Sociology Assignment: VAADA Agency's Role in AOD and Youth Wellbeing
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This report critically evaluates the Victorian Alcohol and Drug Association (VAADA) agency's approach to addressing alcohol and other drug (AOD) issues among at-risk youth in Australia. It begins with an introduction to the prevalence of AOD use among young people and the role of agencies like VAADA. The report then describes the agency, its vision, and the issues faced by at-risk youth, including the impact of substance use on their physical and mental health. The sources of funding for VAADA are outlined, followed by a discussion of the agency's activities, including its projects and advocacy efforts, and the public's perception of its services. The core of the report focuses on the evidence-based model employed by VAADA, specifically the ten-point action plan and cognitive behavioral therapy (CBT), detailing how these models are applied to support young people. The report concludes by summarizing the key findings and emphasizing the importance of VAADA's work in promoting youth well-being and reducing the harms associated with AOD use.

Running Head: Sociology
0
VAADA
Alcohol and Other Drugs
AOD and at-risk youth in Australia
3/12/2020
0
VAADA
Alcohol and Other Drugs
AOD and at-risk youth in Australia
3/12/2020
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Sociology
1
Contents
Introduction......................................................................................................................................2
Description of the agency................................................................................................................2
Issues in the AOD and at-risk youth in Australia............................................................................2
Where does the funding come from?...............................................................................................3
What are the activities the agency does and the people reviews towards the agency?....................3
What evidence-based model do they use?.......................................................................................5
Conclusion.......................................................................................................................................6
References........................................................................................................................................7
1
Contents
Introduction......................................................................................................................................2
Description of the agency................................................................................................................2
Issues in the AOD and at-risk youth in Australia............................................................................2
Where does the funding come from?...............................................................................................3
What are the activities the agency does and the people reviews towards the agency?....................3
What evidence-based model do they use?.......................................................................................5
Conclusion.......................................................................................................................................6
References........................................................................................................................................7

Sociology
2
Introduction
In today's, world, the population of young people is getting attracted to the use of alcohol
and the other drug and they are badly affected by that. The people are using drugs and other
substances as they get relief from the stress. So many agencies in Australia majorly focused on
the health promotion charity of the youth people are facing the issues related to the youth drug
and alcohol. The agency which has chosen for this assessment is VAADA which is the Australia
based agency and focuses on preventing the human health that is affected by AOD issues
(Hallam, et al., 2018). In this assessment evidence-based model will be choose whose description
will be given in this report and the programs and services offered by the VAADA agency will
also elaborate.
Description of the agency
VAADA stands for the Victorian Alcohol and Drug Association which is the agency in
Victoria, Australia. This agency provides the representation and advocacy of Victorian drugs and
alcohol to the policy-making bodies and the government. The main vision of this agency is to
promote the well-being of the youth people and in reducing the use of the drugs and the alcohol
so that harm associated with it can also be declined (Espelage, et al., 2014). This agency focuses
on young people and their families and helps them in preventing from escalating. VAADA
agency is prioritizing on the young people who focus on proactive engagement and treatment
retention. This agency also ensures to provide a health services system to the youth and create
capacity for services to respond to the issues related to the young AOD clients (VAADA, 2019).
Issues in the AOD and at-risk youth in Australia
It was observed in Victoria Australia there major death is causing among the youth is due
to the high consumption of drugs and alcohol. It is seen that the children between the ages of 12
to 17 are leading to death and are indulging with poor performances (Farrugia and Fraser, 2017).
They are taking illegal drugs and doing unconscious things due to depressions or anxiety. The
physical health of young people is affected due to the use of alcohol and drug and they are
engaging in high sexual behavior.
2
Introduction
In today's, world, the population of young people is getting attracted to the use of alcohol
and the other drug and they are badly affected by that. The people are using drugs and other
substances as they get relief from the stress. So many agencies in Australia majorly focused on
the health promotion charity of the youth people are facing the issues related to the youth drug
and alcohol. The agency which has chosen for this assessment is VAADA which is the Australia
based agency and focuses on preventing the human health that is affected by AOD issues
(Hallam, et al., 2018). In this assessment evidence-based model will be choose whose description
will be given in this report and the programs and services offered by the VAADA agency will
also elaborate.
