Introduction
Several priority groups in Australia face higher risks of experiencing disproportionate harms associated with alcohol and drug use. A good example is the Aboriginal and Torres Strait Islander peoples (or the indigenous Australians). Several studies have established that the rate of alcohol and drug use among the indigenous is higher than among the non-indigenous Australians. Several factors can be attributed to these findings, most of which are associated with socioeconomic factors. Lower incomes and higher representation of the aboriginals in the country’s prisons are among the key determinants of the higher vulnerabilities of the indigenous peoples. The focus of this paper is to critically evaluate the patterns of alcohol and other drug usage among the Aboriginal and Torres Strait Islanders, drug-related harms, barriers, prevention, and treatment issues faced in Australia.
Literature Review
Patterns of Drug Use
Alcohol and tobacco are among the main drugs abused by indigenous Australians. Smoking prevalence has changed historically, whereby a declining trend has been observed. Before colonization, there are not many documents that can reveal the true extent of tobacco use. However, the early immigrants highlighted that they used tobacco to entice and solicit the services of the aboriginals. During colonization, tobacco was also used as a civilizing influence, which resulted in higher numbers of smokers. Recent surveys indicate that daily smoking stands at 40.2%, and the less-than-daily rates are 3.2% (Colonna et al., 2020). The percentages do not differ significantly between the gender, considering that 45.6% of males and 41.2% of females are reported to be smokers. However, significant differences occur between urban and rural populations. According to Colonna et al. (2020), there have been substantial drops in the smoking rates since 1994. Therefore, even though this population is among the most vulnerable to the dangers of smoking, the declines indicate that the situation may change.
Alcohol depicts almost the same patterns as tobacco because the Aboriginal and Torres Strait Islanders are among the groups recording high rates of consumption. Examining the patterns would reveal that social, economic, and historical factors tend to affect the availability, use, and uptake of alcohol and other drugs (Nathan et al., 2020). A study by Nathan et al. (2020) reveals that the patterns before the colonial period were different and that the colonizers played a key role by introducing the drugs. Lower incomes and homelessness are among the main challenges faced by this group and which contributed to higher rates of drug and alcohol use. Besides higher rates of use and abuse, the health effects also disproportionately affect indigenous Australians. Among the key health, consequences include human immunodeficiency virus (HIV), hepatitis C, increased risk of suicide, and psychological distress (MacRae & Hoareau, 2016). Therefore, it can be argued that the changes in the socio-economic environment of Australia have historically rendered the indigenous people more vulnerable. Additionally, the best approach is arguably through addressing the social and economic inequalities in the country.
Several studies have attempted to examine the prevalence of the use of various drugs among the aboriginals. Besides alcohol and tobacco, other commonly abused drugs by the indigenous people include cannabis and methamphetamine (MacRae & Hoareau, 2016; Reilly et al., 2020). The most observable patterns include the relationship between socioeconomic status and drug use. As established by Reilly et al. (2020), the users of these drugs have such characteristics as low education levels, high poverty, mental illnesses, and unemployment. Therefore, it can be argued that Australian society has treated the aboriginals unfairly, a point proved by the fact that these drug use patterns were not visible before colonization. Additionally, the disproportionate health effects can be associated with the fact that the indigenous people do not have the same level of access to medical facilities, which means that their suffering is not fully addressed by the Australian healthcare system.
Drug-Related Harms
Diseases and injuries remain among the most critical drug-related harms experienced by indigenous Australians. According to MacRae and Hoareau (2016), such diseases and health complications as HIV, hepatitis C, increased risk of suicide, and psychological distress are the major results of alcohol and drug use among this population. Additionally, co-occurring mental health issues and complex medical conditions, including chronic diseases, have been suggested by Bofa et al. (2019). A closer examination of these studies reveals that while there is an agreement that the health of the aboriginal suffers as a result of drug use, the true extent of health consequences is not fully understood. General statements have been made to associate drug use with health outcomes. However, empirical evidence is limited, which means that it is impossible to understand why this population is deemed among the most vulnerable ones.
However, the limited literature on the health effects of drug use is adequate to make general inferences. According to Colonna et al. (2020), several key chronic diseases resulting from drug use among aboriginal Australians include cancers, which are caused by the estimated 69 of the 7000 chemicals found in tobacco. Atherosclerotic diseases, which include coronary heart disease, peripheral arterial disease, and cerebrovascular disease, also pose dangers for the population. These three examples are caused by the damage to the artery lining, which results in chronic inflammations. Other chronic diseases include type 2 diabetes and chronic obstructive pulmonary diseases. Besides the study by Colonna et al. (2020), there are few other attempts to explain the full extent of health complications. However, it can be argued that the evidence of these chronic diseases should be a reason for Australia to consider developing an effective intervention to fight against alcohol and drug use among the indigenous people.
Barriers
Barriers to healthcare among the alcohol and drug patient in Australia is a sensitive subject. Indigenous Australians are also disproportionately affected in this regard, as explained by Islam et al. (2018). The inadequate access is majorly the result of the lack of culturally appropriate resources and services. Considering the culture and nature of the aboriginals, the current Australian healthcare system fails to accommodate this population effectively. Therefore, the prevalence of both the use of alcohol and drugs and the health effects associated with these substances could also be caused by inadequate treatment. The various barriers to healthcare tend to delay help-seeking, which has a further effect on sustained high prevalence rates.
