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Introduction: Contrary to stereotypes, Aboriginal and Torres Strait Islander Australians are more likely to abstain from drinking than other Australians. We explored characteristics and experiences of Aboriginal and Torres Strait Islander Australians who do not drink alcohol. Method: We conducted a cross‐sectional, representative survey of 775 Aboriginal and Torres Strait Islander Australians (16+ years) in remote and urban South Australia. We explore correlates of not drinking alcohol using multi‐level logistic regression. We describe reasons for non‐drinking and harms participants experienced in past 12 months from others' drinking. Results: Non‐drinking participants were more likely to be older (OR 1.35 [95% CI 1.21, 1.50] per decade) and unemployed (OR 2.72 [95% CI 1.77, 4.20]). Participants who spoke Aboriginal Australian languages at home were three times more likely to be lifetime abstainers from drinking (OR 3.07 [95% CI 1.52, 6.21]). Common reasons for not drinking alcohol were health and family. Most did not report harms from others' alcohol consumption (79.6%, 76.9%, urban and remote respectively). Stress from others' alcohol consumption was the most reported harm by non‐drinkers (14.5% and 23.1%, urban and remote, respectively). Discussion and Conclusions: Culture such as speaking Aboriginal Australian languages might have protective effects that promote abstaining but was rarely explicitly cited as a reason for not drinking. A greater understanding of local values held by people who do not drink alcohol could help inform health messaging and other interventions to reduce alcohol‐related harms. Understanding local reasons for abstaining can help tailor health messaging to suit local contexts. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol screening among Indigenous Australians is important to identify individuals needing support to reduce their drinking. Understanding clinical contexts in which clients are screened, and which clients are more or less likely to be screened, could help identify areas of services and communities that might benefit from increased screening. Methods: We analysed routinely collected data from 22 Aboriginal Community Controlled Health Organisations Australia‐wide. Data collected between February 2016 and February 2021 were analysed using R, and aggregated to describe screening activity per client, within 2‐monthly extraction periods. Descriptive analyses were performed to identify contexts in which clients received an Alcohol Use Disorders Identification Test consumption (AUDIT‐C) screen. Multi‐level logistic regression determined demographic factors associated with receiving an AUDIT‐C screen. Three models are presented to examine if screening was predicted by: (i) age; (ii) age and gender; (iii) age, gender and service remoteness. Results: We observed 83,931 occasions where AUDIT‐C was performed at least once during a 2‐monthly extraction period. Most common contexts were adult health check (55.0%), followed by pre‐consult examination (18.4%) and standalone item (9.9%). For every 10 years' increase in client age, odds of being screened with AUDIT‐C slightly decreased (odds ratio 0.98; 95% confidence interval [CI] 0.98, 0.99). Women were less likely to be screened with AUDIT‐C (odds ratio 0.95; 95% CI 0.93, 0.96) than men. Discussion and Conclusions: This study identified areas where alcohol screening can be increased (e.g., among women). Increasing AUDIT‐C screening across entire communities could help reduce or prevent alcohol‐related harms. Future Indigenous‐led research could help identify strategies to increase screening rates. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol dependence is a chronic condition impacting millions of individuals worldwide. Safe and effective medicines to reduce relapse can be prescribed by general practitioners but are underutilised in the general Australian population. Prescription rates of these medicines to Aboriginal and Torres Strait Islander (First Nations) Australians in primary care are unknown. We assess these medicines in Aboriginal Community Controlled Health Services and identify factors associated with prescription. Methods: Baseline data (spanning 12 months) were used from a cluster randomised trial involving 22 Aboriginal Community Controlled Health Services. We describe the proportion of First Nations patients aged 15+ who were prescribed a relapse prevention medicine: naltrexone, acamprosate or disulfiram. We explore associations between receiving a prescription, a patient AUDIT‐C score and demographics (gender, age, service remoteness) using logistic regression. Results: During the 12‐month period, 52,678 patients attended the 22 services. Prescriptions were issued for 118 (0.2%) patients (acamprosate n = 62; naltrexone n = 58; disulfiram n = 2; combinations n = 4). Of the total patients, 1.6% were ‘likely dependent’ (AUDIT‐C ≥ 9), of whom only 3.4% received prescriptions for these medicines. In contrast, 60.2% of those who received a prescription had no AUDIT‐C score. In multivariate analysis, receiving a script (OR = 3.29, 95% CI 2.25–4.77) was predicted by AUDIT‐C screening, male gender (OR = 2.24, 95% CI 1.55–3.29), middle age (35–54 years; OR = 14.41, 95% CI 5.99–47.31) and urban service (OR = 2.87, 95% CI 1.61–5.60). Discussion and Conclusions: Work is needed to increase the prescription of relapse prevention medicines when dependence is detected. Potential barriers to prescription and appropriate ways to overcome these need to be identified. [ABSTRACT FROM AUTHOR]

Several initiatives have sought to increase the number of First Nations individuals with a higher degree in research (i.e., PhD or research masters)—in Australia and in similarly colonised countries. However, little has been written on day‐to‐day support structures and mechanisms that might help First Nations Australian candidates thrive in postgraduate research degrees and beyond. For sensitive research fields such as alcohol, emerging Aboriginal and Torres Strait Islander researchers must grapple with topics which are stigmatising and in some instances associated with traumatic associations. There is also a lack of studies internationally that describe optimal support for First Nations students undertaking a higher degree by research with a primary focus on alcohol. Here we discuss what we have learned from the support offered through the Centre of Research Excellence in Indigenous Health and Alcohol—from the perspective of academic staff, students, trainees and early career researchers. We consider what may be generalisable lessons from this experience. [ABSTRACT FROM AUTHOR]

