Dr. Sharon Lambert:

The reality is that research we have done in this jurisdiction and abroad shows the level of mental health issues among people who access addiction services is between 80% and 90%. Not everyone who has ended up in substance dependence has experienced trauma, though a large number has. We have not looked at this yet, but we potentially have many older men and women who are in addiction who have undiagnosed autism or other neurodivergence. We live in quite a social country where people have to go the pub to drink and if they do not, there is something wrong with them. How many men and women of the 1980s and 1990s were alcoholics as a result of us not understanding that? People have to change and adapt to the culture around them by drinking and that will have a totally different impact.

The other matter we need to look at is menopause in women. Women who enter addiction treatment services are often older. Sometimes that is because, as Ms Kearney said, they cannot look for help if they are mothers, because their children might be taken away from them. The other thing we know is that women who are entering menopause are drinking more because menopause is having a detrimental impact on their mental health. These things cannot be easily separated. There was always a view that drug use caused mental health problems, but actually a huge study by Kessler et al that looked at thousands of people found that the majority of mental health issues start before the age of 18 and the majority of substance use dependence diagnoses happen after the age of 18. Studies of cannabis use and youth mental health were mentioned earlier. Correlation is not causation. If someone comes to a service and says, "I had psychosis", these are the things we do not know. If I go into hospital tomorrow and am having a psychotic incident and I am tested for drugs - which we rarely do because if someone says they have used cannabis and that is why they are psychotic, we accept it - we will not always know whether it is one of those new psychoactive substances. I might test positive for THC, but there might have been something contaminating the cannabis that we do not know about. We therefore have to be very careful about how we interpret information and the expertise of the people using it. Are they coming from a biomedical model? The issues are across the bio-psycho-social area. We are not doing enough to support people with a dual diagnosis.