Emerging alcohol policy innovation in the Northern Territory, Australia

"You Don't Get That from Professionals": A Consumer-Led Peer Recovery Program for Families and Friends of Individuals with Alcohol and Other Drugs Use Issues in Darwin

While there has been a reduction in alcohol consumption among Australians aged 18 years and above, about 25% of people still drink above the recommended limit. The use of alcohol and other drugs is a substantial issue in the Northern Territory; however, there have been significant investments in alcohol reforms over the past few years. This paper reports on a pilot study that involved co-designing, implementing, and evaluating the Circles of Support consumer-led recovery and empowerment program for families and friends of individuals with alcohol and other drugs use issues. The evaluation comprised a mixed-methods approach; however, this article only presents the qualitative component (n = 7). Interview data were thematically analysed, and four main themes were identified: (1) the value of a peer-to-peer approach; (2) facing challenges and distress; (3) adopting self-care strategies; and (4) the development of valuable skills. Participants enjoyed the program content and learning. This involved self-care and communication strategies, boundary setting, service navigation, the concept of post-traumatic growth, the circles of control, and the stages of change model for families. Our findings strongly support the scaling up of the program in Darwin and other locations across the Northern Territory and future program adaptation for different vulnerable target audiences.

Impact on the health service in the Top End, Northern Territory following the introduction of an electric scooter sharing service

OBJECTIVE

To investigate patients presenting to EDs following the recent introduction of a shared electric scooter (e-scooter) scheme in Northern Territory (NT).

METHODS

We conducted a prospective observational cohort study in Darwin, a regional city in NT, Australia with a population of approximately 150 000. Any patient who disclosed involvement of an e-scooter in the reason for their presentation to the ED was included. A descriptive analysis was derived for age, sex, triage time, alcohol level, injury type and the requirement of operating theatre, inpatient stay or ED discharge. Categorical variables were analysed using χ² -tests, with odds ratios (ORs), 95% confidence intervals (CIs) and P-values reported. Costing analysis to ED of attendances and inpatient hospital admissions was undertaken.

RESULTS

There were 111 presentations over the 8-month study period (January-September 2021). Forty-nine percent (n = 51) of patients were male and 51% (n = 54) were female. Extremity (n = 70) and craniofacial (n = 61) injuries were most common and approximately a quarter of patients (n = 24) required operative management for injuries sustained. Approximately half (n = 51) of patients were intoxicated and the average alcohol level of those tested was 0.18% (range 0.05-0.49%). The average cost per ED attendance was AU$777 and total cost of inpatient admissions being AU$352 255. All inpatient admissions were a result of injury while intoxicated.

CONCLUSION

Harm minimisations strategies targeting implementation of alcohol testing and penalties for riders may be able to reduce the effect that the introduction of e-scooters on the strained health system in the NT.

Impact of alcohol policy changes on substance‐affected patients attending an emergency department in the Northern Territory with police

OBJECTIVE

Assess the impact of Northern Territory alcohol policy changes to ED utilisation at Royal Darwin-Palmerston Regional Hospitals.

METHODS

Interrupted time series analysis explored trends in monthly ED attendance numbers and the proportion self-discharging prior to policy changes (September 2016 to August 2017) and after three sequential interventions; the Banned Drinker Register, introduced September 2017, system changes to the sobering shelter, January 2018, and the minimum unit floor price (MUFP), October 2018. A targeted cohort of attendances transported by police as an alternative to the sobering shelter or police watch-house when there is a medical concern was selected as they are likely impacted by all policy changes.

RESULTS

Police transported 1176 patients on 2070 occasions from September 2016 to March 2019. There was a downward trend in monthly attendances across the study period, with no significant change attributable to the Banned Drinker Register, a significant step decrease with the sobering shelter changes (P = 0.002), and a significant gradual decrease following the MUFP (P = 0.025). This represented an immediate decrease of 3.82 attendances per month/10 000 residents following the sobering shelter changes and a gradual decrease of 0.92 attendances/10 000 residents after the MUFP. Rates of self-discharge were high, 45% in the pre-intervention phase, decreasing to 28% following the MUFP but this trend did not reach significance with any intervention.

