This chapter provides a review of the effectiveness of measures to prevent psychoactive substance misuse in indigenous minority populations in Australia, New Zealand, Canada and the United States of America. Despite considerable heterogeneity between and within these populations, there are also important commonalities. Generally, levels of substance misuse are significantly higher among them than among the non-indigenous majority populations of those countries and this results in commensurately high rates of substance caused health and social problems
These levels of misuse and harm are socially determined. They are a consequence of a complex hierarchy of social relationships – including a common histories of colonialism and dispossession and economic and social marginalisation – that influence both demand for and supply of various substances. As well as focusing on interventions to address the obvious manifestations of substance misuse, strategies to prevent the elevated levels of substance misuse among indigenous peoples must address the underlying social determinants.
Interventions aimed specifically at indigenous populations usually seek to: make interventions for general populations more culturally appropriate for indigenous populations; to address those factors that exacerbate levels of substance misuse and related harm among indigenous populations; or employ elements of indigenous cultures to address misuse and related harm. Such interventions – which generally focus on the individual, family or community levels – are considered under the headings: supply reduction, demand reduction and harm reduction. Rigorous evaluations of these interventions are relatively few but point to some successes and to the factors that contribute to them.
Nevertheless, overall, such interventions have had limited success in reducing indigenous substance misuse. This and the limited impact of large-scale programs aimed at ameliorating the status of indigenous peoples – as attested by the social inequalities they continue to face – indicates the need for greater efforts to address the structural inequalities that contribute to indigenous substance misuse and related harm