Substance use

Harmful alcohol and other drug (AOD) use can undermine the physical, social, emotional, spiritual and mental wellbeing of people [50377]. The use of AODs can also leave people more vulnerable to developing difficulties with mental health [46545].

Co-occurrence, comorbidity or dual diagnosis are terms often used to describe the co-existence of mental health conditions and AOD use disorders [46545]. Co-occurrence may occur because a mental health condition leads to an AOD use disorder or, vice versa [50377][46545]; one disorder can impact the social determinants of health, affecting life chances (e.g. completing school and employment) that result in the chance of developing the other disorder, or the conditions may occur because of shared biological, psychological, social or environmental risk factors [50377][46545]. The co-existence of problematic AOD use and mental health difficulties can affect a person’s identity, sense of belonging and purpose in life [46545].

AOD use or substance use can include alcohol, tobacco, cannabis, amphetamines (stimulants), benzodiazepines (prescription drugs), heroin (depressant) and inhalants (sniffing, chroming), which can have a range of harmful effects on the mental health of users [51235]. Not all substance use is harmful [50377], and the two main classification systems that provide the parameters for the diagnosis of mental disorders are the Diagnostic and statistical manual of mental disorders and the International classification of diseases [46545]. It is important to note that individuals may not always have all the symptoms to meet a full diagnosis according to the classification systems, however, their symptoms can still impact their functioning and treatment outcomes. When a person presents for treatment, it is important for the AOD worker to consider the whole person.

The social and emotional wellbeing of Aboriginal and Torres Strait Islander people in relation to the harmful use of AOD needs to be viewed in the context of the impacts of colonisation, racism, the social determinants of health and the Stolen Generations [27487]. Many of these issues remain largely unresolved and have an ongoing impact on the lives of Aboriginal and Torres Strait Islanders people today.

Mainstream treatment models for co-existing mental health and substance use disorders have their foundations within a Western system of knowledge [46545]. These often ignore the importance of cultural aspects of Aboriginal and Torres Strait Islander people and their communities. Cultural security (a respect and knowledge of cultural differences) is fundamental in the development and delivery of programs, services, policies and strategies [27487], and consideration should be given to the following when working with Aboriginal and Torres Strait Islander people in an AOD treatment setting:

• a holistic concept of health[1]
• an understanding of the historical factors that have influenced AOD use
• culture as a key underlying element
• an understanding of the concept of family and kinship connections
• Aboriginal ownership and control of programs, policies and strategies developed and implemented.

The Australian Indigenous HealthInfoNet’s Alcohol and Other Drugs Knowledge Centre provides further information on AOD programs, policies, resources, organisations and workforce development in relation to the Aboriginal and Torres Strait Islander population.

[1] The holistic concept of health places importance on connection to land, sea, culture, family, spirituality and community [27487][38676].