Raising the Bar on Alcohol and Other Drug Treatments in Australia

Simone Henriksen

doi:10.25907/00760

Alcohol and other drug (AOD) use is a significant problem for society. The use of AODs is associated with health, social and economic harms.1 AOD treatment is a therapy designed to reduce a person’s harmful use of alcohol or other substance and provide them with a pathway to recovery. 2 Research shows that AOD treatment services produce beneficial outcomes such as reduced recidivism, improved health, reduction in mortality rates, improved social functioning and inclusion and lower health care costs.3 At the same time, problems exist with delivery of AOD treatment in Australia. Patients seeking AOD treatment in Australia risk being exposed to financial exploitation, the use of non-evidence-based therapies, poor quality and inappropriate treatment.4 Other problems include the lack of restrictions relating to who may own and operate an AOD treatment facility.5 Despite the important benefits of AOD treatment to the individual and the broader community, there is a sparsity of research into the governance of AOD treatment in Australia. This thesis examines the governance structure and regulation of the AOD treatment sector in Australia. It uses a combination of doctrinal and theoretical research methodologies and legal empirical analysis of heath practitioner misconduct in the AOD treatment sector in Australia. This thesis draws upon regulatory theory to examine the dynamic nature of governance within the AOD treatment sector. Nodal governance theory is applied to identify who the regulatory actors are, how they govern and potential governance issues.6 Responsive regulation theory is then used to analyse the compliance mechanisms that feature in the sources of governance identified through the application of nodal governance theory to the AOD treatment sector. A legal empirical analysis of disciplinary decisions involving health practitioner misconduct is used to assess the risk of harm present in the AOD treatment sector in Australia. This thesis also provides recommendations for improving the governance of AOD treatment in Australia. The contribution of this thesis is twofold. First, it contributes to the literature on nodal governance theory and regulatory theory around governance and quality frameworks. Second, this thesis provides a novel contribution to the literature in terms of its critical analysis of the regulatory landscape of the AOD treatment sector in Australia and recommendations for reform. This thesis finds that regulatory controls for ensuring safe, effective and appropriate treatment vary across the AOD treatment sector. Two broad classes of regulatory targets are identified within the sector: health practitioners and AOD treatment facilities. Licensing, registration, negative licensing, accreditation, quality frameworks and public-private partnerships govern the delivery of treatment services in Australia. The nature of treatment, the provider and the jurisdiction of the provider determine the regulatory requirements that must be met when delivering AOD treatment in Australia. It is found that this has led to a piecemeal approach to governance of the sector because many factors influence the choice of regulatory tools and how they interact. This thesis finds that there is a risk of harm associated with the delivery of AOD treatment in Australia. The risk arises from health practitioner misconduct and poor organisational governance of AOD treatment facilities. It is found that the current governance mechanisms may provide some protection to the public. However, significant issues arise with regard to the governance of unregistered health practitioners and AOD treatment facilities in Australia. These issues include the way in which unregistered health practitioner misconduct is managed, and the detection and under reporting of unregistered health practitioner misconduct. Further, there is no consistent national approach to the regulation of unregistered health practitioners. Systemic issues at an organisational level within AOD treatment facilities also give rise to a risk of harm. Despite a range of regulatory tools being engaged across the sector to promote quality and safety in the delivery of AOD treatment at an organisational level, there remains no broader oversight of the sector at a state or national level. This thesis finds that the National Quality Framework (NQF) which was introduced in 2019 to provide a nationally consistent approach to the quality and safety of AOD treatment fails to provide this broader oversight due to a distinction between publicly and privately funded providers. To reduce the risk of harm associated with the delivery of AOD treatment and realise the individual and broader social and economic benefits of AOD treatment, these issues need to be addressed. This thesis makes recommendations in regard to the governance of unregistered health practitioners and specialist AOD treatment providers to minimise the risk of harm associated with the delivery of AOD treatment in Australia. The recommendations for unregistered health practitioners include: enacting consistent mandatory reporting requirements to improve the detection of misconduct; developing common definitions of the scope of practice for unregistered practitioner roles in the AOD sector; developing consistent training standards for unregistered practitioner roles in the AOD sector; enactment of a broader range of enforcement strategies for managing the conduct of unregistered health practitioners; and improved co-ordination of information regarding unregistered practitioner misconduct between all states and territories. The recommendations for reform to health facility governance focus on improving consistency in the NQF by clearly defining ‘quality AOD treatment’, reducing the choice of accreditation standards to fewer, more industry specific standards, and implementing a monitoring and enforcement strategy for the NQF which does not distinguish between the funding status of a specialist AOD treatment provider.

Raising the Bar on Alcohol and Other Drug Treatments in Australia

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