Description of the agency
VAADA stands for the Victorian Alcohol and Drug Association which is the agency in
Victoria, Australia. This agency provides the representation and advocacy of Victorian drugs and
alcohol to the policy-making bodies and the government. The main vision of this agency is to
promote the well-being of the youth people and in reducing the use of the drugs and the alcohol
so that harm associated with it can also be declined (Espelage, et al., 2014). This agency focuses
on young people and their families and helps them in preventing from escalating. VAADA
agency is prioritizing on the young people who focus on proactive engagement and treatment
retention. This agency also ensures to provide a health services system to the youth and create
capacity for services to respond to the issues related to the young AOD clients (VAADA, 2019).
Issues in the AOD and at-risk youth in Australia
It was observed in Victoria Australia there major death is causing among the youth is due
to the high consumption of drugs and alcohol. It is seen that the children between the ages of 12
to 17 are leading to death and are indulging with poor performances (Farrugia and Fraser, 2017).
They are taking illegal drugs and doing unconscious things due to depressions or anxiety. The
physical health of young people is affected due to the use of alcohol and drug and they are
engaging in high sexual behavior.
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Young people also take drugs for relieving stressor to get out of emotional problems. The
accident and injuries are increasing as younger people drive ruthlessly after intoxication. The
liver of the young people get affected by this and the women have to suffer from the problem
like depression and osteoporosis (Vuong, et al., 2019). The youth is at the risk in Australia as
they are using drugs like alcohol, tobacco, and cannabis. Young people are using the alcohol and
drugs for many reasons such as for the feeling better, for fun and curiosity, etc.
Where does the funding come from?
Several sources help the agencies to work on the youth so that they get rid of the use of
alcohol and drugs. The government also helps these agencies to give better treatment and to
provide effective services to the patients so that young people get a better life. There are many
other agencies also which are dealing with the issues related to the AOD so they also provide the
funding to the agency so that they give the netter environment. The campaigns are organized to
collect the funds especially for the children program where the funding in Australia came
(Mitchell, et al., 2016).
The government department of Western Australia also helps in collecting eth funding and
also organizes the program for the care services of the Drug and Alcohol. There are many
departments of health and aging in Australia which majorly focus on the health of the women
and the children so they also provide the funding to this agency so that they provide the effective
services and effectively perform their programmers. So there are several sources of funding for
the agency VAADA and with the help of this funding, the agency works on the issues related to
the AOD and helps in ensuring to deliver the best services to the youth people (VAADA, 2019).
What are the activities the agency does and the people's reviews towards the agency?
VAADA agency has several projects in Australia which are focusing on the betterment of
the youth people who are facing the issues related to the AOD. The agency is indulging in the
four projects which are North West Melbourne primary health network, western victoria primary
health network, AOD Family violence reform resources and the Co-occurring capacity Building
project (Wishart, et al., 2019).
3
Young people also take drugs for relieving stressor to get out of emotional problems. The
accident and injuries are increasing as younger people drive ruthlessly after intoxication. The
liver of the young people get affected by this and the women have to suffer from the problem
like depression and osteoporosis (Vuong, et al., 2019). The youth is at the risk in Australia as
they are using drugs like alcohol, tobacco, and cannabis. Young people are using the alcohol and
drugs for many reasons such as for the feeling better, for fun and curiosity, etc.
Where does the funding come from?
Several sources help the agencies to work on the youth so that they get rid of the use of
alcohol and drugs. The government also helps these agencies to give better treatment and to
provide effective services to the patients so that young people get a better life. There are many
other agencies also which are dealing with the issues related to the AOD so they also provide the
funding to the agency so that they give the netter environment. The campaigns are organized to
collect the funds especially for the children program where the funding in Australia came
(Mitchell, et al., 2016).
The government department of Western Australia also helps in collecting eth funding and
also organizes the program for the care services of the Drug and Alcohol. There are many
departments of health and aging in Australia which majorly focus on the health of the women
and the children so they also provide the funding to this agency so that they provide the effective
services and effectively perform their programmers. So there are several sources of funding for
the agency VAADA and with the help of this funding, the agency works on the issues related to
the AOD and helps in ensuring to deliver the best services to the youth people (VAADA, 2019).
What are the activities the agency does and the people's reviews towards the agency?
