Vapes (or e-cigarettes) are devices that heat a liquid to create an aerosol that users inhale. Some vapes contain nicotine (even if it is not listed as an ingredient on the label) [47541]). Other components include chemicals from flavourings and e-liquids which become toxic when heated as an aerosol [51755].  Vaping prevalence in Australia, especially among young people, has increased greatly in recent years [40728].

Long term harms:

• the evidence is still emerging about the long term harms of vaping however there is strong evidence that e-cigarettes expose users of vapes to carcinogens and is likely to cause cancer particularly of the the lung and mouth [51755].

Short term harms:

• injuries (poisoning, burns and seizures)
• e-cigarette or vaping use-associated lung injury (EVALI)
• nicotine dependence
• increased uptake of tobacco use among non-smokers [46823].

In Australia, you can only purchase nicotine vapes or nicotine refills if you are an adult with a valid prescription [44426]. Vaping is not recommended as an effective first-line method for quitting smoking [46982].

Data on vaping prevalence is limited. Figures from 2018/19 indicated that less than one in ten Aboriginal and Torres Strait Islander adults had tried vaping, and around 1 in 100 currently vaped. Vaping is more common among Aboriginal and Torres Strait Islander people who are younger, male and living in non-remote areas [40033].

For a summary of statistical information updated annually on vaping among Aboriginal and Torres Strait Islander people, see the latest Overview of Aboriginal and Torres Strait Islander health status.

Healing is a process of recovery for the mind, body and spirit after a person has experienced trauma [40355]. The experience of trauma may be from a single, life threatening or distressing event or it can be from ongoing violence, abuse or other events that threaten a person’s safety. Past policies and practices, cultural dislocation and the impacts of intergenerational trauma on Aboriginal and Torres Strait Islander people have had a profound effect on the health and wellbeing of individuals as well as communities [27487].

Recovery from trauma is assisted by [29064]:

• creating a sense of control and choice in life
• having safe and calm places where we feel we can trust others
• reconnecting with family, community and other supportive relationships
• empowerment in decision making at both an individual and community level.

Healing is a different journey for each person [36986]. Healthy and strong communities can provide a pathway to healing by providing a safe space for individuals to tell their story and reconnect with culture. Having connection to family, community and supportive relationships are important to recovery and restoring a sense of self. Knowing where you come from, where you belong and where you fit, in passing on cultural knowledge helps to protect and nurture social and emotional wellbeing [29064]. Community activities that support healing include yarning circles, gatherings, healing camps, art, dance, song, weaving, and cultural ceremonies.

Sometimes distressing memories and emotions can feel overwhelming. There are some useful strategies for individuals to help calm the mind. These include [36369]:

• Talking to someone – call a support person or a friend
• Taking a moment – physically leave the situation, reminding yourself you are not running away, just taking a break
• Breathing and meditation – staying in the present moment and slowing down your breathing calms stress and nerves. Try this guided meditation that is in Pitjantjara and English.
• Speaking your truth – you decide if you would like to participate in a conversation. If speaking about your experience makes you feel empowered you are entitled to speak your truth. The decision is completely yours.
• Acknowledging your feelings
• Connecting to Country
• Making art
• Drinking water
• Exercising and eat well.

See Key resources on this page for more information on resources, programs and organisations to support healing.

Preventing harmful alcohol use begins with supporting strong communities. When people have the opportunity to be involved in Culture, and where there is access to education, employment and stable accommodation there is less demand for alcohol [23519]. Strategies and programs that nurture social connections and encourage people to look after their health, help to support community members to make healthy choices in their lives.

Education on the harms of alcohol use also has a role in preventing alcohol use. People can make informed choices when they know more about the short and long term effects of alcohol use, including the harms they might not be aware of such as the risk of diabetes and liver disease. Education may be provided through school-based education programs, advertising campaigns, community information sessions or providing people with advice on where to get help [34063].

From an Aboriginal and Torres Strait Islander¹ perspective health and wellbeing is more than just about the physical wellbeing of the individual. It is also about the social, emotional and cultural wellbeing of the whole community [10985] . For most Indigenous alcohol and other drug (AOD) workers, their main aim is to improve the health and wellbeing of their communities, with whom they feel unified in heart and spirit [28152].

