One of the factors shaping the public perception of drug use is the ongoing association of drugs and violence. One of the most common descriptive factors of methamphetamine, for example, is that it is a cause of violent or psychotic behaviour. We also know that alcohol is often cited as a contributing factor in violence.
Violence can occur in public places or in the home. It can be part of a confrontation between two or more people or it can be perpetrated as an attack on innocent bystanders or family members.
Violence is a significant problem in Australian society. In 2012-13, an estimated 498,000 people were the victim of a physical assault . It is clearly something we need to address.
I want to look at what role drug and alcohol use plays in violence in Australia and whether better regulation can be part of the solution to our problem with violence. This article will focus primarily on alcohol and methamphetamine, as well as heroin and prescription drugs, comparing rates of violence involving these substances and how differing measures are needed to tackle the misuse of each substance if we are going to reduce drug and alcohol-associated violence.
The various types of violent crime all have a serious, negative impact on the community. There are four major categories of violent crime - homicide, physical assault, sexual assault and robbery . Of these, physical assault is the most common. Between 1996 and 2007, violent crime involving assault increased by 55% . Sixty percent of assault victims are male . Males were more likely to be assaulted by a stranger in a public place, whereas females were more likely to be victimised at home by a person known to them.
Armed robbery is the third most commonly-reported violent crime. In 2010, approximately 5,000 individuals and organisations reported experiencing armed robbery . Armed robbery is closely linked with property crime. Instances of armed robbery have been decreasing, and fell 14% from 5,631 in 2013 to 4,855 the following year, a five-year low . However, other types of property crime, including unlawful entry with intent and motor vehicle theft, increased by 1% and 3% respectively in 2015 .
Between 2002 and 2012, 2,631 homicide incidents were recorded by the National Homicide Monitoring Program (NHMP); of these, 41% were classified as domestic/family homicides . Intimate partners accounted for the majority of domestic/family homicide victims, and comprised 23% of all homicides recorded during this period . Reported homicides decreased nationally by 2% in 2015, the fourth consecutive year reports of homicide have fallen .
Police recorded 21,380 victims of sexual assault in 2015, a 3% rise on the previous year and the highest number of reports seen in six years . A rise in family and domestic violence (FDV)-related sexual assault was reported in 2015, with an increase of 7% . Seventeen percent of women and 4% of men experienced sexual assault since the age of 15, and 93% of offenders are male .
Drug and alcohol use and crime are often heavily associated with each other. Over a 13-year period, the Drug Use Monitoring in Australia program (DUMA) collected data from more than 40,000 police detainees, both self-reported and urinalysis. Most recently, it found that 66% of these offenders tested positive to at least one drug . Almost half (47%) reported having taken drugs at the time of their offending. These findings are a clear indication that substance use is more common amongst offenders than in the general community.
Despite both alcohol and illicit drugs such as methamphetamine having links to increased instances of violence, the responses from governments and the public have differed significantly.
Of all police-reported family/domestic (FDV) incidents in Australia, alcohol is involved in about half . Additional police and hospital data indicates that the probability of FDV is increased when the perpetrator consumes alcohol. Findings indicated physical assault is over 10 times more likely on a day when alcohol is consumed.
In the case of domestic/family and other homicides, data recorded over the 10 year period 2002-2012 indicated alcohol was a more frequent contributing factor than illicit drugs in both types of homicide, recorded in 22% of domestic/family homicides and 30% of other homicides . In all recorded cases, the offender was more likely than the victim to be affected by drugs and/or alcohol. Some studies have pointed to a potential causative association between alcohol and violence, noting that as population alcohol use rates decline, so do rates of homicide .
Aside from homicides and FDV, studies have indicated alcohol to be directly involved in violent, late night assaults [18 ALSO 19]. The rates of physical abuse perpetrated by an alcohol-affected person were more than twice the rate for other drug types . This indicates that alcohol’s disinhibiting effects can lead to a higher likelihood of violence occurring. Personality is also a factor in alcohol-related violence. Aggression isn’t present in all who drink, but those who are more irritable, with less anger control and less empathy towards others are more likely to be aggressive when alcohol-affected .
