At a community level, justice reinvestment is one approach that can be used to reduce harmful alcohol and drug use associated with an increased risk of imprisonment [36769][34873]. Justice reinvestment puts resources back into communities where there are high rates of incarceration, instead of police and prisons.  This strategy recognises the links between social disadvantage, risk factors such as alcohol and drug use and being imprisoned [30136]. By addressing the underlying causes for offences committed, the high rates of imprisonment of Aboriginal and Torres Strait Islander people can be reduced [34873][35942].

Giving up harmful alcohol and other drug use can make a big difference in helping a person stay connected with their community and reconnect with individual goals. There are programs available to help prevent re-offending connected to alcohol and drug use, as well as services that support people while they are in prison and after release from prison.

Diversion programs

Programs aimed at diverting people away from the justice system when their offence is related to their alcohol and other drug use include:

• drug courts
• mental health courts
• other court diversion programs that allow people to participate in rehabilitation [40403][30136].

Positive outcomes have been found for diversion programs including reduced alcohol and drug use.

Culturally adapted programs involving Elders or facilitators in addressing the concerns of Aboriginal and Torres Strait Islander defendants have better results than mainstream programs [30136][22997].

Support services

Organisations such as the Community Restorative Centre (CRC) in New South Wales provide a range of services for people and their families who come into contact with the justice system. They can help with alcohol and other drug dependence as well as other issues. For people who are leaving prison, it is important they receive support to:

• have their physical and mental health needs followed up in the community
• find stable housing
• develop skills to secure employment
• help them reconnect with community.

Services such as ACSO  (Australian Community Support Organisation) provide a range of specialist alcohol and other drug programs and services in Victoria, New South Wales and Queensland, for people in contact or at risk of being in contact with the criminal justice system.

See Key resources on this page for more information on programs, resources and organisations to support people in contact with the justice system address alcohol and other drug use.

Mental health is not just about the mind but also about a person’s social and emotional wellbeing. It includes a person’s connection to land, to culture, spirituality, family, and community. When these connections are lost or put under stress it affects people’s mental and physical health. Some people may turn to alcohol and other drugs to make them feel better when they feel stressed. Over time, people may start using alcohol and drugs a lot to cope with emotional distress which can result in addiction (dependence).

Alcohol

Alcohol can have many different effects on people’s mental health.

Watch the Menzies School of Health Research’s The grog brain story animation to hear about how drinking alcohol can affect mental health and wellbeing.

There are things that can help to reduce alcohol use and improve people’s social and emotional wellbeing. These include improving young people’s involvement at school and increasing their self-esteem, and having good relationships with family and being connected to culture. You can do these things in many ways, including playing sports, working, studying, and doing cultural activities [34063].

Ice

Ice affects people differently and may cause more problems for some people than others, especially if they have a history of mental health conditions. Read about the effects of ice on mental health here.

Recovery from ice use is possible. Strong connection to country and community can help to reduce ice use [37676]. Watch these videos from Onemba Koori Health and listen to stories of people who have healed from ice use. Check out these videos from Cracks in the Ice about what ice is, the person behind the substance and what you can do if someone you care about is using ice.

Cannabis

Using cannabis (gunja, yarndi) can affect people’s mental health in different ways. Using cannabis may trigger mental health conditions in some people, especially if they have a family history. Cannabis can cause people to be more tired and less motivated to do things, which may lead to isolation from friends, family and community [35968]. Read more about the effects cannabis can have on mental health in our Facts about gunja factsheet.

Tobacco

Until recently people thought that smoking cigarettes did not have much of an effect on mental health. Some people even thought that smoking could help control feeling worried all the time (anxiety). We now know that tobacco use can make anxiety worse and can make some medicines not work as well, including some medicines that are used for stress and anxiety [40465][40467].

It is never too late for people to give up smoking. Giving up smoking is good for mental health and wellbeing. Quitting has been found to improve people’s mood and reduce depression, anxiety, and stress compared to if people keep smoking [40466]. The Aboriginal Quitline has more information to assist with helping people to quit.

Where to go for help

If you or your community need urgent help for mental health or alcohol and other drugs find help here.

See our listing of services to find culturally secure alcohol and drug treatment services near you.

More information

See Key resources on this page for more information on resources, programs and organisations that address alcohol and drug use and mental health.

