We heard extensively across New Zealand that alcohol and other drugs are viewed as serious public health concerns and a blight on our communities. Alcohol, in particular its promotion, socialisation and ease of access, was a specific concern, and we heard from submitters concerned about the number of liquor outlets in their communities and their lack of power to influence this. Alcohol is the most common substance of addiction, and in any given year nearly 20% of New Zealanders’ drinking could be classified as hazardous.191
Harmful alcohol use has significant impacts on an individual’s health and society, including causing damage to developing brains (from in utero to adolescence),192 impairing self-control, and playing a role in at least half of youth suicides193 and one-third of recorded offences.194 Further, alcohol use can negatively affect personal relationships (causing harm to the wellbeing and health status of others),195 decrease work productivity and increase absenteeism,196 negatively affect educational outcomes,197 and cause public nuisances such as litter, noise and property damage.198
Despite alcohol’s harm, New Zealand has a normalised heavy drinking culture that, by and large, does not recognise current alcohol use as a crisis. Strong vested interest groups have incentives to resist change. We see parallels with tobacco control and smoking, and believe a similar approach will be needed to tackle the harmful use of alcohol.
In relation to illicit drugs, we heard how their illegality poses a barrier to seeking help and how a criminal conviction for drug use has far-reaching impacts across a person’s life; for example, by negatively impacting on employment or eligibility for access to housing. We also heard very strongly about the impact of methamphetamine (or ‘P’) on users and on their families, whānau and communities. While only just over 1% of New Zealanders are estimated to use amphetamines (including methamphetamine),199 the impacts of methamphetamine are substantial, and it is a significant problem for some communities.
Across the country there was a clear call to adopt an approach to drug use that minimised harm. Minimising harm from drug use requires viewing use as a health and social issue that can be solved, or at least managed, by providing support, compassion and access to treatment for users. It also requires us all to counter prejudices about people who use drugs.200
New Zealand’s National Drug Policy 2015–2020, the Substance Addiction (Compulsory Assessment and Treatment) Act 2017 and the Psychoactive Substances Act 2013 are all intended to minimise harm and promote and protect wellbeing. They are also, however, fundamentally underpinned by an approach that criminalises personal drug use. These issues are playing out on the international stage also; for example, the 2018 Global Commission on Drug Policy report recommended responsible approaches to the regulation of drugs as the best way for governments to take control of illegal drug markets and weaken the hold of organised crime.201
Demand for addiction services is already increasing, and current issues associated with the capacity and capability of addiction services to meet the needs of New Zealanders will continue to increase, yet very little has been invested into services such as residential treatment.
Action on reducing the harmful use of alcohol has stalled. Current policy approaches are not having the required impacts, particularly for some groups who are disproportionately affected by harmful alcohol use such as Māori and people living in the most socioeconomically deprived areas. We believe the Government has already been presented with evidence-based options for reducing the impact of harmful alcohol use and that immediate action is needed to curb New Zealand’s problematic drinking culture.
In 2008, in an attempt to respond to the harms associated with alcohol, the Law Commission was tasked with examining and evaluating the laws and policies relating to the sale, supply and consumption of alcohol in New Zealand and formulating a policy framework covering the principles that should regulate the sale, supply and consumption of alcohol. While the Government adopted most of the Law Commission’s recommendations, the most substantial and potentially reformative recommendations were not implemented. These recommendations were to:
Further work on alcohol pricing that considered the potential impact and effectiveness of a minimum price regime202 and on advertising and sponsorship has been undertaken. The Ministerial Forum on Alcohol Advertising and Sponsorship, for example, reported in 2014 and made several recommendations with a focus on reducing harm to young people arising from alcohol advertising and sponsorship.203 However, there has not yet been a comprehensive government response to recommendations about combating harmful alcohol consumption and to the work on pricing or on advertising and sponsorship.
In relation to alcohol reform, it has long been argued that most New Zealanders drink responsibly and should not be ‘punished’ for the actions of the small minority who do not drink responsibly. We do not believe one in five New Zealanders drinking hazardously each year is a small minority. We also know that alcohol’s reach across society is far greater than simply the sum of its impacts on individual drinkers; families, friends and communities are all touched through one person’s drinking.
Throughout the Inquiry process, we heard a strong appetite for strengthening alcohol reforms, particularly around decreasing the exposure of young people to alcohol advertising and promotions. We believe the case for change has been made and action on alcohol reform is required.
In our view, the main impediment to stronger alcohol reform is a lack of political will.
The criminalisation of drugs is widespread around the world, yet it has failed to decrease drug use or the harmful effects of drug use and has contributed to social issues such as gangs’ involvement in the supply of drugs, prison overcrowding, unemployment and family separations. Criminalisation downplays the health and social impacts of drug use that can best be managed by providing support to people early and throughout their lives. Having a conviction for a drug offence can affect an individual’s ability to gain employment, maintain relationships and travel, and the fear of these long-term consequences (in addition to potentially serving time in prison) creates a significant barrier to a drug user seeking support for recovery.
