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DRUG
Drug Use in Australian Society

Written by leading experts, Drug Use in Australian Society, Second Edition,
brings together all the relevant concepts, theories and practices pertinent to
understanding alcohol and other drug use in Australian society. It introduces the
history of drug use in Australian society and outlines theoretical perspectives. It
also explores the rates of drug use and harms, drug use as framed in the media
and popular culture, drugs and the internet, and public policy responses to drug
use, including prevention, treatment, legal issues, regulation and policing.
IN
New to this edition
• New Chapter 5, Images of Drugs in Popular Culture
• New Chapter 9, Drug Pharmacology and Pharmacotherapy Treatments
• New chapter on primary prevention (Chapter 7)
• New case study feature to help readers see the application of theory to
practice
• Expanded range of discussion questions, useful for classroom discussion
AUSTRALIAN SOCIETY
and helping readers develop their understanding of key issues
• Completely updated with current policy and references
Alison Ritter is the Director of the Drug Policy Modelling Program (DPMP) and
Deputy Director of the National Drug and Alcohol Research Centre (NDARC) at the
University of New South Wales.
Trevor King is the Director of Programs at UnitingCare ReGen Alcohol and Drug
Service.
Nicole Lee is an Adjunct Associate Professor at the National Drug Research
Institute, Curtin University and director at 360Edge, a specialist consultancy for
service and workforce development in the alcohol and other drug sector.
Second Edition
Second
Edition
Edited by
Ritter
King
Lee
ISBN 978-0-19-030645-8
Edited by
Alison Ritter
9 780190 306458 Trevor King
visit us at: oup.com.au or
contact customer service: cs.au@oup.com Nicole Lee
RIT_DUAS_06458_CVR_SI.indd 1 cyan magenta yellow black 11/07/2017 3:09 PM

vi Contents
Chapter 12: Drug Law Enforcement: Reducing the Supply of Drugs 247
Lorraine Mazerolle and Jenna Thompson
Chapter 13: Making Drugs Policy: Policy Models and Influences on Policy
Processes 266
Alison Ritter and Kari Lancaster
Glossary 292
Bibliography 313
Index 364
00_RIT_DUAS_06458_PRELIMS_SI.indd 6 19/06/2017 12:11 PM

vii
Expanded Contents
Figures, Tables and Boxes xi
Abbreviations xiii
About the Editors xvi
About the Contributors xvii
Chapter 1: Introduction 1
Alison Ritter, Trevor King and Nicole Lee
Introduction 2
Why do people use psychoactive drugs? 5
What are the harms associated with psychoactive drugs? 6
Terminology: labels matter 11
Responses to drugs 12
The ‘three pillars’ 13
Reconciling licit and illicit drug policies? 14
Book overview 16
Chapter 2: Historical Perspectives on Drug Use and Their

Possible Implications for the Future 20
Wayne Hall and Adrian Carter
Introduction 21
The globalisation of psychoactive drug use 22
The history of alcohol use in Australia 23
Alcohol policy in the late twentieth and early twenty-first century 25
Alcohol use among Aboriginal peoples 26
The history of other psychoactive drug use in Australia 28
A heroin epidemic in the 1990s 33
The history of the illicit use of stimulant drugs 35
Chapter 3: Epidemiology: Analysing Patterns of Drug Use and Harms 41

Paul Dietze, Mark Stoové and Anne-Marie Laslett
Introduction 42
Sources of data about alcohol and other drug use and harms 44
The prevalence of drug use in Australia 46
The epidemiology of drug-related harm 55
Other considerations 66

viii Expanded Contents
Chapter 4: Frameworks for Understanding Drug Use and

Societal Responses 69
Robin Room and Wayne Hall
Introduction 70
Dealing with problematic use: frameworks and governing images 71
Shifting attitudes towards alcohol, tobacco and other drugs 73
Governing images and action models: within frameworks, and across them 75
The rise of specialist AOD treatment systems 77
The disruptive potential of new ideas and trends 78
Looking beyond the frames: is there an optimal response and what might it be? 80
Chapter 5: Images of Drugs in Popular Culture 84

Amy Pennay and Sarah MacLean
Introduction 85
Images of drugs in the news media 86
Images of drugs in fictional film and television programs 91
Images of drugs in music 95
Images of drugs in social media 97
Chapter 6: Drugs and the Internet 102

Monica J. Barratt and Simon Lenton
Introduction 103
Overview of internet technologies 104
Theorising internet and drugs 106
Intersecting internet and drugs 107
How are drug practices shaped by internet technologies? 108
How are our responses to drug practices shaped by internet technologies? 109
Drug market innovations driven by internet technologies 110
Drug cryptomarkets 110
New psychoactive substances 112
Policy responses 114
Chapter 7: Primary Prevention for Alcohol and Other Drug

Use among Australian Adolescents 124
Katrina Champion, Nicola Newton, Louise Birrell and Maree Teesson
Introduction 125
What is primary prevention? 125
Why is prevention important? 127

Expanded Contents ix
Risk and protective factors for alcohol and other drug use 130
When should prevention occur? 132
Where should prevention occur? 132
School-based prevention approaches 134
Non-school-based prevention 138
Future directions 140
Chapter 8: Harm Reduction: Reducing the Harms from Drug Use 144
Craig Rodgers and Ingrid van Beek
Introduction 145
Illicit drugs 148
Alcohol 159
Tobacco 162
Indicators of injecting drug use harm reduction uptake 166
Australian harm reduction –successes and failures 166
Harm reduction: the politics of drug policy and the ongoing criminalisation of drug use 168
Chapter 9: Drug Pharmacology and Pharmacotherapy Treatments 174

Suzanne Nielsen and Natasa Gisev
Introduction 175
Pharmacology of different drugs 177
Pharmacotherapy treatments 184
Chapter 10: Psychosocial Treatments for Drug Problems 200

Nicole Lee and Amanda Baker
Introduction 201
Setting the groundwork for psychological treatment 203
Treatment and intervention options 208
Intensive psychological treatments 214
Residential rehabilitation and therapeutic communities 218
Treatment of co-occurring mental health disorders 219
Addressing smoking in treatment 220
Addressing lifestyle behaviours in treatment 220
Chapter 11: Drug Laws and Regulations 223

David McDonald and Caitlin Hughes
Introduction 224
Australia’s current approach 227
The international context 230

x Expanded Contents
Implementing drug laws 231

Understanding statistics on drug law enforcement 232
Criminal penalties and behaviour change: the importance of drug law enforcement 235
Alternate approaches and lessons 236
The drug law reform movement 237
Alternatives to total prohibition 241
Policy processes in developing and reviewing drug laws 243
Chapter 12: Drug Law Enforcement: Reducing the Supply of Drugs 247
Lorraine Mazerolle and Jenna Thompson
Introduction 248
Overview of different levels of drug law enforcement interventions 249
Current challenges for drug law enforcement 251
Transborder drug law enforcement 252
Mid-level or intra-border drug law enforcement 255
What is (and is not) effective drug law enforcement 257
Future challenges 262
Chapter 13: Making Drugs Policy: Policy Models and Influences

on Policy Processes 266
Alison Ritter and Kari Lancaster
Introduction 267
Policy as formal statements of intent 268
Governance of drug policy 275
Policy as action: evidence-based drug policy 276
Policy levers 279
Challenges for evidence-informed policy 280
Policy process theories and models: policy as dynamic, political, ambiguous 283
Measuring drug policy success 288
Glossary 292
Bibliography 313
Index 364

xi
Figures, Tables and Boxes
Figures
1.1 The relationship between harm and availability 15
3.1 Smoking prevalence rates for males and females, Australia 1945–2013 47
3.2 Per capita consumption of alcohol (litres absolute alcohol), Australia 1800–2012 48
3.3 Percentage of per c
apita consumption of alcohol (litres absolute alcohol)
by beverage type, Australia, 1960/61–2013/14 49
3.4 Opioid prescriptions of selected opioids in Australia, 1992–2012 55
3.5 Rate of deaths due to opioids per million persons aged 15–54, 1988–2011 58
3.6 Percentage of total closed treatment episodes for the four most frequently
presenting primary drug problems recorded in the Alcohol and Other
Drug Treatment Services National Minimum Data Set 61
3.7 Drug-related arrests (consumer and provider) in Australia, 2004/05–2013/14 62
4.1 Governing ideas about alcohol, tobacco and other drugs 75
4.2 Schema of frames of social handling of substance use problems 76
7.1 The mental health intervention spectrum 126
9.1 Comparison of full agonist, partial agonist and antagonist effects 187
12.1 Drug activity pyramid 250
12.2 Dimensions of policing strategies 256
Tables
1.1 Policy options and the three pillars of drug policy 13
3.1 Prevalence of alcohol consumption in Australia by risk level, age and gender, 2013 50
3.2 Prevalence of reported recent (past year) use of drugs, National Drug Strategy
Household Surveys 2001–13 52
3.3 Prevalence of selected drug use conditions in Australia, 2007 56
3.4 Hospitalisations by drug-related principal diagnosis and duration, 2013–14
(number and percentage) 59
7.1 Risk and protective factors 131
7.2 Types of prevention settings 133
7.3 Characteristics of comprehensive social-influence prevention programs 137
9.1 Some common signs and symptoms of acute opioid effects and opioid
withdrawal 178
9.2 Overview of pharmacological treatment options for opioid dependence 188
9.3 Overview of pharmacological treatment options for nicotine dependence 194