Introduction: Involuntary drug and alcohol treatment occurs in many countries and its role is often controversial. This can be a particular concern in relation to First Nations or other culturally distinct populations. This study explores beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in New South Wales (NSW), Australia. Methods: The Involuntary Drug and Alcohol Treatment program (IDAT) is legislated by the NSW Drug and Alcohol Treatment Act 2007. There are two IDAT units—in urban (Sydney, four beds) and regional NSW (Orange, eight beds). NSW Health drug and alcohol clinicians who had referred clients to IDAT between 2016 and 2018 were invited to participate in a semi‐structured 1:1 interview. Eleven clinicians (n = 2, male) from six local health districts (urban through to remote) agreed to participate. A descriptive qualitative analysis of responses was conducted. Results: Two key themes summarised the beliefs and attitudes that clinicians reported influencing them when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in NSW: (i) dilemma between saving someone's life and being culturally safe; and (ii) need for holistic wrap‐around care. Discussion and Conclusions: Almost all clinicians were worried that being in IDAT would further erode their Aboriginal client's autonomy and be retraumatising. Strategies are needed to support the involvement of Aboriginal‐specific services in IDAT processes and ensure local support options for clients on discharge. Future research should examine the effectiveness, acceptability and feasibility of involuntary drug and alcohol treatment programs. [ABSTRACT FROM AUTHOR]

Introduction: First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood. Methods: We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms. Results: Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing. Discussion and Conclusions: First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives. [ABSTRACT FROM AUTHOR]

The Australian Government will set the direction for addressing road safety over the next decade with its 2021–2030 National Road Safety Strategy. This road map will detail objectives and goals agreed upon by all Australian states and territories. Similar to previous national strategies, Aboriginal and Torres Strait Islander (Indigenous) Australians are a high priority population. Indigenous Australians are over‐represented in serious injury and fatal road crashes, with alcohol a leading factor. Therapeutic and educational programs are a major strategy among the suite of measures designed to reduce and prevent drink driving in Australia. The release of this new strategy provides a timely opportunity to reflect on what is known about drink driving among Indigenous Australians and to consider the suitability of existing therapeutic and educational drink driving programs for Indigenous Australian contexts. Here, we summarise factors that contribute to drink driving in this population and identify outstanding knowledge gaps. Then, we present an overview of drink driving programs available for Indigenous Australians along with suggestions for why tailored programs are needed to suit local contexts. The response to address drink driving among Indigenous Australians has been fragmented Australia‐wide. A coordinated national response, with ongoing monitoring and evaluation, would improve policy effectiveness and inform more efficient allocation of resources. Together this information can help create suitable and effective drink driving programs for Indigenous drivers and communities Australia‐wide. [ABSTRACT FROM AUTHOR]

Introduction: Aboriginal and Torres Strait Islander (Indigenous) Australians have identified alcohol consumption as an area of concern. Accurate screening tools are required to help detect and assist at‐risk drinkers, and to provide accurate data to policy makers. The Finnish method (determining drinking patterns based on the last two to four drinking occasions), has been proposed as a culturally appropriate and effective screening tool for detecting Indigenous Australians at risk from alcohol consumption. While it has been found to be valid and acceptable for use with Indigenous Australians, the Finnish method has not been compared to the three‐item Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) which is currently recommended by the Australian government for use in Aboriginal community‐controlled health services. Methods: We compared the performance of the AUDIT‐C and Finnish method as screening tools for detecting harms experienced from alcohol in a representative, cross‐sectional, sample of Indigenous Australians. Results: AUDIT‐C was substantially faster for participants to complete than the Finnish method. Metrics derived from both the AUDIT‐C and Finnish method were similarly linked to the frequency of self‐reported International Classification of Diseases, 11th revision dependence symptoms and harms. Discussion and Conclusions: The AUDIT‐C is likely most appropriate for use in clinical settings due to its speed and ease of use. The Finnish method provides relatively detailed information about drinking and is better suited to population surveys. [ABSTRACT FROM AUTHOR]

Introduction: Aboriginal clients accessing Aboriginal community‐controlled residential alcohol and other drug rehabilitation services in New South Wales, Australia believe they have better outcomes due to culturally appropriate care. However, there is a paucity of published treatment outcome data. This study aims to identify predictors of treatment outcomes based on client characteristics at intake. Methods: A cross‐sectional, retrospective, observational study of 2326 admissions to six services between January 2011 and December 2016. The outcomes were: (i) leaving treatment early; (ii) self‐discharge or house discharge (by staff); and (iii) re‐admission within two years. The predictors examined were Aboriginal status, age, justice system referral and primary substance of concern. Competing risk and Poisson regression analyses were used to identify trends in the data. Results: The mean age of clients was 33 years, and the majority (56%) stayed at least 6 weeks. Aboriginal clients whose primary substance of concern was stimulants were almost eight times more likely to re‐admitted within 2 years than other clients (risk ratio 7.91; P < 0.001). Aboriginal clients who were also referred from justice were more likely to self‐discharge (risk ratio 1.87; P < 0.001). Furthermore, Aboriginal clients who were aged older than 30 were less likely to have a re‐admission (risk ratio 0.32; P ≤ 0.001). Discussion and Conclusions: This study showed client characteristics that are predictive of harmful outcomes include age under 30, justice client, primary substance of use and their interactions. Future research could build on these results to aid ongoing development of residential rehabilitation programs for Aboriginal peoples. [ABSTRACT FROM AUTHOR]

