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Puzzling decision to cut Aboriginal alcohol and drug treatment services

Last week more than 400 people gathered in Fremantle for the second National Indigenous Drug and Alcohol Conference to share their experience in working to tackle substance misuse.  Most were Aboriginal or Torres Strait Islander.

The alcohol and drug field is not easy.  Many clients have had extraordinarily difficult lives.  And workers must accept that not everyone can be cured, or indeed wants to be cured. But there is great satisfaction in being able to help, and evidence confirms the difference that treatment makes in people’s lives.

Aboriginal communities face far too many of the risk factors for alcohol dependence, including childhood separation or trauma, lack of connectedness to society or control over life, unemployment and major ongoing stress.  And although Aboriginal people are less likely to drink than other Australians, some families or communities have severe alcohol problems.  Affected individuals typically have both physical and mental comorbidities, so Aboriginal health professionals face daunting challenges.

At the conference a Handbook for Aboriginal Alcohol and Drug Work was launched. This plain English, evidence-based guide was written with and for Aboriginal people.  It resulted from a partnership between the University of Sydney and Aboriginal and mainstream agencies. The four Aboriginal editors (out of a total of six) collectively have more than 60 years of professional experience in health, spanning treatment and prevention in urban and remote settings.  Bradley Freeburn and Steve Ella have been inducted into NSW and National Halls of Fame respectively for their work. Jimmy Perry and Warren Miller are regularly asked to teach others about their work in remote communities.

The very week the book was being printed in early May, we were stunned to learn that the Commonwealth had decided to withdraw funding from the agencies of three out of our four Aboriginal editors. Warren and Jimmy would be unemployed within three months. And this was despite the latest independent evaluation of their program recommending its expansion.  Bradley, who heads the respected Drug and Alcohol Unit at the Redfern Aboriginal Medical Service, would have to close his doors three days out of every five.  If your aim was to remove talented individuals with real capacity to make a difference, these three would have been high on your list.  And collectively these programs have unique capacity to reach the most disadvantaged Australians.

They were not alone: an estimated 90% of federally funded Aboriginal controlled alcohol and drug programs around the country had lost that funding.  This seemed to be a nation-wide kick in the guts for Aboriginal professionals who were striving to make a difference.  Several highly skilled professionals said they felt like throwing in the towel.

Aboriginal workers were all agreed that any lazy and corrupt agencies should be fixed or closed.  But, except for a small minority of services (four were mentioned by Minister Snowdon), no such accusation was made.

Widespread uproar followed and, to the Government’s credit, many of these decisions have since been reversed. But for some individuals there was a lag of over a month before they knew they would have a job in July. The emotional toll on them, their families and communities was immense.

The decision-making processes on these issues, which are key to ensuring the health of Aboriginal families and communities, need careful review.  Many workers in the field were led to question the Government’s stated respect for Aboriginal people’s right to have a say.

At the conference, Minister Snowdon defended the Department of Health and Ageing’s decision to remove funding from services by citing a story about an Aboriginal man who had relapsed to drinking after completing a period of rehabilitation. However in the best treatment services in the world, alcohol dependence cannot universally be cured.  Yet when we cannot cure cancer, people say “We need more funding for cancer research”.  But when we cannot cure every case of alcohol dependence, the message seems to be “Close down the treatment centre”.   The tale also raises questions about governments that profit from alcohol sales, are unable to effectively address risk factors for alcohol dependence or provide sufficient treatment services, then apportion all blame for the harms of drinking to the Aboriginal community.

The Government has made some important contributions to Aboriginal health workforce development.  It would be unfortunate if there were ever a repetition of the destructive series of events that recently occurred.

Many Aboriginal staff working in drug and alcohol programs still have at most three year’s job security and minimal career advancement opportunities.  One would question why they would persevere.   Luckily they do so because of a deep commitment to their people.

 

Kate Conigrave

Addiction Medicine Specialist, Public Health Physician, and Professor,

School of Medicine, University of Sydney;  a Director of the Foundation for Alcohol Research and Education, and one of the six handbook editors.

 

See an electronic copy of the handbook at:

http://sydney.edu.au/medicine/addiction/indigenous/resources

 

This article was first published on the Crikey Health blog Croakey.

 

Kate Conigrave

Kate Conigrave

Professor Kate Conigrave is an Addiction Medicine Specialist and Public Health Physician based at Royal Prince Alfred Hospital. Professor Conigrave has co-authored a clinical textbook on addiction medicine, and has many years of research experience, including on early detection and intervention for alcohol problems. She has also had the opportunity to collaborate with several Aboriginal communities in their efforts to reduce harms from substance misuse.

2 comments

  • Rehab works for people and more importantly if services workers have more than an 8 to 4.30 working mentality. Where most of the problem exists is when people return to their old environment with the peer pressure applied. For alcoholics and there are plenty out there who come into treatment abstinence is the answer and for a lot of people who are not alcoholics but end up in treatment harm minimization and early intervention will work. So a holistic approach is the best and not putting one treatment option above the other, hence the reason for treatment agencies to case manage people properly. If there is dead wood within the system get rid of them as the govt loves to reveiw the AOD field based on outcomes rather than the quality of life the people may experience.

  • Wonderful site you have here but I was wondering if you knew of any
    community forums that cover the same topics discussed here?
    I’d really love to be a part of online community where I can get advice from other experienced people that share the same interest. If you have any suggestions, please let me know. Cheers!

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