Gotowa bibliografia na temat „Harm minimisation”

Harm minimisation has been proposed as a means of supporting people who self-injure. When adopting this approach, rather than trying to stop self-injury immediately the person is allowed to injure safely whilst developing more appropriate ways of dealing with distress. The approach is controversial as the health care professional actively allows harm to occur. This paper will consider a specific objection to harm minimisation. That is, it is a misguided collaboration between the health care professional and the person who self-injures that is morally and clinically questionable. The objection has two components. The first component is moral in nature and asserts that the health care professional is complicit in any harm that occurs and as a result they can be held morally responsible and subject to moral blame. The second component is clinical in nature and suggests that harm minimisation involves the health care professional in colluding in the perpetuation of self-injury. This element of the objection is based on a psychodynamic understanding of why self-injury occurs and it is argued that harm minimisation is merely a mechanism for avoiding thinking about the psychotherapeutic issues that need to be addressed. Thus, the health care professional merely reinforces a dysfunctional pattern of behaviour and supports the perpetuation of self-injury. I will consider this objection and argue that it fails on both counts. I conclude that the use of harm minimisation techniques is an appropriate form of intervention that is helpful to certain individuals in some situations.

Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.

AbstractObjectives: The aim of this study was to compare aspects of the quality of life of drug users on a methadone maintenance programme to drug users on a harm minimisation programme.Method: Thirty-six clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale (HADs) to measure psychological morbidity.Results: More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI(1.2,15.2). On the HADs, clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in ‘change in health’ over the previous year than clients on the methadone maintenance programme.Conclusions: Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which need to be considered when providing future services for drug users.

This thesis applies Bacchi's (2009; 2016) policy analysis framework, to Australian illicit drug policy texts (1985–2017) to interrogate exercises of power in illicit drug policy. Findings reveal the dominance of legal and health/well-being discourses which produce the body as a site of self-governance ('responsibilisation'), while epidemiological narratives narrow the cannabis 'problem' and omit why cannabis is used for recreation. Failure to resolve the historical influence of morality associated with public health rationalities and their intersection with law and order has meant that harm minimisation, which empowers citizens through the governance of self, is constrained by sovereign power.

Decentralised health systems in low- and middle-income countries impacted by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Cross-cultural screening and diagnostic tools, alongside innovative treatment approaches that are safe, cost-effective, and scalable are needed. The primary aims of this study included (1) examining the clinical validity of a new screener, the Global Psychotrauma Screen (GPS), among refugees; (2) identifying candidate cognitive and electrophysiological diagnostic markers of combined clinical and subclinical PTSD; and (3) investigating the preliminary efficacy of a novel trauma-focused mobile App intervention via changes in clinical symptomatology, cognitive performance and electrophysiological brain activity. A non-randomised clinical trial was conducted with 70 African refugees in Australia. Participants completed clinical interviews, neuropsychological tests, quantitative electrophysiology (qEEG) recordings, and the seven-day App intervention from home. On the eighth day, participants returned to the lab to repeat all baseline assessments, followed by 1-, 3-, 6-, and 12-month interviews. The GPS demonstrated high sensitivity and specificity in detecting a probable diagnosis of PTSD, depression, and dissociative subtype. Baseline analyses indicated that the PTSD group had increased qEEG power across multiple brain regions, and faster rapid visual information processing. The intervention was associated with significant reductions in PTSD severity and related comorbidities, and changes in qEEG and cognitive performance. In conclusion, this study (1) indicated that the GPS may be a useful screening tool for refugees; (2) identified novel diagnostic and prognostic markers for clinical and subclinical PTSD, and (3) provided preliminary evidence for the efficacy of the proposed App in reducing PTSD severity and comorbid symptomatology. Randomised trials are recommended to further develop mobile-based screening, diagnostic and prognostic features, and determine the App’s cross-cultural efficacy in emergency settings.

