Rates of serious injury requiring aeromedical retrieval by the Royal Flying Doctor Service (RFDS) are at their lowest recorded level in four remote Queensland Indigenous communities, according to research published in the Medical Journal of Australia. These low injury rates have occurred after government restrictions on access to alcohol in these communities.

An alcohol supply-reduction strategy (SRS) was introduced in 2002-2003 in remote Indigenous communities in Queensland. After the success of this strategy, a second SRS was introduced in 2008 with even tighter alcohol restrictions, ranging from limited access to total prohibition, across in all 19 discrete Indigenous communities in Queensland.

Associate Professor Stephen Margolis at the Education and Research Unit for the RFDS in Cairns and co-authors documented the changes in rates of serious injuries after the second SRS in four of the communities.

"After the second SRS in these four Indigenous communities, there were substantial, significant and consistent decreases in serious-injury rates by 53 per cent to historically low levels, and coincidental decreases in the proportions of serious injuries in all retrievals," Prof Margolis said. "The overall rate of serious injury has dropped by 78 per cent since 2002."

Prof Margolis acknowledges that his study has limitations, and that, without measuring blood- alcohol levels, he cannot confirm that the alcohol restrictions are the reason for the lower serious- injury rates. He also points out the complexity of strategies to minimise substance related harm and that SRS is one strategy within a comprehensive approach.

In an accompanying comment, Professor Peter d'Abbs, from the Menzies School of Health Research, Darwin, said alcohol restrictions have an important place in any strategic approach to preventing and managing alcohol problems in Indigenous communities.

"Such strategies, however, raise at least two further questions. First, what processes will do most to ensure that the restrictions genuinely enhance community capacity to manage alcohol, and second, what additional measures, apart from supply reduction, are required?" Prof d'Abbs said.

Dennis Gray, Professor of Medical Anthropology for the National Drug Research Institute at the Curtin University of Technology, Perth, and colleague, Associate Professor Edward Wilkes, who is Chair of the National Indigenous Drug and Alcohol Committee, also provided a comment on the study. While acknowledging that restrictions on alcohol supply have been shown to be effective in reducing alcohol-related harm, they were adamant that such restrictions should not be imposed without the full involvement of Indigenous communities.

"In towns where Aboriginal and non-Aboriginal leaders have worked together, alcohol restrictions have proved beneficial. Blanket bans such as those imposed on remote communities under the Northern Territory Emergency Response are counterproductive," Prof Gray said.

"They take away Indigenous initiative, leading to resentment and exacerbation of existing social problems, both of which undermine willingness to work cooperatively with outsiders to address such problems."

"Indigenous Australians need support to control their own way out of poverty - including addressing harmful alcohol and other drug use, which are consequences of that poverty."

The Medical Journal of Australia