field, and pathways to achieve them, would
                                                           responding to the needs of older people,
help to address this shortcoming. For some
                                                           leadership skills, child and family sensitive
members of the AOD workforce, the required
                                                           practice and responding to special needs
capabilities could be aligned with the attainment
                                                           groups, such as those outlined in Outcome
of specified competencies in the vocational
                                                           Area 7.
education and training sector. Others would
require capabilities that could be attained via          • Ensuring that workforce capabilities evolve
tertiary study, inservice training, recognition of         to reflect emerging research evidence
prior learning, assessment of clinical skills by           (such as drug trends and intervention
supervisors, or completion of a professional               effectiveness).
development program (such as that provided by
the Chapter of Addiction Medicine). A credentialing      • Exploring options for the formation of
program (such as that provided by the Drug and             national workforce development programs
Alcohol Nurses of Australasia), represents a way of        and resources (including web-based
measuring the attainment of these capabilities.            approaches).

                                                         • Ensuring that mentoring, clinical supervision
It will be important to ensure that these
                                                           and appraisal programs support the
capabilities are set at comparable levels with
                                                           attainment of identified capabilities.
other fields. If they are set at levels which are
higher than comparative fields this could reduce
                                                        Key Performance Indicators could include:
the attractiveness of AOD work. In addition, it
is important that the identified capabilities are        • Capability requirements and the pathways
not regarded as employment pre-requisites.                 to achieve these are clearly identified for all
Opportunities must be provided for new entrants            major roles in the specialist AOD field.
and existing staff to acquire the required capability    • Level of articulation between different types
levels during their employment. In addition, it will       and levels of competencies required to
be important not to disadvantage workers who               work in the AOD field.
wish to remain in their current roles for which
identified capabilities did not previously exist.        • Evidence of capabilities being reviewed and
                                                           updated based on emerging research.

NATIONAL AOD WFD STRATEGY 2015-2020                                                                          17
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