xii Figures, Tables and Boxes
11.1 Australian data on consumer and provider arrests, state/territory and gender,
year to 30 June 2014 233
11.2 Detected illicit drug offenders, Australia, 2014–15, by age group 234
13.1 Comparisons of international approaches to drug policy 270
13.2 Policy levers and examples 281
Boxes
Box 1.1 What do we mean by ‘drugs’? 3
Box 1.2 Reasons that people consume drugs 5
Theory to practice Fears of a cocaine epidemic 35
Theory to practice Different windows on alcohol-related child abuse and neglect 64
Box 4.1 Main governing images and frames of understanding problems
with drugs72
Box 5.1 Analysis of Australian news media and drugs 86
Theory to practice Australian media reports on methamphetamine research 90
Theory to practice Adulterants: the case of NBOMe drugs as adulterants to LSD or
MDMA113
Case study School-based drug education 137
Theory to practice Sydney’s Medically Supervised Injecting Centre 151
Box 9.1 Psychoactive drug classification 176
Box 9.2 Common synthetic cannabinoids 182
Box 9.3 Example DSM-5 opioid use disorder criteria 185
Case study Treating heroin dependence 190
Box 10.1 Example DSM-5 criteria for stimulant use disorder 202
Case study Case formulation: psychological treatment 204
Box 10.2 Examples of freely available alcohol and drug self-help and
treatment websites 210
Box 10.3 The twelve steps of Alcoholics Anonymous 217
Box 11.1 Drug law options 227
Theory to practice A music festival, ‘sniffer’ dogs and Ella 229
Box 11.2 Laws on new psychoactive substances 230
Box 11.3 Australian data on arrests 234
Box 11.4 The offence of self-administration of illegal drugs 240
Theory to practice Using computer simulation models to test drug law enforcement 261
Box 13.1 Prohibition, depenalisation, decriminalisation, legalisation 274
Box 13.2 Types of evidence for use in drug policy 278
Theory to practice The application of different policy process theories to the
medically supervised injecting centre, Sydney 284

xiii
Abbreviations
ABS Australian Bureau of Statistics
ACMA Australian Communications and Media Authority
ACT Acceptance and Commitment Therapy
ADCA Alcohol and Other Drugs Council of Australia
AFP Australian Federal Police
AHTCC Australian High Tech Crime Centre
AIVL Australian Injecting & Illicit Drug Users League
ALRC Australian Law Reform Commission
ANCD Australian National Council on Drugs
AOD Alcohol and Other Drugs
APSAD Australasian Professional Society on Alcohol and other Drugs
ASHM Australasian Society of HIV Medicine
BI Brief Intervention
CAPR Centre for Alcohol Policy Research
CATI Computer Assisted Telephone Interviewing
CBT Cognitive Behavioural Therapies
CEN Cannabis Expiation Notice scheme
CN Contingency Management
CNB Central Narcotics Bureau
CNS Central Nervous System
COAG Council of Australian Governments
CPTED Crime Prevention Through Environmental Design
CREMS Centre of Research Excellence in Mental Health and Substance Use
DALY Disability-Adjusted Life Year
DBT Dialectical Behaviour Therapy
DCR Drug Consumption Room
DEVS Drug Education in Victorian Schools
DFZ Drug-Free Zone
DPMP Drug Policy Modelling Program
EDRS Ecstasy and Related Drug Reporting System

xiv Abbreviations
FOHP Federal Office of Public Health
GABA Gamma-Aminobutyric Acid
GABA-A Gamma-Aminobutyric Acid-A
GBD Global Burden of Disease
GHB Gamma Hydroxybuterate
GLB Gay, Lesbian and Bisexual
GLBTIQ gay, lesbian, bisexual, transgender, intersex and queer
HAT Heroin-Assisted Treatment
HCV Hepatitis C Virus
HIV Human Immunodeficiency Virus
IGCD Intergovernmental Committee on Drugs
IDRS Illicit Drug Reporting System
IGSAHO International Group for the Study of Alcohol’s Harm to Others
ISP Internet Service Provider
KRC Kirketon Road Centre
LSD Lysergic Acid Diethylamide
MBCT Mindfulness-Based Cognitive Therapy
MBRP Mindfulness-Based Relapse Prevention
MCDS Ministerial Council on Drug Strategy
MDMA 3,4-methylenedioxymethamphetamine, Ecstasy
MET Motivational Enhancement Therapy
MI Motivational Interviewing
MSIC Medically Supervised Injecting Centre
NAS Neonatal Abstinence Syndrome
NBOMe N-methoxybenzyl
NCADA National Campaign Against Drug Abuse
NCD Noncommunicable Disease
NCEPH National Centre for Epidemiology and Population Health
NCP National Cannabis Policy
NDARC National Drug and Alcohol Research Centre
NDS National Drug Strategy

Abbreviations xv
NDSHS National Drug Strategy Household Survey
NGO Non-Government Organisation
NHMRC National Health and Medical Research Council
NIAAA National Institute on Alcohol Abuse and Alcoholism
NIDA National Institute on Drug Abuse
NMDA N-methyl-d-aspartate
NPS New Psychoactive Substances
NRT Nicotine Replacement Therapy
NSP Needle and Syringe Program
OEND Overdose Education and Naloxone Distribution program
ONDCP Office of National Drug Control Policy
PWID People Who Inject Drugs
R&R Rest and Recreation
RBT Random Breath Testing
RP Relapse Prevention
RTD Ready To Drink
SAMHSA Substance Abuse and Mental Health Services Administration
SHAHRP School Health And Alcohol Harm Reduction Project
SIF Supervised Injecting Facility
TC Therapeutic Community
TGA Therapeutic Goods Administration
THC Δ-9-tetrahydrocannabinol
TSF Twelve-
Step Facilitation
UN United Nations
UNAIDS Joint United Nations Programme on HIV/AIDS
UNGASS United Nations General Assembly Special Session
UNODC United Nations Office on Drugs and Crime
UNSCAP United Nations Economic and Social Commission for Asia and the Pacific
WHO World Health Organization

xvi
About the Editors
Professor Alison Ritter is a leading drug policy researcher and Director of the Drug Policy
Modelling Program (DPMP) at the National Drug and Alcohol Research Centre (NDARC) at the
University of New South Wales. She is a National Health and Medical Research Council Senior
Research Fellow (from 2012 to 2017) leading a collaborative, multi-disciplinary program of
research on drug policy. Professor Ritter worked as a clinical psychologist in the alcohol and
drug treatment sector prior to commencing full-time research. She was the Deputy Director of
Turning Point Alcohol and Drug Centre from 1995 to 2005. She is the Immediate Past President
of the International Society for the Study of Drug Policy, Vice-President of the Alcohol and Drug
Council of Australia and an editor for a number of journals. Professor Ritter has an extensive
research grant track record. She has published widely in the field including two edited books,
multiple book chapters and more than 150 other publications.
Trevor King is Director of Programs at Uniting: ReGen Alcohol and Drug Service in Melbourne.
He has worked in the drug and alcohol sector for over 35 years. Over this time he has held
senior positions in the government and non- government sectors including manager of
methadone and needle and syringe programs for the Victorian Department of Human Services
in the late 1980s; Director of Community Programs –Drug Services Victoria in the early 1990s;
Head of Education and Training Services at Turning Point Alcohol and Drug Centre from 1995
to 2005 and Deputy Director from 2006 to 2009; and Deputy Director of the Drug Policy
Modelling Program from 2009 to 2013. At this time he also had a research translation role at
the Burnet Institute –Centre for Research Excellence into Injecting Drug Use. His roles have
included co-author of the most recent national alcohol strategy; membership of the Capital City
Lord Mayor’s Drug Advisory Committee; and Australian representative on the United Nations
Office of Drugs and Crime: Global Network of Drug Treatment Centre’s (TreatNet).
Professor Nicole Lee is Adjunct Professor at the National Drug Research Institute, Curtin
University and Director at 360Edge, a specialist consultancy for service and workforce
development in the alcohol and other drug sector. She is a consultant psychologist with
25 years’ experience in research and evaluation, training and workforce development, clinical
practice and service management. Nicole was previously Head of Research at Turning Point
Alcohol and Drug Centre. She is the Immediate Past National President of the Australian
Association for Cognitive and Behaviour Therapy and Deputy Editor at the Drug and Alcohol
Review Journal. She has previously served on the boards of the Alcohol and Other Drugs
Council of Australia (ADCA) and Australasian Professional Society on Alcohol and other Drugs
(APSAD). She has consulted to the World Health Organization and the United Nations Office on
Drugs and Crime as well as international, Australian and state governments. Nicole has written
more than 100 journal articles, books, book chapters and clinical practice guides.