This thesis is based on an Australian Research Council funded research grant. Fifty-one qualitative interviews were conducted with human service workers to gain an understanding of their interpretations of their clients’ ‘drug problems’ and of their own role, the service system and wider policies. Although harm minimisation has been Australia’s official drug policy since 1985, little is known about how harm minimisation is ‘enacted’ in the helping culture. To date human service workers have not been recognised in their constitutive role in harm minimisation discourse. Whilst a significant part of drug policy interventions are delivered via human services, the helping subject has not come under scrutiny. The drug using subject remains ill-conceived as a result of neglecting its partnering others or indeed its overlapping with other subject positions. Moving beyond recognising workers only in terms of staff opinions and attitudes, a relational and multi-level approach is adopted to introduce more complexity into the debate. After a brief historic discussion of the creation of the ‘human service worker’ and the ‘drug user’ (as client) and methodological considerations about discourse analysis, the thesis proceeds with the introduction of a conceptual framework consisting of four levels: the individual, relational, institutional and cultural political economic level. These levels are used to examine the existing literature on ‘drug problem factories’ and for the analysis of the data. By focusing on these levels the critical analysis of the interview material shows that ‘harm’ and ‘minimising’ are themselves contested categories and that different harms and different harm producing and minimising practices can be identified some of which have come into discourse, others are excluded or entirely absent. The human service workers struggle to make sense of their own role and to define how drug users are being ‘helped’ and could or should be helped. Their understanding of harm minimisation discourse aligns with, supports and/or resists other discourses such as (neo)liberalism, neoconservatism, prohibition and economic rationalism. The workers are portrayed as having substituted increasing complexity for initial simplicity in the course of working with ‘drug users’. In summary, this thesis offers a poststructuralist analysis of how harm minimisation is constituted, negotiated and undermined from the perspective of human service workers and shows how the service systems’ helping cultures enrol human service workers in harm producing and harm minimising practices. Harm minimisation consists of discursive and non-discursive elements and is a product of deliberate social forces as well as messy contingencies and unintended consequences.

This thesis is based on an Australian Research Council funded research grant. Fifty-one qualitative interviews were conducted with human service workers to gain an understanding of their interpretations of their clients' 'drug problems' and of their own role, the service system and wider policies. Although harm minimisation has been Australia's official drug policy since 1985, little is known about how harm minimisation is 'enacted' in the helping culture. To date human service workers have not been recognised in their constitutive role in harm minimisation discourse. Whilst a significant part of drug policy interventions are delivered via human services, the helping subject has not come under scrutiny. The drug using subject remains ill-conceived as a result of neglecting its partnering others or indeed its overlapping with other subject positions. Moving beyond recognising workers only in terms of staff opinions and attitudes, a relational and multi-level approach is adopted to introduce more complexity into the debate. After a brief historic discussion of the creation of the 'human service worker' and the 'drug user' (as client) and methodological considerations about discourse analysis, the thesis proceeds with the introduction of a conceptual framework consisting of four levels: the individual, relational, institutional and cultural political economic level. These levels are used to examine the existing literature on 'drug problem factories' and for the analysis of the data. By focusing on these levels the critical analysis of the interview material shows that 'harm' and 'minimising' are themselves contested categories and that different harms and different harm producing and minimising practices can be identified some of which have come into discourse, others are excluded or entirely absent. The human service workers struggle to make sense of their own role and to define how drug users are being 'helped' and could or should be helped.;Their understanding of harm minimisation discourse aligns with, supports and/or resists other discourses such as (neo)liberalism, neoconservatism, prohibition and economic rationalism. The workers are portrayed as having substituted increasing complexity for initial simplicity in the course of working with 'drug users'. In summary, this thesis offers a poststructuralist analysis of how harm minimisation is constituted, negotiated and undermined from the perspective of human service workers and shows how the service systems' helping cultures enrol human service workers in harm producing and harm minimising practices. Harm minimisation consists of discursive and non-discursive elements and is a product of deliberate social forces as well as messy contingencies and unintended consequences.