Introduction: In response to a high burden of opioid use disorder (OUD), Iran established a network of opioid agonist treatment (OAT) centres beginning in 2002. To increase treatment diversity, particularly for patients who use opium as their drug of choice, opium tincture (OT)‐assisted treatment was introduced to the network. This study aimed to explore factors influencing OT‐assisted treatment selection for OUD in Tehran, Iran. Methods: We conducted 54 in‐depth interviews with patients with OUD (n = 33), family members of patients (n = 9) and drug treatment providers (n = 12). Participants were recruited from 12 drug treatment centres across Tehran, between September and November 2019. All interviews were audio‐recorded, transcribed and coded in OpenCode 4.02 software and analysed using thematic analysis. Results: Study participants more commonly reported individual‐level factors as facilitators (e.g. to reduce harms associated with illicit opioid use, achieve recovery through a gradual dose reduction regimen combined with Congress 60 recovery program) and structural level factors (e.g. low adoption by OAT system and lack of familiarity of treatment providers) as barriers for utilisation of OT‐assisted treatment regimens. OT was perceived to produce lower levels of physiological dependence than methadone, but the requirement for twice supervised dosing was restrictive. Low familial and community acceptance were also seen as barriers to access. Discussion and Conclusions: This research identified a range of perceived benefits for OT‐assisted treatment ranging from harm reduction to an intermediate step to achieve recovery. However, several structural‐, individual‐, familial‐ and community‐level barriers impede its availability and acceptability. [ABSTRACT FROM AUTHOR]

In Australia, Aboriginal and Torres Strait Islander community controlled health services have been established since 1971 to provide accessible, quality and culturally‐appropriate primary healthcare. The first of these services, the Aboriginal Medical Service Cooperative Redfern ('the AMS'), created its own Drug and Alcohol Unit ('the Unit') in 1999. The Unit initially prescribed opioid substitution treatment (OST) and its coordinator, Bradley Freeburn, a Bundjalung man, provided counselling. Soon afterwards, the Unit started dispensing OST. It now cares for around 150 individuals, each of whom is understood in the context of family, community and culture. The Unit is on the same site as the AMS's primary care service, specialised medical and mental health clinics, and dental clinic. This allows for integrated physical and mental health care. The Unit contributes to drug and alcohol workforce development for other AMS staff, state‐wide and nationally. Several Aboriginal and Torres Strait Islander community controlled health services around Australia now offer OST prescription, and a small number administer slow‐release buprenorphine. We are not aware of others that dispense Suboxone. In the USA and Canada, over the last 10 years, First Nations communities have also responded to lack of treatment access, by creating standalone OST clinics. We were not able to find examples of Māori‐controlled OST clinics in Aotearoa, New Zealand. The feasibility of this model of readily accessible OST, situated within a holistic, culturally‐grounded primary health‐care service recommends it for consideration and evaluation, for Indigenous or non‐Indigenous communities. [ABSTRACT FROM AUTHOR]

Introduction: Measuring self‐reported alcohol use is challenging in any population, including when episodic drinking may be common. Drinking among Indigenous Australians has been shown to vary greatly within and between communities. However, most survey methods assume 'regular' patterns of drinking. National estimates have also been shown to underestimate alcohol use among this group. This paper describes drinking patterns in two representative community samples (urban and remote). Methods: Indigenous Australians (aged 16+ years) in two South Australian sites were recruited to complete the Grog Survey App. The App is a validated, interactive tablet‐based survey tool, designed to help Indigenous Australians describe their drinking. Drinking patterns were described using medians and interquartile ranges; gender and remoteness were compared using Wilcoxon rank‐sum tests. Spearman correlations explored the relationship between drinking patterns and age. Logistic regressions tested if beverage or container preference differed by remoteness or gender. Results: Three‐quarters of participants (77.0%, n = 597/775) were current drinkers. Median standard drinks per occasion was 7.8 (78 g), 1.3 drinking occasions per month (median). Three‐quarters of current drinkers (73.7%) reported a period without drinking (median: 60 days). Remote drinkers were more likely to drink beer. Improvised containers were used by 40.5% of drinkers. Discussion and Conclusions: Episodic drinking with extended 'dry' periods and from non‐standard drinking containers was common in this representative sample of Indigenous Australians. The diversity of container use and beverage preference, by gender and remoteness, illustrates nuances in drinking patterns between communities. It shows the importance of community‐level data to inform local strategies addressing alcohol misuse. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the prevalence of current alcohol dependence in Indigenous Australian communities. Here we identify the frequency of reported symptoms, estimate the prevalence and describe the correlates of current alcohol dependence. Methods: A representative sample of Indigenous Australians (16+ years) was recruited from an urban and remote community in South Australia. Data were collected between July and October 2019 via a tablet computer‐based application. Participants were likely dependent if they reported two or more dependence symptoms (ICD‐11; in the last 12 ‐months), weekly or more frequently. Chi‐square tests described the relationship between demographics, remoteness and alcohol dependence. Spearman correlations estimated the relationship between symptoms of dependence, consumption characteristics and demographics. Results: A total of 775 Indigenous Australians participated. The most frequently reported symptoms were prioritising alcohol over other things and loss of control. Overall, 2.2% were likely dependent on alcohol (n = 17/775). Prevalence did not vary by remoteness. Participants who drank more and more frequently tended to report more frequent symptoms of dependence. In the urban site, men tended to report more frequent symptoms of dependence than women. Age, income and schooling were not linked to dependence. Discussion and Conclusions: The prevalence of current alcohol dependence in this representative sample was similar to that of the general Australian and international estimates. Understanding risk factors for current alcohol dependence will be useful to inform the allocation of funding and support. Accurate estimates of the prevalence of current alcohol dependence are important to better identify specialist treatment needs. [ABSTRACT FROM AUTHOR]

