Does adolescent depression modify the association between psychosocial job stressors and mental health in emergent adulthood?

BACKGROUND: Job stressors can be particularly harmful to the mental health of disadvantaged groups through differential exposure, differential sensitivity to the effects of exposure, or both. In this paper, we assess the extent to which emergent adult workers with an adolescent history of high depression symptoms may be differentially sensitive to the effect of job stressors on mental health. METHODS: We conducted a secondary analysis of three waves of the Australian arm of the International Youth Development Study (n = 1262). We used multivariable linear regression to assess whether self-reported measures of high depression symptoms at one or two time points in adolescence (ages 11-16 years) modified the cross-sectional association between four self-reported job stressors (job demands, job control, job strain, and incivility at work) and psychological distress (Kessler-10 scores) in emergent adulthood (ages 23-27 years). RESULTS: For all four job stressors, there was a consistent pattern of approximately a doubling in the magnitude of association for participants with a history of high depression symptoms at two points in adolescence compared with those with no history of depression. However, results of effect modification analysisfor only job demands and job strain excluded chance as a potential explanation. CONCLUSIONS: Findings showed partial support for the hypothesis that a history of high depression symptoms in adolescence predicts stronger associations between job stressor exposures and psychological distress among those employed in emergent adulthood. The limitations of this secondary analysis suggest a need for purpose-designed studies to answer this important research question more definitively.

Alcohol-Tolerant Workplace Environments Are a Risk Factor for Young Adult Alcohol Misuse on and off the Job in Australia and the United States.

The workplace has been understudied as a setting for the prevention of young adult alcohol misuse. This study examined if alcohol-tolerant workplace environments are associated with greater risk for alcohol use and misuse on and off the job among young adults. Data were collected in 2014 from state-representative, sex-balanced samples (51% female) of 25-year-olds in Washington, U.S. (n = 751) and Victoria, Australia (n = 777). Logistic regressions indicated that availability of alcohol at work, absence of a written alcohol policy, and alcohol-tolerant workplace norms and attitudes were independently associated with a 1.5 to 3 times greater odds of on-the-job alcohol use or impairment. Alcohol-tolerant workplace norms were associated also with greater odds of high-risk drinking generally, independent of on-the-job alcohol use or impairment. Associations were mostly similar in Washington and Victoria, although young adults in Victoria perceived their workplaces to be more alcohol-tolerant and were more likely to use alcohol or be impaired at work and to misuse alcohol generally than young adults in Washington. Cross-nationally, workplace interventions that restrict the availability of alcohol, ban alcohol at work, and reduce alcohol-tolerant norms have the potential to prevent and reduce young adults' alcohol use and misuse on and off the job.

Do Australian adolescents with permission to drink at home engage in different alcohol use behaviours and experience more harms than those without such permission?

INTRODUCTION: Around half of Australian students aged 16-17 are estimated to have drunk alcohol in the past month, with 11% drinking at 'risky' levels. This study investigated: (i) how many Australian adolescents aged 16-17 had parental permission to drink at home in 2016/17 and whether prevalence differed by adolescent sex; (ii) whether adolescents allowed to drink at home had drunk more recently and were drinking greater quantities; (iii) if adolescents allowed to drink at home experienced more alcohol-related harms; and (iv) if parental drinking patterns were associated with permitting adolescents to drink at home. METHODS: Data from Wave 7 of the Longitudinal Study of Australian Children were used. Descriptive and bivariate analyses addressed Aims i-iii. Nested multivariable logistic regression models addressed aim iv. RESULTS: In 2016/17, 28% of Australian adolescents aged 16-17 were allowed to drink alcohol at home. More adolescents with permission had drunk alcohol in the past month (77% vs. 63% of those without permission). There was no difference in quantity of alcohol consumed in the past week between groups. More adolescents allowed to drink at home had experienced alcohol-related harm compared to those without permission (23% vs. 17%). In multivariable analyses, alcohol consumption by primary parents was associated with an increased likelihood of allowing adolescents to drink at home. DISCUSSIONS AND CONCLUSIONS: In order to reduce adolescent alcohol use and associated harms, parents should avoid permitting alcohol use among adolescents at home. Frequent (twice or more/week) primary parental alcohol consumption was especially associated with greater odds of allowing adolescents to drink at home.

