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by Cassandra Wright, Menzies School of Health Research; Beau Jayde Cubillo, Menzies School of Health Research; John Holmes, University of Sheffield; Mark Mayo, Menzies School of Health Research; Mark Robinson, The University of Queensland; Michael Livingston, Curtin University; Nicholas Taylor, Curtin University; Sarah Clifford, Menzies School of Health Research, and Tim Stockwell, University of Victoria*

The new Northern Territory government is planning a swathe of changes to alcohol policy.

If implemented, these changes fly in the face of what evidence shows works to reduce alcohol-related harms. Some are also out of step with the rest of Australia.

Among our concerns are plans that would lead to harmful alcohol products becoming cheaper, alcohol becoming more easily available, criminalising public drunkenness, and a particularly worrying type of mandatory alcohol treatment – all of which evidence suggests will cause more harms.

No one is downplaying the magnitude and complexities of alcohol-related issues in the NT. But we hope the territory government will pay more heed to the evidence and voices of those most impacted.

Alcohol-related harm in the NT is complex
Alcohol-related harms in the NT are significantly higher (for both Aboriginal and non-Aboriginal people) than elsewhere in Australia.

In the territory, these harms contribute to health and social outcomes costing at least A$1.4bn [US$1bn]  a year. Alcohol harms result in costs related to health care, deaths, crime, policing and child protection.

Aboriginal communities in the NT have for decades cried out for solutions and services that effectively respond to alcohol-related harm. Instead, they found their lives made part of a political football match on law and order. Policies have been reactive and mostly ineffective. They’ve been overturned at each election.

Now, the new NT government is discussing changes that promise to exacerbate the very issues it aims to address.

1. Cheap alcohol that contributes most harm would be on the market
The World Health Organisation recognises that raising the price of alcohol is one of the most effective ways for governments to reduce alcohol-related harm.

So some governments around the world, including in the NT, have set a price below which alcohol cannot be sold, known as the minimum or “floor price”. This targets cheap, high-strength alcohol associated with patterns of drinking that cause the most harm.

The new NT government plans to repeal this, despite evidence showing this works to reduce harms.

Since the NT alcohol floor price was set at A$1.30 per standard drink in 2018, there has been a:

• 14% reduction in alcohol-related assaults in Darwin and Palmerston

• 11% reduction in domestic and family violence assaults

• 21% reduction in domestic and family violence assaults involving alcohol

• 19% reduction in alcohol-related emergency department attendances.

Originally, experts recommended a A$1.50 floor price but this was reduced to A$1.30 after a backlash from alcohol industry lobbyists. Had the policy not been watered down, evidence suggests the impacts above would likely have been greater.

The floor price has likely also lost some of its initial impact as it has never been indexed for inflation.

The best available research shows the floor price has reduced alcohol-related harms with no evidence of unintended consequences or negative impacts on the alcohol industry, despite claims otherwise.

Researchers and experts from around the world have been writing to NT ministers urging them to reconsider repealing this effective policy.

This includes researchers from the United Kingdom and Canada, who have coauthored this article. In these countries, evidence on the effectiveness of minimum pricing has been used to increase the floor price by 30%, not abolish it.

2. Bottle shops could be open longer
There are also proposals to repeal current restrictions on bottle shop trading hours. Such restrictions are highly effective in reducing alcohol harms, including violence.

Our paper from earlier this year found that in the town of Tennant Creek, restrictions to reduce trading hours and introduce purchase limits at bottle shops resulted in a 92% reduction in alcohol-involved domestic and family violence assaults.

Preliminary analyses of the reduced trading hours introduced in Alice Springs following Prime Minister Anthony Albanese’s visit in early 2023 also suggest a clear reduction on violence rates.

3. New public drunkenness offence
Ministers were also set to pass laws to create a new offence for “nuisance” public intoxication (also known as public drunkenness). This would allow police officers to arrest people and fine them up to A$925, in addition to current powers to seize and tip out alcohol from people drinking in prohibited areas.

