Difference and indifference : Australian policy and practice in indigenous substance abuse

Abstract

This research addresses the ways in which alcohol problems among indigenous Australians have been conceptualised and acted upon by the people themselves, and by government policy-makers. The thesis considers two main questions. First, how has it eventuated that Aborigines have become excluded from national and international innovation in the management of drug and alcohol problems? Second, are mainstream models of best practice for alcohol intervention, particularly secondary prevention activities, acceptable to and feasible for Aboriginal people? I examine how the growth of the indigenous rights movement came to underpin assertions of cultural difference from other Australians, which in turn influenced the growth of separate community-controlled health and other organisations. National policymakers found it difficult to deal with demands for the recognition of cultural difference through the provision of special funds and separate services. As a result of this increased sensitivity, national policies often gave inadequate consideration to indigenous issues. Alcohol problems in particular received little expert attention, and the division of community-controlled alcohol programs from health services for Aborigines exacerbated these shortcomings. Aboriginal approaches to alcohol were influenced by a small group of charismatic activists who pursued a unitary position and remained insulated from the changes in policy and practice available to the wider population. While the health services came to be influenced by an all encompassing 'Aboriginal' definition of health - associated with the broad WHO definition of health emanating from the Alma-Ata Declaration of 1978 - alcohol programs maintained a narrow, disease-based focus. Cultural difference is presented throughout the thesis as being a crucial issue, and it is analysed as a political construct with continuing salience in the face of the unequal distribution of resources. The constructions of difference are discussed and contested in the areas of culture and healing, in health, and in approaches to alcohol problems. I demonstrate that the politics of difference has masked the fact that many Aboriginal dependent drinkers manage to give up drinking, either on their own or with the encouragement of a health professional, just as do others in the population. The politics of difference is also implicated in the rejection of innovative and varied approaches to alcohol problems emanating from mainstream treatment research. This has deprived Aboriginal people experiencing serious alcohol problems of access to a range of interventions which could assist them much earlier in their drinking careers. Some relevant approaches include brief and opportunistic interventions delivered by health professionals, which are found to be relevant and feasible for use with Aboriginal clients of primary health care services.