xvii
About the Contributors
Professor Amanda Baker is a National Health and Medical Research Council Senior Research
Fellow in the School of Medicine and Public Health at the University of Newcastle, New South
Wales. She is the President of the Australian Association of Cognitive Behaviour Therapy (from
2016 to 2019) and also Co-Director of a Centre of Research Excellence in Mental Health and
Substance Use (from 2013 to 2017). Amanda has a major interest in multiple health behaviour
change, addressing mental health, smoking, substance use and diet and activity levels among
people with mental health and/or substance use disorders. She leads a program of clinical
research, trialling novel interventions that target coexisting mental health and substance use
problems. Amanda is also a senior clinical psychologist and has practised in mental health,
forensic and alcohol and other drug treatment settings in the United Kingdom and Australia.
Dr Monica J. Barratt is a National Health and Medical Research Council Postdoctoral Fellow
at the Drug Policy Modelling Program at the National Drug and Alcohol Research Centre at the
University of New South Wales. She trained in psychology, sociology and public health, and has
over 10 years’ experience conducting mixed-methods research into drug use practices and
policies in increasingly digitised societies. Monica leads a program of work investigating the
newest trends in drug markets: new or novel psychoactive substances, high-dose MDMA pills
and powders, and internet-facilitated drug supply, including darknet markets or cryptomarkets,
webstores and app-based drug trading. She previously worked in research at Turning Point
Alcohol and Drug Centre and the National Drug Research Institute, Curtin University, where she
currently holds an adjunct research position. She is also a Visiting Fellow at the Burnet Institute,
lead Australian researcher on the Global Drug Survey, Associate Editor at the International Journal
of Drug Policy, Assistant Editor at the Drug and Alcohol Review, and the Director of Research
at the international drug harm reduction community, Bluelight.org. Monica publishes regularly in
drugs and methods journals (over 60 peer-reviewed articles, letters and chapters) as well as to
the wider public (over 100 media appearances and five articles in The Conversation, an online
news source written by academics in collaboration with journalists).
Louise Birrell is a Research Officer at the National Drug and Alcohol Research Centre. She
works as part of the prevention team at the Centre of Research Excellence in Mental Health and
Substance Use, which seeks to improve treatment, prevention and epidemiology for comorbid
drug, alcohol and mental health conditions. Louise has worked on the first online preventative
trial to combine substance use education with depression and anxiety education for high
school students, as well as numerous other school-based prevention research trials. She has
also worked as a Lifeline crisis telephone counsellor at Lifeline Harbor to Hawkesbury and has
counselled many individuals facing mental health and other crises.
Dr Adrian Carter is Senior Research Fellow and Head, Neuroethics and Public Policy Group at the
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,
Monash University, and Director, Neuroethics Program, Australian Research Council Centre of
Excellence for Integrative Brain Function. His research examines the impact that neuroscience
has on our understanding and treatment of addiction and other compulsive behaviours. Adrian
is currently funded by a National Health and Medical Research Council Career Development
Fellowship (2017–21). He received the Australasian Professional Society of Alcohol and Other

xviii About the Contributors
Drugs ‘Early Career Award for Excellence in Research and Science’ (2012) and the Australian
National Drug and Alcohol Award for Excellence in Research (2010). He has over 120 publications,
including the book Addiction Neuroethics: The Promises and Perils of Addiction Neuroscience’
(Cambridge University Press, 2012). Adrian has been an adviser to the World Health Organization,
the European Monitoring Centre for Drugs and Drug Addiction, the Australian Ministerial Council
on Drugs Strategy and United Nations Office on Drugs and Crime. He is also Deputy Chair of the
Australian Academy of Science Early and Mid Career Research Forum Executive.
Dr Katrina Champion is a National Health and Medical Research Council Early Career Research
Fellow at the Centre of Research Excellence in Mental Health and Substance use at the
National Drug and Alcohol Research Centre. Katrina’s research focuses on the development,
evaluation and dissemination of online resources to improve the health and wellbeing of
Australians. Her PhD (University of New South Wales, 2016) resulted in the development and
evaluation of the first online prevention program for ecstasy and new psychoactive substances.
Katrina has also worked on a large trial of a combined universal and selective substance
use prevention program (CAP Study) since 2011, and is Project Manager of an Australian
Government Department of Health study to develop an online community toolkit about crystal
methamphetamine. Dr Champion has published in leading addiction and prevention journals,
and is an Early Career Reviewer for Prevention Science.
Professor Paul Dietze is an epidemiologist working in the field of alcohol and other drugs. He has
established new surveillance systems as well as conducted specific research projects that break
new ground in the epidemiology of heroin overdose in particular. Paul has been involved in the
development and implementation of a variety of heroin overdose prevention initiatives, including
take-home naloxone programs in Australia and was a member of the World Health Organization
(WHO) Guidelines Development Group for the Guidelines on the Management of Opioid Overdose.
He is currently Executive Editor of Drug and Alcohol Review, one of the leading scientific journals
in the alcohol and other drugs field. Paul is a past Australian Research Council Future Fellow and
a current National Health and Medical Research Council Senior Research Fellow.
Dr Natasa Gisev is a pharmacist and a National Health and Medical Research Council Early
Career Research Fellow based at the National Drug and Alcohol Research Centre, University of
New South Wales. Over the last 10 years she has worked across a number of different settings
including community pharmacy, hospital pharmacy and academia (both teaching and research).
Her main area of research expertise and interest is in pharmacoepidemiology and the use of
linked administrative data sets to examine the patterns and outcomes associated with medicines
use in complex populations, including older adults, people with mental health disorders and
people with substance use disorders. Natasa recently completed work on a large data linkage
study which examined the impact of opioid substitution therapy on crime and mortality, with a
particular focus on the outcomes of prisoners. She is currently working on a number of projects
examining the pharmacoepidemiology of opioid medicines to identify the potential burden, risks
and harms associated with the use of these medicines in the Australian population.
Professor Wayne Hall is the Director of the Centre for Youth Substance Abuse Research at
the University of Queensland and a Professor at the National Addiction Centre, King's College
London. He also has visiting professorial appointments at the London School of Hygiene and
Tropical Medicine and the National Drug and Alcohol Research Centre, University of New South

About the Contributors xix
Wales. Wayne was formerly a National Health and Medical Research Council Australia Fellow at
the University of Queensland Centre for Clinical Research and the University of Queensland Brain
Institute (from 2009 to 2014); Professor of Public Health Policy, School of Population Health,
University of Queensland (from 2005 to 2009); Director of the Office of Public Policy and Ethics at
the Institute for Molecular Bioscience (from 2001 to 2005), University of Queensland; and Director
of the National Drug and Alcohol Research Centre, University of New South Wales (from 1994 to
2001). He has advised the World Health Organization on the health effects of cannabis use; the
effectiveness of drug substitution treatment; the contribution of illicit drug use to the global burden
of disease; and the ethical implications of genetic and neuroscience research on addiction.
Dr Caitlin Hughes is a criminologist and Senior Research Fellow at the National Drug and
Alcohol Research Centre, University of New South Wales, Australia, where she works as part of
the Drug Policy Modelling Program. Her research focuses on evaluating and informing drug laws;
evaluating and informing criminal justice policies (including alternatives to arrest); monitoring
trends in drug trafficking and drug markets; and researching the policy processes by which drug
policy is informed and made. Caitlin has written over 40 peer-reviewed articles, book chapters
and reports. She has spent many years analysing the impacts of the Portuguese decriminalisation
of illicit drugs, as well as Australian drug laws and the complexities of Australia’s system of de
facto decriminalisation of illicit drug use and possession. Her research has also contributed to
direct policy change in Australia, including the redesign of drug trafficking thresholds limits and
the expansion of drug diversion programs.
Dr Kari Lancaster is a Research Associate at the Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Australia. Since joining the
Drug Policy Modelling Program in 2009, Kari has undertaken qualitative research investigating
policy processes, with a particular interest in examining ‘problematisation’ and how drug
policy problems and policy knowledge(s) are constituted. A selection of projects, past and
present, include investigating strategic advocacy processes in the establishment of overdose
prevention and management programs, analysis of the emergence of methamphetamine as
a policy issue in Australia, and examining the science–policy interface in drug policy. Kari has
collaborated with the Australian Injecting & Illicit Drug Users League to investigate how people
who use drugs perceive drug policy, and also the Australian National Council on Drugs to
explore young people’s ideas about responding to alcohol and other drug issues.
Dr Anne-Marie Laslett is a senior research fellow at the National Drug Research Institute, Curtin
University and a research fellow at the Centre for Alcohol Policy Research, La Trobe University.
She has worked in the area of alcohol and drug social epidemiology at Centre for Alcohol Policy
Research and Turning Point for the past 20 years and currently directs the Range and Magnitude
of Alcohol’s Harm to Others project. While this research has involved a wide range of health and
social health problems, the current emphasis of Anne-Marie’s research is on alcohol’s harm to
children for which she has a National Health and Medical Research Council fellowship. She is also
a co-investigator and technical adviser to the World Health Organization–Thai Health international
collaborative research project on the harm to others from drinking, and is the coordinator of the
International Group for the Study of Alcohol’s Harm to Others.
Professor Simon Lenton is the Director at the National Drug Research Institute at Curtin University,
where he has worked since 1993. In addition, he works part time as a clinical psychologist in

xx About the Contributors
private practice. His research interests include bridging the gap between drug policy research
and drug policy practice, illicit drug use and harm reduction, the impact of legislative options
for drugs, and the wider availability of naloxone to prevent opioid overdose deaths. Simon has
published widely on drugs, health and the law and provided advice to a range of government
and private organisations, both in Australia and internationally, on evidence-based drug policy
and other drug issues.
Dr Sarah MacLean is Senior Lecturer in the Department of Community and Clinical Allied Health
at La Trobe University and is an affiliate of the Centre for Alcohol Policy Research. Much of Sarah’s
research has explored people’s experiences of alcohol and other drug use. Her PhD was a study
of the social meanings of inhalant use for marginalised young people. Sarah was awarded an
Australian Research Council postdoctoral fellowship to investigate cultures that frame alcohol
use among young adults in inner and outer urban areas of Melbourne (from 2010 to 2014). Her
current research entails trialling a family empowerment intervention to address substance use
within an Aboriginal community.
Professor Lorraine Mazerolle is an Australian Research Council Laureate Fellow (2010–