The thesis presents a case study of New Zealand's Alcoholism and Drug Addiction Act 1966 - a civil commitment law used to detain alcoholics and drug addicts for up to two years in state-certified residential treatment facilities. The thesis positions itself as a call for legislative reform. The central argument is that the Act is an anachronistic and potentially draconian piece of social legislation which has no place on the modern-day New Zealand statute book. In the first part of the thesis, Chapter 1 introduces the research, outlines the structure and methodology of the thesis, and locates the study within a wider tradition of scholarship on the management of people with alcohol problems. Chapter 2 summarises the analytical framework that is used to evaluate the Act, attaching particular importance to both the philosophical traditions and the practical strategies of harm minimisation and therapeutic jurisprudence. Chapter 3 gives a positivist reading of the legislation : outlining the evolution of the Act, essaying its major provisions, and noting the efforts that have been made to refine or reform the statute since it was passed in the mid-1960s. Chapter 4 draws on the limited amount of data available to describe how the Act is currently operating 'on the ground'. In the second part of the thesis, the Alcoholism and Drug Addiction Act is put into a comparative context by describing examples of similar-type statutes that exist in two other jurisdictions. Chapter 5 focuses on the New South Wales Inebriates Act 1912; Chapter 6 focuses on the Swedish Act on Care of Addicts in Certain Cases 1989. The final part of the thesis builds a case for reform of the Alcoholism and Drug Addiction Act. Chapter 7 identifies various practical and clinical problems with the Act, which mean that the statute does not work in instrumental terms. It is submitted that the Act cannot be said to make better provision for the care and treatment of alcoholics. Chapter 8 highlights several legal and philosophical difficulties with the Act, which mean that the legislation does not work in value terms. It is submitted that the Act is offensive to the right to refuse treatment and fundamentally conflicts with the principles of individual autonomy and informed consent. Chapter 9 proposes three options for reforming the Act, expressing a preference for the outright repeal of the statute. Finally, Chapter 10 draws conclusions from the preceding discussion, and speculates on the likelihood that the recommended reforms will be implemented.

Alcohol consumption is enmeshed with Australian culture (Palk, 2008) and the use and misuse of alcohol contributes to considerable health and social harms (Barbor et al., 2010; English et al., 1995; Gutjahr, Gmel, & Rehm, 2001; Palk, 2008; Steenkamp, Harrison, & Allsop, 2002). Despite shifts in the way that alcohol is consumed and how it is used, it has been reported that one-third of all alcohol consumed is done so within licensed premises (Lang, Stockwell, Rydon, & Gamble, 1992). Consequently, licensed premises are over-represented as settings in which alcohol-related harms occur. These harms, particularly those related to violence, are associated with particular licensed premises operating in the night-time economy (Briscoe & Donnelly, 2001b; Chikritzhs, Stockwell, & Masters, 1997; Homel, Tomsen, & Thommeny, 1991; Stockwell, 1997). Police have a role in not only responding to the manifestation of harms, such as crime, injuries, assaults, domestic violence, stealing and sexual offences, but they also have a role in preventing problems, and thereby reducing alcohol and other drug-related harms (Doherty & Roche, 2003). Given the extent of alcohol consumption within licensed premises and the nature and extent of the harms, as well as the lack of opportunity to influence outcomes in other settings (e.g. the home), licensed premises offer police and other stakeholders a significant opportunity to influence positively the reduction of alcoholrelated harm. This research focuses specifically on the police role in policing licensed premises. Primarily, this research aims to investigate the factors which are relevant to why and how police officers respond to alcohol-related incidents inside and outside licensed premises. It examines the attitudes and beliefs of police and assesses their knowledge, capacity and ability to effectively police licensed premises. The research methodology uses three distinct surveys. Each contributes to understanding the motivations and practice of police officers in this important area of harm reduction. Study One involved a survey of police officers within a police district (Brisbane Central District) in Queensland, Australia and used a comprehensive questionnaire involving both quantitative and qualitative techniques. A key research outcome of Study One was the finding that officers had low levels of knowledge of the strategies that are effective in addressing alcohol-related harm both inside and outside licensed premises. Paradoxically, these officers also reported extensive recent experience in dealing with alcohol issues in these locations. In addition, these officers reported that alcohol was a significant contextual factor in the majority of matters to which they responded. Officers