Introduction

Abstract

This chapter outlines the objectives of the book that follows and contextualises it. The objectives are, firstly, to review actions and programs adopted by Aboriginal communities and organisations to reduce alcohol-related harms in the half-century that has passed since legal prohibition on Aboriginal drinking alcohol in Australia was rescinded. A second objective is to synthesise evidence from these actions and programs in order to improve the evidence-base available to current and future initiatives. The chapter concludes with an overview of topics explored in the following chapters.

1.1 Introduction

This book is about actions taken to prevent or reduce alcohol-related harm in Aboriginal communities in Australia, with an emphasis on actions by Aboriginal communities or organisations themselves, rather than measures imposed by governments (although the two, as we show at numerous points below, are inextricably inter-twined). It is not about why some Aboriginal people drink or how much they drink, or the impacts of drinking on health and wellbeing. By way of background and context, we summarise some indicators of these aspects below. But the focus of this book is on solutions, not problems.

The book is made up of two components: our own original writing, and extracts from pre-existing documents. Our rationale for writing and compiling it has several strands. The first is that in the fifty years or thereabouts that have passed since Aboriginal Australians in state/territory jurisdictions were granted the legal right to drink alcohol, many programs and measures have been tried in efforts to prevent or treat the harms that alcohol can cause. Some of these—both among the successful and the not-so-successful interventions—hold lessons for people or groups pursuing similar goals today or in the future. But in order to learn those lessons we need to have access to the experiences of those who went before.

For many people today, such access is limited or non-existent. In 2003, the National Drug Strategy Aboriginal and Torres Strait Islander Peoples Complementary Action Plan 2003–2006 drew attention to the damaging effects of a lack of evidence about alcohol and other drug (AOD) prevention and treatment options:

In many Aboriginal and Torres Strait Islander communities, programs to deal with use of alcohol, tobacco and other drugs have made little impact on their health and wellbeing, increasing feelings of hopelessness and despair’ (Ministerial Council on Drug Strategy (MCDS) 2003: 3).

The Complementary Action Plan, which was subsequently extended through to 2009, identified the need for information about what works and does not work in approaches to dealing with alcohol, tobacco and other drugs as a ‘key action area’ (Ministerial Council on Drug Strategy 2006). Despite these recommendations, it appears that little progress has been made (Gray et al. 2010). The National Aboriginal and Torres Strait Islander Peoples Drug Strategy 2014–2019, which superseded the earlier Plan in 2014, stated:

Despite a broader acceptance that there are principles and approaches that are successful, the ‘evidence base’ for Aboriginal and Torres Strait Islander-specific interventions relating to harmful use of AOD is limited for a range of reasons. These include a low number of formal evaluations of interventions, as well the complexity related to the diverse number of potential settings and solutions that exist within Aboriginal and Torres Strait Islander communities. There is therefore a need to improve the data (and supporting systems) available to build the evidence base and support those interventions that do show promise or success (Intergovernmental Committee on Drugs (Australia) 2014: 33)

Both of the factors cited in the 2014–2019 Strategy—the dearth of evaluations of interventions and the complexity of the relationships between ‘potential settings and solutions’—continue to this day to impede the creation of a robust evidence-base for interventions.

This brings us to the second strand in our rationale for writing the book: it will, we hope, contribute to redressing this gap, in at least two ways: firstly, by retrieving accounts of interventions, many of which are in danger of slipping into pre-digital era obscurity. Secondly, we hope to show that the available evidence regarding interventions and outcomes—for all its shortcomings—can do more to enhance our understanding of both the challenges and potential benefits of alcohol interventions than has been recognised to date.

The potential loss of information that we endeavour to alleviate is a by-product of the increasingly digitised world in which we live, and the search strategies used for retrieving information in this world. Many of the documents in which accounts of earlier interventions are to be found either belong in so-called ‘grey literature'—that is, documents that, while not confidential, were never published or formally placed in the public domain—or they take the form of reports that, while possibly made publicly available at one time, have long since become out of print, and are unlikely to come to light in online literature searches.

