A historical overview of legislated alcohol policy in the Northern Territory of Australia: 1979–2021

Background The Northern Territory (NT) has the highest levels of alcohol consumption and harms in Australia. Since the creation of the NT Liquor Act 1978, which came into effect in 1979, numerous legislated alcohol policies have been introduced to attempt to address these harms. We present a narrative historical overview of alcohol policies implemented in the NT from 1979 to 2021. Methods Using scoping review methodology, databases were searched from 1979 to 2021. Of 506 articles screened, 34 met inclusion criteria. Reference lists of all included articles were searched, resulting in the inclusion of another 41 articles and reports, totalling 75 final documents. Policies were organised using Babor and colleagues (2010) established framework: 1. pricing/ taxation; 2. regulating physical availability; 3. modifying drinking environments; 4. drink-driving countermeasures; 5. restrictions on marketing; 6. education/persuasion; 7. treatment/early intervention. Results Two pricing/taxation policies have been implemented, Living With Alcohol (LWA) and Minimum Unit Price, both demonstrating evidence of positive effects on health and consumption outcomes. Eight policies approaches have focused on regulating physical availability, implemented at both individual and local area levels. Several of these policies have varied by location and been amended over time. There is some evidence demonstrating reduction in harms attributable to Liquor Supply Plans, localised restrictions, and General Restricted Areas, although these have been site specific. Of the three policies which targeted modifying the drinking environment; one was evaluated, finding a relocation of social harms, rather than a reduction. The literature outlines a range of controversies, particularly regarding policies in domain 2–3, including racial discrimination and a lack of policy stability. No policies relating to restricting marketing or education/persuasion programs were found. The only drink-driving legislated policy was considered to have contributed to the success of the LWA program. Three policies relating to treatment were described; two were not evaluated and evidence showed no ongoing benefits of Alcohol Mandatory Treatment. Discussion The NT has implemented a large number of alcohol policies, several of which have evidence of positive effects. However, these policies have often existed in a context of clear politicisation of alcohol policy, frequently with an implicit focus on Aboriginal people’s consumption. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11957-5.


Survey of residents with a post office box in Alyangula
Licensing Commission records of the process of formation of the Alcohol Management System Small decrease (9%) in volume of alcohol sold by licensed premises; notable decrease in reduction of heavy beer (20%), partiality offset by an increase in mid-strength beer (11%) People, particularly women, in the community reported feeling safer.
Police data also demonstrates a 67% decrease in aggravated assaults (lowest in four years), 86% reduction in house break-ins, 23% decrease in number of adults admitted to correctional centres from Groote Eylandt and Bickerton Island (also lowest in four years).
Some concerns were raised regarding community members leaving Groote Eylandt to access alcohol, although the responses to this were mixed. LSP / AMP intervention had an effect on alcohol sales in addition to the existing downward trend Alcohol related hospital separations as a proportion of total separations reduced from 16.2% prior to the LSP / AMP introduction to 14.1% in the year following the introduction (p < 0.000).
Absolute number of police recorded assaults did not change significantly, however the proportion of serious assaults decreased in the year after LSP / AMP (p=0.004). Reasons for review: scope of report does not address terms of reference; inadequate and uncritical review of literature; dearth of comparison sites; failure to consider several key indicators; incorrect analysis methods; no separation of data by Aboriginality, and a "general lack of rigour and apparent lack of expertise in the field [which] has led to… a set of inadequate, if not potentially harmful, recommendations (pg. 11)." Overall, this re-evaluation asserts that the magnitude of reduction of harms (particularly regarding lack of inclusion of grievous bodily harm offences, road traffic accidents, alcohol-attributable injuries in hospital separations) and consumption were underestimated by Senior et al. (2009)  All administrative data examined (emergency department presentations for alcohol-related disorders; alcohol-related and injury hospital separations; assaults; disturbances and anti-social behaviour; and public drunkenness) demonstrated similar trends, with an immediate decrease followed by an upwards trend that surpassed pre-LSP/AMP levels.
The most notable being an 8.5% total increase in apprehensions for public drunkenness, 16.1% total increase in alcohol-related hospital separations and 32% total increase in alcohol-related assaults. Aboriginal presentations to Gove Hospital Emergency Department coded as 'mental and behavioural disorders due to alcohol' decreased by 22% in 12 months following permit system. The next 12 months this number decreased by another 50%. Aboriginal hospital separations for this code also fell by 35.8% and then a further 7.1% Hospital separations for injury in Aboriginal patients decreased by 9.3% and non-Aboriginal separations declined by 13.7% in the 12 months following the permit system Trends in disturbances and anti-social behaviour also declined, however this decline had begun prior to the introduction of the permit system. Since the Intervention (2007) introduced restrictions on club trading hours, ban on full strength beer and takeaway (in conjunction with income management) 5 clubs recorded significant decline in wholesale supply; 2 clubs (the smallest) had insufficient data to examine trends; and 1 club demonstrated no change until 2009, after which it slightly declined. Gaps in records for this club preclude definitive conclusions.
Prior to and at the time of the Intervention (2007) alcohol-related harms were much higher in communities with clubs, however since then harms in club communities have reduced while harms in NT as a whole and other communities have increased.
Hospital separations indicate communities with clubs have a slightly lower rate of alcohol-related separations than those without clubs. Shaw et al. (2015) conclude that communities with clubs do not experience a marked difference in alcohol-related harms compared to other communities, however adherence to shortened hours and a ban on full-strength beer is important.

