This is a transcription of a presentation delivered by Professor Kate Conigrave and her colleague Peter Jack, on behalf of Addiction Medicine at the University of Sydney, to the House of Representatives Inquiry into the harmful use of alcohol in Aboriginal and Torres Strait Islander communities on 5 September 2014.
Peter and I have between us over fifty years of experience working in the alcohol and other drugs field – including in urban, regional and remote settings around Australia.
Peter has worked in residential rehabilitation and a variety of community services, including programs taking young offenders to work along the SA ‘dog fence’ through to adult prisoner support. I am an Addiction Medicine specialist, and so see patients, and a Public Health Physician.
Alcohol related harms are a source of concern to Aboriginal and Torres Strait Islander communities, and many have attempted to reduce these harms.
Worldwide research tells us that individuals who face past or present traumas or who lack a sense of control and connectedness face an increased risk of alcohol-related harms.
We now understand the neurobiological mechanisms at the core of the ‘strong, sometimes overpowering’ desire to drink in alcohol dependence. This understanding has led to the development of relapse prevention medicines which offer improved treatment outcomes.
However even with cutting edge treatment, alcohol dependence remains a challenge. It typically behaves as a chronic, relapsing disorder. Yet alcohol dependence is rarely included on the chronic disease agenda and efforts in prevention and early detection lag behind those for chronic physical disease.
It is important that policies relating to alcohol dependence are based on realistic expectations of outcomes. International studies show that less than half the individuals completing a residential detoxification can maintain continuous abstinence for the next 90 days. Yet without modern medicines or outreach support this percentage can be as low as one in six.
Given these figures, it is disturbing to see a criminal rather than a health model being applied in Australia for alcohol dependence. This is most noticeable with alcohol protection orders in the NT. Also of concern is the expansion of mandatory treatment despite limited evidence for its effectiveness and limited access to voluntary treatment.
Currently, over 40% of Indigenous prison inmates report symptoms of alcohol dependence. But most prisons still do not offer comprehensive alcohol treatment. Furthermore, based on US experience in justice reinvestment, the money spent on imprisonment would be more effectively used supporting families at risk and increasing opportunities for youth employment and resilience building.
Accessing treatment for alcohol dependence is an ongoing challenge. In rural NSW individuals may travel more than six hours to access residential services. Lack of childcare or family friendly services pose a challenge, and residential youth programs are scarce. Furthermore, many services do not accept individuals with complex physical or psychiatric illness and this complexity is more common among Indigenous Australians.
Paradoxically withdrawal management services and rehabilitation services are often separate. Many patients face a gap of several weeks after detox before they can access a rehab bed, during which time they often relapse to drinking.
Aboriginal community controlled services and Aboriginal staff have a unique ability to improve treatment access and to provide culturally appropriate care. However historically Indigenous services suffer from inadequate and insecure funding. This stands in the way of maintaining professional staffing and development.
Of course not all problem drinkers are dependent on alcohol, and broad-based preventive initiatives are crucial.
Controlling the accessibility of alcohol is the best proven way to reduce alcohol-related harms. Taxation can reduce the availability of cheap high volume alcohol, which is a concern around Australia.
Local alcohol supply controls can also be applied and do NOT have to be discriminatory. Any community – white or black, urban or remote – with a high burden of alcohol-related harms can have its supply of alcohol restricted, with measures ranging from reduced opening hours through to complete restriction.
To ensure public confidence in government decision making, political donations from the alcohol industry need to be stopped. Also communities, and women in particular, need to be supported to have a greater input in government consultation and in liquor licensing hearings.
In conclusion, there is a pressing need for bipartisan, long term action on alcohol, designed in partnership with communities, to prevent ongoing harms from alcohol to Aboriginal and Torres Strait Islander Australians.