While rates of methamphetamine use in Australia have remained fairly stable at 2.1% over the past ten years, there has been a shift among people who use the lower-grade powdered form of methamphetamine (speed) to using the higher-grade crystal form (ice) in recent times.
Ice is much stronger than speed and has the potential to cause greater problems.
As a result, Australia has seen significant increases in ambulance call-outs, hospital visits, people seeking treatment and police arrests related to methamphetamine use.
There has been particular concern about increases in methamphetamine use among Aboriginal and Torres Strait Islander people. So what do we know about ice in these communities? And what are the effective responses?
Rates of use
Methamphetamine use in remote Aboriginal communities appears to be very limited. Only 0.8% of the remote area population uses methamphetamine. Like the general population, the greater percentage of users are in the cities.
The data is limited, but the rate of Aboriginal people seeking treatment for methamphetamine-related problems seems to be following the same upward trend as other people who use. Service providers report the use of ice in particular has increased among young Aboriginal people.
Although there is no widely available medicine to treat methamphetamine dependence, psychological treatment is effective. One study found people who use methamphetamine have the best treatment outcomes of all alcohol and other drug users.
Cognitive behaviour therapy (CBT), motivational interviewing (MI) and acceptance and commitment therapy (ACT) are both effective, as is residential rehabilitation. As little as two sessions of CBT and MI increases abstinence, even among heavily dependent users.
The evidence is limited for mutual support groups, such as 12-Step (Alcoholics and Narcotics Anonymous) and SMART Recovery (Self-Management and Recovery Training). But this type of post-treatment support may increase the chances of maintaining abstinence. Peer worker or telephone contact are other options, but there is little methamphetamine-specific research.
The overall relapse rate after treatment, however, is high and there are few ongoing supports after treatment.
Although Aboriginal and Torres Strait Islander people access these interventions through both mainstream and Aboriginal-specific services, little is known about their outcomes.
Prison diversion programs
There are a number of mechanisms through which people who use drugs can access treatment via the justice system.
Drug courts, for instance, divert illicit drug users from the prison system into treatment. These operate in most states and have been found to be effective.
Aboriginal people are heavily over-represented in the justice system, but participation rates in drug court programs varies. Where drug courts have taken a collaborative approach to design and implementation, working closely with Aboriginal and other organisations, participation rates are higher.
Improving access to treatment and support
It is generally agreed responses to alcohol and other drug use in Aboriginal and Torres Strait Islander communities should be community owned and driven.
The Mallee District Aboriginal Services (MDAS) in Victoria, for example, has conducted research to advocate for service improvement. MDAS developed a short film where Aboriginal people discuss how they have reduced their own ice use and ice use in their families.
This work highlights the vital role of families in helping people to give up using ice and avoid relapse. The Family Wellbeing Program has been shown to empower Aboriginal individuals and families to take greater control of their lives. This may involve re-engaging in education and employment, addressing challenges such as family conflict and advocating for community services and support.
MDAS is partnering with La Trobe University to evaluate whether the program is a useful add-on to alcohol and drug treatment in supporting individuals and families who are affected by ice use.
The Victorian government has made some progress in improving treatment and support. It has piloted an 18-month program to link mainstream specialist services with Aboriginal services. The aim is to build the capacity of both sectors to respond specifically to Aboriginal people and their families who are affected by the use of methamphetamine. The pilot is under evaluation.
But there is plenty of room for improvement. Both the Aboriginal and generalist drug and alcohol workforce have identified a need to be better skilled in responding to the needs of Aboriginal people who use methamphetamine.
Culturally appropriate harm-reduction strategies are critical for people who continue to use methamphetamine. Indigenous people in the United States, for example, have successfully used culturally targeted education and social marketing, plus individual and family treatment, to reduce methamphetamine-related incidents and arrests.
Finally, we need better data and project evaulations to create an accurate picture of methamphetamine use among Aboriginal Australians and develop more effective responses.
Nicole Lee works as a consultant to health services to support best practice implementation of methamphetamine and other drug treatment and is the President of the Australian Association for Cognitive and Behaviour Therapy. She has previously been awarded grants by the NHMRC and Australian Government for research into methamphetamine treatment options. Nicole is leading the team evaluating the Aboriginal Metropolitan Ice Partnership Program.
Sarah J MacLean receives funding from the Australian Research Council. She has received funding in the past from the University of Melbourne to investigate methamphetamine use in Aboriginal communities, and is currently funded by La Trobe University to undertake pilot research into the effectiveness of a family wellbeing intervention as an adjunct to alcohol and drug treatment for methamphetamine users.