It is always exciting to learn about innovative global approaches to harm reduction, prevention, and treatment for alcohol use/abuse. This year, I was fortunate enough to meet Dr. Alison Hutton, a visiting professor in the United States from Flinders University in Australia. Dr. Hutton is an Associate Professor and Associate Dean (Research) at the School of Nursing and Midwifery in Adelaide, Australia. She has been engaged in targeting alcohol-related harm reduction strategies toward youth, especially at mass gatherings called Schoolies Festivals. Many of her publications focus on this topic and are listed below (Hutton & Cusack, 2013; Hutton, Cusack, & Zannettino, 2011; Hutton, Munt, Zeitz, Cusack, Kako, & Arbon, 2010; Hutton, Ranse, Verdonk, Ullah, and Arbon, 2013; Hutton, Roderick, Munt, Mayner, Kako, & Arbon, 2012; Hutton, Savage, Ranse, Finnell, & Kub, 2015). I had the pleasure of interviewing her this month to learn more about alcohol use among youth in Australia and a unique approach to harm reduction.
Q: I Would Like to Ask You About Your Experiences Working With Harm Reduction for Adolescents in Australia. What is a Schoolies Festival in Australia?
A: Schoolies are young people, between ages 17 and 20 years, who are celebrating their completion of high school. They have a week or weekend event to celebrate their graduation. These events are similar to spring break for college students in the United States. The one difference though is that our legal drinking age in Australia is 18 years. Therefore, most of the kids are legal drinkers. For many of these Schoolies though, this may be their first experience drinking or drinking in such large gatherings.
Q: Where do the Festivals Take Place?
A: The largest Schoolies Festival is on the Gold Coast in Queensland. It has about 30,000 people each year. The two other sites are Rottnest Island in Western Australia and Victor Harbor in South Australia. This last event is the one that I have been researching over the past 5 years. The Rottnest Island is a national park, whereas Victor Harbor is a seaside town not too far from Adelaide where many people retire. It has a population of 10,000, and the population actually doubles during the Schoolies Festival. The Gold Coast is a tourist town. Tourists have actually been warned to avoid the area during the month of November because of the festival. It has quite a notorious reputation.
Q: How did These Festivals Come About?
A: In the 1970s, a Gold Coast entrepreneur started the event thinking he could make some money. Then, there were "copycat" festivals in different states. In the eastern part of Australia, young people travel up to the Gold Coast from Sydney and Melbourne; that is why this festival is larger. The one in Adelaide started organically by school leavers. In the early 1990s, a faith-based organization, Encounter Youth, decided it would be beneficial to support the Schoolies at the festivals by encouraging them to party in a safe way. The harm reduction approach stems from the activities of this group.
Q: What Are the Activities of this Faith-Based Group?
A: The basic motivation of the faith group, Encounter Youth, is about giving service to God, but in addition, the group was also concerned with creating an environment to help young people celebrate as safely as possible. This is done knowing that young people will drink alcohol and may drink to excess on one of the nights of the Festival. We have structured the environment where the Schoolies stay. There is a dry zone for Schoolies to "party" in and caravan parks where they camp. We have worked with the four caravan parks within the town. We give all of the Schoolies identification bands or arm bands to identify who should be in what park. There is also a free bus service that drives around to all caravan parks and to the dry zone. This service eliminates Schoolies driving or trying to get into other parks. It is all about keeping the Schoolies in designated areas, where they can be observed and supported. In addition, 600 youth volunteers (the Green Team [GT]) provide pastoral care to Schoolies over the 3 days of the festival. For example, they have tents and chill out rooms where the young people can come to get away within the caravan parks and the dry zone. They provide nonalcoholic beverages and also feed the Schoolies pancakes, sausages, and donuts. A big part of the pastoral care is related to helping the Schoolies have access to fluids and sustenance. They may not be looking after themselves when their primary intent is to have fun.
When Schoolies come into the dry zone, no alcohol is allowed. We realize they will drink before entering this area, so to add further protection, a dry zone exists for about 5 km around the main event area and ends at the Caravan Parks. This strategy is to prevent Schoolies walking to the event drinking alcohol in public; we also want the community to feel safe too. We do not want Schoolies to be a public nuisance. In the caravan park, Schoolies can drink, but they do so in an environment where they are observed and can call for help if need be, thus the continued presence of the green team here.
Q: What Other Strategies are Happening From a Harm Reduction Perspective?
