Objective: To examine birth cohort trends in the prevalence, age of initiation and durability of the use of psycho-stimulant and psycho-depressant drugs in Australia between 1988 and 1998.

Method: Nine synthetic birth cohorts were constructed from a pooled dataset of the three National Drug Strategy Household Surveys (1988, 1993, 1998). The design-effect adjusted weighted lifetime and recent prevalence, age of initiation and durability of use, of three popular psycho-stimulants (amphetamine, cocaine and ecstasy) and three popular psycho-depressants (cannabis, heroin and inhalants) were estimated. Significance tests of difference use chi-square statistics and the sociodemographic predictors of trends were tested using logistic regression techniques.

Results: Lifetime and recent prevalence and durability of use increased and ages of initiation decreased, with each successive cohort. Psycho-stimulants were predictors for psycho-depressant use and vice versa. Being male, aged under 35 years, Australian born, employed or in fulltime education, and a tobacco smoker were significant predictors of increased risk of using both classes of drugs. Being married or having no post-secondary education qualifications were significant predictors of lower risk of using either class of drugs.

Conclusions: Younger cohorts are more likely to use both classes of psychoactive drugs, to have commenced using the drugs earlier and to have maintained their drug habits longer, compared to older cohorts. While increased availability is an important factor in the likelihood of exposure to illicit drugs, interventions implemented since the National Drug Strategy began in 1985 do not appear to have reduced the probability that young people will initiate and maintain illicit psychoactive drug use, exposing them to associated health and legal consequences.

This study investigated the social ecology of substance use among 162 tertiary students studying at Northern Territory University in April 2000. The sample was predominantly female (69.6%), Australian born (70%), non-Indigenous (77.2%), not active in the labour market (58.8%) and intending to complete an undergraduate degree (62.7%). Substance use was prevalent, and 77.6% of students were current drinkers, 59.4% currently smoked tobacco and 28.5% used other drugs. Polydrug use was evident, with 24.8% of students using more than one substance on the same occasion in the previous month. Substance use tended to be associated with relaxing, socialising and wanting to feel good. Most students were not concerned about their alcohol use and their perceptions of normal drinking behaviour highlight the challenges in addressing substance misuse patterns in this population.

Background: In the 1990s, heavy kava use in Aboriginal communities was linked to reports of unusual neurological events which were often described as ‘fits’ or ‘seizures’. Kava use has also been associated with extra-pyramidal movements. We now raise the possibility that kava toxicity and kava withdrawal may be associated with grand mal seizures. This paper describes some of ’these “seizure” episodes’ in kava drinkers. Nine communities and associated homelands in the eastern Arnhem Land (Miwatj) region (Northern Territory, NT) including 7001 Aboriginal people of whom 4217 were over 15 years. Twenty-one kava users experienced 32 “seizure” episodes for which the date of occurrence and other data was recorded in notes in community health clinic files dating from the 1980s up to 1999 in a sample of the Miwatj population. Kava, alcohol, tobacco, cannabis use and petrol sniffing, year in which “seizure” occurred, notes of kava toxicity or withdrawal. Kava toxicity effects were suspected in 15 and withdrawal effects in six of 32 “seizure” episodes. In seven episodes impaired consciousness and abnormal movements were adequately documented to suggest grand mal seizures. The maximum number of “seizures” experienced was three and three individuals experienced this number between 1990 and 1999. One was a heavy kava user. Six other individuals experienced two “seizures” each and five of these were heavy users. Sixteen individuals experienced 19 “seizures” during 1994-1997 when kava supply may have reached its peak. Fifteen of the 21 individuals experiencing “seizures” were heavy users described locally as dja[aw'marama. The clinical data and the coincidence of peak supply with records of “seizures” suggest kava toxicity and withdrawal seizures may both occur with heavy kava use. Further systematic analysis is warranted to confirm this and to assess kava's effects with respect to possible confounders such as alcohol.

Background: Isolated reports exist in the literature of hallucinations occurring as harmful outcomes of kava use. Kava's well-known mood-altering qualities contrast sharply with reports of such serious unwanted side effects. Arnhem Land Aboriginal people have used kava since 1982. Is there any evidence that kava use is associated with these kinds of effects in this population?

Objectives: This paper describes the context and circumstances for 18 individuals who were reported to have experienced hallucinations in a sample of the Miwatj population in eastern Arnhem Land (Northern Territory. NT) (see Clough. Cairney. Maruff, Burns & Currie. 2001). The role of kava use in these occurrences is discussed. Alcohol, tobacco, cannabis use and petrol sniffing as well as psycho-social factors were also noted in community health clinic files and health worker reports.

Results and conclusions: There was no evidence that hallucinations recorded in individuals were related to kava use. Instead, social and personal stress, pre-existing psychiatric conditions and excessive use of alcohol were more prominent. To describe the kinds of perceptual shifts experienced by kava users as hallucinations would seem imprudent without consideration of other environmental factors.

There is increasing worldwide recognition of the social and economic burden of psychotic illness. Substance use disorders frequently complicate the treatment of psychosis and are associated with increased readmission rates, decreased compliance, and increased violence and suicide risk. The Northern Territory of Australia has a scattered remote population – 25% of whom are Indigenous people. There are increasing rates of drug use across the Territory, and hospital admission rates have been gradually increasing. Psychotic disorders are the most frequent cause of hospital admissions, and substance abuse complicates the majority of these admissions. It is imperative that comprehensive treatment programs are established, integrating services, and utilising culturally appropriate cost-effective strategies.

Needle and syringe programs (NSP) are an integral component of Australia's response to the HIV/AIDS epidemic and as such, have been in place since the early days of the epidemic. Because of their early implementation, they have played a key role in helping to stem the spread of HIV among people who inject drugs. Also, they have been instrumental in ensuring that clients have had access to appropriate resources and education. However, these programs have often operated in the face of considerable resistance from a range of stakeholders and in particular, local communities. This article provides an insider's perspective on the operation of a large Sydney NSP and describes how the Program caters to the expressed needs of all members of the community, while continuing to provide an effective and responsive health service to people who inject drugs.