VAADA agency has several projects in Australia which are focusing on the betterment of
the youth people who are facing the issues related to the AOD. The agency is indulging in the
four projects which are North West Melbourne primary health network, western victoria primary
health network, AOD Family violence reform resources and the Co-occurring capacity Building
project (Wishart, et al., 2019).
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The agency does several seeks such as they support the policies and the development of
the program which are engaged with the AOD, they also advocate for the change in the system,
there is some priority issue in the AOD so they provide the leadership on that issues. In the
alcohol and drugs sector, there were several relevant issues so this agency also put the major
focus on keeping the stakeholders and the members informed with these issues (Hetrick, et al.,
2017). They also support the evidence-based models and practices so that the youth people who
are using the AOD services, whose dignity can be maintained. The agency also within the AOD
sector, create the space for the collaboration.
From the annual report of this agency, it was identified that the main motive of this
agency is to promote the wellbeing of the people and reduce the harmful impact of the AOD
uses. People also have good reviews regarding this agency as it helps the people in providing
effective services and also helps them in serving good health. The young people have recovered
from the services provided by the agency and also appreciate this agency as they work with
ethical conduct and with integrity (Tremblay, et al., 2019). It is the peak organization so people
are involved in it as it gives the prevention, treatment, and rehabilitation with the activities
associated with the alcohol and drug.
People also give the values to this VAADA agency as they are very transparent in
accountably its services to its stakeholders and members. The agency is also preferable by the
youth people and their families as it is collaborating with the competitive environment. There are
the positive reviews but there are some people who also give the negative reviews regarding the
VAADA agency such as this agency facilitates in providing the planning and the development in
the sector of AOD but there were many other issues also through which the youth people are
going through and this agency is not focusing on that (Pedersen, et al., 2017). They are providing
services like counseling, diversion, Legal services, health centers but they are not putting the
major focus on the related social work which is related to the AOD sector.
What evidence-based model do they use?
This agency is using the ten-point action plan model so that they can provide the best
practices to the youth people and keep pace with the changes and the demands on the AOD
sector (Young, et al., 2015). Step 1 is to priorities young people who are mostly facing this risk
4
The agency does several seeks such as they support the policies and the development of
the program which are engaged with the AOD, they also advocate for the change in the system,
there is some priority issue in the AOD so they provide the leadership on that issues. In the
alcohol and drugs sector, there were several relevant issues so this agency also put the major
focus on keeping the stakeholders and the members informed with these issues (Hetrick, et al.,
2017). They also support the evidence-based models and practices so that the youth people who
are using the AOD services, whose dignity can be maintained. The agency also within the AOD
sector, create the space for the collaboration.
From the annual report of this agency, it was identified that the main motive of this
agency is to promote the wellbeing of the people and reduce the harmful impact of the AOD
uses. People also have good reviews regarding this agency as it helps the people in providing
effective services and also helps them in serving good health. The young people have recovered
from the services provided by the agency and also appreciate this agency as they work with
ethical conduct and with integrity (Tremblay, et al., 2019). It is the peak organization so people
are involved in it as it gives the prevention, treatment, and rehabilitation with the activities
associated with the alcohol and drug.
People also give the values to this VAADA agency as they are very transparent in
accountably its services to its stakeholders and members. The agency is also preferable by the
youth people and their families as it is collaborating with the competitive environment. There are
the positive reviews but there are some people who also give the negative reviews regarding the
VAADA agency such as this agency facilitates in providing the planning and the development in
the sector of AOD but there were many other issues also through which the youth people are
going through and this agency is not focusing on that (Pedersen, et al., 2017). They are providing
services like counseling, diversion, Legal services, health centers but they are not putting the
major focus on the related social work which is related to the AOD sector.
What evidence-based model do they use?
This agency is using the ten-point action plan model so that they can provide the best
practices to the youth people and keep pace with the changes and the demands on the AOD
sector (Young, et al., 2015). Step 1 is to priorities young people who are mostly facing this risk

Sociology
5
due to the use of high substances. The severe complexity can be reduced through stabilizing the
young people to reduce the use of this AOD and by making a positive environment. The second
step is to maximize the capacity for early intervention so that the quality treatment services can
be served to the young people and their health can be protected. The third step of this model is to
focus on proactive engagement and treatment retention. The young people can overcome the
issues when they will retain in the youth AOD treatment.