A: When Schoolies come into the dry zone, we engage young people through using positive role modeling. The GT greet them and are very vibrant and fun; they dance with the Schoolies, give out sunglasses and dark bracelets that glow. The GT show Schoolies that they can party without alcohol and that it is important to look after your mates. The GT is split into groups, for example, the engagement group and also the recovery group who will take Schoolies to seek medical care if needed. We also work closely with the police and make them visible in a nonconfrontational way. For example, they either walk, ride bikes, or ride on horseback throughout the area so that they are accessible and visible to young people.
We also have an App that provides the bus schedules and ongoing activities such as theme nights and other activities on the weekend. The App also includes emergency numbers and information that the Schoolies may need to support themselves. We visit schools beforehand throughout the year. We talk about safe partying and how alcohol affects the body. We talk about how to not get into trouble and how to help friends. We do a lot of work focused on looking out for friends, helping and supporting them.
We do a lot of periphery work. We just started seminars with parents, focused on how they can support their adolescent children. We also provide parents with information about alcohol. One example from last year that convinces me that things are working is that there were 71 complaints to police from young people when three older men were trying to sell drugs to Schoolies. To me, this shows that what we are doing is acknowledged by Schoolies as positive and they want to be a part of protecting the safe supportive environment that has been created for them.
Q: How Many Years Have You Been Doing This?
A: For six years now, since 2008, I knew the director, and we had coffee to discuss possibilities. I really wanted to get their good work out there. I wanted to show how positive interventions can be effective. I think we sometimes focus on risk too much. In working with adolescence, it is about developing rapport and acknowledging that they are still learning and finding their feet and learn how we can support them? I do believe that creating safe supportive environments for young people is a must.
Australia has such a strong culture focused on drinking. Advertisements illustrate the benefits of drinking. We normalize it so much. I did not notice this as much in the United States when I was there. We have, for example, a lot of advertising focused on celebrations with alcohol or champagne on TV. The message we are giving young people is that celebrating with alcohol is normal. We are giving mixed messages to teens. I am really interested in having conversations about alcohol in a different way. I wanted to address how they are going to integrate alcohol into their life and, if they are going to do so, how they can do it in a safe responsible manner.
Q: When You Think About Adolescents and Their Involvement With Alcohol, I Want to Understand the Extent of Drinking in Australia. At This Festival, It is a Lot. I Am Also Interested in the Patterns of Use Overall for Adolescents
A: We do have binge drinking. In the past, we have shown that people who present for onsite care are those who have been binge drinking, more than 5 drinks in one sitting. Now, we rehydrate them and send them back into the event. We never used to do. We still do a lot of pastoral care. My research is showing that young people nominate who will "go hard" for the night. It is quite planned in terms of decision making. They decide who will be the responsible "adult," showing that drinking is quite organized. They see alcohol as their mechanism to having fun.
Q: How Have You Addressed Safety Issues in Using Excessive Alcohol?
A: We try to assure that the Schoolies avoid driving. We have a partnership with the Motor Accident Commission. They sponsor five buses to assist Schoolies commuting down to the event. It is not a lot (800 places), and it is only the tip of the iceberg, but if your get your requests in early enough, you can get a ticket to get to the site. It is 86 km of winding roads. There used to be so many accidents-we have really taken care of that. We also ask the parents to take their children down and pick them up.
For those who do drive, there is a board in each caravan park to place your car keys. Schoolies are allowed to ask the police for their keys but are required to demonstrate that they are ok to drive. This is a condition of staying in the caravan park. This strategy has been really successful. It has really enabled the Schoolies to have a positive relationship with the police. You know they have to walk "the white line," demonstrate that they are sober, and this allows a conversation with the police and allows the Schoolie to experience what it feels like to be over the limit. They may say they feel fine but realize then that they are not. This approach has been successful. There still are some people that drive though. We have not gotten to Schoolies who stay in private accommodations. We try to discourage this as much as possible. I am sure this happens all around the world. You have the "haves," those who are quite wealthy. They have accommodations in Victor Harbor because it is quite beautiful. They will invite their friends to go down there with no adult supervision. We try to go into those schools to talk about how to make their parties safe. That is the area where we still have work to do.
The other thing we do as a group-the Green Team, police, and emergency team-is to get together every hour during the festival. We talk about the areas we are concerned about. We also meet three times per year to plan the event. Every year, we evaluate our efforts-what went well and what did not go so well-and continually improve services each year.
Q: What Else Makes This so Successful?
A: The glue to this is the Green Team, young people providing pastoral care to other young people. The Green Team provides a lot of support for Schoolies, and of course, it is dependent on what the Schoolies want. A lot of my research of young people in hospitals had similar findings-young people when ill wanted nurses to be around-but as soon as they were well, they wanted to be with their friends and be left alone. I have found the same thing with the Schoolies. They really want the Green Team to be there to support them if they need them. If they don't need them, that is different. This is common adolescent behavior. They want to be given their head to do what they like but want someone to look after them if need be-it is a common thread in all of my work.