In seeking to improve the wellbeing of communities, it is also important for workers, their supervisors and managers to understand what they (i.e. the worker) can do to improve their own wellbeing by reducing stress and burnout. Each worker needs to recognise how they respond to stress in their work role. This is different for each person.

Understanding the factors and events that trigger stress and applying strategies to lower stress levels is essential for worker wellbeing.

What is work-related stress and burnout?

Stress occurs when people feel they cannot cope with the demands placed upon them. Work stress refers to what happens when work demands get too much over a short-term period.

Burnout is different to stress (but it may include signs and symptoms of stress). Burnout is a longer-term process where workers do not function well at work and develop negative and cynical attitudes towards clients and work in general. Stressful working conditions and job demands can result in worker burnout over time.

When people are burnt out they:

• feel emotionally exhausted (feeling overextended and emotionally and physically drained)
• have a negative, detached or cynical view of their work
• feel like they are not accomplishing much at work
• feel they are stupid or that nothing they do has any effect [28152].

Stress and burnout can lead to:

• reduced job satisfaction
• lower job performance (quality and quantity of work)
• an increase in being absent from work and staff turnover
• reduced commitment to work and the organisation [26602].

Stress, burnout and Aboriginal and Torres Strait Islander alcohol and other drug workers

Workers in health and welfare jobs often have high levels of work-related demands and stressors. They are more likely than other workers to experience stress and burnout.

Working in the AOD sector can be stressful and challenging but also rewarding [38246]

For many Aboriginal and Torres Strait Islander AOD workers, working in the AOD sector may be even more challenging for a range of reasons [28152]. There are 10 major sources of work-related stress which affect Aboriginal and Torres Strait Islander AOD workers, listed in Table 1.

Strategies to address stress and burnout

The best strategy to prevent (or reduce) stress and burnout is an approach that focuses on both:

• organisational responses
• individual responses.

Individual stress reduction strategies should be used in conjunction with organisational strategies to reduce stress, not in isolation [28152].

What can Aboriginal and Torres Strait Islander alcohol and other drug workers do to reduce stress and risk of burnout?

Individual workers can do a lot to manage their stress and reduce risk of burnout.

Cultural backgrounds

Many Aboriginal and Torres Strait Islander people have overcome extraordinarily difficult experiences and have gained great strength and resilience from their cultural backgrounds.

Key elements in maintaining worker wellbeing include:

• having close family bonds
• telling and hearing cultural stories
• spirituality.

Connections to community

Doing work that allows workers to keep and strengthen their links with their communities is an important stress management tool for many workers. Being able to give and receive support from their communities is extremely important to worker wellbeing.

Laughter

Laughter is a helpful way to remain positive and resilient. Humour can also be used within the workplace as a way to manage distressing events and contain minor irritations.

Having realistic expectations

Developing an understanding of what can and cannot be done, and being aware that it is not possible to help everyone, is essential for worker wellbeing. Developing realistic expectations can reduce the stress on Indigenous AOD workers. Recognising stressful situations that are likely to occur as part of Aboriginal and Torres Strait Islander AOD workers’ roles can help reduce stress when these situations do arise.

Prioritising work tasks

Prioritising the jobs to be done at work is important to reduce stress, particularly where workloads are overwhelming. It is important to learn techniques and strategies to give work tasks that are most important at the time they need to be attended to. Knowing how to prioritise tasks is a key way to keep on top of the demands and expectations from communities, peers and managers.

Work/life balance

Work/life balance is the relationship between work and other commitments in workers’ lives and how they impact on one another. Many Aboriginal and Torres Strait Islander AOD workers struggle to balance work and the responsibilities of caring for children, community and kin. There is no ideal work/life balance. Everyone is different and the ‘right’ balance may change as commitments change. Flexible work arrangements help to manage work and life demands, for instance by allowing employees to work in patterns and places that fit their personal commitments.