Step four of this model is to ensure that the services which are provided to the youth and
the health service system are integrated with the AOD services. The issues can be responded
effectively if the Youth AOD systems collaborate with the services and the community of the
health and community (Kennedy, et al., 2016). Step five is to increase the capacity for the
services especially for the vulnerable young people to involve the careers and families too. Step
six is to adopt the framework which is related to the evidence-based trauma so that young people
can manage the distressing symptoms. After this step seven is to maintain an emphasis on all the
behavioral change and psychosocial stability. The basic needs of young people can be met by
creating psychosocial stability.
Step eights are to create the options for the patients who are suffering from the ALOD so
that economic and social participation can be increased. Step nine is to respond to the AOD
related issues in the youth population and to build the capacity to respond to the AOD related
trends (Newton, et al., 2017). Step 10 is the last step and the basic step of the evidence-based
model which incorporates the participation of the young people and their families and provides
the quality services to them and helps in maintaining the health care services and improving
health management.
The service and care model is also used to prevent the complex mental health needs.
Several therapeutic models are related to developing and maintain psychosocial problems among
adolescents. Cognitive management therapy is used by the agency VAADA (Kelly, et al., 2015).
This theory-practice identifies the pattern through changing moods and behaviors and helps the
management in changing the reactions which are unhealthy to the health one. The person who is
suffering can be developed and overcome with the problem by this therapy as it helps in
individual patient collaborate with the therapist and relate to the changing behavior.
5
due to the use of high substances. The severe complexity can be reduced through stabilizing the
young people to reduce the use of this AOD and by making a positive environment. The second
step is to maximize the capacity for early intervention so that the quality treatment services can
be served to the young people and their health can be protected. The third step of this model is to
focus on proactive engagement and treatment retention. The young people can overcome the
issues when they will retain in the youth AOD treatment.
Step four of this model is to ensure that the services which are provided to the youth and
the health service system are integrated with the AOD services. The issues can be responded
effectively if the Youth AOD systems collaborate with the services and the community of the
health and community (Kennedy, et al., 2016). Step five is to increase the capacity for the
services especially for the vulnerable young people to involve the careers and families too. Step
six is to adopt the framework which is related to the evidence-based trauma so that young people
can manage the distressing symptoms. After this step seven is to maintain an emphasis on all the
behavioral change and psychosocial stability. The basic needs of young people can be met by
creating psychosocial stability.
Step eights are to create the options for the patients who are suffering from the ALOD so
that economic and social participation can be increased. Step nine is to respond to the AOD
related issues in the youth population and to build the capacity to respond to the AOD related
trends (Newton, et al., 2017). Step 10 is the last step and the basic step of the evidence-based
model which incorporates the participation of the young people and their families and provides
the quality services to them and helps in maintaining the health care services and improving
health management.
The service and care model is also used to prevent the complex mental health needs.
Several therapeutic models are related to developing and maintain psychosocial problems among
adolescents. Cognitive management therapy is used by the agency VAADA (Kelly, et al., 2015).
This theory-practice identifies the pattern through changing moods and behaviors and helps the
management in changing the reactions which are unhealthy to the health one. The person who is
suffering can be developed and overcome with the problem by this therapy as it helps in
individual patient collaborate with the therapist and relate to the changing behavior.
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Sociology
6
The youth who is suffering from depression and anxiety took the AOD so this cognitive
behavioral therapy model helps in recovering from the mental and health problems. This model
has majorly focused on the collaboration and active participation so that the problems related to
the AOD issues can be resolved in the cognitive terms (Brown, et al., 2016). This therapy helps
the person in changing their thinking and behavior so that they can reduce the use of the AOD.
Conclusion
It has been analyzed from the above discussion that AOD is majorly seen in the youth
population and it is due to the increasing depression and anxiety. The youth of Victoria Australia
are very much addicted to the issues of AOD and they are suffering from health issues. The
VAADA agency is the agency that mainly focuses on promoting the well-being of the youth
people and in reducing the use of the drugs and the alcohol so that harm associated with it can
also be declined. They also support the evidence-based models and practices so that the youth
people who are using the AOD services, create the space for collaboration. The physical health
of the young people is affected and their liver is getting damaged with that so the agency
VAADA has used the model of cognitive-behavioral therapy which helps the person in changing
their thinking and behavior so that they can reduce the use of the AOD.