To assert, as we do by writing this book, that earlier accounts of interventions contain relevant and useful evidence for present and future interventions is by implication to raise the question of what we mean by ‘evidence’ and how we assess evidence. Many existing accounts of interventions are not, to use the terminology of the Drug Strategy referred to above, ‘formal evaluations of interventions’. Most are descriptions of programs, contain little or no quantitative data or outcome data, and have few of the attributes of evaluative or other social science research. (In this, as Sanson-Fisher et al. (2006) demonstrate, they are typical of literature published on Aboriginal health not only in Australia, but also in the US, Canada and New Zealand over recent decades.) From the perspective of the hierarchies of evidence that underpin contemporary evidence-based medicine (EBM) and evidence-based policy (EBP)– they would be classified as evidence of the lowest order, or in some cases possibly excluded altogether (Head 2010; Parkhurst and Abeysinghe 2016; Rychetnik et al. 2002). Such works are also unlikely to survive the culling process adopted in systematic literature reviews, that routinely exclude studies that fail to satisfy methodological selection criteria based on hierarchies of evidence.

The concept of a hierarchy of evidence evolved in the late twentieth century in conjunction with the promotion of EBM—that is, clinical practice informed by the highest quality evidence of treatment effectiveness rather than by other criteria such as customary practice (Sackett et al. 1996). At the top of the hierarchy are research designs that demonstrate a causal connection between intervention and outcome, control for possible effects of confounding variables, have high validity (that is, measure what they claim to be measuring) and are less susceptible than other designs to observer bias. The designs that best satisfy these criteria are large sample randomised control trials (RCTs) with randomised intervention samples (who receive the intervention) and control samples (who do not, but who may receive a placebo). Other evaluation designs, such as observational studies (where participants are tracked over time, but not assigned to an intervention and control group), case studies, or collation of expert opinions, are considered to be less robust on one or more of these criteria and therefore occupy lower places on the hierarchy (Kemm 2006).

The thinking behind EBM has also been extended to public health interventions, where its applicability, however, has been questioned. Rychetnik et al (2002), while accepting many of the principles of EBM and the hierarchy of evidence that underpins it, argue that both are insufficient as a framework for assessing public health interventions, for several reasons. Firstly, they argue, in reviewing evidence, practitioners sometimes mistake the quality of an evaluation for the quality of the intervention being evaluated. The failure of an evaluation to demonstrate an outcome may be due to flaws in the evaluation rather than in the intervention, but if the evaluation is excluded from systemic reviews because of those flaws, we have no way of knowing if that is the case. Secondly, they argue that public health interventions are typically complex and dependent for implementation on contextual factors—attributes that RCTs are ill-equipped to address. Public health interventions, they suggest, should be assessed according to at least four additional criteria: (1) consideration of whose interests are served by intervention outcomes, in particular whether or not the interests of those most directly affected by the intervention are served; (2) the emergence of unintended as well as intended effects; (3) the economic efficiency of the intervention, and (4) its transferability to other settings (Rychetnik et al. 2002).

The need to attend to the perspectives of practitioners and lay participants alike becomes even more important—and takes on added dimensions—when we consider interventions in Aboriginal settings. Here, questions concerning the kind of knowledge that is being generated in evaluations and other research, and whose interests are served by this knowledge, are framed by a historical context in which these activities are widely viewed among Aboriginal people as instruments of colonisation. Research has tended to be conducted on Aboriginal people rather than with them and has typically addressed questions posed by non-Aboriginal people (Katz et al. 2016; Smith 2021). Today, efforts to reform evaluation and other research practices are directed at two inter-related issues: the kinds of data generated by research, and the role of communities and community agencies in designing research and utilising findings.