In 2009-10, DUMA found that more than 70% of those detained by police for violent assaults in Kings Cross, Sydney, tested positive to at least one drug type, with opiates the most commonly detected . This was followed by benzodiazepines, cannabis, heroin and amphetamines. An increase in the use of performance-enhancing drugs such as steroids have also been linked with an increase in violent assaults in the same area. A 2013 survey found 74% of people who started injecting drugs had obtained performance and image-enhancing drugs, compared with 27% in 2003 .
As a psychostimulant, methamphetamine is more closely associated with violent behaviour than opioids such as heroin. This is because psychostimulants, unlike opioids, can induce psychosis which - while temporary - can involve delusions and hallucinations, leading to hostile behaviour . Psychostimulants are one of the most commonly detected illicit substances in homicide offenders and victims.
The Australian Crime Commission recorded a number of instances in a 12-month period where people addicted to crystal methamphetamine caused fatal car accidents, attempted murders, and other incidents of violent crime . In 2015, a report by DUMA noted 37% of adult detainees tested positive to amphetamines, a 13% increase on 2011-12 .
Illicit drugs such as methamphetamine and heroin have been associated with acquisitive - or property - crime, where those dependent on the drug will steal to fund their habit. A survey of police detainees found regular users of both amphetamine and heroin self-reported violent and property offences at a rate more than five times higher than prisoners with no history of frequent drug use . Data recorded by DUMA indicated an increase in methamphetamine use among police detainees, from 14% in 2009 to 37% in 2014 . Given methamphetamine’s close association with acquisitive crime, an increase in methamphetamine use, at least amongst offender demographics, anticipates an increase in acquisitive crime. Another factor in methamphetamine’s propensity to influence violent behaviour is its increase in potency over the past decade. There are three main forms of the drug - methamphetamine powder (‘speed’), methamphetamine base, and crystalline methamphetamine, more commonly known as ‘ice’, or ‘crystal meth’. The likelihood of violent behaviour increases with the potency of methamphetamine. Crystalline methamphetamine, far more potent than base or speed, has been associated with increased potential for psychotic and violent behaviour . This is due to the rapid psychopathological decline amongst users of the drug. A survey of 400 regular methamphetamine and heroin users found 82% had committed a violent crime at some point in their life, and two in five had committed such a crime in the preceding 12 months  . The study found those primarily using methamphetamine were more likely to have committed a violent crime (51%) than those mainly using heroin (35%). Heavy alcohol use was listed as an additional factor increasing the risk of violent crime amongst this group.
There have been reports of manipulative patients with pharmaceutical drug problems doctor shopping and deliberately targeting young doctors and female GPs with violent threats in order to obtain prescriptions . Prescribers have been known to experience violence from patients desperate for scripts. A survey amongst GPs in New South Wales found the most common forms of violence experienced included verbal abuse (42.1%) and property damage (28.6%), although GPs also reported experiencing sexual harassment (9.3%) and physical abuse (2.7%) .
It is important to examine the role of multiple drug misuse and its relationship to crime.
A number of causal factors arise when looking at the role multiple drug misuse plays in incidents of crime, particularly the potential interactive effects of “drug mixing”, in terms of the resulting chemical reaction and its impact on judgement or behaviour . Alcohol appears to be a common factor in violence involving multiple drugs. People who abuse cocaine and mix it with alcohol have an increased tendency towards violence . In 2009, DUMA recorded data from 1,884 detainees, with 753 charges for violent crime. Of these, alcohol was a factor in over 33% of cases and illicit drugs in 12% . However, a combination of alcohol and illicit drugs was a factor in over 40% of cases. Based on these findings it would appear that while certain drugs, such as methamphetamine, singlehandedly increase the risk of violent crime, the risk worsens when mixed with alcohol.
People who use illicit drugs also have a higher risk of being victimised by violent crime. Studies have found 70% of respondents have a lifetime prevalence of being physically assaulted  and both males and females who use drugs experience higher rates of sexual violence .
