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Alcohol management in Aboriginal and Torres Strait Islander communities has been a deeply divisive issue, as seen recently in Alice Springs in the Northern Territory.

and welcomed emergency restrictions on the sale of alcohol from January 24 2023.

This approach resulted in an immediate decrease in alcohol-related harms, including family violence and emergency department presentations.

But Elders in Alice Springs these restrictions “should not let governments off the hook” from addressing the underlying social determinants of alcohol-related harm.

This reflects a long-standing community concern that prohibition alone does nothing to address issues such as intergenerational trauma, poverty, housing, education, unemployment, access to alternative activities, access to adequate health care and racism.

Critics of government-imposed alcohol management argue the allocation of resourcing is toward supply reduction – and especially law enforcement – with inadequate funding of demand-reduction and harm-reduction strategies.

Our commentary, published this week in the , highlights the need for culturally responsive approaches to alcohol in remote communities. Reductions in alcohol use are linked with the strength of culture, empowerment and community.

Incorporating Aboriginal culture

Australia’s outlines three ways to address alcohol-related harm, by reducing:

1. demand – preventing people taking up drinking or delaying starting, providing education, and offering treatment services

2. supply – reducing alcohol availability and greater policing

3. harm – encouraging responsible service of alcohol and providing services such as sobering-up shelters that reduce harm for people who are intoxicated.

But development and implementation of these strategies has overlooked culturally responsive approaches to meet the needs of Aboriginal and Torres Strait Islander peoples. One such approach is the “interplay wellbeing framework”.

The is based on Indigenous concepts of wellbeing and positions risky alcohol use in the context of systemic inequities across all the social determinants of health, including housing, education, employment and wealth.

Such approaches show how government and communities can work together in a shared and respectful space to progress the ³Ô¹ÏÍøÕ¾ Drug Strategy.

Non-drinkers and risky drinkers

Overall, Indigenous Australians are to be non-drinkers (15.4%) compared to non-Indigenous people (7.9%).

But alcohol-related harm has been very destructive for many Indigenous communities. In 2018, alcohol of the total burden of disease and injury for Indigenous Australians. This harm is preventable.

Risky levels of alcohol use for Indigenous Australians are often due to the ongoing . This includes intergenerational trauma, which manifests as and is sometimes interlinked with risky alcohol consumption.

How alcohol harms

According to the , many people who drink at risky levels don’t consider themselves as heavy drinkers. Nor do they identify alcohol use as a cancer, heart disease, stroke, liver disease and gastrointestinal disorders.

related to alcohol use include physical assaults, injuries, child neglect and abuse, suicidal thoughts, partner violence and crime. Lives are lost prematurely to family violence, homicide, suicide and accidents.

The costs of alcohol-related social harm are estimated at in Australia from 2017-2018.

Alcohol industry is a barrier to reducing harms

The alcohol industry uses to promote alcohol as a safe product. The DrinkWise program, for instance, is . It seeks to as an irresponsible drinker. This reduces the need for the alcohol industry to take responsibility for its harmful product.

Harm-minimisation strategies need the genuine support of the alcohol industry if they are to effectively reduce alcohol use and respond to the impact of illness and disease related to alcohol use.

But to date, the alcohol industry has capitalised on the challenges communities face. It provides easy access in areas of lower socioeconomic status. This exploitative practice increases the risk of alcohol-related harm to people living in these areas.

Healing through culture

to alcohol-related harm promote holistic wellbeing and draw on the healing qualities that Aboriginal culture offers. This is an effective way of alleviating intergenerational trauma and interrelated alcohol harm.

Community-level healing- and trauma-informed approaches can overcome barriers that prevent people accessing health and social support systems.

However, they need to be adequately funded and resourced. Culturally responsive healing approaches need to be community-, evidence- and theory-informed and inclusive of both traditional healing and western methodologies.

How the model can work

The value of culture on Country has been demonstrated through a healing model of care for promoting effective rehabilitation.

is a three-month program that combines 12-step treatment with residential treatment facility focusing on:

• healing through culture and Country
• emotional safety and relationships
• strengthening life skills
• improved wellbeing.

Information collected found that embedding culture and being on Country enhanced participants’ feelings of connection, identity and spirituality.

Indigenous leadership and self-determination

require and culture to counter the harms associated with alcohol use.

This ensures the healing process can privilege resistance, resilience, interpersonal relationships and strengths. Incorporating a holistic view of community and culture can facilitate mutually respectful collaboration and – and lead to sustained change.

Lorelle Holland receives funding from the ³Ô¹ÏÍøÕ¾ Health and Medical Research Council (NHMRC) Post Graduate Scholarship (PGS) and The Australian Academy of Science Douglas and Lola Douglas Scholarship in Medical Science.

Andrew Smirnov, Natasha Reid, Nicole Hewlett, and Tylissa Elisara do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.