Introduction: SMART Recovery is a popular mutual support group program. Little is known about its suitability or perceived helpfulness for Indigenous peoples. This study explored the cultural utility of SMART Recovery in an Australian Aboriginal context. Methods: An Indigenous‐lensed, multi‐methods, exploratory study design was used to develop initial evidence of: (i) attributes of Aboriginal SMART Recovery facilitators and group members; (ii) characteristics of Aboriginal‐led SMART Recovery groups; (iii) perceived acceptability and helpfulness of SMART Recovery; and (iv) areas for potential improvement. Data were collected by synthesising Indigenous qualitative methods (research topic and social yarning) with western qualitative and quantitative methods (participant surveys, program adherence rating scale, group observations and field notes). Data were analysed using thematic analysis. Results: Participants were a culturally diverse sample of male and female Aboriginal facilitators (n = 10) and group members (n = 11), aged 22–65 years. Aboriginal‐led SMART Recovery groups were culturally customised to suit local contexts. Program tools 'goal setting' and 'problem solving' were viewed as the most helpful. Suggested ways SMART Recovery could enhance its cultural utility included: integration of Aboriginal perspectives into facilitator training; creation of Aboriginal‐specific program and marketing materials; and greater community engagement and networking. Participants proposed an Aboriginal‐specific SMART Recovery program. Discussion and Conclusions: This study offers insights into Aboriginal peoples' experiences of SMART Recovery. Culturally‐informed modifications to the program were identified that could enhance cultural utility. Future research is needed to obtain diverse community perspectives and measure health outcomes associated with group attendance. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Substance use significantly contributes to increasing the disease burden experienced by young Aboriginal and Torres Strait Islander (Aboriginal) Australians. Little is known about the primary healthcare needs of young Aboriginal people who use drugs. The aim of this study was to pilot Audio Computer Assisted Self-Interviewing (ACASI) as a method of asking young Aboriginal people who use illicit drugs about their health concerns and service preferences, in inner-Sydney, New South Wales.Design and Methods: We employed a sequential mixed methods exploratory study design. Qualitative data was collected using a focus group and in-depth interviews. These findings informed the development of the ACASI survey, which asked questions on substance use, health concerns, health service usage, barriers and preferences for services. Recruitment sites included youth and health services. Qualitative results were analysed thematically, and survey results using descriptive statistics.Results: Eight people participated in the focus group and two in in-depth interviews. Of the 38 survey respondents, 68% reported illicit drug use. Reported barriers to service access included waiting time and services seeming unfriendly or not understanding Aboriginal people. Participants expressed preferences for Aboriginal-friendly health services that provide internet access, literacy skill development and opportunities to learn about Aboriginal culture. Participants found the ACASI survey user-friendly.Discussion and Conclusions: This is the first report describing health concerns and service preferences of young Aboriginal people who use illicit drugs. The ACASI survey appears to be an appropriate and efficient approach to giving a voice to young Aboriginal people. [ABSTRACT FROM AUTHOR]

The article presents information on the measures taken in Australia to encourage an healthy environment by discouraging substance abuse. The primary focus being on helping the aborigines, there being specific Aboriginal AOD (Alcohol and other drug) workers to help the people, and information on various organizations supporting the cause are presented.

Introduction and Aims Historically, Aboriginal alcohol and other drug ( AOD) workers had little formal training, but this situation has changed rapidly in recent years. To understand how to better support and develop the workforce, we present the most detailed profile yet published of Aboriginal AOD workers in Australia. Design and Methods Workers were identified through the Aboriginal Drug and Alcohol Network, New South Wales. Participants completed a modified version of the Work Practice Questionnaire by pen-and-paper or interview in 2009. Results Fifty-one workers were identified, representing 85% of the known New South Wales workforce at the time. Two in three (62.7%) were male, and over half (56.9%) were aged 30-49. More workers were employed in non-government than government (60.8% vs. 39.2%) workplaces. Workers were employed under more than four different awards and with approximately eight position titles, spanning prevention and early intervention, clinical care and workforce development. Nearly all ( n = 49/51, 96.1%) felt they had the necessary experience to respond to AOD issues. However, over half ( n = 27/51, 52.9%) felt too much was expected of them. Just under a third ( n = 15/51, 29.4%) reported no formal supervision, with fewer non-government workers compared with government receiving supervision ( P = 0.02). Over half ( n = 27/40, 67.5%%) earned AUD ≤ $50 000 annually, with government (vs. non-government) employment and female gender predicting a salary of >$50 000. Discussion and Conclusions To improve worker retention and encourage professional skills development, discrepancies in salary and award conditions need addressing. Clarifying position descriptions and improving access to formal supervision are important to maximise workforce potential and reduce stress. [Ella S, Lee KSK,Childs S, Conigrave KM. Who are the New South Wales Aboriginal drug and alcohol workforce? A first description. Drug Alcohol Rev 2014] [ABSTRACT FROM AUTHOR]

Introduction and Aims Aboriginal Australian women have an important role in raising strong families. Yet there are many challenges for women with mental health disorders, sometimes following past traumas. This study examines experiences of Aboriginal women engaging with treatment services for co-occurring mental health and substance use disorders ( SUD), and the experiences of their family, and of health staff seeking to support them. Design and Methods The study was implemented by four Aboriginal Community Controlled Health Services in urban and regional New South Wales to inform improvements to local health service delivery. All Aboriginal female clients with a diagnosed comorbid mental health and SUD were offered study participation by staff of that Aboriginal Medical Service. Semi-structured interviews were conducted by an independent Aboriginal interviewer: 21 with clients, 12 with adult family members of these clients and 11 with Aboriginal health workers from these services. Results Clients (aged 21-60) experienced a range of mental health and SUD, attributed by them to negative events early in life. Clients and family members reported that the disorders have severe impacts on the women and their families, including children. Considerable barriers to accessing relevant services were described. Suggested service improvements included more local inpatient treatment options, more friendly and flexible services, better service promotion and improved staff professional development opportunities. Discussion and Conclusion Barriers to accessing mental health and SUD treatment (Aboriginal and mainstream) need addressing. Research is needed to optimise treatment to meet the complex needs of Aboriginal Australians with co-occurring mental health and SUD. [Lee KSK, Harrison K, Mills K, Conigrave KM. Needs of Aboriginal Australian women with comorbid mental and alcohol and other drug use disorders. Drug Alcohol Rev 2014;33:473-481] [ABSTRACT FROM AUTHOR]

The author discusses methods that can be used to gather alcohol and drug use data from Aboriginal and Indigenous communities in Australia. The author suggests various approaches that could improve self-reported data accuracy among Indigenous and Aboriginal population group. The author cites various shortcomings that limits the scope and validity of household survey data regarding the substance and alcohol use of the population group.

