title: A Multi-criteria Framework for Analysing Cross-cultural Differences in Adolescent Drug Policy
Creators: name: Wong, Gabriel
Publisher: name: Griffith University
Year: 2017
Subjects: subject: Adolescent drug policy
subject: Drug involvement
subject: Accumulation of harm
subject: DHP model

description: Adolescent drug involvement and its associated harms reflect a dynamic and multifaceted phenomenon, which makes holistic policy decisions and trade-offs of intended and unintended policy impact difficult to manage. Drug prevention scientists commonly perceive the involvement of drugs as a continuum with consecutive stages from non-use to dysfunctional use. Each of these stages reflects a unique system of risks and harms (in personal, social and environmental domains) which is specific to the subpopulation within the culture. Hence, for drug intervention to be effective, it is crucial that the design and selection of policies are risk-and-harm-focused and contextually relevant to the problem. In order to address these complex risks and harms in a culturally acceptable and contextually practical manner, policymakers demand empirical evidence and input and contribution from experts with extensive knowledge, expertise and substantial experience in the related area. Not only are experts considered as a source of evidence, but their opinions, if not accommodated adequately, may facilitate public objections that affect the implementation and ultimate success of a policy. In other words, an endpoint of a policy can be directly or indirectly driven/influenced by inputs from a variety of sources, including evidence (scientific studies and economic analyses) and the opinions and preferences of effectiveness of available policy options as judged by experts, coupled with general public opinion, which can also be influenced by expert opinion. A better understanding of how experts perceive the drug problem and prefer alternative drug policy is therefore pivotal. This research aims to solicit key expert and stakeholder attitudes regarding: (1) the dynamic risks and harms of drug involvement at each stage; and (2) the effectiveness of alternative interventions used to respond to illicit drug use and its associated harms among adolescents in two very distinct regions (Hong Kong and Australia). The two regions differ considerably with regard to their drug policies. Australia perceives a general normalisation of consumption and focuses on the goal of overall harm reduction, while Hong Kong maintains a zero tolerance approach, favouring prevention, treatment and prohibition options. Using the Dynamic Hierarchy Process (DHP), which is a method for multi-criteria analysis, regional differences in the epidemiological pattern and potential heterogeneity of key expert preferences for 19 drug interventions were examined. The DHP decomposes the complex multi-attribute drug problem into its constituent parts (i.e. risk factors and policy alternatives) and develops a comprehensible and manageable hierarchy of the decomposed decision problem. As a method commonly used in the field of decision sciences, DHP seeks to capture and synthesise diverse knowledge and opinion from experts that do not necessarily agree on the choice of policy alternatives. In this research, 83 experts (41 from Australia and 42 from Hong Kong) were randomly selected from a list of eligible organisations in three key sectors (research, health and law enforcement) to complete the survey. Experts were asked to: (1) weight multiple risk factors with their relative influence in the accumulation of harms and consequences among adolescents at different stage of drug involvement (non-use, priming, initial use, experimental use, occasional use, regular use and dysfunctional use); and (2) rate the effectiveness of 19 drug interventions in addressing the identified risks and harms. Regional differences among experts were found to be concerned with regard to personal factors (e.g. temperament), social factors (e.g. general social trust and neighbourhood social capital), and environmental factors (e.g. risks and harms associated with party drug subculture and hidden drug use). Hong Kong experts were more likely than Australians to prefer media campaigns, school-based drug education programs, drug testing in schools and the community, crackdowns and raids, and intensive policing, while Australian experts gave higher preference scores to community programs, family-focused interventions, peer-led support programs, needle syringe programs (NSPs), controls on precursor chemicals, and brief interventions. Overall, experts from both regions agreed on the need for outreach programs, family-focused interventions, community programs, peer-led support programs, and drug therapy in interrupting drug involvement and mitigating its associated harms. Collectively, the experts believed that prohibition and drug testing options are not adequate solutions for adolescent drug problems. The findings of this research highlight a challenge for policymakers in accommodating diverse preferences among stakeholders. The results, however, do assist policymakers in understanding the profound knowledge our experts possess. Results assist in building robust policy that is informed by empirical evidence generated by a methodology/tool that is commonly used in the decision-making sciences. Importantly, this study assists in understanding the influence of key factors that are crucial in interrupting the progression of drug involvement and the accumulation of harm. Focusing on the preferences for policy alternatives, the DHP model developed in this study provides an opportunity for experts to reveal the potential intended and unintended consequences of various policies. These preferences were generally consistent with existing evidence, but when they were not, the expert preferences highlighted major cultural or moral barriers to the implementation of certain forms of interventions (e.g. needle syringe programs or decriminalisation of drug use and possession).