AOD Policy and Government Recommendations
The alcohol and other drugs (AOD) policy and government recommendations in Australia often focus on the risk mitigation and treatment practices for the patients. However, it is important to acknowledge that there lacks adequate attention to the indigenous people because the programs in place are yet to be culturally designed for this population. Much of the AOD policy implementation rests with law enforcement, including drug checking or pill testing. These are harm reduction strategies that have also been adopted across the world. The national drug strategy has been designed to help achieve evidence-informed responses targeting demand, supply, and harm reduction (Groves, 2018). The focus on evidence-based approaches seems to be the best approach, with the only downside being that the current evidence on the disproportionate harm to the aboriginals is yet to be acted upon.
Prevention and Harm Minimization Issues
In Australia, prevention and harm minimization practices are embedded in the AOD policies and strategies described above. According to Boffa et al. (2019), Congress has advocated for evidence-based practices for many years. Congress acts on three major domains to address the AOD-related harm prevention among the aboriginals. The first domain is concerned with addressing the economic and social determinants of health. The second involved building alliances to help drive the population-level actions intended to reduce the supply of alcohol. Lastly, culturally responsive support and treatment for the indigenous Australians with AOD-related issues are developed. However, it is important to acknowledge that even though Congress leads the race to develop prevention and harm reduction mechanisms, the implementation of its agenda has been inadequate, which means that little has been achieved to date. As mentioned earlier, the disproportionate manner in which the aboriginals are affected by AODs illustrates the need for overarching approaches, including bridging the inequality gaps. However, reducing the physical and economic availability of the substances has been the more preferred approach in Australia. The efficacy of these practices is yet to be empirically explored, which leaves a major research gap.
Treatment Issues
As mentioned earlier, Congress has an agenda for culturally safe support and treatment for aboriginals suffering from AOD harms. The current effort acknowledges the fact that excessive consumption of substances exposes this population to chronic diseases and mental health issues (Boffa et al., 2019). However, cultural factors play a key role in the search for treatment, which makes it difficult to implement treatment programs fully. For example, the aboriginals feel shame in seeking help or being seen as fearful of getting into trouble with the law for drug use. Therefore, the availability of treatment centers across the solution would only be a partial solution, which means that the main challenge would be to get the patients to accept treatment. According to MaClean et al. (2016), there is little evidence of treatment and intervention outcomes for users of such drugs as methamphetamine among the aboriginals. The main argument is that evidence-based approaches are hardly deployed in developing the relevant treatment programs for the indigenous people.
Recommendations
Recommendations for the prevention, harm reduction, and treatment of aboriginal AOD patients take into consideration that there are socioeconomic and cultural risk factors that need to be addressed for any efforts to be successful. First, a greater emphasis on culturally responsive approaches should be manifested through custom treatment and prevention programs. Such responsiveness can be reflected through the development of awareness programs intended for the population. Cultural modifications can help reduce the cultural barriers, including offering the original a better perception of the country’s healthcare system, which will make it easier for the patients to seek treatment.
Second, much of the efforts should go towards bridging the inequality gap, which is seen as the major reason for the disproportionate way in which the indigenous people suffer from AODs. Employment in the rural areas and special education programs can help increase socioeconomic and education status, which could help the aboriginals perceive themselves are part of the broader Australian society. Lastly, limiting the economic and physical access strategies can work best if the community is made fully aware of the dangers of substance abuse. Therefore, awareness programs for this population will be vital for the success of any prevention and treatment program.
Conclusion
The Aboriginal and Torres Islander people of Australia are particularly vulnerable to the problem of alcohol and other drug use. They disproportionately suffer from the harm caused by the AODs, which makes it imperative for the country to develop better prevention and treatment programs. The socioeconomic and cultural determinants of health tend to play a critical role. As such, it has been recommended that the newly developed programs should seek to address the inequality gaps to ease both the harm and access to treatment.
References
Boffa, J., Tilton, E., & Chee, D. (2019). Preventing alcohol-related harm in Aboriginal and Torres Strait Islander communities: The experience of an Aboriginal Community Controlled Health Service in Central Australia. Australian Journal of General Practice, 47(12), 851-854. Web.
Colonna, E., Maddox, R., Cohen, R., Marmor, A., Doery, K., Thurber, K., Thomas, D., Guthrie, J., Wells, S., & Lovett, R. (2020). Review of tobacco use among Aboriginal and Torres Strait Islander peoples. Australian Indigenous HealthBulletin, 20(2), 1-62. Web.
Groves, A. (2018). ‘Worth the test?’ Pragmatism, pill testing and drug policy in Australia. Harm Reduction Journal, 15(12), 1-13. Web.
Islam, M., Oni, H., Lee, K., Hayman, N., Wilson, S., Harrison, K., Hummerston, B., Ivers, R., & Conigrave, K. (2018). Standardised alcohol screening in primary health care services targeting Aboriginal and Torres Strait Islander peoples in Australia. Addiction Science & Clinical Practice, 13(5), 1-11. Web.
MaClean, S., Hengsen, R., & Stephens, R. (2016). Critical considerations in responding to crystal methamphetamine use in Australian Aboriginal communities. Drug and Alcohol Review, 36(4), 502-508. Web.
MacRae, A., & Hoareau, J… (2016). Review of illicit drug use among Aboriginal and Torres Strait Islander people. Australian Indigenous HealthReviews, 18, 1-40. Web.
Nathan, S., Maru, K., Williams, M., Palmer, K., & Rawtorne, P. (2020). Koori voices: self-harm, suicide attempts, arrests and substance use among Aboriginal and Torres Strait Islander adolescents following residential treatment. Health & Justice volume, 8(4), 1-13. Web.
Reilly, R., Wand, H., McKetin, R., Quinn, B., Ezard, N., Dunlop, A.,… Ward, J. (2020). Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non-Indigenous people who have recently used methamphetamine: the NIMAC survey. Drug and Alcohol Review, 39(6), 646-655. Web.