15), a Professor in the School of Social Science at the University of Queensland, and a Chief
Investigator with the Australian Research Council Centre of Excellence for Children and Families
over the Life Course. Her research interests are in experimental criminology, policing, drug law
enforcement, regulatory crime control, and crime prevention. She is the Editor-in-Chief of the
Journal of Experimental Criminology, past Chair of the American Society of Criminology Division
of Experimental Criminology (2014–15), an elected Fellow and past President of the Academy of
Experimental Criminology (AEC), and an elected fellow of the Academy of the Social Sciences,
Australia. Lorraine is the winner of the 2016 American Society of Criminology Division of Policing
Distinguished Scholar Award, the 2013 AEC Joan McCord Award, and the 2010 American Society
of Criminology Division of International Criminology Freda Adler Distinguished Scholar Award.
David McDonald is the Director of Social Research & Evaluation Pty Ltd. David is a social
scientist with research interests in public health and criminology, particularly alcohol and other
drugs policy and better understanding the research–policy nexus. As well as being a Consultant
in Social Research and Evaluation, he is a Visiting Fellow at the Australian National University’s
National Centre for Epidemiology and Population Health, and a collaborator with the Drug
Policy Modelling Program research team. David’s academic qualifications are BA, DipSocWork
(Sydney), MA (Alberta), Grad Dip Population Health (Australian National University). He has wide
experience in research, policy and program development and evaluations in the alcohol and
other drugs, criminal justice and related fields. In 2011, he was inducted into the National Drug
and Alcohol Honour Roll.
Associate Professor Nicola Newton is a senior researcher at the National Drug and Alcohol
Research Centre, University of New South Wales and Director of Prevention Research at the
National Health and Medical Research Council Centre of Research Excellence in Mental Health
and Substance Use. Prior to this, she held a competitive University of New South Wales Vice-
Chancellor’s Research Fellowship, providing her the opportunity to spend two years at the Institute
of Psychiatry, King’s College London (from 2010 to 2011). She leads a large program of research
developing, evaluating and translating online and innovative approaches to prevent substance
use and mental health problems. Nicola has received national and international recognition for

About the Contributors xxi
her research, most recently the 2014 Australian Institute of Policy and Science Young Tall Poppy
Award for outstanding scientific research. She has published in leading international journals
including Journal of Child Psychology and Psychiatry, Preventive Medicine and Addiction and a
recent article the prestigious journal JAMA Psychiatry.
Dr Suzanne Nielsen is a Senior Research Fellow at the National Drug and Alcohol Research
Centre. In addition she works as a part-time pharmacist in a specialist drug and alcohol service,
with over 15 years’ clinical experience in community pharmacy and specialist drug treatment
settings. Her research work has examined different aspects of opioid substitution treatment and
stimulant treatment, and her current research has focused on understanding and responding to
dependence to pharmaceutical drugs, including prescribed and over-the-counter opioids, and
benzodiazepines. Suzanne also conducts research examining opioid use in chronic pain treatment,
and in understanding best practice for the treatment of concurrent pain and opioid dependence.
Dr Amy Pennay is a National Health and Medical Research Council Early Career Fellow in the
Centre for Alcohol Policy Research at La Trobe University. Amy completed an ethnographic PhD
in 2012, which explored the social, cultural, economic and environmental influences of alcohol
and party drug use among a group of young adults. She has worked in alcohol and drug research
for more than 10 years, using a diverse range of methodologies, but has a particular interest
in qualitative research. Amy’s research has primarily focused on risky drinking, drug use and
energy-drink use in the night-time economy, but she also has an interest in cultures of drinking
and stigma, relating to socio-economic status, ethnicity and sexual orientation.
Dr Craig Rodgers has been working as Staff Specialist in Addiction Medicine at St Vincent’s
Hospital, Darlinghurst, since 2012. He initially completed General Practice training in 2000 and
was then accepted as a Foundation Fellow in the Royal Australasian College of Physicians,
Chapter of Addiction Medicine in 2005. Prior to commencing work at St Vincent’s Hospital,
he enjoyed 10 years as the Medical Unit Manager of the Kirketon Road Centre in Kings Cross,
which provides HIV prevention, treatment and care to ‘at risk’ young people, sex workers and
people who inject drugs as well as a methadone access program for more highly marginalised
drug users. He has also completed a master’s degree in Public Health at the University of New
South Wales in 2005 and is a Conjoint Lecturer with the University of New South Wales via the
St Vincent’s Clinical School. In addition to his work in addiction medicine he continues to work in
general practice and is also a Clinical Advisor for the Australasian Society of HIV Medicine, where
he contributes regularly to their training programs as well as to the further education of general
practice and addiction medicine registrars.
Professor Robin Room was a researcher at the National Alcohol Research Centre (Berkeley,
California) from 1963 to 1991, and the Scientific Director from 1977 to 1991. He was Vice-
President for Research at the Addiction Research Foundation of Ontario, Canada, from 1991 to
1998. In 1999 Professor Room was appointed Professor and Founding Director of the Centre
for Social Research on Alcohol and Drugs at Stockholm University, and retains an adjunct
appointment there. In March 2006, he returned to Australia as a professor at the University
of Melbourne, heading the Centre for Alcohol Policy Research, then at Turning Point Alcohol
and Drug Centre. In 2015, along with the centre, he moved to his current positions at La Trobe
University. He is a long-time adviser for the World Health Organization, and is Editor-in-Chief of
Drug and Alcohol Review. Robin’s research is on social, cultural and epidemiological studies of

xxii About the Contributors
alcohol, drugs and gambling behaviour and problems, and studies of social responses to alcohol
and drug problems and of the effects of policy changes. He has received awards for scientific
contributions in the United States, Sweden and Australia, and the premier international award in
alcohol studies, the Jellinek Memorial Award for Alcohol Studies.
Associate Professor Mark Stoové is head of Public Health at the Burnet Institute in Melbourne,
Australia, and has researched the transmission and impact of sexually transmitted infections
and blood-borne viruses among key risk populations, primarily people who inject drugs and
men who have sex with men, for over 15 years. His research interests focus on undertaking
innovative epidemiological and public health research and disease surveillance, with particular
interests in prospective observational studies and the application of record linkage and bio-
behavioural data collection to these study designs. He currently leads a large National Health
and Medical Research Council-funded prospective cohort study following people with a history
of injecting drug use following their release from prison, and is a chief investigator on Australia's
largest prospective study of community recruited people who inject drugs. Mark has published
over 100 peer-reviewed journal articles and assumes editorial and review responsibilities across
several international journals.
Professor Maree Teesson is the Director of the National Health and Medical Research Council
Centre of Research Excellence in Mental Health and Substance Use, a National Health and
Medical Research Council Principal Research Fellow at the National Drug and Alcohol Research
Centre, Australian Academy of Health and Medical Sciences Fellow, a Fellow of the Academy of
Social Sciences in Australia, and Professorial Fellow at the Black Dog Institute, University of New
South Wales. Maree was awarded the Australian Museum Eureka Prize for Outstanding Mentor of
Young Researchers. In 2014, she was named one of the Australian Financial Review/Westpac’s
100 Women of Influence in the category of innovation. She has made a major contribution to
Australia’s health and medical research effort in the field of mental health and substance use. In
particular, she is known nationally and internationally for her research on the comorbidity between
mental health and substance use disorders.
Dr Jenna Thompson is a Technical Analyst within the Department of Defence located in Canberra,
Australia. She completed her Bachelor of Science in the field of mathematics at the University
of Queensland in 2010. In June 2011, Jenna graduated with first-class honours in mathematics
from the University of Queensland with her thesis on Authentication Schemes (Cryptography).
In 2016, she completed her PhD thesis on graph algorithms and motif identification in complex
networks.
Dr Ingrid van Beek, AM MBBS MBA FAFPHM FAChAM MD, is a public health and addiction
medicine physician who has worked at the sharp end of harm reduction for the past 30 years.
Ingrid has been the Director of the Kirketon Road Centre (KRC) since 1989. Located in Sydney's
Kings Cross, KRC is among the world's most comprehensive primary health care services
targeting the needs 'at risk' young people, people who inject drugs and sex workers. Ingrid was
also the founding Medical Director of the Sydney Medically Supervised Injecting Centre from
2000 until 2008, which was the first and still only service of this kind in Australia. Ingrid became a
member of the Order of Australia (AM) in recognition of her contribution to public health in 2010.
She also became a doctor in medicine (MD) that same year in recognition of her significant body
of published work in the international field of Harm Reduction.

