The Alcohol Mandatory Treatment Act: evidence, ethics and the law
The authors of this Ethics and Law article published in the Medical Journal of Australia contend that 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.
The Northern Territory has per capita alcohol consumption levels about 50% higher than the Australian average, and alcohol-attributable deaths occurring 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, write that there is “little evidence of the scheme’s efficacy”. The AMT program costs around $27 million annually.
Although some changes have been made to the AMT Act since its introduction — notably that criminal sanctions for absconding from treatment have been removed — the authors observe that there are still aspects of the Act that might concern the medical community.
“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”, the authors write.
The authors suggest there are 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 conclude.