Drinking Context

Aboriginal or Torres Strait Islander peoples are less likely to drink alcohol than non-Indigenous Australians. Those who do drink, drink less often, but are more likely to drink at risky levels. There are few data on the prevalence of alcohol use disorder among Aboriginal or Torres Strait Islander communities. 

For Aboriginal or Torres Strait Islander Australians, unhealthy alcohol use typically occurs on a background of social and economic disadvantage, and often on a personal and community-wide experience of trauma, grief and stress. Transgenerational trauma and enduring impacts of colonisation, including impacts of child removal policies and ongoing racism, are risk factors for poor mental health and unhealthy drinking. Alcohol consumption also typically occurs in the context of complex medical and sometimes mental health issues. Accordingly, treatment needs to be mindful of these factors, and be combined with support to address them where possible. 

Aboriginal or Torres Strait Islander peoples can face many barriers to accessing mainstream (general population) alcohol treatment services, namely: 

• a lack of cultural appropriateness of service delivery 
• language barriers for those from remote regions 
• concerns about confidentiality  
• shame, fear of being judged, or discrimination 
• fear of child removal 
• lack of transport or childcare 
• services which exclude clients who have significant mental or physical health comorbidities, those on opioid treatment programs, pregnant women or families 
• lack of awareness of available services, including outpatient options. 

Given these barriers to treatment services, respectful and non-judgemental care is required. Where possible and safe to do so, treatment should be provided at the point of detection of unhealthy drinking. If referral is needed, support should be offered to help a client access that service. 

Engagement is key; engagement with individuals and ideally also with community. The Aboriginal or Torres Strait Islander perspective of wellbeing includes the individual in the context of family, community and country. Care should be holistic, considering mental and physical health, socio-economic needs including housing, relationships with family community, and culture. Where desired by the client, members of family or community can be involved in care. 

Cultural training and resources should be available to non-Indigenous clinicians to help them work in a culturally appropriate way. Working in partnership with Aboriginal and Torres Strait Islander health staff can increase their capacity to deliver appropriate and accessible care.