6
The youth who is suffering from depression and anxiety took the AOD so this cognitive
behavioral therapy model helps in recovering from the mental and health problems. This model
has majorly focused on the collaboration and active participation so that the problems related to
the AOD issues can be resolved in the cognitive terms (Brown, et al., 2016). This therapy helps
the person in changing their thinking and behavior so that they can reduce the use of the AOD.
Conclusion
It has been analyzed from the above discussion that AOD is majorly seen in the youth
population and it is due to the increasing depression and anxiety. The youth of Victoria Australia
are very much addicted to the issues of AOD and they are suffering from health issues. The
VAADA agency is the agency that mainly focuses on promoting the well-being of the youth
people and in reducing the use of the drugs and the alcohol so that harm associated with it can
also be declined. They also support the evidence-based models and practices so that the youth
people who are using the AOD services, create the space for collaboration. The physical health
of the young people is affected and their liver is getting damaged with that so the agency
VAADA has used the model of cognitive-behavioral therapy which helps the person in changing
their thinking and behavior so that they can reduce the use of the AOD.
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References
Brown, A., Rice, S. M., Rickwood, D. J., & Parker, A. G. (2016). Systematic review of barriers
and facilitators to accessing and engaging with mental health care among at‐risk young
people. Asia‐Pacific Psychiatry, 8(1), 3-22.
Espelage, D. L., Low, S., Rao, M. A., Hong, J. S., & Little, T. D. (2014). Family violence,
bullying, fighting, and substance use among adolescents: A longitudinal mediational
model. Journal of Research on Adolescence, 24(2), 337-349.
Farrugia, A., & Fraser, S. (2017). Young brains at risk: Co-constituting youth and addiction in
neuroscience-informed Australian drug education. BioSocieties, 12(4), 588-610.
Hallam, K. T., Landmann, O., Hall, K., Kutin, J., Bruun, A., & Ennis, D. (2018). The Victorian
youth needs census: Report on the needs and characteristics of young people in the youth
alcohol and other drug system in 2016–2017. Melbourne, Australia.
Hetrick, S. E., Bailey, A. P., Smith, K. E., Malla, A., Mathias, S., Singh, S. P., ... & Moro, M. R.
(2017). Integrated (one‐stop shop) youth health care: Best available evidence and future
directions. Medical Journal of Australia, 207(S10), S5-S18.
Kelly, J., Davis, C., & Schlesinger, C. (2015). Substance use by same sex attracted young
people: Prevalence, perceptions and homophobia. Drug and Alcohol Review, 34(4), 358-
365.
Kennedy, D. P., Hunter, S. B., Osilla, K. C., Maksabedian, E., Golinelli, D., & Tucker, J. S.
(2016). A computer-assisted motivational social network intervention to reduce alcohol,
drug and HIV risk behaviors among Housing First residents. Addiction science & clinical
practice, 11(1), 4.
Mitchell, P. F., Kutin, J. J., Daley, K., Best, D., & Bruun, A. J. (2016). Gender differences in
psychosocial complexity for a cohort of adolescents attending youth-specific substance
abuse services. Children and Youth Services Review, 68, 34-43.
7
References
Brown, A., Rice, S. M., Rickwood, D. J., & Parker, A. G. (2016). Systematic review of barriers
and facilitators to accessing and engaging with mental health care among at‐risk young
people. Asia‐Pacific Psychiatry, 8(1), 3-22.
Espelage, D. L., Low, S., Rao, M. A., Hong, J. S., & Little, T. D. (2014). Family violence,
bullying, fighting, and substance use among adolescents: A longitudinal mediational
model. Journal of Research on Adolescence, 24(2), 337-349.
Farrugia, A., & Fraser, S. (2017). Young brains at risk: Co-constituting youth and addiction in
neuroscience-informed Australian drug education. BioSocieties, 12(4), 588-610.
Hallam, K. T., Landmann, O., Hall, K., Kutin, J., Bruun, A., & Ennis, D. (2018). The Victorian
youth needs census: Report on the needs and characteristics of young people in the youth
alcohol and other drug system in 2016–2017. Melbourne, Australia.
Hetrick, S. E., Bailey, A. P., Smith, K. E., Malla, A., Mathias, S., Singh, S. P., ... & Moro, M. R.
(2017). Integrated (one‐stop shop) youth health care: Best available evidence and future
directions. Medical Journal of Australia, 207(S10), S5-S18.