surveyed reported that alcohol increased the difficulty of responding to situations and that licensed premises (e.g. nightclubs, licensed clubs and hotels) were the most difficult contexts to police. Those surveyed were asked to self-assess their knowledge of the Liquor Act (Qld), which is the primary legislative authority in Queensland for regulating licensed premises. Surprisingly, well over half of the officers (65%) reported ‘no’ to ‘fair’ knowledge of the Act, despite officers believing that their skill level to police such premises was in the ‘good to very good range’. In an important finding, officers reported greater skill level to police outside licensed premises than inside such premises, indicating that officers felt less capable, from a skill perspective, to operate within the confines of a licensed premise than in the environment immediately outside such premises. Another key finding was that officers reported greater levels of training in responding to situations outside and around licensed premises than to situations inside licensed premises. Officers were also asked to identify the frequency with which they employed specified regulatory enforcement and community-based strategies. Irrespective of the type of response, ‘taking no action’ or passive policing interventions were not favoured by officers. The findings identified that officers favoured taking a range of strategies (sending home, releasing into the custody of friends, etc.) in preference to arrest. In another key finding, officers generally reported their support for operational stakeholder partnership approaches to policing licensed premises. This was evidenced by the high number of officers (over 90%) reporting that there should be shared responsibility for enforcing the provisions of the Liquor Act. Importantly, those surveyed also identified the factors which constrain or prevent them from policing licensed premises. Study Two involved interviewing a small but comprehensive group (n=11) of senior managers from within the Queensland Police Service (QPS) who have responsibility for setting operational and strategic policy. The aim of this study was to examine the attitudes, perceptions and influence that senior officers (at the strategy and policy-setting level) had on the officers at the operational level. This qualitative study was carried out using a purposive sampling (Denzin & Lincoln, 2005; Guba & Lincoln, 1989), focused interview and thematic analytic approach. The interview participants were drawn from three tiers of management at district, regional as well as the whole-of-organisational level. The first key theme emerging from the study related to role, in terms of both the QPS broader organisational role, and the individual officer role with respect to the policing of licensed premises. For the QPS organisational role, participants at all three strategic levels had a high degree of congruity as to the organisations service role; that is, to enhance public safety. With respect to participants’ beliefs as to whether police officers have knowledge and understanding of their individual roles concerning licensed premises (as opposed to the QPS role), participants reported most commonly that officers had a reasonable to clear understanding of their role. Participant comments also were supportive of the view that officers operating in the research area, Brisbane Central District (BCD), had a clearer understanding of their role than police operating in other locations. The second key theme to emerge identified a disparity between the knowledge and capability of specialist police, compared with general duties police, to police licensed premises. In fact, a number of the responses to a variety of questions differentiated specialist and general police in a range of domains. One such example related to the clarity of understanding of officer role. Participants agreed that specialist police (Liquor Enforcement & Proactive Strategies [LEAPS] officers) had more clarity of understanding in terms of their role than generalist police. Participants also were strongly of the opinion that specialist police had higher skill levels to deal with issues both inside and outside licensed premises. Some participants expressed the view that general duty police undertook purely response-related activities, or alternatively, dealt with lower order matters. Conversely, it was viewed that specialist police undertook more complex tasks because of their higher levels of knowledge and skill. The third key theme to emerge concerned the identification of barriers that serve to restrict or prevent police officers from policing licensed premises. Participant responses strongly indicated that there was a diversity of resourcing barriers that restrict police from undertaking their roles in licensed premises. Examples of such barriers were the lack of police and the low ratio of police to patrons, available officer time, and lack of organisational investment in skills and knowledge acquisition. However, some participants indicated that police resourcing in the BCD was appropriate and officers were equipped with sufficient powers (policy and legislation). Again, the issue of specialist police was raised by one participant who argued that increasing the numbers of specialist