Addressing Harmful Alcohol & Other Drug Use Among Indigenous Australians Dennis Gray (Ted Wilkes)

1. Addressing Harmful Alcohol & Other Drug Use Among Indigenous Australians Dennis Gray (Ted Wilkes)

2. Associate Professor Ted Wilkes

3. http://www.aihw.gov.au/closingthegap/

4. The social context of harmful AOD use among Indigenous Australians Patterns of Indigenous AOD use Strategies to address harmful use Facilitators and barriers to intervention Gaps in service provision AIMS To provide an overview of:

5. Clinical (Diagnostic and Statistics Manual of Mental Disorders – DSM-IV) Substance misuse Substance dependence Public Health Harmful use (misuse) is any use of alcohol or other drugs that impacts negatively on the health, social and emotional well being of users themselves and others Harmful Alcohol and Other Drug Use Definitions

6. Alcohol consumption is increasing 20% of Australians report drinking to the point of intoxication at least once per month Alcohol accounts for 3.2% of the total burden of disease (males 4.9%, females 1.6%) 45% of perpetrators and 43% of victims of assault were intoxicated at the time of the event Alcohol costs the community in excess of $15,318 m per year Harmful AOD use: Not Just an Indigenous Problem

7. Estimated per capita adult alcohol consumption, 1994–98 and 2009

8. Estimated numbers and age standardised population rates (per 10,000) of alcohol attributable deaths for adults (≥15 years), 2005

9. Estimated numbers and crude population rates (per 10,000 Indigenous residents) of alcohol attributable deaths for adults by (former ATSIC Zones) 2000–04

10. Social determinants of Health & AOD Use

11. Alcohol dependence, illicit drug use and cigarette smoking are all closely associated with markers of social and economic disadvantage. (Wilkinson & Marmot 2003:24)

12. Estimated Indigenous to non-Indigenous outcomes 2041

13. Prevalence of recent alcohol and other drug use, persons aged ≥15 years

14. Indigenous to non-Indigenous hospitalisation rate ratios for tobacco and alcohol related conditions

15. Changes in prevalence of recent AOD use

16. Address the underlying structural determinants Prevent or minimise the up-take of harmful use Provide safe care for those who are intoxicated Provide treatment for those who are dependent Support disabled or cognitively impaired Support those whose lives are affected by the others’ harmful use Strategies to Prevent Harmful AOD Use Among Indigenous Australians

17. Strategic Platforms/Building blocks (a) Early Childhood (b) Schooling (c) Health (d) Economic Participation (e) Healthy Homes (f) Safe Communities (g) Governance and Leadership

19. Based on the principle of harm minimisation encompassing Supply reduction Demand reduction Harm reduction National Drug Strategy Aboriginal & Torres Strait Islander Peoples Complementary Action Plan

20. Enhanced capacity Whole-of-government commitment – in collaboration with the community-controlled sector Substantially improved access to services A range of holistic approaches – locally available and accessible Workforce initiatives Sustainable partnerships in research, monitoring, evaluation and dissemination Complementary Action Plan Key Result Areas

23. Strategies to disrupt the production and supply of illicit drugs, and the control and regulation of licit substances Supply Reduction

24. Price controls  Trading hours  Outlet density  Dry community declarations  Local dry area bans  Liquor licensing accords / Other legislation and enforcement  Supply Reduction

25. Strategies to prevent the uptake of harmful drug use, including abstinence orientated strategies and treatment to reduce drug use Demand Reduction

26. The most unspeakable truth for open and honest drug education is that drug use is often fun, exciting, rewarding, pleasurable, usual, risky, ‘deviant’, social, tough, status-full and naughty. (O’Connor & Saunders 1992:169) A Troublesome Truth

27. Early intervention  Alternatives to alcohol and other drug use  Education and persuasion  Treatment  Residential treatment On-going care  Demand Reduction

28. Strategies to reduce drug-related harm to individuals and communities Harm Reduction

29. Community patrols  Sobering-up shelters  Care for the physically and cognitively impaired  Harm Reduction

31. Indigenous support and control Responsive to local community needs Adequately resourced and supported Cater for clients with complex needs Provide on-going care Balance broad-based and substance specific services Be part of a planned, integrated set of interventions Factors facilitating efficacy

32. Short-term, one-off funding Provision of services in isolation Failure to develop Indigenous capacity Limited, up-to-date research and data Barriers to efficacy

33. Gaps in Service Provision

34. Many of key result areas of Complementary Action Plan not achieved Inadequate access to a full range of services High levels of non-recurrent funding and lack of continuity in service provision Lack of on-going care Treatment services for women and young people Lack of planning Gaps in Service Provision

35. The underlying social determinants need to be addressed There is a range of effective strategies available to reduce harmful AOD use Communities need to be provided with the full range of services We know what works – what is needed is a commitment to work with Indigenous communities to do it Conclusions

36. Addressing Harmful Alcohol & Other Drug Use Among Indigenous Australians Dennis Gray (Ted Wilkes)