Introduction
This Indigenous population makes up 2.4% of Australian population according to the 2006 Census and face incredible social disadvantage with about two-thirds living in areas that are classified as “rural”. Recent literature suggests that the Indigenous people of Australia are disproportionately affected by health problems. As it is, there are gross inequalities between Indigenous people and their non-Indigenous counterparts in many areas including health care where Indigenous people have poorer health outcomes. This situation is compounded by the fact that many of the indigenous people are at risk of misusing substances such as alcohol, tobacco, cigarettes and marijuana.
The Indigenous of Australia who consist mostly of Aboriginal and Torres Strait Islander people are uniquely affected by alcohol and drugs as compared to the general population since they tend to either abstain from alcohol and other drugs or fully indulge. Delahunty and Putt (2006) document that people of the Indigenous communities who drink or use other drugs “swing between the two extremes of abstinence and indulgence”.
This negatively predisposes the Indigenous communities to suffering from the adverse health effects that extensive substance use results in. With this in mind, this paper shall set out to discuss the current status of Australian Indigenous people in relation to alcohol, cigarette and other drug use. The paper shall in particular address the socio-economic issues which make the Indigenous communities more susceptible to substance abuse. The paper shall then propose possible solutions for this issues which disproportionately affect the Indigenous population of Australia.
Analysis of Substance Use
Alcohol
Alcohol abuse has been acknowledged to be the most prevalent social disorder among the citizens of Australia with a significant percentage of the population aged between 18 and 30 indulging in alcohol use. A survey by the World Health Organization on alcohol patterns in Australia indicated that 4% of men died as a result of alcohol consumption while the figure for women was 2%. Injuries that could be attributed to alcohol were 4.9% with men at 6.6% while women made up 3.1% (WHO 2003). While the Indigenous population does not constitute the highest consumers of alcohol in Australia, they make up a significant number of people hospitalized from alcohol related injuries or diseases.
The condition faced by the Indigenous people is dire bearing in mind that their risk of death from alcohol-attributable injury is over twice that of non-Indigenous people (Pascal, 2009).Research further indicates that the number of indigenous males hospitalized for conditions related with high alcohol use were 2 to 7 times higher than for non-Indigenous males in 2003 (Overcoming Indigenous Disadvantage: Key Indicators 2005).
The death rate due to cirrhosis of the liver among Indigenous women is 11 times greater than that of non Indigenous women while that for men is still five times greater (Wilson 2004). In addition to this, Pascal (2009) reveals that alcohol-attributable deaths for the female Indigenous population is approximately four times higher than that for women in the general population. Alcohol-attributable suicides in men were 30% higher for indigenous men when compared with the general population. This demonstrates that alcohol has an even more adverse effect among the Indigenous population.
Children of Australian Indigenous population have a highly likelihood to take up drinking as compared to the rest of the population. This is because most of the indigenous populations indulge in drinking from a home setting. Dabbs (2010, p.507) asserts that alcohol misuse in Indigenous communities is the product not only of the addictive chemical properties of alcohol but also the “absence of adequate informal social control mechanisms; and lack of incentives for meaningful activities in either employment or cultural activities”. Research has it that children brought up in an environment where alcohol consumption is common, end up using it too.
For example, a child brought up in a family where the father is a drunkard is more likely to start drinking than a child brought up in a home where the parents do not drink. In addition to this, peer pressure has been known to be one of the leading causes to substance abuse. This applies to all age brackets where people indulge in such activities in a bid to associate themselves with their peers and fit in.
Cigarettes
Tobacco use among Indigenous people has been high with adverse health implications. This is partly because tobacco is legal and easily accessible to the community. While illegal drug use has emerged as a significant cause of health-related harms in Indigenous communities, it is still licit substances that are the major killers of Aboriginal. Cigarette smoking in particular is a major issue among the Indigenous communities with high rates of tobacco use being reported. NDLEFR (2006) records that Indigenous people exhibit high rates of hospitalization and/or death from coronary disease, stroke and many forms of cancer directly linked to excessive smoking. Statistics also indicate that Aboriginal women are eight times more likely to die from smoking related conditions than women in the general population (Wilson, 2004).
