Adolescent Illicit Drug Use and Policy Options in Australia: A Multicriteria Decision Analysis

• Author: Matthew Manning,Gabriel T. W. Wong
• DOI: 10.1177/0022042617719444
• Published date: 01 October 2017
• Date: 01 October 2017
• Subject Matter: Articles

https://doi.org/10.1177/0022042617719444

Journal of Drug Issues

2017, Vol. 47(4) 638 –664

© The Author(s) 2017

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DOI: 10.1177/0022042617719444

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Article

Adolescent Illicit Drug Use and

Policy Options in Australia: A

Multicriteria Decision Analysis

Gabriel T. W. Wong1,2 and Matthew Manning2

Abstract

The etiology of illicit substance involvement is a multidimensional problem shaped by factors

across individual, social, and environmental domains. In this study, a multicriteria framework

is employed to incorporate the input of specialists regarding risk and protective factors and

the effectiveness of alternative interventions to mitigate the adverse harms and consequences

associated with adolescent drug initiation and subsequent use. Using a seven-stage drug use

continuum (nonuse, priming, initial use, experimental use, occasional use, regular use, and

dysfunctional use), experts rate social and environmental factors as the most important from

nonuse to occasional use. Experts often support preventive and harm-minimizing strategies to

interrupt the progression of drug involvement and accumulation of drug-related harms among

adolescents. Compared with preferable interventions, less preferable options (e.g., drug testing/

monitoring) are considered to have a negative policy impact on key social, environmental, and

drug dimension domains, which tend to override their positive impacts on other areas.

Keywords

multicriteria decision analysis, drug policy, adolescents, harm minimization, drug prevention

Introduction

Illicit drug (“drugs” hereon) use among Australian adolescents aged 14 to 19 years from 2007

until 2013 fluctuated little—from approximately 16.7% in 2007 to 17.6% in 2013 (Australian

Institute of Health and Welfare [AIHW], 2014). The 2011 Student Survey (White & Bariola,

2012) reports that 2.7% of Australian students (aged 12-17) admitted use of “any illicit substance

in their lifetime.” The average age of initiation into illicit drug use among the younger Australian

population (aged 14-24) is 16.6 years (AIHW, 2014), with young people most likely to have used

drugs for the first time due to curiosity or by introduction from a friend or family member.

Common reasons for continuation along the drug continuum (i.e., from initiation to

dysfunctional use) include “wanting to enhance experiences” and “wanting to improve mood/to

stop feeling unhappy” (AIHW, 2014).

1The Australian National University, Canberra, Australia

2Griffith University, Brisbane, Australia

Corresponding Author:

Gabriel T. W. Wong, ANU Centre for Social Research and Methods, The Australian National University, 13 Ellery

Crescent, Canberra 2601, Australia.

Email: gabriel.wong@anu.edu.au

719444JODXXX10.1177/0022042617719444Journal of Drug IssuesWong and Manning

research-article2017

Wong and Manning 639

Since 1985, Australia’s documented drug strategy has been to address the harmful use of licit

(e.g., tobacco, alcohol), illicit (e.g., heroin, cannabis), and other psychoactive substances (e.g.,

inhalants), using a harm-minimization approach. This approach embraces the three pillars of

demand, harm, and supply reduction (Ministerial Council on Drug Strategy, 2011). Harm mini-

mization seeks a balance between these elements, and is regarded as an evidence-based and

pragmatic approach (Ritter & Cameron, 2006). Although it is argued that this approach facilitates

collaboration across health, law enforcement, and education, as well as partnerships between

governments and with nongovernment agencies and community stakeholders, the majority of

attention has be placed on the supply side (e.g., police crackdowns; Mazerolle, Soole, &

Rombouts, 2006), whereas demand (e.g., educational programs) and harm reduction (e.g., needle

syringe programs [NSPs]) have been less emphasized (Ritter & McDonald, 2008).

Is this approach to reducing adolescent drug use and the associated harms the most appro-

priate? Head (2008) proposes that a three-lens approach should be adopted to synthesize

research, political, and practice-based knowledge for the development of evidence-based pol-

icy that meets the needs of different policy actors. Jones and Seelig (2004) and McDonald,

Bammer, and Deane (2009) highlight the importance of incorporating expert opinion and

knowledge of researchers and practitioners in the policy process. These experts, by virtue of

their unique skillset and knowledge, play an essential role as knowledge brokers who synthe-

size and translate existing evidence for policy makers (Goldfeld, 2010). An important role is

also filled by advisory councils and committees, which, with experts, contribute with regard to

knowledge translation and policy input (Bronitt, 2010; Hobbs & Hamerton, 2014). For instance,

the developing mechanism of expert committees and expert advice contributed significantly in

the process of remedicalizing cannabis in the United Kingdom since the mid-20th century

(Taylor, 2016).

Although expert knowledge is only one influence on the complex policy decision-making

processes and other inputs (e.g., voices of the affected community [young people]) should also

be included and weighed up in policy deliberation (see Ritter, 2015), we argue that experts and

practitioners (as key opinion leaders) tend to represent influential voices that are capable of

affecting the public. In other words, when expert beliefs, interests, or opinion are not appropri-

ately accommodated or recognized in the policy decision-making process, these unaccommo-

dated views may be translated into objections (or public social rejections) toward a given policy.

Preventing or avoiding public and social objections of a policy can be crucial as such a prefer-

ence plays an important and significant role for shaping policy, and ultimately determines the

success of policies (including policies designed to curb the illicit drug problem; Matthew-

Simmons, Love, & Ritter, 2008; Zureik, Stalker, & Smith, 2006). We believe the understanding

of these views and how they are formed can provide insights for policy makers for more efficient

policy making and its implementation.

Several knowledge translation models have been used to facilitate the synthesis, dissemina-

tion, exchange, and application of expert knowledge to address important policy questions in the

drug sector (e.g., Bammer, 2005; Manning, Wong, Ransley, & Smith, 2016; McDonald et al.,

2009; Nutt, King, & Phillips, 2010). Two key set of methods, the dialogue methods and the mul-

ticriteria decision (MCD) modeling, have been assessed and/or applied to synthesise expert opin-

ion and knowledge to analyze drug policy. For example, McDonald et al. (2009) provide a

methodological overview of dialogue methods with an application of some selected methods to

a hypothetical policy problem of the use of illegal amphetamines by young people. With regard

to the application of MCD modeling, Nutt et al. (2010) assess the harms caused by the misuse of

a range of drugs in the United Kingdom by applying the MCD modeling. Saaty (2015) applies

the Analytic Hierarchy Process (AHP), an MCD analysis method, to analyze the legalization of

marijuana via evaluating its benefits, opportunities, costs, and risks. Manning, Ransley, Smith,

Mazerolle, and Cook (2013) and Manning et al. (2016) illustrate the use of the AHP to