Commentary on Conigrave et al. (2020): Meta-analysis of drinking patterns in Aboriginal and Torres Strait Islander populations highlights policy and research opportunities.

Abstract

Tailored community-driven alcohol interventions require information regarding local alcohol consumption patterns and the factors driving alcohol consumption behaviours. Future research could focus on the moderators of risky drinking patterns so that local interventions can be successfully developed. Routinely, policy in this area is informed using national statistics regarding alcohol consumption, resulting in what Conigrave and colleagues refer to as ‘broad-stroke’ interventions that are not tailored to the communities in which they are implemented. This problem is further exacerbated by the heterogeneous nature of drinking behaviours between different Indigenous Australian subgroups, as described by this meta-analysis [1]. In response, the authors call for community-controlled responses to risky drinking at a local level, which is a promising approach given evidence for improved health outcomes among Indigenous people who receive health care from Aboriginal community-controlled health services (ACCHS) rather than mainstream general practice [2]. However, it is unclear exactly how these ACCHS, or other organizations, could deliver interventions reducing risky drinking behaviours. This lack of clarity regarding how to achieve this is not unique to this article [3, 4]. It does, however, highlight a clear need for further research on the ‘solution’ in the future, rather than further quantification of the ‘problem’ of high levels of risky alcohol use. For example, a randomized controlled trial currently under way, which involves several of the authors of this meta-analysis [5], is addressing this gap by investigating the effectiveness of a model of tailored and collaborative support for ACCHS in increasing use of alcohol use screening and treatment provision. Conigrave and colleagues [1] also highlight the often damaging sporadic drinking patterns in ‘dry’ communities propagated by current policy aimed at encouraging abstinence. Future research could examine these patterns more fully. For instance, studies could explore how community-driven social marketing approaches may impact upon such episodic patterns. These approaches employ the use of marketing concepts with the purpose of eliciting positive behaviour changes among their target audiences [6]. Social marketing, which has been used effectively to promote positive life-style changes in Canadian First Nation's communities, is underutilized in Australian Indigenous communities [7], despite evidence for its effectiveness in promoting healthy behaviour changes [7, 8], including reductions in risky drinking behaviours [6]. While this approach does not take into account the social determinants that potentially drive risky alcohol use among Australian Indigenous people, it may have the potential to be a pragmatic solution allowing adaption to suit the needs of individual communities. Conigrave and colleagues also highlighted the influence of moderators such as gender and age on drinking patterns among Australian Indigenous people, reflecting the findings of a number of other studies conducted among non-Indigenous populations [9, 10]. We agree with the authors that future research examining these moderating factors, especially from a socio-cultural perspective, is critical. It should be coupled with research into other moderating factors, such as socio-economic status, which was poorly reported in the studies reviewed [1], and past experience of trauma or violence, which has a known impact but was not examined [11]. Furthermore, as many studies in this area have traditionally been guided by western paradigms [11], there is clearly an urgent need for the involvement of Indigenous researchers and Elders in the design and implementation of future studies, and for the culturally appropriate adaptation of instruments measuring alcohol consumption for an Indigenous context [1]. In conclusion, the meta-analysis by Conigrave et al. [1] highlights a number of critical directions for policy and research policy, including strengthening the evidence base for effective interventions targeting risky drinking patterns (especially by ACCHS) and the crucial need for future research to consider the benefits of a social marketing approach, and the roles of socio-economic status and a broader range of other moderating factors on risky drinking patterns among Australian Indigenous populations. None. Cheneal Puljević: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Helen Haydon: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Centaine Snoswell: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization.