This book began as a response to a dearth of evidence about the effectiveness of programs aimed at preventing or managing alcohol-related harms in Aboriginal communities or among Aboriginal people in Australia. The response has been informed by a belief that, after fifty years in which all sorts of programs and services have been established, there ought to be more by way of useful lessons that have been gleaned to date. We also suggested in the Introduction at the beginning of this book that at present we may not be availing ourselves of those lessons as well as we might, partly because relevant documents are fading into obscurity, and partly because a narrow understanding of what constitutes ‘evidence’ may result in potentially useful material being overlooked.

In the foregoing chapters, we reviewed documented evidence of programs and services in eight domains:

  • Primary prevention;

  • Secondary prevention or early intervention;

  • Treatment and rehabilitation;

  • Local restrictions on supply of liquor;

  • Community-controlled liquor outlets in communities;

  • Liquor permit schemes;

  • Programs for preventing and diagnosing FASD and providing support to families impacted by Fetal Alcohol Spectrum Disorders (by FASD);

  • Community patrols and warden schemes.

Almost all of these programs, it should be recognised, have been constrained by two limiting factors. The first is that alcohol interventions, virtually by definition, address symptoms rather than causes: the symptoms are various kinds of alcohol-related harms and the drinking patterns that give rise to them. The causal factors—poverty, marginalisation, intergenerational trauma and, behind all of these, the ongoing legacy of colonisation—are rarely addressed, although healing programs aim to break the cycle of intergenerational trauma. To assert this point is not to deny that alcohol misuse in itself, once it becomes embedded culturally, is not a causal phenomenon in its own right, it is simply to acknowledge that alcohol programs themselves can only focus on a few components of large and complex causal chains. Other components, some of which are often conceptualised as the social, political and economic determinants of alcohol and other drug misuse, must be addressed in their own right. The second limitation is that few programs are established in a way conducive to adequate and appropriate monitoring and evaluation, either in terms of financial resources, program design or evaluation expertise.

It is not surprising then, that perhaps the most obvious outcome of our inquiry is confirmation that, as others have said before us, the evidence-base is thin (Gray and Saggers 2005; Gray and Sputore 1998; Loxley et al. 2004; Intergovernmental Committee on Drugs (Australia) 2014; James et al. 2018; Ministerial Council on Drug Strategy (MCDS) 2003). With the partial exception of local restrictions on supply and some descriptive studies of the prevalence of FASD (which have a potential to provide valuable baseline data for future programs), there is little evidence available to assess likely outcomes of most programs. Much of the limited and not very good quantitative data generated by programs tracks implementation processes rather than outcomes.

What we have also found, however, is a considerable amount of qualitative evidence about factors that tend to enable or impede successful implementation of programs, and this, we would argue, is of practical value not only to policy-makers and funding bodies but also to those involved on the ground in designing and implementing programs. By evidence here, we mean empirically supported observations of factors that enable or impede successful implementation and/or outcomes of programs.

Table 10.1 summarises the main findings from preceding chapters regarding enabling and impeding factors in each of the program domains listed above. These factors are discussed further in the relevant preceding chapters.

Table 10.1 Summary of factors enabling and impeding interventions
Full size table

In addition to the factors identified in Table 10.1, many of which are specific to particular types of programs, we have identified three other issues that, we believe, are relevant to all of the program domains explored in this book, and that have implications for future initiatives. These are, firstly, the nature of community control; secondly, the importance of personal relationships, and thirdly, questions to do with defining relevant knowledge. We conclude this book by discussing each of these briefly.

10.1 Community Control

Most of the accounts of programs in this book, especially the more successful ones, have stressed the importance of control by the local community or its agencies. There are good reasons for this. Alcohol misuse is, at least in part, a product of personal and collective powerlessness, and is unlikely to decline as long as powerlessness remains pervasive. Individuals may stop drinking heavily, but others will take their place. (This is why law-enforcement based strategies targeting public drunkenness—which we have not reviewed in this book—achieve little other than new forms of resistance by drinkers). The culture of binge drinking that has long typified some Aboriginal alcohol consumption emerged in the first instance in a context where Aboriginal people were denied any rights to manage their encounter with alcohol—or many other aspects of their lives (Beckett 1964; Brady 2008). It has persisted to this day in part as a response to ongoing powerlessness (Brady 1990; Brady and Palmer 1984; Cowlishaw 1994; Sackett 1988). In this context, the act of asserting control over alcohol, whether by an individual, group or community, is to refuse to assent to powerlessness, to reclaim a degree of power.

Another reason is pragmatic. As numerous examples in this book demonstrate, dealing with alcohol-related harm is hard work that requires a sustained commitment. It often generates resistance, either from determined drinkers or the outlets that supply them—or both. As a result, in addition to the inherent difficulties in changing established drinking patterns, groups or communities intent on reducing alcohol-related harms face the challenge of maintaining ongoing support for their chosen programs. The kind of commitment required is unlikely to be maintained in the absence of a high level of community involvement from the outset in identifying problems and prioritising solutions.

