Former Territorian with a wealth of experience in alcohol and its relation to public health Peter d’Abbs - who is now Associate Professor, School of Public Health, Tropical Medicine and Rehabilitation Sciences at the Cairns campus of James Cook University - said yesterday in Crikey:Only time will tell whether the Commonwealth’s moves to cut off alcohol supplies to Aboriginal communities in the NT will restore order. In the meantime, they have exposed another, equally important need -- for better programs and more $$ to reduce demand for alcohol among Indigenous drinkers.
It isn’t surprising that governments generally have much less to say about this. There are no quick fixes, no comparable options to sending in the troops. So what are the needs, and the options?
First, the needs – and let’s begin by laying one misconception to rest. Banning alcohol in communities will not fill the streets with hundreds of deranged alcoholics tortured by withdrawal symptoms. Much Aboriginal binge drinking is opportunistic, and some of the heaviest drinkers periodically go for long periods without a drop.
The real needs are for services to help those drinkers who choose to set out on the long journey to sobriety. A few make it more or less on their own. Some come to sobriety through Christianity. But for many drinkers, trapped in cultures saturated in booze, the road out has to be just that – a road out.
But where to? A few remote communities have their own outstations where drinkers can at least dry out and enjoy some sort of cultural recharging. Most, however, will head for one of the Aboriginal-controlled rehabilitation centres scattered around the country. Some of these offer outpatient services, most are residential. Their hardworking counselors are unlikely to be highly trained, and clients probably won’t be offered the range of therapeutic interventions (including pharmacological therapies) available in more ‘mainstream’ services.
Aboriginal alcohol rehabilitation centres are the unwanted child of alcohol and other drug services. Most of their funding comes from the Commonwealth, which has been trying to back out of the role, but no state/territory government is willing to step in. So the Commonwealth is stuck with them, but lacks the expertise to embark on the kind of long-term capacity building they so badly need.
What would this entail? First, a Commonwealth/State cost-shared program is required to fund and support Aboriginal-controlled rehabilitation. The Commonwealth should use its fiscal power to make the States/Territories pay their share. The program should pursue five objectives:
- Combine evidence-based best practice with cultural acceptability;
- Enhance, through workforce development, the clinical skills, management capacity and directors’ skills of Aboriginal-controlled services;
- Break down the current walls between Aboriginal-controlled and mainstream AOD (alcohol and other drug) services
- Strengthen links between Indigenous alcohol treatment services and mental health services;
- Foster after-care services in communities, in order to provide support to ex-treatment clients on their return. At present these are conspicuously absent.
None of these measures are easy or cheap. Nor do they obviate the need for diversion and other preventive measures. But simply turning off the taps is not enough.
