CAPE YORK SUBSTANCE ABUSE STRATEGY

1
CAPE YORK SUBSTANCE ABUSE STRATEGY
2
AGENDA

• The Facts
• A Comprehensive Strategy
• Alcohol Management Plans
• Issues for Success

3
WE HAVE A SUBSTANCE ABUSE EPIDEMIC
Nationally, Indigenous persons more likely to use
drugs(1)
In Queensland, Aborigines over-present in
substance abuse clinics(2)


98
87
Indigenous
57
Non-Indigenous
37
32
17
2
13

• From Australian Bureau of Statistics, The Health
  and Welfare of Australias ATSI Peoples, 2003.
  Data from 2001
• Cape York Justice Study (Fitzgerald), 2001

4
ALCOHOL IS A LARGE PART OF THIS EPIDEMIC
Illustrative Distribution of Drinking Behavior
Across Cape York Indigenous and QLD
Non-Indigenous Persons

20
40
Non-drinker
10
60
Moderate (social) drinker
Excessive drinking
2.5x(1)
50
20
Illustrative of the missing moderate drinking
class and the dominance of alcoholism in Cape York
(1) From Justice Study report. Base is
undefined Note Illustrative distribution of
lack of moderate drinking class Source Cape York
Justice Study (Fitzgerald) 2001 Cape York
Institute Estimates
5
SUBSTANCE ABUSE IS THE MAIN CAUSE OF ABORIGINAL
SOCIETYS PROBLEMS
Substance Abuse
Violence
Poor health
Criminal over-representation
Cultural erosion
Key point Defense
Grog abuse is the main cause of all types of
Aboriginal violence and violence-related
injury There are certainly other causes of
violence. However, effectively attacking grog
abuse will also mean attacking violence Self-deni
al and family denial of addiction exacerbates
violence
Substance abuse is the key factor in poor health
through in Aboriginal communities Poor diet and
exercise, lack of services, and poor environment
are also causes. However, epidemic grog and drug
abuse prevents the lifestyle changes necessary to
address these other factors.
Substance abuse is the main cause of Aboriginal
over-representation in the criminal justice
system There are certainly other causes, but the
majority of Aboriginal criminal casesespecially
those of violent crimes and homicidesinvolve
substance abuse.
Substance abuse is hindering the transmission of
cultural knowledge across generations Certainly
there are other challenges to preserving language
and culture. Tackling these challenges is
difficult enough sober. It is virtually
impossible for a people addicted.
6
CAPE YORK STATISTICS ILLUSTRATE THIS NEGATIVE
IMPACT

• Mortality rates in Cape York are 2x-3x than those
  in Queensland overall
• Median age at death is at least 20 years younger
  for Indigenous Queenslanders
• Alcohol-related death rates are 21x the overall
  Queensland average
• Alcohol-related violence and homicide 18x the
  overall Queensland average

Source Queensland Government brochure Alcohol
Restrictions in Indigenous communities
7
SLIDE INTO ADDICTION STARTS WITH
EXPERIMENTATIONAlcoholics Anonymous Feelings
Chart
Feelings Chart
Phases of Addiction
Explanation
OK
Good
Bad
Normally we hover around the okay mark, with
some good and bad moments in life For a number
of reasons, we may be tempted to try a drug, and
discover a pleasurable effect With recognition
that the drugs pleasurable effect relieved
stress or anxiety, we seek its effect again As
seeking becomes habitual, the good phase of the
drug becomes shorter. Without the drug, the
feeling starting point moves from OK to Bad.
The drug is necessary just to briefly relieve our
Bad state
Normal state
Base state
Experimental phase
Seeking phase
Dependency or addiction
Why addictions become epidemic and how addiction
should be handled oft a subject of debate
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WE REJECT PRIOR EXPLANATIONS OF AND PROPOSED
SOLUTIONS TO THE EPIDEMIC
Prior explanations or solution
Description
Rationale
Basis for rejection
Symptom theory Voluntary
rehabilitation Normalization or
responsible drinking Harm minimization
Addiction epidemics are a symptom caused by
underlying social and economic problems a society
faces Addict will eventually seek help for
their addiction Programs aimed at changing
concept of drinking, promoting moderation Deal
with the consequences of substance abuse so as
to minimize harm to self and others
Less stressful environments and mutual
understanding are first steps in solving
substance abuse and addiction Things will
eventually become so bad that rehabilitation will
seem the only option Responsible behavior
will be practiced if the be responsible message
is repeated Substance abuse has become
entrenched and therefore endemic. The best
approach is education, safer venues, and
increased law enforcement
Addiction (maintained through denial) is a
condition in its own right. It can be addressed
without first righting the social, historical
and economic wrongs Damage is already done.
Directly, the addict has modeled abuse and
recruited new addicts. Indirectly, he/she has
caused chaos in community Alcoholics (and the
abuse epidemic they make up) cannot abstain, by
definition. Moreover, moderate drinkers are the
recruiting example, not drunks Rather than deal
with the consequences of abuse, we should not
tolerate it to begin with. Harm minimization
essentially accepts abuse as a given.
?
?
?
?
Our core principle is intolerance of abuse
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WE MAINTAIN THAT THE CAUSES OF SUBSTANCE ABUSE
ARE STRAIGHTFORWARDFive Factors Underpin Current
Epidemic
Availability of drug
Money to acquire the drug
Time to use drug
Neighbors who use the drug
Society/Ideology that permits use
1
2
4
5
3

