The oratory of addiction: a 30-year perspective on alcohol and drug misuse

The annual Leonard Ball Orations illustrate changing perspectives in Australia over 30 years on medical and social effects of misuse of alcohol and other substances. The first oration, in 1968, examined causal factors in the context of 'agent', 'purveyor' and 'host' and provided themes for subsequent orators. In regard to the agent (alcohol), it was proposed that availability (and cost) determined not only overall consumption within the community, but also numbers of users at hazardous levels. This principle seemed applicable to substance misuse and addictive behaviours overall. The influence of purveyors (and advertisers) was discussed with expectedly different perspectives from the liquor industry and social and health-care providers. The role of host was examined in terms of genetic predisposition, foreshadowing current experimental applications of gene transfer and disruption technologies in mice to substance misuse and the promise of the Human Genome Project in clarifying inheritance of substance misuse. Individual successes in harm reduction were described in the context of alcohol and road trauma, smoking prevention and heroin addiction. Government intervention was introduced with the 1987 National Campaign Against Drug Abuse. The focus shifted during the 1980s from alcohol to addictive drugs, in line with community concerns. The 1996 oration on the aborted Canberra trial of supervised heroin administration illustrated the need for, and problems associated with, such studies. The prescience and achievements of the Ball orators provide optimism and direction for efforts in the future.