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NT mandatory alcohol rehabilitation has 'little evidence' to justify it – health experts NT mandatory alcohol rehabilitation has 'little evidence' to justify it, say health experts
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Mandatory detention for alcohol rehabilitation in the Northern Territory has little evidence to justify it, may discriminate against Indigenous people and is not cost-effective, health experts have said.Mandatory detention for alcohol rehabilitation in the Northern Territory has little evidence to justify it, may discriminate against Indigenous people and is not cost-effective, health experts have said.
Rates of alcohol consumption and alcohol-related deaths are far higher in the Northern Territory than nationally, and the 2013 Alcohol Mandatory Treatment Act introduced in response requires that anyone who is picked up by police for being drunk three times in two months be placed under an alcohol mandatory treatment (AMT) order and forced into rehabilitation.Rates of alcohol consumption and alcohol-related deaths are far higher in the Northern Territory than nationally, and the 2013 Alcohol Mandatory Treatment Act introduced in response requires that anyone who is picked up by police for being drunk three times in two months be placed under an alcohol mandatory treatment (AMT) order and forced into rehabilitation.
The Act involves the “dubious” application of medical intervention, and is “disturbing” in the way it only targets problem drinkers in public, rather than all problem drinkers, according to the ethics and law article published in the Medical Journal of Australia on Monday. The act involves the “dubious” application of medical intervention and is “disturbing” in the way it only targets problem drinkers in public rather than all problem drinkers, according to the ethics and law article published in the Medical Journal of Australia on Monday.
The policy has attracted widespread criticism that it unfairly targets Indigenous people and criminalises alcoholism, as homeless and itinerant people – most of whom are Indigenous in the territory – are much more likely to be picked up.The policy has attracted widespread criticism that it unfairly targets Indigenous people and criminalises alcoholism, as homeless and itinerant people – most of whom are Indigenous in the territory – are much more likely to be picked up.
Dr Fiona Lander from the Harvard TH Chan school of public health, Prof. Dennis Gray and Ass. Prof. Edward Wilkes, from the national drug research institute at Curtin University, have added to the criticism, writing that there was “little evidence of the scheme’s efficacy”. Dr Fiona Lander from the Harvard TH Chan School of Public Health, Professor Dennis Gray and Associate Professor Edward Wilkes from the National Drug Research Institute at Curtin University have added to the criticism, writing there was “little evidence of the scheme’s efficacy”.
Related: Labor puts banned drinker register back on the cards for Northern TerritoryRelated: Labor puts banned drinker register back on the cards for Northern Territory
The article cites an Australian National Council on Drugs report which concluded “the empirical evidence for the effectiveness of compulsory treatment is inadequate and inconclusive”.The article cites an Australian National Council on Drugs report which concluded “the empirical evidence for the effectiveness of compulsory treatment is inadequate and inconclusive”.
While they acknowledge that some changes have been made to the policy, including decriminalising the act of absconding from a treatment centre, the authors say in the article there are several concerning aspects, including a lack of evaluation and transparency. The government has released no data on relapse rates in its publicly released information on the program. While they acknowledge some changes have been made to the policy, including decriminalising the act of absconding from a treatment centre, the authors say there are several concerning aspects, including a lack of evaluation and transparency. The government has released no data on relapse rates.
“It is also disturbing that the scheme is openly targeted at ‘chronic drinkers who are publicly intoxicated’ – not all problem drinkers,” they write. “This use of a medical intervention to deal with a perceived social problem should concern clinicians.“It is also disturbing that the scheme is openly targeted at ‘chronic drinkers who are publicly intoxicated’ – not all problem drinkers,” they write. “This use of a medical intervention to deal with a perceived social problem should concern clinicians.
“Finally, it is disquieting that around $27m annually is being spent on a potentially discriminatory program lacking in evidence,” reads the paper.“Finally, it is disquieting that around $27m annually is being spent on a potentially discriminatory program lacking in evidence,” reads the paper.
It says 418 people were referred to the program in the year to June 2014, at an approximate cost of $64,000 per person.It says 418 people were referred to the program in the year to June 2014, at an approximate cost of $64,000 per person.
