Context for Alcohol and Other Drug Interventions

In all areas of community service work, including AOD services, you must work within a legal and ethical framework. This includes meeting legislative requirements.

In the AOD sector, there are several pieces of legislation that have an impact on your work. Legal Principles and Legal Requirements

Alcohol and Other Drugs Legislation and Services

In Australia, legislation around alcohol and other drugs is divided between the Commonwealth/Federal Government and state/territory governments. Federal police, state/territory police, and regulatory bodies are responsible for enforcing legislation. This makes understanding legislation specific to alcohol and other drugs and AOD services quite complex, and you will need to research relevant AOD legislation for your own state/territory. In simple terms, the use of alcohol and other drugs is regulated and, in some cases, prohibited.

Historically, the use of alcohol and other drugs has been dealt with by the criminal justice system. Still, current thinking is that drug and alcohol abuse, dependence and addiction are (or should be) treated as a public health issue rather than as a criminal matter.

AOD treatment services are provided by government, non-government and private organisations. The Commonwealth Government funds state/territory governments to provide and manage AOD services.

AOD Service Standards: The National Quality Framework

The National Quality Framework sets out benchmarks and standards for the provision of AOD services and aims to achieve a consistent, evidence-informed service approach, positive outcomes for clients, consumer engagement and continuous improvement.

Other Relevant State/Territory AOD Legislation

You will be required to be familiar with and adhere to other specific legislation, such as the Privacy Act 1988 (Cth), different legislation in your state or territory around mental health, drugs and controlled substances, and workplace health and safety (WHS) legislation.

The following table lists just a few of the specific AOD legislation by state/territory:

State	Legislation
Australian Capital Territory	Medicines, Poisons and Therapeutic Goods Act 2008 Liquor Act 2010 Mental Health Act 2015
New South Wales	Drug and Alcohol Treatment Act 2007 Drug and Alcohol Treatment Regulation 2017 Mental Health Act 2007
Northern Territory	Misuse of Drugs Act 1990 Kava Management Act 1998 (designed to reduce kava supply) Alcohol Reform (Substance Misuse Assessment and Referral for Treatment Court) Act 2011 Mental Health and Related Services Act 1998
Queensland	Drugs Misuse Act 1986 Mental Health Act 2016 Liquor Act 1992 (recognises banning orders imposed by a court)
South Australia	Public Intoxication Act 1984 Tobacco & E-Cigarette Products Regulation Act 1997 Mental Health Act 2009
Tasmania	Misuse of Drugs Act 2001 Poisons Act 1971 Mental Health Act 2013
Victoria	Severe Substance Dependence Treatment Act 2010 (allows for brief detention to save a person’s life) Drugs, Poisons and Controlled Substances Act 1981 (covers prescription drugs) Mental Health Act 2014
Western Australia	Misuse of Drugs Act 1981 Liquor Control Act 1988 Alcohol and Other Drugs Act 1974 Mental Health Act 2014

^{Additionally, there is Australia’s National Drug Strategy, which is a policy framework to support both government and non-government organisations to prevent harm caused by alcohol, tobacco and drug use. It is a 10-year plan currently set from 2017 to 2026.}

Harm Minimisation

The focus of service provision is to reduce the demand for alcohol and other drugs and to minimise or reduce the harm they cause. Harm minimisation programs include needle exchanges and safe injecting spaces, the use of medication to reduce dependence, sobering-up services, and diversion programs within the criminal justice system.

‘Harm minimisation’ means working to reduce the harm associated with substance abuse rather than to prohibit the use of harmful substances such as alcohol and drugs.

Watch

Watch the video below to learn more about harm minimisation:

Other Legislation Relevant to AOD Services

Mental Health Legislation

Mental health services in Australia are funded by the Commonwealth Government and managed and provided by the state/territory governments. As with AOD services, mental health services are a mix of government, non-government, private ‘for-profit’ and ‘not-for-profit’ organisations.

Many clients with AOD issues have coexisting mental health issues, so understanding the mental health sector and legislation will help you to explain options to your clients and develop resources and networks to support referrals to the mental health sector.

Child Protection and Mandatory Reporting

Every state and territory has laws that mandate the reporting of suspected child abuse and neglect. These laws vary significantly from state to state regarding who is required to report, how they are required to report, and when they are required to report. Therefore, you must be familiar with your state or territory’s laws and your organisation’s policies and procedures around mandatory reporting.

You have responsibilities related to the safety of the children and young people in your care. You also have a role in ensuring that your team implements and adheres to policies and procedures. You may need to support your team members in reporting child abuse.

Understanding your responsibilities under child protection legislation can be relevant in AOD work when clients’ children are affected by their parent’s alcohol and drug use.

Children in the Workplace

In general, it is illegal for children under the age of 13 to be employed, and children under the age of 15 must have a special permit.

National Principles for Child-Safe Organisations

One of the outcomes of the 2013 Royal Commission Into Institutional Responses to Child Sexual Abuse was the development of national principles for establishing child-safe organisations.

The ten national principles aim to embed a child-safe culture across all sectors of society in which children are found. This includes organisations providing services, such as AOD services, as clients' children may be involved in the services their parents receive.

For example, drug and alcohol dependence often go hand in hand with issues such as domestic and family violence, homelessness and mental illness. If you are working with clients who have complex issues, you may need to collaborate with other services to meet the needs of any children and the needs of the adults. The National Principles for Child Safe Organisations will be directly relevant if a client brings a child or children to a counselling session.

A child-safe organisation consciously and systematically:

• creates an environment where children’s safety and wellbeing [are] the centre of thought, values and actions
• emphasizes genuine engagement with and valuing of children
• creates conditions that reduce the likelihood of harm to children and young people
• creates conditions that increase the likelihood of identifying any harm
• responds to any concerns, disclosures, allegations or suspicions.
• National Principles for Child Safe Organisations

Anti-Discrimination Legislation

Anti-discrimination legislation makes it illegal to discriminate against a person based on their age, gender, sexual orientation, disability, religion, race or ethnic background. This applies in AOD services as in any other community service sector.

Discrimination in this context means being treated unfairly based on an arbitrary characteristic. Discrimination often leads to stereotyping, devaluation and marginalisation. People with addictions are often stereotyped as ‘drunks’ or ‘junkies’, which adds to their disadvantages and can create a ‘vicious circle’ in which loss of hope exacerbates their substance abuse. Working to reverse the devaluation they experience can be a significant aspect of interventions, services and support.

Watch

Watch this video for information about Australian anti-discrimination legislation.

Cultural Considerations and Cultural Safety

Valuing diversity is a fundamental value in community services. In AOD work it is important to show respect for cultural differences and requirements and to provide services that are ‘culturally safe’. This means addressing cultural requirements in policies, procedures, practices, and the environment.

This applies to people from any diverse cultural background, and in particular to First Nations People, whose history since the arrival of Europeans in Australia has led to intergenerational trauma, which is linked to a high incidence of alcohol and drug use.

Privacy Legislation

The Australian Privacy Act 1988 regulates how government departments and other organisations collect, use, store and share information.

Organisations must follow ten privacy principles in all aspects of gathering, storing, and using personal information.

You must explain to clients:

• What information collected will be used for
• Who within your organisation will have access to it
• How will it be protected from disclosure outside your organisation?

Workplace Health and Safety Legislation

Safe Work Australia is responsible for developing national policies and resources to support WHS, and the Commonwealth Government, states, and territories are responsible for implementing, regulating and enforcing WHS laws in their jurisdictions.

In general terms, employers must provide and maintain safe work environments and safe work practices. Workers have the right to expect safe workplaces, and they have a duty to participate in maintaining safe work environments by following safe work practices and by identifying and reporting risks and hazards. Employers also have a duty to ensure that staff have the skills and knowledge to carry out their work safely and to provide training in WHS issues, policies and procedures.

Within the context of AOD services and depending on the work setting, risks often relate to clients’ potentially unpredictable or challenging behaviour, including self-harm. So, you will need skills and strategies for managing and de-escalating challenging behaviour and responding to crises, including self-harm and potential suicide. Community and outreach programs may present specific risks and hazards associated with visiting clients in their homes or in community settings, especially in outreach services for people who are homeless.

Watch

For general information about WHS responsibilities, watch this video:

Human Needs

Much research has been completed on human needs, and there are many definitions and theories. The majority of theories agree that the term ‘human need’ refers to basic necessities that are required for survival, such as food, water, shelter and safety. A more expansive list of human needs might also include elements like love, belonging and self-fulfilment.

Human needs in community services are based on Maslow’s hierarchy of needs. Maslow’s hierarchy of needs is shown below.

Human Rights

While human needs refer to the needs of an individual, human rights encompass the relationships and meeting of needs between people. The Australian Human Rights Commission describes human rights as:

In all aspects of your work, it is important to be aware of and support human rights. Many clients, including clients of AOD services, have experienced disadvantage, discrimination, devaluation and having their rights ignored or violated.

