The Northern Territory's Alcohol Mandatory Treatment Act 2013 (AMT Act), which permits mandatory residential alcohol rehabilitation for up to 3 months, has little evidence to justify it, is not cost-effective, and may discriminate against Aboriginal and Torres Strait Islander peoples, according to the authors of an Ethics and Law article published in the Medical Journal of Australia.

The Northern Territory has per capita alcohol consumption levels about 50% higher than the Australian average, and alcohol-attributable deaths at 3.5 times the national rate.

The AMT Act was introduced to combat this problem.

Dr Fiona Lander from the Harvard T.H. Chan School of Public Health in Boston, USA, and Professor Dennis Gray and Associate Professor Edward Wilkes from the National Drug Research Institute at Perth's Curtin University, wrote that there was "little evidence of the scheme's efficacy".

Additionally, "the NT Government could adopt more cost-effective alternatives that would not involve the dubious application of a medical intervention to reduce public intoxication, with its concomitant legal and ethical issues". The AMT program costs around $27 million annually.

Although some changes had been made to the AMT Act since its introduction - notably that criminal sanctions for absconding from treatment had been removed - there were still aspects of the Act that should concern the medical community, the authors observed.

"Concerns remain regarding the lack of evaluation of the program; the use of what is ostensibly a medical intervention to target a social problem; opacity around tribunal proceedings; the potentially discriminatory application of the scheme to Aboriginal people; and the scheme's questionable cost-effectiveness", they wrote.

It was "disturbing" that the scheme targets "chronic drinkers who are publicly intoxicated" and not all problem drinkers.

"Homeless or itinerant individuals are much more likely to fall foul of the scheme.

"Homelessness rates among Indigenous Australians are up to four times higher than those of non- Indigenous Australians, and the practice among them of staying in the 'long grass' (living rough) has been well documented.

"When read together with research confirming high rates of alcohol usage among homeless and itinerant Aboriginal people, it is unsurprising they are more likely to be referred through the scheme than non-Aboriginal citizens."

The authors suggested there were more cost-effective methods of reducing alcohol misuse in the NT, such as restrictions on alcohol pricing and hours and days of sale for licensed premises, and capacity-building among primary health care organisations to manage alcohol dependence.

"Implementation of any or all of these interventions using the significant funding allocated to the AMT scheme could see enormous benefits flow to the NT population more broadly, rather than providing for the temporary and likely ineffective compulsory treatment of a small number of people", the authors concluded.