CONCLUSION

The sequential introduction of broad sweeping alcohol policy changes introduced by the Northern Territory government was associated with significant reductions in ED utilisation. The proximity of the introduction of interventions creates difficulties identifying individual policy influence.

First Nations Australians' experiences of current alcohol policy in Central Australia: evidence of self-determination?

Alcohol is the leading cause of healthy years lost. There is significant variation in alcohol consumption patterns and harms in Australia, with those residing in the Northern Territory (NT), particularly First Nations Australians, experiencing higher alcohol-attributable harms than other Australians. Community leadership in the planning and implementation of health, including alcohol, policy is important to health outcomes for First Nations Australians. Self-determination, a cornerstone of the structural and social determinants of health, is necessary in the development of alcohol-related policy. However, there is a paucity of published literature regarding Indigenous Peoples self-determination in alcohol policy development. This study aims to identify the extent to which First Nations Australians experience self-determination in relation to current alcohol policy in Alice Springs/Mbantua (Northern Territory, Australia).Semi-structured qualitative yarns with First Nations Australian community members (n = 21) were undertaken. A framework of elements needed for self-determination in health and alcohol policy were applied to interview transcripts to assess the degree of self-determination in current alcohol policy in Alice Springs/Mbantua. Of the 36 elements, 33% were not mentioned in the interviews at all, 20% were mentioned as being present, and 75% were absent. This analysis identified issues of policy implementation, need for First Nations Australian leadership, and representation.Alcohol policy for First Nations Australians in the NT is nuanced and complicated. A conscious approach is needed to recognise and implement the right to self-determination, which must be led and defined by First Nations Australians.First Nations Australians' experiences of current alcohol policy in Central Australia: evidence of self-determination?

Self-determination by First Nations Australians in alcohol policy: Lessons from Mbantua/Alice Springs (Northern Territory, Australia)

BACKGROUND

First Nations Australians have an internationally-recognised right to self-determination - a key social determinant of health. The recognition and application of this right varies within different regions and policy contexts but is currently unknown for First Nations Australians' engagement in alcohol policy development. This study seeks to: explore First Nations Australians' experiences of alcohol policy in Central Australia (Northern Territory); and identify how First Nations Australians' right to self-determination can be recognised and applied in the development of alcohol policy in Mbantua/Alice Springs.

METHODS

Using a blended yarning and appreciative inquiry approach, 24 interviews were conducted. Interviews were thematically coded in multiple stages, using diagrammatic methods.

RESULTS

Four key themes emerged: (i) experiences of purchasing alcohol; (ii)communication of the current alcohol policy; (iii) experiences of policy described by participants (and their community); and (iv) self-determination in alcohol policy.

CONCLUSIONS

Current pathways for contributing to alcohol policy have been ineffective in achieving meaningful engagement with Australia's First Nations community members. This study provides some guidance as to how self-determination can more effectively be incorporated in the development of alcohol policy in the NT.

Learning from alcohol (policy) reforms in the Northern Territory (LEARNT): protocol for a mixed-methods study examining the impacts of the banned drinker register

INTRODUCTION

The Banned Drinker Register (BDR) was reintroduced in the Northern Territory (NT) in September 2017. The BDR is a supply reduction measure and involves placing people who consume alcohol at harmful levels on a register prohibiting the purchase, possession and consumption of alcohol. The current study aims to evaluate the impacts of the reintroduction of the BDR, in the context of other major alcohol policy initiatives introduced across the NT such as Police Auxiliary Liquor Inspectors and a minimum unit price for alcohol of US$1.30 per standard drink.

METHODS AND ANALYSES

The Learning from Alcohol (policy) Reforms in the Northern Territory project will use a mixed-methods approach and contain four major components: epidemiological analysis of trends over time (outcomes include health, justice and social welfare data); individual-level data linkage including those on the BDR (outcomes include health and justice data); qualitative interviews with key stakeholders in the NT (n≥50); and qualitative interviews among people who are, or were previously, on the BDR, as well as the families and communities connected to those on the BDR (n=150). The impacts of the BDR on epidemiological data will be examined using time series analysis. Linked data will use generalised mixed models to analyse the relationship between outcomes and exposures, utilising appropriate distributions. Qualitative data will be analysed using thematic analysis.

