The National Drug Strategy is a framework for action that identifies national priorities in relation to alcohol, tobacco and other drugs [33425]. Its purpose is to guide governments in partnership with service providers to address the harms from alcohol and other drug use, using a combination of strategies. The principle of harm minimisation is the underlying principle of the National Drug Strategy which recommends using a balanced approach by applying demand reduction, supply reduction, and harm reduction [27647]. These three approaches (referred to as the three pillars) are the foundations that can be used to support collaboration across health, law enforcement and education agencies, and between governments and communities.

National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy

The National Aboriginal and Torres Strait Islander Peoples’ Drug Strategy NATSIPDS [30136] recognises that Aboriginal and Torres Strait Islander people have an increased risk of health and social harms from alcohol and other drug use compared with the general population. Therefore, specific strategies have been developed which are relevant to Aboriginal and Torres Strait Islander people and in communities.

The NATSIPDS identifies four additional principles within the broad approach of demand reduction, supply reduction and harm reduction:

• • Aboriginal and Torres Strait Islander ownership of solutions – Aboriginal and Torres Strait Islander people should be meaningfully included and genuinely consulted regarding the development of solutions to harmful alcohol and other drug (AOD) use.
  • Holistic approaches that are culturally safe, competent and respectful These are approaches that focus on the physical, spiritual, cultural, emotional and social well‐being of the individual, family and community and emphasise the importance of strengthening cultural systems of care, control and responsibility.
  • Whole-of-government effort and partnerships – solutions to harmful AOD use require multiple government‐agency engagement at the Commonwealth, state/territory and local government level.
  • Resourcing on the basis of need – in order to achieve improvement of outcomes in relation to AOD issues for Aboriginal and Torres Strait Islander peoples; available resources should be provided in a well‐targeted manner that supports sustainability and evidence‐based results.

Demand reduction

The current National Drug Strategy includes demand reduction strategies which aim to:

• prevent the uptake and/or delay the onset of use of alcohol, tobacco and other drugs
• reduce the use of alcohol, tobacco and other drugs in the community
• support people to recover from dependence through evidence-informed treatment [33425] .

Demand reduction strategies range from prevention and education (such as providing alternatives to substance use, and raising awareness about the health effects of substance use) to treatment services for people who use drugs.

Demand reduction can also be addressed through appropriate policies that address the social determinants of health [15]. The social determinants (factors such as employment, housing, early life experiences social inclusion/exclusion and chronic stress) have an ongoing influence on a person’s health throughout their life [25048]. It is important to consider these factors in health interventions (including those aimed at drug use). The social determinants of health approach attempts to address the causes of alcohol and drug use, rather than the symptoms, by reducing risk and building strong communities.

Community based approaches towards demand reduction recognise that behaviours such as drug use are influenced by personal issues at home, work and in community settings where we spend time [15]. Programs such as the Maranguka Justice Reinvestment Project aim to reduce demand for drugs and alcohol by redirecting resources back to the community to give them the power to address the underlying causes of imprisonment. Community based programs such as Binar Sports  and the Central Australian Youth Link Up Service are examples of programs which nurture social connection and provide a pathway for young people to positively engage  in community settings. Other community programs focus on connecting with Aboriginal and Torres Strait Islander culture, such as the Red Dust Healing Program and the Yiriman Ranger Project [29786].

Treatment

Treatment programs aim to change behaviour by reducing an individual’s demand for drug use. These can include; withdrawal management and pharmacotherapies, counselling, and residential rehabilitation [10]. In Australia, treatment may be delivered in residential or community settings, through specialist alcohol and other drug treatment services, or generalist services such as primary health care and Aboriginal Medical Services. People who use drugs may come into contact with the criminal justice system, and treatment may also be delivered in these settings through programs which divert people who have drug use and possession offences away from the criminal justice system and into education and treatment [17]. Determining what works best in treatment for Aboriginal and Torres Strait islander people is the subject of current research with a call to establish more localised data and systematic culturally validated ways of evaluating outcomes [34811]. Increasingly Aboriginal led research is calling for culturally secure approaches to treatment which incorporates Aboriginal and Torres Strait islander values and knowledge systems and a recognition of the trauma caused by colonisation [28917][41496].

Supply reduction

Supply reduction aims to remove or reduce the supply of alcohol and other drugs within the community [10]. Within the current National Drug Strategy, supply reduction strategies are those which prevent and disrupt the production and supply of illegal drugs  as well as regulate the availability of alcohol, tobacco and other legal drugs such as pharmaceuticals [33425].

Legal drugs such as tobacco and alcohol are regulated and controlled through restrictions on sales to people under 18 years, controlling where tobacco and alcohol can be sold, and restrictions on public alcohol consumption [11][16][20]. Pricing and taxation of alcohol and tobacco are also important tools available to the Federal Government to regulate the availability of these legal drugs in the community. Increasing the price of alcohol has been shown to be an effective measure for reducing consumption [24410].

In the context of Aboriginal and Torres Strait Islander communities, supply control measures have been used successfully to regulate the availability of alcohol and volatile substances [33620][31839]. Alcohol management plans when run and initiated by the community can reduce consumption and the harms associated with alcohol use [29873][22969].The substitution of sniffable petrol with  Low aromatic fuel (LAF) has significantly reduced the prevalence of volatile substance use in remote communities [31839]. However where supply control measure such as alcohol management plans have been left to small communities without being embedded in a supportive wider regional strategy, supply control measures can become difficult to sustain [33531].

Harm reduction

Harm reduction seeks to minimise the harmful consequences of drug use to the individual, families and the community at large [33425][10]. Within the current National Drug Strategy, harm reduction strategies aim to reduce risky behaviours and encourage safer environments [33425]. In Australia, the main harm reduction activities for illicit drugs include needle syringe programs to reduce the transmission of blood borne viruses, supervised injecting facilities, overdose education and naloxone distribution programs [21]. For alcohol, harm reduction strategies include; responsible service of alcohol, mobile patrols, drink driving interventions, and sobering up shelters [21]. Reducing exposure to tobacco smoke is an important harm reduction strategy for preventing the harms from passive smoking, especially for young people.