A focus on harm reduction

8.20     As a response to harms associated with alcohol abuse and misuse, governments have prepared and implemented various strategies or plans. For example, the Intergovernmental Committee on Drugs developed the National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy 2014–2019 (Drug Strategy).^[23] The Drug Strategy provides a roadmap for work that might be done to minimise the negative effects of alcohol and other drugs (AOD), suggesting:

In order to reduce high levels of harmful AOD use among some segments of the Aboriginal and Torres Strait Islander population it is necessary to: prevent or minimise the uptake of harmful use; provide safe acute care for those who are intoxicated; provide treatment for those who are dependent; support those whose harmful AOD use has left them disabled or cognitively impaired; and support those whose lives are affected by other’s harmful AOD use.^[24]

8.21     The Drug Strategy adopted a harm minimisation approach, identifying ‘three pillars’ of reduction focused on demand, supply and harm.^[25]

8.22     In an Aboriginal and Torres Strait Islander context such approaches were described as follows:

Demand reduction strategies aim to reduce the appeal of alcohol, tobacco and other drugs, and drug taking. Prevention and early intervention are key elements of effective demand reduction strategies. Strategies that are effective in this context include preventative strategies such as early intervention, education and health promotion, provision of alternatives to AOD use; community‐led initiatives leading to alcohol bans, permits and restrictions on hours of supply. For optimal treatment outcomes, a range of treatment options (provided in various settings) aimed at reducing individual demand, including screening and brief interventions, withdrawal management, pharmacotherapies, counselling, social support and ongoing support to reduce relapse rates need to be available.

Supply reduction strategies aim to reduce the availability of alcohol, tobacco and other drugs, and control their use. Strategies that are effective in this context include indirect price controls by banning cheap high alcohol content beverages such as cask wine, restrictions on trading hours, fewer outlets, dry‐community declarations and culturally sensitive enforcement of existing laws. A petrol sniffing strategy implemented by the Australian Government replacing unleaded petrol with a low aromatic alternative has led to significant reductions in petrol sniffing.

Harm reduction strategies aim to reduce the negative effects of AOD use, without necessarily expecting people who use drugs to stop or reduce their use. Effective harm reduction strategies include: bans on the serving of alcohol in glass containers, night patrols, and sobering‐up shelters.^[26]

8.23     A range of responses have been recommended in combating alcohol abuse in Aboriginal and Torres Strait Islander communities. These include: dry communities; pricing controls; supply reduction strategies and reduction in trading hours; community controls and patrols; and other laws that restrict the sale of alcohol to intoxicated persons.^[27] The 2015 House of Representatives Inquiry noted that Justice Reinvestment approaches also provided a ‘promising strategy for reducing the number of Aboriginal and Torres Strait Islander people who are incarcerated for alcohol-related offences’.^[28]

8.24     One review has suggested that the following alcohol reduction measures have not been successful at reducing harm, and, in some cases, have increased harm:

• staggered opening hours for licensed premises (which may increase violence);

• restrictions on service to intoxicated people when not enforced;

• liquor accords and community-based interventions when not enforced;

• local dry area alcohol bans (which do not decrease public disorder or hospitalisations, tends to elevate harms to Indigenous people, and often have the effect of being discriminatory);

• wet canteens in Indigenous communities … community concerns relate to conflict between control of consumption and dependence on profits).^[29]