Substance misuse intervention research in remote Indigenous Australian communities since the NHMRC 'Roadmap'.

OBJECTIVE: Describe program theories of substance misuse interventions with Aboriginal and Torres Strait Islander (Indigenous) Australians funded by the National Health and Medical Research Council (NHMRC) since the 'Roadmap' for Indigenous health.

METHODS: Projects funded 2003-2013 were categorised by intervention strategies. Realist concepts informed the program theory: intended resources and responses; influence of context on outcomes; explicit and implicit program assumptions.

RESULTS: Seven interventions were included. Three randomised controlled trials targeted tobacco using psychosocial interventions in primary health centres using the program theory: "Local Indigenous health workers extend and sustain the effects of conventional clinical brief intervention by engendering social and cultural resources". Four pragmatic trials of multiple-component, community-based interventions using controlled, semi-controlled or before-and-after designs used the program theory: "Discrete intervention components targeting locally defined substance misuse issues will activate latent capacities to create an environment that favours cessation." Publications did not report clear effect, implementation fidelity or explicit mechanisms affecting participant thinking.

CONCLUSIONS: Rigorous intervention designs built on 'Roadmap' principles neither reduced substance use in the populations studied nor identified transferable mechanisms for behaviour change. Implications for public health: Substance misuse impacts among Indigenous Australians remain severe. Theoretical mechanisms of behaviour change may improve intervention design.