Assessing solutions

8.25     This section outlines a range of responses that have been trialled to address alcohol-related offending, including liquor accords, restrictions on the sale of alcohol, banned drinkers registers and mandatory treatment programs, and asks for submissions on their effectiveness.

Owning solutions

8.26     The Drug Strategy pointed out that, to achieve meaningful outcomes, there would need to be Aboriginal and Torres Strait Islander ownership of solutions, where ‘development of actions to achieve each outcome should be led by local communities in collaboration with government and non‐government sectors’:^[30]

Aboriginal and Torres Strait Islander people should be meaningfully included and genuinely consulted regarding the development of solutions to harmful AOD use. Aboriginal and Torres Strait Islander ownership of solutions should occur from inception and planning, right through to implementation and provision, and monitoring and evaluation of any solutions.^[31]

8.27     The Drug Strategy identified four priority areas:

Priority area one

Build capacity and capability of the AOD service system, particularly Aboriginal and Torres Strait Islander community‐controlled services and its workforce, as part of a cross‐sectoral approach with the mainstream AOD services to address harmful AOD use.

Priority area two

Increase access to a full range of culturally responsive and appropriate programs, including prevention and interventions aimed at the local needs of individuals, families and communities to address harmful AOD use.

Priority area three

Strengthen partnerships based on respect both within and between Aboriginal and Torres Strait Islander peoples, government and mainstream service providers, including in law enforcement and health organisations, at all levels of planning, delivery and evaluation.

Priority area four

Establish meaningful performance measures with effective data systems that support community‐led monitoring and evaluation.^[32]

8.28     The importance of ownership of solutions has been emphasised by Dennis Gray and Edward Wilkes, who argued that ‘[d]espite gaps in our knowledge, there is ample evidence to show what can be done to reduce AOD (Alcohol and other drug)-related harm. What is needed is the commitment to do it—with and not for Indigenous people’.^[33]

Liquor accords

8.29     The liquor industry, comprised of off-licence packaged liquor retailers commonly referred to as ‘bottle shops’, and on-licence liquor providers, such as hotels and registered clubs, have in many instances sought to regulate the sale of liquor to reduce or minimise the harm of alcohol misuse or alcohol abuse.

8.30     Large liquor industry players, such as Wesfarmers (Coles), having a 33.5% share, and Woolworths, having a 40.2% share of the retail liquor market as of 2015,^[34] have historically joined as members of accords across states and territories.

8.31     A liquor accord, as the NT chapter of the Australian Hoteliers Association (AHA (NT)) has explained, is

a written agreement between licensed venues and other stakeholders, with the purpose of working together to support one another on issue/s of mutual concern. For example a liquor accord may be created to assist in the reduction of alcohol misuse and associated harms within a local community.

Depending on the specific needs and characteristics of the region involved, most liquor accords include members from the local business community, local councils, local police, government departments and other community focused organisations. Voluntary participation by licensees in local area initiatives is allowed for when a stakeholder of a liquor accord and liquor related problems can be addressed with the introduction of practical solutions. Such teamwork aims to ensure that precincts and venues are safe and enjoyable places in which to meet and socialise which will ultimately enhance community life and enjoyment of the local area.^[35]

8.32     The AHA (NT) assists in the development and implementation of Alcohol Management Plans and received funding from the Department of Business to assist industry to develop, maintain and promote liquor accords within the NT.

8.33     The AHA (NT) considered that liquor accords were ‘extremely worthwhile’, provided that

all parties come to the table as equals and have a long-term view of the benefits which can flow from an effective liquor accord. This requires a strong commitment from all members (licensees, police, government) who must be able to work together to make change happen. It may also present an opportunity for local police and councils to improve their working relationships with industry on issues of common interest.^[36]

8.34     Liquor accords may raise concerns relating to anti-competitive behaviours. With respect to this, the AHA (NT) said that these could be addressed

by seeking immunity from the competition provisions of the Trade Practices Act through the ‘authorization’ process. There is a clear process to follow which will prevent any legal repercussions for members of an accord. The problem of alcohol abuse within local communities and the need for a range of strategies to address the problems are understood by the ACCC [Australian Competition and Consumer Commission]. Where the ACCC is satisfied that the public benefit from the arrangements between competitors will outweigh any public detriment, it can grant immunity from legal action.^[37]

