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Taking stock: Australian responses to alcohol and other drugs in the longer term.

The following essay [1] is Les Drew’s response when we asked him for a historical perspective on Australia’s responses to alcohol and other drug problems in recent decades. Dr Drew is no stranger to these pages (referred to in his piece as ‘the Journal’). As what is now the Australasian Professional Society on Alcohol and Other Drugs was formed in 1982, he was the ‘Convenor & Editor’ of its new journal, now the Drug and Alcohol Review [2]. Les played a pivotal role in the formative period for current Australian alcohol and drug policies, as the Senior Medical Adviser on drugs and alcohol in the federal Department of Health from 1975 to 1988. It was during this period, as he reminds us, that Australia first decided it had a ‘drug problem’ other than with alcohol. In a period when Australian political leaders were quite responsive to medical and professional views, the longterm commitment of his professional generation to harm reduction approaches both for alcohol and for other drugs carried considerable weight.Nevertheless, the tide was running against these views; by 1988, when he left his position in the ministry to return to psychiatric practice, he ‘felt so dejected. I was disappointed that I had not been able to achieve more change’ [3]. Throughout his period of government service, Les contributed to the research literature in these pages and elsewhere, making conceptual and empirical contributions which would be unusual for a civil servant today. These included several contributions on means for reducing rates of alcohol and other drug problems, solidly based on data he had pulled together on epidemiological patterns and trends (e.g. [4,5]). Many of his observations and recommendations about problems in the strength and emphases of Australian alcohol research in his 1985 review [6] could be repeated today. In those times, and throughout his career, Les has always pulled against what might be conventionally expected of someone with his background and roles. He is a psychiatrist who has been critical of disease concepts of addiction [7], an alcohol abstainer (coming from two generations of Salvation Army officers) who is committed to a harm reduction approach [8], an advocate while in government service of considering legalisation of cannabis [9], a scholar who is critical of the limits of a purely rational, scientific approach [10]. In his essay, Les recounts some of the achievements of the period from the 1960s to the 1990s—a period in which the Australian record of achievements in the field is indeed substantial. However, it is hard to argue with his conclusion that, except for tobacco, the record so far in the 21st century does not match it: ‘useful approaches are being ignored’. On alcohol and on controlled drugs, the Australian dialogue these days between the world of scientific and professional knowledge and the world of political judgement and action seems fractured and dysfunctional; on many relevant issues, the political system has frozen up. Drew’s stocktaking in his essay challenges us to recapture the pragmatic boldness of the recent past.