Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Tier 3—Responsive—3.11 Access to alcohol and drug services
Why is it important?Alcohol and other drug services provide a variety of treatment interventions for alcohol and other drug use (see measures 2.16 and 2.17). The term ‘other drugs’ include the use of illegal substances (e.g., heroin) and misuse of legally available substances (e.g., petrol inhalation and prescription drugs). Services are provided in both residential and non-residential settings and can include detoxification and rehabilitation programs, information and education courses, pharmacotherapy treatments and counselling (AIHW 2010a).
Treatment services which reduce harm from alcohol and other drugs can significantly reduce the level of associated diseases such as liver disease; injuries from motor vehicles accidents and assaults; and social disruptions (AIHW 2006b). Reducing drug and alcohol related harm can improve health, social and economic outcomes at both individual and community levels (Steering Committee for the Review of Government Service Provision 2011b).
Access to alcohol and other drug services by Aboriginal and Torres Strait Islander peoples may be impacted by geography (e.g., physical distance to health services, availability/affordability of transport and quality of roads), the cultural competency of services (see measure 3.08), affordability (e.g., of services, pharmaceuticals, and other associated costs such as travel), and availability of services and health professionals.
Findings:In 2010–11, the Australian Government funded Aboriginal and Torres Strait Islander stand-alone substance use services, in the OATSIH Services Reporting (OSR) dataset, provided treatment and assistance for substance use issues to 28,600 clients. This was an increase of 9% compared with 2009–10. Of these clients, 76% were Aboriginal or Torres Strait Islander.
Services provided to clients included approximately 3,600 residential episodes of care (a 6% increase from the previous year); 14,600 sobering-up, residential respite and short-term episodes of care (a 10% decrease from the previous year); and 76,000 non-residential, follow-up and aftercare episodes of care (a 36% increase from the previous year).
Services were distributed across geographical areas, with 18% in remote areas, 25% in major cities, 20% in outer regional areas, 18% in inner regional areas and 18% in very remote areas.
Most services provided treatment or assistance to individual clients for alcohol (98% of services), marijuana (98%), tobacco and nicotine (80%) or multiple drug use (80%). All services provided information and education about substance abuse, with about 86% providing this in the form of community education and activities, and 55% in school-based education visits. More than half (61%) of the 883 full-time equivalent positions at these services were held by Aboriginal or Torres Strait Islander people.
In 2009–10, there were 18,442 treatment episodes for Indigenous Australians in drug and alcohol services included in the Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS NMDS). This was 13% of all treatment episodes. Note that 17 substance use-specific services reported under both the OSR and the AODTS NMDS and therefore these data include some double counting. On average, 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. Indigenous clients accessing treatment services were more likely than non-Indigenous clients to undergo assessment without subsequent treatment (18% compared with 14%) and less likely to have withdrawal management (12% compared with 17%) (AIHW 2011g; AIHW 2011a).
After adjusting for differences in the age structure of the two populations, general practitioners managed drug abuse and alcohol abuse for Indigenous patients at 4.2 and 3.9 times the rate of other patients during the period April 2006 to March 2011. In the same period, general practitioners offered counselling or advice on alcohol at 2.5 times the rate for Indigenous patients than for other patients. Alcohol counselling or advice represented 2% of all clinical and therapeutic treatments provided to Indigenous people.Top of page
Among Indigenous Australians during the period July 2008 to June 2010, there were approximately 7,800 hospitalisations due to alcohol and 4,500 due to drug use. After adjusting for difference in the age structure of the two populations, Indigenous males were five times as likely to be hospitalised for alcohol use as non-Indigenous males and Indigenous females four times as likely as non-Indigenous females. Indigenous males and females were also 4 times as likely to be hospitalised for mental and behavioural disorders due to alcohol and drugs.
On a ‘snapshot day’ in 2010, there were 2,591 Indigenous clients receiving pharmacotherapy for opioid dependence in NSW, Qld, SA and the ACT combined (other jurisdictions were unable to provide information about clients’ Indigenous status). Aboriginal and Torres Strait Islander clients accounted for 9% of all clients in these jurisdictions.
Implications:The National Healthcare Agreement includes a focus on ensuring that Australia’s health system promotes social inclusion and reduces disadvantage, especially for Indigenous Australians. The agreement affirms that Australia’s health system should:
- be shaped around the health needs of individual patients, their families and communities;
- focus on the prevention of disease and injury and the maintenance of health, not simply the treatment of illness;
- support an integrated approach to the promotion of healthy lifestyles, prevention of illness and injury, and diagnosis and treatment of illness across the continuum of care; and
- provide all Australians with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.
Under the Strategy, seven sub-strategies will be developed. One of the sub-strategies is 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.
From 2012–13, around 100 Indigenous service providers across Australia and around 150 non-government organisations are funded by the Department of Health and Ageing through the Substance Misuse Service Delivery Grants Fund and Non-Government Organisation Treatment Grants Program 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 Indigenous primary care services.
As part of the Stronger Futures in the Northern Territory plan, the Australian Government has allocated funding (commencing from 2012–13) for the provision of an additional 20 new workers to provide drug and alcohol treatment services in remote communities with Alcohol Management Plans in place or being implemented. The additional drug and alcohol workforce will build on the existing drug and alcohol workforce established through the Northern Territory Emergency Response (NTER). The Australian Government has also continued to support successful elements of the drug and alcohol services component of the NTER by investing in treatment and rehabilitation organisations to provide increased service delivery.
Several state and territory level initiatives have also been put in place to increase access to alcohol and other drug services. For example, in Qld funding is provided for alcohol treatment and counselling services in or near 21 Indigenous communities. Services will be provided by up to 63 extra staff including nurses, allied health staff and Indigenous community support workers to provide an integrated clinical and therapeutic pathway from hospital back to the community. In 10 communities this will be further supported by alcohol withdrawal services.
The Alcohol Treatment Guidelines for Indigenous Australians provide an evidence-based, user-friendly resource to assist health professionals understand and manage alcohol-related issues experienced by their Indigenous clients.Top of page
Figure 176—Episodes of care provided to Indigenous people at Australian Government funded stand-alone substance use services, by age and sex, 2010–11
Source: AIHW OSR data collection
Figure 177—Counselling/advice on alcohol provided by general practitioners, by Indigenous status, April 1998 to March 1999, April 2004 to March 2005 and April 2010 to March 2011Top of page
Source: BEACH survey of general practice, AGPSCCTop of page