Enjoying the successes

Working with clients, particularly one-on-one, and helping them to achieve their goals is a major source of worker satisfaction. Seeing clients who previously had AOD problems living, working, and participating in community activities is rewarding and can balance out the stress and demands experienced by workers. Focussing on and sharing successes, no matter how small, is very important.

What can organisations do to support worker wellbeing?

Organisations can support workers by addressing aspects of the work situation that cause stress. This could be things like:

Regularly consult with staff about their workload

• make sure staff are not overloaded
• ensure workloads are shared evenly
• involve staff in decision-making on issues which impact their work.

Understanding Aboriginal and Torres Strait ways of working

• have flexible working arrangements to allow workers to balance work, family and community commitments
• recognise the importance of connections and obligations to land, community and kin
• consult widely with communities.

Provide role clarity

• Better job descriptions let workers know what their roles are within their organisations.

Supervision and support

• clinical supervision – involves an experienced worker helping a less experienced worker to develop their clinical skills by providing guidance and support. This is an important way of preventing and managing stress. For Aboriginal and Torres Strait Islander AOD workers, this needs to occur in an Indigenous specific and culturally safe way.
• debriefing – helps workers to carefully reflect on stressful events. This includes factors such as what led to the event, the worker’s reactions to the event and how future stressful events can be prevented. It is important for organisations to provide appropriate debriefing that best suits their workers.
• mentoring – is where more experienced workers (mentors) work with less experienced workers. It provides a safe and supportive way to help the person being mentored, learn to manage stressful and hard situations. Mentoring also helps develop problem solving skills to address issues and problems that happen in the AOD field.

Career paths

• limited promotion opportunities for Aboriginal and Torres Strait Islander AOD workers can make it difficult to attract and keep staff. It is important to provide career paths for staff and to create senior staff positions that can be attained.

Salaries

• Aboriginal and Torres Strait Islander AOD workers do difficult and valuable work and deserve appropriate salaries. Equivalent salaries for staff from government, community controlled and non-government health services are important.

Team and co-worker support

• team and co-worker support is particularly important for Aboriginal and Torres Strait Islander AOD workers, especially those working in remote areas. It is recommended that Indigenous appointments are not made in isolation. This is especially important for young or new workers.

Qualifications and training

• Aboriginal and Torres Strait Islander AOD workers and their managers may need additional and ongoing training to allow them to do their jobs well. Improved training and advanced skill development helps reduce stress levels among workers.

Where to get more information on Aboriginal and Torres Strait workforce support

The Australian Indigenous Alcohol and Other Drugs Knowledge Centre maintains a range of resources to support Aboriginal and Torres Strait Islander AOD workers in their practice. For more information please click on the links below:

Drug and alcohol courses

• a comprehensive listing of current drug and alcohol courses relevant to Aboriginal and Torres Strait Islander AOD workers.

Conferences, events and workshops

• a range of professional development opportunities in each state.

Handbook for Workers

• the Handbook for Aboriginal alcohol and other drug work provides practical information to guide AOD workers in their day-to-day work. Each chapter includes detailed information on approaches to alcohol and drug work, ranging from clinical guidelines and general principles of counselling to information on specific drugs.

Aboriginal community controlled health organisations also offer a wide variety of workforce support options, including workforce development units, health worker networks, accredited training courses and newsletters and magazines. Contact your relevant state or territory’s peak community controlled health organisation for more information about what is available in your region.

Information in this section is based on the Indigenous alcohol and other drug workers’ resource kit [26582] produced by the National Centre for Education and Training on Addiction in consultation with Aboriginal and Torres Strait Islander alcohol and other drug workers.

Endnote

¹The terms Aboriginal and Torres Strait Islander and Indigenous are used interchangeably throughout this document. We understand that some people have a preference for using one term over the other and we have used the terms interchangeably to be sensitive to these differing perspectives.

What is the current profile of the Aboriginal and Torres Strait Islander AOD workforce?

