Conversation With...

Can you share some information about Milliya Rumurra Rehabilitation Centre and your residential family-based program?

Milliya Rumurra Aboriginal Corporation has been providing support to individuals, families and communities affected by alcohol and other drugs since 1978. Milliya Rumurra means ‘First Day’ or ‘Brand New Day’ (Yawuru), we are located in Broome in the West Kimberley region of Western Australia. 

Our programs include a 13-26 week residential program, 39-week continuing care, transitional housing, a sobering-up shelter and a non-residential community program.

Alcohol and Other Drug (AOD) Residential Rehabilitation is an effective intervention for Aboriginal people where community, family and social environments provide significant barriers to individuals and families wanting to cease or reduce their alcohol and/or drug use.

Following feedback from our clients wanting their partners to participate with them in our residential program, we transitioned into our family-based program 12-years ago. Including family in AOD treatment is culturally secure and it is consistent with community expectation.

Having families in treatment has many benefits. It provides an opportunity for families to establish and re-establishing family routines without alcohol and drugs, strengthen relationships and positive attachments with children. Family plans are developed for areas such as high risk situations, resolving conflict and relapse prevention enhancing post-treatment recovery.

We also are accessible to pregnant women. We are receiving increased numbers of referrals for pregnant women at various stages of their pregnancy. Our preference is for pregnant women to access our service early in their pregnancy and remain with us until the birth of their child.

What is the ‘life course’ approach to AOD harm?

The ‘life course’ approach is not new, it has been a prominent component of many disciplines for decades. The approach has been applied to disorders such as chronic disease and cancer. The importance of critical stages of development and the association between exposures and outcomes at the individual and population level is fundamental to this approach.

AOD dependence and addiction is a chronic disease. The ‘life course’ approach applied to alcohol and other drugs addresses the harm across multiple life stages, identifying risk and protective factors so that targeted interventions can be implemented when they are needed such as during specific developmental periods when we are more “plastic” or “sensitive” to environmental signals. Early intervention being key to this approach.

Examples of the approach begins at the preconception stage focusing on key areas such as sexual health, unplanned pregnancy, nutrition, mental health and wellbeing. The next stage is the prenatal phase (embryonic and fetal periods) and the impact that alcohol, drugs and maternal stress (metabolic, psychological and immunological) has on this critical period of development. The postnatal period including neonatal, infancy, early childhood, middle childhood, pre-teenage, teenage, early adulthood, middle age and old age are the other areas for targeted interventions.

What are some of the current challenges in the Indigenous AOD sector? Has COVID-19 impacted on services?

COVID-19 has created many challenges for us. It has also presented opportunities for our services to explore different ways to engage and work with our clients, stakeholders and the community. Some of the positive changes will be continued post COVID-19.

During the early stages of the pandemic we experienced a decrease in referrals and our non-residential clients reduced their engagement with us. As clients began self-isolating there was concern with the impact this was having on substance use and the mental wellbeing of individuals.

We saw a decrease in drug supply as the Kimberley region went into lockdown. Drug substitution was a potential problem, including volatile substance use.

Recently we have seen the negative impact the Centrelink economic support payment was having in the community with an increase in alcohol fuelled violence including family and domestic violence.

Are there any areas of Indigenous AOD research that you think need more focus? How could the research community support the sector?

The evidence base evaluating the effectiveness of AOD interventions is well documented within the non-Indigenous population. However, within the Aboriginal population, good evidence suggesting what interventions work is limited. Implementing mainstream evidence based interventions and applying cultural elements such as identity, connectedness with culture and country, healing and family based programs is an area for further research.