The Australian Human Rights Commission’s role is to uphold human rights in Australia and to provide an avenue for complaints about breaches of human rights.

Duty of Care and Dignity of Risk

Duty of Care

Duty of care is a legal principle based in common law (which means there is no ‘duty of care act’) stating that we all have an obligation or duty, whenever we are in a situation where our actions might afiect other people, to avoid causing foreseeable harm through our actions— that is, we must not cause harm to others through carelessness. It sounds simple, but the law with negligence can be complex, which is why lawyers representing clients seeking damages or compensation can charge such high fees.

These three questions summarise the elements of duty of care:

• Am I in a situation where my actions could affect other people?
• Could my actions cause any reasonably foreseeable harm to others?
• What would a reasonable person do in this situation?

If the answer to the first two questions is ‘yes’, then you have a duty of care to avoid causing harm to others by acting carelessly or negligently.

In providing interventions to people with AOD issues, we have a significant duty of care towards our clients. We are presumed to have greater skills and knowledge about the interventions we use than our clients do, and we are expected to have the ability to identify foreseeable risks to our clients. This means that we must be extra careful.

Dignity of Risk

This is the other side of the coin, and in working with clients, you will often find yourself trying to balance your duty of care with your client’s dignity of risk.

‘Dignity of risk’ refers to the principle that we all have a right to make our own choices, which can include taking reasonable risks, and that we learn through the consequences of our actions. This is, of course, assuming that we can understand our actions' nature and potential consequences.

If we do not have that capacity—because of an impairment of some kind, or because we are intoxicated or experiencing delusions or we lack relevant experience and knowledge—then the balance might fall towards the other person’s duty of care rather than towards our right to experiment with something risky, and the other person might step in and try to protect us from harm.

In AOD work, striking the balance between dignity of risk and duty of care can be a significant ethical and legal dilemma. How far should a worker go to protect a client from harm from a risky act? The answer will depend on factors such as the client’s capacity, the degree of risk and the potential harm and benefits.

Guidelines for Balancing Duty and Risk

Every situation will be different, so you must assess the specifics of each situation and take into account what you know of your client’s capacity, skills, knowledge, frame of mind, and past experience.

Your job role description or duty statement provides a good starting point. Work within the boundaries of your role and within the limits of your knowledge, skills or expertise. You can also refer to a code of ethics, code of practice, or service standards, which may also provide guidelines. In addition, your organisation’s policies and procedures may be relevant. If in doubt, consult your supervisor, a mentor or an experienced colleague.

Watch

Watch this video to understand more about the duty of care and dignity of risk.

Post your answers in the forum.

Informed Consent

The concept of informed consent has come from the medical community. Informed consent is permission granted by a person or advocate to undergo a treatment with full knowledge of the consequences, risks and benefits.

Informed consent is a cornerstone of person-centred practice. When the client is at the centre of decision-making about the care and services they access, they must be fully aware of the risks and benefits that may arise before they consent to access.

For your clients to be able to give informed consent, you must provide them with information about their options that is free of bias and easily understood. This means that you may need to provide the following information:

• in languages other than English
• in plain English using descriptive pictures
• through a translator, such as an AUSLAN interpreter.

Informed consent needs to be voluntary. You cannot coerce a person into consenting to a service or type of care, and a client’s family or support network cannot coerce the client into consenting, either.

Your organisation may require you to gain written consent from a client. Review your organisation’s policies on this matter to ensure you are following the organisation’s processes correctly.

To give informed consent to something, a person must have the capacity to understand the nature and likely consequences of what they are consenting to.

In providing services, interventions and support, you must obtain your client’s informed consent. This means explaining to your client:

• What you plan to do
• What other alternatives are available
• The likely outcomes of each option.

For example, if you encourage your clients to enter a detox program, you need to provide all the relevant information so they know what to expect.

Informed consent is one element of legal consent. A person can give legal consent only if they:

• Are legally an adult (over 18)
• Understand the nature and consequences of their agreement
• Consent voluntarily, without threats, bribes, trickery or persuasion.

Privacy, Confidentiality and Disclosure

We discussed the Privacy Act 1988 (Cth) and the Australian Privacy Principles in section 1.1, so here we will focus on confidentiality and disclosure. ‘Confidentiality’ means keeping private, personal information secret or confidential. Confidentiality applies to verbal information, written information, and electronic media. Your clients have a right to expect confidentiality in their dealings with you and, if you do share information about them with colleagues or other agencies, you will first obtain their consent.