The Aboriginal and Torres Strait Islander alcohol and other drug (AOD) workforce comprises workers who respond to AOD issues and provide services to Aboriginal and Torres Strait Islander people and communities in Australia. This includes, but is not limited to, Aboriginal and Torres Strait Islander health workers, mental health workers, and liaison officers, as well as Aboriginal and Torres Strait Islander doctors, nurses, drug and alcohol clinicians, social workers, community health workers, and mobile patrol staff [34733].

In Australia, the designated role of Aboriginal AOD Worker usually refers to individuals of Aboriginal or Torres Strait Islander identity who work in the AOD field in various roles with an emphasis on improving quality and accessibility of care [23662].

In a 2020 national survey of the alcohol and other  drug workforce, 6% of respondents identified as Aboriginal and/or Torres Strait Islander[40939].

What are the issues and challenges facing the Aboriginal and Torres Strait Islander AOD workforce?

A broad range of issues can impact on the wellbeing of Aboriginal and Torres Strait Islander and non-Indigenous AOD workers. These include high levels of stress due to stigmatisation, complex client presentations, difficult working conditions and limited training and support [34733][45293] . These issues are likely to be exacerbated for Indigenous workers as they attempt to support community and family members dealing with profound and complex AOD problems.

Aboriginal and Torres Strait Islander AOD workers find aspects of their jobs extremely rewarding including helping their community members, enhancing community services and improving Aboriginal and Torres Strait Islanders’ health outcomes and life expectancies. Nevertheless, against a background of disadvantage and complex AOD use,  Aboriginal and Torres Strait Islander AOD Workers face unique stressors including:

• heavy work demands and a lack of clearly defined roles and boundaries reflecting high community need and a shortfall of Aboriginal and Torres Strait Islander AOD Workers
• dual forms of stigmatisation stemming from attitudes to AOD work and racism
• difficulties translating mainstream work practices to meet the specific needs of Aboriginal and Torres Strait Islander clients
• challenges of isolation when working in remote areas
• dealing with clients with complex comorbidities and health and social issues
• lack of cultural understanding and support from non-Indigenous collegaues  [23662].

These challenges mean that Aboriginal and Torres Strait Islander AOD Workers have distinct workforce development needs, and workforce development strategies need to be implemented in a culturally safe manner. This includes measures such as:

• recognising and responding to the importance of gender balance among Aboriginal and Torres Strait Islander AOD Workers
• ensuring that new Aboriginal and Torres Strait Islander AOD Workers participate in culturally appropriate orientation and induction programs
• ensuring access to culturally secure AOD training and working environments which recognise the importance of Aboriginal and Torres Strait Islander ways of working 1
• enhancing access to Aboriginal and Torres Strait Islander mentors and clinical supervisors.

Endnote

1. Aboriginal and Torres Strait Islander ways of working refers to recognising the importance of, and impact on, Aboriginal and Torres Strait Islander peoples of issues such as: Australia’s post-colonial Indigenous history; kinship; commitment to community; grief, loss and sorry business; holistic approaches to health; women’s and men’s business; Aboriginal and Torres Strait Islander concepts of time; respect for Elders; and connection to Country and health [27674].

Each community has its own strengths and values as well as its own challenges [23519]. Communities have the capacity to identify their own priorities and with appropriate resourcing, respond to issues with local solutions which contributes to empowering communities in the long term [29064][25048]. One of the first steps needed to establish healthy communities is to acknowledge the impact of the loss and trauma from colonisation. This allows a collective and individual healing to take place, that can then be followed up by strategies to address current needs [29064].

There are many examples of successful community led initiatives that address a range of issues including reducing harms from alcohol and other drug use. Programs such as mentoring young men, skills development, providing recreational and cultural activities that connect people to one another, and social support to assist people with housing or mental health, all contribute to developing community capacity.

Broad based prevention strategies include [47241][46914][33707]:

• supporting community led activities developed by and for Aboriginal and Torres Strait Islander people
• developing collaborative partnerships with Aboriginal and Torres Islander organisations
• providing opportunities to be included in the wider society through employment and education.

