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Silence of the sociologists: Indigenous alcohol use, harm minimisation and social control
Peter d'Abbs
Menzies School of Health Research, Darwin & Queensland Health, Cairns QLD
Abstract
In Australia, as in a number of other countries, the dominant and officially sanctioned policy for managing alcohol-related problems today is one of 'harm minimisation' - that is, the primary objective is to reduce the harmful health, social and economic consequences associated with alcohol use, while acknowledging both the legal status of drinking and the evidence that some forms of consumption appear to have beneficial consequences for the health of some types of drinkers (Commonwealth Department of Health and Aged Care 2001).
Conceptually, the policy of harm minimisation is grounded in the principles and perspectives of public health, sometimes designated the 'new public health' to distinguish it from classical public health models of the early 20th Century (Petersen & Lupton 1996).
Throughout the 1970s and 1980s, the single most important means for reducing alcohol-related harm advocated was that of reducing mean per capita consumption across the total population; since then, however, with increasing recognition of the impact of binge drinking and drunkenness on the overall burden of harm, attention has shifted from drinking levels - amongst both individuals and populations - to drinking patterns, a concept that incorporates not only the amount and frequency of consumption over a given period, but also the amount per drinking occasion (Stockwell, Hawks et al 1996; Roche 1997).
Article Text
Attempts to address alcohol problems by indigenous Australians, however, have not for the most part made use of either harm minimisation as an objective or the new public health model as a framework (Fua & Kahan 1997; Brady 2000).
While some indigenous communities and groups have imposed local controls on alcohol availability in recent years (Saggers & Gray 1998; Brady 2000; d'Abbs & Togni 2000; Gray, Saggers et al 2000; Gray, Saggers et al 2000) - a key public health measure - most indigenous-controlled alcohol programs have favoured abstinence from drinking as a goal, residential treatment as the favoured means, and the concepts of addiction and/or alcoholism as the core explanatory notions. Indeed, as Brady points out, for many indigenous agencies and workers in Australia, harm minimisation is 'anathema' (Brady 2000, p.490). This is true among indigenous people in the US, Canada and New Zealand as well as Australia (Landau 1996; Sellman & Huriwai 1997).
A number of indigenous writers have also criticised not only the assumptions and objectives underpinning harm minimisation, but also the efforts of non-indigenous social scientists to describe and explain indigenous alcohol use (Gibson 1987; Pearson 2001).
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