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. Conigrave and colleagues' recent meta-analysis [1] provides valuable insights into alcohol drinking patterns among Australian Aboriginal and Torres Strait Islander (or Indigenous) people. Using a comprehensive systematic review including three decades of academic literature and meta-regression analysis to combine the findings, the authors identified considerable heterogeneity in estimates of drinking risk within and between Indigenous communities. In response, they recommended the implementation of programmes to reduce risky drinking be designed by or in partnership with local communities. In this commentary, we aim to highlight the policy implications and future research opportunities arising from the Conigrave review. 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.