Several Aboriginal and other researchers have argued a need for explanatory models of sickness and health grounded in Aboriginal cultural perspectives rather than western biomedical models (Atkinson 2006; Blignault and Williams 2017; Gray and Sputore 1998; Katz et al. 2016; Phillips 2003). McKendrick et al. (2017), reviewing Aboriginal healing programs, note the presence of tensions between mainstream notions of treatment efficacy and a belief among Aboriginal service providers that RCTs and similar designs are not suited to documenting the gradual and complex processes entailed in Indigenous healing. Moreover, because these programs emphasise concepts such as spirituality, they are often regarded with scepticism by mainstream funding and other bodies. Several attempts have been made to develop evaluation designs more attuned to Aboriginal priorities (eg., Nichols 2010; Williams 2018). Katz et al (2016) conclude a review of approaches to evaluating programs in Aboriginal settings by summarising what they view as the features necessary for a successful evaluation:

There is little direct evidence relating specifically to evaluation but there is now a large body of evidence that research with Aboriginal peoples (and other Indigenous nations) is only successful if it is conducted with the participation (and preferably the control) of Aboriginal communities. Successful research is characterised by ‘de-colonising’ approaches which do not privilege western methods, understandings or theories over those of Indigenous peoples. In particular, community members should not be seen as passive subjects and evaluators should not have the role of experts – rather the project needs to be co-produced. In addition, Aboriginal knowledge should not be exploited by the evaluator and should be seen as the property of the community. Overall, research and evaluation must be seen as part of the self-determination of Aboriginal communities and the methods and approaches must be congruent with this objective (Katz et al. 2016: 36).

In the chapters that follow, we show how these issues have emerged in specific contexts such as evaluating residential treatment programs or monitoring community patrols. For now, we do no more than flag our use in this book of a more inclusive and less hierarchical notion of what constitutes evidence than trends discussed above allow. We draw on descriptions and analyses that we believe have useful insights or information for contemporary efforts to reduce alcohol-related harms, regardless of their ranking on a methodological hierarchy.

A third reason for writing this book is because the topic matters. Alcohol misuse is deeply implicated in many of the challenges facing Aboriginal people in Australia today. The nature of the nexus between alcohol and disadvantage, and the different ways in which people have attempted to understand and explain it, are the subject of the next chapter. Here, we note three key features of Aboriginal alcohol use. The first is that Aboriginal people are more likely not to drink at all than non-Aboriginal Australians. The most recent evidence for this long-standing difference comes from the 2019 National Drug Strategy Household Survey (NDSHS), which reported that the age-standardised proportion of Aboriginal and/or Torres Strait Islander people who reported not having consumed alcohol in the previous twelve months was 27.9%, compared with 24.1% among non-Aboriginal people (Australian Institute of Health and Welfare 2020). The proportion of non-drinkers is even higher in remote Aboriginal communities. According to the 2018–2019 National Aboriginal and Torres Strait Islander Health Survey, 37% of people living in remote Aboriginal communities had not consumed alcohol in the previous 12 months, compared with 23% of people in non-remote areas (Australian Bureau of Statistics 2019).

A second characteristic of Aboriginal alcohol use is that, among drinkers, the proportion consuming at high risk levels is higher than among non-Aboriginal drinkers. Again, this was demonstrated in the 2019 NDSHS. Amongst Aboriginal and Torres Strait Islander drinkers, the proportion whose consumption exceeded the current NHMRC Guidelines of no more than two Standard Drinks per day (National Health and Medical Research Council (NHMRC) 2020) was 27.3%, compared with 21.4% among non-Aboriginal drinkers.¹ The disparity was even more pronounced for single occasion heavy drinking—or binge drinking—with 47.9% of current Aboriginal and Torres Strait Islander drinkers consuming more than four Standard Drinks on one occasion at least monthly, compared with 34.3% of non-Aboriginal drinkers. Taken together, these patterns mean that, in comparison with non-Aboriginal populations, where most people consume alcohol at moderate levels, Aboriginal populations tend to be polarised between non-drinkers and heavy drinkers. Both of these characteristics have also been found among Native American populations (Cunningham et al. 2016).