High levels of alcohol and other drug (AOD) use are closely linked to an increased risk of contact with the justice system and spending time in prison [48039]. As with the non-Indigenous prison entrants, a significant proportion of Aboriginal and Torres Strait Islander people who enter prison are at increased risk of experiencing an alcohol or other drug use dependence [50284]. Alcohol and tobacco are the most commonly reported drugs used prior to prison, followed by cannabis and methamphetamine [48039].

Being incarcerated separates people from family and culture, and impacts on a person’s capacity to maintain connection with employment, education and community. Young Aboriginal and Torres Strait Islander people are particularly affected, with many young detainees transported a long way from their communities [33707]. Spending time in prison potentially exposes people to many additional harms including unsafe practices such as sharing needles [50254].

A number of strategies have been developed to keep people out of prison such as justice reinvestment and diversion programs. Justice reinvestment is an approach that reinvests resources back into communities that would normally be spent on incarceration. In partnership with the community, key areas of concern are identified and local responses are designed and evaluated for outcomes to address the underlying causes of crime including AOD use [34378].

Diversion programs also aim to keep people out of prison. They include police discretion to issue a caution for small amounts of cannabis, as well as drug courts which offer participants the opportunity to address their AOD use through counselling and support [22997]. Studies have shown Aboriginal and Torres Strait Islander people are less likely to be issued a cautionary fine than non-Indigenous people, and more likely to be charged with possession and pursued through the courts [46716]. Counselling diversion programs have been shown to be effective for Aboriginal and Torres Strait Islander people when they have been culturally adapted to meet the needs of participants [22997].

Many Aboriginal and Torres Strait Islander people view health as holistic; encompassing mental, physical, cultural and spiritual health [33834].

In 1989 the National Aboriginal Health Strategy Working Party defined health as:

Not just the physical well-being of the individual but the social, emotional, and cultural well-being of the whole community. This is a whole-of-life view and it also includes the cyclical concept of life-death-life[10967].

Maintaining a connection to culture and self-determination are important protective factors that contribute to a stable and optimal sense of mental health and social and emotional well-being [29074]. This can include connection to:

• ancestry and kinship networks
• spiritual beliefs – which offer guidance and comfort in times of distress, death and loss
• guidance from Elders
• having defined roles within community [28917][28925].

The continuing legacy of colonisation that has caused displacement of Aboriginal and Torres Strait Islander people from their traditional lands and ways of being, as well as the systematic devaluing of Aboriginal and Torres Strait Islander culture, has had an ongoing impact on the lives of Aboriginal and Torres Strait Islander people[28916]. Alcohol and drug use is one way individuals cope with life stressors and emotional distress [33834][28925][23503].

Strategies and programs to address harmful alcohol and other drug  use among Aboriginal and Torres Strait Islander people are important for restoring the health and social and emotional wellbeing not only of individuals, but of their families and communities [27794].

The transmission of blood borne viruses (BBVs) from person to person can occur via injecting drug use, or as a result of risky behaviour from alcohol and other drug use [50865][35376]. These BBVs can include:

• hepatitis C
• hepatitis B
• HIV
• HTLV-1, which is prevalent in Central Australia [35376][50866].

If people who inject drugs share their equipment (needles, syringes, spoons, water or tourniquets) with other people, then there’s a chance they might be exposing themselves to a BBV [23505]. Some drug users might not realise they have a BBV, so it’s important to get tested regularly. To reduce the likelihood of passing on, or getting a BBV, there’s a few strategies that people can take:

• keeping your hands clean using soapy water (or swabbing with a new swab) before and after injecting drugs
• finding a clean area to inject in
• using new needles and syringes, sterile water and also spoon, swabs, filters and tourniquets
• do not share injecting equipment
• when finished, safely dispose of all the equipment [41459].

There are treatment options available for people who have hepatitis C. These treatments are combinations of Direct Acting Anti-viral (DAA) drugs which are listed on the Australian Pharmaceutical Benefits Scheme [36094]. These drugs have been found to have a very high success rate, with a cure rate for around 90% of people treated.

There is also medicine to prevent a person from acquiring HIV, an antiretroviral treatment called pre-exposure prophylaxis (PrEP). This medicine comes in the form of a pill, taken daily, which will reduce the risk of getting HIV (but it will not treat it) [50205].

