Creating pathways for Indigenous Australians to lead the way in alcohol research
The Centre of Research Excellence in Indigenous Health and Alcohol aims to create the best opportunities for Aboriginal and Torres Strait Islander people to find solutions to alcohol problems through research. The Centre’s research agenda is based on priorities of Aboriginal and Torres Strait Islander health professionals and communities, and informed by what is already known through research. This symposium will showcase some of the work being conducted by this Centre. It will conclude with a ‘question and answer’ session facilitated by Dr Michael Doyle.
Presentation #1: Yarning about SMART Recovery
SMART recovery is one of the world’s most popular and accessible substance use recovery support options. However, there is no empirical evidence validating its cultural utility or acceptability for Aboriginal people and contexts. The aims of this study are: 1) To explore Aboriginal people’s experiences and views of the SMART Recovery Australia operational processes and program features; and 2) To describe how Aboriginal people and their communities utilise and benefit from the SMART recovery model.
This study used transformative mixed methods grounded in an Indigenous decolonising research paradigm. Participants were Aboriginal group attendees (n=13), Aboriginal SMART recovery-trained facilitators (n=10) and health professionals (n=5) connected to a community-run SMART recovery group New South Wales, South Australia and Western Australia. They were located in rural, regional and remote community settings. Data collected included: semi-structured ‘yarning’ interviews with all participant groups; group attendee and facilitator surveys, a SMART recovery program adherence rating scale and group observations (n=3). Findings were triangulated and analysed using modified grounded theory.
Findings provided important new insights about Aboriginal peoples’ experiences of SMART Recovery. This included recommendations for how the model could be improved to enhance its cultural meaning and relevance as a recovery resource for Aboriginal peoples.
Future research is warranted to facilitate consultation between SMART Recovery and Aboriginal stakeholders to assist with program modifications.
Presentation #2: Client characteristics of treatment retention in six Aboriginal alcohol and other drug residential rehabilitation services
Aboriginal community-controlled alcohol and other drug residential rehabilitation services have provided treatment for Aboriginal people with substance use disorders for over fifty years in NSW. They deliver health care that is compatible with Aboriginal cultural beliefs and values. The six residential treatment services in New South Wales that participated in this project are all community controlled and community-driven. This talk will describe some work done with the Aboriginal Drug and Residential Rehabilitation Network to improve what we know about who leaves residential rehabilitation services early. It is hoped that services can use this information to further tailor the programs and support offered.
Two types of predictive analyses were conducted. Poisson regression was used for leaving early and readmission data. As house discharge and self-discharge are competing events, competing risk regression analysis was used.
Being Aboriginal on its own was not a statistically significant predictor of self-discharge, house-discharge or a readmission within two years of an original admission. Being aged under 30, being referred to a resi rehab from justice and having stimulants, alcohol, cannabis or opioids as a was correlated with house discharge and readmission.
This is the first study in Australia and internationally to examine predictors of who leaves early and who stays in six Aboriginal resi rehabs. This data offers an opportunity for services to look at factors of client retention – to enable them to further tailor programs offered to clients.
Presentation #3: The potential of ‘justice capital’: healing for justice-involved youth and their families
The Banksia Hill Detention Centre Fetal Alcohol Spectrum Disorder (FASD) Prevalence
Study found that more than one third (36%) of detained youth were diagnosed with FASD. In this same study, nearly nine in ten young people (89%) were diagnosed with neurodevelopmental impairments in the severe range. The Banksia Hill Prevalence study is the first of its kind undertaken in an Australian youth detention facility. It is also the first internationally to run a qualitative study that tries to understand participant experiences. This presentation will present this qualitative work.
Detained young people and their caregivers participated in social yarning-research topic yarning interviews about FASD and assessment participation. Non-custodial staff participated in focus groups about the benefits of assessments for justice-involved youth. The views of around 70 participants were thematically analysed.
Around three quarters (75%) of participating youth were Aboriginal and came from families and communities who suffer repeated injuries as a result of colonial systems.
Despite multiple agency involvement, few of these young people had their neurodevelopmental disabilities recognised and considered. All groups saw assessments as beneficial. However, there were a variety of cultural understandings about diagnosis and interpretation of assessments. These must be considered to mitigate harm from receiving a diagnosis.
The presentation will discuss the importance of understanding cultural differences in diagnostic understandings and empowering individuals and communities to draw on their recovery capital resources to heal and flourish.
Presentation #4: Prevalence and correlates of alcohol dependence in an Australian Aboriginal and Torres Strait Islander representative sample
To support recovery from alcohol use disorders we need to know how many people need help and support. However, little is known about the prevalence of current (last 12-months) alcohol dependence among Indigenous Australians. Among non-Indigenous people in Australia, just over one in eighty (1.4%) are alcohol dependent. In Australia there is no Indigenous-specific data showing risk factors of current alcohol dependence. We need to know these risk factors to identify people who might need more support. This study aimed to report the frequency of symptoms, the prevalence, and the factors linked with current alcohol dependence.
Data was collected via the Grog Survey App. The App is an acceptable and accurate way to help Indigenous Australians describe what they drink. The study was conducted in two Aboriginal communities in South Australia (remote and urban). Individuals needed to be Aboriginal and/or Torres Strait Islander, aged 16 or older, and living in one of the two study sites to take part.
The App was completed by 775 Indigenous Australians from two sites – urban (91%) and remote (9%). For the overall sample, the prevalence of current alcohol dependence was 2.2%. For current drinkers only, the prevalence of dependence was 2.8%. Individuals who drank more alcohol, and drank more frequently, tended to report more frequent symptoms of dependence. The most frequently reported symptoms of dependence were spending more time drinking grog over other things and people feeling like grog is the boss of them. Almost one in ten (9.3%) remote drinkers feel like grog is the boss of them most days or every day.
The prevalence of current alcohol dependence is similar to the general Australian population (2.2% versus 1.4%). To inform unmet treatment needs and see how to care for our people we need more work on the factors that are associated with current alcohol dependence.
Presentation #5: Barriers and enablers faced by clinicians when referring Aboriginal clients to an involuntary drug and alcohol treatment unit
Since 2012 the Involuntary Drug and Alcohol Treatment Unit (IDAT) in New South Wales has provided treatment and assessments in a secure facility for individuals experiencing severe dependence on alcohol and other drugs. This program gives access to a safe medical withdrawal program followed by a range of comprehensive assessments (e.g. medical, cognitive, functional, mobility). While alcohol-attributable hospitalisations for Aboriginal people in NSW have increased compared to their non-Aboriginal counterparts (between 2016-17), referrals of Aboriginal people into an IDAT program have decreased. This study explores the factors that influence drug and alcohol clinicians when referring Aboriginal clients to involuntary drug and alcohol treatment in NSW Health.
NSW Health has two IDAT Units – Bloomfield Campus in Orange (8 beds) and Herbert Street based at Royal North Shore Hospital (4 beds). Referrals are accepted from all local health districts across NSW. This qualitative study conducted interviews with NSW Health drug and alcohol clinicians who have referred a client to an IDAT between September 2016 and December 2018. The interview schedule was comprised of 16 questions organised into four themes: 1) About you and where you work; 2) About referring Aboriginal clients to IDAT; 3) Advantages and disadvantages of an involuntary treatment admission; 4) Supports to assist with admissions and discharges. An inductive thematic analysis approach was used.
Preliminary analysis will be presented from this interview data.
This study gives valuable insight into factors that help or hinder clinicians when referring Aboriginal clients to IDAT. It could also be used to inform the existing referral and admission process. It could have broader relevance for similar programs around Australia or with Indigenous peoples internationally in similarly colonised countries (New Zealand, Canada, United States of America).
Presentation #6: Inclusion of First Nations Australians in alcohol-related policy development and implementation
First Nations Australians have a strong history of developing community-controlled responses to health concerns, including the social and physical impacts of alcohol. Growing evidence shows that inclusion in decisions over one’s life – self-determination – can contribute to improved wellbeing. Opportunities for First Nations Australians to be involved in the development of policies are limited. Community-led approaches provide valuable evidence of how self-determination by First Nations Australians can be realised in the development and implementation of effective evidence-based alcohol policy.
Focussing on the Northern Territory, this study will examine how First Nations Australians’ self-determination can be part of helping to develop and implement effective evidence-based alcohol policies. The findings of this study will identify how communities can advocate to be involved in change in policy. This presentation focuses two phases of the study. Firstly, the learnings from the international evidence of Indigenous Peoples’ inclusion in policy development processes, and possible elements of self-determination. Secondly, First Nations Australian health, alcohol, and policy experts’ opinions regarding these elements of self-determination in policy processes. The presentation will discuss how these findings can be used to ensure that self-determination is underlying the processes to develop and implement policy.