ABSTRACT
BACKGROUND: There is a pressing need to improve alcohol treatment services for Aboriginal and Torre Strait Islander peoples with alcohol dependence. One component of treatment is the use of medicines including naltrexone and acamprosate. Access to these medicines among the general drinking population is poor and, anecdotally, even worse for Aboriginal and Torre Strait Islander peoples who drink. OBJECTIVE: This article aims to review the relative efficacy and safety of naltrexone. It will also discuss reasons why it may be a preferable first-line pharmacotherapy for Aboriginal and Torre Strait Islander peoples with alcohol dependence who are seeking to change their drinking. DISCUSSION: The major effect of naltrexone is reducing episodic heavy drinking, a pattern often seen in Aboriginal and Torre Strait Islander peoples with alcohol dependence. Possible genetic and epigenetic factors, and practical considerations including once-daily dosing also make naltrexone an appealing agent in this population.
Subject(s)
Alcoholism/drug therapy , Alcoholism/ethnology , Health Services Accessibility/organization & administration , Health Services, Indigenous , Naltrexone/therapeutic use , Native Hawaiian or Other Pacific Islander , Australia/epidemiology , Humans , Narcotic Antagonists/therapeutic useABSTRACT
BACKGROUND: There is concern from within Aboriginal and Torres Strait Islander communities about the lack of access to alcohol withdrawal management ('detox') services. Outpatient detox is described within national Australian guidelines as a safe option for selected drinkers. However, uncertainly exists as to how suited Aboriginal and Torres Strait Islander peoples are to this approach. METHODS: Consultations were conducted with stakeholders of four health services providing outpatient detox for Aboriginal and Torres Strait Islander peoples in NSW. Thematic analysis was performed to determine elements perceived as important for success. RESULTS: Key themes that emerged were individual engagement, flexibility, assessment of suitability, Aboriginal staff and community engagement, practical support, counselling, staff education and support, coping with relapse and contingency planning. DISCUSSION: There is a need to improve access to alcohol detox services for Aboriginal and Torres Strait Islander peoples. The outpatient setting seems to be a feasible and safe environment to provide this kind of service for selected drinkers.
