Maximise early intervention opportunities to reduce alcohol harms in Victoria

Key takeaways

> Rising demand for alcohol and other drug (AOD) services, and delays in help seeking for alcohol harms are resulting in increasingly complex presentations and escalating health system costs.

> A lack of early intervention means harms are not prevented and escalate, with many people’s first contact with health responses being when they are in crisis or experiencing severe harms. 

> Effective early interventions – such as public education, behaviour change, AOD helpline and harm reduction initiatives – will enable people to receive support early and often, before harms escalate and become more complex and costly to treat.

Escalating harms are increasing demand for treatment and health system costs

Roughly 300,000 Australians who need help for alcohol dependence cannot access it.¹ Around half of everyone seeking AOD treatment report alcohol as their primary drug of concern, with 37% more Australians seeking help for alcohol harms compared to a decade ago.² 

In Victoria, alcohol-related: 

• ambulance attendances increased 32%, from 19,695 in 2013-14 to 26,073 in 2022-23;³

• hospital admissions increased 41%, from 26,675 in 2012–13 to 37,586 in 2021–22;⁴ and

• deaths increased 25%, from 7,415 in 2012 to 9,289 in 2021.⁵

These dramatic increases in alcohol-related harms and the associated burden on the health system are key drivers of increasing health system costs. Indeed, alcohol related healthcare costs amounted to around $2.2 billion in 2021, with roughly $430 million attributable to ambulance and emergency services, and a further $729 million incurred by hospital inpatient services.⁶

A lack of early intervention underpins escalating harms and costs 

Investment has not kept pace with the increasing severity of AOD harms and service demand. Almost two thirds of Australia’s AOD budget is spent on law enforcement, with the remaining comprising treatment, prevention, and harm reduction.⁷ AOD harms account for at least 6.7% of the total disease burden,⁸ but Victoria’s AOD budget comprises only 1.3% of the total health budget.⁹ 

Victoria has implemented an Early Intervention Investment Framework over the past four budgets, but despite escalating harms and evidence for significant return on investment, there has been no sustained investment in early intervention for alcohol (and other drug) harms as part of this initiative. This under-investment in early intervention means the harms of alcohol are not prevented and escalate, with many people’s first contact with health responses being when they are in crisis or experiencing severe harms.

Greater investment in early intervention will reduce pressure and costs on the health system

Increasing investment in early interventions presents an opportunity to generate significant returns. Every dollar spent on AOD counselling saves up to $23,¹⁰ and every dollar spent on harm reduction saves up to $27.¹¹ Examples of early interventions include:

• Population-wide, evidence-based public education and anti-stigma campaigns raise awareness of alcohol-related harms and reduce discrimination;¹²

• Behaviour change and schools-based programs reduce high risk and underage alcohol consumption;¹³ 

• Harm reduction services such as Sobering Up Centres reduce demand for emergency services; ¹⁴

• Telephone and online services can be contacted anonymously from anywhere and at any time, making helpline counselling a highly accessible entry point to care, especially for those living in rural and remote areas;¹⁵  

• Primary care screening and brief intervention for alcohol increase the early identification and management of alcohol harms.¹⁶

Recommendation

With more and more Victorians seeking support for increasingly severe alcohol-related harms, there is an urgent need for greater investment in early interventions to prevent and minimise alcohol harms before they escalate and become more complex and costly to manage.

ACV_EarlyIntervention_Final.pdf

Download PDF • 196KB

References

1 Alison Ritter, Jenny Chalmers and Maria Gomez, ‘Measuring Unmet Demand for Alcohol and Other Drug Treatment: The Application of an Australian Population-Based Planning Model’ [2019] (18) Journal of Studies on Alcohol and Drugs, Supplement 42, 47.

2 ‘Alcohol and Other Drug Treatment Services in Australia Annual Report’, Australian Institute of Health and Welfare (Web Report, 21 June 2023) <https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/alcohol-other-drug-treatment-services-australia/contents/about>.   

3 ‘Ambulance Attendances’, AODstats (Web Page, 19 April 2024) <https://aodstats.org.au/explore-data/ambulance-attendances/>. 

4 ‘Hospital admissions’, AODstats (Web Page, 24 April 2024) <https://aodstats.org.au/explore-data/hospital-admissions/>. 

5 ‘Deaths’, AODstats (Web Page, 8 November 2023) <https://aodstats.org.au/explore-data/deaths/>. 

6 Unpublished Turning Point analysis.  

7 Alison Ritter at al, The Australian ‘Drug Budget’: Government Drug Policy Expenditure 2021/22 (Monograph, No 36, 4 June 2024) 11 <https://apo.org.au/node/327038>.

8 Vanessa Prescott et al, Impact of Alcohol and Illicit Drug Use on the Burden of Disease and Injury in Australia: Australian Burden of Disease Study 2011 (Report, 29 March 2018) ix <https://www.aihw.gov.au/reports/burden-of-disease/impact-alcohol-illicit-drug-use-on-burden-disease/summary>.

9  Victorian Government, Helping Families: Service Delivery (Budget Paper, No 3, 7 May 2024) 132 <https://www.budget.vic.gov.au/budget-papers>.  

10 Alexandra Voce and Tom Sullivan, What are the Monetary Returns of Investing in Programs That Reduce Demand for Illicit Drugs? (Report, No 657, 8 September 2022) 8 <https://www.aic.gov.au/publications/tandi/tandi657#>.  

11 National Centre in HIV Epidemiology and Clinical Research, Return on Investment 2: Evaluating the Cost-Effectiveness of Needle and Syringe Programs in Australia (Report, 2009) 8 <https://www.acon.org.au/wp-content/uploads/2015/04/Evaluating-the-cost-effectiveness-of-NSP-in-Australia-2009.pdf>.

12 Simone Pettigrew et al, ‘Evaluation Outcomes of an Alcohol and Pregnancy Campaign Targeting Multiple Audiences’ (2023) 42(1) Drug and Alcohol Review 36, 42; The National Social Marketing Centre, Time to Change (Case Study Report) <https://www.thensmc.com/resources/showcase/time-change>.

13 Dan Lubman et al, ‘Twelve-Month Outcomes of MAKINGtheLINK: A Cluster Randomized Controlled Trial of a School-Based Program to Facilitate Help-Seeking for Substance Use and Mental Health Problems’ (2020) 18(100225) The Lancet EClinicalMedicine 1, 6.

14 Victorian Parliamentary Budget Office, MDMA-Related Overdoses: Overdoses, Service Responses and Cost to the Government (Report, January 2024) 2 <https://pbo.vic.gov.au/response/6533>. 

15 Jasmin Grigg et al, ‘A Latent Class Analysis of Perceived Barriers to Help-Seeking Among People with Alcohol Use Problems Presenting for Telephone-Delivered Treatment’ (2023) 58(1) Alcohol and Alcoholism 68, 70; Peart et al, ‘The Impact of the COVID-19 Pandemic on Calls to an Alcohol and Drug Helpline in Victoria, Australia, for Alcohol, Methamphetamine and Cannabis Use Concerns’ (2024) Drug and Alcohol Review 1, 6 (advance).

16 Elizabeth Sturgiss et al, ‘Multifaceted Intervention to Increase the Delivery of Alcohol Brief Interventions in Primary Care: A Mixed-Methods Process Analysis’ (2023) 73(735) British Journal of General Practice e778, e785.