Returning to the nest: Emerging adults living with parents during the COVID-19 pandemic.

Changes in the working, study and social lives of emerging adults due to the COVID-19 pandemic have led to greater need for external supports. Many who lived independently may have sought that support by returning to live with parents. This study identifies factors associated with returns made between 2019 and 2020. It describes supports needed and obtained, relationships between parents and their resident emerging adults and identifies correlates of poor coping and high psychological distress. Data from the Longitudinal Surveys of Australian Youth and the Longitudinal Study of Australian Children were used and showed half of the emerging adults who moved did so due to COVID-19 restrictions. Loss of work and increased need for emotional and financial support were key drivers of moves. Nineteen per cent who returned found spending more time with family difficult and over half did not have their support needs fully met, increasing their odds of poor coping at that time (OR = 2.9, 4.3, respectively) and subsequent psychological distress (OR = 6.0). Families were an important source of support but could not necessarily mitigate all challenges; for some emerging adults, returning to live with parents gave rise to additional difficulties which negatively affected mental health.

Educational and Employment Outcomes among Young Australians with a History of Depressive Symptoms: A Prospective Cohort Study.

The aim of this study was to investigate whether depressive symptoms reported during adolescence are associated with subsequent educational and employment outcomes, including whether experiences of depressive symptoms in adolescence are associated with higher exposures to adverse psychosocial job stressors among those who were employed in emerging adulthood. We used data from the Victorian arm of the International Youth Development Study (IYDS). Multiple logistic regression analyses were used to model the association of depressive symptoms reported in 2002 (wave one) and/or 2003 (wave two) and self-reported completion of compulsory secondary schooling, employment status, and exposure to a number of psychosocial job stressors roughly a decade later (i.e., at wave three in 2014). In fully adjusted models, reporting high depressive symptoms at waves one or two (odds ratio (OR) 0.71, 95% confidence interval (CI) 0.55 to 0.92), as well as at both waves (OR 0.55, 95% CI 0.41 to 0.75) were associated with a reduced likelihood of completing secondary schooling by wave three. High depressive symptoms reported at multiple waves were also associated with a reduced likelihood of employment (OR 0.49, 95% CI 0.36 to 0.66). Amongst those employed at wave three (n = 2091; 72.5%), adolescent depressive symptoms were associated only with workplace incivility. Psychosocial job stressor exposures should be considered in the design and selection of jobs for young workers with a history of depressive symptoms in order to increase employment participation and sustainability for young people experiencing symptoms of depression.

Self-reported injury in Australian young adults: demographic and lifestyle predictors.

OBJECTIVES: Injury is the major cause of mortality and morbidity among adolescents and young adults. This study examined the use of injury self-reports and various causes of injury among adolescents. METHODS: A cohort recruited in 2002 as a representative sample of students from the State of Victoria in south-east Australia was followed and resurveyed in young adulthood in 2010 (mean age 21.0) and 2012 (mean age 23.1) with 75% of the target sample retained (N=2,154, 55.8% female). RESULTS: Prior injuries were reported by 55.5% in 2010 and 54.6% in 2012, leaving 18% with continuing disability. Reported causes of injury in 2012 were sports (55.1%) and alcohol use (9.7%). Logistic regression revealed that injury in 2012 was predicted by rural school attendance in 2002 (Adjusted Odds Ratio [OR] 1.4 CI 1.1-1.7) and in 2010 by male gender (OR 2.2, CI 1.8-2.6), reported self-harm (OR 1.6 CI 1.1-2.2), and unemployment (OR 0.7, CI 0.5-1.0). CONCLUSIONS: Self-reported injury among young adults is reliably reported, and suggests the need to further examine gender, rural communities and self-harm, and indicates modifiable contributors to injury. Implications for public health: Modifiable contributors to injury prevention are revealed as work environment, sports participation and alcohol use.