police would ameliorate the difficulties for police officers policing licensed premises. The fourth and last key theme to emerge from Study Two related to the perception of senior officers regarding the opportunity and capability of officers to leverage off external partnerships to reduce harms inside and outside licensed premises. Police working in partnership in BCD was seen as an effective harm reduction strategy and strongly supported by the participants. All participants demonstrated a high degree of knowledge as to who these partners were and could identify those government, non-government and community groups precisely. Furthermore, the majority of participants also held strong views that the partnerships were reasonably effective and worked to varying degrees depending on the nature of the partnership and issues such as resourcing. These senior officers identified better communication and coordination as factors that could potentially strengthen these partnerships. This research finding is particularly important for senior officers who have the capacity to shape the policy and strategic direction of the police service, not only in Queensland but throughout Australasia. Study Three examined the perceptions of those with links to the broader liquor industry (government, non-government and community but exclusive of police) concerning their understanding of the police role and the capacity of police to reduce alcohol-related harm inside and outside licensed premises, and their attitudes towards police. Participants (n=26) surveyed represented a range of areas including the liquor industry, business represenatives and government representatives from Queensland Fire and Rescue Service, Queensland Ambulance Service, Brisbane City Council and Queensland Health. The first key theme to emerge from Study Three related to participant understanding of the QPS organisational role, and importantly, individual officer role in policing licensed premises. In terms of participant understanding of the QPS role there was a clear understanding by the majority of participants that the police role was to act in ways consistent with the law and to otherwise engage in a range of enforcement-related activities. Participants saw such activities falling into two categories. The first category related to reactive policing, which included actions around responding to trouble in licensed premises, monitoring crowd controllers and removing trouble-makers. In the second category, proactive approaches, participants identified the following activities as consistent with that approach: early intervention with offenders, support of licensed premises operators and high visibility policing. When participants were asked about their understanding of individual officer roles in the policing of licensed premises, a range of responses were received but the consistent message that emerged was that there is a different role to be played by general duty (uniformed) police compared to specialist (LEAPS Unit) police, which reflects differences in knowledge, skill and capability. The second key theme that emerged from the data related to the external participants’ views of the knowledge and capability of specialist police, compared with general duty police, to police licensed premises. As noted in the first key theme, participants were universally of the view that the knowledge, skill and capability of police in specialist units (LEAPS Unit) was at a higher level than that of general duty police. Participants observed that these specialist officers were better trained than their colleagues in generalist areas and were therefore better able to intervene knowledgeably and authoritatively to deal with problems and issues as they emerged. Participants also reported that officers working within BCD generally had a positive attitude to their duties and had important local knowledge that they could use in the resolution of alcohol-related issues. Participants also commented on the importance of sound and effective QPS leadership, as well as the quality of the leadership in BCD. On both these measures, there was general consensus from participants, who reported positively on the importance and effectiveness of such leadership in BCD. The third key theme to emerge from Study Three concerned the identification of barriers that serve to restrict or prevent police officers from policing licensed premises. Overwhelmingly, external participants reported the lack of human resources (i.e. police officers) as the key barrier. Other resourcing limitations, such as available officer time, police computer systems, and the time taken to charge offenders, were identified as barriers. Some participants identified barriers in the liquor industry such as ‘dodgy operators’ and negative media attention as limitations. Other constraints to emerge related to government and policy barriers. These were reflected in comments about the collection by government of fees from licensees and better ‘powers’ for police to deal with offenders. The fourth and final key theme that emerged from Study Three related to the opportunities for and capability of police to leverage off external partnerships to reduce harms inside and outside licensed premises. Not surprisingly, participants had a