The only situations in which you can dispense with the person’s consent and share private information about them are:

• If it is necessary to keep the person or someone else safe
• If the information has been formally requested by a court of law.

Confidentiality also applies to medical practitioners and their patients, so doctors must not disclose information without the consent of the patient or a person authorised to act on the patient’s behalf. Doctors may disclose information about children to their parents and/ or guardians.

Records Management

The Australian Privacy Principles also apply to managing records containing private, confidential information. This means that you must follow the Privacy Principles and your organisation’s policies and procedures for accessing, using, sharing and storing records, especially records that contain information about clients. This applies to hard copy and electronic materials.

Rights and Responsibilities of Employers, Workers and Clients

Employers

The general responsibilities of employers include:

• Providing agreed services to clients
• Providing and maintaining safe workplaces for their workers.

Employers have the right to expect workers to:

• Comply with relevant legislation and policies
• Meet relevant service standards
• Carry out tasks and duties specified in their job role descriptions.

Workers

Workers’ general responsibilities include:

• Carrying out the tasks and duties specified in their job role descriptions
• Meeting relevant legislative and regulatory requirements
• Meeting relevant service standards
• Following the organisation’s policies and procedures
• Following relevant codes of ethics and codes of practice.

Workers have the right to expect their employer to:

• Provide and maintain safe workplaces and practices
• Meet their obligations under relevant legislation.

Clients

Clients have the right to:

• Receive services provided by the organisation
• Be treated with respect
• Have access to complaints and appeals procedures
• Have personal information held in confidence unless they consent to the information being disclosed.

Many AOD organisations have a charter of client responsibilities and rights. The following quotation is an example of one of these charters:

Policy Frameworks and Principles

The Australian National Framework for Alcohol, Tobacco and Other Drug Treatment 2019–2029 (the National Framework) identifies treatment interventions that aim to reduce harm arising from the use of alcohol, tobacco, prescribed medications and illegal drugs.

Raising awareness, prevention and early intervention initiatives form part of the strategies addressing AOD issues but are not included in the framework, which focuses on treatment.

The National Drug Strategy 2017–2026 and the National Quality Framework for Drug and Alcohol Treatment Services support the National Framework.

Principles underpinning the National Framework state that services should be:

Overview of AOD Approaches and Services in Australia

Person-Centred, Strengths-Based Approaches.

Person-centred, strengths-based approaches are used in treatments and interventions in AOD services because they focus on individual needs and build on the person’s existing strengths and capacities. This fits with the principles outlined in the National Framework and with the values that underpin work in the AOD sector.

These approaches also support the person’s rights, especially the right to autonomy, meaning that the person has choice and control over planning, implementing and evaluating services provided to them. This is important because people are more likely to change their behaviour if they feel that they are in control, and the aim of most AOD interventions is to support the person to change negative behaviours such as substance abuse.

Holistic Treatment

Many clients have complex needs and issues, so a holistic approach to treatment is appropriate. This means addressing the needs of the whole person. Many people with substance abuse issues have complex needs, for example, homelessness, mental illness and social isolation. A holistic approach would include finding accommodation, treating the mental illness and supporting the person to engage in social and community activities.

Recovery-Oriented Approaches

A recovery-oriented approach is commonly used in the mental health sector, and it is also appropriate for supporting people with AOD issues.

This approach is based on the premise that, although there may be no cure for mental illness, the person is able to live a meaningful, satisfying life by managing their symptoms and condition and that they are capable of doing this independently and with support.

The same principle can be applied to alcohol and drug dependence and addiction, based on the belief that the person is capable of changing their negative behaviours and living a meaningful, satisfying life.

Ethics and Ethical Practice

Ethical principles govern how we conduct ourselves. Individuals, groups and professions adopt these principles to guide decisions on how professionals interact with others and work.

A code of ethics is a statement developed by an organisation, group or professional association that sets down expectations of how its people work with its clients. In community services, a code of ethics is an important tool in ensuring that the people that we work with have their safety and well-being protected.

Some agencies will develop their own code of ethics. Others will work with the Australian Association of Social Workers code of ethics or the Australian Community Workers Association’s ethics and good practice guide.

‘Ethical practice’ means doing the ‘right thing’, and ‘ethics’ are guidelines or rules that tell us what the right thing is based on beliefs and values.

Ethical practice is particularly important in AOD work because the people we provide services to are vulnerable in many different ways and because substance abuse involves significant risks to users and to the people around them.