• How easily obtained is the drug or grog?
• Cost
• Distribution channels

• Is there money available (disposable or
  misappropriated) to purchase the drug?
• Cost
• Timing

• Is there enough time to use the drug to an
  addictive level?
• Supervision (youth)
• Employment (adults)
• Involvement in outside activities

• Are there immediate examples in the community of
  those who misuse drugs?
• Parents
• Friends
• Other role models
• Television

• Is there a social standard and cultural ideology
  that is permissive of the drugs use?
• Soft consequences
• Disorganization
• Sense of defeat

Substance Abuse Addiction
Moreover, once established, addiction becomes a
cause in its own right
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AGENDA

• The Facts
• A Comprehensive Strategy
• Alcohol Management Plans
• Issues for Success

11
SUBSTANCE ABUSE MUST BE TACKLED FROM MULTIPLE
ANGLESSix-Pronged Approach Required
Rebuild intolerance
Control supply
Manage money
Manage time
Treatment and rehabilitation
Fix up home and community
1
2
3
4
5
6

• Must confront the evil in our midst, not deny it.
  A community-led resurgence of pride claiming
  that dysfunction is not endemic to indigenous
  society
• Bestow Community Justice Groups with power to
  rebuild/reinforce Aboriginal Law
• Establish a regional CJG
• Create new methods of policing
• Have zero tolerance of abuse

• Consumption is not possible without supply, and
  unfettered supply is disastrous. But, controlling
  supply is not the magic bullet
• Prohibit takeaways from canteens
• Prohibit importation of alcohol in communities
  where there are canteens
• Develop community-specific Alcohol Management
  Plans developed by CJGs

• Lack of financial institutions and poor family
  income management skills create a cash economy
  that fuels substance abuse
• Implement assisted family income management
  programs
• Establish credit union or other fiduciary
  presence
• Make income management compulsory for abusers

• Boredom is the consequence of passive welfare,
  addictions, and social dysfunctionnot the other
  way around
• Build jobs
• Develop volunteerism
• Digitally preserve cultural knowledge
• Increase sport and recreation opportunities
• Provide 4WD transport to help get to country
• Increase travel

• Current primary health care system treats
  Aboriginal patients in isolation from family
  health and family circumstances
• Provide for mandatory and voluntary
  rehabilitation
• At family request
• In and upon leaving detention
• Increased screening and doctor intervention
• Employ a AA counseling methodology

• Aboriginal communities are in squalor, reflecting
  low levels of social and cultural capital and no
  responsibility for our environment
• Maintain physical environment
• Responsi-bility of local govt
• Develop bylaws with standards of maintenance
• Reform CDEP to support community improvements
• Work towards home ownership

Reason Action
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CAPE YORK HAS A COMPREHENSIVE STRATEGY TO END
SUBSTANCE ABUSE
Accept causes
Availability of drug
Money to acquire the drug
Time to use drug
Neighbors who use the drug
Society/Ideology that permits use
1
2
4
5
3
Substance Abuse Increased violence, crime, poor
health, cultural erosion
Recognize impact
Implement strategy
Rebuild intolerance
Control supply
Manage money
Manage time
Treatment and rehabilitation
Fix up home and community
1
2
3
4
5
6

• Empower community justice groups

• Limit alcohol available in communities

• Enable income management through banking, FIM

• Employment as well as volunteerism, sport, and
  travel

• Screening, intervention, rehab, AA, compulsory
  attendance

• Address squalor through better maintenance and
  fostering pride in appearance

Focus of this document is supply control
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AGENDA

• The Facts
• A Comprehensive Strategy
• Alcohol Management Plans
• Inception
• Policy implications
• How it works
• Issues for Success

14
ALCOHOL MANAGEMENT PLANS BASED ON FOUR PRINCIPLES

• Reduce the volume of alcohol available
• Restrict the kinds of alcohol available
• Restrict the venues where alcohol may be consumed
• Restrict the time of day alcohol is available

Actual establishment took many years
15
GRASSROOTS EFFORTS PROMPTED GOVERNMENT ACTION
Grassroots momentum
Government consideration and legislation
Community-empowered development of
rules/regulations
Prior
2000
2001
2002
2003
2004
Future
Cape York Justice Study Queensland government
sponsored study on the extent of social problems
in Cape York Recommended many activities
including need for community-based Alcohol
Management
Meeting Challenges, Making Choices Queensland
government response to Justice Study Provided
policy direction on the amendment to
legislation(2) to enable CJGs to regulate alcohol
possession and consumption Aurukun first to
implement
Grog and Drugs Strategy Noel Pearson, in
cooperation with Apunipima and Cape York
Partnerships, outlined the causes of and remedies
for the abuse epidemic Finalization of strategy
completed in 2002
Momentum for change building Community elders and
Justice Groups frustrated by continued decline of
order and values Apunipima(1) and Cape York
Partnerships formed working group, focused on
practical strategy
Alcohol Management takes hold Napranum, Wujal
Wujal, Kowanyama, Lockhart River, and Pormpuraaw
implement alcohol management plans
Alcohol Management spreads further Hope Vale,
Northern Peninsula Area (Bamaga. Seisa, Injinoo,
New Mapoon, Umagico), Mapoon, and Yarrabah
implement alcohol management plans
Development of Regional Justice Group Consistency
of Alcohol Management Plans across communities
Community Justice Groups responsible for plan
development
(1) Cape-based health advocacy organization (2) Co
mmunity Services Legislation Amendment Act of 2002
16
IN DEVELOPING THESE PLANS, COMMUNITY JUSTICE
GROUPS MUST CONSIDER MANY QUESTIONS

• Should the community be dry?
• Should drinking happen only in the canteen?
• How much and what type of alcohol can be brought
  into the community?
• When should the canteen be open?
• How many takeaways should be allowed?
• How can sly grogging be stopped?
• What should be the consequences for
  non-compliance?

17
PROCESS OF PLAN DEVELOMENT IS A PARTNERSHIP
BETWEEN COMMUNITY LEADERS AND GOVERMENT

• Develops Alcohol Management Plan with
  recommendations
• to the Community Liquor License Board
• about community alcohol limits
• Deals with behavior

Community Justice Groups

• When a dispute between two, refer to Executive
  Director of the Liquor Licensing Division

Community Liquor License Board

• Minister appoints members
• Holds canteen license
• Sets license conditions in consultation with CJG
• Appoints/manages canteen manager

Community Canteen

• Managed as a business in accordance with license
  conditions
• Manager of canteen in non-voting member of Liquor
  License Board
• Profits go to Community council

Council

• Profits from canteen operations listed separately
  on council books
• Apply profits to socially responsible initiatives

18
AGENDA

• The Facts
• A Comprehensive Strategy
• Alcohol Management Plans
• Inception
• Policy implications
• How it works
• Issues for Success

19
OUR ALCOHOL MANAGEMENT PLANS HAVE SIGNIFICANT
POLICY IMPLICATIONS
Implication
Rationale
Reject notion of majority rule Reject
top-down alcohol laws Moderate drinker loses
rights
In communities where alcoholism is epidemic, the
alcoholic is dominant in both physical number and
coercive behavior. To develop plans via majority
rule would be to allow the alcoholic to govern
(or not govern) his consumption. Hence the
minority must rule with regard to plan
development While seductively simple and
uniform, state and federal level alcohol laws do
not sufficiently control supply for the
Aboriginal context. Moreover, they do not allow
any flexibility for the unique situation in each
community. Community-led plans are best For the
average non-indigenous, this is difficult to
understand. First, there is a fine line between
responsible and irresponsible drinking and that
line is not absolute but varies by individual.
Hence a rule of thumb is difficult to employ.
Second, historically, indigenous drinkers do not
manage moderationquickly slipping into
addiction. Finally, and most importantly, they
play a strong if indirect role in recruitment of
new experimenters. The alcoholic is not the
poster of fun, the moderate drinker is. Alcohol
management plans ask the moderate drinker to
sacrifice for the good of all
Biggest pill to swallow is the sacrifice of
moderate drinker
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AGENDA

• The Facts
• A Comprehensive Strategy
• Alcohol Management Plans
• Inception
• Policy implications
• How it works
• Issues for Success

21
TOWNSHIPS DO NOT HAVE ALCOHOL MANAGEMENT PLANS
Aboriginal Community
Township
City
Communities vary in how they address alcohol
22
THREE MAIN MODELS OF ALCOHOL MANAGEMENT CURRENTLY
EMPLOYED ON THE CAPE
No-canteen community
Canteen community with zero limit carriage
Canteen community with limited carriage

