Krakouer Jacynta, Savaglio Melissa, Taylor Karinda, Skouteris Helen
Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia.
First Peoples' Health and Wellbeing, Thomastown and Frankston, Australia.
Drug Alcohol Rev. 2022 Sep;41(6):1418-1427. doi: 10.1111/dar.13477. Epub 2022 May 11.
The transgenerational impacts of colonisation-inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation-places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community-based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community-based models of AOD support for First Nations adults in Australia.
A systematic search of the empirical literature from the past 20 years was conducted.
Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap-around psychosocial support, increased local community participation and engagement, funding and breaking down silos.
Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community-based AOD services for First Nations peoples.
There is a limited evidence-base for community-based AOD programs for First Nations peoples. First Nations-led research that is controlled by and co-produced with First Nations peoples is necessary to extend our understanding of community-based programs within First Nations communities.
殖民化的跨代影响——包括剥夺、代际创伤、种族主义、社会和经济排斥以及边缘化——使澳大利亚的原住民面临酒精和其他药物（AOD）使用及其相关危害的重大风险。然而，支持为原住民成年人提供基于社区的AOD治疗的知识和证据有限。因此，本综述旨在研究澳大利亚为原住民成年人提供基于社区的AOD支持模式的影响和可接受性。
对过去20年的实证文献进行了系统检索。
纳入了17项研究。9项研究评估了该项目对物质使用的影响，10项研究评估了项目的可接受性（两项研究同时评估了两者）。9项研究中只有3项在物质使用方面有统计学上的显著减少。可接受的组成部分包括文化安全、原住民AOD工作者、家庭和亲属的纳入、外展和团体支持。需要改进的方面包括更注重全面的心理社会支持、增加当地社区的参与和投入、资金以及打破壁垒。
由原住民和组织主导的、涉及当地社区成员的文化安全、全面和综合的AOD外展支持，可能会帮助有AOD问题的原住民。这些发现可能为为原住民重新设计和重新开发基于社区的AOD服务提供参考。
为原住民提供基于社区的AOD项目的证据基础有限。由原住民主导、控制并与原住民共同开展的研究对于扩展我们对原住民社区内基于社区的项目的理解是必要的。