(It should also be noted that the proportions of Aboriginal people drinking at risky levels are declining: the proportion recorded in the NDSHS as consuming on average more than two Standard Drinks per day declined from 40.7% in 2010 to 27.3% in 2019, while the proportion consuming more than four Standard Drinks on a single occasion at least monthly fell from 52.5% in 2010 to 47.9% in 2019 (Australian Institute of Health and Welfare 2020). A cautionary note should, however, be attached to national level estimates of Aboriginal drinking patterns such as these: a recent meta-analysis of 41 studies reporting estimates of drinking patterns among Aboriginal samples found evidence of high levels of variation both within Aboriginal communities and between communities, particularly with respect to gender, age and region (Conigrave et al. 2020)).

A third feature of alcohol use among Aboriginal people is the heavy burden it imposes on the health, safety and wellbeing, not only of drinkers, but also their families and communities. Calabria et al (2010) compared alcohol-related harms among Aboriginal and non-Aboriginal Australian populations using as their measure disability-adjusted life years (DALYs).² They found that rates of alcohol-related harm among Aboriginal males were three times the rate in the general Australian male population, while rates for Aboriginal females were seven times higher than in the general female population (Calabria et al. 2010). The conditions causing the most harm among both males and females were homicide and violence, suicide, alcohol use disorders (including harmful use and dependence), and road traffic accidents (Calabria et al. 2010).

These epidemiological comparisons do not begin to evoke the many other dimensions and consequences of alcohol misuse, such as the corrosive effects on household and community safety, or the illusory release that drinking offers from pre-existing intergenerational trauma. But these, as we said at the outset, are not the focus of this book. (For more detailed accounts of harms associated with alcohol among Aboriginal Australians, see Gray et al. 2018 and the 2020 report of the Productivity Commission (Australian Government Productivity Commission 2020, Chap. 11)).

This is not the first attempt to synthesise literature on Aboriginal alcohol programs in Australia. In addition to numerous journal articles focusing on particular types of programs and referred to elsewhere in this book, several more comprehensive studies precede this one. Saggers and Gray, in a monograph published in 1998, described dimensions of alcohol-related harms among indigenous populations in New Zealand and Canada as well as Australia, and reviewed explanatory models and intervention approaches (Saggers and Gray 1998). They attributed what they viewed as limited impact of interventions to two key factors: inadequate resources and failure to address the social and economic determinants of disadvantage and the substance-misuse that accompanied it. In other subsequent articles, the authors have also drawn attention to the need for evaluation approaches that pay due attention to Aboriginal cultural perspectives and intervention priorities (Gray and Saggers 2005; Gray et al. 2010).

Brady’s The Grog Book, originally published in 1998 and revised in 2005 and 2012, carries a subtitle ‘strengthening indigenous community action on alcohol’ (Brady 2012). It is a rich resource that provides a handbook of evidence-based ideas for community groups seeking to broaden their options for managing alcohol at a local level, mainly in the form of brief case studies.³ While The Grog Book and this book are dedicated to the same purpose—conveyed in the subtitle of the former—ours adopts a more historical and analytical perspective in tracing the evolution of intervention approaches and identifying achievements and continuing challenges.

1.2 Overview of the Book

The remainder of this book comprises nine chapters, the first of which, entitled ‘Explaining Aboriginal alcohol use: changing perspectives, hidden assumptions’, outlines different ways in which alcohol use by Aboriginal people in Australia has been conceptualised or ‘framed’. Our purpose here is not so much to critique these frames but to show how each has informed distinctive approaches to the prevention and/or treatment of alcohol-related harms—approaches that are described in later chapters. We begin with biological explanations that posited race-based differences in the effects of drinking alcohol. While no longer accepted or supported by evidence, these explanations served a historically important role in legitimising policies prohibiting possession or consumption of alcohol by Aboriginal people. Other explanations outlined in this chapter are: Aboriginal alcoholism as a disease; psychological explanations; alcohol viewed as a public health problem warranting restrictions on supply; sociological and anthropological explanations for Aboriginal alcohol use, and critiques of these explanations, and conceptualisation of alcohol misuse as a product of unresolved, intergenerational trauma precipitated in the first place by the violence and dispossession wrought by colonisation.

