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Article << Previous     |     Next >>   Contents Vol 16(4)

Engaging primary health care workers in drug and alcohol and mental health interventions: challenges for service delivery in rural and remote Australia

Julaine Allan

Research and Training Program, Lyndon Community, Orange NSW, Australia. Email: jallan@lyndoncommunity.org.au

Australian Journal of Primary Health 16(4) 311-318 http://dx.doi.org/10.1071/PY10015
Submitted: 12 May 2010  Accepted: 9 September 2010   Published: 3 December 2010

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Access to drug and alcohol treatment services is a particularly salient issue for Australia. The nation is paying considerable attention to risky drug and alcohol use. Indigenous Australians are particularly concerned about drug and alcohol related harms in their communities. Access to treatment is the most effective way of reducing drug related harm for disadvantaged populations. Primary health care is the optimal site for delivering drug and alcohol treatment. Semi-structured in-depth interviews with 47 primary health care, drug and alcohol and other health and welfare workers in rural and remote locations were conducted. Thematic analysis of interview data identified divergent perspectives according to a participant’s work role about drug and alcohol treatment, client needs and problems and service delivery approaches. Primary health care workers were conceptualised as locals. They tended to perceive that drug and alcohol interventions should quickly prevent individuals from on-going problematic use. Drug and alcohol workers were conceptualised as insiders. Most did not have knowledge or experience of the primary health care setting. Therefore they could not assist primary health care workers to integrate drug and alcohol interventions into their interactions with clients. Professional and organisational barriers constrain the primary health care worker role and limit the application of specialist interventions. Drug and alcohol work is only one of many competing demands in the primary health setting. The lack of understanding of the primary health care worker role and responsibilities is the most significant barrier to implementing specialist interventions in this role. Primary health care workers’ perceptions of substance misuse are more consistent with the individual moral or personal deficit philosophy of drug and alcohol treatment than harm minimisation approaches. This is a challenge for a specialist agency that is promoting harm minimisation and an adaptive approach to treatment within the primary care setting. Building the capacity of primary health care workers to do more varied tasks requires a good understanding of the pragmatic and practical realities of their day to day practice and the philosophies that underpin these.

Additional keywords: Aboriginal primary health care, drug and alcohol interventions, rural and remote Australia.


ABS, AIHW (2008) ‘The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples.’ (Commonwealth of Australia: Canberra)

Allan J, Ball P, Alston M (2007) Developing sustainable models of rural health care: a community development approach. Rural and Remote Health 7, 818. http://www.rrh.org.au/publishedarticles/article_print_818.pdf

Australian Institute of Health and Welfare (2003) ‘Statistics on drug use in Australia 2002.’Cat. No. PHE 43. (AIHW, Canberra)

Battye K (2007) ‘Murdi Paaki Community Consultations: findings and recommendations .’ (Consultant’s Report to Commonwealth Department of Health and Aging: Canberra)

Brady M (2007) Equality and difference: persisting historical themes in health and alcohol policies affecting Indigenous Australians. Journal of Epidemiology and Community Health 61, 759–763.
CrossRef | PubMed |

Foley S, Valenzuela A (2005) Critical ethnography: the politics of collaboration. In ‘The Sage handbook of qualitative research’. 3rd edn. (Eds N Denzin, Y Lincoln) pp. 217–234. (Sage: Thousand Oaks, CA)

Genat B (2006) ‘Aboriginal Health Workers: primary health care at the margins .’ (UWA Press: Perth)

Goddard P (2003) Changing attitudes towards harm reduction among treatment professionals: A report from the American Midwest. The International Journal on Drug Policy 14, 257–260.
CrossRef |

Gray D, Saggers S, Sputore B, Bourbon D (2000) What works? A review of evaluated alcohol misuse interventions among Aboriginal Australians. Addiction 95, 11–22.
CrossRef | PubMed |

Gray D, Saggers S, Atkinson D, Wilkes E (2007) Substance misuse. In ‘Aboriginal primary health care: an evidence-based approach’. (Eds S Couzos, R Murray) pp. 432–491. (Oxford University Press: Melbourne)

Ministerial Council on Drug Strategy (2004) ‘The National Drug Strategy: Australia’s integrated framework 2004–2009.’ Intergovernmental Committee on Drugs and the Australian National Council on Drugs, Canberra. Available at http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/national-drug-strategic-framework-lp [Verified April 2009]

Mohajer N, Bessarab D, Earnest J (2009) There should be more help out here! A qualitative study of the needs of Aboriginal adolescents in rural Australia. Rural and Remote Health 9, 1137
| PubMed |

Mooney GH (2008) The people principle in Australian health care. The Medical Journal of Australia 189, 171–172.
| PubMed |

National Preventative Health Taskforce (2008) ‘Australia: the healthiest country by 2020.’ Available at http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/discussion-healthiest [Verified August 2009]

Schmuck RA, Perry E (2006) ‘Practical action research: A collection of articles.’ (Corwin Press: Thousand Oaks, CA)

Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457–502.
CrossRef | PubMed |

Steering Committee for the Review of Government Service Provision Overcoming Indigenous Disadvantage (2005) ‘Key indicators 2005 .’ (Productivity Commission: Canberra)

Strauss A, Corbin J (1998) ‘Basics of qualitative research: grounded theory procedures and techniques.’ 2nd edn. (Sage: Thousand Oaks, CA)

Swift W, Copeland J (1996) Treatment needs and experiences of Australian women with alcohol and other drug problems. Drug and Alcohol Dependence 40, 211–219.
CrossRef | PubMed |

Treloar C, Holt M (2006) Deficit models and divergent philosophies: service providers’ perspectives on barriers and incentives to drug treatment. Drugs Education Prevention & Policy 13, 367–382.
CrossRef |

Weatherburn DJ (2008) The role of drug and alcohol policy in reducing Indigenous over-representation in prison. Drug and Alcohol Review 27, 91–94.
CrossRef | PubMed |

World Health Organization (1978) ‘Declaration of Alma-Ata.’ (World Health Organization: Geneva) Available at http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf [Verified October 2010]

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