Kelly, J., Davis, C., & Schlesinger, C. (2015). Substance use by same sex attracted young
people: Prevalence, perceptions and homophobia. Drug and Alcohol Review, 34(4), 358-
365.
Kennedy, D. P., Hunter, S. B., Osilla, K. C., Maksabedian, E., Golinelli, D., & Tucker, J. S.
(2016). A computer-assisted motivational social network intervention to reduce alcohol,
drug and HIV risk behaviors among Housing First residents. Addiction science & clinical
practice, 11(1), 4.
Mitchell, P. F., Kutin, J. J., Daley, K., Best, D., & Bruun, A. J. (2016). Gender differences in
psychosocial complexity for a cohort of adolescents attending youth-specific substance
abuse services. Children and Youth Services Review, 68, 34-43.

Sociology
8
Newton, N. C., Champion, K. E., Slade, T., Chapman, C., Stapinski, L., Koning, I., ... &
Teesson, M. (2017). A systematic review of combined student‐and parent‐based
programs to prevent alcohol and other drug use among adolescents. Drug and alcohol
review, 36(3), 337-351.
Pedersen, M. U., Thomsen, K. R., Pedersen, M. M., & Hesse, M. (2017). Mapping risk factors
for substance use: Introducing the YouthMap12. Addictive behaviors, 65, 40-50.
Tremblay, J., Bertrand, K., Blanchette-Martin, N., Rush, B., Savard, A. C., L’espérance, N., ... &
Genois, R. (2019). Estimation of needs for addiction services: A youth model. Journal of
Studies on Alcohol and Drugs, Supplement, (s18), 64-75.
VAADA (2019) Annual Report. Retrieved from:
https://www.vaada.org.au/wp-content/uploads/2019/05/PUB_VAADA-Annual-Report-
2018-WEB_01092018.pdf
Vuong, T., Ritter, A., Hughes, C., Shanahan, M., & Barrett, L. (2019). Mandatory alcohol and
drug treatment: What is it and does it work?. Bulletin No.
Wishart, M., Davis, C., Pavlis, A., & Hallam, K. T. (2019). Increased mental health and
psychosocial risks in LGBQ youth accessing Australian youth AOD services. Journal of
LGBT Youth, 1-19.
Young, J. T., Arnold-Reed, D., Preen, D., Bulsara, M., Lennox, N., & Kinner, S. A. (2015).
Early primary care physician contact and health service utilisation in a large sample of
recently released ex-prisoners in Australia: prospective cohort study. BMJ open, 5(6),
e008021.
8
Newton, N. C., Champion, K. E., Slade, T., Chapman, C., Stapinski, L., Koning, I., ... &
Teesson, M. (2017). A systematic review of combined student‐and parent‐based
programs to prevent alcohol and other drug use among adolescents. Drug and alcohol
review, 36(3), 337-351.
Pedersen, M. U., Thomsen, K. R., Pedersen, M. M., & Hesse, M. (2017). Mapping risk factors
for substance use: Introducing the YouthMap12. Addictive behaviors, 65, 40-50.
Tremblay, J., Bertrand, K., Blanchette-Martin, N., Rush, B., Savard, A. C., L’espérance, N., ... &
Genois, R. (2019). Estimation of needs for addiction services: A youth model. Journal of
Studies on Alcohol and Drugs, Supplement, (s18), 64-75.
VAADA (2019) Annual Report. Retrieved from:
https://www.vaada.org.au/wp-content/uploads/2019/05/PUB_VAADA-Annual-Report-
2018-WEB_01092018.pdf
Vuong, T., Ritter, A., Hughes, C., Shanahan, M., & Barrett, L. (2019). Mandatory alcohol and
drug treatment: What is it and does it work?. Bulletin No.
Wishart, M., Davis, C., Pavlis, A., & Hallam, K. T. (2019). Increased mental health and
psychosocial risks in LGBQ youth accessing Australian youth AOD services. Journal of
LGBT Youth, 1-19.
Young, J. T., Arnold-Reed, D., Preen, D., Bulsara, M., Lennox, N., & Kinner, S. A. (2015).
Early primary care physician contact and health service utilisation in a large sample of
recently released ex-prisoners in Australia: prospective cohort study. BMJ open, 5(6),
e008021.
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