8.35     Liquor and Gaming New South Wales suggest that some liquor accords have reduced harmful effects of alcohol misuse and abuse:

Successful liquor accord groups generate many benefits for licensees, patrons and the community:

• Less alcohol-related assaults and anti-social behaviour
• Local neighbourhoods that are safer and more welcoming
• Better reputations for licensees
• Improved business environment
• Constructive relationships between licensees, councils, patrons, residents and police
• Stronger compliance
• Less under-age drinking
• More awareness about responsible consumption of alcohol.^[38]

8.36     The Norseman liquor accord is an example of an accord that has community support and is driven by community priorities:

In the early 2000s members of the Indigenous community in Norseman in Western Australia became increasingly concerned that heavy alcohol consumption was the main cause of chronic health problems in their community. The community, in collaboration with local Health Department officers, worked with individuals and their families to prevent harmful drinking, but were not able to sustain a change to low risk drinking, and so decided that a different approach was needed … The Indigenous community in Norseman is not geographically discrete, rather it is distributed throughout the township. Consequently, the option used by many Indigenous communities, of declaring themselves dry was not available. However, there was clear recognition within the Indigenous community that certain beverages were particularly associated with heavy drinking. In an effort to reduce the amount of alcohol consumed, in particular the packaged liquor most linked to heavy drinking, the community proposed restricting the quantity and the hours of sale of these products.^[39]

8.37     An evaluation of the Norseman liquor accord found that the accord had reduced alcohol-related harms:

the Indigenous community was the driving force for introducing the restrictions, in response to the domestic violence, chronic disease and death that was associated with heavy drinking. The reasons given for not allowing sales, other than between midday and 6pm, was to limit the period of drinking so there was break for heavy drinkers to sober up. There was almost universal agreement that the behaviour of drinkers, the amount of alcohol consumed and alcohol-related harms had all changed for the better since the introduction of restrictions … [and] the benefits for the Norseman community are clear. The restrictions are still in place, have increased social order, are still overwhelmingly supported by the community including the Licensee, and have remained effective in keeping in check those beverages identified from initial community discussions as problematic. These findings indicate that … an Accord, which is fashioned by key stakeholders, and supported by the whole community, can have a long-term impact on local alcohol problems.^[40]

8.38     The ALRC invites comment on the effectiveness of liquor accords in addressing alcohol-related offending, and ways in which state and territory governments can facilitate the development and implementation of such accords in Aboriginal and Torres Strait Islander communities where there is community support for them.

Fitzroy Crossing ban on full strength alcohol

8.39     In a 2010 report, the Australian Human Rights Commission detailed the implementation of alcohol restrictions in Fitzroy Crossing, noting its community-driven genesis:

In 2007 … the senior women in the Fitzroy Valley decided to discuss the alcohol issue and look for solutions at their Annual Women’s Bush Meeting. The Women’s Bush Meeting is auspiced by Marninwarntikura; it is a forum for the women from the four language groups across the Valley. At the 2007 Bush Meeting, discussions about alcohol were led by June Oscar and Emily Carter from Marninwarntikura. The women in attendance agreed it was time to make a stand and take steps to tackle the problem of alcohol in the Fitzroy Valley. While the women did not represent the whole of the Valley, there was a significant section of the community in attendance. Their agreement to take action on alcohol was a starting point and it gave Marninwarntikura a mandate to launch a campaign to restrict the sale of alcohol from the take-away outlet in the Fitzroy Valley. The community-generated nature of this campaign has been fundamental to its ongoing success. The communities themself were ready for change.^[41]

8.40     The Fitzroy Crossing initiative did not seek the complete prohibition on the sale of alcohol or to make Fitzroy Crossing a dry community. Instead, it sought to prevent the sale of full strength alcohol.