ETHICS AND DISSEMINATION

Ethics approvals have been obtained from NT Department of Health and Menzies School of Health Research Human Research Ethics Committee (HREC), Central Australia HREC and Deakin University HREC. In addition to peer-reviewed publications, we will report our findings to key organisational, policy, government and community stakeholders via conferences, briefings and lay summaries.

A historical overview of legislated alcohol policy in the Northern Territory of Australia: 1979-2021

BACKGROUND

The Northern Territory (NT) has the highest levels of alcohol consumption and harms in Australia. Since the creation of the NT Liquor Act 1978, which came into effect in 1979, numerous legislated alcohol policies have been introduced to attempt to address these harms. We present a narrative historical overview of alcohol policies implemented in the NT from 1979 to 2021.

METHODS

Using scoping review methodology, databases were searched from 1979 to 2021. Of 506 articles screened, 34 met inclusion criteria. Reference lists of all included articles were searched, resulting in the inclusion of another 41 articles and reports, totalling 75 final documents. Policies were organised using Babor and colleagues (2010) established framework: 1. pricing/ taxation; 2. regulating physical availability; 3. modifying drinking environments; 4. drink-driving countermeasures; 5. restrictions on marketing; 6. education/persuasion; 7. treatment/early intervention.

RESULTS

Two pricing/taxation policies have been implemented, Living With Alcohol (LWA) and Minimum Unit Price, both demonstrating evidence of positive effects on health and consumption outcomes. Eight policies approaches have focused on regulating physical availability, implemented at both individual and local area levels. Several of these policies have varied by location and been amended over time. There is some evidence demonstrating reduction in harms attributable to Liquor Supply Plans, localised restrictions, and General Restricted Areas, although these have been site specific. Of the three policies which targeted modifying the drinking environment; one was evaluated, finding a relocation of social harms, rather than a reduction. The literature outlines a range of controversies, particularly regarding policies in domain 2-3, including racial discrimination and a lack of policy stability. No policies relating to restricting marketing or education/persuasion programs were found. The only drink-driving legislated policy was considered to have contributed to the success of the LWA program. Three policies relating to treatment were described; two were not evaluated and evidence showed no ongoing benefits of Alcohol Mandatory Treatment.

DISCUSSION

The NT has implemented a large number of alcohol policies, several of which have evidence of positive effects. However, these policies have often existed in a context of clear politicisation of alcohol policy, frequently with an implicit focus on Aboriginal people's consumption.

The impact of a minimum unit price on wholesale alcohol supply trends in the Northern Territory, Australia

OBJECTIVE

The Northern Territory (NT) Government introduced a minimum unit price (MUP) of $1.30 per standard drink (10g pure alcohol) explicitly aimed at reducing the consumption of cheap wine products from October 2018. We aimed to assess the impact of the NT MUP on estimates of beverage-specific population-adjusted alcohol consumption using wholesale alcohol supply data.

METHODS

Interrupted time series analyses were conducted to examine MUP effects on trends in estimated per capita alcohol consumption (PCAC) for cask wine, total wine and total alcohol, across the NT and in the Darwin/Palmerston region.

RESULTS

Significant step decreases were found for cask wine and total wine PCAC in Darwin/Palmerston and across the Northern Territory. PCAC of cask wine decreased by 50.6% in the NT, and by 48.8% in Darwin/Palmerston compared to the prior year. PCAC for other beverages (e.g. beer) were largely unaffected by MUP. Overall, PCAC across the Territory declined, but not in Darwin/Palmerston.

CONCLUSION

With minimal implementation costs, the Northern Territory Government's MUP policy successfully targeted and reduced cask wine and total wine consumption. Cask wine, in particular, almost halved in Darwin/Palmerston where the impact of the MUP was able to be determined and considering other interventions. Implications for public health: Implementation of a minimum unit price for retail alcohol sales is a cost-effective way to reduce the consumption of high alcohol content and high-risk products, such as cheap cask wine.

Industry views about the Banned Drinker Register in the Northern Territory: Early lessons from a qualitative evaluation

Introduction and Aims

The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take‐away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol‐related harms.

Design and Methods

Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR.

Results

Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health‐focused approach to therapeutic services and referrals identified in other sources.

Discussion and Conclusions

Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives.