The Royal Commission into Aboriginal Deaths in Custody (RCIADIC) reported various cultural, social and historical explanations for alcohol misuse among Aboriginal people. It noted that single factor explanations used in program and policy frameworks did not adequately address the complex and inter-related causes of alcohol misuse. For example, the disease model was a single-factor explanation commonly used in treatment programs to understand alcohol dependence and misuse. It conceptualised that an ‘alcoholic’ suffered from the disease of ‘alcoholism’, a disease that cannot be cured but rather abstained from. The Commission noted that this framework did not account for the many causations of alcohol dependence and was critiqued by professionals and academics. Other models may be more appropriate including the acculturation/anomie model that considers the misuse of alcohol by Aboriginal people as a reaction to the breakdown of their culture and marginalisation within Australian society.

The RCIADIC emphasised the need to prioritise integrated models, that account for a variety of explanations of alcohol misuse, in policies and programs.

Department of Health

The Department of Health reiterated earlier assessments that this recommendation was fully implemented in Victoria but noted related service delivery challenges.

Safer Care Victoria ensures that policies and programs recognise complex causes of alcohol misuse. However, programs and services often do not cater for all aspects of treatment. Addiction/dependence can be characterised as a bio-psycho-social phenomenon although often the ‘biological’ component of treatment can be missing. For example, there remains a lack of pharmacotherapy services available for treatment of opioid use disorder even in Aboriginal community-controlled health services where cultural overlays are well understood. There is also limited access to pharmacotherapy for alcohol use disorder despite the treatment being prominent in the national alcohol guidelines.

Victorian Alcohol and Drug Association, Submission to the Yoorrook Justice Commission

The Victorian Alcohol and Drug Association’s (VADA) submission to the Yoorrook Justice Commission included information on Aboriginal peoples’ experiences and their interactions with the AOD service system. VADA noted that Aboriginal people, like many Australians, use AOD for various reasons, including enjoyment, social connection, coping with stress or trauma, and responding to experiences of racism or other injustices. While alcohol has caused considerable harm to Aboriginal communities, it has also played a role in fostering cultural and social connections. For example, Uncle Jack Charles explained in his Yoorrook Justice Commission testimony that Fitzroy pubs were important places where he connected with family, culture, and his heritage.

A significant body of research, combined with firsthand accounts from Aboriginal people, details how patterns of AOD use and related policy responses have contributed to systemic disadvantages. VADA noted that policy documents can be ‘impersonal and objectifying’ only presenting health and wellbeing outcomes and failing to recognise the histories of trauma and colonial exploitation thus continuing to perpetuate harmful colonial narratives.