IMPROVING OUR UNDERSTANDING OF ALCOHOL DEPENDENCE AMONG INDIGENOUS PEOPLES: AN INTERNATIONAL SYSTEMATIC REVIEW AND QUANTITATIVE STUDY OF TWO AUSTRALIAN ABORIGINAL COMMUNITIES

Alcohol use is common globally and the health risks from drinking are recognised. However, Indigenous Peoples who have been impacted by colonisation, trauma and racism, could be at greater risk of developing alcohol-related harms. One of these harms could be alcohol dependence, the strong internal drive to use alcohol with an inability to control use, prioritising alcohol and also physiological characteristics. The way alcohol dependence is interpreted or identified can be different across cultures and for Indigenous Peoples. The overall aim of this thesis was to identify the prevalence of alcohol dependence among Indigenous Peoples globally, and the associations of dependence in an Indigenous Australian community sample. Chapter 2 is a systematic review of the prevalence of alcohol dependence among Indigenous Peoples globally and examines how dependence is identified. Chapter 3 estimates the prevalence and describes the correlates of alcohol dependence in a representative community sample of Indigenous Australians. Chapter 4 identifies the associations between alcohol dependence with harms and getting help for drinking in a representative community sample of Indigenous Australians. This research reports that the prevalence of current alcohol dependence among Indigenous Peoples globally from similarly colonised countries varies widely and shows few tools have been validated for Indigenous Peoples. The prevalence in the representative community sample of Indigenous Australians is similar to the general Australian population. Dependent drinkers were more likely to report harms and more likely to get help for their drinking. Researchers, health professionals and clinicians do well to use Indigenous-specific survey tools or operationalise existing tools when trying to identify alcohol dependence among Indigenous Peoples. Accurate prevalence data can better inform treatment needs and unmet needs. Indigenous Australians need support and treatment options that are readily available, accessible and culturally appropriate. Identifying these needs could help with funding and resource allocation