Chapter
1
Introduction
Alison Ritter, Trevor King and Nicole Lee
Overview
1 This chapter provides an introduction to drug use in Australian society.
2 Drugs are psychoactive substances and include alcohol, tobacco, heroin, cocaine, cannabis,
methamphetamine, LSD and ecstasy (MDMA) to name a few.
3 We are reminded that drug use has occurred over millennia and there are many reasons that people
consume drugs. These include for pleasure, to manage aspects of living, to manage emotions, to
reduce pain, to increase a sense of belonging, to expand consciousness, and/or to counteract the
effects of another drug.
4 While most drug use is not harmful, there are harms associated with more intensive drug use.
These include health, social and economic consequences. Harm can also vary for different parts of
Australian society, and we summarise issues for specific sub-populations, such as young people,
Indigenous populations, women, elderly people, those from culturally and linguistically diverse
backgrounds, and others.
5 Terminology matters, and many terms used to describe drug use and the people who use drugs
can be stigmatising. Terms such as ‘addict’, ‘alcoholic’ and ‘injecting drug user’ are not benign and
can result in discrimination, stigma and prejudice.
01_RIT_DUAS_06458_TXT_SI.indd 1 19/06/2017 12:23 PM

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genital plates is also pierced by the madreporic pores. Some
zoologists have separated the ocular and the genital plates under
the name of "calyx" from the rest of the corona, under a mistaken
idea that they are homologous with the plates of the body or calyx of
a Crinoid.
Fig. 229.—The peristome of Echinus esculentus. × 2. 1, Tube-feet of the lower

ends of the radii; 2, gill; 3, teeth; 4, buccal tube-foot; 5, smooth peristomial
membrane. (After Kükenthal.)
The periproct (Fig. 228, 4) is covered with small plates and bears a
few pedicellariae. The peristome (Fig. 229) is covered by flexible
skin with abundant pedicellariae; it terminates in a thick lip
surrounding the mouth, from which the tips of five white teeth are just
seen projecting. There are ten short tube-feet projecting from the
peristome—one pair in each radius—and each tube-foot terminates
in an oval disc and is capable of little extension, and each has
around its base a little plate. The presence of these tube-feet shows
that in Echinus the peristome extends outwards beyond the water-
vascular ring, whereas in Asteroidea it is contained entirely within the
ring. In the primitive Cidaridae (Fig. 235) the whole peristome down
to the lip surrounding the mouth is covered with a series of
ambulacral and interambulacral plates similar to those forming the
corona, though smaller and not immovably united, and the series of
tube-feet is continued on to it. It is thus evident that the peristome is
merely part of the corona, which has become movable so as to
permit of the extension of the teeth. In Echinus the peristome is
continued in each interradius into two branched outgrowths called
gills, the relation of which to the respiratory function will be described
later. These gills (Fig. 229, 2) are situated in indentations of the edge
of the corona called "gill-clefts" (Fig. 230, g).
Fig. 230.—The dried peristome of Echinus esculentus and the surrounding

portions of the corona. × 1. amb, Ambulacral plate; b.t, buccal tube-foot; g,
gill-cleft; inter, interambulacrum; per, peristome.
The most conspicuous plates in the peristome are those surrounding

the buccal tube-feet; besides these, however, there are in Echinus
esculentus, and probably in most species, a large number of thinner
irregularly-scattered plates (Fig. 230).
The term ambulacral plate, applied to the plate pierced by the pores
for the tube-feet, conveys a misleading comparison with the
ambulacral plate of an Asteroid. In Echinoids the ambulacral groove
has become converted into a canal called the "epineural canal," and
the ambulacral plates form the floor, not the roof, of this canal; they
may perhaps correspond with the adambulacral plates of the
Starfish, which one may imagine to have become continually
approximated as the groove became narrower until they met.
Fig. 231.—Dissection of Echinus esculentus. × 1. The animal has been opened
by a circumferential cut separating a small piece of the skeleton at the
aboral end, which is turned outwards exposing the viscera on its inner
surface. The other viscera are seen through the hole thus made. amp,
Ampullae of the tube-feet; aur, auricle; b.v, so-called "dorsal blood-vessel";
comp, "compasses" of Aristotle's lantern, often termed "radii" by English
authors; comp.elv, elevator muscles of the compasses; comp.ret, retractor
muscles of the compasses; eph, epiphyses of the jaws in Aristotle's lantern;
gon, gonad; g.rach, genital rachis; int, intestine; oe, oesophagus; prot,
protractor of Aristotle's lantern; rect, rectum; ret, retractor of Aristotle's
lantern; siph, siphon; st, stomach; stone.c, stone-canal.
The internal organs of the Urchin can best be examined by making a

horizontal incision about one-third the distance from the mouth and
pulling the two parts gently asunder. A large amount of fluid escapes
from the exceedingly spacious coelomic cavity, the alimentary canal
being comparatively narrow.
The alimentary canal commences with a short vertical tube which

has been shown to be a stomodaeum; this is surrounded by the
upper ends of the teeth and their supporting ossicles, which are
collectively termed "Aristotle's lantern." The oesophagus leads into a
baggy, flattened tube, the stomach, which runs horizontally round the
animal, supported by strings of tissue from the coelomic wall, so that
it hangs down in a series of festoons. Having encircled the animal, it
bends directly back on itself and immediately opens into the
intestine, which is also a flattened tube, which runs round the
circumference of the animal, but in the opposite direction, the
festoons of the second circle alternating with those of the first. The
intestine opens into a short rectum which ascends vertically to open
by the anus. The stomach is accompanied by a small cylindrical tube
called the "siphon" (Fig. 231, siph), which opens into it at both ends;
this represents merely a gutter which has been completely grooved
off from the main intestine; it is lined by cilia, and its function is
believed to be that of keeping a stream of fresh water flowing
through the gut, so as to subserve respiration.
Echinus esculentus seems to feed chiefly on the brown fronds of

Laminaria and the small animals found thereon, which it chews up
with its teeth, but it may regale itself on the same diet as Brittle
Stars, as Allen[474] has shown to be the case in Plymouth Sound.
Dohrn[475] has described the Neapolitan Sphaerechinus granularis
attacking and capturing Crustacea such as Squilla.
The water-vascular system presents several features of great

interest. The ring-canal is situated at a considerable distance above
the nerve-ring, and is separated from it by the whole of the jaws and
teeth. It has five small interradial pouches on it, which apparently
correspond to Tiedemann's bodies in an Asteroid. The stone-canal
(Fig. 231) opens as usual into the ring-canal, and is accompanied by
the axial sinus and genital stolon. The name "stone-canal" is very
unsuitable in this order, for there are no calcifications in its walls; it is
a simple membranous tube of circular section. On reaching the
upper wall of the test it expands into an ampulla, into which the
numerous ciliated pore-canals traversing the madreporite open. The
radial canals, starting from the ring-canal, pursue a downward
course till they come into contact with the radial nerve-cords, and
they then bend upwards and run along the centre of the ambulacral
region, finally terminating in the small terminal tentacles. In the just
metamorphosed Echinoid these are well-developed tube-feet, each
with a well-developed sucker, in the centre of which is a conical
sensory prominence, but as development proceeds they become
enclosed in a circular outgrowth of the test, so that only the tip
projects in the adult.
The long extensible tube-feet are connected by transverse canals

with the radial canal. Instead of the pair of valves which in Asteroids
prevent the reflux of liquid into the canal, there is a perforated
diaphragm[476] with circular muscles, which by contraction close the
opening in the diaphragm, while when they are relaxed fluid can
return from the tube-foot. The ampulla is flattened, and is contracted
by muscular fibres called "trabeculae" stretching across its cavity.
These muscular strands are developed by the cells lining the
ampulla. The external portion of the tube-foot, as in Asteroids, is
provided with powerful longitudinal muscles, and there is the same
alternate filling and emptying of the ampulla as the tube-foot is
contracted and expanded. The tube-foot is connected by a double
canal with the ampulla, the object of which is to assist in respiration.
The cells lining it are ciliated, and produce a current up one side of
the tube-foot and down the other, and the double canal leading to the
ampulla separates these two currents and prevents them interfering
with one another. Thus water is continually transported from the
ampulla to the tube-foot, through the thin walls of which it absorbs
oxygen, and it is then carried back to the ampulla, and transfers its
oxygen to the fluid of the general body-cavity through the walls of the
ampulla. The disc of the tube-foot is supported by a calcareous plate
(Fig. 232, oss), a circumstance which enabled Johannes Müller to
recognise the Echinoid larva when the form of the adult was as yet
unrecognisable. Below the edge of the disc there is a well-marked
nerve-ring, from which two bundles of nerve-fibres go to the disc
itself, in the edge of which there is an abundance of sense-cells.
The buccal tube-feet (Fig. 229, 4) are much shorter than the rest,
and are provided with oval discs which are highly sensory. These
feet are not used for seizing, but for tasting food; when a piece of
food is placed near them they are thrown into the most violent
agitation.
Fig. 232.—Diagrammatic transverse section of the radius of an Echinoid.
amb.oss, Ambulacral ossicle; amp, ampulla of the tube-foot; ep, epineural
canal; musc, muscles attaching spine to its boss; nerv, nervous ring in base
of spine; n.r, radial nerve-cord; oss, ossicle in sucker of tube-foot; ped,
tridactyle pedicellaria; perih, radial perihaemal canal; pod, tube-foot; wv.r,
radial water-vascular canal.
The nervous system has the same form as in an Asteroid, viz. that
of a ring surrounding the mouth and giving off radial nerve-cords
(Fig. 232, n.r), one of which accompanies each water-vascular canal
to the terminal tentacle, where it forms a nervous cushion in which
pigmented cells are embedded.
A large band-like nerve is given off from the radial nerve-cord to

