Professor John Toumbourou, Chair in Health Psychology at Deakin University and co-leader of the SEED Research Centre, recently appeared on The Unnecessary Harm Podcast to discuss his decades of prevention science research. During the conversation, he traced his journey from studying recovery in the 1990s to championing evidence-based approaches that have achieved measurable reductions in youth substance use across Australia.

At the same time, the podcast episode coincides with the publication of a significant research paper co-authored by Professor Toumbourou with Shane Varcoe (Dalgarno Institute) and Elizabeth Jane Doery. Published in the International Journal of Mental Health and Addiction, “Prioritising Abstinence-Based Prevention, Regulation, and Recovery to Reduce Substance-Related Harm and Promote Mental Health at a Population-Level” highlights the evidence base and policy framework that emerged from this body of research.

Professor Toumbourou will be speaking at the Drug Advisory Council of Australia’s Cocktail Reception and Oration at Kew Golf Club on Tuesday 14th October at 6:00 pm, alongside Dr Philip Drum and Paul D. Santamaria KC.

Book at : www.trybooking.com/DEXGT or

Visit: https://drugadvisorycouncilaustralia.org.au/

From Recovery Research to Prevention Science

On the podcast, Professor Toumbourou described how his doctoral research at the Odyssey House therapeutic community exposed him to the devastating impact of addiction. “I really wanted to get to the bottom of what’s going on, what sort of reasons do people have for starting to use drugs and then how can we help them recover,” he explained. “That’s been a real feature of what I’ve been interested in my career.”

Witnessing the difficulties many faced in achieving lasting recovery catalysed a shift in his thinking. Rather than accepting substance use as inevitable, he began asking: what if we could prevent these problems from developing in the first place?

This question led to longitudinal studies comparing Australian and American youth. The research revealed that adolescent substance use patterns differed dramatically between countries with different policy approaches.

Australia’s Policy Shift: The Evidence

During the podcast conversation, Professor Toumbourou detailed how until 2009, Australia’s policies were dominated by approaches that assumed preventing adolescent substance use was impossible. This led to substantially higher rates of alcohol, tobacco and overall substance use compared to demographically matched American peers.

“At that stage, the mindset in Australia was that the Americans had it all wrong, that really there was no way that you would ever stop young people using drugs,” Professor Toumbourou explained. “And so many people would say to you, well, it’s inevitable they’re going to do it. And so we might as well just try and minimise the number of them getting into trouble with it.”

The research identified that the same risk factors predicting substance use in the United States also operated in Australia. “It became very clear that we just had it wrong. Our policies were just wrong,” he said on the podcast.

The newly published paper documents how the movement towards abstinence-based prevention was associated with large reductions in adolescent alcohol and other drug use across Australia from 2002 to 2015. Large school trials demonstrated that rates of adolescent heavy alcohol use could be reduced by 25% through parent education that discouraged adults from supplying and supervising adolescent alcohol use.

The increasing rates of adolescent alcohol abstinence resulted in generational changes whereby recent young adult populations have reduced rates of alcohol use and associated problems. Young people who didn’t begin using substances during adolescence largely continued those patterns into adulthood.

[Listen to the full podcast episode with Professor John Toumbourou on The Unnecessary Harm Podcast to hear his personal journey through prevention science research]

Why Abstinence-Based Prevention Works

The published research paper outlines clear life-course benefits of prioritising a substance-free approach. Longitudinal research shows that adolescents and young adults with low rates of substance use experience better mental health through their adult lives and make larger contributions to social capital and social cohesion.

For children, the benefits are particularly stark. The paper documents how increasing numbers of children worldwide are harmed through exposure to parental substance use, including household tobacco smoke, foetal alcohol problems, and impacts of parent alcohol use. Cannabis legalisation has been causally associated with increased birth deformities and child development problems.

On the podcast, the conversation touched on the UN Convention on the Rights of the Child Article 33, which acknowledges that children should be kept away from any drug-using environment.

The Role of Regulation

During the podcast discussion, Professor Toumbourou explained how effective abstinence-based prevention requires robust regulatory frameworks. The published paper presents evidence that public health is improved through interventions to restrict alcohol markets. This includes raising minimum purchase ages, enforcing sales regulations, and restricting marketing.

“We still have about double the rate of young people using alcohol in high school compared to the US,” Professor Toumbourou noted on the podcast. “And it’s not rocket science what they’re doing in the US to reduce alcohol use, one of them is to have an age 21 legal drinking age. It can be done just with the Premier’s approval tomorrow, it could happen.”

The tobacco control experience provides a template. Australia achieved some of the world’s lowest smoking rates through consistent, population-level messaging combined with regulatory restrictions and treatment support.

Cannabis policy presents a different picture. Professor Toumbourou stated on the podcast: “With medical cannabis, there has been absolutely no regulatory research to investigate any therapeutic benefits. It’s been brought in through lobbying. And so it’s now become incredibly popular. People are being sold actually a poison and told that it’s medicine. And this needs to be called out.”

The research paper documents how the worldwide trend toward cannabis liberalisation and legalisation has been associated with increased adult use, disorders, and various adverse outcomes including cancer and birth defects.