• e.g. Hope Vale
• Can bring in limited amount and type

• e.g. Aurukun
• Cannot bring in alcohol
• No takeaways from canteen

• e.g. Northern Peninsula Area
• Can bring in limited amount and type
• Can takeaway from canteen

Canteen
Canteen
?
?
Imagination is keyMore models can exist!
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CAPE YORK COMMUNITIES (AMP DETAILS)
Backup
Canteen/Tavern
Community
Date Enacted
Carriage
Exists?
Hours per week
Type served
Limit
Takeaway?
Exceptions
NPA (Bamaga, Injinoo, Seaisa Umagico, New
Mapoon) Aurukun Hope Vale Kowanyama Lockh
art River Mapoon Napranum Prompurraw Wuja
l Wujal Yarrubah
14/4/2004 30/12/2002 14/4/2004 5/12/200
3 3/10/2003 14/4/2004 30/5/2003 5/12/2003
3/10/2003 6/2/2004
9L light/mid beer AND 2L non-fortified
wine Zero 9L L/M beer AND 2L
wine Zero Zero 9L L/M beer AND 2L
wine Zero 4.5L Heavy OR 9L L/M
beer Zero 9L L/M beer OR 9L premixed OR 9L
combination
Yes (Bamaga Injinoo) Yes No Yes Yes
No Yes Yes No Yes
? ? n/a ? ? n/a ? ? n/a ?
? L/M beer, pre-mixed spirits with
meal n/a L/M beer ? n/a L/M beer,
premixed spirits ? n/a L/M beer, premixed
spirits
? ? n/a ? ? n/a ? ? n/a ?
Yes, up to carriage limit No n/a No No
n/a No Yes, to carriage limit n/a Yes,
to carriage limit
None None Isabella Crk Rd Barret Crk
Rd Cameron Crk Rd None Portland and Frenchman
Rds None Peninsula Dev. RdRine River
Bay Albatross Bay None Bloomfield Falls and
Track None
24
STATISTICS SHOW PLANS ARE WORKING(1)

• Overall(2)
• 48 reduction in alcohol-related injuries
• 54 reduction in presentations for assault
• Kowanyama(3)
• 65 drop in alcohol-related offenders
• 68 reduction in offences against the person
• Aurukun
• 73 drop in alcohol-related health clinic
  presentations
• Lockhart River
• 67 drop in alcohol-related presentations
• 82 drop in assault presentations

• Data from the Premiers press release. Additional
  data not yet publicly available
• Results for six communities across QLD 4 in Cape
  York include Aurukun, Lockhart River, Pormpuraaw,
  and Wujal Wujal.
• Mornington Island and Doomadgee also included
• (3) Press release cites Kawanyama but does not
  indicate its figures are included in the Overall
  statistics
• Source Queensland Premiers office Press
  Release 6/7/04

25
AGENDA

• The Facts
• Comprehensive Strategy
• Alcohol Management Plans
• Issues for Success

26
DESPITE INITIAL SUCCESS, OBSTACLES DO STILL EXIST

• Roadhouses and canteens outside the community are
  most often not under restriction
• Drunks can still be present in the community
• Sly-grogging, or illegally bringing drinks into
  the community, is difficult to stop
• Roadhouse takeaways
• Boats
• Flights
• Cars
• Police are under-resourced and often inconsistent
  in their monitoring
• Cross-community inconsistency of policy breeds
  some resentment

A regional, macro-level approach appears necessary
27
REGIONAL APPROACH COULD START WITH A REGIONAL
JUSTICE GROUP

• Membership comprised of the best of members of
  Community Justice Groups
• Jurisdiction over cross-community issues
• Support role for local justice groups
• Interface for CJGs and senior Government officials

Specifics of Regional Approach still under
development
28
THE MAIN THING TO REMEMBER ALCOHOL MANAGEMENT
IS ONLY ONE PIECE OF THE PUZZLE
Accept causes
Availability of drug
Money to acquire the drug
Time to use drug
Neighbors who use the drug
Society/Ideology that permits use
1
2
4
5
3
Substance Abuse Increased violence, crime, poor
health, cultural erosion
Recognize impact
Implement strategy
Rebuild intolerance
Control supply
Manage money
Manage time
Treatment and rehabilitation
Fix up home and community
1
2
3
4
5
6

• Empower community justice groups

• Limit alcohol available in communities

• Enable income management through banking, FIM

• Employment as well as volunteerism, sport, and
  travel

• Screening, intervention, rehab, AA, compulsory
  attendance

• Address squalor through better maintenance and
  fostering pride in appearance