each tube-foot. This pedal nerve, as it is called, contains bipolar
neurons, and is really an extension of the nerve-cord itself. Beneath
the sucker it branches out to form a sensory ring. From the base of
the pedal nerve, branches are given off which run to the ectoderm
and enter into connexion with the plexus there. Romanes[477]
scraped away the radial cords and found that the spines still
converged when a point on the ectoderm was stimulated, but that,
on the other hand, if definite locomotor movements were to be
carried out, the presence of these cords was a necessity; hence he
concluded that the superficial plexus sufficed for ordinary reflexes,
but that for purposeful movements the central nervous system was
necessary.
Von Uexküll[478] has made an exhaustive study of the physiology of

the nervous system in the Echinoidea. He points out that all the
organs controlled by the nervous system, spines, pedicellariae, tube-
feet, and (see below) Aristotle's lantern, give two opposite reactions
in response to the same stimulus according as it is strong or weak,
bending away from the point of stimulation when it is strong and
towards it when it is weak. This reversal of reaction can only be due
to the action of the neuron in altering the effect of the stimulus on the
muscles, and this Uexküll regards as its fundamental property. Thus
in Preyer's[479] experiments with Starfish the strong form of
stimulation is obtained by directly applying the stimulus to the radial
cord or to the tube-feet, the weak form by stimulating the back, when
of course the stimulus has to traverse a longer path before affecting
the tube-feet, and is consequently weakened. Von Uexküll also
introduces the conception of "tone" with regard to the nervous
system. This term has been used to denote the amount of chronic
contraction in a muscle, and it is to be distinguished from the fleeting
contractions which cause movement. The more tone there is in a
muscle the less responsive it is to stimuli tending to bring about
movement. As applied to the nervous system "tone" denotes a
condition when it is not receptive to small stimuli, but when it is
maintaining a condition of tone in a muscle by which of course its
own tone is measured. Tone in a neuron can therefore be measured
by the produced tone in the muscle, and the one is to be
discriminated from the other only by using stimulants, such as
caffeine, which have no direct action on muscle. Tone can also be
measured by the amount of stimulus necessary to irritate the neuron.
When muscles are stretched the tone is lowered, and this loss of
tone extends to the neuron controlling the muscle, and vice versa.
When the spines on being gently stimulated bend towards the point
of stimulation, this is due to the contraction of the muscles on the
side towards the point of stimulus, for if the superficial plexus of
nerve-fibres be cut through so that the stimulus has to pursue a
round-about course the spine will bend towards the direction from
which the stimulus comes. The bending of the spines away from the
stronger stimulus is likewise due to the muscles on the side towards
the stimulus. It is caused by a sudden fall of tone in these muscles,
which causes them to yield to the tone of the muscles on the
opposite side, and this fall of tone is due to a fall of tone in the
neurons, for it can be produced by chemicals, and the direct action
of all chemicals applied to muscle is to raise tone.
In Arbacia this form of reaction cannot be produced; the spines

respond to stimuli of all degrees of intensity by convergence towards
the point of stimulation.
When a general skin-irritant like dilute acetic acid, or even strong

light, is applied to the skin of a Sea-urchin the spines bend
alternately to all points of the compass, or, in a word, rotate. This is
due to the fact that the weight of the inclined spine stretches the
muscles of one side and so renders them more open to the general
stimulus; these muscles in consequence, contract, and so move the
spine to a new position in which other muscles are stretched, and a
similar result follows. A continuation of this process brings about
rotation.
When a piece of glass rod or other light object is laid on the spines of
a Sea-urchin, it naturally, by its weight, presses asunder the spines
and stretches their muscles on one side, thus lowering the tone. If
now the skin be stimulated at any point the piece of rod will be rolled
by the spines towards the point of stimulation. This is caused by the
fact that the muscles of the spines holding the rod are made more
receptive by being stretched, and therefore they contract more than
do the others in response to the stimulation, and so the rod is rolled
onwards on to the next spines, which then act in the same manner.
This passage of stimulus is entirely independent of direct nervous
connexion between the bases of the spines, for it will traverse at
right angles a crack going clean through the shell; it is merely the
result of the mechanical weight of the object and of the juxtaposition
of the spines.
If the stimulation be too violent the first spines affected diverge wildly
and strike their neighbours with vehemence, so arousing into activity
the block musculature of these. This causes them to stand rigidly up,
and so the path of the stimulus is barred.
Now the escape movements of the animal under strong stimulation
which Romanes[480] alludes to are just an example of this handing
on of stimulation from spine to spine, not by nervous connexion but
by mechanical touch only; the object in this case is the substratum
on which the animal lies, which is, so to speak, rolled towards the
point of stimulation, or putting it otherwise, the animal is rolled away
from it. Righting when upset is another example of the same
phenomenon; the aboral spines are stretched by the weight of the
animal, and the animal acts as if it were stimulated in the region of
the periproct. When a Sea-urchin is in its normal position and is
stimulated in the periproct (as for instance by a strong light), it would,
according to this rule, tend to move downwards, which is of course
impossible; but as the stimulus never affects all sides quite alike the
result is that the Urchin rotates, turning itself ever away from the
point of strongest stimulation. In the case of Strongylocentrotus
lividus when living on limestone, as on the west coast of Ireland, this
results in the animal excavating for itself holes in the rock, where it is
safe from the action of the breakers.[481]
But it may be objected that no account is taken in the above

description of the action of the "central nervous system," i.e. of the
ring and the radial cords, and yet Romanes found that when they
were removed the escape movements could not be carried out. The
answer is that the central nervous system is a store-house of tone,
not, as in higher animals, a controlling centre for co-ordinating the
movements of the spines. When it is removed at first the escape
movements can be carried out, but in a day or two all tone in the
spine-muscles is lost, and then, since the tone of all is equally low,
there is no tendency in those that are stretched to be more
responsive than others, and hence the escape movements cannot
be carried out. Sea-urchins kept in the tanks of an aquarium are apt
to lose the tone of their spines owing to the poisoning of the nervous
system.
The central nervous system is, however, the system which controls
the movements of the tube-feet. As we have seen, extensions of the
radial nerves run to the tip of each podium. Tube-feet are chiefly
used in ordinary progression; when this is quickened the spines
come into play exclusively. The extent to which these two organs of
locomotion are used varies from genus to genus. Thus
Centrostephanus uses its spines a good deal, Echinus and
Strongylocentrotus very little. The last-named genus sometimes
walks on its tube-feet entirely without touching the ground with its
spines.
The faculty of vision in its simplest form may be defined as

sensitiveness to light and shade. Now strong light acts on all Sea-
urchins as a general skin irritant. They fly from it towards the darkest
corner, and then if it continues the spines rotate. A number of little
violet spines on the aboral pole of Centrostephanus longispinosus
are especially sensitive to light, and hence are almost constantly in
rotation. This is due, according to Uexküll,[482] to a pigment of a
purple colour, which can be extracted by means of alcohol and which
is decomposed by light, the products of decomposition being
supposed to irritate the nerves. Centrostephanus when exposed to
light becomes darker in colour. This is due to the migration outwards
of amoebocytes, which carry a pigment which acts as a screen in
order to prevent the valuable visual purple being too rapidly
decomposed. Not all Sea-urchins, in fact very few of those living in
northern waters, give a reaction to shadow. C. longispinosus is one
of the few; it reacts to a shadow by converging its spines towards it.
A much larger number of species inhabiting tropical waters show this
reaction. It is entirely stopped if the radial nerve-cords be removed,
whereas the reaction to strong light continues. The reaction to shade
is strongest after a long previous exposure to light, hence Uexküll
has given the following explanation of it. The continued irritation due
to light, having spread to all the spines, eventually reaches the radial
cords and is there stored in the bipolar nerve-cells as tone. When the
light-stimulus is interrupted some of the stored tone spreads
upwards to the spines, causing the weak form of spine reaction, and
the spines converge.
Fig. 233.—To show character and distribution of the sphaeridia in
Strongylocentrotus droëbachiensis. A, a portion of a radius, with sphaeridia,
and the adjoining edge of the peristome. p, Pair of pores for a tube-foot; per,
peristome; t, primary tubercle. B, an isolated sphaeridium. (After Lovén.)
It will be seen therefore that the so-called central nervous system of