Communities That Care Model

The published paper highlights the Communities That Care model as demonstrating how prevention can be systematically implemented across large populations. Professor Toumbourou serves as director of Communities That Care Limited.

A US community trial showed that implementation led to significant reductions in adolescent substance use and antisocial behaviour, yielding a $12.88 return for each dollar invested. When predicted downstream economic benefits of increased college completion were included, returns exceeded double this amount.

Large community trials in Australia demonstrated that adolescent alcohol use can be reduced by 10% and abstinence intentions significantly increased using the Communities That Care model. These programmes work by strengthening protective factors and increasing adolescent social bonding to community members with healthy attitudes and behaviours.

Evidence for Abstinence-Based Treatment

The research paper reviews a Cochrane review that found high-quality evidence that programmes such as Alcoholics Anonymous and Twelve Step Facilitated treatment have superior effects to alternative clinical interventions in supporting long-term abstinence from alcohol use. Randomised controlled trials showed improved rates of continuous abstinence at 12 months by 21%, with this effect consistent at both 24 and 36 months.

“In Australia, our level of advocacy for these types of very effective programs is really low,” Professor Toumbourou said on the podcast. “They have real difficulty cutting through the service environment in Australia.”

The paper argues for better integration between prevention and recovery approaches, noting that both emphasise that substance-free living is achievable and beneficial. Both recognise the importance of community support, moral recovery, and addressing underlying trauma or social determinants.

Population-Level Targets

The research paper proposes clear, measurable targets across life-course periods:

• Childhood: Fewer children exposed to parental substance use
• Adolescence: Increased numbers of young people remaining substance-free
• Young adults and parents: More choosing to remain abstinent during conception and child-rearing years
• Adults: Fewer harmed by substance use, with recovery becoming more common and comprehensive

The paper emphasises that abstinence-based approaches should be targeted to address community inequalities, embrace diversity, and enhance inclusion, particularly in families and communities experiencing socioeconomic disadvantage and in regional and remote locations.

Three Key Changes for Policy

The published research identifies three key changes needed to realise the full potential of abstinence-based prevention:

First, economic modelling and public health planning must identify equitable and effective community investment strategies. Research should compare the costs and benefits of alternative models for maximising population health outcomes.

Second, funding and policy support should continue to trial and advance integrated system models. Coalition-based programmes like Communities That Care can be adapted to target adult issues including substance sales, marketing and regulation in retail, sporting, socialisation and workplace settings.

Third, treatment services should expand abstinence-based options including therapeutic communities, facilitated twelve-step models, peer recovery coaching and counsellor referrals to fellowship groups. Workforce opportunities should include recovered individuals who provide social norms reinforcing substance-free living.

The Fence or the Ambulance?

At the end of the podcast, host Shane Varcoe asked Professor Toumbourou a question he poses to most guests: “The fence or the ambulance? The fence at the top of the cliff or the ambulance? Which one or both?”

Professor Toumbourou’s response encapsulates his research approach: “You’ve heard me say very much where to invest would be in the fence. So that’s where I put my career. It doesn’t mean that you’re against the proper use of an ambulance, but it’s absolutely going to be impossible if you think that the only answer is going to be just to forget the fence and only use the ambulance. So, I absolutely believe in prevention and I can see ways that we can get to a point where all of these things work together harmoniously in a community level.”

Hear More at the October Event

Professor Toumbourou will expand on this research at the Drug Advisory Council of Australia’s Cocktail Reception and Oration at Kew Golf Club on Tuesday 14th October at 6:00 pm. He will be speaking alongside Dr Philip Drum and Paul D. Santamaria KC.

This event offers an opportunity to hear directly from one of the world’s leading prevention science researchers. Professor Toumbourou was awarded the prestigious International Society for Prevention Research President’s Award in 2023 for his lifetime contribution to prevention science.

Book your place at www.trybooking.com/DEXGT or

Visit: https://drugadvisorycouncilaustralia.org.au/

Conclusion

The evidence presented in the research paper and discussed on the podcast demonstrates that substance use amongst children and adolescents is not inevitable. Population-level reductions are achievable when communities, schools, families and regulatory frameworks align around the goal of keeping young people substance-free.

As Professor Toumbourou stated on the podcast about the recently published paper: “This has really been the culmination of that, to be able to write this paper and to know actually that to write it with great confidence, which is really I do believe this paper provides it’ll provide a clear direction for drug policy for the next 10 years and will really shine a light for brighter futures internationally.”

To explore this research further:

• Listen to the full conversation on The Unnecessary Harm Podcast with Professor John Toumbourou discussing his prevention science journey
• Read the complete research paper in the International Journal of Mental Health and Addiction: “Prioritising Abstinence-Based Prevention, Regulation, and Recovery to Reduce Substance-Related Harm and Promote Mental Health at a Population-Level” by Toumbourou, J.W., Doery, E.J., and Varcoe, S.
• Attend the event on Tuesday 14th October at 6:00 pm at Kew Golf Club where Professor Toumbourou will be speaking. Book at www.trybooking.com/DEXGT

For more information on protecting children from drug exposure, see the Eindhoven Declaration: https://www.youtube.com/watch?v=0oJD1UM7sYA&t=5s