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Reducing Stigma and Discrimination for People Experiencing Problematic Alcohol and Other Drug Use

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Reducing Stigma and Discrimination for People Experiencing Problematic Alcohol and Other Drug Use Reducing stigma and discrimination for people experiencing problematic alcohol and other drug use A report for the Queensland Mental Health Commission Final report April, 2017 Dr Kari Lancaster1 Dr Kate Seear2 Professor Alison Ritter1 1Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales 2 Faculty of Law, Monash University 1 Table of Contents Executive summary ................................................................................................................................. 7 1. Project Background ........................................................................................................................... 13 1.1 Project Aims ............................................................................................................................ 13 2. Methods and approach to analysis ................................................................................................... 14 2.1 Literature review ..................................................................................................................... 14 2.2 Legislation review ................................................................................................................... 15 2.3 Interviews and analytical case studies based on interviews ................................................ 16 3. Results: Literature review ................................................................................................................. 18 3.1 Definitions: what are stigma and discrimination? ...................................................................... 18 3.2 ‘Felt’, ‘enacted’ and ‘internalised’ stigma ................................................................................... 20 3.3 Stigma and AOD .......................................................................................................................... 20 3.4 Considerations of stigma and the law......................................................................................... 25 3.5 Interventions for reducing stigma .............................................................................................. 27 Mass media interventions ............................................................................................................. 29 Educational and school-based interventions ................................................................................ 30 Community-based interventions .................................................................................................. 30 Interventions for health professionals and service providers ...................................................... 31 Interventions relating to treatment uptake .................................................................................. 33 Interventions relating to internalised stigma ............................................................................... 33 Considerations of co-stigma ......................................................................................................... 34 Involving the affected community in policy and practice ............................................................. 34 Changing cultural constructions ................................................................................................... 35 Conclusion ..................................................................................................................................... 36 4. Results: Legislation review ................................................................................................................ 37 4.1 Mapping AOD under Queensland law ........................................................................................ 37 4.2 Establishing the different areas of law in which AOD is relevant ............................................... 37 4.3 Analysing the relationship between law and stigma .................................................................. 43 Targets of law ................................................................................................................................ 53 Definitions of the targeted practices, activities and behaviours .................................................. 54 Who makes decisions and what kinds of decisions can be made? ............................................... 55 What kinds of protections are offered? ........................................................................................ 56 Summary ....................................................................................................................................... 57 2 5. Interviews and analytical case studies based on interviews ............................................................ 59 5.1 Experiences and effects of stigma .............................................................................................. 60 Stereotypes and assumptions ....................................................................................................... 60 Subjectivity, self-esteem and self-worth ...................................................................................... 60 Effects on drug use ........................................................................................................................ 62 Stigma as a barrier to help-seeking............................................................................................... 62 Within group stigma ..................................................................................................................... 62 5.2 Settings ........................................................................................................................................ 63 Family/social ................................................................................................................................. 63 Health care .................................................................................................................................... 65 Employment .................................................................................................................................. 68 Police/Public order ........................................................................................................................ 70 Child services/Legal issues/Courts ................................................................................................ 71 Other services ............................................................................................................................... 72 Society at large .............................................................................................................................. 73 Summary ....................................................................................................................................... 74 5.3 Analytic case examples ............................................................................................................... 76 Case example – Accessing medical care ....................................................................................... 76 Case example – Fear of blood borne viruses ................................................................................ 78 Case example – Employment dismissal without warning or support ........................................... 79 Case example – Supportive employers ......................................................................................... 81 Case example – Centrelink and social services ............................................................................. 83 Case example – Being heard ......................................................................................................... 84 Case example – Police attention ................................................................................................... 85 Case example – Homelessness and public order .......................................................................... 86 6. Recommendations ............................................................................................................................ 87 6.1 Overarching recommendations .................................................................................................. 88 Recommendation 1: Implement a Queensland Human Rights Charter ....................................... 88 Recommendation 2: Conduct anti-stigma awareness training across all relevant workforces ... 89 Recommendation 3: Ensure consumer participation in policy and actions designed to reduce stigma and discrimination ............................................................................................................. 91 6.2 Health care/public health ........................................................................................................... 91 Recommendation 4: Increase the access and availability of AOD treatment ............................. 91 Recommendation 5: Improve the marketing of AOD treatment ................................................. 92 3 Recommendation 6: Better support family members of those in AOD treatment, through education and information resources .......................................................................................... 92 Recommendation 7: Invest in improvements in the physical facilities within AOD treatment services .........................................................................................................................................
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