‘Pre-loading’, that is, drinking large amounts prior to heading out to licensed venues, is a major factor in alcohol-related violence . There is evidence that such violence can be reduced through better regulation of sales, hours and prices, and improving the management of environments in which alcohol is served . Increased regulation of alcohol availability can occur through restricting the hours in which it can be sold, and reducing the number of alcohol retailers. There is evidence it has worked, including in the former Soviet Union, which had strict alcohol regulation around when and where it could be sold, and saw a rapid fall in alcohol-related violence as a result. Economic modelling has also shown that increasing taxes on alcohol can be effective, although political influence wielded by beverage industry and bootleg alcohol markets in developing countries can inhibit this strategy .
A small number of licenced venues can be responsible for the majority of alcohol-related violent incidents that occur in public, usually over the weekend. Identifying and targeting high-risk venues, conducting safety audits  and implementing various restrictions, for example on opening hours, is an effective evidence-based response .
High rates of alcohol-related violence in countries like Australia are also associated with our attitude to drinking, in particular the accepted culture of binge drinking and pre-loading before a night out. Alcohol advertising is extremely prevalent in Australia, and has become an entrenched part of the way we participate in notable events, whether it be sport, public holidays, or even to celebrate finishing school . Even more alarmingly, despite the fact that pre-drinking before going out is commonplace in a number of other cultures - particularly Europe where nightlife venues tend to open later - they do not see the same levels of alcohol-related violence. Heavy drinking, while part of Australian culture for decades, has been enhanced by extended trading hours in outlets selling cheaper alcohol . Yet alcohol is often cheaper in other countries, so this doesn’t entirely explain why we drink more.
So how can we take steps to reforming our national attitude to alcohol?
Addressing and changing the Australian cultural mentality about alcohol is a significant step towards reducing rates of drinking and related violence, both in public and within families. Some ways in which this is possible is through better regulation and limitation on how alcohol is promoted to certain groups, particularly young people .
Reduced promotion and advertising can exist alongside awareness campaigns highlighting the health and social problems associated with excessive alcohol consumption . This could also be used to address steroid misuse, particularly as such misuse appears to stem from the growth in steroid use marketed for aesthetic purposes - particularly towards young men - and the increased availability of new performance-enhancing drugs .
There is growing awareness that tackling harmful use of methamphetamine and related violence is not something governments can “police their way out of” , as vulnerable users and dealers at the lower end of the scale often end up targeted as a result. Awareness campaigns, usually broadcast as television and online advertising, often use a fear-based approach, which has been shown to do little else besides further stigmatise people who use ice and potentially inhibit them from accessing treatment . Misinformation is also a problem - governments and the media often claim Australia is facing an “ice epidemic”, when in reality ice is just one form of methamphetamine and recent research suggests the proportion of Australians using any of the three types has remained relatively stable in the past 10 years . As previously mentioned, the recent rise in violence associated with methamphetamine use is likely due to increased purity.
International evidence suggests a number of harm reduction efforts can be effective in tackling the risks of methamphetamine use . The Medically Supervised Injecting Centre in Sydney is an effective health service, and also acts as a buffer against violence by providing a safe, supervised place for people who inject drugs. There have been calls for more safe-injecting facilities around Australia, including an “ice smoking room”, which has been shown to reduce methamphetamine-related violence and death in other countries . However, this proposal, along with better regulation of illicit drugs through policies such as decriminalisation, are seen as politically unpopular . Decriminalising illicit drugs has had a positive impact in jurisdictions such as Portugal, which decriminalised all illicit drugs in 2001 and has seen rates of lifetime use, drug-related disease, and drug-related harm diminish. Improved regulation of the methamphetamine market in Australia might mean authorities have better control over purity levels by making legally available prescriptions for cheaper, less potent forms of the drug, similar to the Canadian government’s strategy for those dependent on heroin . In Canada’s case, the move is anticipated to create more opportunities for specialist clinics practicing heroin-assisted treatment, and there is no reason to expect Australia cannot develop similar strategies for ice. Considering heroin and methamphetamine are associated with high rates of acquisitive crime, and that this is largely due to the financial situation many dependent users find themselves in, regulating the drug market could lead to the elimination of the illegal black market , and in its place a government-controlled system where these drugs are cheaper and more accessible, similar to how legal, everyday medicines are regulated now. The intended consequence of that is the reduction of violent types of property crime, such as armed robbery.