8.41     Speaking to SBS about her experiences implementing the ban on full strength alcohol in Fitzroy Crossing, June Oscar AO stated:

We couldn’t continue to live in a community that was just being decimated by alcohol. Every aspect of life. Every facet of life was being affected. And in 2005–6 we had 50 deaths in the valley. Many of them were alcohol-related deaths. Our right to a future was important. We had to fight for that future. So the women decided then in July of 2007 enough was enough. We want to pursue restrictions on the sale of full strength alcohol … Within the first 3 to 6 months we saw the presentations at hospital from 85% alcohol-related injuries drop to 25, 15%.^[42]

8.42     The Fitzroy Crossing initiative allowed members of the Fitzroy Crossing community to design and implement strategies to reduce the prevalence of FASD in the community. The Australian Human Rights Commission noted:

In October 2008, just over a year after the alcohol restrictions were brought into the Fitzroy Valley, members of the communities gathered to discuss FASD and other alcohol-related problems … In November 2008, a draft strategy was developed by the CEO of Marninwarntikura, June Oscar and Dr James Fitzpatrick, a paediatric trainee serving the communities. The strategy was called Overcoming Fetal Alcohol Spectrum Disorders (FASD) and Early Life Trauma (ELT) in the Fitzroy Valley: a community initiative. This strategy is now described locally as the Marulu Project. Marulu is a Bunuba word meaning ‘precious, worth nurturing’.^[43]

8.43     In an evaluation of the effects of alcohol restrictions in Fitzroy Crossing two years following their implementation, a report by the University of Notre Dame (Australia) found ‘continuing health and social benefits for the residents of Fitzroy Crossing and the Fitzroy Valley communities’, including:

• reduced severity of domestic violence;

• reduced severity of wounding from general public violence;

• reduced street drinking;

• a quieter town;

• less litter;

• families purchasing more food and clothing;

• families being more aware of their health and being proactive in regard to their children’s health;

• reduced humbug and anti-social behaviour;

• reduced stress for service providers;

• increased effectiveness of services already active in the valley;

• generally better care of children and increased recreational activities; and,

• a reduction in the amount of alcohol being consumed by Fitzroy and Fitzroy Valley residents.^[44]

8.44     Another analysis also noted the benefits flowing from the experience in Fitzroy Crossing:

In Fitzroy Crossing and Halls Creek, where the impetus for alcohol restrictions came from strong local women and where responsible serving of alcohol is now being enforced, there has been a noticeable decline (between 20% and 40%) in the number of alcohol-related crimes and alcohol-related admissions to hospitals.^[45]

8.45     However, the same analysis also noted that, while

stricter controls on alcohol has made these towns more pleasant places to live … the restrictions have not addressed the reasons why people are drinking in the first place. Controls on alcohol supply help mitigate the harms that alcohol causes, but they will not solve the alcohol problem.^[46]

8.46     Kayla Calladine has also suggested that there are several limitations of alcohol restrictions, including the prevalence of unlawful sales of liquor at highly inflated prices to dry communities, otherwise known as ‘sly grogging’. However, she concludes that ‘early evidence suggests prima facie improvement in living conditions, suggesting that voluntary prohibition regimes contribute to the aims of substantive equality’.^[47]

8.47     Concerns also exist that prohibition of alcohol within dry communities has led to the substitution of illicit drugs for alcohol. The Healing Foundation has suggested that ‘[m]any dry communities now face the scourge of drugs as a substitute for grog, causing many of the same issues such as violence that alcohol did’.^[48]

8.48     The ALRC invites stakeholder comment about the usefulness of initiatives, like that in Fitzroy Crossing, to prohibit the sale of full strength alcohol, and also about how state and territory governments might play a role in facilitating this where there is community support to do so.

Alcohol Mandatory Treatment and Banned Drinkers Register

8.49     During stakeholder consultations in the NT, the ALRC was made aware of mixed views about the appropriateness and success of the Alcohol Mandatory Treatment (AMT) Scheme operating in the NT and the possible reimplementation of a Banned Drinkers Register (BDR).

8.50     The Department of Health (NT) has described AMT as a ‘mandatory treatment for adults who are taken into police custody for being intoxicated in public three or more times in two months’:

Individuals are clinically assessed and an independent tribunal then decides the best treatment options including:

• up to three months in a secure residential treatment facility

• up to three months in community residential treatment facility

• another form of community management, such as income management.