The fear of having children removed by Oranga Tamariki—Ministry for Children or being sent back to prison for alcohol or other drug use while on probation was highlighted to us as examples of other barriers to seeking treatment. We also heard that while great strides have been made in reducing stigma associated with mental health, significant stigma is still associated with drug addiction, potentially compounding existing barriers to people seeking help.
It is clear to us that New Zealand’s approach to drugs needs to change. While New Zealand was the first country to introduce a state-sponsored needle exchange programme, we seem to have lost our spirit and failed to put people’s health at the centre of our approach. In its review of the Misuse of Drugs Act 1975, the Law Commission made a range of recommendations for reforming our drug laws that focused on minimising harm and promoting health. Potentially transformative recommendations from the review that were not adopted include:
In addition to considering these recommendations, we had the opportunity to consider how other countries have adopted health-based approaches to drug use. Some of these approaches, such as from Portugal, appear to be generating great success, are widely advocated for across New Zealand, and show great promise for transforming our current approach.
Portugal’s approach to personal drug use
A drug crisis during the 1980s and 1990s led Portugal to dramatically overhaul its approach to personal drug use. In 2001, Portugal decriminalised the purchase, possession and consumption of all drugs for personal use. In lieu of traditional justice sector processes, three-member Dissuasion Commissions were established as the sole bodies responsible for adjudicating administrative drug offences and imposing potential sanctions. While various sanctions are available to the commissions, they are often used as a last resort, particularly if the drug user seeks treatment for their drug use.
As was hoped, decriminalisation removed the most substantial barrier to drug users seeking treatment – their fear of being treated as criminals and entering the justice system. Now, more people than ever are receiving treatment for their drug use, and Portugal has experienced significantly decreased incidence of new HIV infection, decreased use of almost all drugs by people under 18, and a lower prevalence of drug use than the European Union average in schools and across the overall population.
Another benefit is that the quality and response capacity of healthcare networks for people with addictions improved dramatically across the country, so treatment is available to all people with addictions who seek treatment.
Although there were concerns Portugal would become a drug haven for tourists, these concerns are unfounded; roughly 95% of those cited for drug offences each year are Portuguese nationals.204
In summary, we note that New Zealand’s current official National Drug Policy is based on harm minimisation, but that this needs to be extended given it is still underpinned by the criminalisation of drug use. The criminalisation of drug use has failed to reduce harm around the world and a shift towards considering personal drug use as a health and social issue is required if we are to minimise the harm associated with drug use. This approach runs counter to the views of a minority of submitters who supported a ‘tougher’ approach to drug use. However, we believe the ‘war on drugs’ approach has been ineffective and has done little to address the myriad of harms that drug use causes, including the increasing role of organised criminal organisations.
Central government appears to have lost traction on alcohol and other drug issues, although we note the recent formation of a cross-party group on drug harm reduction. Overall, leadership is weak and it is unclear where responsibility for coordinated strategy and policy lie.
Given the significant role that alcohol and other drugs play in people’s wellbeing across New Zealand, a unit with a strong cross-sectoral focus dedicated to advancing alcohol and other drug policy is critical. One option is for the proposed social wellbeing agency (discussed in chapter 7) to take on this role and provide strong, coordinated leadership. Whoever is tasked with leadership should be mandated to tackle alcohol use in the same way as New Zealand successfully tackled smoking. Although the approach to alcohol use will differ, the same kind of focus and commitment to reducing harmful alcohol use is needed.
It is difficult to determine a desirable balance between spending on addiction treatment and mental health services. However, addiction services receive a relatively small proportion (about 11%)205 of the total public expenditure on mental health and addiction services, and the addictions sector has long been considered the ‘poor cousin’. An injection of investment into the addictions sector is required to increase the number of services available to people across the country and to promote better collaboration between the mental health and addiction sectors. There should be a comprehensive range of culturally responsive, evidence-informed options that give people choices.
Over time, additional investment in addiction services should lead to savings and enable resources to be shifted towards earlier intervention, for example, through a decrease in the prison population. In the short term, the investment we recommend for services in the ‘middle ground’ (chapter 4) should also increase access for people requiring support for alcohol and other drug challenges. This will include a range of services, from brief interventions in general practice and primary care settings through to social and detox options and follow-up community-based services.
Therapeutic support programmes
Two Alcohol and Other Drug Treatment (AODT) Court pilots were established in Auckland in 2012. The objective is to help repeat offenders deal with their drug and addiction and criminal behaviour through a model of intensive therapeutic interventions. The AODT Court is founded on evidence-based policies and procedures and has embedded Kaupapa Māori approaches through appointment of a cultural advisor (Pou Oranga), and use of peer-support workers. Each AODT Court can take a maximum of 50 participants per year. Participation is voluntary, but allows an opportunity to avoid jail on graduation from the programme, which takes about 18 months.
In a collaboration between the judiciary, Ministry of Justice, Ministry of Health, Department of Corrections and New Zealand Police, each person receives a customised treatment programme that best suits their recovery and is assigned a multidisciplinary team. In addition to clinical interventions (such as treatment through programmes such as those run by Higher Ground and Odyssey), the team also helps participants repair stressful social and emotional situations, such as homelessness and relationships with whānau.
