There is clearly a need to explore preventive strategies to address this major public health issue. The recommendations within current health preventative strategies  aim to shift the culture of alcohol through regulation, legislation, health promotion and treatment services. In the NT there has been recent focus on legislative changes through new alcohol reforms  which seek to reduce the per capita consumption of alcohol (currently the highest in the country) to the national average. The new and amended legislation to support the ‘Enough is Enough’ Alcohol Reform includes introduction of a ‘Banned Drinker Register’, Alcohol Court Reform and the establishment of an Alcohol and Other Drugs Tribunal, training and resource provision for health care providers across the Territory, and communication and awareness campaigns .
In addition, the Northern Territory Alcohol Policing Strategy, which complements the Northern Territory’s 2030 Strategy,  supports a range of activities such as night patrolling services across the Territory . These patrols are designed to maintain community security and safety through transfer of intoxicated people to sobering-up shelters or rehabilitation services . The NT Alcohol framework  and NT Liquor Act under review at present  are important other avenues with potential to prevent harm. Legislation is only one aspect of a suite of strategies needed. One of the priority areas of the Expanding Health Service Delivery Initiative (EHSDI), a joint Australian and Northern Territory Government initiative seeking to close the gap in Aboriginal and Torres Strait Islander disadvantage, is to enhance access to alcohol interventions through primary and acute health care services .
There are several approaches to the treatment of alcohol use disorders. Approaches include family therapy, cognitive-behavioural interventions, motivational interviewing, pharmacological treatments, and Alcoholics Anonymous . Many of these are conducted in specialised centres such as rehabilitation clinics, which are separated from the main public hospital centres. Hospitalisation for alcohol-related trauma and injury provides an opportunity to enhance access through identification and referral of individuals with underlying alcohol problems requiring treatment. Admission to a hospital ward is preferable: this is presumably, “as an opportunity for brief intervention” . Hospitilisation for alcohol-related trauma in the maxillofacial or trauma ward also creates an opening for motivating patients to review their alcohol consumption at a time when their facial injury may make them more receptive to advice. However as patients with alcohol-related injuries are often treated in maxillofacial surgery unit, where mental health is not a primary focus and the surgical workload is often great, such opportunities for intervention are frequently overlooked.
Clinical staff and health professionals need to be appropriately trained to explore appropriate intervention/treatment strategy and referral pathways for trauma patients with alcohol misuse in the hospital setting. A common misconception by clinical staff in the health care setting is to believe that only a specialist can handle patients with alcohol misuse, such is the nature of a highly compartmentalised public hospital system. There is also a need for increasing research in this area. Researchers need to train in intervention research methodology and also the funding bodies that are being urged to fund alcohol intervention studies in order to increase the research workforce in this field . Legislative amendment and media involvement are also pivotal in enhancing the work of treatment services based at the hospital setting to reduce the alcohol-related harms that are currently faced by society .
Brief interventions have been shown to be effective with mild symptoms of alcohol dependency and non-dependent drinkers for reducing alcohol intake, risky drinking practices, alcohol-related negative consequences and injury frequency [35–38]. Miller and Sacnhez describe 6 common elements to a brief intervention, summarized by the acronym FRAMES; FEEDBACK of personal risk or impairment, emphasis on personal RESPONSIBILITY for change, clear ADVICE to change, a MENU of alternative change options, therapeutic EMPATHY as a counseling style, and enhancement of client SELE-EFPICACY or optimism . Mutiple randomized trials have shown a significant reduction in alcohol consumption with the use of brief interventions in appropriately targeted non-Indigenous populations in a variety of health care settings, provided the patients are non- dependent drinkers [36, 40, 41].
The compelling evidence of association between alcohol misuse, injury and reinjury has led the American College of Surgeons to recommend routine screening and brief behavioural interventions for all trauma admissions . The computerized tailored brief intervention is associated with a significant decrease in alcohol use and at-risk drinking in sub-critically injured trauma patients . However, while there is some evidence of effectiveness of these strategies in hospital settings , it remains inadequate . The training and support initiatives continue to show no significant effects on uptake by staff, prompting calls for systematic approaches to implementing brief intervention in the hospital setting . Four key elements underlie health-care practitioner’s perceptions of alcohol screening and brief intervention; outcome expectancy; role congruence; utilisation of clinical systems and processes; and options for alcohol referral . Despite this work, there is a dearth of studies that examine intervention strategies for Indigenous Australians: there is atleast one study , albeit unsuccessful.
There is general agreement that brief interventions have positive outcomes for patients and generally comply with the time constraints and the cost conscious environment of the hospital. However, in the context of Australian Indigenous patients, brief interventions may not be culturally appropriate and effective in their traditional format.