This is at the time when nearly every other jurisdiction in Australia is in the process of decriminalising public drunkenness, making the NT out of step with the rest of the nation.

The NT’s proposed new laws on public drunkenness would criminalise more people who are already locked out from our society, placing them at risk of the negative, intergenerational and preventable impacts that often arise from contact with the justice system.

4. Mandatory rehab
Mandatory alcohol treatment was also an election commitment.

In its previous term of government, mandatory alcohol treatment was focused on people with a public intoxication offence rather than providing quality care to people with alcohol dependence in life-saving circumstances. If the same model is reintroduced, this is potentially harmful and at best ineffective.

In the NT, this model of mandatory alcohol treatment had no better outcomes than for those who may not have received any treatment at all. But it cost the taxpayer three times as much.

Where to from here?
Researchers, health professionals and partner organisations have urged the NT government to reconsider these decisions, as we have well-founded concerns these may worsen the very issues the government aims to address.

There’s no need to guess the outcomes of changing, repealing or introducing alcohol policies. We can draw on robust evidence, including extensive research from the NT, on what works in our communities.

*This piece is republished from The Conversation under a Creative Commons license. Read the original piece. ■

[Read more…] about Guest post: Why Northern Territory alcohol reforms would be a disaster, according nine experts

A recent piece highlighting the difficulty of getting help when we have both mental health and alcohol or other substance use problems attracted insight with sources spanning from Glasgow to Tauranga. Below is a lightly-edited selection.

“I’d say this isn’t ‘becoming’ the norm, I heard this in the field ten years ago regularly and it has never changed,” Michael Pearson, counsellor at Bristol University, UK.

“This article raises a very real problem and one that I did not realise was an international problem. It is things like this that cause my team and I to want to be identified as alcohol and drug workers rather than anything else. People need Hope and that is what we try to provide,” Darryl Wesley, The Salvation Army, Bridge & Oasis, Tauranga, New Zealand.

“All the evidence suggests that the best approach is to treat both in parallel. The fact that it’s so difficult for service users to get the help they need borders on criminal.” Norman Beecher, Kensington and Chelsea Recovery Care, London, UK.

“I come across this all too much in my work! While I understand that sometimes you have to remove substances to find out if certain mental health is triggered by these, what I know works from experience, is a joined up approach to mental health and substance use. It has far better lasting outcomes for people I’ve worked with,” Nicole Cooper,

a recovery facilitator at Bracknell Forest Council, UK

“A lot of services unwittingly provide care, treatment and support to people with a dual diagnosis, because it wasn’t identified as an issue. The problem comes when it is identified as an issue that clinicians lose confidence in their ability to provide care, treatment and support to a person who needs assistance,” Stephen Mihaly, director of nursing at The Endoscopy Centre, Melbourne, Australia.

“This has been an issue for my entire career in community services of over 20 years. Every conference I go to will have a well researched piece on why holistic no-wrong-door treatment services are what’s needed – yet still it doesn’t happen,” Xenia Girdler, working in education and training at Welways, Melbourne, Australia.

“With all the money and focus that was done some 11 years ago with Dual Diagnosis and State and Fed initiatives—this seems to now have gone backward. It is so disappointing.” Renee Hayden, CEO of HealthCare, Melbourne Australia.

“This is a very, very big issue. A new set of recruits with knowledge of both would really help. The amount of people pushed from pillar to post because they have both mental health and dependency issues. We have had dual diagnosis’s workers that seemed to have achieved nothing. It either gets dismissed as the dependency or the dependency needs to be dealt with first before we can do anything. And, when people get frustrated, upset and exhibit any anger they are often told to leave, ‘we will not tolerate that behaviour’ Despite the person clearly being unwell and desperate for help.” Mark Masterson, carer, UK.

