Tuesday, 4 July 2017

Alcohol and Other Drug Treatment in Indigenous Australia: some policy questions

The Australian Institute of Health and Welfare has just released its report: Alcohol and other drug treatment services in Australia 2015–16 (link here). The report is worth reading as it presents a window into the substantive impact of licit and illicit drugs on society, including Aboriginal society.

In this post, I focus on issues related to Indigenous citizens presented in the report, and then make a number of policy related observations.

Here is a high level extract of its findings from its Executive Summary:
Alcohol and other drug (AOD) treatment services across Australia provide a broad range of treatment services and support to people using drugs, and to their families and friends. This report presents information for 2015–16 about publicly funded AOD treatment service agencies, the people they treat, and the treatment provided.
An estimated 134,000 clients received treatment in 2015–16, an 11% rise since 2013–14 (119,000). This equates to a rate of 650 clients per 100,000 people, or about 1 in 180 people. About two-thirds of clients were male (67%), and half were aged 20–39 (55%).
Despite only comprising 2.6% of the population, 1 in 7 (14%) clients were Aboriginal and Torres Strait Islander. This is a rate of 3,400 clients per 100,000 Indigenous Australians, compared with 540 clients per 100,000 non-Indigenous Australians.
Treatment agencies provided about 207,000 treatment episodes in 2015–16—an average of 1.5 episodes per client—and 4 in 5 (79%) episodes ended within 3 months. Of those clients who received treatment in 2015–16, 11% also received treatment in 2013–14 and 2014–15.

The report makes clear that it is focussed on information for 2015–16 about publicly funded AOD treatment service agencies, the people they treat, and the treatment provided. It does not encompass all AOD treatments provided by agencies and professionals beyond the 796 agencies covered by the data set used. The report notes that most Indigenous primary health care organisations, and the treatments they provide, are not included in the data set analysed in the report (page 4). In other words, around 18,000 Indigenous people receiving on average 1.5 treatments per annum represent a subset of the Indigenous population seeking drug related treatment. Not all people are seeking treatment for themselves; it may relate to a family member.

The report notes that the social costs of inappropriate licit and illicit drug use in Australia are substantial, with financial impacts estimated by some researchers as $56bn. Publicly funded drug treatment increased by 11% in the two years leading up to 2015-16. 

The report notes that despite only comprising 2.6% of the Australian population, 14% of all clients were Aboriginal or Torres Strait Islander people aged 10 and over in 2015–16. This varied by client type—about 1 in 7 (14%) clients receiving treatment for their own drug use, and 11% of clients receiving support for someone else’s drug use were Indigenous. The main drugs that led clients to seek treatment were alcohol, amphetamines, cannabis, and heroin. This was consistent for both Indigenous and non-Indigenous clients (page 9).

In terms of the geographic spread of AOD treatment agencies, over half (54% or 432) of the treatment agencies were located in major cities and nearly one-quarter (24%) in Inner regional areas. Relatively few agencies were located in Remote or Very remote areas (both 4%). This pattern was similar across most states and territories, except for Northern Territory where 35% of agencies were located in Remote or Very remote (22%) areas (page 12). Section 5.2 of the report (pages 48-52) includes some highly informative maps outlining the intensity of treatment provision across the nation. The data suggests that alcohol is a particular problem in remote areas, cannabis also a serious issue in some remote areas, while amphetamines and heroin are more serious issues in urban Australia.

I have not done justice to the wealth of data and information in the report, and recommend readers examine it for themselves. Nevertheless, there is enough here to raise a number of policy questions in relation to Indigenous service provision, and Indigenous policy generally.

First, given the over-representation of Indigenous citizens in the treatment data set (and the knowledge that many other Indigenous citizens are being treated by primary health care organisations outside the data set), are we doing enough both in the proactive prevention space and the treatment space itself to assist Indigenous drug users?

Second, is there an argument for allocating greater weight to remote services within the resource allocation arrangements for AOD services?

Third, the figure of 18,000 clients suggests that at a minimum somewhere around 2% of the Indigenous population seek treatment for drug and alcohol issues each year. Yet the interconnected structure of most Indigenous families suggests that the impact of drug issues will extend to a much larger cohort, including children. What then are the social cost implications of drug misuse within Indigenous Australia? Where do those costs fall, and what do those costs mean for individuals, their families, and the life opportunities of all involved?

Fourth, it seems clear that licit drugs (alcohol, nicotine, and I would include sugar) are more problematic than illicit drugs in terms of the social damage and costs they inflict, particularly for Indigenous citizens. While illicit drugs are by definition banned, licit drugs are subject to strong interest group lobbying over the nature and extent of the regulatory oversight put in place by government. One consequence of the ‘pressure’ exerted within our political systems by commercial interests is that governments explore and too often implement alternative (and potentially less effective) policy mechanisms to regulate individual behaviour (for example income management designed inter alia to address alcohol misuse). There is a case for much more comprehensive and holistic analysis of alternative policy mechanisms aimed at regulating licit drug use, and in particular, explicit assessment of the comparative efficacy of price based mechanisms and other supply restrictions designed to minimise the social and individual harm licit drugs cause.

In recent years, many advocates within the Indigenous policy world have argued against what they term ‘deficit discourse’. They are in my view at most only partially correct. We cannot afford to ignore the over-representation of Indigenous people in social indicators of wellbeing, not least because to do so would remove the already limited focus on the ‘policy deficit’ which governments appear willing to accept and live with, with significant adverse flow on impacts on the life opportunities of thousands of Australian citizens. 

Overcoming and removing Indigenous disadvantage will require systemic changes including a focus on building individual responsibility, but also a stronger preparedness by government to explicitly focussing on closing the ‘policy deficit’ gap; a gap which can only be closed through leadership by governments.