Introduction and Aims Support groups are typically offered as part of specialist alcohol or other drug treatment. However, their usefulness with Indigenous Australians has not been examined. This paper provides a profile of Aboriginal women attending an inner city outpatient alcohol and other drug treatment service, insight into how effective women and staff perceive the support group to be at meeting their needs and suggestions for improvements. Design and Methods Structured interviews were conducted with 24 Aboriginal female clients of an outpatient treatment service and with 21 staff from across that service and the local Aboriginal Medical Service. Client interviews also assessed alcohol consumption and mental health risk ( Indigenous Risk Impact Screen). Results Clients reported social and health indicators illustrating disadvantage and complex needs. Most clients and staff perceived the group to be useful and easily accessible. The participants discussed positive elements including opportunities for shared experience in a non-judgemental environment, practical support and health education. Staff reported how the safe, relaxed environment of the group helped with early identification of issues and user-friendly pathways for treatment access. Suggested improvements included greater involvement from Aboriginal staff and community members and enhanced communication with other staff. Discussion and Conclusions Clients and staff recognised the usefulness of the group, including the opportunities it provided for socialisation and early intervention. Comprehensive research is needed to determine the types and sources of support that best assist Aboriginal women with substance use disorders. [Lee KS K, Dawson A, Conigrave K M. The role of an Aboriginal women's group in meeting the high needs of clients attending outpatient alcohol and other drug treatment. Drug Alcohol Rev 2013;32:618-626] [ABSTRACT FROM AUTHOR]

Introduction and Aims Targeted primary health-care services for injecting drug users have been established in several countries to reduce barriers to health care, subsequent poor health outcomes and the considerable costs of emergency treatment. The long-term sustainability of such services depends on the resources required and the coverage provided. This study assesses the additional cost required to operate a nurse-led primary health care in an existing needle syringe program setting, estimates the costs per occasion of service and identifies key factors influencing improved service utilisation. Design and Methods Using standard costing methods and the funder perspective, this study estimates costs using the 'ingredients' approach where the costs of inputs are based on quantities and unit prices (the ingredients). Results During the 2009-2010 fiscal year, the primary health-care clinic provided 1252 occasions of service to 220 individuals, who each made an average of 3.9 presentations. A total cost of AU$250 626 was incurred, 69% of which was for personnel and 22% for pathology. During the study period the average cost per occasion of service was AU$199.96, which could be as low as AU$93.32 if the clinic reached its full utilisation level. Discussion and Conclusions Although the average number of presentations per client was satisfactory, the clinic was underutilised during the study period. Proactive engagement of clients at the needle syringe program shopfront and an increased range of services offered by the clinic may help to attract more clients. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Opioid substitution therapy ( OST) ideally constitutes a window of opportunity for the provision of essential primary health care ( PHC) for OST clients. In the absence of such opportunities, however, OST clients access PHC from existing outlets, either general services or those targeted to specific groups. This study examined OST clients' current main source and preferred future outlets of PHC services and correlates of preferences. Design and Methods. Anonymous interviews conducted with n = 257 clients of two public OST clinics in Sydney's inner-west. Results. Overall, 61% ( n = 158) of participants reported currently accessing PHC primarily from general outlets (general practitioners or medical centres: 51%, hospital/emergence departments: 10%) and the remainder (39%, n = 99) from outlets that target specific groups (e.g. Aboriginal Medical Services, OST prescriber/clinics, drug user-targeted PHCs). Twenty-two percent reported discomfort disclosing drug use to their current PHC providers. However, the majority were satisfied with the care they received and reported a preference to remain with their current PHC providers for a range of reasons, most commonly familiarity with and trust in staff (56%) and not feeling judged about their drug use (49%). Nevertheless, 28% reported that they would access PHC through their OST clinic if it were available. Discussion and Conclusions. PHC outlets that target specific groups appear to have an ongoing and important role in providing accessible health care to OST clients. [ABSTRACT FROM AUTHOR]

Introduction and Aims. In remote Indigenous Australian communities measuring individual tobacco use can be confounded by cultural expectations, including sharing. We compared self-reported tobacco consumption with community-level estimates in Arnhem Land (Northern Territory). Design and Methods. In a cross-sectional survey in three communities (population 2319 Indigenous residents, aged≥ 16 years), 400 Indigenous residents were interviewed (206 men, 194 women). Eight community stores provided information about tobacco sold during the survey. To gauge the impact of 255 non-Indigenous residents on tobacco turnover, 10 were interviewed (five men, five women). Breath carbon monoxide levels confirmed self-reported smoking. Self-reported number of cigarettes smoked per day was compared with daily tobacco consumption per user estimated using amounts of tobacco sold during 12 months before the survey (2007-2008). 'Lighter smokers' (< 10 cigarettes per day) and 'heavier smokers' (≥ 10 cigarettes per day) in men and women were compared. Results. Of 400 Indigenous study participants, 305 (76%) used tobacco; four chewed tobacco. Of 301 Indigenous smokers, 177 (58%) provided self-reported consumption information; a median of 11-11.5 cigarettes per day in men and 5.5-10 cigarettes per day in women. Men were three times (odds ratio = 2.9) more likely to be 'heavier smokers'. Store turnover data indicated that Indigenous tobacco users consumed the equivalent of 9.2-13.1 cigarettes per day; very similar to self-reported levels. Sixty per cent (= 6/10) of non-Indigenous residents interviewed were smokers, but with little impact on tobacco turnover overall (2-6%). Discussion and Conclusions. Smoking levels reported by Indigenous Australians in this study, when sharing tobacco was considered, closely reflected quantities of tobacco sold in community stores. [Clough AR, MacLaren DJ, Robertson JA, Ivers RG, Conigrave KM. Can we measure daily tobacco consumption in remote Indigenous communities? Comparing self-reported tobacco consumption with community-level estimates in an Arnhem Land study. Drug Alcohol Rev 2010] [ABSTRACT FROM AUTHOR]