Interviews with community members and local staff, including police
Although permits may been seen as a method of encouraging moderate consumption most purchasing entitlements are in excess of NHMRC consumption guidelines for minimising alcoholrelated harms, and therefore do not promote low-risk consumption.
74 (77%) of NT Aboriginal communities do not have a permit scheme; 14 have exemption schemes, which allow for staff living and working in the community be exempt from 'dry' conditions; and 8 have permit-based alcohol management systems (Maningrida, Wurrumiyanga, Milikapiti, Pirlangimpi, Alyangula, Nhulunbuy, Yirrkala, Gunyangara).
The liquor schemes were considered to provide benefits to communities and to be generally well accepted. The review identified some issues and inconsistencies with the application of graduated permit levels, what evidence Liquor Permit Committees should consider admissible and inadmissible, and the need to maintain a balance between community control and centralised bureaucratic management. Secondary supply remains an issue, particularly in the context of humbug (pressure to share). Logically, AMT only affected a small percentage of NT residents and is unlikely to have impacted wholesale supply data.
Although some participants reported short term improvements in health as a result of access to services provided with AMT (ie. dental care), no ongoing health benefits were identified.
The majority of participants cycled in and out of AMT with most "re-apprehended by NT Police multiple times, entering custody from homelessness and ending up homeless again" (p. iii).
There was a high rate of absconding, some individuals absconded up to four times while serving one treatment order BDR 6month process evaluation There was no immediate impact on the frequency of alcohol-related events, however there was a statistically significant gradual decline in the rate of individual's alcohol-related events once they were on the BDR. Relatively few individuals on the BDR escalated their frequency and types of contact with the justice system.
Aboriginal people were significantly overrepresented on the BDR (87.9%) -likely reflecting the over-representation of Aboriginal people in the justice system: 64% of bans were police-issued and 26% were court-issued.
Uptake of referral pathways outside of the justice system was low -10% of people referred by sources other than the police or courts.
Use of therapeutic services among people on the BDR was low -only 7% had commenced treatment in the first 12 months of the BDR.
MUP Between February and August 2019 there was an average of 3819 people on the BDR; 65% via police ban, 26% via court ban, 6% via the BDR Registrar and 3% via corrections (parole). Aboriginal people are overrepresented on the BDR (84%).
The introduction of PALIs was associated with a substantial downwards trend in alcohol-related assault offences, assault apprehensive, and protective custody episodes; however, the report notes that the impact of the BDR may be cumulative as banned drinkers enter the register incrementally, and they attribute the decreasing