ASPM 2023 Conference

Challenging behaviours and human suffering: trauma, tobacco, alcohol and other drugs (17671)

Hester Wilson 1
  1. Royal Australian College of GPs, Sydney, NSW, Australia

Substance use (tobacco, alcohol, and other drugs) is common in the Australian community. For many this is a harmless enjoyable past time, but for some it causes significant morbidity and mortality. People who experience harmful dependent substance use often have psychological and physical co-morbidities and the incidence of past and ongoing trauma is high. Our culture’s moral judgement of substance use and the lack of understanding or acceptance of dependency as a legitimate health concern are evidenced by government policy and limited treatment access. People with harmful/dependent substance use experience stigma and discrimination in our communities and in our health care system. This adversely affects their health outcomes, making it difficult for them to seek, access or stay in treatment.


In addition, substance use and trauma can play out in behaviours that challenge us as health care workers (HCWs) and compound the person’s experience of stigma. As HCWs, we can experience these behaviours as difficult, manipulative or even criminal. The person is non-compliant, may miss appointments or not follow our treatment plan. We can experience negative and difficult emotions when working with them and this can lead to adverse experiences that impact both us and the person seeking help.


This 90-minute session draws on our own lived experience and asks all of us to reflect on the challenges and triumphs of working with people with trauma and substance use. We’ll revisit what has worked/not worked in the past and consider how we can work in the future to improve the person’s experience of health care, their health outcomes and simultaneously improve our work life.

Learning Objectives

1. Be aware the literature that discusses issues people with trauma and substance use face

2. Reflect on our own lived experience when working with people with trauma and substance use and our emotional responses and those of our colleagues and the health system

3. Leave the session with practical solutions for working with people with trauma and substance use in clinical settings

  1. AIHW Alcohol, tobacco and other drugs in Australia 2022 Alcohol, tobacco & other drugs in Australia, About - Australian Institute of Health and Welfare (aihw.gov.au)
  2. AIHW Impact of alcohol and illicit drug use on the burden of illness and injury in Australia. Australian burden of Disease Study 2011 Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011 , Summary - Australian Institute of Health and Welfare (aihw.gov.au)
  3. Khoury L, Tang YL, Bradley B, Cubells JF, Ressler KJ. Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress Anxiety. 2010 Dec;27(12):1077-86
  4. Wilson H How stigmatising language affects people in Australia who use tobacco, alcohol and other drugs. March 2020, Australian Journal of General Practice 49(3):155-158