Summary - Department of Health and Ageing

labelling supports the low-risk drinking messages in the national guidelines and both
labelling and guidelines contribute to supporting other evidence-based strategies.
Mainstream substance misuse services are available, in principle, to Indigenous Australians
but in practice are sometimes unaffordable, inaccessible and/or culturally inappropriate.
Indigenous Australians have developed a broad range of intervention initiatives suited to
the level of substance misuse within their communities and as an expression of selfdetermination.
Demand reduction has focused on treatment, health promotion and, to a
lesser extent, providing alternatives to substance misuse. In addition, various community
development projects have the goal of prevention of substance misuse, either implicitly or
explicitly.
The 1994 NDS Household Survey figures showed that most Indigenous Australians who
sought treatment did so from Indigenous community-controlled health services, or general
practitioners. While there are no evaluations of brief interventions for Indigenous
Australians, their effectiveness elsewhere suggests they should probably be used by health
care providers. Focused treatment projects in Indigenous communities most often target
alcohol alone, or alcohol and some combination of other substances. Again, evidence of
success varies and evaluations are limited. There are few detoxification facilities in
Indigenous communities—a particularly acute problem for those people injecting drugs.
Prevention projects targeting alcohol have included health education, sporting and
recreational activities, support for homeless people, and community education and
activities. As for treatment, outcomes have been equivocal. A variety of health education
projects have targeted smoking but none have been formally evaluated. There are far fewer
prevention campaigns targeting use of illicit drugs or volatile substances, although a
number of projects have targeted petrol sniffing. A review found some of these to be
effective but commented that the most effective strategies against petrol-sniffing are likely
to be those that improve the overall health and wellbeing of young Indigenous people,
their families and communities.
There is little evidence available on the effectiveness of demand reduction strategies for
persons aged over 65 years. Concern has been raised about alcohol-related problems and
benzodiazepine use. Improved screening and prescribing by health care practitioners is
recommended.
The evidence base for demand reduction strategies ranges from the very strongest (e.g.
brief interventions and some forms of treatment) to those for which evidence is largely
absent, such as drug testing in the workplace. There is a great potential for maximising the
impact of brief interventions and treatment programs on risky drug use and harm at the
population level—for those affected by their own drug use or that of other people. There
is a need to increase the uptake of brief interventions by primary health care workers and
to extend the settings in which they are delivered; and to encourage greater use of
evidence-based treatment strategies matched to different drug users. There is growing
evidence to support community action to reduce problems related to legal drugs,
especially where these actions focus on structural policy changes (e.g. drug availability and
responsible serving practices) though nearly all of the well-designed studies have been
conducted overseas. There is some evidence for the effectiveness of well-designed mass
media campaigns, principally those targeting legal drug problems. National drinking
guidelines and standard drinks labelling can facilitate other evidence-based strategies.