The word ‘community’, however, has many connotations and uses, not all of them helpful in addressing alcohol-related issues. ‘Community’ can be a gloss, implying consensus where consensus does not exist. Individuals and groups will sometimes seek to advance their own interests by claiming to be speaking on behalf of the community. In such instances, it is prudent to ask: who is claiming to speak on behalf of the community, on what authority, and with what objectives? Whose voices, in these situations, are not being heard? Governments also use the term ‘community’ to pursue their own policy objectives. To insist that a particular issue is ‘the community’s responsibility’—as successive governments did through the latter twentieth century with regard to petrol sniffing in some Aboriginal communities—can be a justification for doing nothing or very little. At the other extreme, government agencies also sometimes use the rhetoric of community ownership to conceal the top-down nature of their own policies and programs. An example is the introduction of Alcohol Management Plans in Aboriginal communities in Queensland from 2002 (see the discussion in Chap. 5). The Queensland Government, in response to evidence of high levels of alcohol-related violence in some communities, was determined to divest local Aboriginal councils of control over beer canteens and reduce access to alcohol in many communities. By insisting that communities formulate their own Alcohol Management Plans that complied with the government’s objectives, it could claim that the AMPs were ‘owned’ by the communities concerned (Smith et al. 2019). For an illuminating case study of how this dynamic played out over time in one Cape York community, see Moran (2016: 15–28).

Finally, community control is also inherently fragile and easily eroded—even unintentionally—by the sheer strength of government political and economic power. The recent history of community patrols in many Aboriginal communities demonstrates this all too clearly. Following the 2007 Commonwealth intervention into Aboriginal communities in the Northern Territory, as we show in Chap. 9, the government significantly increased its funding support for patrols, but at the same time it also tightened its control over the roles and activities of patrols, with a result that community involvement ebbed away (Blagg and Anthony 2019).

10.2 The Importance of Relationships

One of the characteristics of successful alcohol programs at a community level—and one that is often overlooked in reports and other written descriptions—is the presence of strong interpersonal relationships among key players. Relationships marked by mutual familiarity, trust and respect, both within the Aboriginal and non-Aboriginal domains and, perhaps even more so, spanning both domains, facilitate the search for solutions and help to navigate the challenges, disagreements and disappointments that are part and parcel of alcohol interventions. These relationships are not part of programs, which helps to explain why their importance is not acknowledged, but in our observation they are often the foundation on which programs are built. Without them, many programs, however well designed, are likely to struggle for sustainability and impact.

10.3 Knowledge for Whom?

Within the world occupied by policy-makers, service providers and researchers, concepts such as ‘evidence-based’, ‘best practice’ and ‘performance indicators’ testify to a culture of rationality and transparency that is viewed as a self-evident good. From a different standpoint, however, as we suggested in Chap. 4, the same culture can be viewed as having in the past facilitated the colonial domination of Aboriginal people and, even today, as according scant respect to Aboriginal ways of ordering the world. In their 2019 report on an Alcohol Management Plan in the Cape York community of Pormpuraaw, Smith et al. question the value of past research on Indigenous alcohol issues, asserting that while it ‘is sometimes of benefit to governments wishing to measure the performance of community groups funded by them, it has contributed little to increasing the capacity of individuals or groups to manage alcohol more effectively’ (Smith et al. 2019: 12). They attribute the failure to a reliance on biomedical and epidemiological analyses of drinking patterns and trends at the expense of research that reveals the complex interactions between social, cultural, economic and political factors that give rise to alcohol-related harms. We would go further, and argue that, as well as paying attention to these factors, research (including evaluation research) should accord greater respect than in the past to Aboriginal perspectives and priorities. As we noted in Chap. 4, some promising steps in this direction have been taken, such as Nichols participatory research project in the West Kimberley of WA, in which Aboriginal people worked with her in designing an evaluation framework that emphasised outcomes such as re-engagement with family and community rather than amounts of liquor consumed by participants (Nichols 2010). Shakeshaft et al.’s collaboration with a NSW treatment centre to produce a ‘Healing Model of Care’, also discussed in Chap. 4, attempts to integrate the logic of evaluation with cultural priorities of the Aboriginal-run program (Shakeshaft et al. 2018).

Differences in perspectives can also arise with respect to applying program models to local settings. Western scientific thinking moves constantly and easily between the particular and the general. Researchers, as a matter of course, think about the generalisability of their findings. Policy-makers and program funders keep a constant eye out for potential ‘models’—that is, programs shown to be successful in one setting and therefore, it is hoped, replicable in others. Aboriginal community organisations, however, often show little interest in such models. Porter (2016), reflecting on fieldwork conducted with three Aboriginal community patrols in urban and regional centres in NSW, noted that those involved in patrols were frequently resistant to the idea that solutions developed elsewhere—regardless of whether or not by Aboriginal people—could be imported to their own communities. Patrols derived their legitimacy through addressing local conditions and being answerable to the local community.

The often-heard claim that “Redfern is not Bourke”, as voiced explicitly by research participants, reflects a sense that imposing general solutions is disrespectful to local Indigenous autonomy, to pre-existing local processes and to the community members in specific locales more generally. More than being disrespectful, the imposition of general solutions or pan-Indigenous programmes—without meaningful collaboration with the local Indigenous community—may have a recolonizing effect (Porter 2016: 563).

This might seem an odd note on which to close this book—which is, after all, about programs ‘developed elsewhere’. We are not, however, advocating the ‘imposition of general solutions or pan-Indigenous programs’ on anybody or any community. At the same time, we believe that there are lessons to be learnt from the experiences of others. Creating programs that are both responsive to local conditions and informed by evidence about what is likely to be effective under these conditions is an art as much as a science. Our hope is that this book makes a useful contribution to both the art and science involved.