This is followed by the first of two chapters focusing on demand reduction. In ‘Prevention and early intervention’, we look at the evolution of programs in the categories of ‘primary prevention’—that is, programs intended to prevent or delay uptake of harmful alcohol use—and ‘secondary prevention’—programs designed to prevent the onset or continuation of harmful alcohol use among people considered to be already drinking or at risk of harmful use. We note, as others have before us, that while primary prevention programs—especially media campaigns and health promotion initiatives—have long enjoyed funding support—secondary prevention was for a long time neglected in favour of residential treatment programs—the subject of the next chapter. Primary prevention initiatives have generated little by way of an evidence-base, but it is possible to identify several factors that appear to be conducive to successful implementation, including community leadership, strategic partnerships with both internal and external agencies, clearly defined and widely supported objectives, and use of data to demonstrate progress. Efforts to embed secondary prevention—also known as early or brief intervention—in routine primary health care settings have faced significant barriers (which are not exclusive to Aboriginal health care settings) but, as we show, efforts to identify and overcome the barriers are continuing.

The following chapter, entitled ‘Treatment and rehabilitation’ addresses activities in the domain known as tertiary prevention: facilitating recovery from dependent or otherwise harmful alcohol use and preventing relapses. We trace the emergence and long-standing dominance of residential treatment that combines the Twelve Steps approach to overcoming alcohol dependence with the self-help and mutual aid principles of Alcoholics Anonymous (AA). We note that many Aboriginal service providers view alcohol dependence as a cultural and spiritual illness requiring spiritual healing, an approach also associated with treatment programs that view alcohol misuse, together with associated violence, sexual abuse and self-harm, as products of unresolved intergenerational trauma requiring healing and cultural reconnection. We also discuss efforts to identify and address administrative and therapeutic challenges associated with residential treatment programs, and ongoing attempts to develop evaluation approaches that meet the requirements of both Aboriginal service providers and funding bodies.

In Chap. 5 we turn to ‘supply reduction’ measures involving local restrictions on alcohol availability (over and above restrictions that form part of liquor licence conditions in all Australian jurisdictions). Community-based restrictions are grounded conceptually in a public health approach to reducing alcohol-related harms that originated with the World Health Organization in the 1970s and was taken up by several Aboriginal organisations in the 1980s. It led to the introduction of restrictions on trading conditions and/or types of liquor that could be sold by outlets in several towns in northern Australia. Restrictions can take the form of voluntary agreements between outlets and community groups; they can be ‘negotiated/mandated’—that is, negotiated by parties involved, then incorporated formally into the licence conditions of relevant outlets, or they can be unilaterally imposed by governments, as when the Northern Territory Government in 2010 imposed a Territory-wide ban on sales of wine casks containing 4 litres or more. Partly because they are inherently politically contentious, examples of local restrictions are usually evaluated. As a result, considerable evidence exists that restrictions—provided they incorporate a high level of community input—are effective in reducing alcohol-related harms. However, they also require complementary action to reduce demand, such as early intervention and treatment options, and their effectiveness can also fade over time and generate unintended consequences along the way. One notable example of local restrictions being used as a ‘breathing space’ for developing more comprehensive measures to address alcohol problems in the community was the introduction of restrictions on take-away sales in Fitzroy Crossing, in the Kimberley region of Western Australia, in 2007. Chapter 6 describes the processes involved in bringing in the restrictions as a case study in community consultation and mobilisation.

In Chap. 7 we focus on two specific approaches to managing alcohol availability in communities: community-owned liquor outlets and liquor permit systems that entitle approved individuals to import and consume liquor in communities where drinking is otherwise prohibited. Both are intended to foster a culture of moderation in place of unsupervised binge drinking, often in unsafe locations. Community-owned liquor outlets are also seen by proponents as a way of keeping the profits from alcohol sales in the community and as an antidote to ‘grog running’—that is, the practice of purchasing liquor and selling it, often with an exorbitant mark-up, on the black market in ‘dry’ communities.