The problem of smoking amongst Indigenous women is especially troubling since it is commonplace for women to continue smoking even when they are pregnant. Smoking by women during pregnancy increases the risk for low birth weight. As it currently stands, Indigenous mothers are twice as likely to deliver underweight women then non-Aboriginal women (Wilson, 2004). This combined with the decreased access to health care facilities by Indigenous women increases the chances of the infants developing complications and hence higher mortality rages.
Cigarettes result in periodontal disease which makes people more susceptible to illness therefore diminishing the quality of their lives. Periodontal disease is defined as “a chronic infectious condition caused by Gram-negative bacteria with a persistent host inflammatory reaction” (Jamieson et al., 2010, p.719). Periodontal disease can have significant impact on quality of life since it is associated with conditions such as diabetes, pulmonary disease and strokes.
Research strongly suggests that lifestyle factors strongly influence periodontal disease. Jamieson (2010) articulate that since tobacco is a vasoconstrictor, it cuts down on the blood supply limiting the flow of oxygen and nutrients to the tissues therefore interfering with the body’s ability to repair damaged tissues. In addition to this, the nicotine contained in cigarettes contains toxics which affect fibroblasts; the cells responsible for generating new connective tissue (Jamieson et al. 2010). This condition is worsened when cigarettes with high nicotine content are used. Most Indigenous smokers prefer high-nicotine cigarettes therefore exposing themselves even further to these harmful effects of cigarettes.
Other Drug Use
Marijuana
While marijuana is widely used in Australia especially by adolescents, the prevalence of use among indigenous people residing in urban areas is almost double that of the general population (Senior & Chenhall, 2008). This scenario is repeated in remote Australia where Indigenous people are recorded to have higher rates of marijuana use than the general population. Studies reveal that while controlling alcohol availability may result in the desired decrease in consumption, it has the unintended consequence of increasing consumption of other mood-altering substances such as marijuana. As such, the growth of the cannabis market among Aboriginal youth has been blamed on the imposition of restrictions on alcohol.
The use of cannabis by aboriginals results in many negative consequences both to the individual and the community at large. A study conducted in River Town in rural Australia revealed that marijuana resulted in weight loss by the user as well as mental retarded behavior such as people talking to themselves and to the tress and laughing for no reason (Senior & Chenhall, 2008, p.77). In addition, the individual became violent if they could not get marijuana. These findings are corroborated by a study on Cannabis and Substance use in aboriginal communities which revealed that users were less likely to participate in education and training and suffered from weight loss in addition to violent rages that were blamed on substance use (Clough, 2004).
Marijuana use also has serious economic effects on the household as the smoker gives smoking priority over all other obligations. In extreme cases, the smoker has his/her life centered on smoking and searching for money to purchase new supplies. Senior and Chenhall (2008) reveal that regular users borrow money from family and friends to purchase the drug and this negatively impacts their lives and those of their dependants. Marijuana therefore has a negative impact on the economic well being of the Indigenous, many of whom already leave in poverty.
Amphetamines
Indigenous people also make use amphetamines and while the use is not excessively high, this group is marginally more likely to inject drugs than the general population. A report by NDLEFR (2006) states that injecting is more common among urban based Indigenous community but the rural and remote communities are also taking up the habit. Use of these drugs has an adverse effect on the social and emotional wellbeing of the individual. In particular, the mental health of the user is impacted with outcomes ranging from; depression, paranoia, hallucinations, mood swings and even drug induced psychosis.