Echinus does not act in any sense as a brain, as indeed might have
been guessed from the absence of any differentiation in it. As
Uexküll points out, when an animal is covered all over with similar
organs, such as spines and pedicellariae, capable of acting
automatically, a brain is not needed. The object of a brain is to direct
organs which are in a certain place to a danger which may come
from any quarter, but in the Sea-urchin any spine is as good as any
other spine, and such orientation is not needed. "In a dog the animal
moves its legs, in a Sea-urchin the legs move the animal." What the
Sea-urchin does need is a means to prevent its pedicellariae
attacking its own organs with which they may come into contact.
Thus it possesses an "autodermin," a chemical contained in the
ectoderm which paralyses the muscles of the pedicellariae, as may
be seen by offering to them a spine of the same animal. If, however,
the spine be treated with boiling water, and then offered, it is
viciously seized, showing that this substance can be dissolved out.
Just as in the case of the Starfish, when the nerve-ring is cut

through, the tube-feet in the various radii are no longer co-ordinated
with one another.
Besides the tips of the tube-feet the Urchin possesses another kind
of sense-organ, the sphaeridia (Fig. 233). These are minute glassy
spheres of calcareous matter attached by connective tissue to
equally minute bosses on the plates of the ambulacra, generally near
the middle line. They are in fact diminutive spines, and like the latter
are covered with a thick layer of ectoderm, beneath which is a
particularly well-developed cushion of nerve-fibrils. Only the layer of
muscles which connects a normal spine with its boss is wanting.
Although definite experimental proof is lacking, the whole structure of
the sphaeridia shows that they belong to the category of "balancing
organs." As the animal sways from side to side climbing over uneven
ground, the heavier head of the sphaeridia will incline more to one
side or to another, and thus exercise a strain on different parts of the
sheath, and in this way the animal learns its position with regard to
the vertical.
Intervening between the radial nerve-cord and the radial vessel is a

single radial perihaemal canal (Fig. 232, perih), representing the
two parallel canals found in the same position in the Asteroid. The
five perihaemal canals lead downwards to a space called the
lantern-coelom, surrounding the oesophagus.[483] Since the
skeleton of the corona is composed of plates immovably connected
together, muscles corresponding to the ambulacral muscles of the
Asteroids would be useless, and so the wall of the perihaemal canal
remains thin and the side of it turned towards the general coelom
develops no muscles, and that turned towards the nerve-cord no
nerve-cells. Where, however, the radial nerve enters the nerve-ring,
and on the ring itself, an inner layer of nerve-cells is developed from
the lantern-coelom which represents the lower or oral portions of the
radial perihaemal canals. These cells control the muscles moving the
teeth. These canals are originally parts of the lantern-coelom, but in
the adult they become closed off from it.
Fig. 234.—Echinus esculentus dissected in order to display Aristotle's lantern, ×
2. The whole upper part of the shell has been cut away. 1, Upper growing
end of tooth; 2, outer forked end of one "compass"; 3, muscle joining
adjacent compasses and acting as elevator of these ossicles; 4, depressor
of the compasses; 5, lower end of jaw; 6, retractor of the whole lantern; 7,
protractor of the whole lantern; 8, auricle; 9, ampullae of the tube-feet; 10,
interambulacral plate; 11, lower part of tooth; 12, water-vascular ring; 13,
meeting-point of a pair of epiphyses; 14, so-called Polian vesicle, really
equivalent to Tiedemann's body in an Asteroid; 15, oesophagus; 16, so-
called ventral blood-vessel; 17, genital stolon; 18, stone-canal; 19, rectum;
20, aboral sinus. (Partly after Chadwick.)
In the outer wall of this space are developed the calcareous rods
forming Aristotle's lantern. These are first: five teeth (Fig. 234, 11),
chisel-shaped ossicles of peculiarly hard and close-set calcareous
matter, the upper ends (1) pushing out projections of the upper wall
of the lantern-coelom. These projections are the growing points of
the teeth, whose lower ends pierce the ectoderm and project into the
lower end of the oesophagus. Each tooth is firmly fixed by a pair of
ossicles inclined towards one another like the limbs of a V and
meeting below. Each ossicle is called an "alveolus," and taken
together they form a "jaw." Their upper ends are connected by a pair
of ossicles called "epiphyses" (13). These two epiphyses meet in an
arch above. The jaws and their contained teeth are situated
interradially. Intervening between successive alveoli are radial pieces
called "rotulae," which extend directly inwards towards the
oesophagus. Above the rotulae are pieces termed "radii" or
"compasses" (2), which are not firmly attached to the other pieces
but lie loosely in the flexible roof of the lantern-coelom.
The uses of the various components of this structure can be made

out from an inspection of the muscles which connect them together.
Overarching each radial perihaemal canal where it leaves the lantern

is a bridge of calcareous matter called the "auricula" (Fig. 234, 8).
This arises as two rods which meet each other in a pent-house over
the canal. It is the only part of the skeleton which can be compared
to the ambulacral ossicles of the Asteroidea, and like them it serves
as the point of insertion for important muscles. Thus we find (1)
protractor (Fig. 234, 7) muscles which arise from the upper ends of
the alveoli and are inserted in the auricula; when these contract they
tend to push the whole "lantern" outwards so as to expose the tips of
the teeth. (2) The retractor muscles (Fig. 234, 6) extend from the
auriculae to the lower ends of the jaws and restore the lantern when
it has been extruded to its original position. (3) The comminator
muscles connect adjacent jaws with one another: these on
contraction approximate the pair of jaws into which they are inserted,
and it will easily be seen that by the successive contraction of the
five comminator muscles a rotating movement of the teeth would be
produced which would cause them to exert an action something like
that of an auger; by their simultaneous contraction the teeth are
brought to a point. (4) The internal and external rotula muscles:
these are small muscles which connect the outer side of the
epiphysis with the rotula. There are two facets on the epiphysis,
which permit it to rock to and fro on the rotula under the action of
these muscles. This rocking action must greatly increase the cutting
power of the tooth. These muscles are controlled by the nerve-ring
and the incipient portions of the radial nerves, which, as we have
seen, have an inner layer of nerve-cells. If the nerve-ring be gently
stimulated on one side the upper end of the lantern bends away from
the spot, causing the lower end, i.e., the teeth, to move towards it;
but a stronger stimulation produces the opposite effect, just as is the
case with spines. But besides these masticatory muscles there are
others which have nothing to do with moving the teeth. These
muscles are attached to the rods called radii or compasses (Fig.
234, 2),[484] which lie in the upper wall of the lantern-coelom, and
may be termed the compass muscles. There are two sets:—(1) The
elevator muscles (Fig. 234, 3), which connect the inner ends of the
compasses with one another. When these contract, the radii tend to
bend upwards at the inner ends and thus raise the roof of the
coelom. (2) The depressor muscles (Fig. 234, 4), which run
downwards from the forked outer ends of the compasses to the
auriculae. Uexküll[485] has shown that the function of these muscles
and of the rods to which they are attached is respiratory. These
muscles are also controlled by the nerve-ring. If this be stimulated by
passing a pin-head into the oesophagus, the roof of the lantern
cavity is raised by the contraction of the elevator muscles. This is
followed by contraction of the depressor muscles lowering it; the
same result may be brought about by placing the animal in water
with excess of carbonic acid. The ten branched gills described on p.
514 are outgrowths of the lantern-coelom. When the roof of this
cavity is depressed the fluid contents are driven out into the gills,
which are thus expanded and then absorb oxygen from the
surrounding sea water. When, on the other hand, the roof is raised
the aerated water is sucked back into the lantern cavity, and the
oxygen passes easily through the thin walls of the lantern into the
fluid filling the main coelomic cavity. There are thus two independent
respiratory mechanisms in the Sea-urchin, the one being the
compass muscles, the other the cilia lining the interior of the tube-
feet.
The function of excretion is performed, as in Asteroidea, by the

amoebocytes floating in the general coelomic cavity. These in part
escape through the thin bases of the gills. In other parts of the body
they seem not to succeed in reaching the exterior at all, but to
degenerate and to form masses of pigment; the colour of the animal
is largely due to these excrementitious substances.
The reproductive system, as in the two preceding orders, consists

of a vertical pillar, the "genital stolon," and a circular "genital rachis"
giving off interradial branches from which the genital organs bud.
The genital stolon is developed from the wall of the general coelom
near the upper end of the axial sinus; it attains a great development
and ultimately completely surrounds the axial sinus, which then
appears like the cavity of a glandular tube, the walls of which are
constituted by the genital stolon. The compound structure consisting
of stolon and axial sinus was actually described as a nephridium by
the Sarasins[486] in the case of Asthenosoma. Its true nature,
however, is shown when the upper end is examined; it is then seen
to open into the stone-canal and to be in communication with the
ampulla, into which the pore-canals open. Lying alongside the upper
end of the axial sinus is the somewhat elongated "madreporic
vesicle," or right hydrocoele, which was described by Sarasin as the
accessory kidney (Nebenniere), since like the axial sinus it is partly
enveloped by the genital stolon. Leipoldt,[487] however, showed
clearly that it is a completely closed space.
The genital rachis springs from the upper end of the stolon, and as in
Asteroids, it lies in the outer wall of a space called the "aboral sinus"
(Fig. 234, 20) intervening between it and the test. In adult specimens
it seems to degenerate. The genital organs are situated at the ends
of five interradial branches of the rachis (Fig. 231, gon). Each is an
immense tree-like structure consisting of branching tubes, which are
lined by the sexual cells. So enormous do they become in the
breeding season that they form an article of food among fishermen.
The term esculentus is derived from this circumstance. Other
species are regularly sold for food as Frutta di Mare (Fruit of the
Sea) at Naples, and as "sea eggs" in the West Indian Islands. One
female Echinus esculentus will produce 20,000,000 eggs in a
season.
The so-called blood system is more distinctly developed in
Echinoidea than in Asteroidea and Ophiuroidea. There is an oral ring
of lymphoid tissue surrounding the oesophagus below the water-
vascular ring. From this are given off two strands, the so-called
"dorsal" (Fig. 231, b.v), and "ventral" vessels (Fig. 234, 16), which
run along the two opposite sides of the stomach or first coil of the
alimentary canal. The position of these strands suggests that like the
lacteals of the human intestine they are channels along which the
products of digestion exude from the stomach. The dorsal strand is
situated on the same side as the genital stolon, and from it branches
are given off which ramify on the surface of the stolon, on account of
which this organ, as in Asteroidea, was at one time regarded as a
"heart," but the distinction of the stolon from the strands is easily
made out. An aboral ring enclosing the genital rachis lies embedded
in the septum dividing the aboral sinus (Fig. 234, 20) from the
general coelom.
Classification of Echinoidea.
The Echinoidea are sharply divided into three main orders, which
differ from each other profoundly in their habits and structure. These
are: (1) The Endocyclica or Regular Urchins, of which the species
just described may be taken as the type. (2) The Clypeastroidea or
Cake-urchins, which are of extremely flattened form, and in which
the periproct is shifted from the apical pole so that it is no longer
surrounded by the genital plates, while some of the tube-feet of the
dorsal surface are flattened so as to serve as gills. (3) The
Spatangoidea or Heart-urchins, in which the outline is oval: the
periproct is shifted, as in the Cake-urchins, and the dorsal tube-feet
are similarly modified; but the Heart-urchins have totally lost
Aristotle's lantern, whilst the Cake-urchins have retained it. This
strongly-marked cleavage of the group was primarily due, as in all
such cases, to the adoption of different habits by different members
of the same group. Were we to term the three orders Rock-urchins,
Sand-urchins, and Burrowing-urchins, it would not be entirely true,
for secondary invasions of the other's territory on the part of each
order have undoubtedly taken place; but still the statement would
remain roughly true, and would give a fair idea of the differences in
habitat which have led to the differentiation of the group.
Order I. Endocyclica (Regular Urchins).