During their treatment clients are offered life skills and work readiness programs. On completion of their treatment, clients are provided with an aftercare program to support them when they return home.^[49]

8.51     The proposed BDR identifies people who are banned from purchasing, consuming or possessing alcohol and prevents their purchase of alcohol at a takeaway outlet. A person can be placed on the BDR for reasons including:

• any combination of three alcohol-related protective custodies or alcohol infringement notices in two years
• two low-range drink driving offences or a single mid-range or high-range drink driving offence
• being the defendant on an alcohol-related domestic violence order
• having an alcohol prohibition condition on a court order (including child protection orders), bail or parole order
• by decision of the BDR Registrar after being referred by an authorised person such as a doctor, nurse or child protection worker, or a family member or carer
• self-referral for any reason.^[50]

8.52     The House of Representatives Standing Committee on Indigenous Affairs Inquiry into alcohol use in Aboriginal and Torres Strait Islander communities noted that concerns have been expressed about AMT, including that it criminalised public drunkenness. It took into account the recommendations of the Royal Commission into Aboriginal Deaths in Custody for the abolition of offences around public drunkenness, and the submission of the Law Society of the NT raising concerns about a trend of criminalising addiction within the NT.^[51]

8.53     An inquest into the death of Mr Murrungun, an NT Aboriginal man, heard that, while Mr Murrungun had been taken into police custody more than 60 times in 2014, he had only been referred for assessment under the AMT scheme on two occasions:

In closing submissions at the inquest, counsel assisting the coroner Kelvin Currie described the scheme as ‘illusory’ and said police failed to document protective custody incidents.

Mr Currie said almost 40 protective custody incidents were not recorded and counted towards the AMT scheme, despite laws requiring police to do this.^[52]

8.54     The NT is not the only state or territory that provides for mandatory treatment of persons who abuse alcohol. Victorian laws in respect of mandatory treatment are found in the Severe Substance Dependence Treatment Act 2010, which allows for detention and treatment of a person experiencing severe substance dependence for up to 14 days. In New South Wales, the Drug and Alcohol Treatment Act 2007 allows for initial detention of ‘identified patients’ for 28 days, with an option to extend treatment to three months.

8.55     In a 2017 study, PricewaterhouseCoopers Indigenous Consulting (PwC PIC) noted that, in 2012, the NT AMT replaced the BDR of some 2600 people without an evaluation into the effectiveness of that system.^[53] In April 2017 it was announced that the NT Government is proposing a return of the BDR.^[54]

8.56     Looking at issues relating to people who are not eligible for AMT, PwC PIC found that

[a] significant number of people ‘leaked out’ of the AMT system and received no assessment or treatment. Sometimes this was expected—for example, people with outstanding warrants are not eligible for AMT and people with serious physical or mental health issues are immediately taken to hospital for treatment. This means a number of people who could potentially benefit from treatment were excluded from the process.^[55]

8.57     There have been criticisms made of AMT. Fiona Lander, Dennis Gray and Edward Wilkes have argued that:

there is little evidence of the scheme’s efficacy, and that the NT Government could adopt more cost-effective alternatives that would not involve the dubious application of a medical intervention to reduce public intoxication, with its concomitant legal and ethical issues.^[56]

8.58     Despite criticism of AMT, the PwC PIC evaluation found that

clients were consistently being supported to withdraw from alcohol safely and were being provided all the appropriate medical care during this time. Assessment staff also ensure any other pre-existing conditions are monitored during withdrawal to prevent complications arising. Once a client has safely withdrawn from the effects of alcohol they are provided with full time comprehensive health care and treatment for any existing conditions until transferred elsewhere as an outcome of the tribunal hearing. Assessment staff also ensure that clients learn about and understand their conditions, what their medications are for and the importance of complying with a treatment program. As per usual clinical guidelines, assessment staff request interpreters to help discuss medical issues with clients when it is appropriate.^[57]

8.59     Commenting on evidence from case studies during the evaluation process, PwC PIC said that

by the end of the assessment phase, after clients have had time to sober up and reflect, … they are more open to receiving treatment. For example, after completing the assessment process for the AMT program 75% of the case study group in this evaluation reported being highly or somewhat motivated to continue with the program, while 25% stated they were not very motivated or highly unmotivated/disinterested. Service providers reported that they believed most people were in the pre-contemplative stage after assessment but did agree that most people were compliant and willing to engage in treatment. However, the workers felt that many people may not be ready to make long-term changes in their drinking patterns and lifestyle, and that their experience was that most people would need more than one episode of treatment before changes would be seen. All case study participants responded that they had been shown dignity and respect during the assessment process with one commenting ‘it’s a good place, they gave me clothes’.^[58]

8.60     The ALRC is interested in hearing comment about the ways that BDRs and AMTs can reduce alcohol-related offending within Aboriginal and Torres Strait Islander communities, as well as any negative impacts that these approaches may have.