Alcohol, tobacco and illicit drugs have been linked to a greater likelihood of developing a chronic disease or worsening the symptoms of an existing chronic disease [35376].

Drinking more alcohol than is recommended can result in heart attack or stroke [47098]. Alcohol has also been linked to liver, stomach and bowel cancers, and is a risk factor for liver disease, including alcoholic hepatitis and alcoholic cirrhosis.

Tobacco use and vaping are also linked to chronic disease and long term harms [31577][51755]. Cigarettes contain harmful chemicals which can increase the risk of:

• cardiovascular disease (heart attack and stroke)
• cancer (of the lungs, mouth, lips, throat, stomach, liver, pancreas, kidney and bladder)
• lung disease
• diabetes.

While the evidence for long term harms from vaping are still emerging, there is strong evidence that vaping is linked to inflammation, oxidative stress and exposure to carcinogens [51654]. Long term of effects of cannabis use can include upper respiratory tract cancers, lung and heart disease. The use of stimulants such as amphetamines and cocaine can result in cardiovascular problems and stroke [51655] .

Injecting drug use puts people at risk of being infected with blood borne viruses and is also associated with risk of bacterial infection at the site of injecting or in the bloodstream [23517]. People who inject drugs have a higher chance of overdose than those who take drugs orally because a large quantity of the drug reaches the brain very quickly. There is also a greater chance of sexually transmitted infection as injecting drug use, particularly methamphetamine, is associated with risky sexual behaviour [46755].

One strategy for reducing the harms caused by injecting drug use includes needle syringe programs (NSPs) [33425]. These programs aim to reduce the spread of blood borne viruses (like hepatitis C, B and HIV) and other harms associated with injecting drug use by educating users about safer injecting practices and providing clean needles. In addition to NSPs, other strategies to reduce harms from injecting drug use include: supervised injecting facilities, overdose education and naloxone distribution programs, and treatment programs which help people to control or cut down their use [34324]. Increasingly methamphetamine has been reported as the most commonly injected drug, with heroin being reported as the second most commonly injected drug [49435].

Aboriginal and Torres Strait Islander people who use drugs are more likely than non-Indigenous people to be exposed to situations that put them at risk of unsafe injecting practices, such as group settings where people are sharing needles or prison where clean needles are not available [34107][36092]. They are also less likely to seek help and support. Barriers to seeking help and support include the shame and stigma associated with injecting drug use, difficulty getting to support services due to lack of transport, living in areas where they are no NSPs as well as a range of other social factors which make accessing services more difficult [34361][23503].

Mobile patrols (also called night patrols or street patrols) are community-based programs that work to keep people safe and deal with disputes in a way that respect local cultural values [49911]. They also provide assistance to people who are intoxicated in public and may be at risk of harming themselves or others [29075]. Mobile patrols work with the person to identify a safe place to go to. Often, they can help link people to services they need such as mental health or homeless services.

There has been an increase in the number of mobile patrols in response to Royal Commission into Aboriginal Deaths in Custody recommendations [29075]. There is evidence that mobile patrols have reduced admissions to police lock-ups, youth and alcohol-related crime and protective custody apprehensions [49442].

Sobering up shelters provide a safe place for people who are intoxicated. They can provide a bed for the night, a meal, a shower and sometimes laundry facilities. They can also refer people to treatment and social support services [36111][34063].

Pharmacotherapies are drugs (medicines) which are used to reduce the harmful effects from alcohol and other drug use [34324][23505]. Some examples of pharmacotherapies are:

• nicotine replacement therapy
• opioid substitution treatment
• naltrexone
• naloxone
• acamprosate (Campral).

Nicotine replacement therapy (NRT) provides nicotine in controlled doses in the form of patches or gum to reduce cravings to smoke tobacco [23505]. Overall NRT assists with helping Aboriginal and Torres Strait Islander people to quit smoking, especially when follow up support is provided [29583][23804]. Other medications are varenicline (Champix) and bupropion.

