Alcohol dependence and post-traumatic stress disorder (PTSD) among Aboriginals and Torres Strait Islanders in Australia: a systematic literature review

Alcohol dependence and post-traumatic stress disorder (PTSD) among Aboriginals and Torres Strait Islanders in Australia: a systematic literature review
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Abstract
The Aboriginals and Torres Strait Islanders in Australia represents hundreds of indigenous communities in Australia. It is critical to comprehend that members from these communities face numerous challenges which include marginalization, high poverty levels and lack of access to good healthcare services. Cases of alcohol use are high among individuals from the indigenous communities; both Aboriginals and Torres Strait Islanders in Australia use alcohol as a medication to manage stress and anxiety. Extensive use of alcohol facilitates different forms of assaults and other traumatic experiences that contribute to post-traumatic stress disorder (PSDT). Besides, individuals with PTSD are more likely to misuse different substances, including alcohol.
The research utilizes a systematic literature review method where peer-reviewed articles were selected from different databases, including PubMed, Medline, ERIC and EBSCO. The keywords used during the article selection included ‘Aboriginals,’ ‘Torres Strait Islanders,’ ‘alcohol dependence,’ ‘alcohol use disorder’ and ‘post-traumatic stress disorder.’ The research findings indicated that nearly 61.8% of the indigenous communities in Australia are unemployed, and most of the individuals from these communities did not extend their education beyond year 10. Lack of education effect assesses education, better housing and good healthcare. Additionally, 38% of men and about 86% of women from the indigenous communities have faced mental health disorders in the last twelve months. Besides, 66% of Aboriginals and Torres Strait Islanders have substance misuse disorder, and approximately 25% have been diagnosed with depression. The exposure to various types of stressors have contributed to high alcohol consumption, and alcohol use facilitates other stressors that contribute to PTSD.
Keywords: Aboriginals, Torres Strait Islanders, alcohol dependence, alcohol use disorder and PTSD
Background/Introduction
It can be argued that there is an intricate connection between substance abuse and mental illness because addicted individuals are at a high risk of suffering from different mental conditions. Additionally, the treatment of persons with alcohol use disorder (AUD) may be complicated because of various psychiatric conditions, including post-traumatic stress disorder (PTSD). There are other possible causes of PTSD; these may include accidents and physical or sexual assault. This is undoubtedly true because individuals with substance use problems are at a high risk of developing systematic symptoms, which may include constant changes in moods and would also result in alterations in arousal and reactivity (Petrakis & Simpson, 2017). Moreover, persons with mental health disorders such as PTSD are at a high risk of misusing different types of substances such as alcohol. Carter, Capone & Short (2011) explain that the post-traumatic stress disorder and alcohol use often co-occur and that having PTSD or AUD increases the possibilities of experiencing the other. Therefore, this research is essential in gaining insights about the mental health status of the Aboriginals and Torres Strait Islanders in Australia; this is fundamental because it may influence the policy changes to ensure that adequate health policies are implemented to help people from these communities.
The key players in this research are the indigenous Australian communities, Aboriginals and Torres Strait Islanders. These communities are regarded as the traditional owners of the land, and the archaeological evidence shows that they are among the oldest continuous civilization on earth. Besides, people from these communities were among the first humans who migrated out of Africa through the coastlines of India and Asia until they reached the shores of Australia. The focus on these two groups will be instrumental in determining the health care initiatives that should be implemented to protect and promote the right mental health condition among indigenous Australian communities. There are different factors that are likely to influence the study about the focus groups; these include lack of cultural competences because of different communities that their unique and cultural practices that may be unknown to the researcher. In this case, it may be challenging to determine how the desire to keep the cultural distinctiveness facilitate health risk behaviours. The researcher is needed to be aware of the factors beyond one’s control, such as social disruptions among the aboriginal communities may facilitate health risk behaviours such as alcohol abuse. Further, the stress associated with daily life among the Aboriginals and Torres Strait Islanders in Australia would also promote PTSD and other unhealthy behavioural practices such as alcohol dependence.
In order to acquire knowledge about how social challenges and other cultural factors among the Aboriginals and Torres Strait Islanders facilitate alcohol dependence and post-traumatic stress disorder, the research project will highlight research aims and objectives that guided the researcher throughout the study. Besides, the researcher carried out a literature review to determine what other researchers have asserted about the research matter. The literature review was undertaken by examining current, credible and relevant resources and was instrumental in determining existing research gaps that the current research would fill. The methodology section highlights the approaches the researcher used in collecting, storing and analyzing data gathered from the different sources to acquire insights about AUD and PTSD among the aboriginal communities. The results section will indicate the findings of the research, and the discussion will interpret the describe the significance of the research findings. The conclusion and recommendation sections will summarize the objective of the research and give suggestions about the development of future research.