comprehensive knowledge of a broad range of stakeholders, from a diversity of contexts, influential in addressing issues in licensed premises. Many participants reported their relationships with the police and other stakeholders as effective, productive and consistent with the objectives of partnering to reduce alcohol-related harm. On the other hand, there were those who were concerned with their relationship with other stakeholders, particularly those with a compliance function (e.g. Office of Liquor & Gaming Regulation [OLGR]). The resourcing limitations of partners and stakeholders were also raised as an important constraining factor in fulfilling the optimum relationship. Again, political issues were mentioned in terms of the impact on partnerships, with participants stating that there is at times political interference and that politicians complicate the relationships of stakeholders. There are some significant strengths with respect to the methodology of this research. The research is distinguished from previous work in that it examines these critical issues from three distinct perspectives (i.e. police officer, senior manager and external stakeholder). Other strengths relate to the strong theoretical framework that guides and informs the research. There are also some identified limitations, including the subjective nature of self-report data as well as the potential for bias by the author, which was controlled for using a range of initiatives. A further limitation concerns the potential for transferability and generalisability of the findings to other locations given the distinctive nature of the BCD. These limitations and issues of transferability are dealt with at length in the thesis. Despite a growing body of literature about contextual harms associated with alcohol, and specific research concerning police intervention in such contextual harms, there is still much to learn. While research on the subject of police engaging in alcohol-related incidents has focused on police behaviours and strategies in response to such issues, there is a paucity of research that focuses on the knowledge and understanding of officers engaged in such behaviours and practices. Given the scarcity of research dealing with the knowledge, skills and attitudes of police officers responding to harms inside and outside licensed premises, this research contributes significantly to what is a recent and growing body of research and literature in the field. The research makes a practical contribution to police agencies’ understanding of officer knowledge and police practice in ways that have the potential to shape education and training agendas, policy approaches around generalist versus specialist policing, strategic and operational strategy, as well as partnership engagements. The research also makes a theoretical contribution given that the research design is informed by the Three Circle

The risks of Extasy Use This topic is very present in Czech Republic as the use of soft drugs, including the extasy is becoming increasingly popular. Extasy is considered as a weekend or experimental drug that is mostly used by the young population. Our society is tolerant towards the use of the soft drugs; consequently these drugs are becoming a common part of our lives. Extasy is represented as a soft and safe drug. Nevertheless the use of any addictive substances is far to be without risks. Such risks are often neglected or totally ignored. This diploma thesis consists of two parts: theoretical and practical part. First part, the literature review is embracing all different aspects of the dance drug extasy and its culture. History of the drug, description of its effects, identification of its users, hazards related to its use and also preventive measures - harm reduction programs are being defined. The aim of this work was to present complex information about the extasy drug and yet to describe the hazards linked to the drug abuse and draw attention its dangers. First part also includes the description of the means for minimising such risks and the harm reduction preventive programs {--} analysis of an extasy tablet. Practical part of this work results from several interviews of the formal extasy users. The endeavour of this part was to get more information about the drug. The interviews consisted of a number of parts. Questions in these parts focused on frequency of attendance of the dance parties, number of the extasy tablet used on average and the circumstances of the drug use, knowledge of the drug and its incidences and motivation to stop using it. Other set of questions enquired about the dangers of extasy in combinations with other drugs, ``fake extasy{\crqq} issue and dangerous behavioural under the influence of extasy. In the following part of the interview extasy users were asked to describe their awareness of the dangers and risks linked to the use of the drug, what precautions are they taking to avoid such risks and weather they know about possibility to get the pill analysed for purity and further if they care about the importance of the fluid intake. This thesis demonstrated that the extasy users are well informed about the risks, hazards and dangers of the drug however they overlook it and act as they are not aware of the hazards.