Opioid substitution treatment (OST) is prescribing drugs such as methadone or buprenorphine to replace opioids such as heroin or pharmaceutical oxycodone [23505]. These drugs work by reducing cravings and withdrawal symptoms. They also help to take the person away from the harmful effects of injecting drug use and the drug taking environment.

Naltrexone can be used to help people control their drinking. If people drink alcohol while taking naltrexone, they are still affected (their coordination and memory are affected and they slur their words) but they get less of a high [23505]. Naltrexone is also sometimes used to block the effects of heroin (and other opioids) as part of treatment to support preventing relapse [35303].

Acamprosate may be used as a relapse prevention medication for alcohol dependence after withdrawal, depending on an assessment of the physical and mental health needs of the patient [49439].

See also see specific treatment and support information in the topic sections for alcohol, opioids, cannabis and methamphetamines.

Information on the prevalence of volatile substance use (VSU) is not routinely collected, so it can be difficult to know how common VSU is in Aboriginal and Torres Strait Islander communities. VSU is not a criminal offence and therefore not reported by the police, and data collection about VSU does not always separate information on Aboriginal and Torres Strait Islander and non-Indigenous people [30967].

Studies show that the prevalence of VSU for Aboriginal and Torres Strait Islander communities that have comparable data has been declining in recent years [31839][38141]. This decline has mostly been associated with the introduction of low aromatic fuel (LAF). However there are some regions where communities continue to experience opportunistic or casual use of volatile substances such as sniffing petrol or deodorants [38141].

For the most recent information on prevalence of volatile substance use among Aboriginal and Torres Strait Islander people, see also our latest information and statistics page.

Programs that have been successful in preventing harms from volatile substance use (VSU) have used a broad, multi-pronged approach that includes reducing access to supply, reducing demand and reducing harms [23342].

The Central Australian Youth Link Up service (CAYLUS), based in Alice Springs in the Northern Territory, is one example of a successful program in preventing VSU. The program was initially started to prevent petrol sniffing in 2002 and has gone on to provide a wide range of services for young people by working with communities [30967]. Successful programs such as CAYLUS, support communities to reduce accessibility to VSU and at the same time incorporate strategies that provide alternative activities for young people which create a sense of belonging [23342].

The South Australian program Makin’ Tracks is another example of a program which was also introduced to address VSU in some remote communities. Evaluations of this program have found it was very successful, and this program is still developing strategies with communities across South Australia [39636].

An important part of reducing the harms from VSU is to provide information on the risks without promoting information on methods for inhaling or types of products that can be used [23342][20888]. These can include tailored community-based and culturally secure drug education programs, or health information targeted towards people at risk of using volatile substances [21948].

In Australia there are a number of regulations and strategies that aim to reduce the likelihood of people using volatile substances. One strategy for discouraging the use of volatile substances has been the introduction of low aromatic fuel (LAF). LAF discourages sniffing by lowering the amount of toxic components in the fuel, which are the components that cause the ‘high’ [32722]. The Australian Government subsidises the cost of LAF, so that it costs around the same amount to purchase as regular fuel. LAF is available across many remote regions in Australia.

The introduction of reduced-toxicity spray paints has also been linked to a reduction in sniffing across some areas of Australia [30508].

Other strategies that prevent the use of volatile substances vary from state to state. These include voluntary and statutory restrictions around the sale of solvents [20106][23048]. Many Australian states and territories have laws that prohibit the sale of solvents to certain people (such as children under the age of 18 years). There have also been a number of voluntary local programs introduced to work with retailers to reduce the supply of volatile substances by placing them in locked or secure areas, such as the CAYLUS Supply Reduction Program.

There are currently no medicines available to help people who are experiencing addiction to sniffing inhalants. However, there are medicines that can help to address some of the symptoms of sniffing, such as depression and nervousness (agitation) [23513].

Counselling can be a good way to help people with volatile substance use issues, and can include techniques like:

• brief intervention
• motivational interviewing
• general relapse prevention counselling [23513].

Providing alternative options to VSU or other drugs, especially for young people, is an important way to reduce the contact that young people have with sniffing volatile substances [38141]. These can include programs such as Binar Futures, a not-for-profit, community-based program that uses basketball to help young people aged 5-17 years to strengthen community connections, health and wellbeing.

