Association between alcohol restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities: a systematic review

Abstract

Objective: The objective of this review was to examine the association between alcohol supply restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities. Introduction: Aboriginal and Torres Strait Islander peoples living in remote communities experience a higher rate of alcohol-related harms than other Australians. High rates of alcohol consumption are associated with a range of physical and social harms. Restricting the supply of alcoholic beverages in Aboriginal and Torres Strait Islander communities is often used by governments as a strategy to reduce these harms, but the current evidence is conflicting. Inclusion criteria: This review considered all quantitative studies with Aboriginal and Torres Strait Islander participants living in remote communities in Australia, where the participants were exposed to restrictions on the supply of alcoholic beverages. Harms of interest were i) physical injuries (whether secondary to assaults or accidents), measured as hospital admissions, Royal Flying Doctor Service attendance and transfers, and reported assaults, including intimate partner or family violence; ii) alcohol-related illnesses, measured as hospital admissions for conditions primarily attributed to alcohol consumption; and iii) rates of alcohol consumption, measured as alcohol sales per person or as self-reported consumption. Methods: We searched a wide range of databases and gray literature resources for published and unpublished, English-language studies from 1998 to 2020. Two reviewers independently screened search results and selected citations for full-text retrieval. Two reviewers independently assessed each article for congruence to the inclusion criteria. Critical appraisal and data extraction were conducted by two reviewers working independently. Data were narratively synthesized because statistical pooling was not possible. Results: We included 13 observational studies with more than 15,800 participants. Most included studies reported some harm reductions in association with a variety of alcohol supply restrictions; however, these reductions were sometimes short-lived. Studies reported on a variety of supply reduction strategies, ranging from small limitations on when alcohol could be sold to total prohibition of alcohol within the community. None of the interventions examined in the included studies reported consistent results. Total prohibition of alcohol was initially associated with large reductions in consumption but also led to unintended consequences, such as illicit substance use, alcohol consumption outside of the community, and illegal importation of alcohol into the community. We were unable to make any strong recommendations based on the included studies due to inherent bias in the study designs employed. Conclusions: Problematic use of alcohol by Aboriginal and Torres Strait Islander peoples is unlikely to be solved by a single strategy. Total alcohol prohibition does not stop people from seeking and accessing alcohol, and may in fact lead to a range of negative unintended consequences. Future studies should be more rigorously designed and reported to increase the strength of the evidence and certainty in the results.