Introduction and Aims. To examine predictors of cannabis use at 5 year follow up in an Australian Aboriginal cohort. Design and Methods. A longitudinal study consisting of two waves of data collection 5 years apart was conducted. Of the 100 Aboriginal residents (aged 13–36 years) interviewed about cannabis use in 2001, 83 were re-interviewed in 2005–2006 from three remote communities in Arnhem Land, Northern Territory, Australia. Self-reported cannabis use was categorised at each time point (none; former use, quit≥ 3 months; lighter use, < 6 cones, 2–3 times weekly; daily use,≥ 6 cones, daily) and summarised as any current use, heavy use, dependence or cessation. Other substance use, employment and involvement in school or training were also compiled. Results. Most respondents who reported cannabis use at baseline again reported use at follow up. A history of petrol sniffing predicted later heavy cannabis use (P < 0.05). Trends were evident for men to have persisting cannabis use, and for employment and/or engagement in school or training to be associated with cannabis cessation. Discussion and Conclusions. Ongoing heavy cannabis use is commonplace in this Aboriginal cohort and raises concerns for the physical, social and psychiatric burden on these already vulnerable communities. Prevention, treatment and intervention programs developed with communities are badly needed.[Lee KSK, Conigrave KM, Clough AR, Dobbins TA, Jaragba MJ, Patton GC. Five-year longitudinal study of cannabis users in three remote Aboriginal communities in Arnhem Land, Northern Territory, Australia. Drug Alcohol Rev 2009] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Diversion from court and prison has been recommended for Indigenous Australian youth who commit offences. As no evaluations of such programmes have been published, we describe processes and early outcomes of a diversion programme in the Northern Territory. Design and Methods. From 2003 to 2006, among 1700 remote Indigenous community residents, 35 young people (aged 11-18 years, median 15 years) committed offences. They were diverted from criminal justice and referred to a community-based diversion initiative. Client assessment records and staff interviews furnished data to examine clients' diversion pathways and early programme results. Results. Eighteen clients were reportedly using a substance at the time of their offence; cannabis (n = 9), petrol (n = 5), alcohol (n = 4). The remaining 17 had histories of using one or more of these. Two clients could not complete local diversion programs because they moved to other regions; one case was not pursued for legal reasons, leaving 32 clients exposed to the local programme. By July 2006, four clients were continuing in their programmes, three had breached them, but 25 had completed them in periods ranging from 2 to 60 weeks (median = 26 weeks), a completion rate of 89% (25/28). Just one client re-offended after completing diversion. Discussion and Conclusions. A high completion rate was achieved despite: a dearth of locally available drug and alcohol treatment services and diversion options; shifts in police approaches; heavy administrative burdens to meet legal requirements; and difficulties communicating across cultural barriers. [Clough AR, Lee KK San, Conigrave, KM. Promising performance of a juvenile justice diversion programme in remote Aboriginal communities, Northern Territory, Australia. Drug Alcohol Rev 2008;27:433 - 438] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Substance misuse among Aboriginal Australians is both a symptom of disadvantage and suffering but also a cause of health and social problems. Few data are available on how mainstream drug and alcohol services meet the needs of Aboriginal Australians. We assessed acceptability and accessibility of mainstream services for Aboriginal Australians with alcohol or drug use disorders in an urban Area Health Service (AHS). We identified priorities for improvement and an implementation plan. Methods. We collected feedback via consultation with client groups, with the Aboriginal community and community organisations, with staff of the AHS and of the local Aboriginal Medical Service (AMS) and through direct observation. We examined attendance data. Results. Aboriginal people were well represented in this mainstream service, partly because of existing collaboration with the AMS. Good points in the service were reported to be priority appointments for new Aboriginal clients, professional and caring service and collaboration with the AMS. Suggested improvements included increased cultural sensitivity of communication, more appropriate physical surrounds and printed materials, having Aboriginal staff available, peer support groups and integration of health care for individual, family and community. The action plan included increased recruitment and career opportunities for Aboriginal staff, strengthened partnerships with the Aboriginal community, including ongoing collaboration with the AMS in improving and monitoring mainstream service quality. Discussion and Conclusions. Given the adverse impact of substance use disorders, there is a pressing need for services to work with Aboriginal communities to optimise the quality of mainstream treatment services. [Teasdale KE, Conigrave KM, Kiel KA, Freeburn B, Long G, Becker K. Improving services for prevention and treatment of substance misuse for Aboriginal communities in a Sydney Area Health Service. Drug Alcohol Rev 2008; 27:152-159] [ABSTRACT FROM AUTHOR]

Introduction and Aims. We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. Design and Methods. Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. Results. Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. Discussion and Conclusions. Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use. [Lee KSK, Conigrave KM, Clough AR, Wallace C, Silins E, Rawles J. Evaluation of a community-driven preventive youth initiative in Arnhem Land, Northern Territory, Australia. Drug Alcohol Rev 2008;27:75 - 82] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Recidivist drink drivers pose a considerable threat to public safety. The present study evaluates the effectiveness of a remedial programme for recidivist drink drivers, the New South Wales Sober Driver Programme (SDP). SDP combines educational components and elements of group cognitive behavioural therapy in relation to drink driving behaviour. It is delivered in conjunction with punitive sanctions. Design and Methods. The evaluation design included a comparison of recidivism rates over 2 years for SDP participants and a community control group of convicted drink drivers who received legal sanctions alone. Quantitative and qualitative surveys of SDP participants were also conducted before, immediately after and 4 months after the programme. Outcome measures included recidivism, change in participant knowledge and attitudes, self-reported behavioural intentions and skill development. Results. SDP participants were 43% less likely to re-offend over 2 years compared with community controls who had received sanctions alone. Survey respondents demonstrated improved knowledge, attitudes and skills regarding drink driving. Discussion and Conclusions. SDP appears to be an effective intervention, demonstrating greater reductions in recidivism when compared with legal sanctions alone. [Mills KL, Hodge W, Johansson K, Conigrave KM. An outcome evaluation of the New South Wales Sober Driver Programme: a remedial programme for recidivist drink drivers. Drug Alcohol Rev 2008;27:65 - 74] [ABSTRACT FROM AUTHOR]