In 2015, the federal government pledged $9 million for a media campaign to raise awareness about ice-related harm . We have seen the results of this funding everywhere, particularly in the slick advertising campaign on television, online, and consolidated with blunt messaging on this website: . The government has a website for alcohol-related harm awareness , but without a similar wide-reaching advertising campaign.
A number of experts [59 ALSO 60 AND 61] have cautioned against taking the focus away from alcohol-related violence, which remains a much bigger problem despite the community and media panic around ice. According to the most recent NDSHS (2016), harmful alcohol and methamphetamine use had both declined slightly, although binge drinking remains much more common than harmful methamphetamine use, with 17.1% of the surveyed population drinking to risky levels compared to 1.4% using methamphetamine . This is despite $103.5 million worth of federal funding for a National Binge Drinking Strategy between 2008 and 2012 . Meanwhile, alcohol advertising is as prevalent as ever .
The argument for treating methamphetamine dependence so much more seriously is that the resulting ice-induced psychosis is characterised by violent episodes which can put the dependent person and those around them in danger. However, statistics show that harmful alcohol use can also lead to violence .
The media certainly plays a role in the differing perceptions. The reporting of a particularly violent incident involving methamphetamine, such as a murder, or the increased instances of violence involving methamphetamine in regional areas, is often used to support the assertion that methamphetamine use is increasing . However, media reports often fail to acknowledge the fact that rates of methamphetamine use have remained largely unchanged for nearly two decades, and what has actually changed is the increased preference among users for crystal methamphetamine, or ice, as well as an increase in purity .
Increased prescribing of pain-killing opioids has led to problems such as chronic dependence , which compels users to obtain prescriptions at any cost. This can involve GPs being threatened with violence. Decreasing rates of opioid dependence, and therefore related violent behaviour, is achieved by reducing the number of new dependents and increasing the referral rates of current dependents into treatment . Changing the accepted perception amongst medical professionals that certain kinds of prescription drugs are effective in treating non cancer-related pain may reduce the rate at which they are prescribed, leading to decreased rates of new prescription drug-dependent users. Greater regulation of prescribing practices in Australia has included the establishment of an electronic prescription drug monitoring program, which centralises all information related to drug-type, amount, patient and doctor. This allows doctors to access patient history before providing new prescriptions . Strategies to reduce “doctor shopping” are only part of the solution to reduce prescription drug dependence. There is evidence that psychological therapies have had a positive impact in responding to chronic pain, anxiety and insomnia , ailments which are usually seen as easily treatable with prescription drugs. Such therapies should be given greater consideration in addressing pain and its symptoms, as part of a holistic approach to treating pain that doesn’t monopolise prescription drugs.
Based on the findings, indications point to a tangible link between harmful drug use and violent crime. However, a number of factors and variables influence the risk.
Better regulation of all substances, both licit and illicit, can help reduce rates of violence. This is particularly relevant for alcohol and methamphetamine. A shift away from punitive and fear-based strategies can reduce the stigma around methamphetamine use and violence. As part of a harm reduction approach, regulating amphetamine production and distribution could involve providing cheaper, less potent forms of the drug, similar to prescription heroin trials. Some measures - such as establishing more safe injecting and smoking facilities for methamphetamine-dependent users - are currently politically controversial in Australia, however international evidence suggests this can reduce harm associated with methamphetamine use, including violence, and divert more people into treatment.
For legal substances such as alcohol and prescription drugs, efforts are needed to overhaul broader societal attitudes towards both substances. Addressing cultural attitudes towards alcohol should include greater efforts to highlight alcohol-related harms - much in the same vein as the National Ice Taskforce - whilst better regulating the way it is promoted, particularly to young people. More research is required in Australia to establish patterns of harmful prescription drug use, however measures such as electronic prescription monitoring are being implemented to better regulate prescribing methods, reduce doctor shopping, and therefore reduce violence towards doctors.