3.11 Access to alcohol and drug services
Why is it important?
The 2012–13 Health Survey found that just over half (54%) of Indigenous Australians aged 15 years and over reported exceeding the alcohol guidelines for single occasion drinking and 23% reported using substances in the previous 12 months (see measures 2.16 and 2.17). The range of harms from alcohol and substance misuse includes chronic disease, such as liver disease; injuries from motor vehicle accidents and assaults; incarceration; and social disruptions including family breakdown. Mental health issues are a common comorbidity and, along with poly-drug use, means that people presenting to alcohol and drug services typically have complex, multiple needs (NIDAC 2014).
Alcohol and substance-use services provide a variety of interventions and support that seek to address harmful alcohol and other drug use, and restore the physical, social and emotional wellbeing of clients and their families (NIDAC 2014). The term 'other drugs' includes illegal drugs (e.g. heroin and cannabis); misuse of medicines (e.g. pain-killers); and use of psychoactive substances in a harmful way (e.g. petrol inhalation) (AIHW 2014c). Services are delivered in residential and non-residential settings, in stand-alone facilities or as part of primary care services. Treatment types include detoxification and rehabilitation programs, information and education courses, counselling and pharmacotherapy (AIHW 2014c).
Access to these services by Aboriginal and Torres Strait Islander peoples may be impacted by geography (e.g. physical distance to health services, availability of transport and quality of roads); the cultural competency of services (see measure 3.08); affordability (e.g. of services, pharmaceuticals, and travel costs); and availability of services and health professionals. Additional barriers include cultural beliefs and attitudes concerning alcohol and drug use, such as shame associated with seeking treatment, concern about getting into trouble with the law and fear of losing their children (NIDAC 2014).
In 2012–13, 63 Australian Government-funded Indigenous-specific organisations providing substance-use services were included in the Online Services Report. These organisations provided around 305,000 episodes of care to 49,700 clients. The apparent increase in reported episodes of care from 2011–12 is mainly due to a few organisations with large client bases reporting for the first time. Most episodes of care (90%) were provided to Indigenous clients. Distribution of organisations by remoteness was fairly even with 25% in very remote areas and 17–21% elsewhere. The NT (25%) and NSW (22%) had the highest proportion of organisations (AIHW 2014a).
All organisations reported alcohol as a principal drug of concern, followed by marijuana (97% of organisations), tobacco (64%), multiple drug use (54%) and amphetamines (43%). Information and education (98%), counselling (95%), and support and case management (94%) were the most common treatment types. Depression/hopelessness (86%), family/relationship issues (78%) and grief and loss issues (73%) were key social and emotional wellbeing issues reported in terms of staff time and organisational resources (AIHW 2014a). Services provided to Indigenous clients included around 2,100 residential episodes of care; 23,600 sobering-up, residential respite and short-term episodes of care; and 246,300 non-residential, follow-up and aftercare episodes of care.
In 2012–13, there were around 22,700 treatment episodes for Indigenous Australians in publicly funded drug and alcohol services included in the Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS-NMDS). These episodes accounted for 15% of all treatment episodes. Note that 27 substance-use-specific services reported under both the AODTS-NMDS and the Online Services Report, so these data include some double counting (AIHW 2014a). Indigenous clients tended to be younger than non-Indigenous clients, with the proportion of episodes in the 10–19 and 20–29 year age groups higher for Indigenous clients. There was little difference in the proportion of main treatments provided by Indigenous status. The largest difference was for withdrawal management, which was more likely to be provided to non-Indigenous clients (18%) than to Indigenous clients (10%) (AIHW 2014c).
In addition, the majority of the 205 Australian Government-funded Indigenous primary health care organisations provided care in relation to drug and alcohol issues. Tobacco, alcohol, cannabis, multiple drug use and amphetamines were the most common conditions managed in terms of staff time and organisational resources.
After adjusting for differences in the age structure of the two populations, GPs managed mental health related problems for drug abuse and alcohol abuse for Indigenous patients at 3 and 4 times the rate respectively of other patients during the period April 2008 to March 2013. In the same period, GPs offered counselling or advice on alcohol at 2 times the rate for Indigenous patients than for other patients. Alcohol counselling or advice represented 1.6% of all clinical and therapeutic treatments provided to Indigenous people.
During the period July 2011 to June 2013, there were approximately 10,000 hospitalisations related to alcohol use for Indigenous Australians and 6,900 due to drug use. After adjusting for difference in the age structure of the two populations, Indigenous males were 5 times as likely to be hospitalised for alcohol use as non-Indigenous males and Indigenous females were 4 times as likely as non-Indigenous females. Indigenous Australians were also 2.5 times as likely to be hospitalised for diagnoses related to drug use as non-Indigenous Australians.
In 2013, on a 'snapshot day', over 2,800 Aboriginal and Torres Strait Islander clients received pharmacotherapy treatment for opioid dependence (NSW, Qld, SA, Tas, ACT and NT combined). Indigenous clients accounted for 10% of all clients in these jurisdictions and were around 3 times as likely to have received pharmacotherapy treatment as other Australians.
The National Drug Strategy 2010–2015 provides the framework for an integrated and coordinated approach across all levels of government to reduce the prevalence of drug-related harm and drug use in Australia (MCDS 2011). Since the Strategy began in 1985, the principle of harm minimisation has formed the basis of the approach. Under the Strategy, seven sub-strategies will be developed, including the National Aboriginal and Torres Strait Islander peoples Drug Strategy (NATSIPDS). The NATSIPDS will be informed by the other sub-strategies, including the National Alcohol Strategy, which will aim to prevent and minimise alcohol-related harm to individuals, families and communities through the development of a safer drinking culture in Australia.
In 2014–15, approximately 40 Aboriginal and Torres Strait Islander service providers across Australia were funded by the Department of Health through the Substance Misuse Service Delivery Grants Fund and Non-Government Organisation Treatment Grants Programme to provide, or support, alcohol and other drug treatment and rehabilitation services. Services provide a variety of treatment models including rehabilitation in a residential setting and drug and alcohol workers in Aboriginal and Torres Strait Islander primary care services.
The Alcohol Treatment Guidelines for Indigenous Australians provide an evidence-based resource to assist health professionals understand and manage alcohol-related issues experienced by their Indigenous clients.
The Indigenous Advancement Strategy–Safety and Wellbeing Programme provides funding for strategies known to enhance community safety, including combatting alcohol and other substance misuse. In 2014–15, this included funding to improve access to culturally appropriate substance use and prevention, treatment, rehabilitation and aftercare services for Indigenous Australians, including those in rural and remote areas.
The Policies and Strategies section and measures 2.16 and 2.17 include further detail on government initiatives to address alcohol and substance-use harms among Aboriginal and Torres Strait Islander peoples.
Figure 3.11-1 shows the number of episodes of care provided to Indigenous people at Australian Government funded stand-alone substance use services in 2012–13. Data is presented for Aboriginal men and women in the following age groups: 0-18 years, 19-35 years, and 36 years and over. Data is presented for residential treatment/rehabilitation services; sobering-up/residential respite services; and non-residential/follow-up/after care services.
Source: AIHW OSR data collection
Figure 3.11-2 shows the age-standardised rate of hospitalisations (per 1,000 encounters) with principal diagnoses related to alcohol use and drug use for the period July 2011 to June 2013. Data are presented for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. For both alcohol use and drug use, rates are higher for Aboriginal and Torres Strait Islander people.
Source: AIHW analysis of National Hospital Morbidity Database