Predicting hazardous drinking in late adolescence/young adulthood from early and excessive adolescent drinking - a longitudinal cross-national study of Norwegian and Australian adolescents.

BACKGROUND: Research has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures. METHODS: Data were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14-16 years) to late adolescence/young adulthood (18-25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends' substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring. RESULTS: Hazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders. CONCLUSION: Our findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

Predicting Alcohol Misuse Among Australian 19-Year-Olds from Adolescent Drinking Trajectories.

BACKGROUND: Alcohol use in adolescence predicts future alcohol misuse. However, the extent to which different patterns of adolescent use present risk remains unclear. OBJECTIVES: This study investigated how adolescent trajectories of alcohol consumption during the school years predict alcohol misuse at age 19 years. METHODS: Data were drawn from 707 students from Victoria, Australia, longitudinally followed for 7 years. Five alcohol use trajectories were identified based on the frequency of alcohol use from Grade 6 (age 12 years) to Grade 11 (age 17 years). At age 19 years, participants completed measures indicating Heavy Episodic Drinking (HED), dependency - Alcohol Use Disorders Identification Test (AUDIT) and social harms. RESULTS: At 19 years of age, 64% of participants reported HED, 42% high AUDIT scores (8+), and 23% social harms. Participants belonging to a steep escalator trajectory during adolescence had twice the odds at 19 years of age of high AUDIT scores and social harms, and three times greater odds of HED than participants whose alcohol use slowly increased. Stable moderate consumption was also associated with an increased risk of HED compared to slowly increasing use. Abstinence predicted a reduced likelihood of all forms of misuse at 19 years of age compared to slowly increased alcohol use. CONCLUSIONS: Trajectories of drinking frequency during adolescence predict alcohol misuse at age 19 years. Although rapid increasing use presents the greatest risk, even slowly increasing drinking predicts increased risk compared to abstinence. The findings indicate that alcohol policies should recommend nonuse and reduced frequency of use during adolescence.

Developmental trajectories of adolescent cannabis use and their relationship to young adult social and behavioural adjustment: A longitudinal study of Australian youth.

This study aimed to identify distinct developmental trajectories (sub-groups of individuals who showed similar longitudinal patterns) of cannabis use among Australian adolescents, and to examine associations between trajectory group membership and measures of social and behavioural adjustment in young adulthood. Participants (n=852, 53% female) were part of the International Youth Development Study. Latent class growth analysis was used to identify distinct trajectories of cannabis use frequency from average ages 12 to 19, across 6 waves of data. Logistic regression analyses and analyses of covariance were used to examine relationships between trajectory group membership and young adult (average age: 21) adjustment, controlling for a range of covariates. Three trajectories were identified: abstainers (62%), early onset users (11%), and late onset occasional users (27%). The early onset users showed a higher frequency of antisocial behaviour, violence, cannabis use, cannabis-related harms, cigarette use, and alcohol harms, compared to the abstinent group in young adulthood. The late onset occasional users reported a higher frequency of cannabis use, cannabis-related harms, illicit drug use, and alcohol harms, compared to the abstinent group in young adulthood. There were no differences between the trajectory groups on measures of employment, school completion, post-secondary education, income, depression/anxiety, or alcohol use problems. In conclusion, early onset of cannabis use, even at relatively low frequency during adolescence, is associated with poorer adjustment in young adulthood. Prevention and intervention efforts to delay or prevent uptake of cannabis use should be particularly focussed on early adolescence prior to age 12.

The density of alcohol outlets and adolescent alcohol consumption: An Australian longitudinal analysis.

