Contingency Management To Affect Social Determinants Of Health And Treatment Of Substance Use Disorders

Background: In New South Wales, 40% of the Indigenous community have outstanding debt with the State Debt Recovery Office (SDRO). Indigenous drivers’ licences are suspended over fines at a rate of more than three times that of non-Indigenous drivers. This can impact mobility, and ability to get to work and study commitments. One mitigating measure, however, is the Work and Development Order (WDO), an arrangement by which eligible clients can pay off their debt by engaging in approved treatment or training. The aim of this study was to examine the use of WDOs in the Directorates of Primary and Integrated Health and Mental Health, and implement their use at the Aboriginal Health Centre in La Perouse. Method: Data was obtained from the State Debt Recovery Office to determine how many WDOs were active across the Directorates, as well as the amount of fine debt and WDO credits earned. Interviews were conducted with clinicians and service managers, and community elders and members at La Perouse. Results: Across the two Directorates, as of November 2014 there were 486 WDOs covering a total fine debt of $1,851,343.91. WDO credits of $1,084,476.99 were earned. Drug and Alcohol Services opened the majority of WDOs. Several issues were identified, including problems with documentation and the setting out of expectations and boundaries with clients. WDOs were not offered at La Perouse. Keywords: addiction, drugs, alcohol, behaviour change, equity, inequity Key Messages 1. Fine debt and loss of drivers' licence negatively affects social determinants of health 2. The Indigenous community in NSW is disproportionately affected by fine debt 3. WDOs can mitigate this effect and assist in engagement in treatment

Abigail Yang