Amphetamines also pose a unique problem in that they expose on to blood transmitted infections through the sharing of needles among the users. Research reveals that there has been a rising prevalence of Hepatitis C virus among Aboriginal. This rise has been blamed on illicit drug use since there is a strong association between HCV and injecting drug use. In a study of HCV prevalence among national prison entrants, it was found that the while Aboriginal inmates experienced hepatitis C infection at similar rates to non-Aboriginal inmates, the rates of Aboriginal hepatitis C infection were growing and disproportionately higher that for non-Aboriginal inmates (NDLEFR, 2006).
The rising prevalence of Hepatitis C infections among the prison population presents a significant threat to the health of the Aboriginal in general since many Aboriginal inmates return to rural and remote areas on being released from prison.
Another daunting result of there drugs is that they dispose young people to engaging in prostitution. A report by NDLEFR (2006) stated that substance abuse could cause young people and particularly the homeless to engage in sex for access to substance. The manner in which this trade takes place is characterized by sharing of needles and the practice of unsafe sex. This exposes the young to STDs due to a lack of practicing safe sex. In addition to this, continuous drug use may result in one being a drug addict therefore reducing their capacity to lead a productive life.
Petrol Sniffing
Petrol sniffing is a form of substance abuse that is common among the Indigenous communities. This habit is especially prevalent amongst youths and research indicates that as they get older, they substitute this for other drugs. As such, it can be seen that Petrol sniffing acts as a stepping stone to substance abuse. The preference for petrol inhaling is mostly as a result of its availability as well as the relatively low price as compared to other drugs. Petrol sniffing is almost entirely confined to the poor Indigenous people. This assertion that the socioeconomic situation of the Aboriginal is a predictor for substance abuse is backed by a study that revealed that the misuse of inhalants was a way to suppress hunger and cold especially amongst the youth (NDLEFR, 2006).
Solutions to the Problems
This far, it can be seen that alcohol, cigarettes and drug use has multiple adverse effects on the health of the Indigenous people. It is therefore imperative that measures be undertaken to manage the situation and therefore improve the health of the Indigenous population. One of the reasons which resulted in the prevalence of alcohol abuse among Australian Indigenous was the removal of laws and polices that monitored and controlled the use of alcohol within the community. Wilson (2004) notes that when they were stringent rules in place governing consumption by the indigenous community, the alcohol problem was manageable.
The doing away with these policies which were seen as discriminatory resulted in the prevalence of the vice. However, all this changed owing to the recognition that alcohol abuse was threatening the lives of Indigenous communities. Ernest efforts at offsetting the alcohol problem in Aboriginal communities can trace their root to 2007 when an inquiry into the sexual abuse of children in the Northern Territory brought to attention the even bigger problem of alcohol abuse amongst Aboriginal communities. The Northern Territory Emergency Response Bill 2007 (NTER) banned the sale, possession, transportation and consumption of alcohol in Aboriginal communities. This measure reduced the alcohol intake among the Indigenous population due to lack of access of the substance.
The Australian government has in the past few years increased the taxes levied on Australian breweries. According to Wilson (2009, p.139), the taxes levied on ready to drink alcoholic beverages in Australia were increased by 70% in 2008. In addition to this, there are speculations that a volumetric tax would also be imposed to beer, wine and spirits depending on the alcohol content of the drink. The tax increment is a government tool used to control the availability and prices of alcohol in Australia.
With high taxes, it would mean that the breweries would have to reduce on their output since they will have to increase the prices in order to cover the costs. In addition to this, an increase in retail price would reduce the number of people drinking because even the cheapest brews have heightened their prices. Using the taxes is very effective in especially in the Indigenous people context since many of them are poor and cannot afford the high cost of alcohol that taxation will lead to.
Rehabilitation centers have been seen key to helping people regain sobriety and lead productive life. As such, the most widely used form of treatment for Indigenous people is the Residential treatment centers which cater for people with drug and alcohol problems. Chenhall (2008) states that the programs offered by this treatment centers include group psychotherapy as well as practical and vocational activities which are all based on the local settings of the people.