Higher density of alcohol outlets has been linked to increased levels of adolescent alcohol-related behaviour. Research to date has been cross-sectional. A longitudinal design using two waves of annual survey data from the Australian arm of the International Youth Development Study was used. The sample comprised 2835 individuals with average age at wave 2 of 14 years (SD=1.67; range=11-17 years). GSEM was used to examine how absolute levels of alcohol outlet density was associated with student-reported alcohol use one year later, while controlling for prior alcohol use, risk factors at wave one and changes in density over the 2 years. Adolescents' perception of alcohol availability and friends' alcohol use were tested as potential mediators of the association between alcohol outlet density and adolescent alcohol use. Elasticity modelling identified a 10% increase in overall density at wave one was associated with an approximately 17% increase in odds of adolescent alcohol consumption at wave two. Living in areas with a higher density of outlets was associated with a statistically significant increase in the likelihood of adolescents developing early age alcohol consumption.

Longitudinal effects of school drug policies on student marijuana use in Washington State and Victoria, Australia.

OBJECTIVES: We examined the longitudinal effect of schools' drug policies on student marijuana use. METHODS: We used data from the International Youth Development Study, which surveyed state-representative samples of students from Victoria, Australia, and Washington State. In wave 1 (2002), students in grades 7 and 9 (n = 3264) and a school administrator from each participating school (n = 188) reported on school drug policies. In wave 2 (2003), students reported on their marijuana use. We assessed associations between student-reported and administrator-reported policy and student self-reported marijuana use 1 year later. RESULTS: Likelihood of student marijuana use was higher in schools in which administrators reported using out-of-school suspension and students reported low policy enforcement. Student marijuana use was less likely where students reported receiving abstinence messages at school and students violating school policy were counseled about the dangers of marijuana use. CONCLUSIONS: Schools may reduce student marijuana use by delivering abstinence messages, enforcing nonuse policies, and adopting a remedial approach to policy violations rather than use of suspensions.

A longitudinal study of the association of adolescent polydrug use, alcohol use and high school non-completion.

AIMS: Failure to complete high school predicts substantial economic and social disadvantage in adult life. The aim of this study was to determine the longitudinal association of mid-adolescent polydrug use and high school non-completion, relative to other drug use profiles. DESIGN: A longitudinal analysis of the relationship between polydrug use in three cohorts at grade 9 (age 14-15 years) and school non-completion (reported post-high school). SETTING: A State-representative sample of students across Victoria, Australia. PARTICIPANTS: A total of 2287 secondary school students from 152 high schools. The retention rate was 85%. MEASUREMENTS: The primary outcome was non-completion of grade 12 (assessed at age 19-23 years). At grade 9, predictors included 30-day use of eight drugs, school commitment, academic failure and peer drug use. Other controls included socio-economic status, family relationship quality, depressive symptoms, gender, age and cohort. FINDINGS: Three distinct classes of drug use were identified-no drug use (31.7%), mainly alcohol use (61.8%) and polydrug use (6.5%). Polydrug users were characterized by high rates of alcohol, tobacco and cannabis use. In the full model, mainly alcohol users and polydrug users were less likely to complete school than non-drug users [odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.17-2.03) and OR = 2.51, 95% CI = 1.45-4.33), respectively, P < 0.001]. These effects were independent of school commitment, academic failure, peer drug use and other controls. CONCLUSIONS: Mid-adolescent polydrug use in Australia predicts subsequent school non-completion after accounting for a range of potential confounding factors. Adolescents who mainly consume alcohol are also at elevated risk of school non-completion.

Adolescent predictors and environmental correlates of young adult alcohol use problems.