Masters Coursework - Masters of Clinical Psychology (MClinPsych)
Background: Smoking is the leading cause of preventable death worldwide (World Health Organisation, 2015). The rates of smoking in Australia have been declining in recent years, but not in certain vulnerable populations such as people who use alcohol and other drugs. Smoking cessation strategies have been implemented on both a population and individual level. Smoking cessation strategies have been less successful in this group, and thus the need for new strategies has been recognised. Electronic cigarettes (e-cigarettes) represent a potentially new smoking cessation aid, but little is known about this group’s perception of e-cigarettes. Method: A five-item survey was developed and administered to participants (N= 405) of six local drug and alcohol treatment centres in the Hunter New England local health district over a three month period in 2016-2017. The survey’s questions assessed participants smoking status as well as their perceptions toward e-cigarettes generally, and their usefulness in smoking cessation. Results: 86 percent of participants reported being current smokers of tobacco, with 56 percent reporting ever-use of e-cigarettes. 41 (N=168) percent of participants stated that they believed e-cigarettes are helpful as a smoking cessation strategy. 50 (N=203) percent of participants reported thinking that tobacco cigarettes were more harmful than e-cigarettes. 60 percent of participants (N=243) were of the opinion that e-cigarettes should be used in drug and alcohol clinics to help people quit smoking tobacco. Using chi-square analysis to investigate associations, a person’s smoking status was found to be significantly associated with e-cigarette use (χ² (8, N = 405) =20.16, p<0.05)), the persons perception of the helpfulness of e-cigarettes as a smoking cessation strategy (χ² (4, N = 405) =16.70, p<0.05)) and the persons perception of the harmfulness of e-cigarettes (χ² (6, N = 405) =90.97, p<0.001)). Conclusions: This may be the first study investigating attitudes toward e-cigarettes in an Australian population of people who use drugs. Results found that awareness and use of e-cigarettes was high, with over half (56 percent) of the sample reporting ever-use of e-cigarettes. Results also closely replicate findings of Stein et al. (2014) who found similar results in a North American sample of tobacco smokers accessing an opioid treatment program. This research has implications for the legislative context around e-cigarettes in Australia. In summary, a sample of individuals from an at-risk population are currently using e-cigarettes in conjunction with tobacco cigarettes. Many report being interested in e-cigarettes as a smoking cessation strategy in drug and alcohol treatment centres. This warrants further exploration due to the current illegality of distribution of e-cigarettes in Australia. The strengths of this research are noted as the large sample-size and non-invasive nature of the survey. Limitations may include the generalisability of these findings to the larger population of people who use alcohol and other drugs.

With the exception of horse racing, any form of gambling was criminalised in South Africa until the dawn of constitutional democracy in 1994. In the same year, the Lotteries and Gambling Board Act, 1993, came into force decriminalising, amongst others, casinos and gambling games within the Republic. This Act has since been repealed and gambling is governed by the National Gambling Act, 2004, as well as by provincial gambling laws. Interactive / online gambling is illegal pending authorisation by a national legislation. Such legislation, the National Gambling Amendment Act, 2008, seeking to regulate interactive gambling awaits proclamation of the date of its commencement by the President. The National Gambling Policy, 2016, dashes any hope of regulation of interactive gambling, however, as it seeks to embargo the introduction of (new) forms of gambling, including but not limited to interactive gambling. The scourge of problem gambling and the protection of traditional forms of gambling, that is, casinos, are the main reasons for advocating for the continued prohibition of interactive gambling. Problem gambling is not unique to interactive gambling, but affects all modes of gambling. South Africa is among countries with a high rate of problem gambling. It is feared that interactive gambling will exacerbate the scourge of problem gambling as gamblers with access to the internet will now have unlimited gambling opportunities around the clock. On the other hand, interactive gambling offers practical solutions to the implementation of harm minimisation strategies to deal with problem gambling such as limitations on gambling deposits, losses and time. Prohibition of interactive gambling is difficult to enforce and deprives the country of an opportunity to control, through licensing, this mode of gambling and possible benefit from taxation and licensing fees. It further exposes gamblers – who despite prohibition choose this mode of gambling – to unregulated and illegal gambling websites. This thesis attempts to provide safeguards for regulation of interactive gambling and to embrace the benefits of the technological development that makes interactive gambling a reality. The United Kingdom (UK) is a prime example of a country that has successfully legalised and licensed interactive gambling in its jurisdiction.
Criminal and Procedural Law
LL. D.