Most Indigenous residential treatment centers combine highly structured daily regimen fostering personal responsibility with various culturally appropriate treatments. The effectiveness of rehabilitation centers is increased since it gives people an environment free from alcohol and drugs. Most of the Indigenous have their home environment frequently characterized by heavy drinking. As such, alcohol programs which provide the individual with a time out and away from this home environment can have positive impacts on the individual.
Social conditions are implicated in the health status of communities as is historically demonstrated by the higher rates of diseases among miners. As such, Gray and Saggers (2003) asserts that “Poor Aboriginal mental health and risky health behaviors are not simply the fault of individuals”. This is a thought that is corroborated by The Network of Alcohol & other Drugs Agencies (NADA) which asserts that there exist strong links between the health and social wellbeing of indigenous populations, alcohol and drug use (NADA, 2010).
As such, the social conditions must be addressed so as to curb the health risks posed by substance abuse. Senior and Chenhall (2008) assert that prohibition on alcohol and substance abuse imposed without efforts to address the underlying causes of these problems is bound to fail. Most of the rehabilitation efforts take this into consideration by making educational groups, life-skills workshops and health checks an integral part of the recovery process.
Studies indicate that group therapy is the single most effective intervention for alcohol abuse and that with proper implementation; it can negate the need to be involved in other forms of interventions. This being the case, management of alcohol abuse and alcoholism by use of group therapy is observably the most cost-effective means of treatment (McLellan, 2005). The procedures used in normal practice include talk therapy, hypnosis and non-stimulant medication. Approximately 70 to 80 percent of individuals using group therapy as a mode of treatment exhibit improvement in alcohol abuse symptoms (Wilson, 2009). However, this treatment can only be effective if there is a follow up program and sponsors to ensure that the individuals do not “fall off the wagon.”
Another means through which the problem of alcohol, cigarettes and drug use can be mitigated is through increased awareness. As it currently stands, many of the users of alcohol, drugs and cigarettes are ignorant of the negative consequences that their habits bring about. By use of the mass media, communities can be sensitized on the scale of the problem and the need for behavioral change. Campaigns can be formulated to highlight the various disadvantages that can be accrued from constant use of alcohol, cigarettes and drugs. In addition to using the media, awareness can be increased through programs in the school system. This is especially significant considering that many school aged people are taking up alcohol and drug use. This will go a long way in reducing and to some extent preventing the current abuse of these substances.
Research reveals that older Indigenous people have a higher likelihood of having drinking related health problems. As such, older Indigenous people who drink are likely to give up drinking due to concerns about their health. This is a situation that health professionals can use to address the alcohol problem that afflicts the Indigenous population. Chenhall (2008) states that by providing accurate information regarding alcohol use in a non-judgmental manner and encouraging users to reflect on their alcohol use, older drinkers may be open to considering their drinking choices. This approach includes motivational interviewing where a person is asked to talk about his/her negative experiences with drugs and alcohol. By this reflection, the person can be offered support based on identified needs.
As has been articulated, some of the affected parties in the alcohol, cigarettes and drug abuse incidents among the Indigenous communities have been the youth. This people are increasingly vulnerable since they are exposed to hazardous levels of drug use from an early age. The youth also lack positive influences in their lives hence escalating the situation. Mentoring programs linking at-risk young people with positive role models can help offset this problem. Mentoring is especially an effective tool for reintegrating and resettling the youth after a stint at rehabilitation centers. Mentoring offers the youth a nonjudgmental ear and fresh perspective from a person who is not connected with substance abuse. By having a mentor, the youth stand a better chance of leading a changed life.
As has been noted, drug injection poses a significant threat to the health of the Aboriginal. The current growth in supply and use of amphetamine type stimulants only threatens to further complicate the issue. One effective solution involves dealing with released prisoners who are infected with illnesses such as Hepatitis C. Effective prevention may necessitate screening of this people to ensure they do not infect their communities. By so doing, infections can be contained therefore decreasing the health risks posed to the Indigenous.