AIMS: To examine the rates of young adult alcohol and drug use and alcohol problems, adolescent predictors of young adult alcohol problems and correlations with young adult social, work and recreational environments. DESIGN: Adolescents were followed longitudinally into young adulthood. Predictors were measured in grade 9 (average age 15), and environmental correlates and outcomes in young adulthood (average age 21). SETTING: Students recruited in Victoria, Australia in 2002, were resurveyed in 2010/11. PARTICIPANTS: Analytical n=2309, 80% retention. MEASUREMENTS: Adolescent self-report predictors included past-month alcohol use. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT) together with reports of environmental influences. FINDINGS: Comparisons to United States national school graduate samples revealed higher rates of alcohol, tobacco and illicit drug use (other than cannabis) in Victoria. For example, rates of past month use at age 21-22 were: alcohol 69.3% US versus 84.9%, 95% confidence interval (CI) 81.3-88.6% Victoria; illicit drugs (other than cannabis) 8.8 versus 12.7%, CI 9.7-15.7%. AUDIT alcohol problems (scored 8+) were identified for 41.2%, CI 38.8-43.6% of young adults in Victoria. The likelihood of young adult alcohol problems was higher for frequent adolescent alcohol users and those exposed to environments characterized by high alcohol use and problems in young adulthood. CONCLUSIONS: High rates of alcohol problems are evident in more than two in five Australian young adults, and these problems appear to be influenced both by earlier patterns of adolescent alcohol use and by young adult social, work and recreational environments.

The impact of school alcohol policy on student drinking.

Although it is common for secondary schools to implement alcohol policies to reduce alcohol misuse, there has been little evaluation of the efficacy of these policies. The purpose of this study was to test the impact of the degree and type of alcohol policy enforcement in state representative samples of secondary students in Washington State, USA, and Victoria, Australia (n = 1848). Multivariate logistic regressions were used to examine the prospective association between student reports of school alcohol policy in Grade 8 and self-reported alcohol use in Grade 9, controlling for age, gender, state, family socio-economic status and Grade 8 alcohol use. The likelihood of students drinking on school grounds was increased when students perceived lax policy enforcement. Student perceptions of harm minimization alcohol messages, abstinence alcohol messages and counselling for alcohol policy violators predicted reduced likelihood of binge drinking. Students perceiving harm minimization messages and counselling for alcohol policy violators had a reduced likelihood of experiencing alcohol-related harms. Perceptions of harsh penalties were unrelated to drinking behaviour. These results suggest that perceived policy enforcement may lessen drinking at school 1 year later and that harm minimization messages and counselling approaches may also lessen harmful drinking behaviours as harm minimization advocates suggest.

Adolescent exposure to drink driving as a predictor of young adults' drink driving.

The purpose of this study was to investigate the influence of exposure to others' drink driving during adolescence on self-reported driving under the influence (DUI) of alcohol in young adulthood. Data were drawn from 1956 participants with a driving license enrolled in the International Youth Development Study from Victoria, Australia. During 2003 and 2004, adolescents in Grades 7, 9 and 10 (aged 12-17) completed questionnaires examining whether they had ridden in a vehicle with a driver who had been drinking, as well as other demographic, individual, peer and family risk factors for DUI. In 2010, the same participants (aged 18-24) then reported on their own DUI behaviour. 18% of young adults with a driving license reported DUI in the past 12 months. Exposure to others' drink driving during adolescence was associated with an increased likelihood of DUI as a young adult (OR=2.13, 95% CI 1.68-2.69). This association remained after accounting for the effects of other potential confounding factors from the individual, peer and family domains (OR=1.62, 95% CI 1.23-2.13). Observing the drink driving behaviours of others during adolescence may increase the likelihood of DUI as a young adult. Strategies to reduce youth exposure to drink driving are warranted.

The impact of school tobacco policies on student smoking in Washington State, United States and Victoria, Australia.

This paper measures tobacco policies in statewide representative samples of secondary and mixed schools in Victoria, Australia and Washington, US (N = 3,466 students from 285 schools) and tests their association with student smoking. Results from confounder-adjusted random effects (multi-level) regression models revealed that the odds of student perception of peer smoking on school grounds are decreased in schools that have strict enforcement of policy (odds ratio (OR) = 0.45; 95% CI: 0.25 to 0.82; p = 0.009). There was no clear evidence in this study that a comprehensive smoking ban, harsh penalties, remedial penalties, harm minimization policy or abstinence policy impact on any of the smoking outcomes.

School, parent, and student perspectives of school drug policies.