“As someone with lived experience I lived with the problem of not qualifying for mental health support because of my addiction. The addiction services I did go to actively discouraging me from going to mental health services, despite clearly having both issues. There used to be a very strong division between the types of services which led to people like me falling between the cracks. I did end up focusing on abstinence from my addiction first and years of therapy through those services. I did truly believe that the symptoms I was experiencing (that I later realised were mental health related) to stop once I was abstinent. Of course that didn’t happen and I walked an exceptionally risky path and ultimately ended up in mental health clinical services anyway

There has been a lot of work in New Zealand to work towards that and in the clinical mental health and alcohol and other drug (AOD) clinicians work closely together. I was fortunate to work together with mental health teams which had AOD clinicians as part of their multi-disciplinary team  All clinicians were expected to be able to work with people with both mental health and/or addiction problems. In many ways that worked well especially when it came to sharing experience and knowledge of either area of speciality. So that was real progress in the teams, however, one other concern I had was the division of the people themselves who would really benefit from having both issues looked at, who really didn’t want that. Shame and stigma have a lot to do with that and historical cultures of being labelled as having one or the other issue and often people didn’t think kindly of people in the other group. A lot of stigma and discrimination. It’s changing, slowly. So there is hope of change,” Louise Windleborn, consumer and peer advisor, Wellington, New Zealand.

“I hate the fact this happens. I’m currently working in mental health and am told all the time by my bosses that if there is any hint that a person is using substances we have to signpost them out because ‘we don’t work with people who drink/use drugs’. It frustrates me so much; I’ve worked in a rehab centre where we did treat both the substance use and the underlying mental health issues that were frequently present and I just don’t see why we can’t have more joined up working in order to actually help people,” said a psychological wellbeing practitioner in the UK’s NHS.

“I can understand why stretched mental health services retreat behind this sequenced assessment of need. But then it’s more than a big ask for people who by definition can’t always organise their own wellbeing to fit themselves into service criteria for treatment. Arguably, service design provokes crisis level needs that can’t then be deferred. The treatment gap also shifts the cost of unmet needs onto emergency and criminal justice services. That’s not exactly a cost saving or a social investment either. Sad for the lives and communities in the middle of this,” Dave Chung, a social worker in Doncaster, UK.

“Important but so sad that we’re still where we are. When I was managing the Angel Drug Project in the late 1990s we almost never had a client we couldn’t work with and hopefully help. For me,  the term ‘dual diagnosis’ often told more about how services were configured and the inadequacy of that for all people who were having substance use problems than anything else,” Eric Carlin, a public health and alcohol policy expert currently working at the WHO, based in Glasgow, Scotland. ■

Children and people having difficulties with alcohol should be spared from a “constant bombardment” of alcohol advertising, say health experts with the backing of MPs.

The group describes it as “bizarre” alcohol is not part of the Health and Care Bill, which is meant to introduce advertising restrictions such as a 9pm watershed for ‘less healthy food or drink’ from the end of next year.

“With deaths linked to alcohol at record highs, we are in desperate need of a new approach,” said Professor Sir Ian Gilmore, who heads the Alcohol Health Alliance, which represents over 60 NGOs.

The call comes with the release of a report highlighting how alcohol marketing can be problematic for vulnerable groups, such as those in recovery being a ‘trigger’ for relapse. It says the UK should fall into line with the WHO recommendation to restrict alcohol marketing.

The intense alcohol marketing of alcohol over Christmas and at sports events, makes it difficult for those in active addiction and recovery to fully participate in everyday life, they say.

Speaking at the report launch, Melissa Rice, who is in recovery, asked attendees to imagine the difficulties that might arise if Gogglebox was sponsored by cocaine.

MPs backing the call include Conservatives Christian Wakeford, chair of a parliamentary committee on alcohol harm and the Labour vice-chair, Dan Carden. 

They also include Alex Norris, Labour’s Shadow Public Health Secretary, and Conservative Derek Thomas, Commissioner for Alcohol Harm. ■