It is critical to comprehend that AUD is associated with stress that can promote PTSD. This is possible since there is a direct relationship between heavy drinking and other mental health issues such as anxiety and PTSD, among others. Additionally, people are exposed to high levels of stress may also suffer from post-traumatic stress condition and may drink alcohol as a strategy for managing their symptoms (Neupane, Bramness & Lien, 2017). It is argued that Aboriginal and Torres Strait Islander people in Australia are more likely to exposed to different kinds of stressors that would easily influence their mental wellbeing and increase their risk of AUD and PTSD. The unfavourable social and health factors have played a significant impact on shortening the life expectancy of the aboriginal communities (Markwick et al., 2014). Furthermore, the Aboriginal and Torres Strait Islander people in Australia live in remote areas across the country that experience food shortage and the people face other challenges such as high poverty levels, unemployment, and lack of quality health facilities (Davy, 2016). The exposure to these stressors increases the risk of the minority groups to misuse alcohol and develop PTSD.
Aims and Objectives
Research Aims
1 To evaluate the impact of alcohol dependence and post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia giving rise to PTSD
2 Identifying the factors leading to PTSD among Aboriginals and Torres Strait Islanders in Australia.
Research objectives
1 To assess the factors that contribute to alcohol abuse and post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia.
2 To determine the preparedness of health facilities to respond to issues related to substance abuse and mental health challenges among the minority groups in Australia.
3 To suggest ways that would be evaluated to minimise the risk of mental health in the target population
The research will be critical in evaluating and examining essential issues associated with the extent of alcohol dependence and post-traumatic stress disorder among Aboriginals and Torres Strait Islanders in Australia. The research will identify and evaluate the stressors that increase the risk of the target populations to develop alcohol abuse disorder (AUD) and PTSD. These findings will be critical in the country’s public health systems because it outlines intervention measures that should be implemented to reduce cases of mental health among the indigenous communities across the country. Most importantly, the research will highlight some of the best intervention that would be utilized in helping individuals with alcohol dependence problems and post-traumatic stress disorder.
Literature review
High-risk alcohol consumption has increased among the Aboriginals and Torres Strait Islanders people in Australia. It is keynoting that the indigenous people across rural and remote parts in Australia face serious health issues that are facilitated by risky behaviours such as alcohol dependence and alcohol-related violence. According to Ramamoorthi, Jayaraj, Notaras & Thomas (2015), indigenous communities in Australia constitute about 2.5 per cent of the entire population. By 2008, it was estimated that about seventeen per cent of people from the indigenous communities aged fifteen years and older were involved in risky alcohol consumption behaviours. It is important to note that the problem of alcohol consumption among the Aboriginals and Torres Strait Islanders can be associated with symptoms associated with social phobia (Ramamoorthi, Jayaraj, Notaras & Thomas, 2015). People from these communities are often faced with numerous social fears when interacting with non-indigenous people. Therefore, indigenous communities may use alcohol to help them cope with societal fear and anxiety. Besides, alcohol use is considered as self-medication method for reducing stress among the indigenous communities (Australian Institute of Health and Welfare, 2020). Additionally, (Australian Institute of Health and Welfare (2020), maintains that the number of indigenous people who consume more than two standards drinks per day significantly increased in 2019 from 2015.
Lack of effective process to help people manage and deal with social problems such as stresses also increases the possibilities of the indigenous communities in Australia to use certain substances such as alcohol to help manage fear and anxiety faced when socializing with non-indigenous communities. In this case, the Aboriginals and Torres Strait Islanders use alcohol as a self-medicating to manage and control stress (Turner, Bolton, Mota & Sareen, 2018). However, the use of alcohol to manage other health problem may have undesirable implications. Lazareck et al. (2012) explain that using alcohol and other drugs as a self-medicating technique would result in alcohol dependence and alcohol-related violence that can facilitate mental conditions such as post-traumatic stress disorder. In this case, the indigenous communities in Australia who use alcohol as a method of managing other mental issues may increase the risk of being diagnosed with post-traumatic stress disorder, drug use dependence and other mental health problems.
Ramamoorthi, Jayaraj, Notaras & Thomas (2015) also maintain that poverty is also a critical problem that affects Aboriginals and Torres Strait Islanders. It is essential to comprehend that there is a link between poverty, PTSD and binge drinking. Substance use and mental health problems are associated with difficulties in accessing employment, obtaining education and challenges in accessing proper housing. The social issues create a cycle of poverty that worsen the situation of the indigenous people in Australia. According to the Australian Institute of Health and Welfare (2019), indigenous people in Australia are 1.9 times likely not to get employment as compared to non-indigenous communities. It is keynoting that lack of jobs among Aboriginal and Torres Strait Islander Australians makes it difficult for people from these communities to access other personal and social benefits. Some of the disadvantages that the indigenous communities are likely to face as a result of high unemployment include lack of access to basic social necessities such as quality healthcare. The salaries and wages received by people from indigenous communities may not be enough for meeting housing needs. The challenges encountered by Aboriginal and Torres Strait Islander Australians facilitate high alcohol abuse, violence and homelessness. These factors play a considerable role in increasing the prevalence of mental health challenges such as post-traumatic stress disorder among the indigenous communities.
Heffernan, Andersen, Davidson & Kinner (2015) assert that although there are no reliable data to show the prevalence of PTSD among Aboriginals and Torres Strait Islanders in Australia. The numbers of individuals from these communities who have experienced PTSD would be extremely high because the Aboriginal and Torres Strait Islander people have recorded high numbers of psychological distress. Similar arguments are reported by Jorm, Bourchier, Cvetkovski & Stewart (2012) who maintain that anxiety and depression are 2-3 times more among the indigenous communities in Australia than for non-indigenous communities. There are various factors that contributed to these differences in mental health between indigenous and non-indigenous communities in Australia; these factors may include physical inactivity, tobacco use and alcohol misuse (Jorm, Bourchier, Cvetkovski & Stewart, 2012). Further, Heffernan, Andersen, Davidson & Kinner (2015) emphasize that PTSD among the Aboriginal and Torres Strait Islander Australians would be highly linked to traumatic experiences that include torture by the state, discriminative policies and practices and socioeconomic discrimination. (Heffernan, Dev, Andersen &, Kinner (2012) explain that the rate of hospitalization for mental health care among the indigenous communities in Australia is high. Additionally, in a study by Heffernan, Dev, Andersen &, Kinner (2012) it was found that 72.8 per cent and 86.1 per cent of men and women respectively had been diagnosed with at least one mental health condition in the preceding twelve months. Furthermore, the overrepresentation of the indigenous communities in Australian custody, as well as the complex interaction of trauma and other mental illnesses justify the nature of trauma and other mental conditions such as PTSD among Aboriginals and Torres Strait Islanders in Australia.
It is critical to comprehend that developing an enhanced understanding of post-traumatic stress disorders among the indigenous communities in Australia may help in developing practical and appropriate mental health interventions that would protect individuals vulnerable from alcohol abuse and mental health conditions such as PTSD. (Heffernan, Dev, Andersen &, Kinner (2012) emphasize that the cultural differences and experiences among the Aboriginals and Torres Strait Islanders in Australia places members from these communities. The aboriginal communities are also more likely to report rape, sexual assault and kidnapping, among other traumatic experiences that can cause long-term mental conditions.
Jayaraj et al. (2012) explain that alcohol is among the causes of self-harm and suicide in Australia. Cases of self-inflicted injuries are high among the youths and the number of deaths among youth aged 15-24 have increased in Aboriginal and Torres Strait Islander communities. Additionally, alcohol use problem has also been associated with the high cases of road injuries, family conflicts and domestic violence among the members from the aboriginal communities. Between 2009 and 2010, there were approximately 6678 cases of assault in Australia and nearly sixty per cent were related to alcohol consumption (Jayaraj et al., 2012). Cases of assault among the Aboriginal and Torres Strait Islander people are perpetrated by drunken husbands and other members of the family. Alcohol has also increased cases of injuries such as facial fractures among the Aboriginal and Torres Strait Islander. This information shows the support that alcohol consumption is one of the significant factors that has affected the aboriginal communities in Australia and that this has affected the mental health of people from these communities. However, the existing literature has not highlighted how the health systems in the country are prepared to deal with an alcohol use problem and manage post-traumatic stress disorder among people from these communities.
Menzies (2019) explains that the problem of alcohol consumption and misuse of other drugs are well documented among the Aboriginal and Torres Strait Islander people in Australia. Additionally, the social and mental consequences of these drugs have also been highlighted, and researchers have determined that alcohol misuse facilitate alcoholic hallucinations, anxiety, depression and PTSD, among other disorders. There are, however, studies that evaluate the information about policies that have been set in place to deal with the existing problems in the aboriginal communities to safeguard and protect the vulnerable members of the communities such as youth, children and women who are more likely to be abused by alcohol and other drug users. Gray, Saggers, Sputore & Bourbon (2000), highlight that treatment is one of the common interventions that has been adopted to help individuals struggling with various types of alcohol related-problems. This approach has been affected by different issues, including continued bias. Counselling services have also been made available to residential and community levels, and this has made it possible to promote abstinence. Additionally, the use of such practical approaches has been determined to critical in giving a time out to people with alcohol use problem, and this helps them to stop taking alcohol and also improve their health status (Gray, Saggers, Sputore & Bourbon, 2000). There is a need for evaluating appropriate health promotion programs that should be developed and implemented to make it possible to manage and reduce alcohol consumption among members from the aboriginal communities in Australia.
Aboriginal and Torres Strait Islander Australians are at high risk of developing Post-traumatic stress disorder because they have been exposed to numerous extremely traumatic events that ten to facilitate anxiety, flashback and hopelessness (Dikmen-Yildiz, Ayers, & Phillips, 2018). The events are exhibited by the inability of the aboriginal communities in Australia to access necessities and other essential services which may include health care, fair services from the criminal justice system and homelessness (Menzies, 2019). PTSD is also high among Aboriginal and Torres Strait Islander people in different prisons across Australia. The high poverty levels have resulted in an increase of various crimes, and this has led to a rise in the rate of imprisonment. Heffernan, Andersen, Davidson & Kinner (2015) explain that the high cases of PTSD among indigenous Australians in prisons are associated with co-occurring mental conditions, substance use disorder and suicidal thoughts (Dudgeon, Calma, Holland, 2017). The ability of the community and country to manage alcohol use, misuse of substances and preventing PTSD among the Aboriginals and Torres Strait Islanders in Australia is ...