BACKGROUND: Schools use a number of measures to reduce harmful tobacco, alcohol, and drug use by students. One important component is the school's drug policy, which serves to set normative values and expectations for student behavior as well as to document procedures for dealing with drug-related incidents. There is little empirical evidence of how policy directly or indirectly influence students' drug taking. This study compares how effectively schools communicate school drug policies to parents and students, how they are implemented, and what policy variables impact students' drug use at school and their perceptions of other students' drug use at school. METHODS: Data were obtained from 3876 students attending 205 schools from 2 states in the United States and Australia, countries with contrasting national drug policy frameworks. School policy data were collected from school personnel, parents, and students. RESULTS: Schools' policies and enforcement procedures reflected national policy approaches. Parents and students were knowledgeable of their school's policy orientation. CONCLUSIONS: When delivered effectively, policy messages are associated with reduced student drug use at school. Abstinence messages and harsh penalties convey a coherent message to students. Strong harm-minimization messages are also associated with reduced drug use at school, but effects are weaker than those for abstinence messages. This smaller effect may be acceptable if, in the longer term, it leads to a reduction in harmful use and school dropout within the student population.

A comparison of self-reported puberty using the Pubertal Development Scale and the Sexual Maturation Scale in a school-based epidemiologic survey.

PURPOSE: To examine concordance between two self-reported measures of puberty: Sexual Maturation Scale (SMS) and Pubertal Development Scale (PDS) and their acceptability to adolescents. METHODS: Participants of a school-based study in grades 5, 7 and 9 were classified into one of 5 pubertal stages using each method. RESULTS: 2864 students (age 9-16 years) participated. Agreement was moderate for males (kappa 0.42, 95% CI 0.39, 0.45) and females (kappa 0.57, 95% CI 0.53, 0.61). Concordance within one stage was excellent (females 97%, males 89%), with discrepancies due to females being classified one stage later on the PDS (26%) and males one stage earlier (32%). There were more missing data for the SMS (13%) than the PDS (4%). CONCLUSIONS: Given the level of concordance and difficulties of using the drawings in a school-based survey, we would recommend the PDS as an alternative to assess pubertal status in epidemiological studies.

A cross-national comparison of school drug policies in Washington State, United States, and Victoria, Australia.

Using mail survey data collected from primary and secondary school administrators in Washington State, United States, and in Victoria, Australia, this study compared aspects of the school drug policy environment in the 2 states. Documented substance-use policies were prevalent in Washington and Victoria but less prevalent.in primary schools, especially in Victoria. Victorian school policy-setting processes were significantly more likely to involve teachers, parents, and students than processes in Washington schools. Consistent with expectations based on their respective national drug policy frameworks, school drug policies in Washington schools were more oriented toward total abstinence and more frequently enforced with harsh punishment (such as expulsion or calling law enforcement), whereas policies in Victorian schools were more reflective of harm-minimization principles. Within both states, however, schools more regularly used harsh punishment and remediation consequences for alcohol and illicit-drug violations compared to tobacco policy violations, which were treated more leniently.

A review of school drug policies and their impact on youth substance use.

Youth substance use is an important social and health problem in the United States, Australia and other Western nations. Schools are recognized as important sites for prevention efforts and school substance use policies are a key component of health promotion in schools. The first part of this paper reviews the known status of school policies on tobacco, alcohol and other illicit drugs in a number of Western countries and the existing evidence for the effectiveness of school drug policy in preventing drug use. The review shows that most schools in developed countries have substance use policies but that there is substantial variation in the comprehensiveness of these policies (i.e. the breadth of people, places and times of day that are explicitly subject to policy prohibitions), and the orientation of their enforcement (e.g. punitive versus remedial), both across and within schools. The few studies of policy impact focus solely on tobacco policy and provide preliminary evidence that more comprehensive and strictly enforced school policies are associated with less smoking. The second part of the paper introduces the International Youth Development Study, a new longitudinal research project aimed at comparing school policies and the developmental course of youth drug use in the United States, where drug policies are abstinence-based, with Australia, which has adopted a harm minimization approach to drug policy.