Community-owned liquor outlets usually take the form of licensed clubs, sometimes called canteens. Available evidence indicates that most fail to achieve their objectives. Some become centres of chronic heavy drinking; some collapse under the significant administrative burdens they entail; none have been shown to reduce grog-running. In a few instances, however, community-owned outlets have become venues promoting a moderate, sociable style of drinking. The key ingredients appear to be clear (and quite restrictive) trading conditions imposed and enforced by licensing authorities; a community body able and willing to operate a venue under these conditions; effective policing of grog-runners, and availability of administrative support for the local body managing the outlet.

The use of liquor permit systems as part of community liquor management strategies appears to be limited to some remote Aboriginal communities in the Northern Territory and the territory of Nunavut in northern Canada. Evidence of their impact is limited and inconclusive. However, they appear to facilitate a degree of community control over alcohol use provided three conditions are met: local bodies responsible for administering permit systems are adequately supported and resourced; effective controls are in place to deal with grog-running, and the rules and procedures associated with the permit system are accepted by the community as reflecting community wishes.

In Chap. 8 we turn to an area where some Aboriginal communities and organisations have arguably led the way nationally in developing evidence-based solutions: the prevention and diagnosis of Fetal Alcohol Spectrum Disorders (FASD) and provision of support to individuals and families impacted by FASD. The term FASD refers to neurodevelopmental and physical impairments that can result from prenatal alcohol exposure. Its prevalence in Australia is unknown, as no national study has been undertaken to assess it, but its consequences can be seen not only in families directly affected, but also in health, education, child protection, youth and criminal justice systems. Over the last two decades, several Aboriginal organisations and communities have prioritised prevention and diagnosis of FASD, entering into partnerships with universities and other research bodies to document prevalence and develop programs to support impacted families. These initiatives are described, along with innovative programs to enhance the capacity of primary health care services to diagnose FASD and related disorders.

Chapter 9 focuses on community-based policing of alcohol-related matters, particularly community patrols (or night patrols or street patrols as they are sometimes called) and warden schemes. The first examples of these began in the 1970s as unfunded, undocumented initiatives by elders in remote communities and were designed to utilise Aboriginal cultural authority and culturally-based ways of resolving disputes, either in the absence of a mainstream policing presence, or as an alternative to what were viewed in communities as inappropriate mainstream policing practices. Community patrols gained added prominence following the Royal Commission into Aboriginal Deaths in Custody (RCADIC), which in its final report, tabled in 1991, recommended their adoption as instruments of community-based policing (Royal Commission into Aboriginal Deaths in Custody 1991). The number of community patrols subsequently grew rapidly in remote, regional and urban locations. Some became subject to conflicting expectations as non-Aboriginal agencies insisted that they should serve first and foremost as a transport service for drunks rather than as community-based means of preventing and resolving disputes.

The 2007 Intervention, formally known at the Northern Territory National Emergency Response (NTER), which imposed new policies and new controls over Aboriginal communities in the NT, led to further expansion in resourcing of community patrols in remote communities—particularly but not only in the NT. However, the extra resources came at a price, as the national government sought to align the role of patrols to its own policies for promoting community safety. Anecdotal reports suggest that, since that time, while many patrols have come to enjoy a more secure funding base than in the past, community involvement in running them has declined.

Chapter 10 summarises conclusions from the preceding sections of the book.

As the foregoing summary shows, we have not addressed interventions directed at other drugs besides alcohol. Alcohol, we know, is often a component of polydrug use among Aboriginal people; the use of cannabis, in particular, has become widespread in recent decades. Our objective, however, has been to draw lessons for today from the experiences gained in preventing and managing alcohol-related harms over five decades. Many of these experiences, particularly in prevention, early intervention and treatment, are relevant to other drugs, but to address polydrug use, in our view, would have threatened to blur our focus on the distinctive history of dealing with alcohol.