Relapse is defined as a return to substance abuse following a period of abstinence and it occurs in users who have undergone treatment. Relapse prevention in the Australia Indigenous context is especially significant since an estimated 50-60% of patients return to using within six months of completing treatment (Chenhall, 2008; McLellan et al. 2005). This makes relapse prevention one of the most important aspects of chemical dependency treatment.
Relapse prevention may include measures such as establishing exercising regimes for the Indigenous people. Exercising has been demonstrated to be an effective way or countering chemical dependencies (Perkinson, 2004). Research indicates that exercising not only enhances the physical fitness of patients but it also increases their self-concept. Rigorous exercise also produces natural opioids which give a person a natural high therefore negating the need for drugs and alcohol.
Communities and the authorities alike recognize the corrosive effects of alcohol and drug abuse. Cultural mechanisms for self-regulation are necessarily for dealing with the problem of substance abuse. While enacting policies that restrict drug use may result in substance abuse reduction, law enforcement officers need community support if their enforcement activities are to be regarded as legitimate. NDLEFR (2006) notes that community-level interventions have the effect of reducing illicit drug use and drug-related harms.
This community level tactics involve the strict enforcement of the law to serious breaches while leniency and discretion is exercised when dealing with offenses that the community is capable of helping the law enforcers prevent. Such an approach lays focus on shutting down local dealers and undermining their support base while other forms of intervention are used to deal with offences that involve substance use and possession. This approach is effective since it enables the community to take responsibility for the substance abuse problem and take up measures to alleviate the problem.
Recommendations
Indigenous people generally have poorer health outcomes, higher unemployment and a mean household income that is slightly less than two thirds of that of non-Indigenous Australians (Pascal, 2009).The Australian Aboriginal context and particularly the remote communities is characterized by limited educational opportunities and scarce employment. This undoubtedly contributes to the overrepresentation of the Indigenous people in alcohol and substance abuse.
A study by Chenhall (2008) on Indigenous rehabilitation centers indicated that most Indigenous substance misuse is connected to powerlessness associated with colonization. The government therefore needs to address these issues so as to decrease substance abuse and hence improve the health of the Indigenous. A study by Jamieson (2010) demonstrated that there was an association between diseases and substance misuse among young Aboriginal Australian adults and as such, measures at reducing substance abuse will have periodontal benefits for the population.
The government also needs to increase its funding for Indigenous health initiative so as to address the health crisis that is currently afflicting the people. Ring and Brown (2002) reveal that for every $1 that is spent on health care for the general population, only $.74 is spent on Indigenous Australians. This compounds an already bad situation since Indigenous populations tend to have higher rates of chronic diseases, hypertension and substance-abuse related diseases (Marrone, 2007). By improving the health options for the Indigenous, the problems caused by substance abuse can be managed and people effectively reintegrated.
Conclusion
This paper set out to look at the health status of the Indigenous people in relation to alcohol, cigarettes and other drugs use. To this end, this paper has demonstrated that the Indigenous of Australia are disproportionately afflicted by the negative impacts of substance abuse. This paper has provided undisputed evidence that the health of the Indigenous population is greatly threatened by alcohol, cigarette and other drug use and abuse. As such, there is need for action to be taken to curb the problem of substance abuse and in cases where it has already had health implications on the population, offer effective health services to alleviate the situation.
This paper has proceeded to propose some solutions that assist in dealing with the health issues caused by substance abuse among the Indigenous. As has been seen, there are a myriad of factors that have resulted to the health problems faced by the Indigenous and as such, multiple solutions are needed to deal with the issue. Even so, the government can play a greater role in alleviated the health problems faced by the Indigenous by both increasing health spending for the Indigenous as well as addressing the underlying socio-economic issues that have elevated the problem. This will result in lower substance abuse among the Indigenous therefore positively impacting their health.
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