Introduction and Aims. The study examines risk behaviours of the users of syringe dispensing machines (SDMs) and evaluates the usefulness of these machines in providing injecting drug users (IDUs) with sterile injecting equipment. Design and Methods. Self-administered questionnaires were used among users of SDMs in an Area Health Service of Sydney. Results. The majority of the 167 participants reported being happy with the quality of the SDM services. Problems identified with machines were that they were often broken or jammed (32.8% respondents), not in the right place (21.9%) or require money (16.7%). Just over half (50.9%) of the IDUs use SDMs only from 5 p.m. to 9 a.m., the time when almost all other outlets for accessing sterile injecting equipment remain closed. Relatively young IDUs (age ≤ 30 years) were more likely to prefer SDMs over staffed needle syringe programmes (NSPs) compared with older users (age > 30) and to identify stigma (a desire to hide their identity or not liking the way people treat them at staffed NSPs or chemists) as a main reason for using these machines. Primary users of SDMs do not differ from primary users of NSP/chemists in terms of sharing of needles. Those users who had shared in the last month were nearly four times as likely to have never used condoms in sexual encounters over that period (95% confidence interval: 1.2 - 14.5). Discussion and Conclusion. SDMs appear to complement other outlets of NSPs. Providing free-of-cost equipment from SDMs should be considered carefully, as needing money to buy equipment was a reason given for sharing of needles by 35% of those who shared. [Islam MM, Stern T, Conigrave KM, Wodak A. Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot study. Drug Alcohol Rev 2008;27:13 - 19] [ABSTRACT FROM AUTHOR]

The aim of this study was to examine trends in HIV and related risk behaviours in drug users in Bangladesh, the effects of prevention and harm reduction initiatives that have already been undertaken and to highlight immediate needs. Journal publications, conference abstracts and proceedings were collected and reviewed. As there were relatively few published papers, the grey literature was also reviewed. Experts involved in the development and evaluation of current programmes or policy were contacted for official reports, policy documents or unpublished materials. The trends in injecting and sexual risk behaviours were tabulated. Periodic behavioural and serosurveillance on recognised sentinel groups shows clearly that HIV prevalence among injecting drug users has been increasing steadily. In the capital city, the HIV prevalence among injecting drug users is close to the level of a concentrated epidemic (4.9%). While harm reduction strategies have brought a scope of reduction of injecting-related risk behaviours, the persistent high rates of needle sharing and high prevalence of sexual risk behaviours remains alarming. Non-injecting drug users have maintained a low prevalence of HIV but their high-risk sexual behaviours and transformation into injecting drug users with time are of concern. There are substantial gaps between current needs and the ongoing prevention and harm reduction activities. There is a pressing need for a comprehensive harm reduction programme and review of any policies and laws which may impede this. [Islam MM, Conigrave KM. Increasing prevalence of HIV, and persistent high-risk behaviours among drug users in Bangladesh: need for a comprehensive harm reduction programme. Drug Alcohol Rev 2007;26:445-454] [ABSTRACT FROM AUTHOR]

Amongst people on opioid maintenance treatment (OMT), chronic hepatitis C (HCV) is common but infrequently treated. Numerous barriers, including misuse of alcohol may limit efforts at anti-viral treatment. The aim of this study was to define barriers, including alcohol misuse, to the effective treatment of HCV amongst OMT recipients. Ninety-four OMT patients completed the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). A semi-structured interview was used in 53 subjects to assess alcohol use in detail, psychological health, discrimination and access to HCV treatment. Feasibility of brief intervention for alcohol misuse was assessed. Of the screening participants, 73% reported they were HCV positive. Of the detailed interview participants, 26% reported no drinking in the past month, but 53% scored 8 or more on AUDIT and 42% exceeded NHMRC drinking guidelines. Twenty subjects received brief intervention and among 17 re-interviewed at one month, alcohol consumption fell by 3.1 g/day (p = 0.003). Severe or extremely severe depression, stress and anxiety were found in 57%, 51% and 40% of interviewees respectively. Episodic heavy drinking, mental health problems, perceived discrimination, limited knowledge concerning HCV were all common and uptake of HCV treatment was poor. Brief intervention for alcohol use problems was acceptable to OMT patients, and warrants further study. [Watson B, Conigrave KM, Wallace C, Whitfield JB, Wurst F, Haber PS. Hazardous alcohol consumption and other barriers to antiviral treatment among hepatitis C positive people receiving opioid maintenance treatment. Drug Alcohol Rev 2007;26:] [ABSTRACT FROM AUTHOR]