Elders, family, friends and workmates are often the first people to respond to those who may be stressed or in crisis in the community. They are part of a network of care, connecting people and resources together to provide support to those in need [40401]. These community members provide the vital relationships which build a bridge between people and services. They may also provide opportunities to learn about culture and country, opening a pathway for people to connect with a sense of belonging and knowledge.

There are many examples where people have got together to address issues of concern in their communities [22969][32750]. Culturally secure alcohol and drug services were established by Aboriginal and Torres Strait Islander people who wanted to make sure people would have a place to go where they could receive care and support based on Aboriginal and Torres Strait Islander values. Other programs started by community members support the wellbeing of people by mentoring young people, providing recreation and cultural activities and assisting people with housing and mental health.

The Aboriginal Medical Service Redfern in New South Wales was the first Aboriginal Community Controlled Health Service (ACCHs) in Australia. It was established in 1971. Since then over 140 ACCHs have been established [40045]. The benefits of the model of care they have brought to health is one that provides a holistic approach to healthcare. It is now a model that mainstream services seek to implement.

See Key resources on this page for examples of community-based resources, organisations and programs.

The Handbook for Aboriginal alcohol and other drug work, published by the University of Sydney,  provides practical information to guide alcohol and other drug workers in their day to day work [23503]. Each chapter includes detailed information on approaches to alcohol and drug work ranging from clinical guidelines and general principles of counselling to information on specific drugs. There is also information on prevention, harm reduction strategies, working with communities and working with specific groups such as people in prison. The complete handbook can be downloaded for free from the University of Sydney website (scroll down the page to Resources).

Fetal alcohol spectrum disorder (FASD) is a diagnostic term used to describe a range of neurodevelopmental impairments and other health effects on an individual caused by prenatal alcohol exposure (PAE)[51039]. Neurodevelopmental impairments can include; difficulties with learning, language, memory, planning, emotional regulation and motor skills [42715]. FASD is also associated with an increased risk of health issues with hearing, vision, the heart and musculoskeletal problems [49051]. Diagnosing FASD is complex. It is recognised that some features common to FASD can also be a result of genetic and environmental factors and that the effects of PAE interact with protective and risk factors [51039].

The Australian guidelines for assessment and diagnosis of Fetal Alcohol Spectrum Disorder [51039] and the accompanying Australian guidelines for assessment and diagnosis of Fetal Alcohol Spectrum Disorder: FASD Indigenous framework [51275] are resources aimed at supporting culturally responsive, strength-based and healing informed assessment and diagnostic services for FASD in an Australian context.

FASD may be diagnosed at birth, but in many cases, the diagnosis occurs later, when an individual is having significant problems with learning or behaviour that impacts on their daily functioning [51039]. Early diagnosis can help parents and carers to understand the needs and behaviours of a family member affected by FASD [42527][26090][35916].

Strategies to support families and individuals affected by FASD

Strategies which help to improve the long term outcomes for individuals and families affected by FASD include [51039][51275]:

• shared decision making between practitioners, families and the individual with FASD
• supporting capacity and connection within the whole family
• providing information to access resources and services to support wellbeing
• monitoring changing needs over the life span.

How can we prevent FASD?

At a population level, FASD can be prevented by promoting awareness of the harmful effects of exposure to alcohol while pregnant, and reducing the ready availability of alcohol [35916].

While not every alcohol exposure during pregnancy results in FASD, there is no safe time to have alcohol during pregnancy [42089]. The Australian guidelines to reduce health risks from alcohol recommends that individuals who are planning to have a baby, or are pregnant should not drink alcohol, and for individuals who are breast feeding, the safest choice is not to drink alcohol.

Health workers, GPs, and maternity services have an important role in reducing the risks of FASD through routine screening of all pregnant individuals [35916]. Routine screening creates opportunities to provide information, brief intervention or referral to support services. The role of partners in supporting individuals who are pregnant or breastfeeding to not drink alcohol during pregnancy and breastfeeding is also important [23933].

What is being done about FASD?

The most recent policy in response to FASD, the National Fetal Alcohol Spectrum Disorder (FASD) Strategic Action Plan 2018-2028 outlines four national priorities [35916].

These are:

• prevention
• screening
• support and management
• priority groups and populations at increased risk.

A range of health promotion and practice resources have been developed to support health practitioners and raise awareness of FASD. Please see the Knowledge Centre’s listing of  resources, programs, organisations.

For more information about FASD for carers and health professionals please also visit FASD Hub Australia.