The AODT Court is the point of ‘control’ and holds the participant and providers to account during once-weekly hearings.
Preliminary evaluation suggests the AODT Courts have reduced the likelihood of reoffending by around 15% when measured against offenders who go through the standard court process, and that around 60 prisoner places per year may be saved.206
Take strong action on alcohol and other drugs
191 Ministry of Health. 2017. Annual Data Explorer 2016/17: New Zealand Health Survey (data file). https://minhealthnz.shinyapps.io/nz-health-survey-2016-17-annual-update(external link) (accessed 19 October 2018).
192 K Stratton, C Howe and F Battaglia (eds). 1996. Fetal Alcohol Syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington DC: Institute of Medicine; S Bava and SF Tapert. 2010. Adolescent brain development and the risk for alcohol and other drug problems. Neuropsychology Review 20(4): 398–413.
193 P Gluckman. 2017. Youth Suicide in New Zealand: A discussion paper. Wellington: Office of the Prime Minister’s Chief Science Advisor. www.pmcsa.org.nz/wp-content/uploads/17-07-26-Youth-suicide-in-New-Zealand-a-Discussion-Paper.pdf(external link)
194 New Zealand Police. 2010. Framework for Preventing and Reducing Alcohol-related Offending and Victimisation 2010–2014. Wellington: New Zealand Police. www.police.govt.nz/sites/default/files/publications/alcohol-safety-strategy-2010-2014.pdf(external link).
195 S Casswell, RQ You and T Huckle. 2011. Alcohol’s harm to others: reduced wellbeing and health status for those with heavy drinkers in their lives. Addiction (13 January). https://doi.org/10.1111/j.1360-0443.2011.03361.x.
196 Law Commission. 2010. Alcohol in Our Lives: Curbing the harm (NZLC R114). Wellington: Law Commission. www.lawcom.govt.nz/our-projects/regulatory-framework-sale-and-supply-liquor?id=897(external link).
197 Law Commission. 2010. Alcohol in Our Lives: Curbing the harm (NZLC R114). Wellington: Law Commission. www.lawcom.govt.nz/our-projects/regulatory-framework-sale-and-supply-liquor?id=897(external link).
198 Law Commission. 2010. Alcohol in Our Lives: Curbing the harm (NZLC R114). Wellington: Law Commission. www.lawcom.govt.nz/our-projects/regulatory-framework-sale-and-supply-liquor?id=897(external link).
199 The 2015/16 New Zealand Health Survey reports that in 2015/16, 1.1% of adults (aged 16–64) used amphetamines in the past year. For Māori, amphetamines were used by 2.9% of adults. Ministry of Health. 2016. Amphetamine Use 2015/16: New Zealand Health Survey. Wellington: Ministry of Health. www.health.govt.nz/publication/amphetamine-use-2015-16-new-zealand-health-survey(external link).
200 Global Commission on Drug Policy. 2017. The World Drug Perception Problem: Countering prejudices about people who use drugs. Switzerland: Global Commission on Drug Policy. www.globalcommissionondrugs.org/reports/changing-perceptions/#.(external link)
201 Global Commission on Drug Policy. 2018. Regulation: The responsible control of drugs. Switzerland: Global Commission on Drug Policy. www.globalcommissionondrugs.org/reports/regulation-the-responsible-control-of-drugs/.(external link)
202 Ministry of Justice. 2014. The Effectiveness of Alcohol Pricing Policies: Reducing harmful alcohol consumption and alcohol-related harm. Wellington: Ministry of Justice. www.justice.govt.nz/justice-sector-policy/key-initiatives/sale-and-supply-of-alcohol/alcohol-minimum-pricing-report(external link)
203 Ministerial Forum on Alcohol Advertising and Sponsorship (G Lowe, Chair). 2014. Ministerial Forum on Alcohol Advertising & Sponsorship. www.health.govt.nz/system/files/documents/publications/ministerial-forum-on-alcohol-advertising-and-sponsorship-recommendations-on-alcohol-advertising-and-sponsorship-dec14.pdf.(external link)
204 G Greenwald. 2009. Drug decriminalization in Portugal: Lessons for creating fair and successful drug policies. Washington, DC: Cato Institute.
205 HDC. 2018. New Zealand’s Mental Health and Addiction Services: The monitoring and advocacy report of the Mental Health Commissioner. Auckland: Health and Disability Commissioner. www.hdc.org.nz/resources-publications/search-resources/mental-health/mental-health-commissioners-monitoring-and-advocacy-report-2018(external link)
206 Cabinet Social Policy Committee. 2018. Report-back on the Alcohol and Other Drug Treatment Court Pilot and other AOD-related Initiatives. www.justice.govt.nz/assets/Documents/Publications/Report-back-on-the-Alcohol-and-Other-Drug-Treatment-Court-Pilot-and-other-AOD-related-Initiatives-Paper.pdf.(external link)