For people who might not be ready to stop sniffing, it is important to reduce the harms that are linked to VSU [23513]. Some suggestions for reducing harms when sniffing solvents include:

• staying away from dangerous places like roads or fires
• sniffing in open places so there is lots of oxygen for the lungs
• sniffing with sober people, so they can call for help if needed
• asking for low aromatic fuel (LAF) to be stocked.

There is currently limited statistical information available on the use of opioids by Aboriginal and Torres Strait Islander people. Data from the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection indicated that in 2023, around one in ten opioid pharmacotherapy clients identified as being an Aboriginal and/or Torres Strait Islander person [42740].

In 2022-2023, recent use of painkillers and opioids for non-medical purposes was reported by 4.7% of Aboriginal and Torres Strait Islander respondents [35376]. In 2022-23, heroin was the fourth most common principal drug of concern for clients attending alcohol and other drug treatment services in Australia. Of those clients, 21% were Aboriginal and Torres Strait Islander people [43453]. A 2021 illicit drug survey of 888 injecting drug users (23% of which were Aboriginal and Torres Strait Islander people) indicated that heroin was a drug of choice for around 40% of participants [44731].

Data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) indicated that ‘other drugs’ (which included heroin, methadone, cocaine, petrol and other inhalants) were the second most commonly used illicit drug (5.9%) behind cannabis (24%). However, there was no information available about what proportion of the use of ‘other drugs’ was attributable to opioids. [39231]. In 2018, for illicit drug use risk factors, opioid use was the greatest contributor to disease burden for Aboriginal and Torres Strait Islander people [44827].

There are a variety of strategies that can be used to prevent the non-medical use of opioids and educate people about the potential harms associated with their use.

These strategies include:

• build community knowledge of opioid-related harms
• provide community-level organisations and clubs with prevention programs
• deliver early intervention programs for at-risk youth in schools
• develop and promote culturally appropriate resources about opioids for individuals, families and communities, and professionals who have contact with at-risk people
• engage communities and stakeholders in the development of prevention programs [33425].

Another important means of preventing non-medical use of opioids is reducing the supply of opioids in the community [23503]. This can be done by controlling the amount of opium poppies being grown, and by working with law enforcement to reduce the amount of unregulated opioids being brought into Australia from overseas [23503].

The Australian Government has implemented regulatory changes to reduce the harms caused by opioid prescription medicines [49607]. As of 2018, patients require a prescription to obtain any opioid-based medications in Australia [26504]. In addition, pharmaceutical companies are now required to [49607]:

• provide smaller pack sizes for immediate-release opioids
• add additional warning statements on product information labels
• improve information available to prescribers and consumers
• update prescribing indications (the reason/s for use) for opioids, to ensure the benefits of their use outweigh the risks.

Providing flexible treatment and support options for people who are dependent on opioids is an important way to reduce harms related to opioid use [35303]. Treatment approaches will vary according to stage of life, cultural needs and risk factors.

There are different types of treatment options for people who want to reduce or stop using opioids. Detoxification and withdrawal management can be provided while people are still living in the community [23503]. Residential rehabilitation programs can be effective for people who have complex needs and may be experiencing physical and mental health difficulties [35303]. The outcomes for clients in withdrawal management and residential rehabilitation are improved if accompanied by good aftercare and follow up support. Counselling is also helpful to people who are in early stages of dependent use, and support groups such as Smart Recovery help people to maintain their health gains and prevent relapse [35303][23503].

The main pharmacotherapy for opioid dependence is opioid agonist treatment (OAT) [35303]. OAT refers to long-term treatment approaches that involve the regular provision of long-acting opioid medicine in addition to regular monitoring and psychosocial supportive care. The main types of pharmacotherapies used in OAT are; oral methadone, sublingual buprenorphine and sublingual buprenorphine-naloxone. OAT provides clients the opportunity to stabilise their drug use and to make supportive changes in their substance use and lifestyle.

See also the Alcohol and Other Drugs Knowledge Centre section on Pharmacotherapies.