The principal variations concern (1) the peristome, (2) the periproct,
(3) the corona, (4) Aristotle's lantern and its appendages, (5) the
spines, (6) the pedicellariae, and lastly, (7) the tube-feet. We shall
consider these points in order.
Peristome.—In the vast majority of species this region is covered

only with flexible skin in which ten small plates are embedded,
pierced by pores for the buccal tube-feet; besides these there are
irregularly arranged thin plates. In the Cidaridae both the ambulacral
and the interambulacral series of plates are continued on it; these
plates differ from those of the corona in being movable on one
another. In Echinothuriidae only the ambulacral series of plates is
continued on to the peristome. In the case of both these families
there are a considerable number of tube-feet within the region of the
peristome which may be classed as buccal.
Periproct.—This area, which represents the whole dorsal surface of

Asteroidea, is very large in the Cidaridae, where, as in Echinus, it is
covered with leathery skin in which small plates are embedded. In
the Saleniidae it is covered with a single large sur-anal plate, in the
edge of which the anus is excavated; in the Arbaciidae it is covered
with four valve-like plates; whilst in the remaining species its
condition is similar to that described in the case of Echinus
esculentus.
Corona.—In Echinothuriidae all the plates are separated by slips of

membranous skin, so that the test is flexible. In all other families it is
an unyielding cuirass. In the Cidaridae the pore-plates remain
separate throughout life, and are therefore identical with the
ambulacral plates. These are small and placed in two vertical rows,
and so the ambulacra are exceedingly narrow. In Echinothuriidae
there is some tendency to adhesion amongst the pore-plates; these
are of different sizes, and usually one larger and one smaller adhere
to one another. In all other species regular ambulacral plates are
formed at least in the lower part of the radii near the peristome by
the adhesion of the pore-plates in groups of two, three, or more.
Sometimes as many as nine pore-plates may thus adhere.
When adhesion takes place between the pore-plates it is of course

preceded by crowding, and this interferes with their equal
development. Some which extend so far horizontally as to meet their
fellows of the opposite side of the radius are called primary plates;
others which are small and wedged in between the larger ones are
called demi-plates. Systems of classification have been built up
(chiefly by palaeontologists) in which great stress has been laid on
how the primaries and secondaries enter into the constitution of the
compound plate, but it does not seem to the present author as if this
were at all a satisfactory basis for classification. All the pore-plates
are primarily equivalent, and the question as to which are interfered
with in their growth so as to become secondary is trivial. The so-
called Arbacioid type consists of one primary with a secondary on
each side; the Diadematoid type of three primaries, with occasionally
a secondary between the aboral and the middle primary; and finally
the Triplechinoid type of two primaries, with one or more secondaries
between them.
Aristotle's Lantern.—Under this head we may consider the

auriculae and gills as well as the jaws and teeth. In Cidaridae
external gills appear to be absent, but from the lantern coelom large
radial pouches project upwards into the general coelom cavity.
These pouches are supposed to be respiratory, and are termed
internal gills or Stewart's organs.[488] They co-exist with external
gills in Echinothuriidae and in Diadematidae, though in the last family
they are present only in a vestigial form, two being found in each
radius. The auricular arch both in Cidaridae and in Arbaciidae is
composed of two pillars which do not meet, but in the last-named
family they are based, as in Echinidae, generally on the ambulacral
plates, whereas in Cidaridae they arise from the interambulacral
plates (the ambulacral plates being here very narrow). The
epiphyses are absent in Cidaridae and Arbaciidae, and are imperfect
in Diadematidae.
Spines.—These organs are extraordinarily variable, and usually

differ very much in species of the same genus. In the vast majority of
species there is a limited number of long spines called "primaries,"
amongst the bases of which a large number of much shorter
"secondaries" are distributed. In Cidaridae the primaries are very
long and thick and blunt at the ends, and the secondaries form small
circles around their bases. The primaries in Cidaridae and the tips of
the primaries in Arbaciidae and Echinothuriidae are covered with a
special investment of extremely close, hard, calcareous matter very
different from the loosely fenestrated material out of which the
bodies of the spines of all species are composed. In Colobocentrotus
and Heterocentrotus the primaries are very thick and triangular in
section, whilst the secondaries on the aboral surface have expanded
outer ends, which form a close-set pavement protecting the
ectoderm from the shocks of the breakers. In Echinothuriidae the
primaries are short and so delicate as to be termed silky.
Pedicellariae.—In Cidaridae only gemmiform and tridactyle

pedicellariae are found. In the gemmiform the glands lie inside the
grooved blades instead of outside as normally, and they are covered
internally by ingrowths of calcareous matter from the edges. In
Echinothuriidae only tridactyle and trifoliate are found in most
species, but rudimentary gemmiform are found in one species and
well-developed ophicephalous in another. In some species
(Centrostephanus longispinosus) there are found gemmiform
pedicellariae which have lost the jaws but retained the glands. These
are termed "globiferae." Mortensen[489] uses minute details in the
structure of the pedicellariae to discriminate species and even
genera, but in this the present author is not prepared to follow him.

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(eBook PDF) Drug Use in Australian

Society Second Edition

Drug Use in Australian Society

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Figures, Tables and Boxes xi

About the Editors xvi

About the Contributors xvii

Chapter 2: Historical Perspectives on Drug Use and Their

Chapter 3: Epidemiology: Analysing Patterns of Drug Use and Harms 41

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Chapter 4: Frameworks for Understanding Drug Use and

Chapter 5: Images of Drugs in Popular Culture 84

Chapter 6: Drugs and the Internet 102

Chapter 7: Primary Prevention for Alcohol and Other Drug

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Chapter 9: Drug Pharmacology and Pharmacotherapy Treatments 174

Chapter 10: Psychosocial Treatments for Drug Problems 200

Chapter 11: Drug Laws and Regulations 223

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Implementing drug laws 231

Chapter 13: Making Drugs Policy: Policy Models and Influences

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Figures, Tables and Boxes

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ABS Australian Bureau of Statistics

ACMA Australian Communications and Media Authority

ACT Acceptance and Commitment Therapy

ADCA Alcohol and Other Drugs Council of Australia

AFP Australian Federal Police

AHTCC Australian High Tech Crime Centre

AIVL Australian Injecting & Illicit Drug Users League

ALRC Australian Law Reform Commission

ANCD Australian National Council on Drugs

AOD Alcohol and Other Drugs

APSAD Australasian Professional Society on Alcohol and other Drugs

ASHM Australasian Society of HIV Medicine

CAPR Centre for Alcohol Policy Research

CATI Computer Assisted Telephone Interviewing

CBT Cognitive Behavioural Therapies

CEN Cannabis Expiation Notice scheme

CNB Central Narcotics Bureau

CNS Central Nervous System

COAG Council of Australian Governments

CPTED Crime Prevention Through Environmental Design

CREMS Centre of Research Excellence in Mental Health and Substance Use

DALY Disability-​Adjusted Life Year

DBT Dialectical Behaviour Therapy

DCR Drug Consumption Room

DEVS Drug Education in Victorian Schools

DFZ Drug-​Free Zone

DPMP Drug Policy Modelling Program

EDRS Ecstasy and Related Drug Reporting System

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FOHP Federal Office of Public Health

GABA Gamma-​Aminobutyric Acid

GABA-​A Gamma-​Aminobutyric Acid-​A

GBD Global Burden of Disease

GHB Gamma Hydroxybuterate

GLB Gay, Lesbian and Bisexual

GLBTIQ gay, lesbian, bisexual, transgender, intersex and queer

Chapter 2: Historical Perspectives on Drug Use and Their

Chapter 4: Frameworks for Understanding Drug Use and

DALY Disability-Adjusted Life Year

DFZ Drug-Free Zone

GABA Gamma-Aminobutyric Acid

GABA-A Gamma-Aminobutyric Acid-A

HAT Heroin-Assisted Treatment

MBCT Mindfulness-Based Cognitive Therapy

MBRP Mindfulness-Based Relapse Prevention

MDMA 3,4-methylenedioxymethamphetamine, Ecstasy

NGO Non-Government Organisation

UNAIDS Joint United Nations Programme on HIV/AIDS

Professor Lorraine Mazerolle is an Australian Research Council Laureate Fellow (2010–