We have all gone through adolescence. Part of this journey for all of us is to work out what works and what doesn't. This still continues into adulthood. In Australia, when you are 18 years old, you are a legal adult. You can drink and drive. But the adolescents are cognitively not there yet. The core question is what can we do to provide as much support as possible? Let's support them in making safer choices. Or let's support them in thinking about the decisions they are making that may impact them for the rest of their lives. We know that young people don't think that far ahead.
Q: Do You Know if This Type of Approach is Being Used in the United States or in the World?
A: I did talk to someone in Maryland while I was visiting the United States about seniors going to Ocean City to celebrate graduation. There were individuals putting on activities so youth would not be bored. It was not really a public health model from a harm reduction minimization perspective since the legal drinking age is 21 years. I have been to Ostersund in Sweden twice to consult on their Schoolies, called Skolrslutning. For this group, the main issues were violence associated with drinking from young men. Also, the structure of this event was held in a parade, where young people showed that they had graduated from school by driving through the city on trucks drinking alcohol like a parade. However, after the parade, there was no organized activity so the result was a large group of drunken youths on the streets. Organizing an after party enabled the young people who attended this event to go to one space. In this space, they could be monitored and managed, thus reducing violent incidents and hospitalizations.
Every event will have its own issues, and it is about recognizing the motivation of the young people, the context, and the environment. Then, working with that to design and implement strategies that can support young people to be safe. What has evolved from the work with Schoolies is an awareness of what works and does not work. Youth did not necessarily want to engage in activities during the day, such as tie dying or beach volleyball. We found that food works though, and this is a safe place for engagement and connection. A lot of what we have done is informed by action research. It is important to find out what does not work and to then try other things, so it is a continually evolving process
Q: What are Your Recent Strategies Around Harm Reduction?
A: The latest work that we are doing is called, "A Lighter Night," based here in Adelaide. Every city has a night club strip or area. Here, the night club owners are quite powerful. They arrange happy hour in each club to encourage young people to go from one venue to another. For example, one place will have happy hour between 8 P.M. and 9 P.M., and the next one will have it 9 P.M.-10 P.M. They have set up a pub crawl situation. We have tried to legislate against this with no luck. The owners are quite wealthy and influential. So therefore, the "A Lighter Night" strategy is focused on using positive messages to encourage young people to change their drinking practices, to not drink as much, thus a lighter night. We give out bracelets and glow sticks so they glow in the dark as they dance. A few gimmicks! We tell them that their future is bright. Again, this campaign is focusing on positive messaging and interaction. We rolled out the program, and it has been successful. One third of the young people surveyed said they would think about organizing their nights differently and not drinking so much.
Funding for this project was through the Australian Government Binge Drinking initiative in 2013, and it rolled out in 2014/2015. The GT provides this service on a volunteer basis in partnership with the police and the Adelaide City Council. They are on the main nightclub strip every Saturday night. There are four of them, and they hand out these items and provide positive role modeling between 10 A.M. till the wee hours of the morning.
To encourage young people to evaluate this program, we gave out the bracelets, which had information about safe partying and a link to a questionnaire that young people had to go to retrospectively to fill out a survey. It is not the most rigorous design, but this research is difficult as you do not want to talk to young people when they are inebriated. We really got great results-113 filled out the survey of about 200. We approached 10 young people each night. Overall, the results were really positive.
Q: How Would Your Drinking Patterns and Stats Among Youth Compare With the United States?
A: Drinking has been reduced a little. In Australia, it is so normalized and associated with having fun. Currently, drinking initiation in Australia averages at 15; previously, it was 14. Alcohol is still the leading cause, similar to the United States, of injury in this age group. So creating safe supportive environments for young people is still very important. We need to give young people the support they need in making life decisions. It is not easy.
Q: What Challenges Have You Faced in Your Work?
A: Getting the police on board because of funding has been difficult. Since the efforts have been associated with a faith-based group, addressing sexual risk behaviors has not been easy. Documenting outcomes is always a challenge. In looking back, we do work with media around positive Schoolies stories. We do "controlled media"-what I mean by that is we do not share "horror stories" with media, we only share the good stuff-we want the media to tell the good story, not the bad one. From all of this, I am working with the police now on music festivals-it is a wider audience because we have lots of problems with drugs in this environment. The other important piece is to better understand how young people want to receive messages and how they would like to use media, so it's about staying connected and keeping health promotion messages relevant to this cohort.
All the best for now and the future,
Ally Hutton
E-mail: mailto:[email protected]
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