Julie, a Menang woman from South West­ern WA, was one of the authors of the Aus­tralian Indige­nous HealthInfoNet’s recent review of alco­hol and drug treat­ment for Abo­rig­i­nal and Tor­res Strait Islander peo­ples, along with Mar­guerite Tra­cy, Bradley Free­burn, Kylie Lee and Kate Conigrave.

The review points to the val­ue of com­bin­ing the best of cul­tur­al approach­es with best-evi­dence west­ern med­i­cine, with strate­gies such as col­lab­o­ra­tion and two-way learning.

It empha­sis­es the impor­tance of cul­tur­al­ly secure treat­ment and points to the impor­tance of cul­tur­al aware­ness train­ing for non-Indige­nous staff, and for main­stream ser­vices to recog­nise the strate­gies that engage and build trust between health work­ers and poten­tial clients.

Bar­ri­ers affect­ing the poten­tial for suc­cess­ful treat­ment include stig­ma linked to long-held atti­tudes and stereo­types around sub­stance mis­use by Abo­rig­i­nal and Tor­res Strait Islander peoples.

Peo­ple who need help may have expe­ri­enced or wit­nessed dis­crim­i­na­tion in the past. The stig­ma can be inter­nalised as shame. Fear of involve­ment of gov­ern­ment child pro­tec­tion author­i­ties can also pose barriers.

The review also empha­sis­es the lack of avail­able research exam­in­ing the effec­tive­ness of dif­fer­ent treat­ment approach­es, remark­ing upon the dearth of research pro­vid­ing defin­i­tive con­clu­sions and the method­olog­i­cal lim­its of exist­ing research.

“Giv­en the wide­spread agree­ment of the key role of trau­ma in con­tribut­ing to prob­lem alco­hol and oth­er drug (AOD) use, there is sur­pris­ing­ly lit­tle Aus­tralian research on trau­ma-informed or trau­ma-focused approach­es to heal­ing, out­side of tobac­co man­age­ment, and there is a need for work exam­in­ing cur­rent and poten­tial approach­es,” the review states.

Work­ing with and for communities

While the val­ue of Abo­rig­i­nal and Tor­res Strait Islander staff is wide­ly recog­nised, the empha­sis on the impor­tance of Abo­rig­i­nal and Tor­res Strait Islander ser­vices and staffing is time­ly, Julie says.

“The key is using Abo­rig­i­nal health work­ers, respect­ing their knowl­edge, expe­ri­ence and exper­tise and mak­ing sure that becomes part of the dai­ly prac­tice with­in all med­ical centres.”

She adds that this includes the need for respect to be extend­ed to peo­ple with­in communities.

“If peo­ple are not lis­tened to, it min­imis­es their author­i­ty,” she says.

“The best approach is includ­ing peo­ple with­in the com­mu­ni­ties you are hop­ing to help in con­ver­sa­tions about pre­ven­tion or treat­ment services.

“Talk to the peo­ple, lis­ten to them, and respect the expe­ri­ence of Elders with­in com­mu­ni­ties, the peo­ple fac­ing these issues every day, grand­par­ents look­ing after the kids.

“Make full use of their exper­tise. The Abo­rig­i­nal health work­ers and mem­bers of the com­mu­ni­ty know what their com­mu­ni­ty needs.”

Many improve­ments in alco­hol and drug use treat­ments have been made over the 25 years or so since Julie began work­ing in this field.

“We’ve come a long way,” she says.

“The holis­tic approach, mov­ing away from treat­ing exces­sive alco­hol and drug use as a dis­ease, is now much more wide­ly accept­ed, mov­ing to treat­ing the whole per­son, and extend­ing the focus to look at the wider community.

“If you look at smok­ing, a lot of young peo­ple are not smok­ing any more. If we can get the same result with prob­lem alco­hol and drug use that would be fan­tas­tic. I can see it hap­pen­ing in the future.”

Julie Woods puts for­ward a request: ​“I want spe­cial­ists, peo­ple work­ing in the field of prob­lem alco­hol and drug use to take notice of all the rec­om­men­da­tions in this review. I want these pro­fes­sion­als to read it. It makes sense. I want them to reach out and ask for more information.”