Key ethical issues in AOD work include:

Avoiding Harm	This includes avoiding harm to the person, the people around them, and the community. For example, substance abuse within the family can result in harm to children and other family members, so in working with the parent, you may need to act to protect other vulnerable people. Your client may also be a danger to the community in which they live, so this is another factor you may need to take into account.
Working with vulnerable groups	We have already discussed the concepts of duty of care and dignity of risk. In working with vulnerable people, balancing your duty of care with your client’s right to take risks often raises ethical problems. For example, if you know your client intends to use illicit drugs that are highly dangerous, how far should you go to prevent them from doing so?
Consent	We have also already discussed the issue of informed consent. You may be working with a person whose judgment is impaired due to substance abuse or other causes, making it difficult or impossible to obtain their informed consent to an intervention or treatment. What are the alternatives, and is it ethical to appoint someone to make important decisions for that person?
Privacy and confidentiality	The rules around confidentiality are fairly clear, but what about situations where you suspect that someone may be at risk, but you have no hard evidence of this? Are you justified in breaching confidentiality and risking damaging your relationship with your client?
Working within the law	There are several requirements for working within the law in an AOD context. These may include: Protecting children by ensuring relevant workers have a Working With Children Check Making sure that volunteers and others are covered by insurance Responding appropriately should you become aware that a criminal offence has been committed or is about to be committed.

Service Standards and Practice Standards

In some community services industry sectors, such as disability work and aged care, there are legislated service standards that service providers must meet to retain government funding.

These links are less clear in the AOD sector. Still, the National Quality Framework for Drug and Alcohol Treatment Services provides clear benchmarks and accreditation standards for service providers to meet.

The key principles of practice are:

Each State/Territory has developed its own guidelines based on the National Quality Framework. You can find examples of these below.

• NSW Health: Clinical Care Standards: Alcohol and Other Drug Treatment
• Ethical and legal considerations for communities
• Queensland Alcohol and Other Drug Treatment Service Delivery Framework
• South Australian Specialist: Alcohol and Other Drug Treatment Service Delivery Framework

Codes of Practice and Codes of Conduct

Codes of ethics, practice standards and codes of conduct all provide guidelines for workers within an industry, industry sector, occupation or profession. Codes of ethics provide information about ethical issues. Codes of practice tend to be more specific and set guidelines for good practice (including ethical and practical ‘rules’ and standards), and codes of conduct prescribe the behaviour required of workers in a particular occupation or organisation. These types of codes often overlap, but all are useful guides when you are trying to resolve an ethical dilemma.

An excellent example of a code of ethics and practice standards is the Australian Community Workers’ Association (ACWA) Code of Ethics and Practice Standards, which applies to community service workers. You can access these via the ACWA website.

Each State and Territory will have slightly different Codes of Practice and Codes of Conduct, and they are all based on the National Quality Standards.

Work Role Boundaries, Responsibilities and Limitations

One ethical consideration that is particularly important for AOD workers is that of professional and ethical boundaries.

Setting and maintaining clear professional boundaries is important across all sectors of the community services industry, including the AOD sector. Our clients are often vulnerable, and there is often a power imbalance between clients and workers.

As professionals, we are expected to have knowledge and skills that our clients may not possess, and we have a position that carries with it a degree of authority, which means that we must be careful not to misuse our power.

There are several ways in which we can overstep the boundaries of our work role:

• Carrying out tasks and activities that are not included in the work role

If we carry out a task that is not included in our work role, we put ourselves and our clients at risk, especially if we do not have the skills or expertise for that particular task. If harm to the client results, our client might take action against us for negligence, or we might be disciplined or dismissed by our employer. Working within the scope of our competence protects clients and workers.

• Blurring the lines between a professional relationship and a personal relationship

A professional relationship is one in which one person is providing a professional service to the other. The relationship exists because of this, not because the two people have decided to form a relationship.

A personal relationship is one where people have chosen to engage with each other in a social sense or one in which people are related to each other by family or other personal ties.

This does not mean that we cannot work in caring, friendly ways with our clients, but it does mean that we must be careful not to give our clients the impression that we are there solely because we care about them or because we are their friends. If we do, we risk harming our clients and ourselves by creating unrealistic expectations and by engaging in activities that may not be appropriate to a professional role.

Some of the activities that are off-limits between workers and clients are:

• Borrowing or lending money
• Giving or accepting expensive gifts or entering into other financial transactions
• Inviting clients to your home or participating in clients’ family events and celebrations
• Attending social events together
• Sharing very personal or private information about yourself
• Engaging in sexual activities or relationships with your clients.

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