Early detection and intervention for alcohol problems have been shown to reduce subsequent health consequences. However, the extent to which these practices have been implemented is unclear. The study assessed among hospital in-patients (1) the prevalence of at-risk drinking and smoking, (2) current practice in detection and intervention for at-risk drinking and smoking and (3) self-reported effect of any intervention. A brief self-administered questionnaire was administered to adult in-patients addressing alcohol use [Alcohol Use Disorders Identification Test (AUDIT) questionnaire], smoking and self-reported effect of any recent intervention for drinking or smoking. The participant's smoking status and alcohol use as recorded by medical and nursing staff was compared to self-reports. Of 448 in-patients, 50% (226) participated in the study; 38% (170) were ineligible and 12% (52) refused. Participants were aged 61.3 (±18.9) years. A higher number of problem drinkers (11.9% vs. 3.5%, p < 0.0001) and current smokers (17.3% vs. 9.3%, p < 0.0001) were identified by the questionnaire compared to the medical records. Hospital staff quantified smoking more consistently than alcohol (54% vs. 42%, p = 0.02). Of those who recalled an intervention, 19% of drinkers and 27% of smokers said they had stopped drinking or smoking for a period since that intervention. Further improvement is required in the rates of detection and interventions for alcohol use disorders and smoking in the hospital setting. [Shourie S, Conigrave KM, Proude EM, Haber PS. Detection of and intervention for excessive alcohol and tobacco use among adult hospital in-patients. Drug Alcohol Rev 2007;26:127 – 133] [ABSTRACT FROM AUTHOR]

Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation. [Shourie S, Conigrave KM, Proude EM, Ward JE, Wutzke SE, Haber PS. Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery. Drug Alcohol Rev 2007;26:119 – 125] [ABSTRACT FROM AUTHOR]

Negative attitudes to patients with substance misuse disorders form a well-recognised barrier to the implementation of best practice. The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers was investigated at an Australian university. First-year students were surveyed before and after 3 weeks of drug and alcohol education and in the same year, fourth-year students were surveyed before and after a 9-week block. Males, older students and those with prior clinical experience tended to have more negative attitudes. Attitudes improved significantly after exposure to interactive learning modules which included contact with patients with substance dependence, including individuals in remission. The level of dislike of problem drinkers significantly decreased after teaching. After fourth-year education, students reported a greater sense of responsibility towards providing intervention and less anticipation of discomfort working with these patients. In particular, confidence and attitudes towards heroin users improved near the end of training after contact with illicit drug users in the small group or individual interview setting. By the end of drug and alcohol education, less than half (42%) of students reported they could not imagine working with substance misusers as a career. Findings support the provision of structured drug and alcohol education and supported clinical experience for every medical student if appropriate evidence-based treatment is to be provided. [Silins E, Conigrave KM, Rakvin C, Dobbins T, Curry K. The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers. Drug Alcohol Rev 2007;26:191 – 200] [ABSTRACT FROM AUTHOR]

The Alcohol Use Disorders Identification Test (AUDIT) has been used widely and is reported to be superior to conventional questionnaires in detection of current hazardous and harmful alcohol use. We assessed the validity of an Australian modification of the AUDIT (the AusAUDIT), which has been employed widely in Australian and New Zealand early intervention programmes. We used a cross-sectional study of 370 subjects from the follow-up phase of a randomized controlled trial of early intervention to reduce hazardous alcohol consumption. Scores on the AusAUDIT were compared against 12-month ICD-10 diagnoses of harmful alcohol use and dependence, as determined by the Composite International Diagnostic Interview, and against self-report of alcohol consumption exceeding Australian National Health and Medical Research Council (NH&MRC) recommended limits. AusAUDIT had good internal consistency and discriminated significantly between persons meeting criteria for ICD-10 alcohol use disorders, and drinkers who did not. At currently recommended cut-off scores, AusAUDIT detected more than 85% of people meeting criteria for ICD-10 alcohol use disorders, or drinking over NH&MRC recommended limits, but its specificity was limited (29% in men, and 58% in women for drinking over NH&MRC limits). No subset of questions performed as well as the full AusAUDIT in detection of drinking problems, but the alcohol consumption items provided a reasonable screen for drinking over NH&MRC limits. We conclude that AusAUDIT is effective in detecting problematic drinking, but positive cases should be confirmed by clinical assessment. The findings illustrate the need for validation of questionnaire modifications, and the difficulty in increasing test sensitivity without reducing specificity. \[Degenhardt LJ, Conigrave KM, Wutzke SE, Saunders JB. The validity of an Australian modification of the AUDIT questionnaire. Drug Alcohol Rev 2001;20:143-154]. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusion The Grog Survey App is a validated, visual and interactive self‐administered application for tablet computers that is designed to help Aboriginal Australians describe their alcohol consumption. Each person who completes the App also receives a brief intervention with feedback tailored to their survey responses. We aimed to qualitatively assess the acceptability and perceived quality of the Grog App's brief intervention, among higher risk consumers and health providers at an Aboriginal residential rehabilitation centre.This descriptive qualitative study analysed feedback from clients (n = 20) and staff (n = 10) of a drug and alcohol residential rehabilitation service on the brief intervention element of the Grog App. Data were collected face‐to‐face via semi‐structured interviews over four consecutive weeks between May and June 2021. A content analysis was conducted, which was informed by the Mobile App Rating Scale (MARS).Client and staff feedback is summarised using four themes from the MARS framework: (i) aesthetics; (ii) engagement; (iii) functionality; and (iv) information. Most clients and staff felt like health messages on the brief intervention were written by ‘someone who understands’. Overall, clients and staff described the brief intervention as visually appealing, engaging and likely able to elicit ‘lightbulb moments’.The brief intervention on the Grog App is unique in its provision of tailored advice based on survey responses to all individuals (i.e., those who do not drink through to those with likely dependence). Further research is needed to assess effectiveness of this brief intervention. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the significance of continuing health care for injecting drug users (IDUs) involving the needle syringe programs (NSPS).

Fetal alcohol spectrum disorder (FASD) is a lifelong disability of varying severity that occurs among individuals prenatally exposed to alcohol. Among Aboriginal and Torres Strait Islander (Indigenous) Australians, the effects of colonisation and ongoing racism could increase the risk of alcohol consumption during pregnancy. Much of the research and the effort towards prevention of and caring for people with FASD in Indigenous communities has been targeted towards women and children. More support and effort towards prevention of FASD is needed across the whole Indigenous community. In this paper, we discuss several areas for increased involvement by Indigenous men in future FASD research, prevention, care and support. [ABSTRACT FROM AUTHOR]