1.3 A Note on Terminology

Throughout this book we use the term ‘Aboriginal’ to refer to Aboriginal peoples, communities and organisations unless it is clear from the context that Torres Strait Islanders are also covered by the meaning, in which case we use the term ‘Aboriginal and Torres Strait Islander’. We do not generally use the term ‘Indigenous’ (although it is sometimes the term used in texts that we are citing, in which case we retain it). Where we are using the term in the generic sense to refer to, say, ‘indigenous peoples of Australia, the US, New Zealand and Canada’, then we retain it without capitalising it.

In saying this, we recognise that all of these terms have problematic connotations, since all of them originate in a discursive world dominated historically by non-Aboriginal people and agencies. We intend our usage of these terms throughout this book to convey respect.

We are also open to being taken to task for our uncritical use of the word ‘community’. This is one of the more value-laden terms in the English language for describing places, implying as it does a shared sense of identity and belonging as well as mutual proximity. In the domain of Aboriginal policy, the use of ‘community’ is a product of the transition from assimilation to self-determination in the early 1970s (Smith 1989). Prior to that time, throughout the assimilation era, Aboriginal localities were officially referred to as ‘settlements’, ‘missions’ or ‘pastoral properties’—terms that evoked more explicitly the administrative arrangements that defined them. From 1973, the Department of Aboriginal Affairs—the recently created government agency established to implement the new policy—began replacing all of these labels with ‘community’, which had a much less colonial ring to it (Smith 1989). Communities, in the policy rhetoric of the day, were now viewed as self-managing entities. As Smith points out, however, the shift to ‘community’ was not accompanied by genuine changes in decision-making processes (Smith 1989).

The concept of community in fact conflated two distinct social entities: the geographic community composed of people occupying a particular locality, and the cultural or symbolic community of people linked by kin relationships, ceremonial responsibilities and obligations regarding significant sites (Sutton 2001, 2009). The two entities, as Brady and others have pointed out, did not necessarily coincide; some ‘communities’ were made up of Aboriginal people from different clan and language groups, whose traditional rights and obligations linked them to localities outside the geographic boundaries of the community (Alexander 1990). Rowse (1992) argues that Aboriginal communities, far from being organic expressions of self-determination, were rather a new iteration of settlement patterns imposed by governments. Peters-Little extends the critique, contending that the term ‘community’ was adopted without consultation with Aboriginal people, who as a result have had little opportunity since then to define the term in ways which might advance genuine self-determination. Indeed, she argues that the term has become increasingly problematic in a context of addressing issues such as native title, reconciliation and self-determination (Peters-Little 2000).

In short, the term ‘community’ carries political baggage beneath its endearing connotations. We retain it, partly because we are not aware of any satisfactory alternative, and partly because it has come to be universally used, particularly with reference to remote Aboriginal localities. It is, however, important not to lose sight of these aspects, particularly when considering issues such as community control, or community action with regard to alcohol use.

1.4 A Time of Transition?

This book, as the title implies, looks back and ahead: back over half a century of efforts to grapple with the many harms that alcohol misuse has brought, ahead to draw lessons from the experiences of those who have gone before. As readers will discover, many of the documents reviewed in these pages—though by no means all of them—are the voices of non-Aboriginal observers. This is not surprising. With some notable exceptions whose voices are also heard in these pages, Aboriginal people throughout much of this period did not enjoy the access to education that gave them influence in shaping policies and priorities. (This is despite the fact, as readers will also find, that many of the programs described in these pages were designed, established and run by Aboriginal people, with varying degrees of governmental support).

That is changing. Today, it is becoming less acceptable to publish academic and other writings about Aboriginal alcohol programs that do not give priority to Aboriginal writers and perspectives.

We see this book as something of a marker of this transition. One of us (Peter d’Abbs) is a non-Aboriginal researcher whose own family came to Australia in 1948, and who has conducted research on alcohol-related issues for much (though not all!) of the half-century under review. The other (Nicole Hewlett) is a proud Palawa woman whose experience in knowledge translation includes, among other fields, maternal use of alcohol, tobacco and other substances.

We hope that this book will help to retain what is valuable from an earlier era as a useful contribution going forward in a context where the search for strength-based solutions to alcohol-related challenges is led by Aboriginal communities and experts.