Peter Dabbs: Professor of substance misude studies at the Menzies School of Health Research
The Queensland government’s recent announcement of a review of alcohol management plans in indigenous Queensland communities has generated, predictably, calls for their relaxation if not abandonment on the grounds they are ineffective and discriminatory. But are they?
Two kinds of evidence are relevant: first, reports of conditions in communities prior to the introduction of AMPs from 2002 onwards; second, evidence relating to the impact of AMPs on alcohol-related problems and the quality of life in affected communities.
On the first question, the most comprehensive analysis is to be found in an inquiry commissioned in 2001 by the Beattie government and conducted by Justice Tony Fitzgerald (Cape York Justice Study 2001). Fitzgerald was asked to examine the causes and consequences of alcohol-related violence, and to recommend strategies to reduce it. He painted a bleak picture: alcohol abuse, he concluded, compounded by a failure on the part of remote communities to engage successfully with institutions of the wider society, had led to “a self-perpetuating cycle of poverty, tragedy and despair”. Much of the harm in the report’s view could be sheeted home to licensed clubs, run by local councils which in turn had acquired a pecuniary interest in maintaining high levels of consumption.
A clinical audit of injuries sustained in one community with a licensed club in 1995 reported levels of violence more akin to a war zone than a functioning community: for example, an all-cause injury rate among 16-44 year olds of 142 injuries per 100 females, 150 per 100 males. Anthropologist David Martin examined sales from canteens located in four Cape York communities, estimating per capita consumption per drinker in 1996-97 at equivalent to between 35 and 43 litres of pure alcohol per year — compared with a Queensland level of 10.9 litres.
It was in this context that Noel Pearson formulated his critique of the destructive nexus between welfare dependency, alcohol and other drug abuse, and social disintegration, while the Beattie government, in response to Fitzgerald’s recommendations, moved to reduce the flow of alcohol into communities, and to strengthen facilities for preventing and managing alcohol misuse, through the introduction of locally-tailored AMPs.
As originally conceived, AMPs were not only designed to restrict alcohol availability; they were also intended to remove local councils from control of liquor outlets, empower local Community Justice Groups to sanction alcohol-related behaviour, and expand resources for intervention, treatment and rehabilitation.
Looking back now, it is easy to spot the implementation flaws: consultation processes were poorly thought out and sometimes bungled; the added responsibilities given to Community Justice Groups were not matched by the resources needed to exercise these powers, and the promised facilities for treatment and rehabilitation have, by and large, not been forthcoming.
Flaws notwithstanding, AMPs were introduced in 18 indigenous Queensland communities. This where the second body of evidence is relevant. A series of evaluations conducted by the Queensland government itself after the first three years of AMPs reported equivocal conclusions. Declines in injury and alcohol-related assaults in several places corroborated quantitatively what qualitative assessments reported: improved peace and safety in the communities concerned.
A more rigorous analysis is furnished by independent studies conducted by Margolis and colleagues and published in the Medical Journal of Australia.
The researchers examined the impact of AMPs on serious injuries requiring aero-medical evacuation in four Cape York communities with AMPs. In the first study, they documented trends over eight years preceding, and two years following, the introduction of AMPs, and found a statistically significant decline following the AMPs.
Injury rates for the two years post-AMP were, on average, 52% lower than for the two years prior to AMPs. Evacuations for conditions other than injury over the same period showed no decline, leading the researchers to conclude that the AMPs had brought about a significant fall in rates of serious injury.
In a follow-up study, the authors extended their analysis of trends up to 2010 to take account of further tightening of restrictions on availability introduced by the Bligh government in 2008. They noted, firstly, that the initial beneficial effects on injury rates reported in their earlier study had weakened, but that with the introduction of amendments in 2008 injury rates again declined. By 2010, they reported, rates of serious injury in the four communities were at their lowest recorded level in 15 years.
These findings echo what other evaluations of comparable initiatives — for example, in Groote Eylandt in the NT and in the Kimberly, WA — tell us: that in situations of pervasive alcohol-fuelled violence and social dysfunction, much of it borne by women and children rather than drinkers themselves, curtailment of availability is a necessary (but not sufficient) pre-condition for change. AMPs are an imperfect instrument for pursuing this end: they require improvement, not dismantling.