“There are a number of more cost-effective interventions that could be implemented in place of the AMT scheme, which would represent a significantly less punitive approach towards [alcohol and other drug]-dependent people in the NT,” the paper says.“There are a number of more cost-effective interventions that could be implemented in place of the AMT scheme, which would represent a significantly less punitive approach towards [alcohol and other drug]-dependent people in the NT,” the paper says.
Dr Tim Senior, a GP specialising in Indigenous health, told Guardian Australia any addiction treatments “tend not to work unless the person wants to make the changes themselves.”Dr Tim Senior, a GP specialising in Indigenous health, told Guardian Australia any addiction treatments “tend not to work unless the person wants to make the changes themselves.”
“The problem with mandatory [treatment] is it becomes a court process and the risk is that with what’s actually a health problem, the response becomes a law and order approach and risks worsening some of the justice [outcomes],” said Senior.“The problem with mandatory [treatment] is it becomes a court process and the risk is that with what’s actually a health problem, the response becomes a law and order approach and risks worsening some of the justice [outcomes],” said Senior.
“In the Northern Territory the Aboriginal prison population is huge, and it runs the risk of making that worse, and that itself has health consequences.”“In the Northern Territory the Aboriginal prison population is huge, and it runs the risk of making that worse, and that itself has health consequences.”
Senior said there was also the danger of reinforcing negative stereotypes around Aboriginal people and policies which target them. Senior said there was also the danger of reinforcing negative stereotypes around Aboriginal people.
“Alcohol isn’t just a problem in Aboriginal and Torres Strait Islander communities,” he said. “Very often the drinking is visible out of doors so it gets picked up, but in communities which are functioning quite well – and there are quite a few in the Northern Territory – alcohol is not a big problem … problems with drinking in non-Aboriginal communities just go on behind closed doors and don’t get addressed.”“Alcohol isn’t just a problem in Aboriginal and Torres Strait Islander communities,” he said. “Very often the drinking is visible out of doors so it gets picked up, but in communities which are functioning quite well – and there are quite a few in the Northern Territory – alcohol is not a big problem … problems with drinking in non-Aboriginal communities just go on behind closed doors and don’t get addressed.”
An expensive policy which is unsuccessful can “reinforce a negative stereotype that nothing works,” Senior said. “But that’s not the case, you just need to choose interventions that do work.” An expensive policy which is unsuccessful can “reinforce a negative stereotype that nothing works”, Senior said. “But that’s not the case, you just need to choose interventions that do work.”
AMTs are part of a suite of alcohol-related measures employed by the Northern Territory government, including stationing police officers outside bottle shops to check customers are not taking purchases back to proscribed dry communities.AMTs are part of a suite of alcohol-related measures employed by the Northern Territory government, including stationing police officers outside bottle shops to check customers are not taking purchases back to proscribed dry communities.
In April, the NT government indicated a step back from the policy when it announced it would not go ahead with a new facility in Katherine, but AMTs remain in place. In April, the NT government indicated a step back from the policy when it announced it would not go ahead with a new alcohol rehabilitation centre in Katherine, but AMTs remain in place.
A Senate inquiry report last week backs up the authors’ claims with a recommendation that “the Northern Territory government prioritise the resourcing of voluntary alcohol treatment and rehabilitation programs in place of the Alcohol Mandatory Treatment program.” A Senate inquiry report last week backs up the authors’ claims with a recommendation that “the Northern Territory government prioritise the resourcing of voluntary alcohol treatment and rehabilitation programs in place of the Alcohol Mandatory Treatment program”.
The report also recommended reintroducing the banned drinkers register (BDR), which stops problem drinkers from buying alcohol. Despite frequent calls from the Labor opposition, the government has repeatedly refused to do so, claiming there was no evidence of its effectiveness.The report also recommended reintroducing the banned drinkers register (BDR), which stops problem drinkers from buying alcohol. Despite frequent calls from the Labor opposition, the government has repeatedly refused to do so, claiming there was no evidence of its effectiveness.
Last week, NT health minister John Elferink dismissed the BDR recommendation made in the Alcohol, Hurting People and Harming Communities report, which he conceded he had not read.Last week, NT health minister John Elferink dismissed the BDR recommendation made in the Alcohol, Hurting People and Harming Communities report, which he conceded he had not read.