Abstract

The harmful use of alcohol and other drugs (AOD) is a recognised risk factor for suicide globally. For Aboriginal and Torres Strait Islander (First Nations) people, unique factors such as colonisation, dislocation, community disruption and racism are associated with suicide and suicide risk, and warrant significant national attention, intervention and investment.

This paper synthesises the limited research on AOD harms and suicide risk among First Nations communities, examining their relationship, potential intervention points, and current policy and practice responses. Consistent with international literature, this paper found that both acute and chronic use of AOD – in particular alcohol – are highly prevalent among those with suicidal behaviour. Alcohol is often present in suicide deaths and self-harm cases, with cannabis and methamphetamine use also contributing to increased suicidal behaviour.

Certain groups, including First Nations men, young people, incarcerated individuals, and those with co-occurring mental health conditions, face heightened risks. Both acute intoxication and chronic AOD use can exacerbate vulnerabilities (including mental ill-health) and contribute to impulsive behaviours, family and relationship breakdown, emotional distress and limited access to support services. The relationship between AOD use and suicide is intertwined with trauma, mental ill-health, stigma and social isolation, and with systemic factors like colonisation, disadvantage, dislocation and racism.

Examination of policy responses, however, reveals a lack of recognition of the relationship between AOD use and suicide risk. Current approaches appear to be siloed, underfunded and outdated, thus failing to address the intersection of AOD use and suicide risk. Furthermore, there is a lack of First Nations representation in bodies advocating and overseeing AOD policy. Effective responses identified in the paper include workforce training, holistic suicide prevention, whole-of-community interventions and postvention approaches. To enhance outcomes, it is essential to address both acute and chronic AOD harms within suicide prevention frameworks that are culturally safe. Looking ahead, the paper notes that systems-level approaches are needed, with self-determination, community ownership, accountability, long-term investment and culture at the centre.

This paper accompanies Harmful use of alcohol and other drugs and its relationship with the mental health and wellbeing of First Nations people: a review of the key issues, policy, and practice approaches which examines the interconnectedness of AOD-related harm and mental ill-health.